Publications by authors named "Susan Morrison"
Background: Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV pre-exposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in BMD beyond those elicited by either product singly.
Methods: From 2018-2022, we conducted a 2-year prospective study with women ages 16-25 years in Kampala, Uganda desiring pregnancy and HIV prevention.
Introduction: Adolescent girls and young women (AGYW) account for two-thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre-exposure prophylaxis (PrEP) but low adherence, which might be improved by point-of-care adherence monitoring with tailored counselling.
Methods: From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16-30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia.
Article Synopsis
- The study investigated the accuracy of HIV point-of-care testing among African women using various contraceptive methods, focusing on the occurrence of true and false positive results.
- Out of 48,234 visits by 7,730 women, true positive results were found in only 0.9% of cases, while false positives occurred in 0.2%, necessitating additional confirmatory testing.
- The findings emphasize the need for confirmatory tests, as not all HIV infections presented typical laboratory results, particularly in populations with low HIV prevalence and repeat testing.
Article Synopsis
- Oral PrEP is recommended for at-risk pregnant cisgender women, but it may negatively impact bone health, which is already affected by pregnancy.
- The study followed 499 young women using PrEP and measured bone mineral density (BMD) over 24 months, noting that 67% of pregnant women continued using PrEP.
- Results showed that women on PrEP during pregnancy had significantly lower BMD compared to non-pregnant women or pregnant women who didn't use PrEP, and adherence to PrEP decreased during pregnancy.
Cervical cancer burden is high where prophylactic vaccination and screening coverage are low. We demonstrated in a multicenter randomized, double-blind, controlled trial that single-dose human papillomavirus (HPV) vaccination had high vaccine efficacy (VE) against persistent infection at 18 months in Kenyan women. Here, we report findings of this trial through 3 years of follow-up.
View Article and Find Full Text PDFBeta-lactam comprehensive allergy management program in a community medical center.
Antimicrob Steward Healthc Epidemiol
October 2023
Objective: The Beta-lactam Comprehensive Allergy Management Program (CAMP) was implemented to facilitate complete beta-lactam allergy history documentation in the electronic medical record (EMR) and increase beta-lactam utilization. The study objective was to assess the rate of complete allergy histories and days of antimicrobial therapy (DOT) before versus after CAMP implementation.
Design: Quasi-experimental study with interrupted time-series analysis.
Randomized controlled phase IIa clinical trial of safety, pharmacokinetics and pharmacodynamics of tenofovir and tenofovir plus levonorgestrel releasing intravaginal rings used by women in Kenya.
Front Reprod Health
June 2023
Article Synopsis
- Many young women globally experience the dual challenges of HIV and unintended pregnancies, highlighting the need for multipurpose prevention technologies.
- A study involving 312 healthy women aged 18-34 randomized participants to use either a tenofovir/levonorgestrel (TFV/LNG), TFV-only, or placebo intravaginal ring to assess safety and effectiveness.
- Results showed that both TFV IVR groups demonstrated significant increases in HIV inhibition in cervicovaginal fluid, with no serious adverse effects linked to the products, indicating their potential as safe prevention methods.
Article Synopsis
- - The study assessed IUD insertion outcomes by newly trained clinicians at 12 sites in Africa, noting a 5.46% failure rate and a 0.27% perforation rate, particularly higher among breastfeeding women postpartum.
- - Results showed that of 2582 women, 493 experienced expulsions, with lower risk in women over 24 and potential higher risk in nulliparous women; however, breastfeeding did not significantly impact expulsion rates.
- - The findings suggest that effective training and ongoing support for new providers can lead to successful IUD insertions in resource-limited settings, aligning with existing literature on safety and efficacy.
Depression is a common cause of morbidity globally and can impact adherence to medications, posing challenges to medication-based HIV prevention. The objectives of this work are to describe the frequency of depression symptoms in a cohort of 499 young women in Kampala, Uganda and to determine the association of depression symptoms with use of HIV pre-exposure prophylaxis (PrEP). Mild or greater depression, assessed by the patient health questionnaire (PHQ-9), was experienced by 34% of participants at enrollment.
View Article and Find Full Text PDFUnlabelled: Few studies have characterized bone mineral density (BMD) among health young African women. In our study of 496 Ugandan women age ≤25 years, we found that women had healthy BMD that were lower on average than the standard reference ranges. Reference ranges available for BMD measurements need greater precision.
View Article and Find Full Text PDFIntroduction: HIV incidence remains high among African adolescent girls and young women (AGYW). The primary objective of this study is to assess pre-exposure prophylaxis (PrEP) initiation, use, persistence and HIV acquisition among African AGYW offered PrEP in order to inform PrEP scale-up.
Methods: POWER was a prospective implementation science evaluation of PrEP delivery for sexually active HIV-negative AGYW ages 16-25 in family planning clinics in Kisumu, Kenya and youth and primary healthcare clinics in Cape Town and Johannesburg, South Africa.
Background: Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure prophylaxis (PrEP) for HIV prevention. Doxycycline post-exposure prophylaxis (dPEP) has been proposed as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea, and trials are ongoing among cisgender men who have sex with men (MSM) and transgender women who are taking PrEP in high-income settings.
View Article and Find Full Text PDFArticle Synopsis
- A randomized clinical trial was conducted in Kenya to evaluate the efficacy of single-dose nonavalent and bivalent HPV vaccines against a meningococcal vaccine among women aged 15 to 20.
- The results indicated that both the nonavalent and bivalent HPV vaccines had very high efficacy rates (97.5%) in preventing persistent infections of HPV types 16 and 18, while significantly fewer infections occurred in the HPV vaccine groups compared to the meningococcal vaccine group.
- Overall, the study supports the potential for single-dose HPV vaccination to simplify vaccination processes and decrease healthcare costs while maintaining strong protective effects against targeted HPV infections.
Article Synopsis
- South Africa has the highest HIV burden globally, and understanding factors contributing to HIV acquisition is essential for improving national prevention strategies and future trials, as investigated in the ECHO study.
- The study followed 5,768 HIV-negative women aged 16-35 who sought contraceptive services between 2015 and 2018, with a total of 345 new HIV infections observed during the study.
- Key risk factors for incident HIV included being 24 years or younger, having a history of sexually transmitted infections, a BMI of 30 or less, and having new or multiple sexual partners prior to enrollment, highlighting the need for better integration of STI management with contraceptive services.
Background: The coronavirus disease 2019 (COVID-19) pandemic has challenged researchers performing clinical trials to develop innovative approaches to mitigate infectious risk while maintaining rigorous safety monitoring.
Methods: In this report we describe the implementation of a novel exclusively remote randomized clinical trial (ClinicalTrials.gov NCT04354428) of hydroxychloroquine and azithromycin for the treatment of the SARS-CoV-2-mediated COVID-19 disease which included cardiovascular safety monitoring.
Background: HPV infection is the primary cause of cervical cancer, a leading cause of cancer among women in Kenya and many sub-Saharan African countries. High coverage of HPV vaccination is a World Health Organization priority to eliminate cervical cancer globally, but vaccine supply and logistics limit widespread implementation of the current two or three dose HPV vaccine schedule.
Methods: We are conducting an individual randomized controlled trial to evaluate whether a single dose of the bivalent (HPV 16/18) or nonavalent (HPV 16/18/31/33/45/52/58/6/11) HPV vaccine prevents persistent HPV infection, a surrogate marker for precancerous lesions and cervical cancer.
Background: Tocilizumab is an interleukin-6 receptor antagonist hypothesized to blunt the uncontrolled immune response, cytokine release syndrome, in severe COVID-19 and prevent attributable morbidity and mortality. Objective: The objective of this study was to assess the impact of tocilizumab on clinical outcomes in COVID-19-associated cytokine release syndrome.
Methods: Single-center, retrospective cohort study assessing sixty-nine adult patients receiving tocilizumab for suspected COVID-19 cytokine release syndrome.
Background: Treatment options for outpatients with COVID-19 could reduce morbidity and prevent SARS-CoV-2 transmission.
Methods: In this randomized, double-blind, three-arm (1:1:1) placebo-equivalent controlled trial conducted remotely throughout the United States, adult outpatients with laboratory-confirmed SARS-CoV-2 infection were recruited. Participants were randomly assigned to receive hydroxychloroquine (HCQ) (400 mg BID x1day, followed by 200 mg BID x9days) with or without azithromycin (AZ) (500 mg, then 250 mg daily x4days) or placebo-equivalent (ascorbic acid (HCQ) and folic acid (AZ)), stratified by risk for progression to severe COVID-19 (high-risk vs.
Background: Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV acquisition. However, adherence among young women (aged 18-24 years) has been challenging. SMS reminders have been shown to improve adherence to antiretroviral therapy in some contexts, including in combination with real-time adherence monitoring.
View Article and Find Full Text PDFBackground: Effective prevention against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently limited to nonpharmaceutical strategies. Laboratory and observational data suggested that hydroxychloroquine had biological activity against SARS-CoV-2, potentially permitting its use for prevention.
Objective: To test hydroxychloroquine as postexposure prophylaxis for SARS-CoV-2 infection.
Background: Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. We aimed to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART.
Methods: We did a household-randomised, unblinded trial (DO ART) of delivery of ART in the community compared with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and the Sheema District, Uganda.
Introduction: Safer conception strategies minimize HIV risk during condomless sex to become pregnant. Gaps remain in understanding the acceptability, feasibility and choices HIV-serodiscordant couples make when multiple safer conception options are available.
Methods: We conducted a pilot study of a comprehensive safer conception package for HIV-serodiscordant couples with immediate fertility desires in Kenya from March 2016 to April 2018.
: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk. Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa.
View Article and Find Full Text PDFObjectives: This is the first statewide census of the product availability, price promotions, and product messaging of vape shops.
Methods: A comprehensive list of New Hampshire vape shops was developed through a previously validated online search method. Store audits were conducted in 55 stores between January and February 2016 using the Vape Shop Standardized Tobacco Assessment for Retail Settings (V-STARS).