Demographic, psychological, and behavioral modifiers of the Antiretroviral Treatment Access Study (ARTAS) intervention.

The present study sought to identify demographic, structural, behavioral, and psychological subgroups for which the Antiretroviral Treatment Access Study (ARTAS) intervention had stronger or weaker effects in linking recently diagnosed HIV-positive persons to medical care. The study, carried out from 2001 to 2003, randomized 316 participants to receive either passive referral or a strengths-based linkage intervention to facilitate entry into HIV primary care. The outcome was attending at least one HIV primary care visit in each of two consecutive 6-month periods. Participants (71% male; 29% Hispanic; 57% black non-Hispanic), were recruited from sexually transmitted disease clinics, hospitals and community-based organizations in four U.S. cities. Thirteen effect modifier variables measured at baseline were examined. Subgroup differences were formally tested with interaction terms in unadjusted and adjusted log-linear regression models. Eighty-six percent (273/316) of participants had complete 12-month follow-up data. The intervention significantly improved linkage to care in 12 of 26 subgroups. In multivariate analysis of effect modification, the intervention was significantly (p < 0.05) stronger among Hispanics than other racial/ethnic groups combined, stronger among those with unstable than stable housing, and stronger among those who were not experiencing depressive symptoms compared to those who were. The ARTAS linkage intervention was successful in many but not all subgroups of persons recently diagnosed with HIV infection. For three variables, the intervention effect was significantly stronger in one subgroup compared to the counterpart subgroup. To increase its scope, the intervention may need to be tailored to the specific needs of groups that did not respond well to the intervention.

HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care.

OBJECTIVES: We examined the relationship between receipt of medical care for human immunodeficiency virus (HIV) infection and HIV transmission risk behavior among persons who had received a recent diagnosis of HIV infection. METHODS: We enrolled 316 participants from 4 US cities and prospectively followed up participants for 1 year. Generalized estimating equations were used to examine whether having at least 3 medical care visits in a 6-month period was associated with unprotected vaginal or anal intercourse with an HIV-negative partner or partner with unknown HIV status. RESULTS: A total of 27.5% of the participants (84 of 305) self-reported having unprotected sex with an HIV-negative or unknown status partner at enrollment, decreasing to 12% (31 of 258) and 14.2% (36 of 254) at 6-month and 12-month follow-ups, respectively. At follow-up, people who had received medical care for HIV infection at least 3 times had reduced odds of engaging in risk behavior, compared with those with fewer visits. Other factors associated with reduced risk behavior were being >30 years of age, male sex, not having depressive symptoms, and not using crack cocaine. CONCLUSIONS: Being in HIV care is associated with a reduced prevalence of sexual risk behavior among persons living with HIV infection. Persons linked to care can benefit from prevention services available in primary care settings.

Self-reported health effects among community residents exposed to perfluorooctanoate.

Serious health effects due to perfluorooctanoate (PFOA) exposure are suspected. The aim of this study was to evaluate the health status of nearby residents, with prolonged exposure to PFOA in their drinking water. A population of 566 white residents who were plaintiffs or potential plaintiffs in a lawsuit was evaluated by questionnaire for health history and symptoms. Standardized Prevalence Ratios were estimated using National Health and Examination Survey (NHANES) data files for comparison rates. The exposed subjects reported statistically significant greater prevalence of angina, myocardial infarction, and stroke (SPR=8.07, 95% C.I.=6.54-9.95; SPR=1.91, 95% C.I.=1.40-2.62, and SPR=2.17, 95% C.I.=1.47-3.21, respectively), chronic bronchitis, shortness of breath on stairs, asthma (SPR=3.60, 95% C.I.=2.92-4.44; SPR=2.05, 95% C.I.=1.70-2.46; SPR=1.82, 95% C.I.=1.47-2.25, respectively), and other serious health problems. The increased prevalence of adverse health effects may be due to PFOA. Further study is needed.

Psychological and behavioral correlates of entering care for HIV infection: the Antiretroviral Treatment Access Study (ARTAS).

The present study sought to examine psychological and behavioral variables as predictors of attending an HIV medical care provider among person's recently diagnosed with HIV. The study, carried out between 2001 and 2003, was a two-arm randomized intervention trial with participants recruited from public HIV testing centers, sexually transmitted disease (STD) clinics, hospitals, and community-based organizations in Atlanta, Georgia; Baltimore, Maryland; Miami, Florida; and Los Angeles, California. Eighty-six percent of those enrolled (273) had complete baseline and 12-month follow-up data. Measures of number of months since HIV diagnosis, readiness to enter care (based on stages of change), barriers and facilitators to entering care, drug use, and intervention arm (case managed versus simple referral) were examined as predictors of attending an HIV care provider, defined as being in care at least once in each of two consecutive 6-month follow-up periods. In logistic regression, seeing a care provider was significantly more likely among participants diagnosed with HIV within 6 months of enrollment (odds ratio [OR] = 2.52, 95% confidence interval [CI], 1.25, 5.06), those in the preparation versus precontemplation stages at baseline (OR = 2.87, 95% CI, 1.21, 6.81), those who reported at baseline that someone (friend, family member, social worker, other) was helping them get into care (OR = 2.13, 95% CI, 1.02, 4.44), and those who received a case manager intervention (OR = 2.16, 95% CI, 1.23, 3.78). The findings indicate a need to reach HIV-positive person's soon after diagnosis and assist them in getting into medical care. Knowing a person's stages of readiness to enter care and their support networks can help case managers formulate optimal client plans.

Initiating HIV care: attitudes and perceptions of HIV positive crack cocaine users.

There is limited data on the initiation and use of HIV care services by HIV-positive crack cocaine users. We analyzed data from a study of 286 recently infected HIV-positive persons recruited from 4 U.S. cities. Participants completed an Audio Computer Assisted Self Interview (A-CASI) regarding HIV care knowledge, attitudes, beliefs and practices related to the initiation of HIV care. In multiple logistic regression analysis, higher scores on an assessment of knowledge, attitudes and beliefs regarding HIV care, and Hispanic race were positively associated with initiating HIV primary care. Crack cocaine use in the past 30 days and male gender were negatively associated with initiating care. Injection drug use was not associated with initiation of care. Targeted interventions for crack cocaine users, including drug treatment, may be required to provide optimal HIV primary care use in this population.

Cluster of systemic lupus erythematosus (SLE) associated with an oil field waste site: a cross sectional study.

BACKGROUND: This is a community comparison study that examines persons living in a subdivision exposed to petroleum products and mercury. METHODS: We compared their health status and questionnaire responses to those living in another community with no known exposures of this type. RESULTS: Pristane house dust among the exposed homes was higher than in the comparison communities. The exposed subdivision has higher ambient air mercury levels compared to the control community. The prevalence of rheumatic diseases (OR = 10.78; CI = 4.14, 28.12) and lupus (OR = 19.33; CI = 1.96, 190.72) was greater in the exposed population compared to the unexposed. A higher prevalence of neurological symptoms, respiratory symptoms and several cardiovascular problems including stroke (OR = 15.41; CI = 0.78, 304.68) and angina (OR = 5.72; CI = 1.68, 19.43) was seen. CONCLUSION: There were statistically significant differences in B cells, Natural Killer Cells, gamma glutamyl transferase, globulin and serum calcium levels between control and exposed subjects.

Residential and biological exposure assessment of chemicals from a wood treatment plant.

This paper evaluates the results of contamination of residents and residential homes located in close proximity to a Wood Treatment Plant. The plant has produced treated wood products continuously since 1904. The principle chemicals used to treat the wood, which is primarily used for railroad ties (oblong objects laid perpendicular to the rails to act as a base for the tracks), are creosote and pentachlorophenol. For a number of years, the plant burned treated waste wood products containing creosote and pentachlorophenol. First the plant pressure impregnates the wood with creosote and pentachlorophenol, and then the wood is stacked on open ground to allow it to air dry. Chemicals from recently treated wood ties are allowed to evaporate into the air or drip onto the ground surrounding the stacked wood. Small drainage ditches carry the liquid wastes into larger water channels where eventually the waste streams are discharged into a river adjacent to the plant. The river serves as a source of drinking water for the nearby community. Prevailing wind patterns favor a drift of air emissions from the plant's boiler stack over the nearby community and its residents. Over the past few years, the town's residents have become increasingly concerned about their health status and have voiced concerns regarding multiple health problems (including cancer), possibly associated with plant discharges. The intention of this study is to examine a representative sample of the potentially affected residents and to evaluate their residential environment for the presence of dioxin and/or its congeners. Data obtained from EPA's Toxic Release Information (TRI) database revealed the plant routinely discharged creosote, pentachlorophenol, dioxin and dioxin-like compounds into the ambient air via fugitive air emissions and surface waste waters. Sampling of household dust and water sediment within and outside of residences within a 2-mile radius of the plant revealed the presence of significantly elevated levels of dioxins, principally octachlorodibenzo-p-dioxin (OCDD) and 1,2,3,4,6,7,8-hepta-CDD. Biomonitoring of 29 subjects identified the presence of significantly elevated chlorinated dioxins and furan levels (OCDD=1049 ppt for exposed and 374 ppt for controls and 1,2,3,4,6,7,8-hepta CDD=132 ppt for exposed and 45.1 ppt for controls). These levels are consistent with exposures to pentachlorophenol in this group of subjects. And they confirm the presence of unsafe levels of chlorinated dioxins in these persons.

System and patient barriers to appropriate HIV care for disadvantaged populations: the HIV medical care provider perspective.

Little is known about the perception of system and patient barriers to adequate HIV care by an essential resource in the provision of HIV care, HIV medical care providers. To evaluate such perceptions, between November 2000 and June 2001 a survey was mailed to 526 HIV medical care providers who cared for HIV-infected individuals in Atlanta, Baltimore, Los Angeles, and Miami. Logistic regression analysis of survey results revealed significant differences in perceptions of system barriers between Black and Hispanic providers versus White providers and non-medical doctor providers versus medical doctor providers. Female providers differed significantly from male providers in assessing the importance of certain system and patient barriers. The authors observed that there are seeming disparities in perceptions of system and patient barriers to HIV medical care by providers of different race/ethnic groups, genders, and professions. More research needs to be conducted to determine if these disparities reflect differences in the provision of adequate HIV care for disadvantaged individuals.

Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care.

OBJECTIVE: The Antiretroviral Treatment Access Study (ARTAS) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis. METHODS: Participants were recently diagnosed HIV-infected persons in Atlanta, Baltimore, Los Angeles and Miami. They were randomized to either standard of care (SOC) passive referral or case management (CM) for linkage to nearby HIV clinics. The SOC arm received information about HIV and local care resources; the CM intervention arm included up to five contacts with a case manager over a 90-day period. The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period. RESULTS: A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [78 versus 60%; adjusted relative risk (RR(adj)), 1.36; P = 0.0005) and at least twice within 12 months (64 versus 49%; RR(adj), 1.41; P = 0.006). Individuals older than 40 years, Hispanic participants, individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be 600-1200 US dollars per client. CONCLUSION: A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after their HIV diagnosis.

Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities.

OBJECTIVES: We investigated physicians' delivery of HIV prevention counseling to newly diagnosed and established HIV-positive patients. METHODS: A questionnaire was developed and mailed to 417 HIV physicians in 4 US cities. RESULTS: Overall, rates of counseling on the part of physicians were low. Physicians reported counseling newly diagnosed patients more than established patients. Factors associated with increased counseling included having sufficient time with patients and familiarity with treatment guidelines. Physicians who perceived their patients to have mental health and substance abuse problems, who served more male patients, and who were infectious disease specialists were less likely to counsel patients. CONCLUSIONS: Intervention strategies with physicians should be developed to overcome barriers to providing counseling to HIV-positive patients.

Test-retest reliability of a complex human immunodeficiency virus research questionnaire administered by an Audio Computer-assisted Self-interviewing system.

OBJECTIVES: To evaluate the test-retest reliability of a complex questionnaire administered by Audio Computer-assisted Self-interviewing to recently diagnosed human immunodeficiency virus-positive patients. METHODS: Thirty-seven English-speaking and 32 Spanish-speaking participants completed both test and retest interviews. Pearson correlation coefficients (r) and kappa (kappa) and weighted kappa (kappa) statistics were obtained for individual questions. From these, overall kappa and Pearson correlation coefficients were calculated across all variables and for groups of questions. RESULTS: Overall measures of reliability were kappa = 0.767, r = 0.728. Some variation in reliability existed for different response formats, question content groups, and languages of the participants. Differences in overall reliability by Spanish compared with English participants were small and not statistically significant. CONCLUSIONS: Audio Computer-assisted Self-interviewing provides reliable measures for items assessed in the Antiretroviral Treatment and Access Study baseline questionnaire. Some differences exist as a result of question content, interview language, and response format, requiring assessment in future studies and consideration in designing Audio Computer-assisted Self-interviewing systems and questionnaires.