Confronting Ebola as a Sexually Transmitted Infection

The unprecedented Ebola outbreak that devastated West Africa evolved within months from a regional outbreak to a global public health emergency. While the rate of confirmed cases declined dramatically, sporadic clusters of Ebola virus disease (EVD) continue well beyond the double incubation period of 42 days used to declare a nation Ebola-free. At the same time, evidence that the virus persists in genital fluids and can be sexually transmitted, along with the potential for lingering virus in other body compartments to permit recrudescence of EVD, has shaken our thinking of what it takes to achieve lasting control of an Ebola epidemic. A comprehensive response to the threat of persistence and sexual transmission of Ebola is required and should build on accessible longitudinal medical care of survivors and accurate genital fluid testing for Ebola. Control of this and future Ebola outbreaks will depend on our ability to recognize and respond to this persistence of the virus in those who survive

Estimating HIV Medication Adherence and Persistence: Two Instruments for Clinical and Research Use

Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence

Outpatient Treatment of SARS-CoV-2 Infection to Prevent COVID-19 Progression

As of March 2021, COVID-19 has caused more than 123 million infections, and almost 3 million deaths worldwide. Dramatic advances have been made in vaccine development and non-pharmaceutical interventions to stop the spread of infection. But treatments to stop the progression of disease are limited. A wide variety of "repurposed" drugs explored for treatment of COVID-19 have had little or no benefit. More recently, intravenous monoclonal antibody (mAb) combinations have been authorized by the US FDA for emergency use (EUA) for outpatients with mild to moderate COVID-19 including some active against emerging SARS-COV-2 variants of concern (VOC). Easier to administer therapeutics including intramuscular and subcutaneous mAbs and oral antivirals are in clinical trials. Reliable, safe, effective COVID-19 treatment for early infection in the outpatient setting is of urgent and critical importance. Availability of such treatment should lead to reduced progression of COVID-19

Antiretroviral Therapy

In this article, the scientific evidence and professional guidelines regarding the timing of antiretroviral therapy initiation are reviewed, with discussion of the increasingly persuasive evidence in favor of starting treatment early in the course of human immunodeficiency virus disease

All-Cause and Cause-Specific Mortality Among Black and White North Carolina State Prisoners, 1995–2005

We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare need

Structural or Dispositional? An Experimental Investigation of the Experience of Winning in Social Casino Games (and Impulsivity) on Subsequent Gambling Behaviors

Background and aims: In the present research, we experimentally investigated whether the experience of winning (i.e., inflated payout rates) in a social casino game influenced social casino gamers’ subsequent decision to gamble for money. Furthermore, we assessed whether facets of dispositional impulsivity – negative and positive urgency in particular – also influenced participants’ subsequent gambling. Methods: Social casino gamers who were also current gamblers (N = 318) were asked to play a social casino game to assess their perceptions of the game in exchange for $3. Unbeknownst to them, players were randomly assigned to one of three experimental conditions: winning (n = 110), break-even (n = 103), or losing (n = 105). After playing, participants were offered a chance to gamble their$3 renumeration in an online roulette game. Results: A total of 280 participants (88.1%) elected to gamble, but no between-condition variation in the decision to gamble emerged. Furthermore, there were no differences in gambling on the online roulette between condition. However, higher levels of both negative and positive urgency increased the likelihood of gambling. Finally, impulsivity did not moderate the relationship between experience of winning and decision to gamble. Conclusion: The results suggest that dispositional factors, including impulsive urgency, are implicated in the choice to gamble for social casino gamers following play

Disease Prevalence and Use of Health Care among a National Sample of Black and White Male State Prisoners

U.S. prisons have a court-affirmed mandate to provide health care to prisoners. Given this mandate, we sought to determine whether use of prison health care was equitable across race using a nationally-representative sample of Black and White male state prisoners. We first examined the prevalence of health conditions by race. Then, across all health conditions and for each of 15 conditions, we compared the proportion of Black and White male prisoners with the condition who received health care. For most conditions including cancer, heart disease, and liver-related disorders, the age-adjusted prevalence of disease among Blacks was lower than among Whites (

Opt-Out HIV Testing of Inmates in North Carolina Prisons: Factors Associated with not Wanting a Test and not Knowing They Were Tested

Opt-out HIV testing is recommended for correctional settings but may occur without inmates’ knowledge or against their wishes. Through surveying inmates receiving opt-out testing in a large prison system, we estimated the proportion unaware of being tested or not wanting a test, and associations (prevalence ratios [PRs]) with inmate characteristics. Of 871 tested, 11.8% were unknowingly tested and 10.8% had unwanted tests. Not attending an educational HIV course (PR=2.34, 95% CI 1.47–3.74), lower HIV knowledge (PR=0.95, 95% CI 0.91–0.98), and thinking testing is not mandatory (PR=9.84, 95% CI 4.93–19.67) were associated with unawareness of testing. No prior incarcerations (PR=1.59, 95% CI 1.03–2.46) and not using crack/cocaine recently (PR=2.37, 95% CI 1.21–4.64) were associated with unwanted testing. Residence at specific facilities was associated with both outcomes. Increased assessment of inmate understanding and enhanced implementation are needed to ensure inmates receive full benefits of opt-out testing: being informed and tested according to their wishes

Borderline Personality Disorder Symptom Severity and Sexually Transmitted Infection and HIV Risk in African American Incarcerated Men

Sexually transmitted infections (STI)/HIV rates are disproportionately high among men involved in the criminal justice system. Mental health disorders, including personality disorders, are also elevated among inmates. Borderline personality disorder (BPD) may be an important risk factor for STI/HIV, yet remains relatively understudied, particularly among inmates

Efforts at the Frontlines: Implementing a Hepatitis C Testing and Linkage-to-Care Program at the Local Public Health Level

The national Viral Hepatitis Action Plan recommends strengthening partnerships among health departments, community-based organizations, and health-care providers for hepatitis services. We implemented a hepatitis C virus (HCV) testing and linkage-to-care program through a local health department using similar strategies reported for HIV care