Publications by authors named "Kourtis A"
In September 2022, CDC funded a nationwide program, Together TakeMeHome (TTMH), to expand distribution of HIV self-tests (HIVSTs) directly to consumers by mail through an online ordering portal. To publicize the availability of HIVSTs to priority audiences, particularly those disproportionately affected by HIV, CDC promoted this program through established partnerships and tailored resources from its Let's Stop HIV Together social marketing campaign. The online portal launched March 14, 2023, and through March 13, 2024, distributed 443,813 tests to 219,360 persons.
View Article and Find Full Text PDFChallenges, risks, and opportunities of antiretroviral drugs in women of reproductive potential.
Expert Rev Anti Infect Ther
April 2024
Article Synopsis
- The HIV/AIDS epidemic poses major challenges for women's health, but advancements in antiretroviral therapy have improved their quality of life and reduced risks in reproductive health.
- Despite these improvements, access to and adherence to these treatments remain issues, highlighting the need for more research on the effects of antiretrovirals during pregnancy and breastfeeding.
- Innovative solutions like multipurpose technologies and long-acting medications could help improve treatment adherence and health outcomes for women living with HIV, alongside necessary advancements in drug safety testing.
Article Synopsis
- The study aimed to estimate the number of prevented perinatal HIV transmissions in the US from 1994 to 2020 due to perinatal zidovudine (ZDV) prophylaxis.
- Researchers calculated the difference between expected and observed perinatal HIV transmissions, using data on births to women with HIV and the transmission rate from a clinical trial (22.55%).
- The results showed a significant decline in infants born with HIV, dropping from 1,263 in 1994 to only 36 in 2020, leading to an estimated 22,732 perinatal HIV infections prevented during this period, marking a major public health success.
Importance: Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide.
Objective: The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity.
Evidence Acquisition: A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted.
Background And Objectives: HIV preexposure prophylaxis (PrEP) is safe, effective, and was approved for adolescents in 2018. Adolescents and young adults make up 20% of HIV diagnoses in the United States. Our objective was to describe trends in adolescents prescribed PrEP during 2018 through 2021 and characteristics of these adolescents and their PrEP providers.
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- The study aimed to assess how vaginal microbiota impacts the levels of antiretroviral drugs in women with HIV initiating hormonal contraception.
- Results showed a significant decrease in lamivudine concentrations after starting contraception, particularly in those using the levonorgestrel implant, but no marked change observed in the DMPA group.
- The findings suggest that starting hormonal contraception does not increase the risk of HIV shedding in the genital area, ensuring that ART efficacy remains intact for women using DMPA or levonorgestrel implants, though further investigation into the link between vaginal bacteria and drug concentrations is needed.
Background: A study from Botswana identified an increased risk of neural tube defects (NTDs) in infants of mothers with HIV who were treated with dolutegravir around the time of conception. We aimed to examine associations of dolutegravir use with NTDs and pregnancy loss using large health-care claims databases from the USA, a country with folic acid fortification of food.
Methods: In this cohort study, we analysed health-care claims data, recorded in the Merative MarketScan commercial database (MarketScan data) and Centers for Medicare & Medicaid Services Medicaid database (Medicaid data) from Jan 1, 2008, to Dec 31, 2020.
Pregnancy is a condition of broad interest across many medical and health services research domains, but one not easily identified in healthcare claims data. Our objective was to establish an algorithm to identify pregnant women and their pregnancies in claims data. We identified pregnancy-related diagnosis, procedure, and diagnosis-related group codes, accounting for the transition to International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, in health encounter reporting on 10/1/2015.
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- In 2012, the CDC set goals to eliminate perinatal HIV transmission in the US, aiming for less than one case per 100,000 live births and a transmission rate of under 1%.
- From 2010 to 2019, the number of live births to HIV-positive women and perinatally acquired HIV cases both significantly declined, with diagnosis rates dropping from 1.9 to 0.9 per 100,000 live births.
- Despite progress, racial and ethnic disparities in HIV diagnosis still existed but improved, highlighting the need for ongoing coordinated healthcare efforts to sustain these gains and expand the model to other public health challenges.
We developed an ad hoc method to estimate the number of excess deaths among persons with HIV (PWH) during the coronavirus disease 2019 (COVID-19) pandemic in the United States. Using this method, we estimated approximately 1448 excess deaths from COVID-19 among PWH in 2020 in the United States. We also developed an Excel workbook for use as a tool to quickly assess excess deaths among PWH in settings with limited surveillance data.
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- The study investigates how hormonal contraceptives (specifically depot medroxyprogesterone acetate and levonorgestrel) affect the immune environment and microbiota in the female genital tract, focusing on Malawian women with and without HIV infection.
- Results indicate that these contraceptives had minimal impacts on vaginal immune markers and microbiota composition, and there were no significant long-term changes observed.
- The findings support the ECHO trial's conclusion that progestin-based hormonal contraceptives pose a minimal risk for HIV-positive women, suggesting they can use these options safely.
HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021.
MMWR Morb Mortal Wkly Rep
December 2022
Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.
View Article and Find Full Text PDFPurpose: Mobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents.
Methods: We recruited 1,210 women aged 14-18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app.
To determine whether the 2gether intervention increases use of a dual protection (DP; concurrent prevention of pregnancy and sexually transmitted infections [STIs]) strategy and decreases pregnancy and STIs among young African American females, who disproportionately experience these outcomes. We conducted a randomized clinical trial comparing the 2gether intervention to standard of care (SOC). Participants were self-identified African American females aged 14-19 years who were sexually active with a male partner in the past 6 months.
View Article and Find Full Text PDFSevere Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022.
MMWR Morb Mortal Wkly Rep
November 2022
Article Synopsis
- * A CDC report analyzed 57 hospitalized monkeypox patients from August to October 2022, revealing that 82% had HIV, most were male (95%), and 68% were non-Hispanic Black; 30% needed ICU care, and 21% died due to severe symptoms.
- * Health care providers are advised to test sexually active monkeypox patients for HIV and consider aggressive treatment for those who are severely immunocompromised
Article Synopsis
- Black and Hispanic/Latino men who have sex with men (MSM) are significantly affected by HIV, prompting the creation of the THRIVE project, which provides targeted prevention services in seven community collaboratives.
- Analysis of HIV diagnosis data from 2014 to 2019 showed that those in THRIVE areas experienced greater declines in HIV diagnoses compared to similar areas without THRIVE funding, particularly among Black and Hispanic/Latino MSM.
- The results underline the effectiveness of the THRIVE model, suggesting that to meet the US goal of ending the HIV epidemic, more focus is needed on increasing preexposure prophylaxis (PrEP) among Black and Hispanic/Latino MSM.
Article Synopsis
- The text reviews and compares the latest recommendations from various medical organizations on how to investigate and manage abnormal uterine bleeding (AUB) in women of reproductive age.
- A thorough personal and family medical history, physical examination, and transvaginal ultrasound are emphasized as key steps in diagnosing AUB, while endometrial biopsy is advised only with additional cancer risk factors (except by RANZCOG).
- The consensus among major organizations is that hormonal or non-hormonal medications should be the first treatment option for most AUB cases, with surgical intervention reserved for specific structural issues or when medication fails.*
Black women are disproportionately affected by the U.S. human immunodeficiency virus (HIV) epidemic.
View Article and Find Full Text PDFObjective: To assess disruption in healthcare services for HIV treatment by national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic in the United States.
Design: Time-series analysis.
Methods: We analyzed the IQVIA Real World Data-Longitudinal Prescriptions Database and calculated time trends in the weekly number of persons with active antiretroviral prescriptions for HIV treatment, and of persons who obtained antiretroviral prescriptions during January 2017-March 2021.
HIV-1 vaccine efforts are primarily directed toward eliciting neutralizing antibodies (nAbs). However, vaccine trials and mother-to-child natural history cohort investigations indicate that antibody-dependent cellular cytotoxicity (ADCC), not nAbs, correlate with prevention. The ADCC characteristics associated with lack of HIV-1 acquisition remain unclear.
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- - The study investigated how the COVID-19 pandemic affected HIV pre-exposure prophylaxis (PrEP) prescriptions in the U.S. from March 2020 to March 2021, using data to project expected prescriptions without the pandemic.
- - It found that the pandemic led to a 22% decrease in PrEP prescriptions and a 25% drop in new PrEP users compared to predicted numbers.
- - The impact was particularly significant among younger individuals and those with commercial insurance, emphasizing the need for better access to HIV prevention during public health crises.
Importance: Thyroid disorders represent one of the most frequent complications of pregnancy associated with adverse obstetric, fetal, and neonatal outcomes, especially in case of delayed diagnosis and suboptimal management.
Objective: The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of these common conditions.
Evidence Acquisition: A descriptive review of guidelines from the Endocrine Society, the European Thyroid Association, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American Thyroid Association, and the American College of Obstetricians and Gynecologists on thyroid disease in pregnancy was carried out.
Background: Globally, women have higher herpes simplex virus type 2 (HSV-2) prevalence than men; data from observational studies suggest a possible association of HSV-2 acquisition with use of intramuscular depot medroxyprogesterone acetate (DMPA-IM).
Methods: Within a randomized trial of the effect of 3 contraceptive methods-DMPA-IM, a copper intrauterine device (IUD), and a levonorgestrel (LNG) implant-on human immunodeficiency virus (HIV) acquisition, we assessed HSV-2 acquisition. HSV-2 and HIV seronegative women, aged 16-35 years, and seeking effective contraception were followed for 12-18 months at 12 sites in Eswatini, Kenya, South Africa, and Zambia from 2015 to 2018.