Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal : a retrospective cohort study

Objectives: Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal. Design: We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres. Setting: All 11 ART centres in the FWR of Nepal. Participants: All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres. Primary outcome measures: IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated. Result: Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation. Conclusions: In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap

Impact of age and race on outcomes of a program to prevent excess weight gain and disordered eating in adolescent girls

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents

Benchmark of a modified Iterated Perturbation Theory approach on the 3d FCC lattice at strong coupling

The Dynamical Mean-Field theory (DMFT) approach to the Hubbard model requires a method to solve the problem of a quantum impurity in a bath of non-interacting electrons. Iterated Perturbation Theory (IPT) has proven its effectiveness as a solver in many cases of interest. Based on general principles and on comparisons with an essentially exact Continuous-Time Quantum Monte Carlo (CTQMC) solver, here we show that the standard implementation of IPT fails away from half-filling when the interaction strength is much larger than the bandwidth. We propose a slight modification to the IPT algorithm that replaces one of the equations by the requirement that double occupancy calculated with IPT gives the correct value. We call this method IPT-$D$. We recover the Fermi liquid ground state away from half-filling. The Fermi liquid parameters, density of states, chemical potential, energy and specific heat on the FCC lattice are calculated with both IPT-$D$ and CTQMC as benchmark examples. We also calculated the resistivity and the optical conductivity within IPT-$D$. Particle-hole asymmetry persists even at coupling twice the bandwidth. Several algorithms that speed up the calculations are described in appendices.Comment: 17 pages, 15 figures, minor changes to improve clarit

A Randomized Depression Prevention Trial Comparing Interpersonal Psychotherapy—Adolescent Skills Training To Group Counseling In Schools

Given the rise in depression disorders in adolescence, it is important to develop and study depression prevention programs for this age group. The current study examined the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a group prevention program for adolescent depression, in comparison to group programs that are typically delivered in school settings. In this indicated prevention trial, 186 adolescents with elevated depression symptoms were randomized to receive IPT-AST delivered by research staff or group counseling (GC) delivered by school counselors. Hierarchical linear modeling examined differences in rates of change in depressive symptoms and overall functioning from baseline to the 6-month follow-up assessment. Cox regression compared rates of depression diagnoses. Adolescents in IPT-AST showed significantly greater improvements in self-reported depressive symptoms and evaluator-rated overall functioning than GC adolescents from baseline to the 6-month follow-up. However, there were no significant differences between the two conditions in onset of depression diagnoses. Although both intervention conditions demonstrated significant improvements in depressive symptoms and overall functioning, results indicate that IPT-AST has modest benefits over groups run by school counselors which were matched on frequency and duration of sessions. In particular, IPT-AST outperformed GC in reduction of depressive symptoms and improvements in overall functioning. These findings point to the clinical utility of this depression prevention program, at least in the short-term. Additional follow-up is needed to determine the long-term effects of IPT-AST, relative to GC, particularly in preventing depression onset

"Exhaustion" Physics in the Periodic Anderson Model using Iterated Perturbation Theory

We discuss the "exhaustion" problem in the context of the Periodic Anderson Model using Iterated Perturbation Theory(IPT) within the Dynamical Mean Field Theory. We find that, despite its limitations, IPT captures the exhaustion physics, which manifests itself as a dramatic, strongly energy dependent suppression of the effective Anderson impurity problem. As a consequence, low energy scales in the lattice case are strongly suppressed compared to the "Kondo scale" in the single-impurity picture. The IPT results are in qualitative agreement with recent Quantum Monte Carlo results for the same problem.Comment: 13 preprint pages including 1 table and 4 eps figures, replaced by revised version, accepted for publication in Europhysics Letters, added references and conten

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

Inference without randomization or ignorability: A stability­ controlled quasi-experiment on the prevention of tuberculosis

When determining the effectiveness of a new treatment, randomized trials are not always possible or desirable. The stability-controlled quasi-experiment (SCQE) (Hazlett, 2019) is an observational approach that replaces the usual “no-unobserved confounding” assumption with one on the change in non-treatment outcome between successive cohorts, or the “baseline trend.” We extend this method to allow variance estimation and inference, and apply it for the first time by examining whether isoniazid preventive therapy (IPT) reduced tuberculosis (TB) incidence among 26,715 HIV patients in Tanzania. After IPT became available in the clinics we studied, a non-random 25% of patients received it. Within a year, fewer than 1% of patients on IPT developed TB, compared to 16% of the untreated. Regression adjustment using available covari-ates produces an equally large and highly significant estimate of -15 percentage point (pp) [95%CI: -16.6, -13.7]. While those estimates may generate confidence in IPT’s effectiveness, they cannot eliminate confounding. By contrast, SCQE reveals that the average treatment effect on the treated must be small and indistinguishable from zero, if we assume the baseline trend was flat over the study period. Rather, to argue that IPT was beneficial requires claiming that the (non-treatment) incidence rate rose by at least 0.5 pp per year. This is plausible, but far from certain. The SCQE approach has broad applicability and will sometimes lead to definitive claims of effectiveness. In this case, it usefully aids in protecting against over-confidence in claims that IPT was effective

A Comparison of PTSD, AUD, and MDD Symptom Patterns in Different Trauma Types

A Comparison of PTSD, AUD, and MDD Symptom Patterns in Different Trauma Types Elizabeth Crump, Depts. of Biology and Sociology, with Dr. Kaitlin Bountress, Virginia Institute of Psychiatric and Behavioral Genetics About 66% of college students have been exposed to a traumatic event (Read et al., 2011). Research thus far suggests that interpersonal trauma (IPT; e.g., physical or sexual abuse or assault) is linked to higher risk of developing posttraumatic stress disorder (PTSD), variability in PTSD symptom cluster presentation, and comorbidities with substance use compared to accidental trauma (e.g., natural disaster, motor vehicle accident; Kessler et al. 1995; Kelley et al., 2009; Kilpatrick et al. 2000). There is little research investigating the role of trauma type in the expression of symptoms related to PTSD (both overall severity and symptom cluster presentation), Alcohol Use Disorder (AUD), and Major Depression (MD) in a representative college population. The first aim of this study was to investigate the relation between trauma type (interpersonal and accidental trauma) and PTSD, AUD, and MD symptoms as well as PTSD symptom cluster presentation (avoidance, arousal, negative thoughts and emotions, and reexperiencing). We also sought to test in an exploratory manner whether there was an association between these symptoms and increased trauma type count (i.e., experiencing both IPT and accidental trauma). Results found that those with IPT exposure experienced the highest rate of all symptom outcomes (excluding MD symptoms and PTSD reexperiencing) and had significantly greater symptom severity as compared to the group with both IPT and accidental exposure. The findings suggest that greater intervention measures should be focused on those who experience IPT trauma due to the greater vulnerability to PTSD, Alcohol Use, and Depressive symptoms.https://scholarscompass.vcu.edu/uresposters/1307/thumbnail.jp