Psychosocial Characteristics of Patients in a Family-Centered HIV Care and Treatment Program in Kinshasa, DRC

Introduction. In resource-limited settings where HIV disproportionately affects women, there is a need for family-centered HIV care that includes the provision of psychosocial support services. This dissertation drew on baseline interviews with HIV-positive adults who were either caregivers or first-line relatives of HIV-infected children enrolled in a family-centered HIV care and treatment program in Kinshasa, Democratic Republic of Congo (DRC). This study explored the relationships among social support, perceived stigma, and quality of life (QOL) in the adult patients. I also examined associations among caregiver education, disease stage upon enrollment, and program attrition among the pediatric patients. Finally, I considered measurement issues in adapting scales developed elsewhere to the context in DRC. Methods. Data were obtained from baseline interviews with 275 HIV-positive adults and from 780 children enrolled in a family-centered HIV care and treatment program. Results. The adult sample was 84% female and largely mothers. There was a positive association between social support and psychological status, one of six domains in the World Health Organization HIV Quality of Life measure, and a negative association between perceived stigma and psychological status. Perceived stigma moderated the relationship between social support and psychological status but did not moderate the relationship between social support and overall QOL. There was a negative association between caregiver education and pediatric HIV clinical stage at enrollment. However, children of caregivers with less education were not more likely to be deactivated from the study than children of caregivers with more education. Conclusions. Enhancing social support may be particularly important for those reporting high stigma in improving psychological status, one of six QOL domains. Though a negative association was observed between caregiver education and pediatric HIV clinical stage at enrollment, children of caregivers with less education were not more likely to be deactivated from the study than children of caregivers with more education. This may have been due, in part, to the psychosocial support services provided to patients and their caregivers. Program recommendations include examining factors associated with delayed enrollment and documenting which patients receive support services so that dose-response relationships can be considered when assessing program attrition

The why, when, and how of computing in biology classrooms [version 1; peer review: 2 approved]

Many biologists are interested in teaching computing skills or using computing in the classroom, despite not being formally trained in these skills themselves. Thus biologists may find themselves researching how to teach these skills, and therefore many individuals are individually attempting to discover resources and methods to do so. Recent years have seen an expansion of new technologies to assist in delivering course content interactively. Educational research provides insights into how learners absorb and process information during interactive learning. In this review, we discuss the value of teaching foundational computing skills to biologists, and strategies and tools to do so. Additionally, we review the literature on teaching practices to support the development of these skills. We pay special attention to meeting the needs of diverse learners, and consider how different ways of delivering course content can be leveraged to provide a more inclusive classroom experience. Our goal is to enable biologists to teach computational skills and use computing in the classroom successfully

Population Impact & Efficiency of Benefit‐Targeted Versus Risk‐Targeted Statin Prescribing for Primary Prevention of Cardiovascular Disease

BACKGROUND: Benefit-targeted statin prescribing may be superior to risk-targeted statin prescribing (the current standard), but the impact and efficiency of this approach are unclear. METHODS AND RESULTS: We analyzed the National Health and Nutrition Examination Survey (NHANES) using an open-source model (the Prevention Impact and Efficiency Model) to compare targeting of statin therapy according to expected benefit (benefit-targeted) versus baseline risk (risk-targeted) in terms of projected population-level impact and efficiency. Impact was defined as relative % reduction in atherosclerotic cardiovascular disease in the US population for the given strategy compared to current statin treatment patterns; and efficiency as the number needed to treat over 10 years (NNT10, average and maximum) to prevent each atherosclerotic cardiovascular disease event. Benefit-targeted moderate-intensity statin therapy at a treatment threshold of 2.3% expected 10-year absolute risk reduction could produce a 5.7% impact (95% confidence interval, 4.8-6.7). This is approximately equivalent to the potential impact of risk-targeted therapy at a treatment threshold of 5% 10-year atherosclerotic cardiovascular disease risk (5.6% impact [4.7-6.6]). Whereas the estimated maximum NNT10 is much improved for benefit-targeted versus risk-targeted therapy at these equivalent-impact thresholds (43.5 vs 180), the average NNT10 is nearly equivalent (24.2 vs 24.6). Reaching 10% impact (half the Healthy People 2020 impact objective, loosely defined) is theoretically possible with benefit-targeted moderate-intensity statins of persons with expected absolute risk reduction >2.3% if we expand age eligibility and account for treatment of all persons with diabetes mellitus or with low-density lipoprotein >190 mg/dL (impact=12.4%; average NNT10=23.0). CONCLUSIONS: Benefit-based targeting of statin therapy provides modest gains in efficiency over risk-based prescribing and could theoretically help attain approximately half of the Healthy People 2020 impact goal with reasonable efficiency

Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

BACKGROUND: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. METHODS: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. RESULTS: In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor-based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. CONCLUSIONS: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years

Factors influencing referrals for ultrasound-diagnosed complications during prenatal care in five low and middle income countries

BACKGROUND: Ultrasound during antenatal care (ANC) is proposed as a strategy for increasing hospital deliveries for complicated pregnancies and improving maternal, fetal, and neonatal outcomes. The First Look study was a cluster-randomized trial conducted in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan and Zambia to evaluate the impact of ANC-ultrasound on these outcomes. An additional survey was conducted to identify factors influencing women with complicated pregnancies to attend referrals for additional care. METHODS: Women who received referral due to ANC ultrasound findings participated in structured interviews to characterize their experiences. Cochran-Mantel-Haenszel statistics were used to examine differences between women who attended the referral and women who did not. Sonographers\u27 exam findings were compared to referred women\u27s recall. RESULTS: Among 700 referred women, 510 (71%) attended the referral. Among referred women, 97% received a referral card to present at the hospital, 91% were told where to go in the hospital, and 64% were told that the hospital was expecting them. The referred women who were told who to see at the hospital (88% vs 66%), where to go (94% vs 82%), or what should happen, were more likely to attend their referral (68% vs 56%). Barriers to attending referrals were cost, transportation, and distance. Barriers after reaching the hospital were substantial. These included not connecting with an appropriate provider, not knowing where to go, and being told to return later. These barriers at the hospital often led to an unsuccessful referral. CONCLUSIONS: Our study found that ultrasound screening at ANC alone does not adequately address barriers to referrals. Better communication between the sonographer and the patient increases the likelihood of a completed referral. These types of communication include describing the ultrasound findings, including the reason for the referral, to the mother and staff; providing a referral card; describing where to go in the hospital; and explaining the procedures at the hospital. Thus, there are three levels of communication that need to be addressed to increase completion of appropriate referrals-communication between the sonographer and the woman, the sonographer and the clinic staff, and the sonographer and the hospital

Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

Background: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings: At a set ''status classification'' date, patients were categorized as either ''active'' or ''LTFU'' according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities - representing 180,718 patients from 19 countries - were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173–181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%–7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%–1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%–21.7%). Conclusions: Based on this evaluation, we recommend the adoption of $180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide

The DESI One-Percent Survey: Evidence for Assembly Bias from Low-Redshift Counts-in-Cylinders Measurements

We explore the galaxy-halo connection information that is available in low-redshift samples from the early data release of the Dark Energy Spectroscopic Instrument (DESI). We model the halo occupation distribution (HOD) from z=0.1-0.3 using Survey Validation 3 (SV3; a.k.a., the One-Percent Survey) data of the DESI Bright Galaxy Survey (BGS). In addition to more commonly used metrics, we incorporate counts-in-cylinders (CiC) measurements, which drastically tighten HOD constraints. Our analysis is aided by the Python package, galtab, which enables the rapid, precise prediction of CiC for any HOD model available in halotools. This methodology allows our Markov chains to converge with much fewer trial points, and enables even more drastic speedups due to its GPU portability. Our HOD fits constrain characteristic halo masses tightly and provide statistical evidence for assembly bias, especially at lower luminosity thresholds: the HOD of central galaxies in $z\sim0.15$ samples with limiting absolute magnitude $M_r < -20.0$ and $M_r < -20.5$ samples is positively correlated with halo concentration with a significance of 99.9% and 99.5%, respectively. Our models also favor positive central assembly bias for the brighter $M_r < -21.0$ sample at $z\sim0.25$ (94.8% significance), but there is no significant evidence for assembly bias with the same luminosity threshold at $z\sim0.15$. We provide our constraints for each threshold sample's characteristic halo masses, assembly bias, and other HOD parameters. These constraints are expected to be significantly tightened with future DESI data, which will span an area 100 times larger than that of SV3

The DESI One-percent Survey: Evidence for Assembly Bias from Low-redshift Counts-in-cylinders Measurements

We explore the galaxy-halo connection information that is available in low-redshift samples from the early data release of the Dark Energy Spectroscopic Instrument (DESI). We model the halo occupation distribution (HOD) from z = 0.1 to 0.3 using Survey Validation 3 (SV3; a.k.a., the One-Percent Survey) data of the DESI Bright Galaxy Survey. In addition to more commonly used metrics, we incorporate counts-in-cylinders (CiC) measurements, which drastically tighten HOD constraints. Our analysis is aided by the Python package, galtab, which enables the rapid, precise prediction of CiC for any HOD model available in halotools. This methodology allows our Markov chains to converge with much fewer trial points, and enables even more drastic speedups due to its GPU portability. Our HOD fits constrain characteristic halo masses tightly and provide statistical evidence for assembly bias, especially at lower luminosity thresholds: the HOD of central galaxies in z ∼ 0.15 samples with limiting absolute magnitude M r < −20.0 and M r < −20.5 samples is positively correlated with halo concentration with a significance of 99.9% and 99.5%, respectively. Our models also favor positive central assembly bias for the brighter M r < −21.0 sample at z ∼ 0.25 (94.8% significance), but there is no significant evidence for assembly bias with the same luminosity threshold at z ∼ 0.15. We provide our constraints for each threshold sample’s characteristic halo masses, assembly bias, and other HOD parameters. These constraints are expected to be significantly tightened with future DESI data, which will span an area 100 times larger than that of SV3