Ann Kurth - Academia.edu (original) (raw)

Papers by Ann Kurth

AIDS Research and Treatment, 2013

The United States has the world's highest prison population, and an estimated one in seven HIV-po... more The United States has the world's highest prison population, and an estimated one in seven HIV-positive persons in the USA passes through a correctional facility annually. Given this, it is critical to develop innovative and effective approaches to support HIV treatment and retention in care among HIV-positive individuals involved in the criminal justice (CJ) system. Information and communication technologies (ICTs), including mobile health (mHealth) interventions, may offer one component of a successful strategy for linkage/retention in care. We describe CARE+ Corrections, a randomized controlled trial (RCT) study now underway in Washington, that will evaluate the combined effect of computerized motivational interview counseling and postrelease short message service (SMS) text message reminders to increase antiretroviral therapy (ART) adherence and linkage and retention in care among HIV-infected persons involved in the criminal justice system. In this report, we describe the development of this ICT/mHealth intervention, outline the study procedures used to evaluate this intervention, and summarize the implications for the mHealth knowledge base.

Current HIV/AIDS Reports, 2012

A substantial proportion of HIV-1-infected individuals in sub-Saharan Africa are in stable relati... more A substantial proportion of HIV-1-infected individuals in sub-Saharan Africa are in stable relationships with HIV-1-uninfected partners, and HIV-1 serodiscordant couples thus represent an important target population for HIV-1 prevention. Couple-based HIV-1 testing and counseling facilitates identification of HIV-1 serodiscordant couples, counseling about risk reduction, and referrals to HIV-1 treatment, reproductive health services, and support services. Maximizing HIV-1 prevention for HIV-1 serodiscordant couples requires a combination of strategies, including counseling about condoms, sexual risk, fertility, contraception, and the clinical and prevention benefits of antiretroviral therapy (ART) for the HIV-1-infected partner; provision of clinical care and ART for the HIV-1-infected partner; antenatal care and services to prevent mother to child transmission for HIV-1-infected pregnant women; male circumcision for HIV-1uninfected men; and, pending guidelines and demonstration projects, oral pre-exposure prophylaxis (PrEP) for HIV-1-uninfected partners.

Journal of Homosexuality, 2003

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who hav... more Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2012

Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as ... more Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as new human immunodeficiency virus-1 (HIV-1) prevention approaches for HIV-1 serodiscordant couples. Among Kenyan HIV-1 serodiscordant heterosexual couples participating in a clinical trial of PrEP, we conducted a cross-sectional study and used descriptive statistical methods to explore couples' willingness to use antiretrovirals for HIV-1 prevention. The study was conducted before July 2011, when studies among heterosexual populations reported that ART and PrEP reduced HIV-1 risk. For 181 couples in which the HIV-1-infected partner had a CD4 count ≥350 cells per microliter and had not yet initiated ART (and thus did not qualify for ART under Kenyan guidelines), 60.2% of HIV-1 infected partners (69.4% of men and 57.9% of women) were willing to use early ART (at CD4 ≥350 cells per microliter) for HIV-1 prevention. Among HIV-1 uninfected partners, 92.7% (93.8% of men and 86.1% of women) reported willingness to use PrEP. When given a hypothetical choice of early ART or PrEP for HIV-1 prevention, 52.5% of HIV-1-infected participants would prefer to initiate ART early and 56.9% of HIV-1-uninfected participants would prefer to use PrEP. Nearly 40% of Kenyan HIV-1-infected individuals in known HIV-1 serodiscordant partnerships reported reservations about early ART initiation for HIV-1 prevention. PrEP interest in this PrEP-experienced population was high. Strategies to achieve high uptake and sustained adherence to ART and PrEP for HIV-1 prevention in HIV-1 serodiscordant couples will require responding to couples' preferences for prevention strategies.

Archives of Pediatrics & Adolescent Medicine, 2009

To determine whether an online intervention reduces references to sex and substance abuse on soci... more To determine whether an online intervention reduces references to sex and substance abuse on social networking Web sites among at-risk adolescents. Randomized controlled intervention trial. www.MySpace.com. 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. Web profiles were evaluated for references to sex and substance use and for security settings before and 3 months after the intervention. 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). 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.

AIDS Education and Prevention, 2011

This study explored perceptions of HIV following local introduction of antiretroviral therapy (AR... more 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. Semi-structured 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 superinfection 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.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015

Shortages of health workers and large number of HIV-infected persons in Africa mean that time to ... more Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. Using time-motion methodology we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. Mean visit length for patients at the rural clinic was 44.5 (SD=27.9) minutes and at urban clinic was 78.2 (SD=42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes (IQR 1.57-7.33) at rural and 3.99 (IQR 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time respectively. Median time patients received ART adherence counseling was 1.29 (IQR 0.77-2.83) minutes at rural and 1.76 (IQR 1.23-2.83) minutes at urban (p=0.001 for difference). Patients received a median of 0.18 (0-0.72) minutes at rural and 0.28 (IQR 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. Though ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of patients, and 'positive prevention' messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.

Youth ages 15-24 in sub-Saharan Africa are more impacted by HIV/AIDS than any other group globall... more Youth ages 15-24 in sub-Saharan Africa are more impacted by HIV/AIDS than any other group globally. In Kenya, young females are 4-times more likely to be positive than males. Gender-specific HIV prevention combining behavioral, structural, and biomedical modalities is necessary to impact the epidemic. Trials of pre-exposure prophylaxis (PrEP) showed efficacy in reducing HIV risk when adherence >=85%. The study analyzed youth knowledge, acceptability, facilitators, and barriers to PrEP adherence, which influence intervention efficacy. Focus groups were conducted in Nyanza, Kenya composed of youth ages 15-24, parents and teachers of youth, and community, district, and religious leaders. Forty six females and 66 males participated (n=112). A content analysis identified themes and sub-themes related to PrEP. Four major themes emerged: (1) limited knowledge of PrEP as an HIV prevention method; (2) PrEP advantages; (3) concern about side-effects; (4) potential risk compensation. Sub-th...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2006

CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and ... more CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and secondary HIV prevention for people living with HIV. Thirty HIV+ men and women participated in our user study to assess usability and attitudes towards CARE+. We observed them using CARE+ for the first time and conducted a semi-structured interview afterwards. Our findings suggest computer counseling may reduce social bias and encourage participants to answer questions honestly. Participants felt that discussing sensitive subjects with a computer instead of a person reduced feelings of embarrassment and being judged, and promoted privacy. Results also confirm that potential users think computers can provide helpful counseling, and that many also want human counseling interaction. Our study also revealed that tablet PC-based applications are usable by our population of mixed experience computer users. Computer counseling holds great potential for providing assessment and health promotion ...

Journal of nurse-midwifery

Identifying, managing, and preventing HIV infection and other sexually transmitted diseases (STDs... more Identifying, managing, and preventing HIV infection and other sexually transmitted diseases (STDs) are essential components of women's health care. Biological, sociocultural, and epidemiological risks, including STDs, increase the likelihood that a woman will become infected with HIV. Infection with a STD facilitates the likelihood of infection with HIV, and many of the same risk behaviors and interventions are relevant. Promoting sexual health in the age of HIV/AIDS necessitates the acknowledgement of behavioral and social aspects of sexuality, as well as clinical approaches and skills that support safer and satisfying sexual lives for women. This article reviews the use of sexual and substance use risk assessment, individualized counseling, and risk-reduction strategies for woman to improve sexual health.

Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence.... more Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence. We tested the use of daily short message service (i.e., SMS/text message) surveys to measure sexual behavior and PrEP adherence in Kenya. Ninety-six HIV-uninfected adult individuals, taking daily oral PrEP in a clinical trial, received daily SMS surveys for 60 days. Most participants (96.9 %) reported taking PrEP on ≥80 % days, but 69.8 % missed at least one dose. Unprotected sex was reported on 4.9 % of days; however, 47.9 % of participants reported unprotected sex at least once. Unprotected sex was not correlated with PrEP use (OR = 0.95). Participants reporting more sex were less likely to report PrEP non-adherence and those reporting no sex were most likely to report missing a PrEP dose (adjusted OR = 1.87). PrEP adherence was high, missed doses were correlated with sexual abstinence, and unprotected sex was not associated with decreased PrEP adherence.

BMJ open, 2015

Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of her... more Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impa...

Journal of public health (Oxford, England), Jan 2, 2015

The correctional population bears a heavy burden of hepatitis C virus (HCV) infection necessitati... more The correctional population bears a heavy burden of hepatitis C virus (HCV) infection necessitating expansion of HCV testing and treatment opportunities. Rapid HCV testing provides point-of-care antibody results and may be ideal for correctional facilities, particularly jails, where persons are often incarcerated for short periods of time, yet feasibility has not been established. We conducted a pilot study of a rapid HCV testing algorithm among short-term inmates with unknown HCV status. Participants completed a questionnaire, viewed an informational video and underwent rapid HCV testing and confirmatory testing, when indicated. Persons with chronic infection were referred to community care after release. Baseline characteristics, risk behaviors, test results and linkage were examined by descriptive analyses. Two hundred and fifty-two inmates were enrolled and 249 completed all study activities. Twenty-five participants (10%) had reactive rapid tests and 23 (92%) completed confirma...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2009

The objective of this paper is to characterize effective patient care reminder strategies for peo... more The 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 ...

Journal of the International AIDS Society, 2015

Introduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care ... more Introduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care for HIV treatment and HIV prevention. However, young people's access to HIV testing is uneven worldwide. The objective of this paper is to review the context and concerns faced by youth around HIV testing in low-as well as high-income country settings. Discussion: HIV testing is a critical entry point for primary and secondary prevention as well as care and treatment for young people including key populations of vulnerable youth. We provide a framework for thinking about the role of testing in the continuum of prevention and care for young people. Brief case study examples from Kenya and the US illustrate some of the common barriers and issues involved for young people. Conclusions: Young people worldwide need more routine access to HIV testing services that effectively address the developmental, socio-political and other issues faced by young women and men.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007

We developed a Web-based application delivered on PDAs (Colecta-PALM in Peru, Pambazuko-PALM in K... more 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.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2008

Colecta-PALM is a Web-based application delivered on PDAs that provides behavioral messaging base... more 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.

Computer Human Interaction, 2005

The evaluation of paper prototypes is normally conducted in controlled settings such as a usabili... more The evaluation of paper prototypes is normally conducted in controlled settings such as a usability lab. This paper, in contrast, reports on a study where evaluations of a paper prototype were performed on the street with young adults. We discuss the merits of this approach and how it impacted the design process. A key finding is that the street location

Current HIV/AIDS Reports, 2011

No single HIV prevention strategy will be sufficient to control the HIV pandemic. However, a grow... more 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.

Journal of acquired immune deficiency syndromes (1999), 2003

To determine strategies to overcome barriers to HIV testing among persons at risk. We developed a... more To determine strategies to overcome barriers to HIV testing among persons at risk. We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to ...

AIDS Research and Treatment, 2013

The United States has the world's highest prison population, and an estimated one in seven HIV-po... more The United States has the world's highest prison population, and an estimated one in seven HIV-positive persons in the USA passes through a correctional facility annually. Given this, it is critical to develop innovative and effective approaches to support HIV treatment and retention in care among HIV-positive individuals involved in the criminal justice (CJ) system. Information and communication technologies (ICTs), including mobile health (mHealth) interventions, may offer one component of a successful strategy for linkage/retention in care. We describe CARE+ Corrections, a randomized controlled trial (RCT) study now underway in Washington, that will evaluate the combined effect of computerized motivational interview counseling and postrelease short message service (SMS) text message reminders to increase antiretroviral therapy (ART) adherence and linkage and retention in care among HIV-infected persons involved in the criminal justice system. In this report, we describe the development of this ICT/mHealth intervention, outline the study procedures used to evaluate this intervention, and summarize the implications for the mHealth knowledge base.

Current HIV/AIDS Reports, 2012

A substantial proportion of HIV-1-infected individuals in sub-Saharan Africa are in stable relati... more A substantial proportion of HIV-1-infected individuals in sub-Saharan Africa are in stable relationships with HIV-1-uninfected partners, and HIV-1 serodiscordant couples thus represent an important target population for HIV-1 prevention. Couple-based HIV-1 testing and counseling facilitates identification of HIV-1 serodiscordant couples, counseling about risk reduction, and referrals to HIV-1 treatment, reproductive health services, and support services. Maximizing HIV-1 prevention for HIV-1 serodiscordant couples requires a combination of strategies, including counseling about condoms, sexual risk, fertility, contraception, and the clinical and prevention benefits of antiretroviral therapy (ART) for the HIV-1-infected partner; provision of clinical care and ART for the HIV-1-infected partner; antenatal care and services to prevent mother to child transmission for HIV-1-infected pregnant women; male circumcision for HIV-1uninfected men; and, pending guidelines and demonstration projects, oral pre-exposure prophylaxis (PrEP) for HIV-1-uninfected partners.

Journal of Homosexuality, 2003

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who hav... more Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2012

Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as ... more Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as new human immunodeficiency virus-1 (HIV-1) prevention approaches for HIV-1 serodiscordant couples. Among Kenyan HIV-1 serodiscordant heterosexual couples participating in a clinical trial of PrEP, we conducted a cross-sectional study and used descriptive statistical methods to explore couples' willingness to use antiretrovirals for HIV-1 prevention. The study was conducted before July 2011, when studies among heterosexual populations reported that ART and PrEP reduced HIV-1 risk. For 181 couples in which the HIV-1-infected partner had a CD4 count ≥350 cells per microliter and had not yet initiated ART (and thus did not qualify for ART under Kenyan guidelines), 60.2% of HIV-1 infected partners (69.4% of men and 57.9% of women) were willing to use early ART (at CD4 ≥350 cells per microliter) for HIV-1 prevention. Among HIV-1 uninfected partners, 92.7% (93.8% of men and 86.1% of women) reported willingness to use PrEP. When given a hypothetical choice of early ART or PrEP for HIV-1 prevention, 52.5% of HIV-1-infected participants would prefer to initiate ART early and 56.9% of HIV-1-uninfected participants would prefer to use PrEP. Nearly 40% of Kenyan HIV-1-infected individuals in known HIV-1 serodiscordant partnerships reported reservations about early ART initiation for HIV-1 prevention. PrEP interest in this PrEP-experienced population was high. Strategies to achieve high uptake and sustained adherence to ART and PrEP for HIV-1 prevention in HIV-1 serodiscordant couples will require responding to couples' preferences for prevention strategies.

Archives of Pediatrics & Adolescent Medicine, 2009

To determine whether an online intervention reduces references to sex and substance abuse on soci... more To determine whether an online intervention reduces references to sex and substance abuse on social networking Web sites among at-risk adolescents. Randomized controlled intervention trial. www.MySpace.com. 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. Web profiles were evaluated for references to sex and substance use and for security settings before and 3 months after the intervention. 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). 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.

AIDS Education and Prevention, 2011

This study explored perceptions of HIV following local introduction of antiretroviral therapy (AR... more 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. Semi-structured 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 superinfection 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.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015

Shortages of health workers and large number of HIV-infected persons in Africa mean that time to ... more Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. Using time-motion methodology we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. Mean visit length for patients at the rural clinic was 44.5 (SD=27.9) minutes and at urban clinic was 78.2 (SD=42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes (IQR 1.57-7.33) at rural and 3.99 (IQR 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time respectively. Median time patients received ART adherence counseling was 1.29 (IQR 0.77-2.83) minutes at rural and 1.76 (IQR 1.23-2.83) minutes at urban (p=0.001 for difference). Patients received a median of 0.18 (0-0.72) minutes at rural and 0.28 (IQR 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. Though ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of patients, and 'positive prevention' messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.

Youth ages 15-24 in sub-Saharan Africa are more impacted by HIV/AIDS than any other group globall... more Youth ages 15-24 in sub-Saharan Africa are more impacted by HIV/AIDS than any other group globally. In Kenya, young females are 4-times more likely to be positive than males. Gender-specific HIV prevention combining behavioral, structural, and biomedical modalities is necessary to impact the epidemic. Trials of pre-exposure prophylaxis (PrEP) showed efficacy in reducing HIV risk when adherence >=85%. The study analyzed youth knowledge, acceptability, facilitators, and barriers to PrEP adherence, which influence intervention efficacy. Focus groups were conducted in Nyanza, Kenya composed of youth ages 15-24, parents and teachers of youth, and community, district, and religious leaders. Forty six females and 66 males participated (n=112). A content analysis identified themes and sub-themes related to PrEP. Four major themes emerged: (1) limited knowledge of PrEP as an HIV prevention method; (2) PrEP advantages; (3) concern about side-effects; (4) potential risk compensation. Sub-th...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2006

CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and ... more CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and secondary HIV prevention for people living with HIV. Thirty HIV+ men and women participated in our user study to assess usability and attitudes towards CARE+. We observed them using CARE+ for the first time and conducted a semi-structured interview afterwards. Our findings suggest computer counseling may reduce social bias and encourage participants to answer questions honestly. Participants felt that discussing sensitive subjects with a computer instead of a person reduced feelings of embarrassment and being judged, and promoted privacy. Results also confirm that potential users think computers can provide helpful counseling, and that many also want human counseling interaction. Our study also revealed that tablet PC-based applications are usable by our population of mixed experience computer users. Computer counseling holds great potential for providing assessment and health promotion ...

Journal of nurse-midwifery

Identifying, managing, and preventing HIV infection and other sexually transmitted diseases (STDs... more Identifying, managing, and preventing HIV infection and other sexually transmitted diseases (STDs) are essential components of women's health care. Biological, sociocultural, and epidemiological risks, including STDs, increase the likelihood that a woman will become infected with HIV. Infection with a STD facilitates the likelihood of infection with HIV, and many of the same risk behaviors and interventions are relevant. Promoting sexual health in the age of HIV/AIDS necessitates the acknowledgement of behavioral and social aspects of sexuality, as well as clinical approaches and skills that support safer and satisfying sexual lives for women. This article reviews the use of sexual and substance use risk assessment, individualized counseling, and risk-reduction strategies for woman to improve sexual health.

Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence.... more Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence. We tested the use of daily short message service (i.e., SMS/text message) surveys to measure sexual behavior and PrEP adherence in Kenya. Ninety-six HIV-uninfected adult individuals, taking daily oral PrEP in a clinical trial, received daily SMS surveys for 60 days. Most participants (96.9 %) reported taking PrEP on ≥80 % days, but 69.8 % missed at least one dose. Unprotected sex was reported on 4.9 % of days; however, 47.9 % of participants reported unprotected sex at least once. Unprotected sex was not correlated with PrEP use (OR = 0.95). Participants reporting more sex were less likely to report PrEP non-adherence and those reporting no sex were most likely to report missing a PrEP dose (adjusted OR = 1.87). PrEP adherence was high, missed doses were correlated with sexual abstinence, and unprotected sex was not associated with decreased PrEP adherence.

BMJ open, 2015

Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of her... more Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impa...

Journal of public health (Oxford, England), Jan 2, 2015

The correctional population bears a heavy burden of hepatitis C virus (HCV) infection necessitati... more The correctional population bears a heavy burden of hepatitis C virus (HCV) infection necessitating expansion of HCV testing and treatment opportunities. Rapid HCV testing provides point-of-care antibody results and may be ideal for correctional facilities, particularly jails, where persons are often incarcerated for short periods of time, yet feasibility has not been established. We conducted a pilot study of a rapid HCV testing algorithm among short-term inmates with unknown HCV status. Participants completed a questionnaire, viewed an informational video and underwent rapid HCV testing and confirmatory testing, when indicated. Persons with chronic infection were referred to community care after release. Baseline characteristics, risk behaviors, test results and linkage were examined by descriptive analyses. Two hundred and fifty-two inmates were enrolled and 249 completed all study activities. Twenty-five participants (10%) had reactive rapid tests and 23 (92%) completed confirma...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2009

The objective of this paper is to characterize effective patient care reminder strategies for peo... more The 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 ...

Journal of the International AIDS Society, 2015

Introduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care ... more Introduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care for HIV treatment and HIV prevention. However, young people's access to HIV testing is uneven worldwide. The objective of this paper is to review the context and concerns faced by youth around HIV testing in low-as well as high-income country settings. Discussion: HIV testing is a critical entry point for primary and secondary prevention as well as care and treatment for young people including key populations of vulnerable youth. We provide a framework for thinking about the role of testing in the continuum of prevention and care for young people. Brief case study examples from Kenya and the US illustrate some of the common barriers and issues involved for young people. Conclusions: Young people worldwide need more routine access to HIV testing services that effectively address the developmental, socio-political and other issues faced by young women and men.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007

We developed a Web-based application delivered on PDAs (Colecta-PALM in Peru, Pambazuko-PALM in K... more 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.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2008

Colecta-PALM is a Web-based application delivered on PDAs that provides behavioral messaging base... more 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.

Computer Human Interaction, 2005

The evaluation of paper prototypes is normally conducted in controlled settings such as a usabili... more The evaluation of paper prototypes is normally conducted in controlled settings such as a usability lab. This paper, in contrast, reports on a study where evaluations of a paper prototype were performed on the street with young adults. We discuss the merits of this approach and how it impacted the design process. A key finding is that the street location

Current HIV/AIDS Reports, 2011

No single HIV prevention strategy will be sufficient to control the HIV pandemic. However, a grow... more 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.

Journal of acquired immune deficiency syndromes (1999), 2003

To determine strategies to overcome barriers to HIV testing among persons at risk. We developed a... more To determine strategies to overcome barriers to HIV testing among persons at risk. We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to ...