Rachel Scott - Academia.edu (original) (raw)
Papers by Rachel Scott
Journal of Maternal and Child Health, 2021
Background: Untreated perinatal depression is a significant public health issue that disproportio... more Background: Untreated perinatal depression is a significant public health issue that disproportionately affects low-income black women and may lead to higher maternal mortality rates and disparate birth outcomes. Despite the growing literature documenting prevalence and risk for perinatal depression among black women, our knowledge of patient preferences of mental health interventions in obstetrical (OB) settings among this population is limited. This study explored mental health treatment preferences among black pregnant and postpartum women in an urban OB practice, serving predominantly black women with public insurance. Subjects and Method: We employed a qualitative approach to examine Black perinatal women's mental health preferences in an OB setting. The study sample consisted of 14 perinatal women at an urban obstetrics practice in Washington, DC. Semi-structured interviews were conducted to gain insight into their emotional experiences during pregnancy and postpartum, and to obtain patient recommendations for mental health interventions within an obstetrics setting. Patient interviews were audio-recorded, transcribed, and analyzed by two coders using inductive thematic analysis and consensus procedures. Results: Participants reported several general content themes: provider-patient relationship and intervention topic feedback. Within the overall content theme of provider-patient relationship, black women noted differences in their overall levels of comfort in discussing stress and mental health issues. Subthemes of authentic connection and perceived stigma emerged. Relevant subthemes on intervention topic preferences discussed content, modality, and logistics. Conclusion: Our findings support the importance of offering integrative, culturally competent, and accessible mental health interventions in order to prevent and treat perinatal depression among low-income black women in OB settings.
Journal of Pain and Symptom Management, 2018
Context. No prospective studies address disease-specific advance care planning (ACP) for adults l... more Context. No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS. Objective. To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record. Methods. Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N ¼ 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition). Results. Patients (n ¼ 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio ¼ 6.58, 95% CI: 3.21e13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001). Conclusions. The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices.
For reproductive-age women living with HIV, birth spacing allows for optimization of maternal hea... more For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to overcome barriers to planned pregnancy and birth spacing
JWHG, 2017
Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single ... more Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single dose methotrexate (MTX) ectopic pregnancy treatment in an urban population. Methods: We performed a retrospective chart review of patients treated for ectopic pregnancy with MTX from January 2009 to December 2012. Results: A total of 117 patients met inclusion criteria. Follow up trends were nonspecific. Ninety-three percent of patients followed up for at least one additional blood draw: day 4 (39.3%), day 5 (32.5%), day 7 (25.6%) and day 8 (34.2%). Standard MTX follow-up was 16.2%. No significant differences in morbidity or treatment failure were associated with patterns of follow-up. Conclusions: Adherence to standard MTX protocol in our urban population was low. Neither success of treatment nor morbidity was adversely affected by non-adherence to current standard protocol.
JWHG, 2017
Objective: To assess condom and sexual knowledge, condom use and negotiation tactics of HIV posit... more Objective: To assess condom and sexual knowledge, condom use and negotiation tactics of HIV positive and negative women, and identify any unmet need for education. Methods: We compiled the survey instrument from previously psychometrically validated questions, including condom knowledge, use, and negotiation skills. We recruited a convenience sample from the Obstetrics and Gynecology and Infectious Disease Clinic waiting rooms. In our analysis, we used descriptive statistics: T-tests, Wilcoxon rank sum, Chi-square and Fisher exact tests and multivariate logistic regression. Results: We collected 438 questionnaires; 114 respondents were HIV positive. Median age was 39.6 and the majority were African American (87.9%). HIV positive women had lower levels of education and income, but higher number of lifetime sexual partners and pregnancies. HIV positive women were more likely to report condom use (80% vs. 45.4% p=0.0001) and consistent condom use; 71% reporting "most of the time" or "always" vs. 43.3% (p=0.0001). Only 53.2% of HIV negative women and 75.4% of HIV positive women reported negotiating condom use when their partner declined (p<0.0001). HIV positive women were more likely to report using condom negotiation strategies such as autocracy, bargaining, bullying, disengagement, manipulation, and supplication. Conclusions: HIV positive women reported increased condom knowledge, use and negotiation skills compared to their HIV negative counterparts. Gaps in knowledge, condom use, and negotiation skills highlight need for further education and empowerment of women with and without HIV to prevent spread of HIV in this high-prevalence, high-risk population.
Contemporary Clinical Trials, 2015
Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has becom... more Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with comorbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, outpatient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.
The Qualitative Report, 2018
For reproductive-age women living with HIV, birth spacing allows for optimization of maternal hea... more For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission of HIV. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to over...
Journal of Pain and Symptom Management
Open Forum Infectious Diseases
Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening... more Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening in pregnancy although CDC, USPSTF, or ACOG still do not—though HCV can be perinatally transmitted and carries associated complications for the mother and fetus. Our study objectives were to analyze prenatal HCV screening practices at a large regional healthcare system and the prevalence of HCV-associated maternal and fetal/neonatal outcomes. Methods We performed a nested propensity score (PS) case–control study of pregnant women who tested HCV Ab+ in a cross-sectional study of women presenting for prenatal care at a large regional healthcare system from January 17 to December 18. We collected retrospective EHR data, including state of residency, HCV Ab, RNA, care engagement, HCV risk factors, comorbidities, maternal and fetal/neonatal morbidity, and neonatal HCV testing (when available). Mixed and generalized linear models were used to examine differences in continuous and categorical v...
Journal of Pain and Symptom Management
Infectious diseases in obstetrics and gynecology, 2018
To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to de... more To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to decrease mother-to-child transmission (MTCT), by comparing the cost and quality-adjusted life years (QALYs) of universal rapid HIV screening at time of delivery to two current standards of care for prenatal HIV screening in the United States. We conducted a cost-effectiveness analysis to compare the cost and QALY of universal intrapartum rapid HIV screening with two current standards of care: (I) opt-out rapid HIV testing limited to patients without previous third-trimester screening and (II) opt-out rapid HIV testing limited to patients without any prenatal screening. We developed a decision-tree model and performed sensitivity analyses to estimate the impact of variances in QALY, estimated lifetime medical costs, HIV prevalence, and cumulative incidence. The incremental cost-effectiveness ratio for universal screening was $7,973.45/QALY. The results remained robust to sensitivity analysi...
Obstetrics & Gynecology
To evaluate whether there is increased mother-to-child transmission of human immunodeficiency vir... more To evaluate whether there is increased mother-to-child transmission of human immunodeficiency virus (HIV)-1 associated with deliveries at 40 weeks of estimated gestational age (EGA) or greater in pregnant women with HIV-1 viral loads of 1,000 copies/mL or less. We performed a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal and Longitudinal Study in Latin American Countries and International Maternal Pediatric Adolescent AIDS Clinical Trials P1025 cohorts. We included pregnant women with HIV-1 with recent viral loads of 1,000 copies/mL or less at the time of delivery and compared delivery outcomes at between 38 and less than 40 weeks EGA with delivery outcomes at 40 weeks EGA or greater, the exposure of interest. Our primary outcome of interest was mother-to-child transmission, and secondary outcomes included indicators of maternal and neonatal morbidity. We examined the association between EGA and mother-to-child transmission using Poisson distribution. Associations between EGA and secondary outcomes were examined through bivariate analyses using Pearson χ and Fisher exact test or the nonparametric Mann-Whitney U test. Among the 2,250 eligible neonates, eight neonates were infected with HIV-1 (overall transmission rate 0.4%, 95% CI 0.2-8.1%, 40 weeks EGA or greater 0.5% [3/621, 95% CI 0.2-1.4%], less than 40 weeks EGA 0.3% [5/1,629, 95% CI 0.1-0.7%]); there was no significant difference in transmission by EGA (rate ratio 1.57, 95% CI 0.24-8.09, P=.77). There was no difference in maternal viral load between the two groups nor was there a difference in timing of transmission among neonates born with HIV-1. In pregnant women with well-controlled HIV-1, the risk of mother-to-child transmission did not differ significantly by EGA at delivery, although we were not powered to demonstrate equivalence of proportions of mother-to-child transmission between EGA groups.
Therapeutic advances in infectious disease, 2018
A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resul... more A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation. We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. We could not evaluate decrease in MTCT rate secondary to low sample size ( = 3324) and no true-positive results. Patients not tested ( = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White ( < 0.01) and older ( < 0.01). There was a negative relationship with physician omission over time. The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unabl...
Research Citation: Rachel K. Scott , et al. (2016) Adherence to the Single-Dose Methotrexate Prot... more Research Citation: Rachel K. Scott , et al. (2016) Adherence to the Single-Dose Methotrexate Protocol for the Management of Ectopic Pregnancy in an Inner City Population: A retrospective cohort and protocol analysis. J Womens Health Gyn 1: 1-10. Abstract Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single dose methotrexate (MTX) ectopic pregnancy treatment in an urban population. Methods: We performed a retrospective chart review of patients treated for ectopic pregnancy with MTX from January 2009 to December 2012. Results: A total of 117 patients met inclusion criteria. Follow up trends were nonspecific. Ninety-three percent of patients followed up for at least one additional blood draw: day 4 (39.3%), day 5 (32.5%), day 7 (25.6%) and day 8 (34.2%). Standard MTX follow-up was 16.2%. No significant differences in morbidity or treatment failure were associated with patterns of follow-up. Conclusions: Adherence to standard MTX protocol in our urban population was low. Neither success of treatment nor morbidity was adversely affected by non-adherence to current standard protocol. Capsule: Adherence to the standard single-dose methotrexate protocol for treatment of ectopic pregnancy is poor; alternate protocols appear safe and may facilitate improved adherence.
Journal of Maternal and Child Health, 2021
Background: Untreated perinatal depression is a significant public health issue that disproportio... more Background: Untreated perinatal depression is a significant public health issue that disproportionately affects low-income black women and may lead to higher maternal mortality rates and disparate birth outcomes. Despite the growing literature documenting prevalence and risk for perinatal depression among black women, our knowledge of patient preferences of mental health interventions in obstetrical (OB) settings among this population is limited. This study explored mental health treatment preferences among black pregnant and postpartum women in an urban OB practice, serving predominantly black women with public insurance. Subjects and Method: We employed a qualitative approach to examine Black perinatal women's mental health preferences in an OB setting. The study sample consisted of 14 perinatal women at an urban obstetrics practice in Washington, DC. Semi-structured interviews were conducted to gain insight into their emotional experiences during pregnancy and postpartum, and to obtain patient recommendations for mental health interventions within an obstetrics setting. Patient interviews were audio-recorded, transcribed, and analyzed by two coders using inductive thematic analysis and consensus procedures. Results: Participants reported several general content themes: provider-patient relationship and intervention topic feedback. Within the overall content theme of provider-patient relationship, black women noted differences in their overall levels of comfort in discussing stress and mental health issues. Subthemes of authentic connection and perceived stigma emerged. Relevant subthemes on intervention topic preferences discussed content, modality, and logistics. Conclusion: Our findings support the importance of offering integrative, culturally competent, and accessible mental health interventions in order to prevent and treat perinatal depression among low-income black women in OB settings.
Journal of Pain and Symptom Management, 2018
Context. No prospective studies address disease-specific advance care planning (ACP) for adults l... more Context. No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS. Objective. To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record. Methods. Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N ¼ 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition). Results. Patients (n ¼ 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio ¼ 6.58, 95% CI: 3.21e13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001). Conclusions. The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices.
For reproductive-age women living with HIV, birth spacing allows for optimization of maternal hea... more For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to overcome barriers to planned pregnancy and birth spacing
JWHG, 2017
Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single ... more Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single dose methotrexate (MTX) ectopic pregnancy treatment in an urban population. Methods: We performed a retrospective chart review of patients treated for ectopic pregnancy with MTX from January 2009 to December 2012. Results: A total of 117 patients met inclusion criteria. Follow up trends were nonspecific. Ninety-three percent of patients followed up for at least one additional blood draw: day 4 (39.3%), day 5 (32.5%), day 7 (25.6%) and day 8 (34.2%). Standard MTX follow-up was 16.2%. No significant differences in morbidity or treatment failure were associated with patterns of follow-up. Conclusions: Adherence to standard MTX protocol in our urban population was low. Neither success of treatment nor morbidity was adversely affected by non-adherence to current standard protocol.
JWHG, 2017
Objective: To assess condom and sexual knowledge, condom use and negotiation tactics of HIV posit... more Objective: To assess condom and sexual knowledge, condom use and negotiation tactics of HIV positive and negative women, and identify any unmet need for education. Methods: We compiled the survey instrument from previously psychometrically validated questions, including condom knowledge, use, and negotiation skills. We recruited a convenience sample from the Obstetrics and Gynecology and Infectious Disease Clinic waiting rooms. In our analysis, we used descriptive statistics: T-tests, Wilcoxon rank sum, Chi-square and Fisher exact tests and multivariate logistic regression. Results: We collected 438 questionnaires; 114 respondents were HIV positive. Median age was 39.6 and the majority were African American (87.9%). HIV positive women had lower levels of education and income, but higher number of lifetime sexual partners and pregnancies. HIV positive women were more likely to report condom use (80% vs. 45.4% p=0.0001) and consistent condom use; 71% reporting "most of the time" or "always" vs. 43.3% (p=0.0001). Only 53.2% of HIV negative women and 75.4% of HIV positive women reported negotiating condom use when their partner declined (p<0.0001). HIV positive women were more likely to report using condom negotiation strategies such as autocracy, bargaining, bullying, disengagement, manipulation, and supplication. Conclusions: HIV positive women reported increased condom knowledge, use and negotiation skills compared to their HIV negative counterparts. Gaps in knowledge, condom use, and negotiation skills highlight need for further education and empowerment of women with and without HIV to prevent spread of HIV in this high-prevalence, high-risk population.
Contemporary Clinical Trials, 2015
Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has becom... more Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with comorbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, outpatient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.
The Qualitative Report, 2018
For reproductive-age women living with HIV, birth spacing allows for optimization of maternal hea... more For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission of HIV. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to over...
Journal of Pain and Symptom Management
Open Forum Infectious Diseases
Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening... more Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening in pregnancy although CDC, USPSTF, or ACOG still do not—though HCV can be perinatally transmitted and carries associated complications for the mother and fetus. Our study objectives were to analyze prenatal HCV screening practices at a large regional healthcare system and the prevalence of HCV-associated maternal and fetal/neonatal outcomes. Methods We performed a nested propensity score (PS) case–control study of pregnant women who tested HCV Ab+ in a cross-sectional study of women presenting for prenatal care at a large regional healthcare system from January 17 to December 18. We collected retrospective EHR data, including state of residency, HCV Ab, RNA, care engagement, HCV risk factors, comorbidities, maternal and fetal/neonatal morbidity, and neonatal HCV testing (when available). Mixed and generalized linear models were used to examine differences in continuous and categorical v...
Journal of Pain and Symptom Management
Infectious diseases in obstetrics and gynecology, 2018
To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to de... more To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to decrease mother-to-child transmission (MTCT), by comparing the cost and quality-adjusted life years (QALYs) of universal rapid HIV screening at time of delivery to two current standards of care for prenatal HIV screening in the United States. We conducted a cost-effectiveness analysis to compare the cost and QALY of universal intrapartum rapid HIV screening with two current standards of care: (I) opt-out rapid HIV testing limited to patients without previous third-trimester screening and (II) opt-out rapid HIV testing limited to patients without any prenatal screening. We developed a decision-tree model and performed sensitivity analyses to estimate the impact of variances in QALY, estimated lifetime medical costs, HIV prevalence, and cumulative incidence. The incremental cost-effectiveness ratio for universal screening was $7,973.45/QALY. The results remained robust to sensitivity analysi...
Obstetrics & Gynecology
To evaluate whether there is increased mother-to-child transmission of human immunodeficiency vir... more To evaluate whether there is increased mother-to-child transmission of human immunodeficiency virus (HIV)-1 associated with deliveries at 40 weeks of estimated gestational age (EGA) or greater in pregnant women with HIV-1 viral loads of 1,000 copies/mL or less. We performed a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal and Longitudinal Study in Latin American Countries and International Maternal Pediatric Adolescent AIDS Clinical Trials P1025 cohorts. We included pregnant women with HIV-1 with recent viral loads of 1,000 copies/mL or less at the time of delivery and compared delivery outcomes at between 38 and less than 40 weeks EGA with delivery outcomes at 40 weeks EGA or greater, the exposure of interest. Our primary outcome of interest was mother-to-child transmission, and secondary outcomes included indicators of maternal and neonatal morbidity. We examined the association between EGA and mother-to-child transmission using Poisson distribution. Associations between EGA and secondary outcomes were examined through bivariate analyses using Pearson χ and Fisher exact test or the nonparametric Mann-Whitney U test. Among the 2,250 eligible neonates, eight neonates were infected with HIV-1 (overall transmission rate 0.4%, 95% CI 0.2-8.1%, 40 weeks EGA or greater 0.5% [3/621, 95% CI 0.2-1.4%], less than 40 weeks EGA 0.3% [5/1,629, 95% CI 0.1-0.7%]); there was no significant difference in transmission by EGA (rate ratio 1.57, 95% CI 0.24-8.09, P=.77). There was no difference in maternal viral load between the two groups nor was there a difference in timing of transmission among neonates born with HIV-1. In pregnant women with well-controlled HIV-1, the risk of mother-to-child transmission did not differ significantly by EGA at delivery, although we were not powered to demonstrate equivalence of proportions of mother-to-child transmission between EGA groups.
Therapeutic advances in infectious disease, 2018
A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resul... more A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation. We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. We could not evaluate decrease in MTCT rate secondary to low sample size ( = 3324) and no true-positive results. Patients not tested ( = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White ( < 0.01) and older ( < 0.01). There was a negative relationship with physician omission over time. The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unabl...
Research Citation: Rachel K. Scott , et al. (2016) Adherence to the Single-Dose Methotrexate Prot... more Research Citation: Rachel K. Scott , et al. (2016) Adherence to the Single-Dose Methotrexate Protocol for the Management of Ectopic Pregnancy in an Inner City Population: A retrospective cohort and protocol analysis. J Womens Health Gyn 1: 1-10. Abstract Objective: To evaluate protocol adherence, treatment success, and associated morbidity to single dose methotrexate (MTX) ectopic pregnancy treatment in an urban population. Methods: We performed a retrospective chart review of patients treated for ectopic pregnancy with MTX from January 2009 to December 2012. Results: A total of 117 patients met inclusion criteria. Follow up trends were nonspecific. Ninety-three percent of patients followed up for at least one additional blood draw: day 4 (39.3%), day 5 (32.5%), day 7 (25.6%) and day 8 (34.2%). Standard MTX follow-up was 16.2%. No significant differences in morbidity or treatment failure were associated with patterns of follow-up. Conclusions: Adherence to standard MTX protocol in our urban population was low. Neither success of treatment nor morbidity was adversely affected by non-adherence to current standard protocol. Capsule: Adherence to the standard single-dose methotrexate protocol for treatment of ectopic pregnancy is poor; alternate protocols appear safe and may facilitate improved adherence.