Scholars@Duke
Nathan Maclyn Thielman

Nathan Maclyn Thielman

Professor of Medicine
Medicine, Infectious Diseases
Duke Box 90519, Durham, NC 27708-0519
310 Trent Drive, Room 201, Trent Hall, Durham, NC 27710

Selected Publications

Tuberculosis Is Associated with Chronic Hypoxemia among Kenyan Adults (CHAKA): A Case-Control Study.

Journal Article Ann Am Thorac Soc · August 2024 Rationale: Data on risk factors for chronic hypoxemia in low- and middle-income countries are lacking. Objectives: We aimed to quantify the association between potential risk factors and chronic hypoxemia among adults hospitalized in Kenya. Methods: A hosp ... Full text Link to item Cite

Proteomics discovery in children and young adults with HIV identifies fibrosis, inflammatory, and immune biomarkers associated with myocardial impairment.

Journal Article AIDS · June 1, 2024 People with HIV are at increased risk of cardiac dysfunction; however, limited tools are available to identify patients at highest risk for future cardiac disease. We performed proteomic profiling using plasma samples from children and young adults with pe ... Full text Link to item Cite

Mobile Phone-Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial.

Journal Article JMIR Res Protoc · May 30, 2024 BACKGROUND: Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social n ... Full text Link to item Cite

Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping.

Journal Article BMC Health Serv Res · March 28, 2024 BACKGROUND: Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of ... Full text Open Access Link to item Cite

Diffuse myocardial fibrosis is uncommon in people with perinatally acquired human immunodeficiency virus infection.

Journal Article AIDS Res Ther · March 4, 2024 BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of death in people living with HIV. Myocardial fibrosis is well-described in HIV infection acquired in adulthood. We evaluate the burden of fibrosis by cardiac magnetic resonance in people wi ... Full text Link to item Cite

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study.

Journal Article JMIR Res Protoc · January 12, 2024 BACKGROUND: Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with child ... Full text Link to item Cite

Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study.

Journal Article Int J STD AIDS · January 2024 INTRODUCTION: People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS: In this qualitative ... Full text Link to item Cite

Predictors of prior HIV testing and acceptance of a community-based HIV test offer among male bar patrons in northern Tanzania.

Journal Article PLOS Glob Public Health · 2024 Community-based HIV testing offers an alternative approach to encourage HIV testing among men in sub-Saharan Africa. In this study, we evaluated a community-based HIV testing strategy targeting male bar patrons in northern Tanzania to assess factors predic ... Full text Link to item Cite

Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention.

Journal Article Ann Glob Health · 2024 BACKGROUND: Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. OBJECTIVES: Co-design a quality improvement interventio ... Full text Link to item Cite

Provider attitudes towards quality improvement for myocardial infarction care in northern Tanzania.

Journal Article PLOS Glob Public Health · 2024 INTRODUCTION: Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence o ... Full text Link to item Cite

Kidney disease characteristics, prevalence, and risk factors in León, Nicaragua: a population-based study.

Journal Article BMC Nephrol · November 12, 2023 BACKGROUND: CKD of unknown etiology (CKDu) disproportionately affects young people in Central America who lack traditional CKD risk factors (diabetes and hypertension) and has instead been variably linked to heat stress, occupational and environmental expo ... Full text Link to item Cite

Experiences of Black Adults Evaluated in a Locked Psychiatric Emergency Unit: A Qualitative Study.

Journal Article Psychiatr Serv · October 1, 2023 OBJECTIVE: Evidence shows that Black individuals have higher rates of coercive emergency psychiatric interventions than other racialized groups, yet no studies have elevated the voices of Black patients undergoing emergency psychiatric evaluation. This qua ... Full text Link to item Cite

Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study.

Journal Article BMJ Open · September 18, 2023 OBJECTIVE: Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya ... Full text Open Access Link to item Cite

Divergent preferences for enhanced HIV testing options among high-risk populations in northern Tanzania: a short report.

Journal Article AIDS Care · September 2023 To achieve the UNAIDS target of diagnosing 95% of all persons living with HIV, enhanced HIV testing services with greater attractional value need to be developed and implemented. We conducted a discrete choice experiment (DCE) to quantify preferences for e ... Full text Link to item Cite

How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples.

Journal Article Glob Health Sci Pract · April 28, 2023 BACKGROUND: Asset-based indices of living standards, or wealth indices, are widely used proxies for economic status; however, such indices are not readily available for small and nonrepresentative samples. METHODS: We describe a simple out-of-sample predic ... Full text Link to item Cite

Six-month blood pressure and glucose control among HIV-infected adults with elevated blood pressure and hyperglycemia in northern Tanzania: A prospective observational study.

Journal Article PLoS One · 2023 BACKGROUND: People with HIV in sub-Saharan Africa are increasingly developing age-related comorbidities. The purpose of this prospective observational study was to describe 6-month outcomes among Tanzanians with HIV and elevated blood pressure or hyperglyc ... Full text Link to item Cite

Six-month incidence of hypertension and diabetes among adults with HIV in Tanzania: A prospective cohort study.

Journal Article PLOS Glob Public Health · 2023 Data describing the incidence of hypertension and diabetes among people with HIV in sub-Saharan Africa remain sparse. In this study, adults with HIV were enrolled from a public clinic in Moshi, Tanzania (September 2020-March 2021). At enrollment, a survey ... Full text Link to item Cite

Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.

Journal Article Int J Public Health · 2023 Objectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-r ... Full text Open Access Link to item Cite

Prevalence and predictors of uncontrolled hypertension, diabetes, and obesity among adults with HIV in northern Tanzania.

Journal Article Glob Public Health · December 2022 HIV is associated with increased risk of cardiovascular disease, but there has been less study of cardiovascular comorbidities among people with HIV in sub-Saharan Africa. In a cross-sectional observational study, Tanzanian adults presenting for outpatient ... Full text Link to item Cite

Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania.

Journal Article Sex Transm Dis · November 1, 2022 Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of t ... Full text Link to item Cite

A community health worker delivered intervention to address hypertension among adults engaged in HIV care in northern Tanzania: Outcomes from a pilot feasibility study.

Journal Article J Clin Hypertens (Greenwich) · August 2022 Current care models are inadequate to address the dual epidemic of hypertension and HIV in sub-Saharan Africa. We developed a community health worker (CHW)-delivered educational intervention, integrated into existing HIV care to address hypertension in per ... Full text Link to item Cite

Healthcare-seeking behaviour, barriers to care and predictors of symptom improvement among patients with cardiovascular disease in northern Tanzania.

Journal Article Int Health · July 1, 2022 BACKGROUND: Little is known about healthcare-seeking behaviour and barriers to care for cardiovascular disease (CVD) in sub-Saharan Africa. METHODS: Emergency department patients in Tanzania with acute CVD were prospectively enrolled. Questionnaires were a ... Full text Open Access Link to item Cite

Association of Black Race With Physical and Chemical Restraint Use Among Patients Undergoing Emergency Psychiatric Evaluation.

Journal Article Psychiatr Serv · July 2022 OBJECTIVE: Few studies have examined the disproportionate use of restraints for Black adults receiving emergency psychiatric care. This study sought to determine whether the odds of physical and chemical restraint use were higher for Black patients undergo ... Full text Link to item Cite

One-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania.

Journal Article Circ Cardiovasc Qual Outcomes · April 2022 BACKGROUND: Little is known about long-term outcomes and uptake of secondary preventative therapies following acute myocardial infarction (AMI) in sub-Saharan Africa. METHODS: Consecutive patients presenting with AMI (as defined by the Fourth Universal Def ... Full text Link to item Cite

Treatment of Acanthamoeba Encephalitis.

Journal Article Am J Med · January 2022 Full text Link to item Cite

Feasibility of Cardiac Rehabilitation Models in Kenya.

Journal Article Ann Glob Health · 2022 BACKGROUND: Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. Cardiac rehabilitation (CR) is known to improve functional capacity and reduce morbidity associated with HF. Although CR is a low-cost inter ... Full text Link to item Cite

Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices.

Journal Article Pan Afr Med J · 2022 CITE THIS ARTICLE: Preeti Manavalan et al. Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices. Pan African Medical Journal. 2022;41(285). 10.11604/pamj.2022.41.285 ... Full text Link to item Cite

Knowledge, attitudes, and preventive practices regarding ischemic heart disease among HIV-positive individuals in northern Tanzania.

Journal Article Trop Med Int Health · December 2021 OBJECTIVES: To describe knowledge, attitudes, and practices (KAP) regarding ischemic heart disease (IHD) among adults with HIV in Tanzania. METHODS: Adults presenting for routine HIV care at a clinic in northern Tanzania were consecutively enrolled and wer ... Full text Link to item Cite

Thirty-day outcomes and predictors of mortality following acute myocardial infarction in northern Tanzania: A prospective observational cohort study.

Journal Article Int J Cardiol · November 1, 2021 OBJECTIVE: There is a rising burden of myocardial infarction (MI) within sub-Saharan Africa. Prospective studies of detailed MI outcomes in the region are lacking. METHODS: Adult patients with confirmed MI from a prospective surveillance study in northern ... Full text Link to item Cite

What factors influence HIV testing? Modeling preference heterogeneity using latent classes and class-independent random effects.

Journal Article J Choice Model · September 2021 Efforts to eliminate the HIV epidemic will require increased HIV testing rates among high-risk populations. To inform the design of HIV testing interventions, a discrete choice experiment (DCE) with six policy-relevant attributes of HIV testing options eli ... Full text Link to item Cite

Incidence of Acute Myocardial Infarction in Northern Tanzania: A Modeling Approach Within a Prospective Observational Study.

Journal Article J Am Heart Assoc · August 3, 2021 Background Rigorous incidence data for acute myocardial infarction (AMI) in sub-Saharan Africa are lacking. Consequently, modeling studies based on limited data have suggested that the burden of AMI and AMI-associated mortality in sub-Saharan Africa is low ... Full text Open Access Link to item Cite

Increasing the Uptake of HIV Testing among Men in Tanzania: A Novel Intervention for Bar Patrons.

Journal Article AIDS Behav · July 2021 We investigated a novel community-based HIV testing and counseling (HTC) strategy by recruiting men from bars in northern Tanzania in order to identify new HIV infections. All bars in the town of Boma Ng'ombe were identified and male patrons were systemati ... Full text Link to item Cite

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review.

Journal Article J Glob Health · May 8, 2021 BACKGROUND: Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in ... Full text Open Access Link to item Cite

Ebola virus antibody decay-stimulation in a high proportion of survivors.

Journal Article Nature · February 2021 Neutralizing antibody function provides a foundation for the efficacy of vaccines and therapies1-3. Here, using a robust in vitro Ebola virus (EBOV) pseudo-particle infection assay and a well-defined set of solid-phase assays, we describe a wide spectrum o ... Full text Link to item Cite

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.

Journal Article PLoS One · 2021 BACKGROUND: The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS: In a prospective obser ... Full text Open Access Link to item Cite

Hypertension Care for People With HIV in Tanzania: Provider Perspectives and Opportunities for Improvement.

Journal Article Journal of the International Association of Providers of AIDS Care · January 2021 One in three people with HIV (PWH) has hypertension. However, most hypertensive PWH in sub-Saharan Africa are unaware of their hypertension diagnosis and are not on treatment. To better understand barriers to hypertension care faced by PWH, we interviewed ... Full text Cite

Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries.

Journal Article Int J Public Health · 2021 Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes. Methods: We used the longitudinal, m ... Full text Link to item Cite

Pediatric refugee health and patterns of health care utilization in durham, north carolina

Journal Article North Carolina Medical Journal · January 1, 2021 Background This study explored the health needs, trends of health care utilization, and barriers to care of a diverse population of refugee children resettled in Durham County, North Carolina. Methods Researchers conducted a retrospective chart review of 3 ... Full text Cite

Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations.

Journal Article BMJ Open · November 6, 2020 INTRODUCTION: Approximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk po ... Full text Link to item Cite

Effect of a Triage-Based Screening Protocol on Diagnosis and Treatment of Acute Coronary Syndrome in a Tanzanian Emergency Department: A Prospective Pre-Post Study.

Journal Article J Am Heart Assoc · August 18, 2020 Background Evidence suggests that acute coronary syndrome (ACS) is underdiagnosed in sub-Saharan Africa. Triage-based interventions have improved ACS diagnosis and management in high-income settings but have not been evaluated in sub-Saharan African emerge ... Full text Link to item Cite

Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.

Journal Article Am Heart J · August 2020 BACKGROUND: Growing evidence suggests that under-diagnosis of acute myocardial infarction (AMI) may be common in sub-Saharan Africa. Prospective studies of routine AMI screening among patients presenting to emergency departments in sub-Saharan Africa are l ... Full text Open Access Link to item Cite

Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania.

Journal Article J Clin Hypertens (Greenwich) · August 2020 Failure to address hypertension among people living with HIV (PLWH) may undermine the significant progress made toward reducing mortality among this high-risk population in sub-Saharan Africa (SSA). Here, the authors report hypertension prevalence, diagnos ... Full text Link to item Cite

Heterogeneous Patient Preferences for Modern Antiretroviral Therapy: Results of a Discrete Choice Experiment.

Journal Article Value Health · July 2020 OBJECTIVE: Limited data describe patient preferences for the growing number of antiretroviral therapies (ARTs). We quantified preferences for key characteristics of modern ART deemed relevant to shared decision making. METHODS: A discrete choice experiment ... Full text Link to item Cite

Early cardiac dysfunction in children and young adults with perinatally acquired HIV.

Journal Article AIDS · March 15, 2020 OBJECTIVE: To define the prevalence of early cardiac dysfunction in children and young adults with perinatally acquired HIV and predictors of cardiac function. DESIGN: Cross-sectional design. METHODS: Early cardiac dysfunction was defined as left ventricul ... Full text Link to item Cite

Predictors of mortality in treatment experienced HIV-infected patients in northern Tanzania.

Journal Article PLoS One · 2020 BACKGROUND: While factors that drive early mortality among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in sub-Saharan Africa (SSA) have been described, less is known about the predictors of long-term mortality for those with ART e ... Full text Link to item Cite

Examining Health Care Access for Refugee Children and Families in the North Carolina Triangle Area.

Journal Article N C Med J · 2020 BACKGROUND Resettled refugees are at increased risk of poor health outcomes due to acculturation challenges, logistical barriers, experiences of trauma, and other barriers to care that are poorly understood. Refugee children may be particularly vulnerable ... Full text Open Access Link to item Cite

"It's because I think too much": Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania.

Journal Article PLoS One · 2020 BACKGROUND: Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their dia ... Full text Link to item Cite

Knowledge, attitudes, and preventative practices regarding ischemic heart disease among emergency department patients in northern Tanzania.

Journal Article Public Health · October 2019 OBJECTIVES: The objective of this study is to increase understanding of knowledge, attitudes, and preventative practices regarding ischemic heart disease (IHD) in sub-Saharan Africa in order to develop patient-centered interventions to improve care and out ... Full text Link to item Cite

Abstract P120: Feasibility of Cardiac Rehabilitation in Resource Limited Settings

Conference Circulation · March 5, 2019 Background: Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to card ... Full text Cite

Using fetal scalp stimulation with Doppler ultrasonography to enhance intermittent auscultation in low-resource settings: a diagnostic trial from Tanzania.

Journal Article BMC Pregnancy Childbirth · February 13, 2019 BACKGROUND: Hypoxia during labor contributes to 2.2 million intrapartum and early neonatal deaths each year. An additional 0.6-1.0 million cases of life-long disability occur because of fetal hypoxia during labor. It is known that fetal heart rate changes ... Full text Open Access Link to item Cite

The burden of hypertension in the emergency department and linkage to care: A prospective cohort study in Tanzania.

Journal Article PLoS One · 2019 OBJECTIVES: Globally, hypertension affects one billion people and disproportionately burdens low-and middle-income countries. Despite the high disease burden in sub-Saharan Africa, optimal care models for diagnosing and treating hypertension have not been ... Full text Link to item Cite

The Burden of Hypertension and Diabetes in an Emergency Department in Northern Tanzania.

Journal Article Ethn Dis · 2019 INTRODUCTION: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa. METHODS: A retrospective review of adult ED patients in northern Tanzania was performed from Se ... Full text Link to item Cite

Knowledge, Cultural, and Structural Barriers to Thalassemia Screening in Migrant Populations in Thailand

Conference Blood · November 29, 2018 AbstractBACKGROUND: Thalassemia syndromes are inherited hemoglobin (Hb) disorders that most severely affect Southeast Asia (SEA). As a result of population migration, thalassemia has grown into a global heal ... Full text Cite

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda.

Journal Article Int J Health Policy Manag · November 1, 2018 BACKGROUND: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strength ... Full text Link to item Cite

Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies.

Journal Article Open Forum Infect Dis · October 2018 Study participants were asked about their interest in switching to novel drug delivery systems that reduce the dosing frequency of antiretroviral regimens. Across a diverse, treatment-experienced cohort, we describe greatest interest in switching to an ora ... Full text Link to item Cite

A Mixed Methods Approach to Understanding Antiretroviral Treatment Preferences: What Do Patients Really Want?

Journal Article AIDS Patient Care STDS · September 2018 As the number of effective antiretroviral therapy (ART) options increases, there is greater opportunity to involve HIV patients in ART selection. To establish the parameters for a shared ART decision-making process, we sought to identify ART characteristic ... Full text Link to item Cite

Pulmonary blastomycosis presenting as primary lung cancer.

Journal Article BMC Infect Dis · July 18, 2018 BACKGROUND: Blastomycosis is an endemic mycosis in North America that is caused by the dimorphic fungus Blastomyces dermatitidis. The illness is a systemic disease with a wide variety of pulmonary and extra-pulmonary manifestations. The initial presentatio ... Full text Open Access Link to item Cite

Anti-Ebola Virus Antibody Levels in Convalescent Plasma and Viral Load After Plasma Infusion in Patients With Ebola Virus Disease.

Journal Article J Infect Dis · July 13, 2018 BACKGROUND: Ebola virus (EBOV) neutralizing antibody in plasma may reduce viral load following administration of plasma to patients with Ebola virus disease (EVD), but measurement of these antibodies is complex. METHODS: Anti-EBOV antibody was measured by ... Full text Link to item Cite

Stressful and traumatic life events as disruptors to antiretroviral therapy adherence.

Journal Article AIDS Care · November 2017 Stressful and traumatic life events (STLEs) are common among HIV-infected individuals and may affect health behaviors such as adherence to antiretroviral (ARV) therapy, with important implications for treatment outcomes. We examined the association between ... Full text Link to item Cite

Apheresis for collection of Ebola convalescent plasma in Liberia.

Journal Article J Clin Apher · June 2017 PURPOSE: This report describes initiation of apheresis capability in Liberia, Africa to support a clinical trial of convalescent plasma therapy for Ebola Virus Disease. METHODS: A bloodmobile was outfitted in the United States as a four-bed apheresis unit ... Full text Link to item Cite

Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda.

Journal Article World Neurosurg · June 2017 OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with ... Full text Link to item Cite

Missed opportunities for timely diagnosis of pediatric lupus in South Africa: a qualitative study.

Journal Article Pediatr Rheumatol Online J · February 23, 2017 BACKGROUND: Systemic Lupus Erythematosus (SLE) is a serious multisystem autoimmune disease, which is more aggressive in children and people of African descent. In South Africa, pediatric SLE (pSLE) patients are at high risk for severe disease. Similar to p ... Full text Link to item Cite

Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa.

Journal Article Lupus · February 2017 Background Systemic lupus erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE on the African continent has been understudied. This study describes a co ... Full text Link to item Cite

Civic engagement among orphans and non-orphans in five low- and middle-income countries.

Journal Article Global Health · October 11, 2016 BACKGROUND: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable popula ... Full text Open Access Link to item Cite

Response.

Journal Article Clin Trials · October 2016 Full text Open Access Link to item Cite

Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania.

Journal Article BMC Infect Dis · September 20, 2016 BACKGROUND: Linkage to HIV care is crucial to the success of antiretroviral therapy (ART) programs worldwide, loss to follow up at all stages of the care continuum is frequent, and long-term prospective studies of care linkage are currently lacking. METHOD ... Full text Open Access Link to item Cite

Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries.

Journal Article AIDS Care · July 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millio ... Full text Link to item Cite

Neighborhood clustering of non-communicable diseases: results from a community-based study in Northern Tanzania.

Journal Article BMC Public Health · March 5, 2016 BACKGROUND: In order to begin to address the burden of non-communicable diseases (NCDs) in sub-Saharan Africa, high quality community-based epidemiological studies from the region are urgently needed. Cluster-designed sampling methods may be most efficient ... Full text Link to item Cite

Improvements in Depression and Changes in Fatigue: Results from the SLAM DUNC Depression Treatment Trial.

Journal Article AIDS Behav · February 2016 Fatigue and depression are common co-morbid conditions among people with HIV infection. We analyzed a population of HIV-infected adults with depression, who were enrolled in a depression treatment trial, to examine the extent to which improvements in depre ... Full text Link to item Cite

A response adaptive randomization platform trial for efficient evaluation of Ebola virus treatments: A model for pandemic response.

Journal Article Clin Trials · February 2016 The outbreak of Ebola virus disease in West Africa is the largest ever recorded. Numerous treatment alternatives for Ebola have been considered, including widely available repurposed drugs, but initiation of enrollment into clinical trials has been limited ... Full text Link to item Cite

Ebola clinical trials: Five lessons learned and a way forward.

Journal Article Clin Trials · February 2016 BACKGROUND: Little progress was made in advancing Ebola-specific therapies during the epidemic that began in West Africa in late 2013. Throughout the last quarter of 2014, which saw the greatest numbers of cases, only a handful of clinical trials were unde ... Full text Link to item Cite

Ongoing life stressors and suicidal ideation among HIV-infected adults with depression.

Journal Article J Affect Disord · January 15, 2016 BACKGROUND: Suicidal ideation is the most proximal risk factor for suicide and can indicate extreme psychological distress; identification of its predictors is important for possible intervention. Depression and stressful or traumatic life events (STLEs), ... Full text Link to item Cite

The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections Among Patients Infected With Human Immunodeficiency Virus in Northern Tanzania.

Journal Article Open Forum Infect Dis · January 2016 Background.  Due to the unintended potential misclassifications of the World Health Organization (WHO) immunological failure criteria in predicting virological failure, limited availability of treatment options, poor laboratory infrastructure, and healthca ... Full text Link to item Cite

Knowledge, Attitudes, and Practices Associated with Chronic Kidney Disease in Northern Tanzania: A Community-Based Study.

Journal Article PLoS One · 2016 BACKGROUND: Non-communicable diseases (NCDs) are a leading cause of death among adults in sub-Saharan Africa, and chronic kidney disease (CKD) is a growing public health threat. Understanding knowledge, attitudes, and practices associated with NCDs is vita ... Full text Link to item Cite

Balancing Contamination and Referral Bias in a Randomized Clinical Trial: An Application of Pseudo-Cluster Randomization.

Journal Article Am J Epidemiol · December 15, 2015 In randomized trials of provider-focused clinical interventions, treatment allocation often cannot be blinded to participants, study staff, or providers. The choice of unit of randomization (patient, provider, or clinic) entails tradeoffs in cost, power, a ... Full text Link to item Cite

Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania.

Journal Article Health Econ Rev · December 2015 OBJECTIVES: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we ... Full text Link to item Cite

Treatment and Outcomes in Pediatric SLE Patients in South Africa

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2015 Link to item Cite

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

Journal Article AIDS · September 24, 2015 BACKGROUND: Depression is a major barrier to HIV treatment outcomes. OBJECTIVE: To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. DESIGN: Pseudo-cluster randomize ... Full text Link to item Cite

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

Journal Article Glob Health Sci Pract · August 25, 2015 BACKGROUND: Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care s ... Full text Link to item Cite

When "need plus supply" does not equal demand: challenges in uptake of depression treatment in HIV clinical care.

Journal Article Psychiatr Serv · March 1, 2015 OBJECTIVE: Depression is common among patients in HIV care and is associated with worse HIV-related health behaviors and outcomes. Effective depression treatment is available, yet depression remains widely underdiagnosed and undertreated in HIV care. METHO ... Full text Link to item Cite

Improvements in depression and changes in quality of life among HIV-infected adults.

Journal Article AIDS Care · 2015 Improving quality of life (QOL) for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research ha ... Full text Link to item Cite

One size does not fit all: HIV testing preferences differ among high-risk groups in Northern Tanzania.

Journal Article AIDS Care · 2015 In order to maximize the effectiveness of "Seek, Test, and Treat" strategies for curbing the HIV epidemic, new approaches are needed to increase the uptake of HIV testing services, particularly among high-risk groups. Low HIV testing rates among such group ... Full text Link to item Cite

The determinants of traditional medicine use in Northern Tanzania: a mixed-methods study.

Journal Article PLoS One · 2015 INTRODUCTION: Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and ro ... Full text Link to item Cite

The epidemiology of chronic kidney disease in Northern Tanzania: a population-based survey.

Journal Article PLoS One · 2015 BACKGROUND: In sub-Saharan Africa, kidney failure has a high morbidity and mortality. Despite this, population-based estimates of prevalence, potential etiologies, and awareness are not available. METHODS: Between January and June 2014, we conducted a hous ... Full text Link to item Cite

Gender (in) differences in prevalence and incidence of traumatic experiences among orphaned and separated children living in five low- and middle-income countries.

Journal Article Glob Ment Health (Camb) · January 2015 BACKGROUND: Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low- and middle-income countries (LMIC) are not well-understood, although support services and preven ... Full text Link to item Cite

HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania.

Journal Article AIDS Care · 2015 HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatmen ... Full text Link to item Cite

Enhancing linkage and retention in HIV care: a review of interventions for highly resourced and resource-poor settings.

Journal Article Curr HIV/AIDS Rep · December 2014 Given the widespread availability of effective antiretroviral therapy, engagement of HIV-infected persons in care is a global priority. We reviewed 51 studies, published in the past decade, assessing strategies for improving linkage to and retention in HIV ... Full text Link to item Cite

Effect of free distribution of safety equipment on usage among motorcycle-taxi drivers in Tanzania--A cluster randomised controlled trial.

Journal Article Injury · November 2014 INTRODUCTION: Deaths due to road traffic injuries, particularly motorcycle crashes, have increased rapidly in many African nations and context-specific strategies to improve preventative behaviours are needed. Although adhering to conspicuity measures by w ... Full text Link to item Cite

Association of first-line and second-line antiretroviral therapy adherence.

Journal Article Open Forum Infect Dis · September 2014 BACKGROUND: Adherence to first-line antiretroviral therapy (ART) may be an important indicator of adherence to second-line ART. Evaluating this relationship may be critical to identify patients at high risk for second-line failure, thereby exhausting their ... Full text Link to item Cite

HIV testing preferences in Tanzania: a qualitative exploration of the importance of confidentiality, accessibility, and quality of service.

Journal Article BMC Public Health · August 12, 2014 BACKGROUND: HIV counseling and testing (HCT), an effective preventive strategy and an entry point for care, remains under-utilized in Tanzania. Limited uptake of HCT, despite the widespread availability of varied testing options, suggests that existing opt ... Full text Link to item Cite

Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer.

Journal Article J Acquir Immune Defic Syndr · March 1, 2014 : The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo ... Full text Link to item Cite

A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania.

Journal Article BMC Infect Dis · February 20, 2014 BACKGROUND: Routine tuberculosis culture remains unavailable in many high-burden areas, including Tanzania. This study sought to determine the impact of providing mycobacterial culture results over standard of care [unconcentrated acid-fast (AFB) smears] o ... Full text Open Access Link to item Cite

A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania

Journal Article BMC Infectious Diseases · February 20, 2014 Background: Routine tuberculosis culture remains unavailable in many high-burden areas, including Tanzania. This study sought to determine the impact of providing mycobacterial culture results over standard of care [unconcentrated acid-fast (AFB) smears] o ... Full text Cite

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania.

Journal Article AIDS Care · 2014 Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and trea ... Full text Link to item Cite

Heterogeneous HIV testing preferences in an urban setting in Tanzania: results from a discrete choice experiment.

Journal Article PLoS One · 2014 BACKGROUND: Efforts to reduce Human Immunodeficiency Virus (HIV) transmission through treatment rely on HIV testing programs that are acceptable to broad populations. Yet, testing preferences among diverse at-risk populations in Sub-Saharan Africa are poor ... Full text Link to item Cite

Three-year change in the wellbeing of orphaned and separated children in institutional and family-based care settings in five low- and middle-income countries.

Journal Article PLoS One · 2014 BACKGROUND: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. METHODS: ... Full text Link to item Cite

VISION: a regional performance improvement initiative for HIV health care providers.

Journal Article J Contin Educ Health Prof · 2014 INTRODUCTION: VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of ... Full text Link to item Cite

Low rates of child testing for HIV persist in a high-risk area of East Africa.

Journal Article AIDS Care · 2014 Children in low- and middle-income countries (LMIC) are the least touched by recent successes in the diagnosis and treatment of HIV/AIDS globally. Early treatment is essential for a child's longer and higher quality of life; however, by 2011, only a small ... Full text Link to item Cite

Association between earthquake events and cholera outbreaks: a cross-country 15-year longitudinal analysis.

Journal Article Prehosp Disaster Med · December 2013 INTRODUCTION: Large earthquakes can cause population displacement, critical sanitation infrastructure damage, and increased threats to water resources, potentially predisposing populations to waterborne disease epidemics such as cholera. Problem The risk o ... Full text Link to item Cite

Trauma History and Depression Predict Incomplete Adherence to Antiretroviral Therapies in a Low Income Country

Journal Article PLoS ONE · October 4, 2013 Background:As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the ... Full text Cite

Providers' attitudes towards treating depression and self-reported depression treatment practices in HIV outpatient care.

Journal Article AIDS Patient Care STDS · March 2013 Depression is highly prevalent among HIV-infected patients, yet little is known about the quality of HIV providers' depression treatment practices. We assessed depression treatment practices of 72 HIV providers at three academic medical centers in 2010-201 ... Full text Link to item Cite

Emergency obstetrics knowledge and practical skills retention among medical students in Rwanda following a short training course.

Journal Article Int J Gynaecol Obstet · February 2013 OBJECTIVE: To describe rates of improved knowledge following a structured 2-day emergency obstetrics training course. METHODS: Quantitative assessments to evaluate emergency obstetrics knowledge and practical skills were administered before, immediately af ... Full text Link to item Cite

Factors associated with change in sexual transmission risk behavior over 3 years among HIV-infected patients in Tanzania.

Journal Article PLoS One · 2013 BACKGROUND: The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income coun ... Full text Link to item Cite

Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country.

Journal Article PLoS One · 2013 BACKGROUND: As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding th ... Full text Link to item Cite

Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

Journal Article BMC Public Health · December 5, 2012 BACKGROUND: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of ... Full text Open Access Link to item Cite

Assessing the effect of Measurement-Based Care depression treatment on HIV medication adherence and health outcomes: rationale and design of the SLAM DUNC Study.

Journal Article Contemp Clin Trials · July 2012 Depression affects 20-30% of people living with HIV/AIDS (PLWHA) in the U.S. and predicts greater sexual risk behaviors, lower antiretroviral (ARV) medication adherence, and worse clinical outcomes. Yet little experimental evidence addresses the critical c ... Full text Link to item Cite

Analysis of traumatic injuries presenting to a referral hospital emergency department in Moshi, Tanzania.

Journal Article Int J Emerg Med · June 8, 2012 BACKGROUND: Injuries represent a significant and growing public health concern in the developing world, yet their impact on patients and the emergency health-care system in the countries of East Africa has received limited attention. This study evaluates t ... Full text Open Access Link to item Cite

Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways.

Journal Article J Acquir Immune Defic Syndr · April 1, 2012 OBJECTIVE: Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We so ... Full text Link to item Cite

Knowledge, attitudes, and practices in safe motherhood care among obstetric providers in Bugesera, Rwanda.

Journal Article Int J Gynaecol Obstet · February 2012 OBJECTIVE: To determine the knowledge, attitudes, and practices of obstetric care providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of safe motherhood services. METHODS: A quantitative descriptive survey in Kinyarwanda targeting all OC ... Full text Link to item Cite

A brief assessment of learning for orphaned and abandoned children in low and middle income countries.

Journal Article AIDS Behav · February 2012 Assessment of children's learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was desig ... Full text Link to item Cite

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania.

Journal Article AIDS Care · 2012 While HIV counseling and testing (HCT) has been considered an HIV preventive measure in Africa, data are limited describing behavior changes following HCT. This study evaluated behavior changes and estimated HIV seroincidence rate among returning HCT clien ... Full text Open Access Link to item Cite

Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health.

Journal Article PLoS One · 2012 BACKGROUND: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregive ... Full text Open Access Link to item Cite

Gastrointestinal Symptoms

Journal Article · December 1, 2011 Full text Cite

Enteric Escherichia Coli Infections

Journal Article · December 1, 2011 Full text Cite

A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.

Journal Article J Acquir Immune Defic Syndr · April 15, 2011 BACKGROUND: Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations. METHODS: We designed a mathematical model to ... Full text Link to item Cite

Gastrointestinal Symptoms

Chapter · April 12, 2011 Full text Cite

Prevalence and correlates of intimate partner violence among women attending HIV voluntary counseling and testing in northern Tanzania, 2005-2008.

Journal Article Int J Gynaecol Obstet · April 2011 Featured Publication OBJECTIVE: To investigate the prevalence and correlates of intimate partner violence (IPV) among women at an HIV voluntary counseling and testing (VCT) center in northern Tanzania. METHODS: In a cross-sectional study, the lifetime history of IPV experience ... Full text Link to item Cite

More than the loss of a parent: potentially traumatic events among orphaned and abandoned children.

Journal Article J Trauma Stress · April 2011 This study examines rates of potentially traumatic events and associated anxiety and emotional/behavioral difficulties among 1,258 orphaned and abandoned children in 5 low- and middle-income countries. The study quantifies the types of events the children ... Full text Link to item Cite

Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South.

Journal Article AIDS Care · February 2011 A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict the ... Full text Link to item Cite

Who tests, who doesn't, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania.

Journal Article PLoS One · January 31, 2011 Featured Publication BACKGROUND: Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) ca ... Full text Open Access Link to item Cite

Child work and labour among orphaned and abandoned children in five low and middle income countries.

Journal Article BMC Int Health Hum Rights · January 13, 2011 BACKGROUND: The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC) worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs), yet little is known abou ... Full text Open Access Link to item Cite

Secretion of MIP-1β and MIP-1α by CD8(+) T-lymphocytes correlates with HIV-1 inhibition independent of coreceptor usage.

Journal Article Cell Immunol · 2011 CD8(+) T-lymphocytes can utilize noncytolytic mechanisms to suppress HIV-1 replication through the secretion of soluble factors. The secretion of MIP-1β, MIP-1α, IP-10, MIG, IL-1α, and interferon gamma correlated most strongly with soluble noncytolytic sup ... Full text Link to item Cite

Acceptability of a group intervention for initiates of antiretroviral therapy in Tanzania.

Journal Article Glob Public Health · 2011 The success of antiretroviral therapy (ART) programmes requires high adherence and retention in care. In light of healthcare shortages, group interventions may be optimal ways to deliver information and provide support to ART patients. This study assessed ... Full text Link to item Cite

Incident stressful and traumatic life events and human immunodeficiency virus sexual transmission risk behaviors in a longitudinal, multisite cohort study.

Journal Article Psychosom Med · September 2010 OBJECTIVE: To assess the association between incident stressful life events (e.g., sexual and physical assault; housing instability; and major financial, employment, and legal difficulties) and unprotected anal or vaginal sexual intercourse (unprotected se ... Full text Link to item Cite

Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries.

Journal Article BMC Public Health · August 19, 2010 BACKGROUND: In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little r ... Full text Open Access Link to item Cite

Safety, tolerability, and mechanisms of antiretroviral activity of pegylated interferon Alfa-2a in HIV-1-monoinfected participants: a phase II clinical trial.

Journal Article J Infect Dis · June 1, 2010 BACKGROUND: To our knowledge, the antiviral activity of pegylated interferon alfa-2a has not been studied in participants with untreated human immunodeficiency virus type 1 (HIV-1) infection but without chronic hepatitis C virus (HCV) infection. METHODS: U ... Full text Open Access Link to item Cite

HIV-stigma and attributes of institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries.

Journal Article BMC Public Health · 2010 BACKGROUND: In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little r ... Link to item Cite

A comparison of the wellbeing of orphans and abandoned children ages 6-12 in institutional and community-based care settings in 5 less wealthy nations.

Journal Article PLoS One · December 18, 2009 Featured Publication BACKGROUND: Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possibl ... Full text Open Access Link to item Cite

Early versus delayed fixed dose combination abacavir/lamivudine/zidovudine in patients with HIV and tuberculosis in Tanzania.

Journal Article AIDS Res Hum Retroviruses · December 2009 Featured Publication Fixed dose combination abacavir/lamivudine/zidovudine (ABC/3TC/ZDV) among HIV-1 and tuberculosis (TB)-coinfected patients was evaluated and outcomes between early vs. delayed initiation were compared. In a randomized, pilot study conducted in the Kilimanja ... Full text Open Access Link to item Cite

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up in Moshi, Tanzania.

Journal Article J Acquir Immune Defic Syndr · December 2009 OBJECTIVES: We evaluated changes in characteristics of clients presenting for voluntary counseling and testing (VCT) before and during care and treatment center (CTC) scale-up activities in Moshi, Tanzania, between November 2003 and December 2007. METHODS: ... Full text Link to item Cite

Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study.

Journal Article Psychosom Med · November 2009 OBJECTIVE: To examine the influence of incident stressful experiences on antiretroviral medication adherence and treatment outcomes. Past trauma history predicts poorer medication adherence and health outcomes. Human immunodeficiency virus (HIV)-infected i ... Full text Link to item Cite

Missed opportunities for diagnosis of tuberculosis and human immunodeficiency virus co-infection in Moshi, Tanzania.

Journal Article Int J Tuberc Lung Dis · October 2009 SETTING: A community-based voluntary counseling and testing (VCT) center in Moshi, Tanzania. OBJECTIVE: To compare rates of prior human immunodeficiency virus (HIV) testing among clients with and without previous tuberculosis (TB) treatment, and HIV seropo ... Link to item Cite

Morbidity and mortality among a cohort of HIV-infected adults in a programme for community home-based care, in the Kilimanjaro Region of Tanzania (2003-2005).

Journal Article Ann Trop Med Parasitol · April 2009 Community home-based care (CHBC) plays an integral role in the care of HIV-infected patients living in resource-limited regions. A longitudinal cohort study has recently been conducted, in the Kilimanjaro Region of northern Tanzania, in order to identify t ... Full text Link to item Cite

Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes.

Journal Article BMC Public Health · March 4, 2009 BACKGROUND: Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes ... Full text Link to item Cite

Invasive disease caused by nontuberculous mycobacteria, Tanzania.

Journal Article Emerg Infect Dis · January 2009 Data on nontuberculous mycobacterial (NTM) disease in sub-Saharan Africa are limited. During 2006-2008, we identified 3 HIV-infected patients in northern Tanzania who had invasive NTM; 2 were infected with "Mycobacterium sherrisii" and 1 with M. avium comp ... Full text Link to item Cite

Validation, performance under field conditions, and cost-effectiveness of Capillus HIV-1/HIV-2 and determine HIV-1/2 rapid human immunodeficiency virus antibody assays using sequential and parallel testing algorithms in Tanzania.

Journal Article J Clin Microbiol · December 2008 Rapid human immunodeficiency virus (HIV) antibody tests support the effort to expand access to HIV testing and counseling services in remote, rural, and poor parts of the world. We validated the Capillus HIV-1/HIV-2 (Trinity Biotech PLC, Bray, County Wickl ... Full text Link to item Cite

Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast.

Journal Article AIDS Patient Care STDS · November 2008 Alcohol and drug use are common among HIV-infected patients and are important determinants of secondary transmission risk and medication adherence. As part of the Coping with HIV/AIDS in the Southeast (CHASE) Study, 611 HIV-infected patients were consecuti ... Full text Link to item Cite

Low sensitivity of T-cell based detection of tuberculosis among HIV co-infected Tanzanian in-patients.

Journal Article East Afr Med J · September 2008 OBJECTIVE: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting among patients with and without HIV infection. DESIGN: Cross-sectional study. SETTING: Two hospitals in Northern Tanzania. SUBJECTS: Eighty three adult male and ... Full text Link to item Cite

Gender differences in the risk of HIV infection among persons reporting abstinence, monogamy, and multiple sexual partners in northern Tanzania.

Journal Article PLoS One · August 27, 2008 BACKGROUND: Monogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the ri ... Full text Open Access Link to item Cite

Effect of trimethoprim-sulfamethoxazole prophylaxis on antimicrobial resistance of fecal Escherichia coli in HIV-infected patients in Tanzania.

Journal Article J Acquir Immune Defic Syndr · April 15, 2008 BACKGROUND: Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected persons in Africa, but its impact on antimicrobial resistance is of concern. METHODS: HIV-uninfected (group A), HIV-infected but not requiring SXT (group B), ... Full text Link to item Cite

The influence of psychosocial characteristics and race/ethnicity on the use, duration, and success of antiretroviral therapy.

Journal Article J Acquir Immune Defic Syndr · February 1, 2008 BACKGROUND: Expanded access to antiretroviral therapy (ART) has produced dramatic reductions in HIV-associated morbidity and mortality. Disparities in access to and benefit from ART have been observed by race, gender, and mental health status, however. MET ... Full text Link to item Cite

Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania.

Journal Article Clin Infect Dis · December 1, 2007 BACKGROUND: Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long-term success. METHODS: A total of 1 ... Full text Link to item Cite

Relation of lifetime trauma and depressive symptoms to mortality in HIV.

Journal Article Am J Psychiatry · November 2007 OBJECTIVE: In an era of highly active antiretroviral therapies, the authors needed to confirm previous findings showing that stress and depression have an impact on HIV disease progression. The goal of the current study was to examine the effects of lifeti ... Full text Link to item Cite

Minorities, the poor, and survivors of abuse: HIV-infected patients in the US deep South.

Journal Article South Med J · November 2007 BACKGROUND: The HIV/AIDS epidemic in the U.S. South is undergoing a marked shift toward a greater proportion of new HIV/AIDS cases in women, African-Americans, and through heterosexual transmission. METHODS: Using consecutive sampling, 611 participants wer ... Full text Link to item Cite

Childhood abuse and initial presentation for HIV care: an opportunity for early intervention.

Journal Article AIDS Care · October 2007 An alarmingly high prevalence of childhood sexual and physical abuse has been observed in HIV-infected men and women, with rates several times higher than observed in the general population. Childhood abuse history has been associated with worse antiretrov ... Full text Link to item Cite

Predicting CD4 lymphocyte count

Journal Article AIDS research and human retroviruses · October 2007 Clinical criteria are recommended to select HIV-infected patients for initiation of antiretroviral therapy when CD4 lymphocyte testing is unavailable. We evaluated the performance characteristics of WHO staging criteria, anthropometrics, and simple laborat ... Cite

Predicting CD4 lymphocyte count <200 cells/mm(3) in an HIV type 1-infected African population.

Journal Article AIDS Res Hum Retroviruses · October 2007 Clinical criteria are recommended to select HIV-infected patients for initiation of antiretroviral therapy when CD4 lymphocyte testing is unavailable. We evaluated the performance characteristics of WHO staging criteria, anthropometrics, and simple laborat ... Full text Link to item Cite

Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort.

Journal Article AIDS Patient Care STDS · September 2007 Advances in the treatment of HIV and associated opportunistic infections (OIs) have led to dramatic reductions in HIV-related morbidity and mortality in the United States, but not all patients have benefited equally. A longitudinal analysis of the Coping w ... Full text Link to item Cite

Association of race and gender with use of antiretroviral therapy among HIV-infected individuals in the Southeastern United States.

Journal Article South Med J · August 2007 BACKGROUND: Women and minorities continue to account for a higher proportion of AIDS incidence and mortality than their male and white counterparts. This study examined whether race and gender were associated with antiretroviral use among HIV-infected indi ... Full text Link to item Cite

Interruption of antiretroviral treatment in HIV-infected patients with preserved immune function is associated with a low rate of clinical progression: a prospective study by AIDS Clinical Trials Group 5170.

Journal Article J Infect Dis · May 15, 2007 BACKGROUND: We sought to determine the safety of treatment interruption (TI) and to identify parameters that would define patients with human immunodeficiency virus (HIV) for whom TI is safer. METHODS: AIDS Clinical Trials Group 5170 was a multicenter, 96- ... Full text Link to item Cite

Antiretroviral treatment strategies in resource-limited settings.

Journal Article Curr HIV/AIDS Rep · May 2007 To date, a minority of persons living with HIV worldwide has benefited from the advances in HIV therapeutics fueled by the scientific community, policy-makers, advocates, and the pharmaceutical industry in the global North. A growing body of evidence demon ... Full text Link to item Cite

Antiretroviral treatment literacy among HIV voluntary counseling and testing clients in Moshi, Tanzania, 2003 to 2005.

Journal Article J Int Assoc Physicians AIDS Care (Chic) · March 2007 Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral treatment adherence. Among northern Tanzanian subjects, antiretroviral treatment awareness was only 17%. Factors associated with low antiretroviral treatment li ... Full text Link to item Cite

Escherichia coli and Shigella spp.

Journal Article · December 7, 2006 Full text Cite

Hookworm infection of the duodenum associated with dyspepsia and diagnosed by oesophagoduodenoscopy: case report.

Journal Article East Afr Med J · December 2006 Hookworm infection and peptic ulcer disease are common in subtropical and tropical countries. While hookworm infection is endemic where sanitary conditions are poor, peptic ulcer disease is associated with a high prevalence of Helicobacter pylori infection ... Full text Link to item Cite

Enteric Escherichia coli Infections

Journal Article · December 1, 2006 Full text Cite

Gastrointestinal Symptoms

Journal Article · December 1, 2006 Full text Cite

Prevalence of childhood sexual abuse and physical trauma in an HIV-positive sample from the deep south.

Journal Article Am J Public Health · June 2006 We examined prevalence and predictors of trauma among HIV-infected persons in the Deep South using data from the Coping with HIV/AIDS in the Southeast (CHASE) study. Over 50% of CHASE participants were abused during their lives, with approximately 30% expe ... Full text Link to item Cite

Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events.

Journal Article AIDS Patient Care STDS · June 2006 Among HIV-infected persons, high-level adherence to antiretroviral medications (>90%-95%) is associated with improved immunologic, virologic, and clinical outcomes, and is necessary to prevent the emergence of viral resistance. This study examines whether ... Full text Link to item Cite

Exploring lack of trust in care providers and the government as a barrier to health service use.

Journal Article Am J Public Health · April 2006 OBJECTIVES: We examined associations between trust of health care providers and the government and health service use and outcomes. METHODS: Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs conce ... Full text Link to item Cite

Diarrhea in patients with AIDS.

Journal Article Curr Treat Options Gastroenterol · February 2006 Diarrhea in patients with AIDS is a worldwide problem that can have a devastating impact on quality of life for the patient. Chronic diarrhea, usually defined as at least 4 weeks' duration, is more common in patients with low CD4-positive T-lymphocyte coun ... Full text Link to item Cite

Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania.

Journal Article Am J Public Health · January 2006 Featured Publication OBJECTIVES: We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. METHODS: We waived the usual f ... Full text Link to item Cite

Improving health outcomes among individuals with HIV, mental illness, and substance use disorders in the Southeast.

Journal Article AIDS Care · 2006 Providing behavioral treatment for mental health and substance use disorders among HIV-infected individuals is critical because these disorders have been associated with negative outcomes such as poorer medication adherence. This study examines the effecti ... Full text Link to item Cite

Gastrointestinal Symptoms

Chapter · December 21, 2005 Full text Cite

Infectious diarrhea in developed and developing countries.

Journal Article J Clin Gastroenterol · October 2005 Diarrhea from gastrointestinal infection remains a common problem. In industrialized countries, management is aimed at reducing morbidity and defining groups that may benefit from further investigation. Most infectious diarrhea is self-limiting and only re ... Full text Link to item Cite

Sociodemographic and clinical characteristics of clients presenting for HIV voluntary counselling and testing in Moshi, Tanzania.

Journal Article Int J STD AIDS · October 2005 HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. Factors associated with HIV infection in VCT clients have not been well characterized in northern Tanzania. We prospectively surveyed 813 VCT clients in Moshi, Tanzania. Client ... Full text Link to item Cite

Substance abuse and symptoms of mental illness among HIV-positive persons in the Southeast.

Journal Article South Med J · January 2005 OBJECTIVES: Mental illness and substance abuse have been consistently associated with poor HIV-medication adherence and other negative health outcomes. METHODS: A brief mental health and substance use screening instrument was administered to 1,362 HIV-infe ... Full text Link to item Cite

How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south.

Journal Article Psychosom Med · 2005 OBJECTIVE: In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient u ... Full text Link to item Cite

Acute infectious diarrhea.

Journal Article N Engl J Med · April 8, 2004 Full text Link to item Cite

HIV-associated morbidity, mortality and diagnostic testing opportunities among inpatients at a referral hospital in northern Tanzania.

Journal Article Ann Trop Med Parasitol · March 2004 Hospitalized patients with HIV infection are among the most likely to benefit from the expanding availability of anti-retroviral therapy in sub-Saharan Africa. Between 1990 and 2000, 3667 people known to be HIV-infected were admitted to Kilimanjaro Christi ... Full text Link to item Cite

Clinical practice. Acute infectious diarrhea.

Journal Article N Engl J Med · January 1, 2004 Featured Publication Full text Link to item Cite

AIDS-associated diarrhea and wasting in Northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum.

Journal Article Braz J Infect Dis · February 2003 Advanced HIV infection is frequently complicated by diarrhea, disruption of bowel structure and function, and malnutrition. Resulting malabsorption of or pharmacokinetic changes in antiretroviral agents might lead to subtherapeutic drug dosing and treatmen ... Full text Link to item Cite

Criterion-related validity of a diarrhea questionnaire in HIV-infected patients.

Journal Article Dig Dis Sci · July 2002 Clinical trials evaluating HIV-related diarrhea have used varied unidimensional end points to assess diarrhea severity. We hypothesized that a self-reported measure of diarrhea that assesses stool form, stool frequency, and diarrhea morbidity would accurat ... Full text Link to item Cite

Update on Traveler's Diarrhea.

Journal Article Curr Infect Dis Rep · February 2002 Diarrhea is one of the most common health problems among travelers. Although enterotoxigenic Escherichia coli is implicated most commonly, enteroaggregative E. coli has recently been described as a major pathogen. Shigella, Campylobacter, and Salmonella or ... Full text Link to item Cite

Fever, headache, and dizziness in a patient with AIDS

Journal Article Infections in Medicine · January 1, 2002 Cite

Emergence of resistance to clarithromycin during treatment of disseminated cutaneous Mycobacterium chelonae infection: case report and literature review.

Journal Article J Infect · October 2001 Results of in vitro susceptibility studies and one clinical trial have led to recommendations of clarithromycin monotherapy for the treatment of disseminated cutaneous Mycobacterium chelonae infections. We describe the case of a 65-year-old woman, immunoco ... Full text Link to item Cite

Persistent diarrhea in the returned traveler.

Journal Article Infect Dis Clin North Am · June 1998 In conclusion, the causes of chronic diarrhea in the returned traveler are protean. Careful evaluation requires an understanding of where the traveler has been, when they were there, the type of diarrheal illness, medications taken, and knowledge of the pa ... Full text Link to item Cite

Role of platelet-activating factor in Chinese hamster ovary cell responses to cholera toxin.

Journal Article J Clin Invest · April 15, 1997 Cholera toxin (CT)-induced intestinal secretion and Chinese hamster ovary cell (CHO) elongation involves cyclic adenosine monophosphate and protein synthesis-dependent prostaglandin formation. We previously reported inhibition of CT-induced intestinal secr ... Full text Link to item Cite

Protozoal agents: what are the dangers for the public water supply?

Journal Article Annu Rev Med · 1997 Safe and efficient treatment of drinking water has been one of the major public health advances of the twentieth century. People in developed countries generally take for granted that their water is safe to drink, a luxury the majority of the world's popul ... Full text Link to item Cite

Delayed-type hypersensitivity testing in Tanzanian adults with HIV infection.

Journal Article J Acquir Immune Defic Syndr Hum Retrovirol · July 1996 Delayed-type hypersensitivity (DTH) testing and total lymphocyte counts as measures of cell-mediated immune function were assessed for medical patients in Dar es Salaam, Tanzania. DTH testing was performed with the Multitest CMI device which simultaneously ... Full text Link to item Cite

Diagnosis and screening of HIV/AIDS using clinical criteria in Tanzanian adults.

Journal Article J Acquir Immune Defic Syndr Hum Retrovirol · August 1, 1995 The clinical utility of the World Health Organization (WHO) clinical case definition (CCD) of acquired immune deficiency syndrome (AIDS) in Africa, several proposed modifications of the WHO CCD, and two proposed screening algorithms for human immunodeficie ... Link to item Cite

Role of platelet activating factor in the inflammatory and secretory effects of Clostridium difficile toxin A.

Journal Article J Lipid Mediat Cell Signal · March 1995 Clostridium difficile is a major recognized cause of antibiotic-associated diarrhea, an effect mediated through its toxin A. Toxin A has been reported to disrupt epithelial tight junctions, attract neutrophils, and cause striking intestinal inflammation an ... Full text Link to item Cite

Enteric Escherichia coli infections

Journal Article Current Opinion in Infectious Diseases · November 4, 1994 Versatile pathogenic mechanisms, define at least six categories of Escherichia coli that cause diarrheal illnesses worldwide. Recent advances have uncovered new potential structure-function relationships among the toxins of enterotoxigenic E. coli, which c ... Full text Cite

Role of platelet activating factor in the intestinal epithelial secretory and Chinese hamster ovary cell cytoskeletal responses to cholera toxin.

Journal Article Proc Natl Acad Sci U S A · September 27, 1994 With the recent heightened concern about cholera around the world come new questions about the mechanism by which cholera toxin causes diarrhea. Peterson and Ochoa have suggested that prostaglandin synthesis is key to both the intestinal epithelial secreto ... Full text Link to item Cite