Faculty Bibliography

We administered a battery of neurocognitive tests to 100 HIV-positive men and women ages 50 to 70 seeking care at a large Northeastern urban HIV care clinic. Performance on neurocognitive assessments varied by demographic states. Across all assessments, approximately 28% of participants reached the threshold for borderline performance while 13% reached the threshold for impairment. When tests were grouped by domain of neurocognitive functioning, 12% of the sample met the threshold for impairment on executive functioning and 19% for processing speed. The findings demonstrate that neurocognitive declines may vary by domains of functioning, that disparities may exist across subpopulations of the seropositive aging population, and that these challenges may exist even in those actively engaged in HIV care.

Academic preparedness, executive function abilities, and positive relationships with teachers have each been shown to be uniquely important for school readiness and success in the early elementary grades. Few studies, however, have examined the joint influence of these readiness variables on early school outcomes. Using data from a prospective longitudinal sample of 1292 children and families in predominantly low-income and rural communities, we found that executive function at child age 48 months and a higher quality relationship with the kindergarten teacher each uniquely moderated the effect of math ability in preschool on math ability at the end of kindergarten. This effect was seen for math ability as measured by the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) mathematics assessment battery but not the Woodcock-Johnson III Tests of Achievement Applied Problems subtest. For children with lower math ability in preschool as assessed by the ECLS-K Math battery, higher executive function abilities and a more positive relationship with the kindergarten teacher were each associated with a higher than expected level of math ability in kindergarten. Conversely, lowest levels of math ability in kindergarten were observed among children with low math ability in preschool and poor executive function or a less positive relationship with the kindergarten teacher.

This study explores an innovative intervention for orphaned children in Uganda. It combines standard health care with an economic empowerment component. We refer to this combination as a family asset-based intervention, which provides each child with a child development account (CDA), a matched savings account for secondary schooling; financial education; and a mentor. This article examines the educational outcomes of the girls in this study. The results from the first two waves of the study indicate that CDAs have the potential to begin to help negate the effects of past gender inequalities and to help provide a path for young girls to move forward.

Studies from sub-Saharan Africa indicate that children made vulnerable by poverty have been disproportionately affected by HIV with many exposed via mother-to-child transmission. For youth living with HIV, adherence to life-saving treatment regimens are likely to be affected by the complex set of economic and social circumstances that challenge their families and also exacerbate health problems. Using baseline data from the National Institute of Child and Human Development (NICHD) funded Suubi+Adherence study, we examined the extent to which individual and composite measures of equity predict self-reported adherence among Ugandan adolescents aged 10-16 (n = 702) living with HIV. Results showed that greater asset ownership, specifically familial possession of seven or more tangible assets, was associated with greater odds of self-reported adherence (OR 1.69, 95% CI: 1.00-2.85). Our analyses also indicated that distance to the nearest health clinic impacts youth's adherence to an ARV regimen. Youth who reported living nearest to a clinic were significantly more likely to report optimal adherence (OR 1.49, 95% CI: 0.92-2.40). Moreover, applying the composite equity scores, we found that adolescents with greater economic advantage in ownership of household assets, financial savings, and caregiver employment had higher odds of adherence by a factor of 1.70 (95% CI: 1.07-2.70). These findings suggest that interventions addressing economic and social inequities may be beneficial to increase antiretroviral therapy (ART) uptake among economically vulnerable youth, especially in sub-Saharan Africa. This is one of the first studies to address the question of equity in adherence to ART among economically vulnerable youth with HIV.

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, +/-1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (DeltaT1-T0 = +14.9, p < .001), pursue vocational training (DeltaT1-T0 = +8.8, p < .01), and start a business (T1-T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, +/-0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43-2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.

Children comprise the largest proportion of the population in sub-Saharan Africa. Of these, millions are orphaned. Orphanhood increases the likelihood of growing up in poverty, dropping out of school, and becoming infected with HIV. Therefore, programs aimed at securing a healthy developmental trajectory for these orphaned children are desperately needed. We conducted a two-arm cluster-randomized controlled trial to evaluate the effectiveness of a family-level economic strengthening intervention with regard to school attendance, school grades, and self-esteem in AIDS-orphaned adolescents aged 12-16 years from 10 public rural primary schools in southern Uganda. Children were randomly assigned to receive usual care (counseling, school uniforms, school lunch, notebooks, and textbooks), "bolstered" with mentorship from a near-peer (control condition, n = 167), or to receive bolstered usual care plus a family-level economic strengthening intervention in the form of a matched Child Savings Account (Suubi-Maka treatment arm, n = 179). The two groups did not differ at baseline, but 24 months later, children in the Suubi-Maka treatment arm reported significantly better educational outcomes, lower levels of hopelessness, and higher levels of self-concept compared to participants in the control condition. Our study contributes to the ongoing debate on how to address the developmental impacts of the increasing numbers of orphaned and vulnerable children and adolescents in sub-Saharan Africa, especially those affected by HIV/AIDS. Our findings indicate that innovative family-level economic strengthening programs, over and above bolstered usual care that includes psychosocial interventions for young people, may have positive developmental impacts related to education, health, and psychosocial functioning.

Besides amyloid deposition, white matter (WM) changes are involved in the early pathogenesis of Alzheimer's Disease (AD), including inflammation, demyelination and axonal loss. Using simultaneous PET and MRI, we investigated differences in WM microstructural integrity, measured with Diffusion Kurtosis Imaging (DKI), with respect to beta amyloid (Aa) deposition as measured with18F-Florbetapir PET. DKI is a clinically feasible diffusion MRI method that extends beyond Diffusion Tensor Imaging and probes non-Gaussian diffusion properties of nervous tissue, and allows for quantifying the microstructural index for the axonal water fraction (AWF), a specific marker for axonal degeneration and demyelination. Methods: 34 subjects were scanned on a 3T integrated PET-MRI system (Siemens Biograph mMR, VB20). 18FFlorbetapir (9 mCi, Eli Lilly) was injected intravenously and a static 20-minute PET image was reconstructed starting at 40 min post-injection using a UTE-based attenuation map. An anatomical MP-RAGE was acquired for cortical and sub-cortical segmentation using Freesurfer. Hippocampal volume was normalized to the estimated total intracranial volume. The standardized uptake values (SUV) in 5 cortical regions known for pathological uptake of Florbetapir (anterior and posterior cingulate, medial orbito-frontal, parietal and temporal), normalized to the cerebellum, yielded mean cortical relative SUV (SUVr). DKI provided parametric maps for the radial diffusivity (RD), radial kurtosis (RK), and the AWF. Using a lower and higher mean SUVr threshold of 1.0 and 1.1, age- and gender-controlled subjects were categorized into Aa negative (Aa-) (n = 13, 5 females, age = 69.8 +/- 5.1 yrs), Aa intermediate (Aai) (n = 13, 8 females, age = 68.9 +/- 4.8 yrs), or Aa positive (Aa+) (n = 8, 4 females, age = 70.6 +/- 5.3 yrs). Using Tract-Based Spatial Statistics (TBSS), skeletonized voxel-wise analysis was performed to identify areas of differences in the diffusion metrics while covarying for age. Separately, WM regions of interests (ROIs) were automatically segmented using atlas registration over which mean values were extracted. Analysis of covariance covarying for age was used to compare diffusion metrics and hippocampal volume among groups. Results: See figure. Results from both TBSS and ROI analysis demonstrated changes in the fornix and the genu of the corpus callosum. Between the Aa- and Aai groups, RD decreased while RK and AWF increased. Conversely, between the Aai and Aa+ groups, RD increased RD while RK and AWF decreased. A trend towards significantly higher hippocampal volume in the Aai group was observed. Conclusions: We report changes in RD, RK and AWF in opposite directions between Aa- and Aa~, and between Aa~ and Aa+, respectively, suggesting that different mechanisms affect the microstructure during different stages of AD. Early on, mechanisms including microglial activation may restrict diffusion, resulting in the observed decrease in RD and increase in RK and AWF. Later on, neurodegenerative effects such as demyelination and axonal loss may outweigh inflammation, resulting in the observed increase in RD and decrease in RK and AWF. [IMAGE PRESENTED]

Background: The United States has an estimated 400,000 residing survivors of torture. The Program for Survivors of Torture (PSOT) at Bellevue Hospital is the only comprehensive torture treatment center in New York City. PSOT offers both medical and mental health treatment to its clients, who are ethnically diverse. There has to date been no comprehensive assessment of the gynecological needs of this population. This study affords a novel opportunity to investigate reproductive health needs of women who have experienced torture. Methods: This is a cross-sectional descriptive study conducted through structured interviews. All women enrolling in PSOT were eligible for inclusion. Data was collected in a REDCap database and analyzed using Stata v14. Outcomes were evaluated using descriptive statistics. Outcomes of interest include obstetric history, contraceptive knowledge and use, and prevalence of prior gender based violence (GBV) and female genital cutting (FGC). Findings: The majority (71.4%) were French-speaking West Africans. All participants reported prior experience of GBV; perpetrators were more likely to be from outside the family (64.3%), but violence from an intimate partner (35.0%) or family member (33.3%) was also common. Prior sexual violence and history of FGC was reported in 66.7% and 25.0% of subjects, respectively. The mean gravidity was 2.1 pregnancies (SD = 1.1) and, of those who have been pregnant (64.3%), 77.8% reported having received antenatal care at some point in pregnancy. While 85.7% reported any prior pregnancy-related complications, 57.1% of them reported seeking medical attention. Current contraception use was only reported in 15.4%, even though over half of women expressed a desire to delay pregnancy (spacers). Moreover, among all spacers, current use of contraception (28.6%) is lower than past use (78.6%). Participants had a better basic knowledge of traditional contraceptive methods (77.5%) compared to modern ones (56.1%). Interpretation: This is the first comprehensive review of gynecologic needs of survivors of torture in NYC. Prior history of GBV is common. It appears that while many have had prenatal care, overall knowledge and use of contraception in this population is very low compared to the general population