A5071434104- Tuberculosis Research and Epidemiology
- Mobile Health and mHealth Applications
- HIV/AIDS Research and Interventions
- Health Literacy and Information Accessibility
- Diagnosis and treatment of tuberculosis
- ICT in Developing Communities
- Infectious Diseases and Tuberculosis
- Pneumocystis jirovecii pneumonia detection and treatment
- Pneumonia and Respiratory Infections
- Mycobacterium research and diagnosis
- Urban, Neighborhood, and Segregation Studies
- Digital Mental Health Interventions
- Homelessness and Social Issues
- Cystic Fibrosis Research Advances
- Bipolar Disorder and Treatment
- Advanced Causal Inference Techniques
- Interpreting and Communication in Healthcare
- Maternal and fetal healthcare
- Healthcare cost, quality, practices
- Statistical Methods and Bayesian Inference
- Lung Cancer Diagnosis and Treatment
- Digital Imaging for Blood Diseases
- Shoulder and Clavicle Injuries
- Orthopedic Infections and Treatments
- COVID-19 Clinical Research Studies
University of California, San Francisco
2019-2024
San Francisco General Hospital
2020-2024
University of California System
2021
University of California, Berkeley
2017-2018
United States Census Bureau
2018
Icahn School of Medicine at Mount Sinai
2018
Institute for Family Health
2018
Berkeley Public Health Division
2017
North Manchester General Hospital
2014
Pennine Acute Hospitals NHS Trust
2014
Tongue dorsum swabs have shown promise as alternatives to sputum for detecting Mycobacterium tuberculosis (MTB) in patients with pulmonary (TB). Some of the most encouraging results come from studies that used manual quantitative PCR (qPCR) analyze swabs. Studies using automated Cepheid Xpert MTB/RIF Ultra qPCR test (Xpert Ultra) exhibited less sensitivity tongue swabs, possibly because is optimized testing sputum, not swab samples. Using two new sample preprocessing methods demonstrated...
BackgroundNon-sputum-based triage tests for tuberculosis are a priority ending tuberculosis. We aimed to evaluate the diagnostic accuracy of late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted prospective study among outpatients with presumed in outpatient clinics Viet Nam, India, Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older reported cough lasting at least 2 weeks. excluded those receiving treatment preceding 12...
Background Adherence to and completion of tuberculosis (TB) treatment remain problematic in many high-burden countries. 99DOTS is a low-cost digital adherence technology that could increase TB completion. Methods findings We conducted pragmatic stepped-wedge cluster-randomized trial including all adults treated for drug-susceptible pulmonary at 18 health facilities across Uganda over 8 months (1 December 2018–31 July 2019). Facilities were randomized switch from routine (control period)...
Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis implementation feedback obtained from people with TB and health care workers (HCWs) involved in REACH Wave 6-funded DAT evaluation projects. Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model their workers. The included questions...
The Moving To Opportunity (MTO) experiment manipulated neighborhood context by randomly assigning housing vouchers to volunteers living in public use move lower poverty neighborhoods five US cities. This random assignment overcomes confounding limitations that challenge other studies. However, differences MTO's effects across the cities have been largely ignored. Such could be due population composition (e.g., racial/ethnic distribution) or economy).Using a nonparametric omnibus test and...
Understanding the mediation mechanisms by which an exposure or intervention affects outcome can provide a look into what has been called "black box" of many epidemiologic associations, thereby providing further evidence relationship and possible points intervention. Rapid methodologic developments in analyses mean that there are growing number approaches for researchers to consider, each with its own set assumptions, advantages, disadvantages. This understandably resulted some confusion...
Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is low-cost digital adherence technology that has emerged as promising tool monitoring and supporting TB completion.
99DOTS is a low-cost digital adherence technology that allows people with tuberculosis (TB) to self-report treatment adherence. There are limited data on its implementation, feasibility, and acceptability from sub-Saharan Africa. We conducted longitudinal analysis cross-sectional surveys nested within stepped-wedge randomized trial at 18 health facilities in Uganda between December 2018 January 2020. The assessed implementation of key components 99DOTS-based intervention, including...
Evidence suggests that aspects of the neighborhood environment may influence risk problematic drug use among adolescents. Our objective was to examine mediating roles school and peer environments on effect receiving a Section 8 housing voucher using it move out public adolescent substance outcomes.
Accessible, accurate screening tests are necessary to advance tuberculosis (TB) case finding and early detection in high-burden countries.
Abstract Introduction Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis implementation feedback obtained from people with TB and health care workers (HCWs) involved in REACH Wave 6-funded DAT evaluation projects. Methods Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model their...
Introduction Low-cost digital adherence technologies (DATs) such as 99DOTS have emerged an alternative to directly observed therapy (DOT), the current standard for tuberculosis (TB) treatment supervision. However, there are limited data support DAT scale-up. The ‘DOT DAT’ trial aims evaluate effectiveness and implementation of a 99DOTS-based TB supervision strategy. Methods analysis This is pragmatic, stepped-wedge cluster randomised trial, with hybrid type 2 effectiveness-implementation...
Accessible, accurate screening tests are necessary to advance tuberculosis (TB) case finding and early detection in high-burden countries. We compared the diagnostic accuracy of available TB triage tests.
Abstract Background Following early implementation of public health measures, San Francisco has experienced a slow rise and low peak level coronavirus disease 2019 (COVID-19) cases deaths. Methods Findings We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at safety net hospital for through April 8, 2020. Each patient had ≥15 days follow-up. Among 26 patients, median age was 54 years (interquartile range, 43 62), 65% were men, 77% Latinx. Mechanical...
Variation in healthcare delivery is increasingly recognized as an important metric of quality. Directly observed therapy (DOT) has been the standard care for tuberculosis (TB) treatment supervision decades based on World Health Organization (WHO) guidelines. However, variation implementation DOT and associated TB practices remains poorly defined.We collected individual patient data from registers at 18 units Uganda including District Centers, Hospitals, Regional Referral Hospitals. We also...
Policies implemented to slow transmission of COVID-19 are expected have disrupted delivery routine health services, including tuberculosis (TB) care.We analyzed daily counts drug-susceptible (DS)-TB case notifications from all facilities affiliated with the Philippines National TB Program (NTP) before and after implementation community quarantine (January 1-December 31, 2020). Using an interrupted time series design, we assessed immediate sustained effects on reporting. 2019 WHO estimates...
The World Health Organization (WHO) has endorsed the next-generation Xpert MTB/RIF Ultra (Ultra) cartridge, and Uganda is currently transitioning from older generation (Xpert) cartridge to as initial diagnostic test for pulmonary tuberculosis (TB). We assessed accuracy of TB among adults in Kampala, Uganda.We sampled referred testing at two hospitals a health center over 12-month period. enrolled with positive random 1:1 sample negative results. Expectorated sputum was collected Ultra, solid...
Abstract 99DOTS is a low-cost digital adherence technology that allows people with tuberculosis (TB) to self-report treatment adherence. There are limited data on its implementation, feasibility, and acceptability from sub-Saharan Africa. We conducted longitudinal analysis cross-sectional surveys nested within stepped-wedge randomized trial at 18 health facilities in Uganda between December 2018 January 2020. The assessed implementation of key components 99DOTS-based intervention, including...
High levels of treatment adherence are critical for achieving optimal outcomes among patients with tuberculosis (TB), especially drug-resistant TB (DR TB). Current tools identifying high-risk non-adherence insufficient. Here, we apply trajectory analysis to characterize behavior early in DR and assess whether these patterns predict outcomes.We conducted a retrospective Philippines treated between 2013 2016. To identify unique adherence, performed group-based modelling on the first 12 weeks...
<sec><title>BACKGROUND</title>Poor treatment outcomes among people with drug-resistant TB (DR-TB) are a major concern. Heteroresistance (presence of susceptible and resistant Mycobacterium tuberculosis in the same sample) has been identified some TB, but its impact on is unknown.</sec><sec><title>METHODS</title>We used targeted deep sequencing to identify mutations associated DR-TB heteroresistance culture samples 624 DR-TB. We evaluated association...
Background: Adolescents (ages 10-19) affected by tuberculosis (TB) face unique challenges to completing TB treatment, resulting in increased loss follow-up and mortality as compared younger children older adults. Digital adherence technologies (DATs) may be a useful tool for treatment monitoring. In this study we aimed assess whether 99DOTS, low-cost DAT, could improve outcomes among adolescents with pulmonary (PTB). Methods: We conducted an interrupted time series (ITS) analysis of...
ABSTRACT Rationale Digital adherence technologies are being scaled-up for tuberculosis treatment despite limited evidence of their effectiveness and concerns about accessibility. Objectives To determine whether an enhanced 99DOTS-based supervision improves uptake 99DOTS outcomes. Methods We included all adults initiated on drug-suceptible pulmonary between August 2019 June 2021 at 18 99DOTS-experienced health (n=6,382) facilities 12 99DOTS-naïve (n=4,253) in Uganda. Using interrupted time...