Christine Pace - Academia.edu (original) (raw)

Papers by Christine Pace

International Journal of Std & Aids, Dec 1, 2012

Objective-To estimate the prevalence and identify correlates of four sexually transmitted infecti... more Objective-To estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex. Methods-This study was a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhea, Chlamydia trachomatis and Trichomonas vaginalis and serum testing for infection with Treponema pallidum. Data on potential demographic and behavioral predictors of STI were obtained from surveys administered at study entry. Results-Of 682 participants, 12.8% (95% CI 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (AOR 2.00, 95% CI 1.13, 3.55). Conclusions-Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits reevaluation.

Annals of Internal Medicine, 2016

This issue provides a clinical overview of substance use disorders, focusing on epidemiology, pre... more This issue provides a clinical overview of substance use disorders, focusing on epidemiology, prevention, diagnosis, complications, and management. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Auth... more Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: Methadone maintenance treatment (MMT) is widely used to treat opioid dependence during pregnancy. Though data suggest pregnant women are more likely to engage in MMT compared to non-pregnant women, few studies have examined the effect of pregnancy on abstinence from illicit substances. In addition, there are scant data on postpartum substance use outcomes despite the importance of the postpartum period in determining whether a woman continues in recovery long-term. Methods: Retrospective study of medical records from pregnant and non-pregnant women who emolled in an MMT program over a five year period. Multivariable generalized estimating equations (GEE) logistic regression was used to examine the effect of pregnancy status (pregnant, postpartum or non-pregnant) on the odds of giving an opiate negative urine drug test, and on the odds of giving a urine that was negative not only for opiates, but also for cocaine and benzodiazepines. Results: Urine drug tests from pregnant and postpartum women had almost three times the odds of being opiate-negative urine compared to those from non-pregnant women (AOR 2.90, 95% CI 1.94, 4.33 for pregnant vs. non-pregnant; AOR 2.78, 95% CI 1.77, 4.38 for postpartum vs. non-pregnant). Drug tests from women who were in a residential program on emollment were more likely to be opiate-negative. Results were similar for urine drug tests that were negative for opiates, cocaine and benzodiazepines. Conclusions: Pregnant women with opioid dependence reduce their use substantially in the context of a comprehensive, multidisciplinary program including MMT, and women who remain in MMT postpartum continue to do well. However, the programming needs of non-pregnant women require more attention. In particular, further research should identify whether enhanced access to residential programs or other treatment modalities could help improve this group's engagementwith recovery

Medical Clinics of North America, 2018

Unhealthy substance use is defined as a level of substance use that can incur health consequences... more Unhealthy substance use is defined as a level of substance use that can incur health consequences, and includes both risky use that does not meet substance use disorder (SUD) criteria, as well as use that reflects an SUD (Fig. 1). Unhealthy substance use is among the most common preventable causes of death, contributes to significant morbidity, 1 is a driver of health care-related and societal costs, 1 and is prevalent among patients seen in primary care settings. 2,3 SUDs have much in common with the

Annals of Internal Medicine, 2016

This issue provides a clinical overview of substance use disorders, focusing on epidemiology, pre... more This issue provides a clinical overview of substance use disorders, focusing on epidemiology, prevention, diagnosis, complications, and management. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Journal of Substance Abuse Treatment, 2014

The optimal approach to postpartum dosing among women treated with methadone maintenance is uncle... more The optimal approach to postpartum dosing among women treated with methadone maintenance is unclear. We examined doses among 101 methadone-maintained pregnant women 2, 6 and 12 weeks postpartum, and compared the incidence of having doses held for oversedation during pregnancy and postpartum. The average dose at delivery was 83.3 mg, and the mean change from delivery to 12 weeks postpartum was −3.7 mg (95% CI −6.3, −1.1). The incidence of oversedation events per 10,000 days was 2.8 among pregnant women and 5.6 for postpartum women (incidence rate ratio [IRR] 2.04, 95% CI 0.66, 6.28). After adjusting for benzodiazepine prescriptions, the IRR of an oversedation event among postpartum women compared to pregnant women was 1.74 (95% CI 0.56, 5.30). In conclusion, postpartum dose changes were small in a methadone clinic using clinical assessments to determine dose. Although the incidence of oversedation events remained low postpartum, the clinically important but not statistically significant increase in events among postpartum women and those prescribed benzodiazepines requires further research. While there are not yet adequate data to support pre-specified postpartum dose reductions, the findings suggest that more frequent clinical assessments continuing as late as 12 weeks postpartum may be warranted.

AIDS and Behavior, 2010

Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Gi... more Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Given alcohol's association with risky sex in other populations and alcohol's role in HIV disease progression, we investigated patterns of alcohol use in HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in Mumbai. Analyses identified factors associated with heavy alcohol use and evaluated the relationship between alcohol use and risky sex. We surveyed 211 female and 205 male individuals; 80/211 FSWs (38%) and 127/205 male clients (62%) drank alcohol in the last 30 days. Among females, 32 and 11% drank heavily and were alcohol-dependent, respectively; among males the respective proportions were 44 and 29%. Men's heavy alcohol use was significantly associated with inconsistent condom use over the last year (AOR 2.40, 95% CI 1.21-4.77, P = 0.01); a comparable association was not seen in women. These findings suggest a need to address alcohol use both to avoid the medical complications of its heavy use in this population and to mitigate inconsistent condom use, the latter issue possibly requiring gender specific approaches. Such efforts to reduce drinking will be an important dimension to secondary HIV prevention in India.

IRB: Ethics and Human Research, 2005

W e surveyed principal investigators in ESPRIT (Evaluation of Subcutaneous Proleukin@ in a Random... more W e surveyed principal investigators in ESPRIT (Evaluation of Subcutaneous Proleukin@ in a Randomized International Trial), a multinational, open-label, randomized, Phase III trial evaluating the effective-ness of subcutaneous interleukin-2 (IL-2) in reducing HIV progression over ...

International Journal of Std & Aids, Dec 1, 2012

Objective-To estimate the prevalence and identify correlates of four sexually transmitted infecti... more Objective-To estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex. Methods-This study was a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhea, Chlamydia trachomatis and Trichomonas vaginalis and serum testing for infection with Treponema pallidum. Data on potential demographic and behavioral predictors of STI were obtained from surveys administered at study entry. Results-Of 682 participants, 12.8% (95% CI 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (AOR 2.00, 95% CI 1.13, 3.55). Conclusions-Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits reevaluation.

Annals of Internal Medicine, 2016

This issue provides a clinical overview of substance use disorders, focusing on epidemiology, pre... more This issue provides a clinical overview of substance use disorders, focusing on epidemiology, prevention, diagnosis, complications, and management. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Auth... more Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: Methadone maintenance treatment (MMT) is widely used to treat opioid dependence during pregnancy. Though data suggest pregnant women are more likely to engage in MMT compared to non-pregnant women, few studies have examined the effect of pregnancy on abstinence from illicit substances. In addition, there are scant data on postpartum substance use outcomes despite the importance of the postpartum period in determining whether a woman continues in recovery long-term. Methods: Retrospective study of medical records from pregnant and non-pregnant women who emolled in an MMT program over a five year period. Multivariable generalized estimating equations (GEE) logistic regression was used to examine the effect of pregnancy status (pregnant, postpartum or non-pregnant) on the odds of giving an opiate negative urine drug test, and on the odds of giving a urine that was negative not only for opiates, but also for cocaine and benzodiazepines. Results: Urine drug tests from pregnant and postpartum women had almost three times the odds of being opiate-negative urine compared to those from non-pregnant women (AOR 2.90, 95% CI 1.94, 4.33 for pregnant vs. non-pregnant; AOR 2.78, 95% CI 1.77, 4.38 for postpartum vs. non-pregnant). Drug tests from women who were in a residential program on emollment were more likely to be opiate-negative. Results were similar for urine drug tests that were negative for opiates, cocaine and benzodiazepines. Conclusions: Pregnant women with opioid dependence reduce their use substantially in the context of a comprehensive, multidisciplinary program including MMT, and women who remain in MMT postpartum continue to do well. However, the programming needs of non-pregnant women require more attention. In particular, further research should identify whether enhanced access to residential programs or other treatment modalities could help improve this group's engagementwith recovery

Medical Clinics of North America, 2018

Unhealthy substance use is defined as a level of substance use that can incur health consequences... more Unhealthy substance use is defined as a level of substance use that can incur health consequences, and includes both risky use that does not meet substance use disorder (SUD) criteria, as well as use that reflects an SUD (Fig. 1). Unhealthy substance use is among the most common preventable causes of death, contributes to significant morbidity, 1 is a driver of health care-related and societal costs, 1 and is prevalent among patients seen in primary care settings. 2,3 SUDs have much in common with the

Annals of Internal Medicine, 2016

This issue provides a clinical overview of substance use disorders, focusing on epidemiology, pre... more This issue provides a clinical overview of substance use disorders, focusing on epidemiology, prevention, diagnosis, complications, and management. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Journal of Substance Abuse Treatment, 2014

The optimal approach to postpartum dosing among women treated with methadone maintenance is uncle... more The optimal approach to postpartum dosing among women treated with methadone maintenance is unclear. We examined doses among 101 methadone-maintained pregnant women 2, 6 and 12 weeks postpartum, and compared the incidence of having doses held for oversedation during pregnancy and postpartum. The average dose at delivery was 83.3 mg, and the mean change from delivery to 12 weeks postpartum was −3.7 mg (95% CI −6.3, −1.1). The incidence of oversedation events per 10,000 days was 2.8 among pregnant women and 5.6 for postpartum women (incidence rate ratio [IRR] 2.04, 95% CI 0.66, 6.28). After adjusting for benzodiazepine prescriptions, the IRR of an oversedation event among postpartum women compared to pregnant women was 1.74 (95% CI 0.56, 5.30). In conclusion, postpartum dose changes were small in a methadone clinic using clinical assessments to determine dose. Although the incidence of oversedation events remained low postpartum, the clinically important but not statistically significant increase in events among postpartum women and those prescribed benzodiazepines requires further research. While there are not yet adequate data to support pre-specified postpartum dose reductions, the findings suggest that more frequent clinical assessments continuing as late as 12 weeks postpartum may be warranted.

AIDS and Behavior, 2010

Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Gi... more Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Given alcohol's association with risky sex in other populations and alcohol's role in HIV disease progression, we investigated patterns of alcohol use in HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in Mumbai. Analyses identified factors associated with heavy alcohol use and evaluated the relationship between alcohol use and risky sex. We surveyed 211 female and 205 male individuals; 80/211 FSWs (38%) and 127/205 male clients (62%) drank alcohol in the last 30 days. Among females, 32 and 11% drank heavily and were alcohol-dependent, respectively; among males the respective proportions were 44 and 29%. Men's heavy alcohol use was significantly associated with inconsistent condom use over the last year (AOR 2.40, 95% CI 1.21-4.77, P = 0.01); a comparable association was not seen in women. These findings suggest a need to address alcohol use both to avoid the medical complications of its heavy use in this population and to mitigate inconsistent condom use, the latter issue possibly requiring gender specific approaches. Such efforts to reduce drinking will be an important dimension to secondary HIV prevention in India.

IRB: Ethics and Human Research, 2005

W e surveyed principal investigators in ESPRIT (Evaluation of Subcutaneous Proleukin@ in a Random... more W e surveyed principal investigators in ESPRIT (Evaluation of Subcutaneous Proleukin@ in a Randomized International Trial), a multinational, open-label, randomized, Phase III trial evaluating the effective-ness of subcutaneous interleukin-2 (IL-2) in reducing HIV progression over ...