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  1. Article ; Online: Limited impact of contact tracing in a University setting for COVID-19 due to asymptomatic transmission and social distancing.

    Stocks, Daniel / Nixon, Emily / Trickey, Adam / Homer, Martin / Brooks-Pollock, Ellen

    Epidemics

    2023  Volume 45, Page(s) 100716

    Abstract: Contact tracing is an important tool for controlling the spread of infectious diseases, including COVID-19. Here, we investigate the spread of COVID-19 and the effectiveness of contact tracing in a university population, using a data-driven ego-centric ... ...

    Abstract Contact tracing is an important tool for controlling the spread of infectious diseases, including COVID-19. Here, we investigate the spread of COVID-19 and the effectiveness of contact tracing in a university population, using a data-driven ego-centric network model constructed with social contact data collected during 2020 and similar data collected in 2010. We find that during 2020, university staff and students consistently reported fewer social contacts than in 2010, however those contacts occurred more frequently and were of longer duration. We find that contact tracing in the presence of social distancing is less impactful than without social distancing. By combining multiple data sources, we show that University-aged populations are likely to develop asymptomatic COVID-19 infections. We find that asymptomatic index cases cannot be reliably discovered through contact tracing and consequently transmission in their social network is not significantly reduced through contact tracing. In summary, social distancing restrictions had a large impact on limiting COVID-19 outbreaks in universities; to reduce transmission further contact tracing should be used in conjunction with alternative interventions.
    MeSH term(s) Humans ; Aged ; COVID-19/epidemiology ; Contact Tracing ; Universities ; Physical Distancing ; Disease Outbreaks
    Language English
    Publishing date 2023-09-08
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2467993-8
    ISSN 1878-0067 ; 1755-4365
    ISSN (online) 1878-0067
    ISSN 1755-4365
    DOI 10.1016/j.epidem.2023.100716
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  2. Article ; Online: Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials.

    Harrer, Mathias / Nixon, Patricia / Sprenger, Antonia A / Heber, Elena / Boß, Leif / Heckendorf, Hanna / Buntrock, Claudia / Ebert, David Daniel / Lehr, Dirk

    BMJ mental health

    2024  Volume 27, Issue 1

    Abstract: Question: Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived ... ...

    Abstract Question: Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived stress, have emerged as a new research paradigm.This individual participant data (IPD) meta-analysis examines if a web-based stress management intervention can be used as an 'indirect' treatment of depression.
    Study selection and analysis: Bayesian one-stage models were used to estimate pooled effects on depressive symptom severity, minimally important improvement and reliable deterioration. The dose-response relationship was examined using multilevel additive models, and IPD network meta-analysis was employed to estimate the effect of guidance.
    Findings: In total, N=1235 patients suffering from clinical-level depression from K=6 randomised trials were included. Moderate-to-large effects were found on depressive symptom severity at 7 weeks post-intervention (d=-0.65; 95% credibility interval (CrI): -0.84 to -0.48) as measured with the Center for Epidemiological Studies' Depression Scale. Effects were sustained at 3-month follow-up (d=-0.74; 95% CrI: -1.01 to -0.48). Post-intervention symptom severity was linearly related to the number of completed sessions. The incremental impact of guidance was estimated at d=-0.25 (95% CrI: -1.30 to 0.82), with a 35% posterior probability that guided and unguided formats produce equivalent effects.
    Conclusions: Our results indicate that web-based stress management can serve as an indirect treatment, yielding effects comparable with direct interventions for depression. Further research is needed to determine if such formats can indeed increase the utilisation of evidence-based treatment, and to corroborate the favourable effects for human guidance.
    Study registration: Open material repository: osf.io/dbjc8, osf.io/3qtbe.
    Trial registration number: German Clinical Trial Registration (DRKS): DRKS00004749, DRKS00005112, DRKS00005384, DRKS00005687, DRKS00005699, DRKS00005990.
    MeSH term(s) Humans ; Depression/therapy ; Bayes Theorem ; Psychotherapy/methods ; Anxiety/therapy ; Internet ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2024-02-13
    Publishing country England
    Document type Meta-Analysis ; Journal Article
    ISSN 2755-9734
    ISSN (online) 2755-9734
    DOI 10.1136/bmjment-2023-300846
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  3. Article ; Online: The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya.

    Mujwara, Deo / Kelvin, Elizabeth A / Dahman, Bassam / George, Gavin / Nixon, Daniel / Adera, Tilahun / Mwai, Eva / Kimmel, April D

    Health policy and planning

    2024  Volume 39, Issue 4, Page(s) 355–362

    Abstract: HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of ... ...

    Abstract HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.
    MeSH term(s) Humans ; Self-Testing ; HIV Infections/diagnosis ; HIV Infections/prevention & control ; Cost-Benefit Analysis ; Kenya/epidemiology ; Truck Drivers ; Mass Screening
    Language English
    Publishing date 2024-02-26
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 632896-9
    ISSN 1460-2237 ; 0268-1080
    ISSN (online) 1460-2237
    ISSN 0268-1080
    DOI 10.1093/heapol/czae013
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  4. Article: Feasibility and acceptability of high-intensity interval training and moderate-intensity continuous training in kidney transplant recipients: the PACE-KD study.

    Billany, Roseanne E / Smith, Alice C / Hutchinson, Ganisha M / Graham-Brown, Matthew P M / Nixon, Daniel G D / Bishop, Nicolette C

    Pilot and feasibility studies

    2022  Volume 8, Issue 1, Page(s) 106

    Abstract: Background: Kidney transplant recipients (KTRs) exhibit unique elevated inflammation, impaired immune function, and increased cardiovascular risk. Although exercise reduces cardiovascular risk, there is limited research on this population, particularly ... ...

    Abstract Background: Kidney transplant recipients (KTRs) exhibit unique elevated inflammation, impaired immune function, and increased cardiovascular risk. Although exercise reduces cardiovascular risk, there is limited research on this population, particularly surrounding novel high-intensity interval training (HIIT). The purpose of this pilot study was to determine the feasibility and acceptability of HIIT in KTRs.
    Methods: Twenty KTRs (male 14; eGFR 58±19 mL/min/1.73 m
    Results: Twenty participants completed the intervention, and 8 of whom achieved the required intensity based on power output (HIIT A, 0/6 [0%]; HIITB, 3/8 [38%]; MICT, 5/6 [83%]). Participants completed 92% of the 24 sessions with 105 cancelled and rescheduled sessions and an average of 10 weeks to complete the intervention. Pre-intervention versus post-intervention V̇O
    Conclusions: This is the first study to report the feasibility of HIIT in KTRs. Although participants struggled to achieve the required intensity (power), this study highlights the potential that exercise has to reduce cardiovascular risk in KTRs. HIIT and MICT performed on a cycle, with some modification, could be considered safe and feasible in KTRs. Larger scale trials are required to assess the efficacy of HIIT in KTRs and in particular identify the most appropriate intensities, recovery periods, and session duration. Some flexibility in delivery, such as incorporating home-based sessions, may need to be considered to improve recruitment and retention.
    Trial registration: ISRCTN, ISRCTN17122775 . Registered on 30 January 2017.
    Language English
    Publishing date 2022-05-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2809935-7
    ISSN 2055-5784
    ISSN 2055-5784
    DOI 10.1186/s40814-022-01067-3
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  5. Article ; Online: Brief Report: Physician Reimbursement and Retention in HIV Care: Racial Disparities in the US South.

    Pan, Zhongzhe / Dahman, Bassam / Bono, Rose S / Sabik, Lindsay M / Belgrave, Faye Z / Yerkes, Lauren / Nixon, Daniel E / Kimmel, April D

    Journal of acquired immune deficiency syndromes (1999)

    2022  Volume 92, Issue 1, Page(s) 1–5

    Abstract: Background: Retention in HIV care remains a national challenge. Addressing structural barriers to care may improve retention. We examined the association between physician reimbursement and retention in HIV care, including racial differences.: Methods! ...

    Abstract Background: Retention in HIV care remains a national challenge. Addressing structural barriers to care may improve retention. We examined the association between physician reimbursement and retention in HIV care, including racial differences.
    Methods: We integrated person-level administrative claims (Medicaid Analytic eXtract, 2008-2012), state Medicaid-to-Medicare physician fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing Medicaid relative to Medicare physician reimbursement across states. Generalized estimating equations assessed the association between the fee ratio and retention (≥2 care markers ≥90 days apart in a calendar year). Stratified analyses assessed racial differences. We varied definitions of retention, subsamples, and definitions of the fee ratio, including the fee ratio at parity.
    Results: The sample included 55,237 adult Medicaid enrollees with HIV (179,002 enrollee years). Enrollees were retained in HIV care for 76.6% of their enrollment years, with retention lower among non-Hispanic Black (76.1%) versus non-Hispanic White enrollees (81.3%, P < 0.001). A 10-percentage point increase in physician reimbursement was associated with 4% increased odds of retention (adjusted odds ratio 1.04, 95% confidence interval: 1.01 to 1.07). In stratified analyses, the positive, significant association occurred among non-Hispanic Black (1.08, 1.05-1.12) but not non-Hispanic White enrollees (0.87, 0.74-1.02). Findings were robust across sensitivity analyses. When the fee ratio reached parity, predicted retention increased significantly overall and for non-Hispanic Black enrollees.
    Conclusion: Higher physician reimbursement may improve retention in HIV care, particularly among non-Hispanic Black individuals, and could be a mechanism to promote health equity.
    MeSH term(s) Aged ; United States ; Humans ; Health Promotion ; Medicare ; HIV Infections/drug therapy ; District of Columbia ; Physicians
    Language English
    Publishing date 2022-09-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645053-2
    ISSN 1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
    ISSN (online) 1944-7884 ; 1077-9450
    ISSN 0897-5965 ; 0894-9255 ; 1525-4135
    DOI 10.1097/QAI.0000000000003105
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    Zs.A 2442: Show issues Location:
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  6. Article: Effect of high intensity interval training and moderate intensity continuous training on lymphoid, myeloid and inflammatory cells in kidney transplant recipients.

    Hutchinson, Ganisha M / Cooper, Andrea M / Billany, Roseanne E / Nixon, Daniel G D / Bishop, Nicolette C / Smith, Alice C

    Exercise immunology review

    2022  Volume 28, Page(s) 100–115

    Abstract: Kidney transplantations are seen to be a double-edge sword. Transplantations help to partially restore renal function, however there are a number of health-related co-morbidities associated with transplantation. Cardiovascular disease (CVD), malignancy ... ...

    Abstract Kidney transplantations are seen to be a double-edge sword. Transplantations help to partially restore renal function, however there are a number of health-related co-morbidities associated with transplantation. Cardiovascular disease (CVD), malignancy and infections all limit patient and graft survival. Immunosuppressive medications alter innate and adaptive immunity and can result in immune dysfunction. Over suppression of the immune system can result in infections whereas under suppression can result in graft rejection. Exercise is a known therapeutic intervention with many physiological benefits. Its effects on immune function are not well characterised and may include both positive and negative influences depending on the type, intensity, and duration of the exercise bout. High intensity interval training (HIIT) has become more popular due to it resulting in improvements to tradional and inflammatory markers of cardiovascular (CV) risk in clinical and non-clinical populations. Though these improvements are similar to those seen with moderate intensity exercise, HIIT requires a shorter overall time commitment, whilst improvements can also be seen even with a reduced exercise volume. The purpose of this study was to explore the physiolocial and immunological impact of 8-weeks of HIIT and moderate intensity continuous training (MICT) in kidney transplan recipients (KTRs). In addition, the natural variations of immune and inflammatory cells in KTRs and non-CKD controls over a longitudinal period are explored. Newly developed multi-colour flow cytometry methods were devised to identify and characterise immune cell populations. Twenty-six KTRs were randomised into one of two HIIT protocols or MICT: HIIT A (n=8; 4-, 2-, and 1-min intervals; 80-90% VO2peak), HIIT B (n=8, 4x4 min intervals; 80-90% VO2peak), or MICT (n=8, ~40 min; 50-60% VO2peak) for 24 supervised sessions on a stationary bike (approx. 3x/week over 8 ± 2 weeks). Blood samples taken pre-training, mid training, post-training and 3 months later. Novel multi-colour flow cytometric panels were developed to characterise lymphoid and myeloid cell population from peripheral blood mononuclear cells. No changes were observed for circulating immune and inflammatory cells over the 8-week interventions. The feasibility study does not suggest that exercise programmes using HIIT and MICT protocols elicit adverse negative effects on immunity in KTRs. Therefore, such protocols may be immunologically safe for these patients. The inability of the participants to achieve the target exercise intensities may be due to physiological abnormalities in this population which warrants further investigation.
    MeSH term(s) Exercise ; High-Intensity Interval Training/methods ; Humans ; Kidney Transplantation ; Leukocytes, Mononuclear ; Transplant Recipients
    Language English
    Publishing date 2022-04-22
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1240985-6
    ISSN 1077-5552
    ISSN 1077-5552
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  7. Article ; Online: HIV virologic response and baseline genotypic resistance in a long-acting cabotegravir/rilpivirine initiation program.

    Masich, Anne M / Gomes, Denese / Higginson, Robert T / Morgan, Zara / Nixon, Daniel / Tran, Melissa / Winthrop, Elizabeth / Fulco, Patricia P

    AIDS (London, England)

    2023  Volume 37, Issue 10, Page(s) 1641–1642

    MeSH term(s) Humans ; HIV Infections/drug therapy ; Anti-Retroviral Agents/therapeutic use ; Rilpivirine/therapeutic use ; Pyridones/therapeutic use ; Anti-HIV Agents/therapeutic use
    Chemical Substances cabotegravir (HMH0132Z1Q) ; Anti-Retroviral Agents ; Rilpivirine (FI96A8X663) ; Pyridones ; Anti-HIV Agents
    Language English
    Publishing date 2023-07-14
    Publishing country England
    Document type Letter
    ZDB-ID 639076-6
    ISSN 1473-5571 ; 0269-9370 ; 1350-2840
    ISSN (online) 1473-5571
    ISSN 0269-9370 ; 1350-2840
    DOI 10.1097/QAD.0000000000003590
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    Zs.A 2228: Show issues Location:
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  8. Article ; Online: Cytomegalovirus viremia and risk of disease progression and death in HIV-positive patients starting antiretroviral therapy.

    Levi, Laura I / Sharma, Shweta / Schleiss, Mark R / Furrer, Hansjakob / Nixon, Daniel E / Blackstad, Mark / Hernandez-Alvarado, Nelmary / Dwyer, Dominic E / Borges, Alvaro H / Lane, H Clifford / Lundgren, Jens / Neaton, James D / Molina, Jean-Michel

    AIDS (London, England)

    2022  Volume 36, Issue 9, Page(s) 1265–1272

    Abstract: Objective: The aim of this study was to assess the prevalence of cytomegalovirus (CMV) viremia in HIV-positive patients starting antiretroviral therapy (ART) and to evaluate its impact on clinical outcomes.: Design: A retrospective analysis of four ... ...

    Abstract Objective: The aim of this study was to assess the prevalence of cytomegalovirus (CMV) viremia in HIV-positive patients starting antiretroviral therapy (ART) and to evaluate its impact on clinical outcomes.
    Design: A retrospective analysis of four clinical trials (INSIGHT FIRST, SMART, START, and ANRS REFLATE TB).
    Methods: Stored plasma samples from participants were used to measure CMV viremia at baseline prior to initiating ART and at visits through 1 year of follow-up after ART initiation. CMV viremia was measured centrally using a quantitative PCR assay. Within FIRST, associations of CMV viremia at baseline and through 8 months of ART were examined with a composite clinical outcome of AIDS, serious non-AIDS events, or death using Cox proportional hazards regression.
    Results: Samples from a total of 3176 participants, 1169 from FIRST, 137 from ANRS REFLATE TB, 54 from SMART, and 1816 from START were available with baseline CMV viremia prevalence of 17, 26, 0, and 1%, respectively. Pooled across trials, baseline CMV viremia was associated with low CD4 + T-cell counts and high HIV RNA levels. In FIRST, CMV viremia was detected in only 5% of participants between baseline and month 8. After adjustment for CD4 + T-cell count and HIV RNA levels, hazard ratios for risk of clinical outcomes was 1.15 (0.86-1.54) and 2.58 (1.68-3.98) in FIRST participants with baseline and follow-up CMV viremia, respectively.
    Conclusion: Baseline CMV viremia in HIV-positive patients starting ART is associated with advanced infection and only persistent CMV viremia after ART initiation is associated with a higher risk of morbidity and mortality.
    MeSH term(s) CD4 Lymphocyte Count ; Cytomegalovirus/genetics ; Cytomegalovirus Infections/complications ; Disease Progression ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Seropositivity/complications ; Humans ; RNA/therapeutic use ; Retrospective Studies ; Viremia/drug therapy
    Chemical Substances RNA (63231-63-0)
    Language English
    Publishing date 2022-04-19
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639076-6
    ISSN 1473-5571 ; 0269-9370 ; 1350-2840
    ISSN (online) 1473-5571
    ISSN 0269-9370 ; 1350-2840
    DOI 10.1097/QAD.0000000000003238
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  9. Article ; Online: A three-armed randomised controlled trial investigating the comparative impact of guidance on the efficacy of a web-based stress management intervention and health impairing and promoting mechanisms of prevention.

    Nixon, Patricia / Boß, Leif / Heber, Elena / Ebert, David Daniel / Lehr, Dirk

    BMC public health

    2021  Volume 21, Issue 1, Page(s) 1511

    Abstract: Background: Web-based stress management interventions (SMI) fit increasingly digital lifestyles, reduce barriers of uptake and are easily scalable. SMIs might lower levels of stress in employees and thereby contribute to the prevention of depressive ... ...

    Abstract Background: Web-based stress management interventions (SMI) fit increasingly digital lifestyles, reduce barriers of uptake and are easily scalable. SMIs might lower levels of stress in employees and thereby contribute to the prevention of depressive symptomatology. Different guidance formats can impact the efficacy of SMIs, with higher intensity assumed to result in larger effects. However, head-to-head comparisons of guidance formats are rare. This is the first trial to examine the impact of adherence-focused guidance compared to self-help on the efficacy of an occupational SMI compared to a wait list control condition. Additionally, it will be investigated if the SMI enfolds its impact on preventing depressive symptomatology by different pathways through reducing health impairing and increasing promoting factors.
    Methods: A three-armed randomised controlled trial (RCT) on an occupational SMI was conducted. 404 employees with elevated levels of perceived stress (PSS-10 ≥ 22) were randomly assigned to: adherence-focused guidance (AFG), self-help (SH) or a wait list control group (WLC). The primary outcome was perceived stress (PSS-10). Secondary outcomes included health- and work-related measures. A parallel mediation analysis with stress and resilience as mediators for the effect on depression (CES-D) was carried out. Data collection took place at baseline (T1), after 7 weeks (T2) and 6 months (T3).
    Results: The SMI was effective for all groups on the primary and secondary outcomes. For stress, analyses of covariance (ANCOVA) revealed significant group effects at T2 (F
    Conclusions: The SMI was effective for reducing stress and improving other health- and work-related outcomes, irrespective of the guidance format. Results did not demonstrate superiority of adherence-focused guidance for the efficacy but for adherence in terms of completed modules. Among other reasons, better communication strategies about offered guidance and awareness-raising measures are discussed. Results from mediation analysis suggest that preventive SMIs should be designed to reach two goals: reducing the risk factor of stress and simultaneously increasing health promoting factors such as resilience.
    Trial registration: German Clinical Trial Registration (DRKS) DRKS00005687 , 6/6/2014.
    MeSH term(s) Counseling ; Health Behavior ; Humans ; Internet ; Internet-Based Intervention ; Psychotherapy
    Language English
    Publishing date 2021-08-05
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ISSN 1471-2458
    ISSN (online) 1471-2458
    DOI 10.1186/s12889-021-11504-2
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  10. Article ; Online: Epidemiological evidence for association between higher influenza vaccine uptake in the elderly and lower COVID-19 deaths in Italy.

    Marín-Hernández, Daniela / Schwartz, Robert E / Nixon, Douglas F

    Journal of medical virology

    2020  Volume 93, Issue 1, Page(s) 64–65

    MeSH term(s) Aged ; COVID-19/epidemiology ; COVID-19/mortality ; Humans ; Influenza Vaccines/administration & dosage ; Influenza Vaccines/immunology ; Influenza, Human/prevention & control ; Italy/epidemiology ; SARS-CoV-2 ; Vaccination/statistics & numerical data
    Chemical Substances Influenza Vaccines
    Keywords covid19
    Language English
    Publishing date 2020-06-09
    Publishing country United States
    Document type Letter
    ZDB-ID 752392-0
    ISSN 1096-9071 ; 0146-6615
    ISSN (online) 1096-9071
    ISSN 0146-6615
    DOI 10.1002/jmv.26120
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