HIV incidence estimates and HIV/AIDS concurrent diagnosis in Houston/Harris County

The purpose of this dissertation was to estimate HIV incidence among the individuals who had HIV tests performed at the Houston Department of Health and Human Services (HDHHS) public health laboratory, and to examine the prevalence of HIV and AIDS concurrent diagnoses among HIV cases reported between 2000 and 2007 in Houston/Harris County. ^ The first study in this dissertation estimated the cumulative HIV incidence among the individuals testing at Houston public health laboratory using Serologic Testing Algorithms for Recent HIV Seroconversion (STARHS) during the two year study period (June 1, 2005 to May 31, 2007). The HIV incidence was estimated using two independently developed statistical imputation methods, one developed by the Centers for Disease Control and Prevention (CDC), and the other developed by HDHHS. Among the 54,394 persons who tested for HIV during the study period, 942 tested HIV positive (positivity rate=1.7%). Of these HIV positives, 448 (48%) were newly reported to the Houston HIV/AIDS Reporting System (HARS) and 417 of these 448 blood specimens (93%) were available for STARHS testing. The STARHS results showed 139 (33%) out of the 417 specimens were newly infected with HIV. Using both the CDC and HDHHS methods, the estimated cumulative HIV incidences over the two-year study period were similar: 862 per 100,000 persons (95% CI: 655-1,070) by CDC method, and 925 per 100,000 persons (95% CI: 908-943) by HDHHS method. Consistent with the national finding, this study found African Americans, and men who have sex with men (MSM) accounted for most of the new HIV infections among the individuals testing at Houston public health laboratory. Using CDC statistical method, this study also found the highest cumulative HIV incidence (2,176 per 100,000 persons [95%CI: 1,536-2,798]) was among those who tested in the HIV counseling and testing sites, compared to the sexually transmitted disease clinics (1,242 per 100,000 persons [95%CI: 871-1,608]) and city health clinics (215 per 100,000 persons [95%CI: 80-353]. This finding suggested the HIV counseling and testing sites in Houston were successful in reaching high risk populations and testing them early for HIV. In addition, older age groups had higher cumulative HIV incidence, but accounted for smaller proportions of new HIV infections. The incidence in the 30-39 age group (994 per 100,000 persons [95%CI: 625-1,363]) was 1.5 times the incidence in 13-29 age group (645 per 100,000 persons [95%CI: 447-840]); the incidences in 40-49 age group (1,371 per 100,000 persons [95%CI: 765-1,977]) and 50 or above age groups (1,369 per 100,000 persons [95%CI: 318-2,415]) were 2.1 times compared to the youngest 13-29 age group. The increased HIV incidence in older age groups suggested that persons 40 or above were still at risk to contract HIV infections. HIV prevention programs should encourage more people who are age 40 and above to test for HIV. ^ The second study investigated concurrent diagnoses of HIV and AIDS in Houston. Concurrent HIV/AIDS diagnosis is defined as AIDS diagnosis within three months of HIV diagnosis. This study found about one-third of the HIV cases were diagnosed with HIV and AIDS concurrently (within three months) in Houston/Harris County. Using multivariable logistic regression analysis, this study found being male, Hispanic, older, and diagnosed in the private sector of care were positively associated with concurrent HIV and AIDS diagnoses. By contrast, men who had sex with men and also used injection drugs (MSM/IDU) were 0.64 times (95% CI: 0.44-0.93) less likely to have concurrent HIV and AIDS diagnoses. A sensitivity analysis comparing difference durations of elapsed time for concurrent HIV and AIDS diagnosis definitions (1-month, 3-month, and 12-month cut-offs) affected the effect size of the odds ratios, but not the direction. ^ The results of these two studies, one describing characteristics of the individuals who were newly infected with HIV, and the other study describing persons who were diagnosed with HIV and AIDS concurrently, can be used as a reference for HIV prevention program planning in Houston/Harris County. ^

Factors associated with needle sharing among Black male injection drug users in Harris County, Texas

Background. Injection drug users (IDUs) are at increased risk for HIV transmission due to unique risk behaviors, such as sharing needles. In Houston, IDUs account for 18% of all HIV/AIDS cases among Black males. ^ Objectives. This analysis compared demographic, behavioral, and psychosocial characteristics of needle sharing and non-sharing IDUs in a population of Black males in Harris County, Texas. ^ Methods. Data used for this analysis were from the second IDU cycle of the National HIV Behavioral Surveillance System. This dataset included a sample of 288 Black male IDUs. Univariate and multivariate statistical analysis were performed to determine statistically significant associations of needle sharing in this population and to create a functional model to inform local HIV prevention programs. ^ Results. Half of the participants in this analysis shared needles in the past 12 months. Compared to non-sharers, sharers were more likely to be homeless (OR=3.70, p<0.01) or arrested in the past year (OR=2.31, p<0.01), inject cocaine (OR=2.07, p<0.01), report male-to-male sex in the past year (OR=6.97, p<0.01), and to exchange sex for money or drugs. Sharers were less likely than non-sharers to graduate high school (OR=0.36, p<0.01), earn $5,000 or more a year (OR=1.15, p=0.05), get needles from a medical source (OR=0.59, p=0.03), and ever test for HIV (OR=0.17, p<0.01). Sharers were more likely to report depressive symptoms (OR=3.49, p<0.01), lower scores on the family support scale (mean difference 0.41, p=0.01) and decision-making confidence scale (mean difference 0.38, p<0.01), and greater risk-taking (mean difference -0.49, p<0.01) than non-sharers. In a multivariable logistic regression, sharers were less likely to have graduated high school (OR=0.33, p<0.01) and have been tested for HIV (OR=0.12, p<0.01) and were more likely to have been arrested in the past year (OR=2.3, p<0.01), get needles from a street source (OR=3.87, p<0.01), report male-to-male sex (OR=7.01, p<0.01), and have depressive symptoms (OR=2.36, p=0.02) and increased risk-taking (OR=1.78, p=0.01). ^ Conclusions. IDUs that shared needles are different from those that did not, reporting lower socioeconomic status, increased sexual and risk behaviors, increased depressive symptoms and increased risk-taking. These findings suggest that intervention programs that also address these demographic, behavioral, and psychosocial factors may be more successful in decreasing needle sharing among this population.^

Prevalence of Staphylococcus aureus colonization among high-risk HIV populations

Staphylococcus aureus is a common microorganism in humans, typically colonizing the nasopharynx, skin and other mucosal surfaces. It is among the most frequent causes of clinically-significant bacterial infections accounting for increased morbidity and mortality among individuals with HIV/AIDS. Evidence of higher colonization rates among high-risk HIV populations have been observed however, prevalence estimates have varied. Additionally, behavioral, biological, and/or environmental factors that may account for these high colonization rates are not understood. Previous literature on clinic-based surveys were subject to considerable biases. Additionally, representative samples of high-risk HIV populations were difficult to obtain due in part to an underrepresentation of individuals who may not regularly obtain health care. ^ The main objective of this project is to determine the prevalence of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant (MRSA) nasal colonization in two populations: 1) men who have sex with men (MSM) and 2) injection drug users (IDU). Both of these populations are included in the third round of the National HIV Behavioral Surveillance System (NHBS) in Houston, Texas. ^ In the NHBS-MSM3 study, logistic regression was used to report odds ratios and 95% confidence intervals (CI). For the NHBS-IDU3 study, to account for the lack of independence between samples, the method of generalized estimating equations was utilized to report adjusted odds ratios and 95% CI. The NHBS-MSM3 study enrolled 202 participants with a MSSA colonization rate of 26.7% and MRSA rate of 3%. In the NHBS-IDU3 study, 18.4% were nasally colonized with MSSA and 5.7% were nasally colonized with MRSA. Among the NHBS-MSM3 population, high-risk sexual practices were associated with colonization. For the NHBS-IDU3 population, age, marital status, employment status, and the presence of scabs, were associated with colonization status when controlling for size of recruitment network. In multivariate GEE analyses, the use of antiretroviral medications and age remained significantly associated with S. aureus nasal colonization when controlling for size of recruitment network and gender. In both studies, a significantly higher than expected S. aureus and MRSA colonization rate was observed as compared to colonization rates described for the general population. However, these estimates were moderate in comparison to reported clinic-based MSM and IDU S. aureus colonization findings. This study validates substantial prevalence differences and biases that may exist with data collected from clinic-based MSM and IDU. The prevalence of MSSA and MRSA nasal colonization did not differ significantly with respect to HIV status among NHBS-MSM3/NHBS-IDU3 participants. Continued examination on the effects of S. aureus colonization and infection should be examined longitudinally to confirm additional community-based determinants in populations that are disproportionately affected.^

Dually Active HIV/HBV Antiretrovirals Protect Against Incident Hepatitis B Infections: Potential for Prophylaxis.

BACKGROUND  Hepatitis-B virus (HBV) has a detrimental effect on HIV natural course, and HBV vaccination is less effective in the HIV infected. We examine the protective effect of dually active antiretroviral therapy (DAART) for HIV/HBV (Tenofovir/Lamivudine/Emtricitabine) in a large cohort encompassing heterosexuals, men-who-have-sex-with-men (MSM), and intravenous drug users (IDU), who are HIV-infected yet susceptible to HBV, with comprehensive follow-up data about risky behavior and immunological profile. METHODS  We defined an incident HBV infection as the presence of any of HBV serological markers (HBsAg/AntiHBc/HBV-DNA) following a negative baseline AntiHBc test. Patients with positive AntiHBs were excluded. Cox proportional hazard models were utilized, with an incident case of HBV infection as the outcome variable. RESULTS  We analyzed 1,716 eligible patients from the Swiss HIV Cohort Study with 177 incident HBV cases. DAART was negatively associated with incident HBV infection (hazard ratio 0.4, 95%CI 0.2-0.6). This protective association was robust to adjustment (0.3, 0.2-0.5) for condomless sex, √CD4 count, drug use, and patients' demographics. Condomless sex (1.9,1.4-2.6), belonging to MSM (2.7,1.7-4.2) or IDU (3.8,2.4-6.1) were all associated with higher HBV hazard. CONCLUSIONS  Our study suggests that DAART, independently of CD4 count and risky behavior, has a potentially strong public health impact including pre-exposure prophylaxis of HBV co-infection.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

Background: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. Methods: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/ use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. Results: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. Conclusion: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Changes in the initiation of heroin use after a reduction in heroin supply

Increasing heroin use in Australia over the past 30 years has been associated with a decline in the age of initiation to heroin use. The 2001 Australian heroin shortage was used to assess the effects of a reduction in heroin supply on age of initiation into heroin injecting. Data collected from regular injecting drug users (IDU) over the period 1996-2004 as part of the Australian Illicit Drug Reporting System were examined for changes in self- reported age of first heroin use after the onset of the heroin shortage. Estimates were also made of the number of young people who may not have commenced injecting heroin during the heroin shortage. The proportion of IDU interviewed in the IDRS who were aged

Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001-2004). The rate of morphine prescription per person aged 15-54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS

Background: Injecting drug use (IDU) and associated mortality appear to be increasing in many parts of the world. IDU is an important factor in HIV transmission. In estimating AIDS mortality attributable to IDU, it is important to take account of premature mortality rates from other causes to ensure that AIDS related mortality among injecting drug users (IDUs) is not overestimated. The current review provides estimates of the excess non-AIDS mortality among IDUs. Method: Searches were conducted with Medline, PsycINFO, and the Web of Science. The authors also searched reference lists of identified papers and an earlier literature review by English et al (1995). Crude. mortality rates (CMRs) were derived from data on the number of deaths, period of follow UP, and number of participants. In estimating the all-cause mortality, two rates were calculated: one that included all cohort studies identified in the search, and one that only included studies that reported on AIDS deaths in their cohort. This provided lower and upper mortality rates, respectively. Results: The current paper derived weighted mortality rates based upon cohort studies that included 179 885 participants, 1 219 422 person-years of observation, and 16 593 deaths. The weighted crude AIDS mortality rate from studies that reported AIDS deaths was approximately 0.78% per annum. The median estimated non-AIDS mortality rate was 1.08% per annum. Conclusions: Illicit drug users have a greatly increased risk of premature death and mortality due to AIDS forms a significant part of that increased risk; it is, however, only part of that risk. Future work needs to examine mortality rates among IDUs in developing countries, and collect data on the relation between HIV and increased mortality due to all causes among this group.

Reciclaje de pavimentos : estudio de las ventajas económicas del reciclaje en frío in situ de pavimentos asfalticos

En los procesos de mantenimiento y rehabilitación de pavimentos, se deben definir los objetivos, bien sea para realizar unas reparaciones superficiales sobre daños generados por el agua como consecuencia de fallas en los drenajes, o bien realizar una intervención sobre la estructura buscando recuperarla a sus condiciones de diseño originales, la cual se realiza con el proceso de reciclaje el cual tiene en cuenta las características físico-químicas de los materiales existentes los cuales se consideran sufrieron el adecuado proceso que les permitió hacer parte de la estructura. Existiendo cuatro tipos de reciclaje de los cuales se realiza una descripción general de cada proceso, el presente trabajo se concentra en el análisis técnico – económico del proceso ―In situ‖ en frio, método utilizado en la rehabilitación de la vía Sopetrán - Puente de Occidente, en el Departamento de Antioquia, en una longitud de 13 Km. El presente estudio se realiza verificando el cumplimiento de las especificaciones a nivel nacional que para estos procesos estableció el Instituto Nacional de Vías (INVIAS) y verificando el cumplimiento de las normas IDU ET-2005. El reciclaje ―in situ‖ en frio tiene ventajas ecológicas (no necesita afectar las eventuales fuentes de materiales de la zona), económico (bajos costos comparados con reconstrucción) y técnico (los equipos para este proceso han presentado importantes avances tecnológicos) lo cual permitió su aplicación en la vía mencionada, lo cual con la adición de un agente estabilizador (cemento para el presente estudio) permite recuperar las condiciones iniciales de diseño de la estructura intervenida. El árbol de decisiones es una herramienta utilizada para el análisis y selección de la mejor opción de estructura a realizar teniendo en cuenta calidad y costos. El presente trabajo termina con un análisis detallado de las condiciones existentes, revisión de las diferentes opciones de intervención y el estudio económico de las diferentes alternativas de estructura de pavimento para la rehabilitación de la vía referida.

Evaluación del sobrecosto en malla vial en la Localidad de Chapinero en el año 2014 por convenio 1292 de 2012

53 p.

Aprovechamiento de los residuos de construcción y demolición (RCD) acopiados en el relleno sanitario Doña Juana de la ciudad de Bogotá D.C., para el mejoramiento de bases granulares

94 p.

Elaboración de procedimientos y formatos que permitan un adecuado control de calidad de los agregados y materiales propios de las actividades de urbanismo del Centro Empresarial Pontevedra en la ciudad de Bogotá. D.C.

73 p.

Plan de negocios Bicigo app

La gran cantidad de personas interesadas actualmente en cuidar de su salud por medio de la Bicicleta, es una tendencia que cada vez toma más fuerza y por esto, se tomara como ventaja que la ciudad de Bogotá con sus últimos alcaldes han decidió apoyar el uso de esta. Aplicación para realizar grupos de ciclistas y poder salir cualquier día de la semana acompañado de más personas por un tema de transporte pero también de ocio. El objetivo es que las personas que no utilizan la bicicleta por miedo a salir solos, puedan unirse a diferentes grupos y hacer bici paseos por la ciudad, también contemplamos el hecho de que existen personas que quieren montar bicicleta como aficionados, es decir que salen por la carreteras aledañas a la capital pero muchas veces no tienen grupo con quien rodar. Queremos para el año 2020, lograr ser una de las aplicaciones de Bicicletas más exitosa de la ciudadanía de Bogotá, siendo una de las aplicaciones que mas apoya el uso diario y deportivo de la bicicleta. Nuestra aplicación ofrece el servicio principalmente de reunir gente y hacer paseos con diferentes personas haciendo uso de las bicicletas, dentro de la ciudad como ocio y transporte se realizarían en la mañana y noches, pero así mismo realizar grupos para hacer uso de la bicicleta por carreteras, es decir más como modo profesional o aficionado. Nuestra aplicación cuenta con una interface para seleccionar el tipo de bici usuario y segundo por donde o a donde quiere dirigirse para así mismo mostrarle las rutas cercanas a él. Nuestra característica principal es la unión de diferentes grupos, personas y entidades para hacer uso de la Bicicleta, tenemos una plataforma interactiva y fácil de usar, tan fácil que cualquier persona que no esté inmersa en el mundo de los Smartphone o aplicaciones pueda aprender a usarla. Unas de las ventajas con las que cuento es que desde muy joven me ha gustado montar en bicicletas y es así como decido crear una aplicación ya que compañeros, familiares y conocidos no salían a montar bicicleta solo conmigo, preferían que fuese un grupo más grande. Así mismo cuento con 3 compañeros de la universidad Javeriana que son programadores y ellos me van a brindar apoyo con la programación de la aplicación, y una compañera cercana a mí que estudio diseño industrial y me brindara apoyo con el diseño e imagen corporativa de la aplicación. Cuento con planta física para ubicar la oficina de nuestra empresa. Esta aplicación va dirigida principalmente a los habitantes de la ciudad de Bogotá, interesados en el cuidado de su salud combinado con medio de transporte, y personas correspondientes al estrato 2 en adelante, ya que son las personas que normalmente hacen uso de la bicicleta o que son personas potenciales para empezar hacer uso de la bicicleta. . La ciudad de Bogotá cuenta con 8’037.732 habitantes y este proyecto va ser desarrollado en toda la ciudad, toca tener en cuenta que la ciudad esta mesclada entre la diferente estratificación, no dirigimos a los estratos 2 y 3 que tenga la posibilidad de tener su Bicicleta y un celular tipo Smartphone, para los estratos 4, 5 y 6 sabemos que tiene la facilidad de obtener una bicicleta y ellos son nuestro usuario potencial el cual generaríamos un cambio y tomarían su bicicleta para hacer ejercicio como ocio y como medio de transporte. En cuanto a la proyección financiera para la aplicación, como se mencionó anteriormente, contamos con una gran ventaja, ya que la inversión requerida será menor debido a la propiedad con la que cuento para llevar a cabo el proyecto. Una propiedad de 60 metros cuadrados para empezar, la cual cuenta con salas de reunión y auditorio, un parqueaderos exteriores. Al hacer la calculación se va tener en cuenta el pago de un arriendo sin importan que sea de nuestra propiedad y así poder evidenciar realmente como es el estado financiero y no subsidiarla. Por otro lado, la inversión en efectivo que se necesitara será aproximadamente de $100.000.000 que serán $50.000.000 de mis padres y el restante saldrán de mis ahorros, Javier Amortegui Babativa, los cuales serán distribuidos para adecuación de planta, equipos y sistemas $17.616.880, para publicidad y mercadeo: $30.000.000, creación de la aplicación $34.000.000, sistemas IOS + Android $421.600, Gastos de composición empresarial y bancarios $11.000.000 y por último se va tener un provisión para imprevistos por el restante $6.961.520. Nuestras proyecciones de ventas han sido basadas en aplicaciones similares con un mismo formato de lucro con el tema de bicicletas pero no con la misma idea de negocio, nuestras proyecciones de ventas estimadas serán de $20.000.000 a $25.000.000 los primeros 3 meses, mientras tomamos fuerza en el mercado.