Enhancing engagement in HIV care among adolescents and young adults: A focus on phone-based navigation and relationship building to address barriers in HIV care.

Structural, psychological, and clinical barriers to HIV care engagement among adolescents and young adults living with HIV (AYAH) persist globally despite gains in HIV epidemic control. Phone-based peer navigation may provide critical peer support, increase delivery flexibility, and require fewer resources. Prior studies show that phone-based navigation and automated text messaging interventions improve HIV care engagement, adherence, and retention among AYAH.

Experiences and perceptions of conditional cash incentive provision and cessation among people with HIV for care engagement: A qualitative study.

Background: Consistent engagement in HIV treatment is needed for healthy outcomes, yet substantial loss-to-follow up persists, leading to increased morbidity, mortality and onward transmission risk. Although conditional cash transfers (CCTs) address structural barriers, recent findings suggest that incentive effects are time-limited, with cessation resulting in HIV care engagement deterioration. We explored incentive experiences, perceptions, and effects after cessation to investigate potential mechanisms of this observation.

Adaptive Strategies for Retention in Care among Persons Living with HIV.

Background: Optimizing retention in human immunodeficiency virus (HIV) treatment may require sequential behavioral interventions based on patients' response.

Methods: In a sequential multiple assignment randomized trial in Kenya, we randomly assigned adults initiating HIV treatment to standard of care (SOC), Short Message Service (SMS) messages, or conditional cash transfers (CCT). Those with retention lapse (missed a clinic visit by ≥14 days) were randomly assigned again to standard-of-care outreach (SOC-Outreach), SMS+CCT, or peer navigation.

Urban biodiversity: Cuterebriasis in free-ranging Robinson's mouse opossum () in the suburbs of Barranquilla, Colombia.

The tropical dry forest is one of the world's most threatened ecosystems and is the habitat of the Robinson's Mouse Opossum (), a small marsupial within the Didelphidae family. This study aimed to describe cases of cuterebriases in free-ranging by examining individuals caught in live animal traps. Sherman traps were deployed in four different sites over three different periods in five days.

Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya.

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms.

AI Estimation of Gestational Age from Blind Ultrasound Sweeps in Low-Resource Settings.

Background: Ultrasound is indispensable to gestational age estimation and thus to quality obstetrical care, yet high equipment cost and the need for trained sonographers limit its use in low-resource settings.

Methods: From September 2018 through June 2021, we recruited 4695 pregnant volunteers in North Carolina and Zambia and obtained blind ultrasound sweeps (cineloop videos) of the gravid abdomen alongside standard fetal biometry. We trained a neural network to estimate gestational age from the sweeps and, in three test data sets, assessed the performance of the artificial intelligence (AI) model and biometry against previously established gestational age.

Adapt for Adolescents: Protocol for a sequential multiple assignment randomized trial to improve retention and viral suppression among adolescents and young adults living with HIV in Kenya.

Background: Adolescents and young adults living with HIV (AYAH) aged 14-24 years in Africa experience substantially higher rates of virological failure and HIV-related mortality than adults. We propose to utilize developmentally appropriate interventions with high potential for effectiveness, tailored by AYAH pre-implementation, in a sequential multiple assignment randomized trial (SMART) aimed at improving viral suppression for AYAH in Kenya.

Methods: Using a SMART design, we will randomize 880 AYAH in Kisumu, Kenya to either youth-centered education and counseling (standard of care) or electronic peer navigation in which a peer provides support, information, and counseling via phone and automated monthly text messages.

Efficient and robust approaches for analysis of sequential multiple assignment randomized trials: Illustration using the ADAPT-R trial.

Personalized intervention strategies, in particular those that modify treatment based on a participant's own response, are a core component of precision medicine approaches. Sequential multiple assignment randomized trials (SMARTs) are growing in popularity and are specifically designed to facilitate the evaluation of sequential adaptive strategies, in particular those embedded within the SMART. Advances in efficient estimation approaches that are able to incorporate machine learning while retaining valid inference can allow for more precise estimates of the effectiveness of these embedded regimes.

The optimal dynamic treatment rule superlearner: considerations, performance, and application to criminal justice interventions.

The optimal dynamic treatment rule (ODTR) framework offers an approach for understanding which kinds of patients respond best to specific treatments - in other words, treatment effect heterogeneity. Recently, there has been a proliferation of methods for estimating the ODTR. One such method is an extension of the SuperLearner algorithm - an ensemble method to optimally combine candidate algorithms extensively used in prediction problems - to ODTRs.

Estimators for the value of the optimal dynamic treatment rule with application to criminal justice interventions.

Given an (optimal) dynamic treatment rule, it may be of interest to evaluate that rule - that is, to ask the causal question: what is the expected outcome had every subject received treatment according to that rule? In this paper, we study the performance of estimators that approximate the true value of: (1) an known dynamic treatment rule (2) the true, unknown optimal dynamic treatment rule (ODTR); (3) an estimated ODTR, a so-called "data-adaptive parameter," whose true value depends on the sample. Using simulations of point-treatment data, we specifically investigate: (1) the impact of increasingly data-adaptive estimation of nuisance parameters and/or of the ODTR on performance; (2) the potential for improved efficiency and bias reduction through the use of semiparametric efficient estimators; and, (3) the importance of sample splitting based on the cross-validated targeted maximum likelihood estimator (CV-TMLE) for accurate inference. In the simulations considered, there was very little cost and many benefits to using CV-TMLE to estimate the value of the true and estimated ODTR; importantly, and in contrast to non cross-validated estimators, the performance of CV-TMLE was maintained even when highly data-adaptive algorithms were used to estimate both nuisance parameters and the ODTR.

Using Positive Emotion Training With Maltreated Youths to Reduce Anger Bias and Physical Aggression.

Maltreated youths often overinterpret anger in others' emotional expressions, particularly expressions that are ambiguous, and this "anger bias" is associated with aggressive behavior. In the current experiment, we tested the effect of an emotion-training intervention on anger bias and subsequent aggression. Eighty-four youths, ages 8 to 17, who had been removed from home because of maltreatment and had screened positive for aggressive tendencies, served as participants.

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

Objective: Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation.

Methods: A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies.

Prenatal buprenorphine exposure and neonatal neurobehavioral functioning.

Aims: Assessments of effects of prenatal opioid exposure on the neonate have consisted principally of evaluations of neonatal abstinence syndrome (NAS) to determine the need for pharmacotherapy. The purpose of this study was to comprehensively evaluate the effects of gestational maternal buprenorphine maintenance on newborn neurobehavioral functioning.

Study Design: Maternal substance use history and psychosocial demographics that can contribute to the neurobehavioral functioning of the infant were explored.

Comparing Public Safety Outcomes for Traditional Probation vs Specialty Mental Health Probation.

Importance: Probation is a cornerstone of efforts to reduce mass incarceration. Although it is understudied, specialty probation could improve outcomes for the overrepresented group of people with mental illness.

Objective: To test whether specialty probation yields better public safety outcomes than traditional probation.