Evaluation of the effectiveness of traffic calming measures on vehicle speeds and pedestrian injury severity in Ghana
Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there are high vehicular speeds and inadequate pedestrian facilities. The objectives of this research were to establish the (1) impact of traffic calming measures on vehicle speeds and (2) association between traffic calming measures and pedestrian injury severity in built-up areas in Ghana.
Virologic failure among people living with HIV initiating dolutegravir-based versus other recommended regimens in real-world clinical care settings
Guidelines for initial antiretroviral treatment regimens have evolved, with integrase strand transfer inhibitors (INSTI) increasingly prominent. Research on virologic failure with INSTI therapy is predominantly from clinical trials not care settings, especially for recently approved medications including dolutegravir. This study compared outcomes among people living with HIV who initiated recommended regimens in clinical care across the United States.
Scaling-up the systems analysis and improvement approach for prevention of mother-to-child HIV transmission in Mozambique (SAIA-SCALE): a stepped-wedge cluster randomized trial
The introduction of option B+-rapid initiation of lifelong antiretroviral therapy regardless of disease status for HIV-infected pregnant and breastfeeding women-can dramatically reduce HIV transmission during pregnancy, birth, and breastfeeding. Despite significant investments to scale-up Option B+, results have been mixed, with high rates of loss to follow-up, sub-optimal viral suppression, continued pediatric HIV transmission, and HIV-associated maternal morbidity. The Systems Analysis and Improvement Approach (SAIA) cluster randomized trial demonstrated that a package of systems engineering tools improved flow through the prevention of mother-to-child HIV transmission cascade. This protocol describes a novel model for SAIA delivery led by district nurse supervisors (rather than research nurses), and evaluation procedures, to serve as a foundation for national scale-up.
The curse of dimensionality: Animal-related risk factors for pediatric diarrhea in western Kenya, and methods for dealing with a large number of predictors
Pediatric diarrhea, a leading cause of under-five mortality, is predominantly infectious in etiology. As many putative causal agents are zoonotic, animal exposure is a likely risk factor. To evaluate the effect of animal-related factors on moderate to severe childhood diarrhea in rural Kenya, where animal contact is common, Conan et al. studied 73 matched case-control pairs from 2009-2011, collecting rich exposure data on many dimensions of animal contact. This study reviews the challenges associated with analyzing moderately-sized datasets with a large number of predictors and presents two alternative methodological approaches.
Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: Results from the pre-operative health and body (PreHAB) study
Exercise after breast cancer diagnosis is associated with lower cancer-specific mortality, but the biological mechanisms through which exercise impacts breast cancer are not fully understood. The Pre-Operative Health and Body Study was a randomized window of opportunity trial designed to test the impact of exercise on Ki-67, gene expression, and other biomarkers in women with breast cancer.
Large, stable, contemporary interspecies recombination events in circulating human herpes simplex viruses
The ubiquitous human pathogens, HSV-1 and HSV-2, are distinct viral species that diverged about six million years ago. At least four small, ancient HSV-1 x HSV-2 interspecies recombination events have affected the HSV-2 genome, with recombinants and non-recombinants at each locus circulating today. However, it is unknown if interspecies recombination can affect other loci and if new recombinants continue to be generated.
Beyond blood smears - qualification of the Plasmodium 18S rRNA as a biomarker for controlled human malaria infections
18S rRNA is a biomarker that provides an alternative to thick blood smears in controlled human malaria infection (CHMI) trials. This study reviewed data from CHMI trials at non-endemic sites that used blood smears and Plasmodium 18S rRNA/rDNA biomarker nucleic acid tests (NATs) for time to positivity. Additionally, researchers validated a multiplex quantitative reverse transcription-PCR (qRT-PCR) for Plasmodium 18S rRNA, prospectively compared blood smears and qRT-PCR for three trials, and modeled treatment effects at different biomarker-defined parasite densities to assess the impact on infection detection, symptom reduction, and measured intervention efficacy.
Preventive misconception and risk behaviors in a multinational HIV prevention trial
Some HIV prevention research participants may hold a "preventive misconception", an overestimate of the probability or level of personal protection afforded by trial participation. However, these reports typically rely upon small, retrospective qualitative assessments that did not use a standardized approach. Researchers administered a measure of PM called PREMIS, during Microbicide Trials Network 020-A Study to Prevent Infection with a Ring for Extended Use, a large, multicenter, placebo-controlled, phase III trial evaluating the safety and efficacy of a dapivirine vaginal ring among women at risk for HIV infection in Malawi, South Africa, Uganda, and Zimbabwe.
Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load
Substance use is common among people living with HIV (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, this study evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved.
Tenofovir-diphosphate as a marker of HIV pre-exposure prophylaxis use among East African men and women
Controlled pharmacokinetic (PK) studies in United States populations have defined categories of tenofovir-diphosphate in dried blood spots for various pre-exposure prophylaxis (PrEP) adherence targets. It is unknown how these categories perform in other populations. Therefore, this study evaluated the sensitivity and specificity of these PK-derived categories compared to daily medication electronic adherence monitoring data among East African men and women using daily PrEP.