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1.
AIDS Care ; 24(10): 1240-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22316090

RESUMO

Timely linkage to HIV medical care has the potential to improve individual health outcomes and prevent secondary HIV transmission. Recent research found that estimates of delayed care entry varied by study design, with higher estimates among studies using only HIV case surveillance data. In this analysis, we compared the prevalence and risk factors for care delay using data from two studies with different designs conducted in New York City. The Medical Monitoring Project (MMP) used a retrospective design to estimate historical delay among persons currently receiving care, while the Never in Care (NIC) study used a prospective design to estimate current delay status among persons who were care-naive at baseline. Of 513 MMP subjects in 2007-2008, 23% had delayed care entry greater than three months after diagnosis. Independent risk factors for care delay were earlier year of diagnosis and testing positive in a nonmedical environment. Of 28 NIC subjects in 2008-2010, over half had tested positive in a nonmedical environment. The primary-stated reasons for delay were the same in both studies: denial of HIV status and lack of perceived need for medical care. The strengths and weaknesses of surveillance only, prospective, and retrospective study designs with respect to investigating this issue are explored. Future studies and interventions should be mindful of the common selection biases and measurement limitations with each design. A triangulation of estimates from varying designs is suggested for accurately measuring care linkage efforts over time.


Assuntos
Soropositividade para HIV/diagnóstico , Soropositividade para HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Soropositividade para HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vigilância da População , Estudos Prospectivos , Projetos de Pesquisa , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
2.
Subst Use Misuse ; 46(14): 1711-5, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21943282

RESUMO

Street outreach in two New York City communities, Harlem and the South Bronx, between May 2001 and March 2003, provided tuberculin skin test (TST) screening to illicit drug users outside the traditional health care system. Persons who used heroin, cocaine, and/or crack were offered a TST, incentives to return for TST reading, and further evaluation if TST was positive. Of 809 participants, 530 (66%) accepted a TST and 81% (429/530) returned for TST reading. Of 429 participants, 40 (9%) were TST positive. Participants found TST positive did not differ from those found TST negative in previous drug user treatment or drug use practices including snorting heroin, sniffing cocaine, smoking crack, and injecting drugs of any kind. Of the 40 participants found TST positive, the 21 who tested TST positive for the first time were more likely to be male (p = .03) and noninjectors (p = .02), than the 19 who had tested TST positive in the past. Only two newly identified persons pursued follow-up care. Street recruitment expanded testing. Better follow-up strategies are needed. The study's limitations are noted.


Assuntos
Tuberculose Latente/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Teste Tuberculínico , Adolescente , Adulto , Relações Comunidade-Instituição , Usuários de Drogas , Feminino , Seguimentos , Humanos , Tuberculose Latente/complicações , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Cooperação do Paciente , Encaminhamento e Consulta , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/complicações
3.
Int J STD AIDS ; 27(12): 1086-1092, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26424160

RESUMO

Individuals infected with HIV who are out of care are at a higher risk of HIV-related morbidity and mortality. It has been difficult to recruit a representative sample of out-of-care patients for epidemiological studies. Using a novel weighting method, we constructed a representative sample of out-of-care HIV patients from a representative sample of in-care patients. In-care patients were weighted based on the probability of receiving care during the study period and the probability of selection to participate in the study, and out-of-care patients were represented by those who were previously out of care and recently returned. The method can be used in other patient populations, if every patient in the population has a known, non-zero probability of receiving care and a known, non-zero probability of participating in the study.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência ao Paciente , Adulto Jovem
4.
Subst Use Misuse ; 42(10): 1613-28, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17918031

RESUMO

A 2004-2005 survey among 503 men who have sex with men who attend public venues in New York City was used to examine the relationship of amphetamine use with sexual risk behaviors. Among the men recruited, 51.1% were under 30 years of age, 27.4% were Latino, and 23.3% were African American. Most identified as either gay (78.9%) or bisexual (18.1%). A standardized questionnaire collected data on demographics, sexual risk behaviors, drug and alcohol use, history of HIV testing, and occurrences of sexually transmitted infections. Amphetamine use in the past year was reported by 13.8%. Of those, 71.0% used amphetamines with sex. Amphetamine use was associated with unprotected receptive anal intercourse with non-main partners. In event-specific analysis, amphetamine use was higher with unprotected encounters compared with protected encounters. This study confirms the association between amphetamine use and sexual risk furthers our understanding of risky circumstances and lays the groundwork for the design of interventions.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Homossexualidade Masculina/psicologia , Assunção de Riscos , Comportamento Sexual/psicologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Infecções por HIV/epidemiologia , Soropositividade para HIV/epidemiologia , Inquéritos Epidemiológicos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Sexo Seguro/psicologia , Sexo Seguro/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais/psicologia
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