Faculty Bibliography

OBJECTIVE:In Nigeria, adolescents and young adults (AYA) who engage in multiple sexual partnerships, transactional sex, and needle-sharing are eligible for preexposure prophylaxis (PrEP) and are prioritized for HIV testing. AYA with PrEP-eligible behaviors should be using facility-based HIV testing services. We examined associations between these behaviors and facility-based HIV testing among AYA aged 14-24 years. DESIGN/METHODS:A longitudinal analysis of a stepped-wedge trial. METHODS:Using Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) data, we fit generalized linear models using generalized estimating equations. We used a two-stage weighted approach to generalize I-TEST estimates to all AYA in Nigeria. RESULTS:Of 1429 trial participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary education as highest level of education completed. Recent facility-based HIV testing uptake was higher among AYA with one [unadjusted risk difference: 11.7%, 95% confidence interval (95% CI): 8.1-15.2], two [11% (5.3, 16.8)], and three or more sexual partners in the past 3 months [17.3% (10.5, 24)], compared to AYA with no recent sexual partners. AYA who engaged in transactional sex had higher facility-based testing uptake [14.7% (9.8, 19.5)] than AYA who never engaged in transactional sex. AYA who shared needles had lower facility-based testing uptake [-3.3% (-6.7, 0.2)] than AYA with no needle-sharing history. The trial and generalized estimates were in the same direction. CONCLUSION/CONCLUSIONS:While facility-based testing may reach AYA who engaged in multiple sexual partnerships or transactional sex, AYA who shared needles may require more tailored HIV testing approaches.

RATIONALE AND OBJECTIVES/OBJECTIVE:Prostate multiparametric magnetic resonance imaging (MRI) is recommended for prostate cancer detection, staging, and surveillance. Incidental bladder lesions are encountered on these studies but remain under-characterized in the literature. The patient characteristics associated with malignancy for these lesions are not well defined. We evaluated the prevalence, histopathologic outcomes, clinical characteristics, and associations with malignancy for incidental bladder lesions on prostate MRI. MATERIALS AND METHODS/METHODS:A retrospective review included 31,241 patients undergoing prostate MRI examinations from January 2013 to January 2023. Imaging reports and medical records were analyzed for incidental bladder lesions, demographic data, clinical symptoms, urinalysis findings, and histopathologic outcomes. Lesions were categorized based on biopsy results or negative clinical follow-up for bladder tumors in chart review. Logistic regression analysis and receiver operating characteristic analyses were performed. RESULTS:Incidental bladder lesions occurred in 0.74% (230/31,241) of examinations, with biopsy-confirmed bladder cancer in 0.11% of patients (34/31,241) or 14.8% (34/230) of cases with lesions. In multivariable analysis, gross hematuria had the strongest association with biopsy-proven bladder cancer (OR 9.26, 95% CI 4.12-20.79, p<0.001). A logistic regression model incorporating age, smoking status, and gross hematuria yielded area under the curve of 0.762 for bladder cancer. CONCLUSION/CONCLUSIONS:Incidental bladder lesions on prostate MRI may represent opportunities for early detection of bladder cancer, but also have potential for harms related to unnecessary procedures. Considering the presence of gross hematuria, possibly stated as part of the MRI referral or patient questionnaire, could improve risk stratification of encountered bladder lesions and early cancer detection.

OBJECTIVE:It is critical to understand the characteristics of people who use cannabis during pregnancy. We examined the prevalence and sociodemographic and clinical correlates of current, recent, former, and never cannabis use among pregnant individuals in the U.S. METHODS:We analyzed pooled data from 1,992 pregnant participants in the National Survey on Drug Use and Health (NSDUH) from 2021 to 2023. We used multinomial regression to identify correlates of cannabis use status (i.e., never use vs. current [past 30-day], recent [past 2-12-month], and former [nonuse in the past year], respectively). RESULTS:Overall, nearly 7% of pregnant participants reported current cannabis use. Among current users, 31% reported any doctor-recommended cannabis use in the past year and 52% bought their cannabis from a dispensary. Compared to never users, current cannabis use was more likely among those aged 18-25 (vs. 26+; Relative Risk Ratio [RRR] = 2.08, 95% CI: 1.04-4.18), unmarried (vs. married; RRR = 2.54, 95% CI: 1.05-6.14), with greater education (vs. < high school; RRR = 2.97, 95% CI: 1.42-6.23), past 30-day cigarette use (RRR = 2.57, 95% CI: 1.11-5.94), alcohol use (RRR = 7.24, 95% CI: 1.52-34.49), e-cigarette use (RRR = 4.92, 95% CI: 1.71-14.10), or serious psychological distress (RRR = 6.25, 95% CI: 2.46-15.85); current use was less likely among those perceiving some risk of weekly cannabis use (vs. no risk; RRR = 0.07, 95% CI: 0.03-0.14). Recent use (vs. never use) was less likely in states where cannabis was illegal (RRR = 0.45, 95% CI: 0.22-0.95). CONCLUSION/CONCLUSIONS:Cannabis use during pregnancy remains high among certain subgroups. Future research should develop tailored interventions targeting motivations of cannabis use during pregnancy, such as risk perceptions and polysubstance use, which negatively impact maternal and fetal health.

ObjectivesRemote patient monitoring (RPM), combining home blood pressure measurements with telehealth services, effectively manages hypertension. Successful implementation of RPM programs at scale requires understanding program costs and financial sustainability. We evaluated the financial performance of an RPM program.MethodsConducted from March to June 2024 in the Cardiology Division at New York University Langone Health, the study used field observation, surveys, and micro-costing methods. A costing tool was developed to quantify program costs in 2024 US dollars, including personnel, equipment, and supplies. RPM-related services reimbursement rates were estimated using Medicare billing information. The return-on-investment (ROI) ratio was calculated by dividing net return (profit) by the RPM program costs. Sensitivity analyses assessed the impact of varying parameters on the ROI of RPM.ResultsThe average RPM program cost was estimated at $330 per patient (range: $208-$452). Major expenses included data review by staff ($172 per patient), blood pressure devices ($48 per patient), and phone communications ($36 per patient). ROI varied based on patient compliance with home blood pressure monitoring (≥16 days per month), with an average estimate of 22.2% (range: -11.1%-93.3%) per patient at a 55% compliance rate. The ROI was most sensitive to changes in data-review costs, insurance reimbursement rates, patient compliance, device setup, and communication costs.ConclusionsThe RPM program achieved a positive ROI from the perspective of a clinical division in a large healthcare system. Successful implementation and financial sustainability of RPM require efforts to reduce human resource costs and enhance patient engagement.

BACKGROUND:Little is known about the use of text messages to promote enrollment in smoking cessation treatment. RESEARCH QUESTION/OBJECTIVE:What is the impact of number of outreach messages and monetary incentives on enrollment in smoking cessation treatment among Latino adults? STUDY DESIGN AND METHODS/METHODS:This pragmatic randomized clinical trial used a 3x2 factorial design. The first factor, monetary incentives, consisted of three conditions: 1) receiving a small fixed amount ($5) when enrolling, 2) getting a chance to win a large amount ($200) when enrolling, and 3) no monetary incentive when enrolling. The second factor, number of cycles, consisted of two conditions: 1) one cycle of messages, and 2) four cycles of messages. Latino adults who smoke (n=2,826) were identified in electronic medical records. Participants were randomized in a 1:1:1 ratio to receive one of three monetary incentive conditions and in a 1:2 ratio to receive one or four cycles of messages. The main outcome was enrollment in a smoking cessation text messaging intervention. RESULTS:Enrollment rates ranged from 1.3% for the group that received no monetary incentive for enrollment and one cycle of messages to 5.4% for the group that received a fixed amount for enrollment and four cycles of messages. Receiving four cycles of messages was associated with a higher likelihood of enrollment compared to receiving one cycle of messages (OR 1.92 [95% CI, 1.22-3.01], p<0.01). Monetary incentives were not associated with enrollment. INTERPRETATION/CONCLUSIONS:Among Latino adults, enrollment in smoking cessation treatment increased significantly with increasing number of cycles. In contrast, monetary incentives did not increase enrollment. While modest, the 5.3% enrollment rate found among participants who received four cycles of messages and no monetary incentive can inform future population-level efforts to advance smoking cessation among Latino adults. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier: NCT05722132.

OBJECTIVES/OBJECTIVE:To identify stakeholder perceived challenges and facilitators for implementing a clean fuel and clean stove intervention to reduce household air pollution and hypertension in Lagos, Nigeria. DESIGN/METHODS:Qualitative study guided by the Exploration and Preparation phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, using focus group discussions and in-depth semi-structured interviews with inductive and deductive thematic analysis. SETTING/METHODS:Peri-urban communities across the five administrative divisions of Lagos State, Nigeria. PARTICIPANTS/METHODS:128 stakeholders from 32 communities, including community, religious, market and youth leaders, primary healthcare staff, and household decision makers. Approximately half were female. INTERVENTIONS/METHODS:This was a pre-implementation needs assessment that included demonstrations of the clean stove and fuel. PRIMARY AND SECONDARY OUTCOME MEASURES/METHODS:Thematic domains describing barriers and enablers to adoption and implementation, mapped to EPIS inner, outer, and bridging factors. RESULTS:Stakeholders reported barriers that included stove stacking, upfront stove cost, concerns about long-term fuel price and availability, equipment durability and maintenance, safety, mistrust of new technology, and uncertainty about stove performance for dishes requiring high heat and long cooking times. Reported facilitators included payment flexibility and subsidies, opportunities to test the stove, perceived benefits of cleaner and faster cooking with less soot, endorsement by community leaders, and interest in local retail and distribution to improve access. CONCLUSIONS:Implementation planning for clean fuel and clean stove programmes should address affordability, reliable fuel supply chains, durability and service, culturally relevant cooking needs, and trust building through community leadership. These findings inform adaptation strategies for scale-up in similar low-resource settings. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT05048147.

Medical mistrust as a construct often places the onus of blame for adverse health outcomes on individuals rather than on social structures. In this study, we aimed to determine if medical mistreatment and access to transgender care were potential determinants of medical mistrust. We used longitudinal survey data from 193 transgender women of colour living in New York City. We measured medical mistrust using the Group-Based Medical Mistrust (GBMM) scale. Additionally, we analysed and coded open-ended survey data from participants regarding their trust towards medical institutions to identify potential determinants of medical mistrust. From the quantitative analysis, we found that individuals who experienced mistreatment in healthcare and those who reported poor access to transgender care had higher GBMM scores. Qualitative findings suggested that negative experiences within the healthcare system and historical trauma were key factors contributing to mistrust in medical institutions. Addressing medical mistrust should not occur at the individual level, but rather at the structural level. Potential interventions include improving access to gender affirming care and training health professionals.

BACKGROUND:Obstructive sleep apnea (OSA) is associated with Alzheimer's disease (AD) risk. Racial-, ethnic-, and sex-specific mechanisms of OSA and AD risk were examined. METHODS:We analyzed data from 3978 polysomnography patients without cognitive decline aged ≥ 60 including 663 OSA+ patients (284 non-Hispanic White, 207 Black, 172 Hispanic) matched to OSA- cohorts (1:1, n = 663; 1:4, n = 2652) and followed for AD through 2013. RESULTS:During the 8.5 (standard deviation 1.4) year period, 358 patients developed AD. AD risk was higher for Black (adjusted hazard ratio [aHR] 2.24 [1.24-2.71]), Hispanic (aHR 1.73, [1.38-3.51]), White (aHR 1.83, [1.21-3.37]), male (aHR 2.38, [1.31-3.47]), and female (aHR 1.37, [1.14-2.41]) patients. Hypoxia, sleep fragmentation, and sleep duration (p < 0.01) were associated with increased risk. Black and Hispanic, and female patients showed stronger effects for hypoxia and duration, and fragmentation, respectively. DISCUSSION/CONCLUSIONS:Hypoxia, fragmentation, and duration may underlie racial-, ethnic-, and sex-specific effects of AD risk.