Wayne Duffus - Academia.edu (original) (raw)

Papers by Wayne Duffus

Http Dx Doi Org 10 1089 Aid 2010 0268, Jun 27, 2011

Current literature on retention in HIV care fails to account for patients who continually/simulta... more Current literature on retention in HIV care fails to account for patients who continually/simultaneously access different providers. This statewide study examined retention in early HIV medical care and its impact on viro-immunological improvement and survival outcomes. It was a retrospective study of South Carolina residents ≥13 years old who were diagnosed with HIV infection in 2004-2007 and initially entered in care. CD4 count/percent and viral load (VL) tests that must be reported to the South Carolina HIV surveillance database were used as a proxy for a clinical visit. Retention was defined as at least one visit in each of four 6-month periods over 2 years postlinkage. Retention rates were categorized as "optimal" (visits in four intervals), "suboptimal" (visits in three intervals), sporadic (visits in two or one intervals), and "dropout" (no visits). Logistic regression and Cox proportional analyses were used to examine retention. Of the 2197 persons, about 50% failed to maintain optimal retention in care postlinkage. Male gender, nonwhite race/ethnicity, younger age, delayed linkage, and HIV-only status were significant predictors of lower rate of retention. Mean decrease in baseline log(10) VL was greater among those with optimal compared to suboptimal (-1.81 vs. -1.42; p < 0.001) and sporadic retention (-1.81 vs. -0.70; p < 0.001). Mean increase in baseline CD4 count was greater in optimal retention compared to suboptimal (169.70 vs. 107.5; p < 0.001) and sporadic retention (169.70 vs. 2.43; p < 0.001). Increased risk of mortality was associated with sporadic retention (aHR 2.91; 95% CI 1.54-5.50) and "dropout" (aHR 4.00; 95% CI 1.50-10.65). Rate of poor retention in early HIV medical care was relatively higher than reported in clinic-based data. Increasing the rate of retention in early HIV care could substantially improve viro-immunological parameters and survival outcomes.

Journal of the South Carolina Medical Association, Dec 1, 2009

Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of pr... more Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of precancerous cells increases the likelihood of treatment success. In fact, the Pap test is one of only a few cancer screening procedures that can prevent cancer by virtue of identifying and intervening upon abnormal precancerous cells in the early stages. There has been a growing prevalence of cervical cancer among HIV-positive women. Early diagnosis is essential to improving survival outcomes of women living with HIV/AIDS. The purpose of this study was to describe Pap test behaviors among women in South Carolina and examine its relationship with HIV testing.

Background: In 2004, South Carolina (SC) ranked 10th in annual AIDS case rates in the US. In Janu... more Background: In 2004, South Carolina (SC) ranked 10th in annual AIDS case rates in the US. In January 2004, SC law mandated the reporting of all HIV viral loads and CD4+ T cell counts to the HARS Surveillance Database. However, there has been no recent characterization of the HIV-infected population using these values. Methods: We used initial CD4counts and viral loads to assess disease stage at the time of diagnosis. All incident cases between May 1 2004 and April 30 2005, who had laboratory values reported, were analyzed using SAS. Stratification of CD4 count and viral load were according to current established guidelines for commencing ART (CD4 <= 350 cells/mm3 and viral load >= 100,000 copies/ml) or initiation of opportunistic infection prophylaxis (CD4 <= 200 cells/mm3). Results: Of 759 individuals who had a CD4 count reported, 56% and 34% had CD4 counts <= 350 and <= 200 cells/mm3, respectively, at initial HIV diagnosis. Compared to those with CD4 counts >200 ...

Background: Early identification of infected patients and early entry into care are pivotal to sl... more Background: Early identification of infected patients and early entry into care are pivotal to slowing the spread of the HIV epidemic. Objective: To assess disease stage at HIV diagnosis and to determine the predictors of late entry into HIV medical care. Method: Cohort study of individuals newly diagnosed from 1/1/04 to 12/31/06 who were reported to the HIV/AIDS Reporting System (HARS). Reporting of all HIV laboratory markers is mandatory by SC law. The first CD4 count was used to stage disease at diagnosis and the second CD4 count or viral load test was used as a surrogate for entry into care (dichotomized at 60 days and 90 days from diagnosis). Logistic regression models were used to adjust for predictors of entry into care. Result: Of the 2362 newly diagnosed individuals, 2129 (90%) individuals had laboratory markers reported. The median initial CD4 cell count was 304 cells/mm3, 735/2129 (35%) had a CD4 count ≤200 cells/mm3, 1194/2129 (56%) had a CD4 count ≤350 cells/mm3, and fo...

Background: Chlamydia is the most commonly reported sexually transmitted disease in the United St... more Background: Chlamydia is the most commonly reported sexually transmitted disease in the United States, and the Southeast leads the nation in prevalence. Complications of untreated chlamydia infection include pelvic inflammatory disease (PID). South Carolina instituted statewide chlamydia screening and surveillance in 1998. We used surveillance data from the South Carolina Department of Health and Environmental Control (DHEC) to determine chlamydia prevalence statewide. Methods: Chlamydia testing was performed on all women aged ≤24 years who visited DHEC family planning and STD clinics and on women aged ≥25 years who met screening criteria. Test positivity was used to calculate statewide prevalence and prevalence by age and ethnic group for 1998-2002. PID incidence during 1998-2001 was obtained from the Hospital Discharge and Outpatient Department Claims data set. Results: Statewide chlamydia prevalence decreased from 9.5% in 1998 to 6.9% in 2002, while the number of tests performed ...

Background: The un-insured or under-insured use the emergency department (ED) as their main sourc... more Background: The un-insured or under-insured use the emergency department (ED) as their main source of primary medical-care and sometimes require inpatient hospitalization (IP) or ambulatory care (OP). Objective: To determine the hospital facilities utilization behavior of South Carolina's (SC) adult HIV-infected population based on their HIV medical-care status. Method: A data file of all adult SC residents reported to the HARS and alive at December 31st, 2003 was linked to statewide all payer health-care database to determine visits for 2004-2005. A hospital visit was categorized as either ED only, IP only, OP only or all. In HIV care was defined as receipt of a viral load test or CD4 cell count during calendar years 2004-2005. Logistic regression was used to estimate relationships between hospital utilization and demographic and behavioral factors. Result: Of the 13,042 HIV-infected adults, 5,130/13,042 (39%) made one or more visits to a hospital facility in 2004-2005 amountin...

Background: Retention in HIV medical-care is associated with improved health outcomes and helps l... more Background: Retention in HIV medical-care is associated with improved health outcomes and helps limit HIV transmission because patients can be educated on ways to modify risky behaviors Objective: To identify characteristics of South Carolina's (SC) adult HIV-infected population associated with HIV medical-care status in 2004. Method: Characteristics of all HIV-infected adults reported to the HIV/AIDS Reporting System (HARS) database who were alive on December 31st, 2003 was used in a cross-sectional study design. Reporting of HIV laboratory markers is mandatory by law and in HIV medical-care was defined as receipt of a viral load or CD4 cell count during calendar year 2004. Logistic regression was used to estimate relationships between care status and demographic and transmission factors. Result: Of the 13,042 HIV-infected adults, 7,303 (56%) were not in HIV medical-care in 2004. Individuals more likely to be in care were: African-Americans (OR 1.21, 95%CI: 1.10, 1.33) compared...

Journal of the South Carolina Medical Association (1975)

The probability of a recurrence of smallpox from intentional release is high enough that all clin... more The probability of a recurrence of smallpox from intentional release is high enough that all clinicians should be familiar with the clinical presentation and immediate response to a possible case. Our most powerful tool is vaccination, which is essentially 100% protective, provides protection even after exposure and is easy to give, but which requires careful screening of persons to be vaccinated because of the possibility of life-threatening complications. Front-line practitioners will have a vital role in initial detection, reporting and isolation of potential cases.

Background: Retention in HIV care is associated with improved health outcomes in patients adheren... more Background: Retention in HIV care is associated with improved health outcomes in patients adherent to antiretroviral therapy. Objective: To determine predictors of retention in HIV care by documenting the presence of CD4 count or viral load values as surrogates for attendance to HIV medical care after diagnosis. Method: Study cohort included newly diagnosed HIV-infected individuals reported to the HIV/AIDS Reporting System (HARS) from 1/1/2004 to 12/31/2005 and alive through 6/30/2007. Reporting of HIV laboratory markers is mandatory by SC law. Assuming that an HIV-infected individual after diagnosis is seen at least once every three months for HIV care, retention was documented as the proportion of quarters since HIV diagnosis in which a CD4 count or viral load result was reported. Poor retention is <75% of eligible time and no show were no reported values. Logistic regression models were used to determine predictors for retention in care. Result: Of the 1596 newly diagnosed ind...

Background:We sought to ascertain factors associated with failure to remain in primary HIV medica... more Background:We sought to ascertain factors associated with failure to remain in primary HIV medical care in a rural Southern state. Our conceptual framework was the Andersen behavioral health model. Methods: We performed a retrospective cohort analysis of the care status of all HIV-infected, non-pregnant adults reported to the South Carolina HIV/AIDS Reporting System during 2004-2006 (n=13,042). Persons receiving a viral load test or CD4 cell count during a 12-month period were defined as being in care for that period. Care status categories were: In Care (IC), care all three years; Not In Care (NIC) no care across the period; and Transitioning (TC), care received during one or more years but not consistently. Reporting of HIV laboratory markers is mandatory by law in SC. We report multinomial logistic regression results. Results: Only 34.7% of HIV-infected adults remained in care across the study period. In unadjusted analysis, blacks were less likely than whites to be NIC rather th...

Journal of the American Society of Hypertension : JASH, Jan 19, 2015

Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV ... more Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV population. We used the South Carolina Medicaid database linked with the enhanced HIV/AIDS system surveillance database for 1994-2011 to evaluate incident hypertension and the impact of combination antiretroviral therapy (cART) in HIV/AIDS population compared with a propensity- matched non-HIV control group. Multivariable, time-dependent survival analysis suggested no significant difference in incidence of hypertension between the HIV group and the non-HIV control group. However, subgroup analysis suggested that among the HIV-infected group, months of exposure to both non-nucleoside reverse transcriptase inhibitors (adjusted hazard ratio, 1.52; 95% confidence interval, 1.3-1.75) and protease inhibitors (adjusted hazard ratio, 1.26; 95% confidence interval, 1.11-1.44) were associated with an increased risk of incident hypertension after adjusting for traditional demographic and metabolic ...

Current infectious disease reports, 2009

The absence of adequate and regular prevention counseling during routine clinical encounters tran... more The absence of adequate and regular prevention counseling during routine clinical encounters translates into missed opportunities for HIV prevention. HIV care providers have considerably more contact with patients than clinicians in other disciplines. These contacts should be translated into opportunities to provide HIV prevention messages to patients and should be a priority for all clinicians caring for HIV-positive patients. Coincidental preventive care for HIV-positive patients is inherently unproductive because of the absence of reinforcing messages. In a recent meta-analysis, HIV-positive individuals who underwent counseling and testing services reduced high-risk behaviors by about 68%. Prevention counseling should focus on positive reinforcement, harm reduction, education, and support. We strongly recommend regular, brief, targeted prevention counseling as a part of every clinical encounter.

Southern medical journal, 2015

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the Un... more The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the United States has shifted to the South, where an increasing proportion is occurring in rural areas. We sought to gain a better understanding of the affected rural population in this region. The statewide HIV/AIDS Electronic Reporting System database was used to examine the epidemiological characteristics of newly diagnosed HIV cases in South Carolina from 2005 to 2011. Rural-urban differences were examined in sociodemographic and clinical characteristics, including progression to AIDS and a decline in HIV viral load (VL) to undetectable levels within 1 year of diagnosis. Of the 5336 individuals newly diagnosed as having HIV, 1433 (26.9%) were from rural areas. Compared with urban residents, a higher proportion of rural residents were black, non-Hispanic (80.1% vs 68.5%; P ≤ 0.0001) and reported heterosexual risk (28.8% vs 22.9%; P = 0.0007). The proportion of female patients was higher in ...

Journal of the South Carolina Medical Association (1975), 2009

Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of pr... more Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of precancerous cells increases the likelihood of treatment success. In fact, the Pap test is one of only a few cancer screening procedures that can prevent cancer by virtue of identifying and intervening upon abnormal precancerous cells in the early stages. There has been a growing prevalence of cervical cancer among HIV-positive women. Early diagnosis is essential to improving survival outcomes of women living with HIV/AIDS. The purpose of this study was to describe Pap test behaviors among women in South Carolina and examine its relationship with HIV testing.

Journal of the South Carolina Medical Association (1975), 2010

Background: The HIV/AIDS epidemic in the U.S has shifted to the South where a large portion of th... more Background: The HIV/AIDS epidemic in the U.S has shifted to the South where a large portion of the infected population lives in the rural areas. This epidemiologic characterization adds to the existing literature because it uses a rural urban commuting area (RUCA)-based definition of rural instead of the customary county-based definitions, it is population-based including individuals who are not-in-care and, is updated with individuals diagnosed after the revised CDC 2006 HIV testing guidelines. Methods: The South Carolina (SC) enhanced HIV/AIDS Reporting System (eHARS) and geocoding data were linked to determine rural or urban residence for all HIV-infected individuals newly diagnosed between 1/1/2005 -12/31/2010. SC state law requires reporting of all CD4 cells and HIV viral load (VL) values which are maintained in eHARS. Each individual was assigned a rural or urban status using the RUCA definition of urban areas. Descriptive and bivariate statistics were used to compare socio-de...

Clinical cardiology, 2014

Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immun... more Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immunodeficiency syndrome (AIDS)-related mortality in the aging human immunodeficiency virus (HIV)-infected population. The incidence rate and clinical correlates of CVD in people living with HIV/AIDS compared to the general population warrants further investigation. HIV/AIDS is associated with increased risk CVD compared to general population. CVD events in a matched cohort of HIV-infected and non-HIV-infected adults, ≥18 years old, served through the South Carolina Medicaid program during 1994 to 2011 were examined using time-dependent proportional hazards regression and marginal structural modeling. A retrospective cohort of 13,632 adults was followed longitudinally for an average of 51 months. The adjusted hazard ratio (aHR) of incident CVD events was higher among HIV-infected individuals exposed to combination antiretroviral therapy (cART) (aHR = 1.15) compared to the non-HIV-infected gr...

Journal of the National Medical Association

To describe the prevalence of serious psychological distress among Deep South residents and human... more To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersen's behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60...

The open AIDS journal, 2012

To examine the prevalence of and factors associated with potentially unnecessary repeat confirmat... more To examine the prevalence of and factors associated with potentially unnecessary repeat confirmatory testing after initial HIV diagnosis and the relationship of repeat testing to medical care engagement. South Carolina HIV/AIDS surveillance data for 12,504 individuals who were newly diagnosed with HIV infection between January 1997 and December 2008 were used for this analysis. State law requires that all positive Western blot [WB] results be reported regardless of frequency. HIV-infected persons, diagnosed from 1997-2008 and followed through 2009, with repeat positive WB results were compared to those who did not have repeat positive WB results. We defined repeat positive testing as documentation of one or more positive WB obtained ≥90 days following initial WB confirmatory result. HIV care engagement for the period from 2007-2009 was assessed by documentation of CD4+ T-cell/viral load reports to the South Carolina HIV/AIDS surveillance system during each six-month period of a cale...

Metabolic Syndrome and Related Disorders, 2013

The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective coho... more The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART). The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia. Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect. Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.

Http Dx Doi Org 10 1089 Aid 2010 0268, Jun 27, 2011

Current literature on retention in HIV care fails to account for patients who continually/simulta... more Current literature on retention in HIV care fails to account for patients who continually/simultaneously access different providers. This statewide study examined retention in early HIV medical care and its impact on viro-immunological improvement and survival outcomes. It was a retrospective study of South Carolina residents ≥13 years old who were diagnosed with HIV infection in 2004-2007 and initially entered in care. CD4 count/percent and viral load (VL) tests that must be reported to the South Carolina HIV surveillance database were used as a proxy for a clinical visit. Retention was defined as at least one visit in each of four 6-month periods over 2 years postlinkage. Retention rates were categorized as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;optimal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (visits in four intervals), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;suboptimal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (visits in three intervals), sporadic (visits in two or one intervals), and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;dropout&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (no visits). Logistic regression and Cox proportional analyses were used to examine retention. Of the 2197 persons, about 50% failed to maintain optimal retention in care postlinkage. Male gender, nonwhite race/ethnicity, younger age, delayed linkage, and HIV-only status were significant predictors of lower rate of retention. Mean decrease in baseline log(10) VL was greater among those with optimal compared to suboptimal (-1.81 vs. -1.42; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and sporadic retention (-1.81 vs. -0.70; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean increase in baseline CD4 count was greater in optimal retention compared to suboptimal (169.70 vs. 107.5; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and sporadic retention (169.70 vs. 2.43; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Increased risk of mortality was associated with sporadic retention (aHR 2.91; 95% CI 1.54-5.50) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;dropout&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (aHR 4.00; 95% CI 1.50-10.65). Rate of poor retention in early HIV medical care was relatively higher than reported in clinic-based data. Increasing the rate of retention in early HIV care could substantially improve viro-immunological parameters and survival outcomes.

Journal of the South Carolina Medical Association, Dec 1, 2009

Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of pr... more Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of precancerous cells increases the likelihood of treatment success. In fact, the Pap test is one of only a few cancer screening procedures that can prevent cancer by virtue of identifying and intervening upon abnormal precancerous cells in the early stages. There has been a growing prevalence of cervical cancer among HIV-positive women. Early diagnosis is essential to improving survival outcomes of women living with HIV/AIDS. The purpose of this study was to describe Pap test behaviors among women in South Carolina and examine its relationship with HIV testing.

Background: In 2004, South Carolina (SC) ranked 10th in annual AIDS case rates in the US. In Janu... more Background: In 2004, South Carolina (SC) ranked 10th in annual AIDS case rates in the US. In January 2004, SC law mandated the reporting of all HIV viral loads and CD4+ T cell counts to the HARS Surveillance Database. However, there has been no recent characterization of the HIV-infected population using these values. Methods: We used initial CD4counts and viral loads to assess disease stage at the time of diagnosis. All incident cases between May 1 2004 and April 30 2005, who had laboratory values reported, were analyzed using SAS. Stratification of CD4 count and viral load were according to current established guidelines for commencing ART (CD4 <= 350 cells/mm3 and viral load >= 100,000 copies/ml) or initiation of opportunistic infection prophylaxis (CD4 <= 200 cells/mm3). Results: Of 759 individuals who had a CD4 count reported, 56% and 34% had CD4 counts <= 350 and <= 200 cells/mm3, respectively, at initial HIV diagnosis. Compared to those with CD4 counts >200 ...

Background: Early identification of infected patients and early entry into care are pivotal to sl... more Background: Early identification of infected patients and early entry into care are pivotal to slowing the spread of the HIV epidemic. Objective: To assess disease stage at HIV diagnosis and to determine the predictors of late entry into HIV medical care. Method: Cohort study of individuals newly diagnosed from 1/1/04 to 12/31/06 who were reported to the HIV/AIDS Reporting System (HARS). Reporting of all HIV laboratory markers is mandatory by SC law. The first CD4 count was used to stage disease at diagnosis and the second CD4 count or viral load test was used as a surrogate for entry into care (dichotomized at 60 days and 90 days from diagnosis). Logistic regression models were used to adjust for predictors of entry into care. Result: Of the 2362 newly diagnosed individuals, 2129 (90%) individuals had laboratory markers reported. The median initial CD4 cell count was 304 cells/mm3, 735/2129 (35%) had a CD4 count ≤200 cells/mm3, 1194/2129 (56%) had a CD4 count ≤350 cells/mm3, and fo...

Background: Chlamydia is the most commonly reported sexually transmitted disease in the United St... more Background: Chlamydia is the most commonly reported sexually transmitted disease in the United States, and the Southeast leads the nation in prevalence. Complications of untreated chlamydia infection include pelvic inflammatory disease (PID). South Carolina instituted statewide chlamydia screening and surveillance in 1998. We used surveillance data from the South Carolina Department of Health and Environmental Control (DHEC) to determine chlamydia prevalence statewide. Methods: Chlamydia testing was performed on all women aged ≤24 years who visited DHEC family planning and STD clinics and on women aged ≥25 years who met screening criteria. Test positivity was used to calculate statewide prevalence and prevalence by age and ethnic group for 1998-2002. PID incidence during 1998-2001 was obtained from the Hospital Discharge and Outpatient Department Claims data set. Results: Statewide chlamydia prevalence decreased from 9.5% in 1998 to 6.9% in 2002, while the number of tests performed ...

Background: The un-insured or under-insured use the emergency department (ED) as their main sourc... more Background: The un-insured or under-insured use the emergency department (ED) as their main source of primary medical-care and sometimes require inpatient hospitalization (IP) or ambulatory care (OP). Objective: To determine the hospital facilities utilization behavior of South Carolina's (SC) adult HIV-infected population based on their HIV medical-care status. Method: A data file of all adult SC residents reported to the HARS and alive at December 31st, 2003 was linked to statewide all payer health-care database to determine visits for 2004-2005. A hospital visit was categorized as either ED only, IP only, OP only or all. In HIV care was defined as receipt of a viral load test or CD4 cell count during calendar years 2004-2005. Logistic regression was used to estimate relationships between hospital utilization and demographic and behavioral factors. Result: Of the 13,042 HIV-infected adults, 5,130/13,042 (39%) made one or more visits to a hospital facility in 2004-2005 amountin...

Background: Retention in HIV medical-care is associated with improved health outcomes and helps l... more Background: Retention in HIV medical-care is associated with improved health outcomes and helps limit HIV transmission because patients can be educated on ways to modify risky behaviors Objective: To identify characteristics of South Carolina's (SC) adult HIV-infected population associated with HIV medical-care status in 2004. Method: Characteristics of all HIV-infected adults reported to the HIV/AIDS Reporting System (HARS) database who were alive on December 31st, 2003 was used in a cross-sectional study design. Reporting of HIV laboratory markers is mandatory by law and in HIV medical-care was defined as receipt of a viral load or CD4 cell count during calendar year 2004. Logistic regression was used to estimate relationships between care status and demographic and transmission factors. Result: Of the 13,042 HIV-infected adults, 7,303 (56%) were not in HIV medical-care in 2004. Individuals more likely to be in care were: African-Americans (OR 1.21, 95%CI: 1.10, 1.33) compared...

Journal of the South Carolina Medical Association (1975)

The probability of a recurrence of smallpox from intentional release is high enough that all clin... more The probability of a recurrence of smallpox from intentional release is high enough that all clinicians should be familiar with the clinical presentation and immediate response to a possible case. Our most powerful tool is vaccination, which is essentially 100% protective, provides protection even after exposure and is easy to give, but which requires careful screening of persons to be vaccinated because of the possibility of life-threatening complications. Front-line practitioners will have a vital role in initial detection, reporting and isolation of potential cases.

Background: Retention in HIV care is associated with improved health outcomes in patients adheren... more Background: Retention in HIV care is associated with improved health outcomes in patients adherent to antiretroviral therapy. Objective: To determine predictors of retention in HIV care by documenting the presence of CD4 count or viral load values as surrogates for attendance to HIV medical care after diagnosis. Method: Study cohort included newly diagnosed HIV-infected individuals reported to the HIV/AIDS Reporting System (HARS) from 1/1/2004 to 12/31/2005 and alive through 6/30/2007. Reporting of HIV laboratory markers is mandatory by SC law. Assuming that an HIV-infected individual after diagnosis is seen at least once every three months for HIV care, retention was documented as the proportion of quarters since HIV diagnosis in which a CD4 count or viral load result was reported. Poor retention is <75% of eligible time and no show were no reported values. Logistic regression models were used to determine predictors for retention in care. Result: Of the 1596 newly diagnosed ind...

Background:We sought to ascertain factors associated with failure to remain in primary HIV medica... more Background:We sought to ascertain factors associated with failure to remain in primary HIV medical care in a rural Southern state. Our conceptual framework was the Andersen behavioral health model. Methods: We performed a retrospective cohort analysis of the care status of all HIV-infected, non-pregnant adults reported to the South Carolina HIV/AIDS Reporting System during 2004-2006 (n=13,042). Persons receiving a viral load test or CD4 cell count during a 12-month period were defined as being in care for that period. Care status categories were: In Care (IC), care all three years; Not In Care (NIC) no care across the period; and Transitioning (TC), care received during one or more years but not consistently. Reporting of HIV laboratory markers is mandatory by law in SC. We report multinomial logistic regression results. Results: Only 34.7% of HIV-infected adults remained in care across the study period. In unadjusted analysis, blacks were less likely than whites to be NIC rather th...

Journal of the American Society of Hypertension : JASH, Jan 19, 2015

Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV ... more Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV population. We used the South Carolina Medicaid database linked with the enhanced HIV/AIDS system surveillance database for 1994-2011 to evaluate incident hypertension and the impact of combination antiretroviral therapy (cART) in HIV/AIDS population compared with a propensity- matched non-HIV control group. Multivariable, time-dependent survival analysis suggested no significant difference in incidence of hypertension between the HIV group and the non-HIV control group. However, subgroup analysis suggested that among the HIV-infected group, months of exposure to both non-nucleoside reverse transcriptase inhibitors (adjusted hazard ratio, 1.52; 95% confidence interval, 1.3-1.75) and protease inhibitors (adjusted hazard ratio, 1.26; 95% confidence interval, 1.11-1.44) were associated with an increased risk of incident hypertension after adjusting for traditional demographic and metabolic ...

Current infectious disease reports, 2009

The absence of adequate and regular prevention counseling during routine clinical encounters tran... more The absence of adequate and regular prevention counseling during routine clinical encounters translates into missed opportunities for HIV prevention. HIV care providers have considerably more contact with patients than clinicians in other disciplines. These contacts should be translated into opportunities to provide HIV prevention messages to patients and should be a priority for all clinicians caring for HIV-positive patients. Coincidental preventive care for HIV-positive patients is inherently unproductive because of the absence of reinforcing messages. In a recent meta-analysis, HIV-positive individuals who underwent counseling and testing services reduced high-risk behaviors by about 68%. Prevention counseling should focus on positive reinforcement, harm reduction, education, and support. We strongly recommend regular, brief, targeted prevention counseling as a part of every clinical encounter.

Southern medical journal, 2015

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the Un... more The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the United States has shifted to the South, where an increasing proportion is occurring in rural areas. We sought to gain a better understanding of the affected rural population in this region. The statewide HIV/AIDS Electronic Reporting System database was used to examine the epidemiological characteristics of newly diagnosed HIV cases in South Carolina from 2005 to 2011. Rural-urban differences were examined in sociodemographic and clinical characteristics, including progression to AIDS and a decline in HIV viral load (VL) to undetectable levels within 1 year of diagnosis. Of the 5336 individuals newly diagnosed as having HIV, 1433 (26.9%) were from rural areas. Compared with urban residents, a higher proportion of rural residents were black, non-Hispanic (80.1% vs 68.5%; P ≤ 0.0001) and reported heterosexual risk (28.8% vs 22.9%; P = 0.0007). The proportion of female patients was higher in ...

Journal of the South Carolina Medical Association (1975), 2009

Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of pr... more Background-Pap tests are used to detect abnormal cell growth in the cervix. Early detection of precancerous cells increases the likelihood of treatment success. In fact, the Pap test is one of only a few cancer screening procedures that can prevent cancer by virtue of identifying and intervening upon abnormal precancerous cells in the early stages. There has been a growing prevalence of cervical cancer among HIV-positive women. Early diagnosis is essential to improving survival outcomes of women living with HIV/AIDS. The purpose of this study was to describe Pap test behaviors among women in South Carolina and examine its relationship with HIV testing.

Journal of the South Carolina Medical Association (1975), 2010

Background: The HIV/AIDS epidemic in the U.S has shifted to the South where a large portion of th... more Background: The HIV/AIDS epidemic in the U.S has shifted to the South where a large portion of the infected population lives in the rural areas. This epidemiologic characterization adds to the existing literature because it uses a rural urban commuting area (RUCA)-based definition of rural instead of the customary county-based definitions, it is population-based including individuals who are not-in-care and, is updated with individuals diagnosed after the revised CDC 2006 HIV testing guidelines. Methods: The South Carolina (SC) enhanced HIV/AIDS Reporting System (eHARS) and geocoding data were linked to determine rural or urban residence for all HIV-infected individuals newly diagnosed between 1/1/2005 -12/31/2010. SC state law requires reporting of all CD4 cells and HIV viral load (VL) values which are maintained in eHARS. Each individual was assigned a rural or urban status using the RUCA definition of urban areas. Descriptive and bivariate statistics were used to compare socio-de...

Clinical cardiology, 2014

Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immun... more Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immunodeficiency syndrome (AIDS)-related mortality in the aging human immunodeficiency virus (HIV)-infected population. The incidence rate and clinical correlates of CVD in people living with HIV/AIDS compared to the general population warrants further investigation. HIV/AIDS is associated with increased risk CVD compared to general population. CVD events in a matched cohort of HIV-infected and non-HIV-infected adults, ≥18 years old, served through the South Carolina Medicaid program during 1994 to 2011 were examined using time-dependent proportional hazards regression and marginal structural modeling. A retrospective cohort of 13,632 adults was followed longitudinally for an average of 51 months. The adjusted hazard ratio (aHR) of incident CVD events was higher among HIV-infected individuals exposed to combination antiretroviral therapy (cART) (aHR = 1.15) compared to the non-HIV-infected gr...

Journal of the National Medical Association

To describe the prevalence of serious psychological distress among Deep South residents and human... more To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersen's behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60...

The open AIDS journal, 2012

To examine the prevalence of and factors associated with potentially unnecessary repeat confirmat... more To examine the prevalence of and factors associated with potentially unnecessary repeat confirmatory testing after initial HIV diagnosis and the relationship of repeat testing to medical care engagement. South Carolina HIV/AIDS surveillance data for 12,504 individuals who were newly diagnosed with HIV infection between January 1997 and December 2008 were used for this analysis. State law requires that all positive Western blot [WB] results be reported regardless of frequency. HIV-infected persons, diagnosed from 1997-2008 and followed through 2009, with repeat positive WB results were compared to those who did not have repeat positive WB results. We defined repeat positive testing as documentation of one or more positive WB obtained ≥90 days following initial WB confirmatory result. HIV care engagement for the period from 2007-2009 was assessed by documentation of CD4+ T-cell/viral load reports to the South Carolina HIV/AIDS surveillance system during each six-month period of a cale...

Metabolic Syndrome and Related Disorders, 2013

The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective coho... more The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART). The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia. Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect. Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.