Ten Sites, 10 Years, 10 Lessons: Scale-up of Routine HIV Testing at Community Health Centers in the Bronx, New York

OBJECTIVE:

In response to the current CDC recommendations for routine HIV testing in clinical settings, the Adolescent AIDS Program at Montefiore Medical Center in the Bronx, New York, developed the Advise, Consent, Test, Support routine HIV testing model (ACTS) in 2003. ACTS was piloted in 10 community health centers operated by Montefiore because they serve populations most at risk for HIV/AIDS.

METHODS:

ACTS streamlined and codified the counseling and testing process, provided a routine HIV testing practice change plan, and provided training and communication materials that promoted routine HIV testing. To determine program success, we measured the number of patients seen at the clinics, the number of HIV test-eligible patients (those aged 13-64 years and not pregnant), the number and percent of patients receiving HIV testing, HIV test results, and the number of patients linked to care.

RESULTS:

HIV testing in the 10 sites increased nearly threefold during the pilot period (2003-2007), from 3,944 of 49,125 eligible patients (8%) tested in 2003 to 11,212 of 55,629 eligible patients (20%) tested in 2007. With little ongoing support, the sites continued or maintained improvements: 13,226 of 56,686 eligible patients (23%) were tested in 2008, 15,965 of 57,025 eligible patients (28%) were tested in 2011, 17,483 of 60,514 eligible patients (29%) were tested in 2012, and 17,971 of 63,172 eligible patients (28%) were tested in 2013. Sites identified 433 HIV-positive patients from 2006 to 2013 (0.2%-0.6% annual seropositivity), and 96% of them were linked to care within 90 days of HIV diagnoses (range: 92% to 98% annually).

CONCLUSION:

ACTS demonstrated that substantial and sustained increases in routine HIV testing can be achieved in health-care settings, not by adding personnel or financial resources, but by using the model's practice change plan and streamlined HIV testing approach.

Full PDF article at:  http://goo.gl/YLO4Zp

By:  Futterman D1, Stafford S1, Meissner P2, Lyle-Gassama M1, Blank A3, DuBois L1, Swartz J4.

• 1Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
• 2Montefiore Medical Center, Office of Research Program Development, Bronx, NY.
• 3Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY.
• 4Montefiore Medical Center, Department of Family and Social Medicine, Bronx, NY. 
• Public Health Rep. 2016 Jan-Feb;131 Suppl 1:53-62.

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When HIV Treatment Goals Conflict with Guideline-Based Opioid Prescribing: A Qualitative Study of HIV Providers

BACKGROUND:

HIV-infected patients have high prevalence of chronic pain and opioid use, making HIV care a critical setting for improving the safety of opioid prescribing. Little is known about HIV treatment providers' perspectives about opioid prescribing to patients with chronic pain.

METHODS:

We administered a questionnaire and conducted semi-structured telephone interviews with 18 HIV treatment providers (infectious disease specialists, general internists, family medicine physicians, nurse practitioners, and physician assistants) in Bronx, NY. Open-ended interview questions focused on providers' experiences, beliefs, and attitudes about opioid prescribing and about use of guideline-based opioid prescribing practices (conservative prescribing, and monitoring for and responding to misuse). Transcripts were thematically analyzed using a modified grounded theory approach.

RESULTS:

Eighteen HIV treatment providers included 13 physicians, 4 nurse practitioners, and 3 physician assistants. They were 62% female, 56% white, and practiced as HIV providers for a mean of 14.6 years. Most reported always or almost always using opioid treatment agreements (56%) and urine drug testing (61%) with their patients on long-term opioid therapy. HIV treatment providers tended to view opioid prescribing for chronic pain within the "HIV paradigm," a set of priorities and principles defined by three key themes: 1) primacy of HIV goals, 2) familiarity with substance use, and 3) the clinician as ally. The HIV paradigm sometimes supported, and sometimes conflicted with guideline-based opioid prescribing practices. For HIV treatment providers, perceived alignment with the HIV paradigm determined whether and how guideline-based opioid prescribing practices were adopted. For example, the primacy of HIV goals superseded conservative opioid prescribing when providers prescribed opioids with the goal of retaining patients in HIV care.

CONCLUSION:

Our findings highlight unique factors in HIV care that influence adoption of guideline-based opioid prescribing practices. These factors should be considered in future research and initiatives to address opioid prescribing in HIV care.

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By:  Starrels JL1, Peyser D2, Haughton L1, Fox A1, Merlin JS3, Arnsten JH1, Cunningham CO1.

• 1 Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
• 2 Center for Alcohol Studies, Rutgers University , New York , NY , USA.
• 3 University of Alabama at Birmingham , Birmingham , AL , USA. 
• Subst Abus. 2016 Feb 9:0. 

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Characteristics of Methadone Maintenance Treatment Patients Prescribed Opioid Analgesics

BACKGROUND:

Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them to MMT patients not prescribed opioid analgesics.

METHODS:

We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012-2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included: patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients' report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-squared tests, t-tests, and Mann-Whitney U tests.

RESULTS:

Of 611 MMT patients, most reported chronic pain (62.0%), HCV infection (52.1%), and currently using illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report HIV infection and chronic pain.

CONCLUSION:

Among MMT patients primarily in three Bronx clinics, nearly one-third reported taking prescribed opioid analgesics. Compared to patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.

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By:  Glenn MC1, Sohler NL2, Starrels JL1,3, Maradiaga J1, Jost JJ1, Arnsten JH1,3, Cunningham CO1,3.

• 1a Albert Einstein College of Medicine , Bronx , NY , USA .
• 2c The City College of New York, Sophie Davis School of Biomedical Education , NY , NY , USA .
• 3b Montefiore Medical Center , Bronx , NY , USA .
• Subst Abus. 2016 Jan 5:0.  

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“I Kicked the Hard Way. I Got Incarcerated.” Withdrawal from Methadone During Incarceration & Subsequent Aversion to Medication Assisted Treatments

Highlights

• This qualitative study examined the barriers to evidence-based opioid agonist treatment in formerly incarcerated individuals with opioid use disorder in the Bronx, NY.
• Inadequate access to methadone maintenance treatment during incarceration was perceived to be a barrier to opioid agonist treatment post-release.
• Subjects who received methadone prior to incarceration reported high levels of withdrawal symptoms during incarceration, which led to subsequent aversion to opioid agonist treatment post-release.
• Policies of American penal facilities may be discouraging individuals with opioid use disorder from seeking opioid agonist treatment upon re-entry.

Incarceration is a common experience for individuals with opioid use disorder, including those receiving medication assisted treatments (MAT), such as buprenorphine or methadone. In the United States, MAT is rarely available during incarceration. 

We were interested in whether challenges with methadone maintenance treatment during incarceration affected subsequent attitudes toward MAT following release. We conducted semi-structured interviews with 21 formerly incarcerated individuals with opioid use disorder in community substance abuse treatment settings. Interviews were audio recorded, transcribed, and analyzed using a grounded theory approach. 

Themes that emerged upon iterative readings of transcripts were discussed by the research team. The three main themes relating to methadone were: 

1. rapid dose reduction during incarceration; 
2. discontinuity of methadone during incarceration; and 
3. post incarceration aversion to methadone. 

Participants who received methadone maintenance treatment prior to incarceration reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration. The severe withdrawal during incarceration contributed to a subsequent aversion to methadone and adversely affected future decisions regarding reengagement in MAT. 

Though MAT is the most efficacious treatment for opioid use disorder, current penal policy, which typically requires cessation of MAT during incarceration, may dissuade individuals with opioid use disorder from considering and engaging in MAT after release from incarceration.

Purchase full article at:   http://goo.gl/KXADkw

By:   Jeronimo A. Maradiaga, B.A., Shadi Nahvi, M.D., M.S., Chinazo O. Cunningham, M.D., M.S., Jennifer Sanchez, M.P.H., Aaron D. Fox, M.D., M.S.

Affiliations

Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461

Correspondence

Corresponding author at: Albert Einstein College of Medicine Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467. Tel.: +1 718 920 3782.

jmaradia@montefiore.org

DOI: http://dx.doi.org/10.1016/j.jsat.2015.11.004

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Bisexual Behavior among Male Injection Drug Users in New York City

Drug using men who have sex with men and women (MSMW) may be at high risk for HIV infection and transmitting HIV to sex partners. 

In 2012, injection drug users (IDUs) were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent-driven sampling. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (95 %CI) to determine correlates of bisexual behavior in the past 12 months. Of 333 participants, 47(14.1 %) reported MSMW. 

Variables independently associated (p < 0.05) with MSMW included bisexual sexual identity (vs. "straight"), Bronx residence [vs. Manhattan], past 12 month behaviors of having sex with ≥3 sex partners, "sold" sex, "bought" sex, and injection methamphetamine use. MSM IDUs are an important subgroup to consider for HIV interventions, as they may not be reached through HIV prevention programming aimed at MSM.

Purchase full article at:   http://goo.gl/5YqMlz

By:  Reilly KH1, Neaigus A2, Wendel T3, Marshall DM 4th4, Hagan H5.

• 1HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN: 22-109, Long Island City, NY, 11101, USA. kreilly3@health.nyc.gov.
• 2HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN: 22-109, Long Island City, NY, 11101, USA.
• 3St. Ann's Corner of Harm Reduction, Bronx, NY, USA.
• 4Center for HIV Educational Studies & Training, New York, NY, USA.
• 5College of Nursing, New York University, New York, NY, USA. 

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Trajectories of Sensation Seeking among Puerto Rican Children and Youth

OBJECTIVE:

To document the natural course of sensation seeking from childhood to adolescence, characterize distinct sensation seeking trajectories, and examine how these trajectories vary according to selected predictors.

METHOD:

Data were obtained from the Boricua Youth Study, a longitudinal study of 2,491 children and adolescents of Puerto Rican background (3 assessments from 2000 to 2004). First, age-specific sensation seeking levels were characterized, and then age-adjusted residuals were analyzed using growth mixture models.

RESULTS:

On average, sensation seeking was stable in childhood (ages 5-10 years) and increased during adolescence (ages 11-17 years). Mean scores of sensation seeking were higher in the South Bronx versus Puerto Rico and among males versus females. Four classes of sensation seeking trajectories were observed: most study participants had age-expected sensation seeking trajectories following the average for their age ("normative," 43.8%); others (37.2%) remained consistently lower than the expected average for their age ("low" sensation seeking); some (12.0%) had an "accelerated" sensation seeking trajectory, increasing at a faster rate than expected; and a minority (7.0%) had a decreasing sensation seeking trajectory that started high but decreased, reaching scores slightly higher than the age-average sensation seeking scores ("stabilizers"). Site (South Bronx versus Puerto Rico) and gender were predictors of membership in a specific class of sensation seeking trajectory.

CONCLUSION:

It is important to take a developmental approach when examining sensation seeking and to consider gender and the social environment when trying to understand how sensation seeking evolves during childhood and adolescence.

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By:  Martins SS1, Wall MM2, Eisenberg R2, Blanco C2, Santaella J3, Ramos-Olazagasti M2, Canino G4, Bird HR2, Brown Q3, Duarte CS2.

• 1Columbia University, Mailman School of Public Health, New York. Electronic address: ssm2183@columbia.edu.
• 2Columbia University and New York State Psychiatric Institute, New York.
• 3Columbia University, Mailman School of Public Health, New York.
• 4Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan.

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Food Insecurity with Hunger Is Associated with Obesity among HIV-Infected & At Risk Women in Bronx, NY

Food insecurity, insufficient quality and quantity of nutritionally adequate food, affects millions of people in the United States (US) yearly, with over 18 million Americans reporting hunger. Food insecurity is associated with obesity in the general population. Due to the increasing prevalence of obesity and risk factors for cardiovascular disease among HIV-infected women, we sought to determine the relationship between food insecurity and obesity in this cohort of urban, HIV-infected and -uninfected but at risk women.

Using a cross-sectional design, we collected data on food insecurity, body mass index and demographic and clinical data from 231 HIV-infected and 119 HIV-negative women enrolled in Bronx site of the Women's Interagency HIV Study (WIHS). We used multivariate logistic regression to identify factors associated with obesity.

Food insecurity was highly prevalent, with almost one third of women (110/350, 31%) reporting food insecurity over the previous six months and over 13% of women reported food insecurity with hunger. Over half the women were obese with a Body Mass Index (BMI) of ≥ 30. In multivariate analyses, women who were food insecure with hunger had higher odds of obesity after adjusting for HIV status, age, race, household status, income, drug and alcohol use.

Food insecurity with hunger was associated with obesity in this population of HIV-infected and -uninfected, urban women. Both food insecurity and obesity are independent markers for increased mortality; further research is needed to understand this relationship and their role in adverse health outcomes.

Full article at:  http://goo.gl/N9qlcT

By: Sirotin N1, Hoover DR2, Shi Q3, Anastos K4, Weiser SD5.

• 1Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
• 2Department of Statistics and Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, United States of America.
• 3Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York, United States of America.
• 4Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America.
• 5Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, California, United States of America. 

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Correlates of Selling Sex among Male Injection Drug Users in New York City

Compared to female IDUs, the correlates of receiving money, drugs, or other things in exchange for sex ("selling sex") among male IDUs are not well understood.

In 2012, IDUs were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent driven sampling. Analyses were limited to male participants. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to determine the correlates of selling sex to (1) men and (2) women in the past 12 months.

Of 394 males, 35 (8.9%) sold sex to men and 66 (16.8%) sold sex to women. Correlates of selling sex to men included bisexual/gay identity (aOR: 31.0; 95% CI: 8.1, 119.1), Bronx residence (vs. Manhattan), and in the past 12 months, being homeless, ≥3 sex partners, non-injection cocaine use, and injecting methamphetamine. Correlates of selling sex to women included, in the past 12 months, ≥3 sex partners, binge drinking at least once a week, non-injection crack use, most frequently injected "speedball" (vs. heroin), and receptively shared syringes.

Among male IDUs, those who sold sex had more sex partners, which may facilitate the sexual spread of HIV among IDUs and to non-IDU male and female sex partners. HIV prevention interventions aimed at male IDUs who sell sex should consider both their sexual and parenteral risks and the greater risk of engaging in exchange sex associated with the use of injection and non-injection stimulant drugs.

Purchase full article at: http://goo.gl/csRkCm

By: Reilly KH1, Neaigus A2, Wendel T3, Marshall Iv DM4, Hagan H5.

• 1HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA. Electronic address: kreilly3@health.nyc.gov.
• 2HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
• 3St. Ann's Corner of Harm Reduction, 310 Walton Ave., Bronx, NY 10451, USA.
• 4Department of Anthropology, John Jay College of Criminal Justice, 899 10th Ave., New York, NY 10019, USA.
• 5College of Nursing, New York University, 726 Broadway, New York, NY 10003, USA.  

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Antiretroviral Drug Use in a Cohort of HIV-Uninfected Women in the United States: HIV Prevention Trials Network 064

Antiretroviral (ARV) drug use was analyzed in HIV-uninfected women in an observational cohort study conducted in 10 urban and periurban communities in the United States with high rates of poverty and HIV infection. Plasma samples collected in 2009–2010 were tested for the presence of 16 ARV drugs. ARV drugs were detected in samples from 39 (2%) of 1,806 participants: 27/181 (15%) in Baltimore, MD and 12/179 (7%) in Bronx, NY. The ARV drugs detected included different combinations of non-nucleoside reverse transcriptase inhibitors and protease inhibitors (1–4 drugs/sample). These data were analyzed in the context of self-reported data on ARV drug use. None of the 39 women who had ARV drugs detected reported ARV drug use at any study visit. Further research is needed to evaluate ARV drug use by HIV-uninfected individuals.

Table 4

Association of Antiretroviral Drug Detection with Behavioral Characteristics of Partners of HIV-uninfected Study Participants in Baltimore, MD and Bronx, NY.

	Baltimore			Bronx			Baltimore and Bronx
	ARV drugs detected			ARV drugs detected			ARV drugs detected
Baseline	Yes	No		Yes	No		Yes	No
Characteristic	27	154	P value	12	167	P value	39	321	P value
HIV positive diagnosis	1 (4%)	1 (1%)	0.28	0 (0%)	2 (1%)	1.00	1 (3%)	3 (1%)	0.37
Reported STI	7 (26%)	18 (12%)	0.07	1 (8%)	16 (10%)	1.00	8 (21%)	34 (11%)	0.11
Illicit drug use	14 (52%)	75 (49%)	0.76	3 (25%)	46 (28%)	1.00	17 (44%)	121 (38%)	0.47
Binge-drinking	15 (56%)	81 (53%)	0.78	9 (75%)	115 (69%)	0.76	24 (62%)	196 (61%)	0.95
Alcohol dependence	16 (59%)	77 (50%)	0.37	6 (50%)	79 (47%)	0.86	22 (56%)	156 (49%)	0.34
Incarceration	24 (89%)	97 (63%)	0.008	7 (58%)	111 (67%)	0.55	31 (80%)	208 (65%)	0.07

The table shows characteristics of partners of HIV-uninfected participants who were enrolled in Baltimore, MD and Bronx, NY (limited to participants whose samples were screened for ARV drugs in this study). Study participants were asked to self-report characteristics of partners within six months of enrollment, unless otherwise specified. Fisher’s exact, chi-square, and Wilcoxon rank sum tests were used to analyze the association between these characteristics and ARV drug detection. P values <0.05 are bolded. Baseline characteristics are defined as follows: Reported STI: Reported partner sexually-transmitted infection, including gonorrhea, syphilis, or chlamydia infection; Substance use: At least weekly substance use (including drug use or binge-drinking [≥4 drinks on 1 occasion]); Binge drinking: ≥5 drinks on 1 occasion; Alcohol dependence: Cut Down, Annoyed, Guilty, and Eye Opener (CAGE) score ≥2; Incarceration: incarcerated during the past 5 years. Abbreviations: ARV: antiretroviral.

Table 3

Association of Antiretroviral Drug Detection with Behavioral Characteristics of HIV-uninfected Study Participants in Baltimore, MD and Bronx, NY.

	Baltimore			Bronx			Baltimore and Bronx
	ARV drugs detected			ARV drugs detected			ARV drugs detected
Baseline	Yes	No		Yes	No		Yes	No
Characteristic	27	154	P value	12	167	P value	39	321	P value
Median number of partners (IQR)	2.0 (1.0, 6.0)	2.0 (1.0, 4.0)	0.74	2.5 (1.0, 3.0)	2.0 (1.0, 4.0)	0.99	2.0 (1.0, 3.0)	2.0 (1.0, 4.0)	0.63
Exchange sex for commoditiesa	13 (50%)	76 (51%)	0.92	3 (25%)	49 (29%)	1.00	16 (42%)	125 (40%)	0.76
Unknown HIV status of last partner	8 (30%)	66 (43%)	0.20	4 (33%)	56 (34%)	1.00	12 (31%)	122 (38%)	0.38
Condom use (vaginal)	4 (15%)	11 (7%)	0.25	4 (33%)	26 (16%)	0.12	8 (21%)	37 (12%)	0.12
Anal sex	12 (44%)	68 (44%)	0.98	5 (42%)	75 (45%)	0.83	17 (44%)	143 (45%)	0.91
Condom use (anal)b	0 (0%)	11 (16%)	0.20	0 (0%)	11 (15%)	1.00	0 (0%)	22 (15%)	0.13
Concurrencya	15 (56%)	72 (47%)	0.42	5 (42%)	68 (41%)	1.00	20 (51%)	140 (44%)	0.37
Self-reported STIa	4 (15%)	25 (16%)	1.00	1 (9%)	14 (8%)	1.00	5 (13%)	39 (12%)	0.80
Substance use	14 (52%)	86 (56%)	0.70	4 (33%)	69 (41%)	0.76	18 (46%)	155 (48%)	0.80
Binge drinkinga	9 (33%)	46 (30%)	0.73	3 (25%)	56 (34%)	0.75	12 (31%)	102 (32%)	0.89
Drug use	11 (41%)	56 (36%)	0.66	1 (8%)	24 (14%)	1.00	12 (31%)	80 (25%)	0.43
Depressive symptomsa	16 (59%)	68 (45%)	0.18	3 (30%)	55 (35%)	1.00	19 (51%)	123 (40%)	0.19
Any history of abuse	11 (41%)	53 (34%)	0.53	6 (50%)	54 (32%)	0.22	17 (44%)	107 (33%)	0.20
Any childhood abuse	18 (67%)	71 (46%)	0.049	7 (58%)	69 (41%)	0.25	25 (64%)	140 (44%)	0.015

The table shows characteristics of HIV-uninfected participants who were enrolled in Baltimore, MD and Bronx, NY (limited to participants whose samples were screened for ARV drugs in this study). Study participants were asked to self-report characteristics within six months of enrollment, unless otherwise specified. Fisher’s exact, chi-square, and Wilcoxon rank sum tests were used to analyze the association between these characteristics and ARV drug detection. P values <0.05 are bolded. Baseline characteristics are defined as follows: Unknown HIV status of last partner: unknown HIV status of man with whom had last vaginal sex; Condom use (vaginal): Condom used with last vaginal sex; Condom use (anal): Condom used with last anal sex; Concurrency: self-report of sex with a man while involved in a sexual relationship with another man during the same period; Self-reported STI: Self-reported sexually-transmitted infection, including gonorrhea, syphilis, or chlamydia infection; Substance use: At least weekly substance use (including drug use or binge-drinking [≥4 drinks on 1 occasion]); Binge drinking: At least weekly binge-drinking (≥4 drinks on 1 occasion); Drug use: At least weekly drug use (excluding cannabis); Depressive symptoms: score ≥7 using the Center for Epidemiologic Studies Depression (CES-D) scale. Abbreviations: ARV: antiretroviral; IQR: interquartile range.

aSome participants did not respond to all of the questions asked. In these cases, the percentage was calculated among all of the respondents.

bThis percentage was calculated among participants who reported ever having anal sex.

Full article at: http://goo.gl/CBdj6y

By: Iris Chen,1 William Clarke,1 San-San Ou,2 Mark A. Marzinke,1 Autumn Breaud,1 Lynda M. Emel,2 Jing Wang,2 James P. Hughes,2,3 Paul Richardson,1 Danielle F. Haley,4 Jonathan Lucas,5 Anne Rompalo,6 Jessica E. Justman,7 Sally L. Hodder,8 and Susan H. Eshleman1,*

¹Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

2Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America

3Department of Biostatistics, University of Washington, Seattle, Washington, United States of America

4Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

5Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America

6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

7ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America

8Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia, United States of America

²Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America

³Department of Biostatistics, University of Washington, Seattle, Washington, United States of America

⁴Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

⁵Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America

⁶Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

⁷ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America

⁸Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia, United States of America

University of Pittsburgh, UNITED STATES

   

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