Use of Death Certificates to Identify Tuberculosis-Related Deaths in Washington State.

Context: Death certificates are routinely used to estimate tuberculosis (TB) mortality rates. The validity of International Classification of Diseases, Tenth Revision (ICD-10) codes and text cause of death data for this purpose is uncertain.

Objective: To evaluate the accuracy of ICD-10 coded and text cause of death data in identifying TB-related deaths in Washington State.

HIV disclosure and subsequent sexual behaviors among men who have sex with men who meet online.

To assess HIV disclosure discussions and related sexual behaviors among men who have sex with men (MSM) who meet sex partners online, 28 qualitative interviews with Seattle-area MSM were analyzed using grounded theory methods and themes and behavior patterns were identified. MSM found a greater ease in communicating and could prescreen partners through the Internet. However, no consistent relationship was found between HIV disclosure and subsequent behaviors: some were safer based on disclosure while perceived HIV status led others to risky behaviors.

Stochastic models to demonstrate the effect of motivated testing on HIV incidence estimates using the serological testing algorithm for recent HIV seroconversion (STARHS).

Objectives: To produce valid seroincidence estimates, the serological testing algorithm for recent HIV seroconversion (STARHS) assumes independence between infection and testing, which may be absent in clinical data. STARHS estimates are generally greater than cohort-based estimates of incidence from observable person-time and diagnosis dates. The authors constructed a series of partial stochastic models to examine whether testing motivated by suspicion of infection could bias STARHS.

Interpopulation variation in HIV testing promptness may introduce bias in HIV incidence estimates using the serologic testing algorithm for recent HIV seroconversion.

Objectives: The serologic testing algorithm for recent HIV seroconversion (STARHS) calculates incidence using the proportion of testers who produce a level of HIV antibody high enough to be detected by ELISA but low enough to suggest recent infection. The validity of STARHS relies on independence between dates of HIV infection and dates of antibody testing. When subjects choose the time of their own test, testing may be motivated by risky behaviour or symptoms of infection and the criterion may not be met.

Access to regular HIV care and disease progression among black African immigrants.

Objective: To describe the characteristics of human immunodeficiency virus (HIV)-infected black African immigrants living in King County, Washington, we evaluated delay in HIV diagnosis, access to HIV care, and risk of progression to AIDS or death.

Methods: We compared differences in the risk of progression to AIDS or death between HIV-positive African-born black individuals and 2 groups of HIV-positive US-born individuals.

Results: There were significant differences across the groups in residence at time of HIV diagnosis, gender, HIV transmission category, and initial CD4 count.

HIV risk associated with gay bathhouses and sex clubs: findings from 2 seattle surveys of factors related to HIV and sexually transmitted infections.

Objectives: We studied the HIV risk behaviors of patrons of the 3 commercial sex venues for men in Seattle, Washington.

Methods: We conducted cross-sectional, observational surveys in 2004 and 2006 by use of time-venue cluster sampling with probability proportional to size. Surveys were anonymous and self-reported.

Trends in evaluation for sexually transmitted infections among HIV-infected people, King County, Washington.

Objective: To assess clinician sexual risk assessment and sexually transmitted infection (STI) screening rates in a large cohort of human immunodeficiency virus (HIV)-infected patients in King County, Washington.

Methods: We abstracted data from medical records of HIV-infected patients seen in diverse clinical settings during 2000-2003 and used [chi]2 and logistic regression to identify factors associated with higher rates of sexual risk assessment and STI testing. We defined patients as having had a sexual risk or STI assessment if the medical record included any information about the patient's recent sexual behavior or included laboratory test results for gonorrhea, chlamydial infection, syphilis, or trichomoniasis.

Telephone notification of HIV test results: impact in King County, Washington.

Objective: We evaluated if receiving HIV test results over the telephone was associated with a change in the number of persons who received results.

Study Design: Data were collected from individuals testing for HIV from 1995 to 2002 at selected public clinics in King County, WA. Rates of receiving HIV test results were calculated for periods before and after telephone results were offered, for persons who were offered and accepted, offered but declined, and not offered telephone results.

Estimating the distribution of a renewal process from times at which events from an independent process are detected.

The analysis of length-biased data has been mostly limited to the interarrival interval of a renewal process covering a specific time point. Motivated by a surveillance problem, we consider a more general situation where this time point is random and related to a specific event, for example, status change or onset of a disease. We also consider the problem when additional information is available on whether the event intervals (interarrival intervals covering the random event) end within or after a random time period (which we call a window period) following the random event.

Increased access to unrestricted pharmacy sales of syringes in Seattle-King County, Washington: structural and individual-level changes, 1996 versus 2003.

We examined pharmacists' attitudes and practices related to syringe sales to injection drug users before and after legal reform and local programming to enhance sterile syringe access. We replicated a 1996 study by conducting pharmacist phone surveys and syringe test-buys in randomly selected pharmacies. Test-buy success increased from 48% in 1996 to 65% in 2003 (P=.

Epidemiology of MDMA and associated club drugs in the Seattle area.

Club drug use, MDMA in particular, appeared as a growing problem in the Seattle area in the late 1990s. To understand more about the patterns of MDMA use and to evaluate the current state of MDMA use, multiple data sources were examined. The seven data sources utilized included local community-based club drug surveys collected in 2003 at raves, treatment agencies, and gay-oriented bars and sex clubs; school surveys (collected in 2002); mortality data (deaths between 2000 and 2002); data from the sexually transmitted disease clinic (October 2002 to October 2003); focus groups (2003) with men who have sex with men; emergency department drug mentions (1995 to 2002); and drug treatment admissions (1999 to 2003).

A media campaign to promote pneumococcal vaccinations: is a telephone survey an effective evaluation strategy?

Purpose: Media campaigns are used to achieve public health goals but few studies have documented whether the goals were met.

Methods: Two communities received community-wide efforts to increase the pneumococcal polysaccharide vaccine (PPV) rate in defined pneumococcal disease-risk groups. One community also received a media campaign consisting of television and newspaper advertisements.

Choosing HIV Counseling and Testing Strategies for Outreach Settings: A Randomized Trial.

Background: In surveys, clients have expressed preferences for alternatives to traditional HIV counseling and testing. Few data exist to document how offering such alternatives affects acceptance of HIV testing and receipt of test results.

Objectives: This randomized controlled trial compared types of HIV tests and counseling at a needle exchange and 2 bathhouses to determine which types most effectively ensured that clients received test results.

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability.

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results.

Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men.

Objective: To determine strategies to overcome barriers to HIV testing among persons at risk.

Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic.

Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture).