Publications by authors named "Rebecca Hershow"

HIV testing decreased during the COVID-19 pandemic among persons who inject drugs (PWID), though it is unclear how these changes in HIV testing affected different sub-groups of PWID. We estimated the change in past-year HIV testing between 2018 and 2022 overall and by sociodemographic and health care characteristics among PWID. Past-year HIV testing significantly decreased between 2018 and 2022 overall and across most sub-groups of PWID, including PWID accessing and not accessing medical and harm reduction services.

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Background: Medications for opioid use disorder (MOUD) are key to preventing opioid overdose. Despite the high risk of opioid overdose among recently incarcerated people who use drugs, missed opportunities for engagement in MOUD treatment persist in this population. We examined the association between unmet need for MOUD and non-fatal opioid overdose among recently incarcerated people who inject drugs (PWID) and assessed prevalence of non-fatal opioid overdose by selected characteristics.

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Article Synopsis
  • Community concerns about syringe waste hindered the implementation of syringe services programs (SSPs) in Kanawha County, West Virginia, especially during an HIV outbreak among people who inject drugs (PWID).
  • A qualitative analysis involving interviews with 26 PWID and 45 community partners revealed mixed opinions on syringe waste, where some believed SSPs did not contribute to waste, while others argued they increased it.
  • The differing perceptions among community partners, including medical professionals and law enforcement, created challenges in discussing and supporting SSPs, highlighting the need for improved syringe disposal methods and community engagement to reduce stigma and address waste concerns.
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Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection.

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In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework.

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Article Synopsis
  • - Hispanic/Latino individuals, especially men who have sex with men (HLMSM), are experiencing a significant rise in HIV diagnoses in Georgia, particularly in metropolitan Atlanta, where rapid transmission clusters have been identified.
  • - A study with service providers and HLMSM explored barriers to accessing HIV services, revealing themes such as language access issues, social and structural barriers, intersectional stigma, and the need for tailored care approaches due to the community's diversity.
  • - Collecting qualitative data during an HIV cluster investigation highlights the challenges faced by HLMSM in accessing care, suggesting that targeted program evaluations and research can help reduce health disparities and improve service access for this population.
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  • The study estimated the COVID-19 impact in adult correctional facilities and nearby counties across 46 U.S. states, focusing on data from January 2020 to July 2021.
  • COVID-19 incidence rates were found to be higher in correctional facilities compared to their associated counties in 42 out of 46 states, indicating a significant burden in these environments.
  • The findings emphasize the urgent need for effective COVID-19 mitigation measures within correctional settings to curb the spread of the virus both inside the facilities and in surrounding communities.
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During February 2021-June 2022, the Georgia Department of Public Health (GDPH) detected five clusters of rapid HIV transmission concentrated among Hispanic or Latino (Hispanic) gay, bisexual, and other men who have sex with men (MSM) in metropolitan Atlanta. The clusters were detected through routine analysis of HIV-1 nucleotide sequence data obtained through public health surveillance (1,2). Beginning in spring 2021, GDPH partnered with health districts with jurisdiction in four metropolitan Atlanta counties (Cobb, DeKalb, Fulton, and Gwinnett) and CDC to investigate factors contributing to HIV spread, epidemiologic characteristics, and transmission patterns.

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  • - In October 2019, the West Virginia Bureau for Public Health reported a rise in HIV diagnoses among people who inject drugs (PWID) in Kanawha County, increasing from less than five cases annually in 2016-2018 to 11 cases within the first ten months of 2019.
  • - Kanawha County, with around 180,000 residents, faces significant challenges with opioid use disorder and related overdose deaths, and is located near Cabell County, which had a significant HIV outbreak in 2018-2019.
  • - In response to the spike in HIV cases, WVBPH issued a Health Advisory, formed an HIV task force with the Kanawha-Charleston Health Department
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  • Serologic assays for SARS-CoV-2 detect various antibody subtypes and utilize different target antigens.* -
  • A comparison between the Spike-Protein ELISA and the Abbott ArchitectTM SARS-CoV-2 IgG assay showed they performed similarly.* -
  • The tests had high concordance, meaning they generally agreed with each other, but there were a few rare instances of differing results.*
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During December 3, 2020-January 31, 2021, CDC, in collaboration with the University of Utah Health and Economic Recovery Outreach Project,* Utah Department of Health (UDOH), Salt Lake County Health Department, and one Salt Lake county school district, offered free, in-school, real-time reverse transcription-polymerase chain reaction (RT-PCR) saliva testing as part of a transmission investigation of SARS-CoV-2, the virus that causes COVID-19, in elementary school settings. School contacts of persons with laboratory-confirmed SARS-CoV-2 infection, including close contacts, were eligible to participate (1). Investigators approached parents or guardians of student contacts by telephone, and during January, using school phone lines to offer in-school specimen collection; the testing procedures were explained in the preferred language of the parent or guardian.

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SARS-CoV-2, the virus that causes COVID-19, can spread rapidly in prisons and can be introduced by staff members and newly transferred incarcerated persons (1,2). On September 28, 2020, the Wisconsin Department of Health Services (DHS) contacted CDC to report a COVID-19 outbreak in a state prison (prison A). During October 6-20, a CDC team investigated the outbreak, which began with 12 cases detected from specimens collected during August 17-24 from incarcerated persons housed within the same unit, 10 of whom were transferred together on August 13 and under quarantine following prison intake procedures (intake quarantine).

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Background And Aims: Evidence suggests that alcohol reduction interventions decrease intimate partner violence (IPV) perpetration, although this remains untested in low- and middle-income countries and among men with human immunodeficiency virus (HIV). This study evaluates the effectiveness of alcohol reduction counseling interventions on IPV perpetration among men on anti-retroviral therapy (ART) and tests whether alcohol use explains the intervention effects.

Design: Secondary analysis of data from a three-arm randomized controlled trial among ART patients with hazardous alcohol use.

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  • * A CDC study conducted in 20 elementary schools in Salt Lake County found that, despite significant community COVID-19 cases, the transmission rate in schools was low, with only 0.7% of susceptible school contacts testing positive for the virus.
  • * High mask usage (86%) and a minimum 3-foot distance between students contributed to the low transmission rates, suggesting that safe in-person learning is possible when effective prevention measures are in place.
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Achieving the 95-95-95 UNAIDS targets requires meeting the needs of adolescents, however we lack evidenced-based approaches to improving adolescent adherence to antiretroviral therapy (ART), increasing viral suppression, and supporting general wellbeing. We developed as a group intervention for adolescents and their adult caregivers and conducted a randomized controlled trial in Ndola, Zambia to test feasibility and acceptability. Fifty pairs (= 100) of adolescents (15-19 years and on ART ≥ 6 months) and their caregivers were randomly assigned either to the intervention consisting of 10 group sessions over 6 months, or to a comparison group, which received the usual care.

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Background: While the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam.

Methods: This study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam.

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Background: Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID.

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Importance: Hazardous and heavy alcohol use is common among people living with HIV and may decrease antiretroviral therapy (ART) adherence, but limited data exist from randomized clinical trials about the effects of interventions on viral load.

Objective: To compare the efficacy of 2 scalable ART clinic-based interventions on alcohol use and viral suppression.

Design, Setting, And Participants: This 3-group randomized clinical trial was conducted among 440 adults with HIV who were being treated at 7 ART clinics in Thai Nguyen, Vietnam.

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Background: Alcohol use is a known risk factor for male-perpetrated intimate partner violence (IPV), although few studies have been conducted globally and among men with HIV (MWH). We estimated the longitudinal effects of alcohol use on IPV perpetration among MWH.

Methods: This study is a secondary analysis of randomized controlled trial data among male and female antiretroviral treatment patients with hazardous alcohol use in Thai Nguyen, Vietnam.

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Limited research examines depressive symptoms, alcohol use, and social support among HIV-infected people who inject drugs. : Using longitudinal data, we investigated whether perceived social support moderates the relationship between depressive symptoms and alcohol use among HIV-infected men who inject drugs in Vietnam. Data were collected from participants ( = 455; mean age 35 years) in a four-arm randomized controlled trial in Thai Nguyen, Vietnam.

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Women living with HIV (WLWH) are more likely to suffer from depression than seronegative women and are also more likely to suffer from depression than men living with HIV. There is limited depression research with WLWH in Vietnam. Twenty in-depth interviews with WLWH were conducted to identify pathways leading to depression and coping strategies for depression.

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We examined the prevalence of intimate partner violence (IPV) perpetration and characteristics of HIV-infected male perpetrators. The cross-sectional study was conducted in Vietnam with male antiretroviral treatment clients (N = 1099; mean age = 40.2 years).

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Despite high pre-exposure prophylaxis (PrEP) acceptability among people who inject drugs (PWID) and PrEP providers, PrEP uptake is low and little is known about how to promote PrEP among PWID. This qualitative study with providers in North Carolina explored views on PrEP delivery approaches for PWID. Interviewers conducted semistructured interviews with 10 PrEP providers and 10 harm reduction (HR) providers.

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The present phase of the overdose epidemic is characterized by fentanyl-contaminated heroin, particularly in the eastern United States (U.S.).

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