HIV screening among newly diagnosed TB patients: a cross sectional study in Lima, Peru.

BACKGROUND: Since 2006, the Peruvian National TB program (NTP) recommends voluntary counseling and testing (VCT) for all tuberculosis (TB) patients. Responding to the differential burden of both diseases in Peru, TB is managed in peripheral health facilities while HIV is managed in referral centers. This study aims to determine the coverage of HIV screening among TB patients and the characteristics of persons not screened. METHODS: From March 2010 to December 2011 we enrolled new smear-positive pulmonary TB adults in 34 health facilities in a district in Lima. NTP staff offered VCT to all TB patients. Patients with an HIV positive result were referred for confirmation tests and management. We interviewed patients to collect their demographic and clinical characteristics and registered if patients opted in or out of the screening. RESULTS: Of the 1295 enrolled TB patients, nine had a known HIV diagnosis. Of the remaining, 76.1% (979) were screened for HIV. Among the 23.9% (307) not screened, 38.4% (118) opted out of the screening. TB patients at one of the health care facilities of the higher areas of the district (OR = 3.38, CI 95% 2.17-5.28 for the highest area and OR = 2.82, CI 95% 1.78-4.49 for the high area) as well as those reporting illegal drug consumption (OR = 1.65, CI 95% 1.15-2.37) were more likely not to be screened. Twenty-four were HIV positive (1.9% of all patients 1295, or 2.4% of those screened). Of 15 patients diagnosed with HIV during the TB episode, ten were enrolled in an HIV program. The median time between the result of the HIV screening and the first consultation at the HIV program was 82 days (IQR, 32-414). The median time between the result of the HIV screening and antiretroviral initiation was 148.5 days (IQR 32-500). CONCLUSIONS: An acceptable proportion of TB patients were screened for HIV in Lima. Referral systems of HIV positive patients should be strengthened for timely ART initiation.

A user-centered model for designing consumer mobile health (mHealth) applications (apps).

BACKGROUND: Mobile technologies are a useful platform for the delivery of health behavior interventions. Yet little work has been done to create a rigorous and standardized process for the design of mobile health (mHealth) apps. This project sought to explore the use of the Information Systems Research (ISR) framework as guide for the design of mHealth apps. METHODS: Our work was guided by the ISR framework which is comprised of 3 cycles: Relevance, Rigor and Design. In the Relevance cycle, we conducted 5 focus groups with 33 targeted end-users. In the Rigor cycle, we performed a review to identify technology-based interventions for meeting the health prevention needs of our target population. In the Design Cycle, we employed usability evaluation methods to iteratively develop and refine mock-ups for a mHealth app. RESULTS: Through an iterative process, we identified barriers and facilitators to the use of mHealth technology for HIV prevention for high-risk MSM, developed 'use cases' and identified relevant functional content and features for inclusion in a design document to guide future app development. Findings from our work support the use of the ISR framework as a guide for designing future mHealth apps. DISCUSSION: Results from this work provide detailed descriptions of the user-centered design and system development and have heuristic value for those venturing into the area of technology-based intervention work. Findings from this study support the use of the ISR framework as a guide for future mHealth app development. CONCLUSION: Use of the ISR framework is a potentially useful approach for the design of a mobile app that incorporates end-users' design preferences.

mHealth Technology as a Persuasive Tool for Treatment, Care and Management of Persons Living with HIV.

Mobile health (mHealth) technology can be a valuable tool in the management of chronic illnesses, including HIV. Qualitative research methods were used to identify the desired content and features of a mobile app for meeting and improving the healthcare needs of persons living with HIV (PLWH). We conducted six focus group sessions with 50 English-or Spanish-speaking PLWH in New York City. To inform data analysis and to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH, we integrated Fogg's functional role triad for computing technology model with the self-determination theory to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH. Participants suggested several tools for meeting their healthcare needs, including: reminders/alerts, lab results tracking, and notes on health status. mHealth technology can function as a social actor by providing chat boxes/forums, testimonials of lived experiences, and personal outreach. Examples of media that can be used as a persuasive technology include games/virtual rewards, coding of health tasks, and simulations on how to connect with PLWH. Findings from these focus groups can be used to design a mobile app for PLWH that is targeted to meet their healthcare needs.

Implementation of a stepped-wedge cluster randomized design in routine public health practice: design and application for a tuberculosis (TB) household contact study in a high burden area of Lima, Peru.

BACKGROUND: We designed a pragmatic stepped-wedge cluster randomized controlled trial in order to evaluate provider-initiated evaluation of household contacts (HCs) of smear positive tuberculosis (TB) cases within a routine TB program in Lima, Peru. METHODS/DESIGN: National TB program (NTP) officers of San Juan de Lurigancho District (Lima, Peru) and university-based researchers jointly designed a pragmatic stepped-wedge cluster randomized trial design in order to evaluate a planned active case finding (ACF) program for all HCs of smear-positive TB cases in 34 district healthcare centres. Randomization of time to intervention initiation was stratified by health centre TB case rate. The ACF intervention included provider-initiated home visits of all new sputum smear positive TB patients in order to evaluate household contacts for active TB. Active TB was diagnosed using symptom screening, sputum screening, chest x-ray and clinical evaluation. Once initiated, ACF was provided by NTP staff and integrated into the routine DOTS TB program activities. DISCUSSION: This study protocol describes the pragmatic stepped-wedge cluster randomized trial of active household contact evaluations within an NTP. The stepped-wedge design met overlapping needs of local TB programmers and researchers to adequately evaluate the large-scale roll out of a new control program in a TB endemic setting. Multiple planning meetings were required to develop the necessary networks and in order to understand the operations, needs and goals of the NTP staff and researchers collaborating on this project. The advantages and challenges of using this study design in practice and within existing routine TB programs in a middle-income country context are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02174380. Registered 24 Jun 2014.

eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review.

BACKGROUND: While the human immunodeficiency virus (HIV) incidence rate has remained steady in most groups, the overall incidence of HIV among men who have sex with men (MSM) has been steadily increasing in the United States. eHealth is a platform for health behavior change interventions and provides new opportunities for the delivery of HIV prevention messages. OBJECTIVE: The purpose of this systematic review was to examine the use of eHealth interventions for HIV prevention in high-risk MSM. METHODS: We systematically searched PubMed, OVID, ISI Web of Knowledge, Google Scholar, and Google for articles and grey literature reporting the original results of any studies related to HIV prevention in MSM and developed a standard data collection form to extract information on study characteristics and outcome data. RESULTS: In total, 13 articles met the inclusion criteria, of which five articles targeted HIV testing behaviors and eight focused on decreasing HIV risk behaviors. Interventions included Web-based education modules, text messaging (SMS, short message service), chat rooms, and social networking. The methodological quality of articles ranged from 49.4-94.6%. Wide variation in the interventions meant synthesis of the results using meta-analysis would not be appropriate. CONCLUSIONS: This review shows evidence that eHealth for HIV prevention in high-risk MSM has the potential to be effective in the short term for reducing HIV risk behaviors and increasing testing rates. Given that many of these studies were short term and had other limitations, but showed strong preliminary evidence of improving outcomes, additional work needs to rigorously assess the use of eHealth strategies for HIV prevention in high-risk MSM.

Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology.

BACKGROUND: Over two decades of research has been conducted using mobile devices for health related behaviors yet many of these studies lack rigor. There are few evaluation frameworks for assessing the usability of mHealth, which is critical as the use of this technology proliferates. As the development of interventions using mobile technology increase, future work in this domain necessitates the use of a rigorous usability evaluation framework. METHODS: We used two exemplars to assess the appropriateness of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating the usability of mHealth technology. In the first exemplar, we conducted 6 focus group sessions to explore adolescents' use of mobile technology for meeting their health Information needs. In the second exemplar, we conducted 4 focus group sessions following an Ecological Momentary Assessment study in which 60 adolescents were given a smartphone with pre-installed health-related applications (apps). DATA ANALYSIS: We coded the focus group data using the 9 concepts of the Health-ITUEM: Error prevention, Completeness, Memorability, Information needs, Flexibility/Customizability, Learnability, Performance speed, Competency, Other outcomes. To develop a finer granularity of analysis, the nine concepts were broken into positive, negative, and neutral codes. A total of 27 codes were created. Two raters (R1 and R2) initially coded all text and a third rater (R3) reconciled coding discordance between raters R1 and R2. RESULTS: A total of 133 codes were applied to Exemplar 1. In Exemplar 2 there were a total of 286 codes applied to 195 excerpts. Performance speed, Other outcomes, and Information needs were among the most frequently occurring codes. CONCLUSION: Our two exemplars demonstrated the appropriateness and usefulness of the Health-ITUEM in evaluating mobile health technology. Further assessment of this framework with other study populations should consider whether Memorability and Error prevention are necessary to include when evaluating mHealth technology.

Understanding HIV testing behaviors of minority adolescents: a health behavior model analysis.

Adolescents and young adults are the fastest-growing age group of people living with HIV infection in the United States. Yet many adolescents and young adults with high-risk behaviors for HIV are unaware of their HIV status and have never had an HIV test. The purpose of our work was to understand minority adolescents' beliefs, attitudes, and behaviors related to HIV testing. We conducted focus group sessions with 41 minority adolescents to assess their perceptions about HIV testing. We triangulated the findings from our focus group data with data from a 125-question survey. Analysis of focus group data demonstrated that Perceived Susceptibility, Perceived Severity, Perceived Benefits, Perceived Barriers, and Cues to Action influenced adolescents' decisions to get tested for HIV. Findings support the need to design interventions that address adolescents' perceived barriers to HIV testing and increase access to and knowledge about HIV testing.

Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM.

HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM.

Use of Design Science for Informing the Development of a Mobile App for Persons Living with HIV.

Mobile health (mHealth) technology presents opportunities to enhance chronic illness management, which is especially relevant for persons living with HIV (PLWH). Since mHealth technology comprises evolving and adaptable hardware and software, it provides many challenging design problems. To address this challenge, our methods were guided by the Information System Research (ISR) framework. This paper focuses on the Design Cycle of the ISR framework in which we used user-centered distributed information design methods and participatory action research methods to inform the design of a mobile application (app) for PLWH. In the first design session, participants (N=5) identified features that are optimal for meeting the treatment and management needs of PLWH. In the second design session, participants (N=6) were presented with findings from the first design session and pictures of existing apps. Findings from the Design Cycle will be evaluated with usability inspection methods. Using a systematic approach has the potential to improve mHealth functionality and use and subsequent impact.

Low prevalence of most frequent pathogenic variants of six PARK genes in sporadic Parkinson's disease.

Genetic variants that confer susceptibility to Parkinson's disease (PD) show unbalanced distribution among different populations; genetic predisposition to either familial or sporadic forms of PD in Mexican-mestizo population has not been comprehensively studied. The aim of the present study was to analyze genetic variants in six PARK genes in PD patients. In total 381 individuals (173 patients, 208 controls) were genotyped for p.Gly2019Ser and p.Gly2385Arg variants of LRRK2. The p.Gly2019Ser variant was present in two patients and one healthy control; the p.Gly2385Arg variant was not found. In a subgroup of early-onset PD (EOPD), MLPA analysis was done for PARKIN (PARK2), PINK1 (PARK6), DJ-1 (PARK7), LRRK2 (PARK8), SNCA (PARK1/4) and ATP13A2 (PARK9). We found a heterozygous deletion of exon 2 in PARK2 in the youngest patient of the early-onset group, who showed limited response to antiparkinsonian therapy. Although the changes Gly2019Ser and Gly2385Arg of LRRK2 are associated with PD in different populations; they may be a rare cause of PD in our population. Novel population-specific variants may underlie PD susceptibility in Mexican mestizos. Our study suggests that the heterozygous deletion of exon 2 in the PARK2 gene is a risk factor for EOPD.

Cryptosporidiosis en pacientes con sida: acciones de la enfermera / Cryptosporidiosis in AIDS patients. Nurse actions

Cryptosporidium spp es una coccidia intestinal con una distribución mundial, que ha sido recientemente reconocida como una importante causa de cuadros diarreicos, malabsorción y pérdida de peso, y que puede llegar a constituir una amenaza para la vida de personas con compromiso inmunológico, como los pacientes con síndrome de inmunodeficiencia adquirida (SIDA). El propósito de este estudio fue reflejar las características de esta parasitosis, en un grupo de 24 pacientes seropositivos al virus de la inmunodeficiencia humana (VIH), que estuvieron ingresados en el Servicio de Medicina del Instituto "Pedro Kourí" (IPK), durante los años 1995 y 1996. Para el análisis de los datos se utilizó la prueba de comparación de proporciones; se encontró que todos los individuos parasitados por esta coccidia estaban comprendidos en el grupo IV de la infección por el VIH. La diarrea y la pérdida de peso fueron las alteraciones clínicas más frecuentemente asociadas con esta parasitosis en los 24 pacientes estudiados (100 porciento). Se revisó el papel fundamental que desempeña la enfermera en la prevención frente a esta problemática en los diferentes niveles de atención en salud

Morbilidad materno neonatal por infecciones de transmisión sexual y sus complicaciones, en gestantes que acuden al Hospital Materno Infantil "Germán Urquidi" en el último trimestre del año 2010 / Maternal and neonatal morbidity sexually transmitted infections and complications in pregnant women attending the Maternal and Child Hospital Urquidi Germain in the last quarter of 2010

La Organización Mundial de la Salud (OMS) estima que 1 de cada 20 personas en el mundo padece una Infección de Transmisión Sexual (ITS) al año.La tasa de ITS en Bolivia en el año 2000 fue de 56.000 casos (14 por 1000 habitantes en edad fértil) en los servicios públicos de salud .Las infecciones de transmisión sexual se encuentran entre las causas de morbimortalidad materna y perinatal más importantes en gestantes. Las complicaciones graves de las infecciones de transmisión sexual provocan embarazo ectópico, enfermedad pélvica inflamatoria, durante el embarazo; parto prétermino, aborto espontáneo, muerte fetal e infecciones congénitas.Por estas razones, se realizó una investigacion retrospectiva, transversal y descriptiva, con una muestra de 130 gestantes que corresponden al último trimestre de 2010.Los resultados reflejan que las ITS más frecuentes fueron la sífilis, condiloma acuminado, VIH-Sida, candidiasis y vaginosis bacteriana, también se encontraron lesiones ginecológicas asociadas a ITS como ser la colpitis, colpocervicitis, cervicitis y vulvovaginitis, lo que refleja el caracter crónico de las ITS.Las complicaciones más frecuentes son las fetoneonatales como ser el óbito fetal, parto pretérmino, bajo peso al nacer, sífilis congénita y sospecha del VIH, las madres presentaron complicaciones en menor frecuencia, destacando la ruptura prematura de membrana, abortos, abortos habituales e infecciones pelvicas inflamatorias en porcentajes bajos