Faculty Bibliography

BACKGROUND:Permanent supportive housing (PSH) is the gold standard intervention for chronic homelessness, but PSH tenants face high risk for overdose due to a combination of individual and environmental risk factors. Little research has examined overdose prevention in PSH. METHODS:We conducted baseline surveys with staff from 20 New York PSH buildings participating in an overdose prevention technical assistance intervention study. PSH staff from participating buildings were invited via email to complete a brief online survey about their knowledge of overdose and perspectives on implementing overdose prevention practices in PSH. RESULTS:Surveys were completed by 178 staff of 286 invitations sent (response rate 62.2%). Average score on the Brief Opioid Overdose Knowledge (BOOK) questionnaire was 8.62 (SD 2.64) out of 12 points. Staff felt very positively (91.6-97.2% agreed or completely agreed) regarding the appropriateness and acceptability of implementing overdose prevention practices in PSH, but less certain about the feasibility of implementing these practices (62.4-65.5% agreed or completely agreed). Most (77.3%) felt it was mostly or definitely true that overdose prevention was a top priority in their building. Most PSH staff (median = 85.0%) but fewer tenants (median = 22.5%) had received a naloxone kit and training in overdose response. CONCLUSION/CONCLUSIONS:Staff feel positively about the acceptability and appropriateness of implementing overdose response practices in PSH, but somewhat more uncertain about the feasibility of implementing these practices. This study's results help hone targets for interventions to help PSH buildings take steps to reduce tenant overdose risk.

IMPORTANCE/UNASSIGNED:High-quality evidence regarding suppressive valacyclovir treatment in herpes zoster ophthalmicus (HZO) is necessary to guide care. OBJECTIVE/UNASSIGNED:To determine whether suppressive valacyclovir compared with placebo delays the occurrence of new or worsening stromal keratitis (SK), endothelial keratitis (EK), iritis, or dendriform epithelial keratitis (DEK) during 12 months of treatment and if treatment benefit persisted at 18 months (secondary end point). DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The Zoster Eye Disease Study (ZEDS) was a randomized clinical trial conducted in 95 sites from November 2017 to June 2024. Immunocompetent, nonpregnant adults with a history of an HZO rash, documented active keratitis or iritis within 1 year, and an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or greater were eligible. After determined to be eligible, participants were randomized in 4 strata: age at onset (<60 years vs ≥60 years) and disease duration (<6 months vs ≥6 months). INTERVENTIONS/UNASSIGNED:A total of 12 months of double-masked daily valacyclovir, 1000 mg, or placebo. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was time to first occurrence within 12 months of new or worsening SK, EK, iritis, or DEK. RESULTS/UNASSIGNED:A total of 527 participants (median [IQR] age, 60 [50-68] years; 266 female [50.5%]; 266 in the valacyclovir group; 261 in the placebo group) were randomized in 4 strata; 481 completed 12 months, and 460 completed 18 months. Data were analyzed by intention to treat. At 12 months, primary end points occurred in 86 participants (33%) assigned to placebo and 74 (28%) assigned to valacyclovir, and at 18 months in 104 participants (40%) assigned to placebo and 86 (32%) assigned to valacyclovir. The hazard ratio (HR) of the primary end point at 12 months was 0.77 for participants taking valacyclovir vs placebo (HR, 0.77; adjusted 95% CI, 0.56-1.05; P = .09) and 0.73 at the secondary end point at 18 months (HR, 0.73; adjusted 95% CI, 0.55-0.97; P = .03). There was a reduction of multiple other secondary end points at 12 months (HR, 0.70; 95% CI, 0.52-0.95; P = .02) and 18 months (HR, 0.72; 95% CI, 0.55-0.95; P = .02). CONCLUSIONS AND RELEVANCE/UNASSIGNED:Although the primary outcome did not show a benefit of suppressive valacyclovir treatment, secondary study outcomes showed treatment superiority at the 18-month end point and reduced number of multiple episodes of keratitis or iritis at both 12 and 18 months. These results support consideration of 1 year of suppressive valacyclovir treatment for HZO. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03134196.

BACKGROUND:HIV status disclosure remains a major challenge among children living with perinatally acquired HIV with many taking treatment up to adolescence without knowing their serostatus. This non-disclosure is influenced by factors like fear of the negative consequences of disclosure. Since HIV status disclosure has been found to have good effects including improving treatment adherence and better mental health outcomes, there is a need to design interventions aimed at improving disclosure rates among children living with HIV. This study aims at adapting a clinic-based pediatric HIV status disclosure intervention and tasking shifting from healthcare workers to caregiver peer supporters in Eastern Uganda. METHODS:The adaptation process involved consultations with caregivers, healthcare workers involved in the care of children living with HIV, researchers in this field, intervention developers, and other experts and stakeholders. This was done through conducting FGDs with HCWs, caregivers, and peer supporters and consultations with researchers in the field of HIV. The original intervention manual was translated to Lusoga which is the commonly spoken dialect in this region. Collected qualitative data were analyzed using an inductive approach to develop themes and subthemes. Written informed consent will be obtained from all participants before participation in the study. RESULTS:A total of 28 participants were involved in the FGDs, while two pediatricians and two HIV researchers/specialists were consulted. Six themes were generated in relation to all suggested changes to the original manual which were related to: (1) sociocultural beliefs/norms/perceptions (5 FGDs), (2) boosting caregiver's confidence for disclosure (5FGDs), (3) disclosure mode, environment, and person (4 FGDs), (4) health facility/system related changes (3 FGDs), (5) reorganization/paraphrasing (3FGDs) and (6) age appropriateness (2FGDs). CONCLUSION/CONCLUSIONS:This study emphasized that whereas some aspects of intervention can apply to various contexts, there is a need for cross-cultural adaptation of interventions before being implemented in settings where they were not developed.

PURPOSE/OBJECTIVE:The Veterans Affairs Health Administration (VA) has experience using telehealth (TH) to deliver care to 10 million enrolled Veterans for many clinical care needs. The VA National TeleOncology Service (NTO) was established in 2020 to provide specialized cancer services regardless of geography. We sought to compare quality in TH-delivered cancer services with traditional (TR) in-person VA care. METHODS:Using electronic health record data, we identified patients with an International Classification of Diseases-10 diagnostic code for an incident malignancy from December 2016 to March 2021 at early adopting sites providing both TR and TH care. We classified patients as TH users if they received TH services at least once for their cancer care. We gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the symptoms and toxicity management (two), end of life and palliative care (10), and core measure domains (13). We report disease-specific measures, QOPI measures descriptively, and performed chi-square tests to compare TH and TR. RESULTS:= .002). TH and TR rates were similar for the other QOPI measures. CONCLUSION/CONCLUSIONS:VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.

BACKGROUND:Plant-based diets are associated with a lower risk of cardiovascular disease (CVD). Proteomics may improve our understanding of the biological pathways underlying these associations. OBJECTIVES/OBJECTIVE:Using large-scale proteomics, we aimed to examine if plant-based diet-related proteins, which have been previously identified, are associated with incident CVD and subtypes of CVD in the Atherosclerosis Risk in Communities (ARIC) Study and Framingham Heart Study (FHS) Offspring cohort. METHODS:Discovery analyses were based on 9,078 participants free of CVD at ARIC visit 3 (1993-1995). Cox proportional hazards regression was used to evaluate the associations between plant-based diet-related proteins and incident CVD, coronary heart disease, heart failure, and stroke. Replication analyses were based on 1,279 participants without CVD in FHS Offspring cohort. RESULTS:In the ARIC Study, over a median follow-up of 21 years, there were 3,167 CVD events. At a false discovery rate (FDR) <0.05, 26 out of 73 plant-based diet-related proteins were significantly associated with incident CVD, after adjusting for important confounders. 18, 1, and 0 proteins were associated with heart failure, stroke, and coronary heart disease, respectively. Three, and 2 additional proteins were associated with CVD, and heart failure risk in FHS Offspring cohort at the nominal threshold (p value <0.05). Soluble advanced glycosylation end product-specific receptor (AGER) was inversely associated with incident CVD whereas thrombospondin-2 (THBS2) and N-terminal pro-BNP (NT-proBNP) was positively associated with incident CVD. THBS2 was positively associated with incident heart failure, whereas neuronal growth factor regulator 1 (NEGR1) and insulin-like growth factor-binding protein 1 (IGFBP1) was inversely associated. CONCLUSION/CONCLUSIONS:These proteins highlight several pathways that could explain plant-based diets-CVD associations.

IMPORTANCE/UNASSIGNED:Hearing loss treatment delays cognitive decline in high-risk older adults. The preventive potential of addressing hearing loss on incident dementia in a community-based population of older adults, and whether it varies by method of hearing loss measurement, is unknown. OBJECTIVE/UNASSIGNED:To calculate the population attributable fraction of incident dementia associated with hearing loss in older adults and to investigate differences by age, sex, self-reported race, and method of hearing loss measurement. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This prospective cohort study was part of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) and had up to 8 years of follow-up (2011-2019). The 4 ARIC field centers in the study included Jackson, Mississippi; Forsyth County, North Carolina; the Minneapolis suburbs, Minnesota; and Washington County, Maryland. Community-dwelling older adults aged 66 to 90 years without dementia at baseline who underwent a hearing assessment at ARIC-NCS visit 6 (2016-2017) were included in the analysis. Data analysis took place between June 2022 and July 2024. EXPOSURES/UNASSIGNED:Hearing loss measured objectively (audiometric) and subjectively (self-reported). MAIN OUTCOMES AND MEASURES/UNASSIGNED:The main outcome was incident dementia (standardized algorithmic diagnosis with expert panel review). The population attributable fractions of dementia from both audiometric and self-reported hearing loss were calculated in the same participants, which quantified the maximum proportion of dementia risk in the population that can be attributed to hearing loss. RESULTS/UNASSIGNED:Among 2946 participants (mean [SD] age, 74.9 [4.6] years; 1751 [59.4] female; 637 Black [21.6%] and 2309 White [78.4%] individuals), 1947 participants (66.1%) had audiometric hearing loss, and 1097 (37.2%) had self-reported hearing loss. The population attributable fraction of dementia from any audiometric hearing loss was 32.0% (95% CI, 11.0%-46.5%). Population attributable fractions were similar by hearing loss severity (mild HL: 16.2% [95% CI, 4.2%-24.2%]; moderate or greater HL: 16.6% [95% CI, 3.9%-24.3%]). Self-reported hearing loss was not associated with an increased risk for dementia, so the population attributable fraction was not quantifiable. Population attributable fractions from audiometric hearing loss were larger among those who were 75 years and older (30.5% [95% CI, -5.8% to 53.1%]), female (30.8% [95% CI, 5.9%-47.1%]), and White (27.8% [95% CI, -6.0% to 49.8%]), relative to those who were younger than 75 years, male, and Black. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study suggests that treating hearing loss might delay dementia for a large number of older adults. Public health interventions targeting clinically significant audiometric hearing loss might have broad benefits for dementia prevention. Future research quantifying population attributable fractions should carefully consider which measures are used to define hearing loss, as self-reporting may underestimate hearing-associated dementia risk.