Chicago, IL, United States
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Spear G.T.,Rush University Medical Center | Kendrick S.R.,John Stroger Hospital of Cook County | Kendrick S.R.,Ruth thstein Core Center | Chen H.Y.,University of Illinois at Chicago | And 4 more authors.
PLoS ONE | Year: 2011

Background: More than one million new cases of sexually transmitted diseases (STDs) occur each day. The immune responses and inflammation induced by STDs and other frequent non-STD microbial colonizations (i.e. Candida and bacterial vaginosis) can have serious pathologic consequences in women including adverse pregnancy outcomes, infertility and increased susceptibility to infection by other pathogens. Understanding the types of immune mediators that are elicited in the lower genital tract by these infections/colonizations can give important insights into the innate and adaptive immune pathways that are activated and lead to strategies for preventing pathologic effects. Methodology/Principal Findings: 32 immune mediators were measured by multiplexed immunoassays to assess the immune environment of the lower genital tract mucosa in 84 women attending an urban STD clinic. IL-3, IL-1ß, VEGF, angiogenin, IL-8, ß2Defensin and ß3Defensin were detected in all subjects, Interferon-α was detected in none, while the remaining mediators were detected in 40% to 93% of subjects. Angiogenin, VEGF, FGF, IL-9, IL-7, lymphotoxin-α and IL-3 had not been previously reported in genital mucosal fluid from women. Strong correlations were observed between levels of TNF-α, IL-1ß and IL-6, between chemokines IP-10 and MIG and between myeloperoxidase, IL-8 and G-CSF. Samples from women with any STD/colonization had significantly higher levels of IL-8, IL-3, IL-7, IL-1ß, lactoferrin and myeloperoxidase. IL-1ß and lactoferrin were significantly increased in gonorrhea, Chlamydia, cervicitis, bacterial vaginosis and trichomoniasis. Conclusions/Significance: These studies show that mucosal fluid in general appears to be an environment that is rich in immune mediators. Importantly, IL-1ß and lactoferrin are biomarkers for STDs/colonizations providing insights into immune responses and pathogenesis at this mucosal site. © 2011 Spear et al.


Lubelchek R.J.,John H Stroger Jr Hospital Of Cook County | Lubelchek R.J.,Rush University Medical Center | Hotton A.L.,John H Stroger Jr Hospital Of Cook County | Hotton A.L.,Womens Interagency HIV Study | And 2 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

INTRODUCTION: Scaling up routine HIV testing represents a key component of the National HIV/AIDS Strategy. Barriers to routine HIV testing have limited widespread adoption. Although many patients visit specialty care providers, few efforts to increase routine HIV testing in specialty care settings have been made. We report on use of a survey of barriers to routine testing coupled with academic detailing-type educational sessions to increase routine testing at specialty clinics in Chicago's main safety-net health system. METHODS: We devised a survey to assess specialty provider knowledge, attitudes, and barriers to routine HIV testing. We administered this at 3 specialty clinics. Each clinic's survey responses informed content for academic detailing-type presentations to each clinic's medical providers. We provide descriptive statistics summarizing survey responses. We report changes in the HIV testing rates and use logistic regression to examine associations between time period and odds of testing at each clinic. RESULTS: Specialty clinic providers demonstrated varying knowledge regarding routine HIV testing guidelines - with trauma providers having the least knowledge. Concerns regarding arranging follow-up for patients with positive results was the most cited barrier to testing. Two of the 3 specialty clinics experienced significant increases in routine HIV testing, whereas the third specialty service, which uses more rotating residents, had downtrending routine testing rates. DISCUSSION: The increase in routine HIV testing in 2 of 3 specialty services suggests that academic detailing-type interventions can improve routine testing uptake in public safety-net specialty care settings and may represent a useful component to incorporate into system-wide scale-up efforts. Copyright © 2013 by Lippincott Williams & Wilkins.


Khawcharoenporn T.,Rush University Medical Center | Khawcharoenporn T.,Ruth thstein Core Center | Khawcharoenporn T.,Thammasat University | Kendrick S.,Rush University Medical Center | And 4 more authors.
AIDS Patient Care and STDs | Year: 2012

Low perception of HIV risk despite behaviors associated with increased risk is thought to be a contributing factor for a higher prevalence of HIV in blacks than other groups in the United States. We sought to determine HIV risk perception and its impact on safer sex practices and interest in preexposure prophylaxis (PrEP). From August 1 to October 31, 2010, an anonymous survey was conducted at a sexually transmitted infection clinic asking questions about demographics, risk behaviors, and PrEP interest. Participants were categorized into high-risk, moderate-risk, and low-risk groups according to predefined HIV risk characteristics. Only heterosexual high-risk participants were further assessed for their risk perception, condom use and PrEP interest. There were 494 participants; 63% male, 70% blacks, 88% heterosexual; 83% were categorized into the high-risk group. Of the 359 heterosexual high-risk participants, 301 (84%) perceived themselves at no or low-risk. Rates of consistent condom use with vaginal, oral, and anal sex were low (<20%) in this group despite high levels of knowledge about HIV transmission risks. Rates of condom use were not affected by risk perception. No interest in PrEP was associated with low education level (adjusted odds ratio 4.97; p=0.02) and low risk perception. These findings suggest that despite having knowledge about HIV transmission risks, the majority of high-risk participants did not recognize their risks and used condoms with low frequency. Low risk perception and low education level may impact PrEP interest. Enhanced interventions are needed to improve HIV risk perception, safer sex practices, and knowledge about PrEP. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Lubelchek R.J.,Ruth thstein Core Center | Lubelchek R.J.,Jr Hospital Of Cook County | Finnegan K.J.,Ruth thstein Core Center | Hotton A.L.,Chicago Developmental Center for Research
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: Improved retention-in-care may enhance health outcomes for people living with HIV/AIDS (PLWHA). Although laboratory surveillance data may be used to gauge retention, no previous reports have compared laboratory surveillance vs. clinic visit-based measures of retention-in-care. We compared laboratory surveillance vs. clinic visit-based approaches for identifying retention status for PLWHA. Methods: We examined 2011 patient visit data from the Ruth M. Rothstein CORE Center, Cook County's HIV clinic. We defined retained patients as those with visits every 6 months over 2 years and matched patients classified through visit data against HIV surveillance laboratories reported to the Chicago Department of Health. We determined the sensitivity, specificity, and receiver operator characteristics of varying laboratory surveillance vs. clinic visit measures of retention. Results: Of patients classified through clinic visit data, 91% of 1714 in-care vs. 22% of 200 out-of-care patients met our most stringent surveillance-based retention definition - having ≥2 viral load/CD4s performed 90 days apart reported by the same laboratory in 2011. Of surveillance laboratory-based definitions for retention, having ≥2 HIV viral load and/or CD4 values at least 3 months apart reported from the same facility possessed the best receiver operator parameters and the receiver operator characteristics' curve comparing several laboratory surveillance vs. clinic visit-based retention measures that had an area under the curve of 0.95. Conclusions: Our findings demonstrate that surveillance laboratory data can be used to assess retention-in-care for PLWHA. These data suggest that bi-directional data sharing between public health entities and care providers could advance re-engagement efforts. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Lubelchek R.J.,John H Stroger Jr Hospital Of Cook County | Lubelchek R.J.,Ruth thstein Core Center | Lubelchek R.J.,Rush University Medical Center | Hoehnen S.C.,Ruth thstein Core Center | And 4 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Introduction: HIV transmission cluster analyses can inform HIV prevention efforts. We describe the first such assessment for transmission clustering among HIV patients in Chicago. Methods: We performed transmission cluster analyses using HIV pol sequences from newly diagnosed patients presenting to Chicago's largest HIV clinic between 2008 and 2011. We compared sequences through progressive pairwise alignment, using neighbor joining to construct an unrooted phylogenetic tree. We defined clusters as .2 sequences among which each sequence had at least 1 partner within a genetic distance of #1.5%. We used multivariable regression to examine factors associated with clustering and used geospatial analysis to assess geographic proximity of phylogenetically clustered patients. Results: We compared sequences from 920 patients, median age of 35 years, 75% male, 67% black, 23% Hispanic, and 8% had a rapid plasma reagin titer 1:16 concurrent with their HIV diagnosis. We had HIV transmission risk data for 54%; 43% identified as men who have sex with men (MSM). Phylogenetic analysis demonstrated 123 patients (13%) grouped into 26 clusters, the largest having 20 members. In multivariable regression, age ,25, black race, MSM status, male gender, higher HIV viral load, and rapid plasma reagin 1:16 associated with clustering. We did not observe geographic grouping of genetically clustered patients. Discussion: Our results demonstrate high rates of HIV transmission clustering, without local geographic foci, among young black MSM in Chicago. Applied prospectively, phylogenetic analyses could guide prevention efforts and help break the cycle of transmission.. Copyright © 2014 by Lippincott Williams &Wilkins.


Espino S.R.,Ruth thstein Core Center | Fletcher J.,New York University | Gonzalez M.,Ruth thstein Core Center | Precht A.,Ruth thstein Core Center | And 2 more authors.
AIDS Patient Care and STDs | Year: 2015

Recent research suggests intimate partner violence (IPV) is commonly experienced by many people living with HIV/AIDS, which can complicate their care. We introduce a novel approach to screening for history of violence among 102 women of color living with HIV and receiving care at an outpatient public health clinic. Using a composite measure composed of data from a variety of screening tools, we were able to determine that 70.6% of the women had a history of violence using the composite measure, and that 43% screened positive using multiple screening tools. Although overall viral load suppression rate was high at 81.4%, women with a history of violence were less likely to be virally suppressed when compared to those without such a history (76.4% versus 93.3%, p<0.05). Our findings suggest using a variety of screening questions at entry and at follow-up care appointments may be key to identifying and supporting women survivors who may not disclose violence when first asked. Future research should foster further development, analysis, and use of a variety of screening tools such as those used in this study. © 2015 Mary Ann Liebert, Inc.


PubMed | University of Texas Health Science Center at San Antonio and Ruth thstein Core Center
Type: Journal Article | Journal: Health promotion practice | Year: 2015

The use of evidence-based interventions is increasingly expected within public health settings. However, there continues to be an evidence gap between what works in the literature and in practice. The current multiple case study focused on the adoption, adaptation, capacity building, implementation, and evaluation of healthy relationships (HR) in two demonstration project sites. Our lens for reflection and writing has been highly practical, with an aim of sharing experiences with others interested in adopting HR or another Diffusion of Effective Behavioral Interventions in clinical settings with resource challenges. Although both sites recognized the powerful influence HR had on participants and staff, they reported that HR is resource-intensive regarding training, implementation, and evaluation, limiting the possibility of sustaining the intervention.


Blank A.E.,Yeshiva University | Espino S.L.R.,Ruth thstein Core Center | Eastwood B.,Brooklyn College | Matoff-Stepp S.,Office of Womens Health | Xavier J.,Special Projects of National Significance
Journal of Health Care for the Poor and Underserved | Year: 2013

In September 2009, the Health Resources and Services Administration, (HRSA) HIV-AIDS Bureau funded 11 programs to engage and retain women of color (WoC) living with HIV in care. This field report describes the rationale for this Special Project of National Significance (SPNS) initiative, the 11 programs in terms of their theoretical frameworks as well as the contexts and mechanism of care, and outlines some factors that may influence engaging and retaining WoC in care. © Meharry Medical College.


Lubelchek R.J.,Jr Hospital Of Cook County | Lubelchek R.J.,Ruth thstein Core Center | Lubelchek R.J.,Hospital of Cook County | Kroc K.A.,Ruth thstein Core Center | And 3 more authors.
Annals of Emergency Medicine | Year: 2011

Objective: We identify undiagnosed HIV among adult emergency department (ED) patients awaiting medicine admission through rapid testing, expedite their redirection to the inpatient HIV service, and improve linkage to ambulatory HIV care. Methods: Two ED health educators offered rapid testing to patients aged 18 to 64 years from the high-acuity ED area from which most medicine admissions originate. Heath educators obtained consent, obtained fingerstick blood, and performed point-of-care testing. Patients with reactive results received counseling, confirmatory testing, and appointments at the affiliated HIV clinic. Results: Between March 1, 2008, and February 28, 2009, 4,755 patients received testing. Thirty patients (0.6%) had received a new diagnosis of HIV; 26 were admitted and redirected to the HIV service. Characteristics of HIV positive patients were mean age 38 years, 87% men, 64% black, and 33% Hispanic; 76% had CD4 counts less than 200 cells/mm3; 67% had HIV-related diagnoses; and 93% reported for ambulatory HIV care in a median of 10 days. During 2 preceding years, these patients had a mean of 3 previous health system visits without testing. During a 6-month quality assurance interval of the 5,340 ED medicine admissions, 31% of patients were eligible for testing, of whom 88% received testing (1% positive) and 12% declined; 29% of the 5,340 were not approached for testing; and 40% were deemed ineligible. Common reasons for ineligibility included older age, recent previous test, and known HIV-positive status. Conclusion: Patients who receive a diagnosis of HIV in our ED before admission are extremely ill, most having AIDS. Targeted HIV screening of ED patients awaiting hospital admission facilitated timely diagnosis and reliable linkage to inpatient and outpatient HIV care. Copyright © 2011 by the American College of Emergency Physicians.


PubMed | Rush University Medical Center, University of Illinois at Chicago, Ruth thstein Core Center and University of North Carolina at Chapel Hill
Type: | Journal: BMC infectious diseases | Year: 2015

Tissue factor (TF) is a protein that mediates the initiation of the coagulation cascade. TF expression is increased in patients with poorly-controlled HIV, and may be associated with increased immune activation that leads to cardiovascular morbidity. The role of TF in immune activation in liver disease in hepatitis C virus (HCV)-monoinfection and HIV/HCV-coinfection has not been explored.Fifty-nine patients were stratified: A) HIV-monoinfection (N = 15), B) HCV-monoinfection with chronic hepatitis C (CHC) (N = 15), C) HIV/HCV-coinfection with CHC (N = 14), and D) HIV/HCV-seropositive with cleared-HCV (N = 15). All HIV+ patients had undetectable HIV viremia. Whole blood was collected for CD4/CD8 immune activation markers by flow cytometry and plasma was assayed for microparticle TF (MPTF) activity. Subjects underwent transient elastography (TE) to stage liver fibrosis. Undetectable versus detectable MPTF was compared across strata using Fishers Exact test.MPTF activity was more frequently detected among patients with HCV-monoinfection (40%), compared to HIV-monoinfection and HIV/HCV-seropositive with cleared HCV (7%) and HIV/HCV-coinfection with CHC (14%) (p = 0.02). Mean TE-derived liver stiffness score in kPa was higher in patients with detectable MPTF (12.4 8.5) than those with undetectable MPTF (6.4 3.0) (p = 0.01). Mean CD4 + HLADR+ and CD4 + CD38-HLADR+ expression were higher in those with detectable MPTF (44 9.8% and 38 8.7%, respectively) than those with undetectable MPTF (36 11% and 31 10.4% respectively) (p = 0.05 and 0.04 respectively).HCV-monoinfection and HIV/HCV-coinfection with CHC were associated with MPTF activity. MPTF activity is also associated with advanced liver fibrosis and with CD4 + HLADR+ immune activation.

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