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Biomedical subjects

J J Potterat

Publications and source records attributed to J J Potterat.

At least 19 recordsLinked to original sources
PubMed1999

Establishing efficient partner notification periods for patients with chlamydia.

OBJECTIVES: To delineate chlamydia partner notification periods with high proportions of infected, untreated sexual partners, and to evaluate relevant Centers for Disease Control (CDC) recommendations. METHODS: Disease Intervention Specialists (DIS) offered contact tracing services to all chlamydia patients (N = 1,309) reported in Colorado Springs between July 1996 and June 1997. Patients were asked to identify sexual partners during the 180 days preceding treatment. Partners were actively sought by DIS and offered DNA amplification testing. RESULTS: Of 1,309 patients, 1,109 were interviewed, resulting in 2,293 named partners. Two fifths of eligible partners were located; inability to examine partners was related to time of last exposure and to frequency of sexual exposure. Of located partners, 95% were tested with DNA amplification technology. Adherence to CDC criteria identified 88% of infected, untreated partners; the other 12% consisted mainly of epidemiologically important asymptomatic men whose infection is seldom identified by current public health interventions. CONCLUSIONS: The chlamydia partner notification recommendations of the CDC are adequate, but miss men with long-standing infection. These men contribute to entrenched chlamydia endemicity; targeted programs to screen high-risk men merit serious consideration.

Adult↗
PubMed1998

Social network dynamics and HIV transmission.

OBJECTIVE: To prospectively study changes in the social networks of persons at presumably high risk for HIV in a community with low prevalence and little endogenous transmission. METHODS: From a cohort of 595 persons at high risk (prostitutes, injecting drug users, and sexual partners of these persons) and nearly 6000 identified contacts, we examined the social networks of a subset of 96 persons who were interviewed once per year for 3 years. We assessed their network configuration, network stability, and changes in risk configuration and risk behavior using epidemiologic and social network analysis, and visualization techniques. RESULTS: Some significant decrease in personal risk-taking was documented during the course of the study, particularly with regard to needle-sharing. The size and number of connected components (groups that are completely connected) declined. Microstructures (small subgroups of persons that interact intensely) were either not present, or declined appreciably during the period of observation. CONCLUSIONS: In this area of low prevalence, the lack of endogenous transmission of HIV may be related in part to the lack of a network structure that fosters active propagation, despite the continued presence of risky behaviors. Although the relative contribution of network structure and personal behavior cannot be ascertained from these data, the study suggests an important role for network configuration in the transmission dynamics of HIV.

Cohort Studies↗
PubMed1998

Using social network and ethnographic tools to evaluate syphilis transmission.

BACKGROUND AND OBJECTIVES: Partner notification has been the cornerstone for the prevention and control of syphilis in the United States. This technique may not make full use of contextual data that an ethnographic and social network approach can offer. GOALS OF THE STUDY: The occasion of a syphilis outbreak among young people was used to investigate the applicability of a social network approach and to test the validity of several traditional approaches to syphilis epidemiology. STUDY DESIGN: An outbreak of syphilis was investigated by interviewing both infected and noninfected people, by directing resources based on network association, by creating and evaluating network diagrams as an aid to the epidemiologic process, and by including ethnographic observations as part of outbreak management. RESULTS: Diagrammatic display of network growth provided a useful alternative to the traditional epidemic curve. Case prevention was demonstrated by identifying uninfected people with multiple concurrent exposures. Concurrent, overlapping exposure in infected people rendered traditional "source" and "spread" criteria moot. CONCLUSIONS: The current discussions of partner notification may be informed by recognizing that it is a subset of a broader and potentially more powerful approach. This approach calls some basic tenets of syphilis epidemiology into question.

Adolescent↗
PubMed1996

Personal risk taking and the spread of disease: beyond core groups.

Disease control efforts directed at human immunodeficiency virus are predicated on the need to reduce personal risk behaviors; that approach may not adequately reflect the complicated interplay between personal behaviors and the social setting in which they occur. Efforts to date, including the application of population ecology, the development of the core group hypothesis, and the use of compartment models to describe disease transmission, have aided in understanding the dynamics of transmission and have highlighted the relationship between personal risk taking and population risk. An area for further development is the application of the techniques of social network analysis to infectious disease spread. Initial work suggests that social structure may act as a barrier (or facilitator) in disease transmission and that the epidemiologic impact of a risky act varies with the social setting. The local context for risk behaviors has important implications for the dynamics of transmission.

HIV Infections↗
PubMed1994

Social networks and infectious disease: the Colorado Springs Study.

The social network paradigm provides a set of concepts and methods useful for studying the structure of a population through which infectious agents transmitted during close personal contact spread, and an opportunity to develop improved disease control programs. The research discussed was a first attempt to use a social network approach to better understand factors affecting the transmission of a variety of pathogens, including hepatitis B virus (HBV) and human immunodeficiency viruses (HIV), in a population of prostitutes, injecting drug users (IDU) and their personal associates in a moderate-sized city (Colorado Springs, CO). Some of the challenges of studying large social networks in epidemiological research are described, some initial results reported and a new view of interconnections in an at risk population provided. Overall, for the first time in epidemiologic research a large number of individuals (over 600) were found connected to each other, directly or indirectly, using a network design. The average distance (along observed social relationships) between persons infected with HIV and susceptible persons was about three steps (3.1) in the core network region. All susceptibles in the core were within seven steps of HIV infection.

Colorado↗
PubMed1994

Mapping a social network of heterosexuals at high risk for HIV infection.

OBJECTIVE: To determine how heterosexuals at risk for HIV infection interconnect in social networks and how such relationships affect HIV transmission. DESIGN: Cross-sectional study with face-to-face interviews to ascertain sociosexual connections; serologic testing. PARTICIPANTS: Prostitute women (n = 133), their paying (n = 129) and non-paying (n = 47) male partners; injecting drug users (n = 200) and their sex partners (n = 41). Participants were recruited in sexually transmitted disease and methadone clinics, an HIV-testing site, and through street outreach in Colorado Springs, Colorado, USA. MAIN OUTCOME MEASURES: Reported behaviors, risk perceptions, sociosexual linkages, and HIV prevalence. RESULTS: Respondents were well informed, but reported engaging in high-risk behaviors frequently. Nevertheless, over 70% of respondents perceived themselves to be at low risk for HIV infection. The 595 respondents identified a social network of 5162 people to which they belonged. Network analytic methods indicated 147 separate connected components of this network; eight of the 19 HIV-positive individuals in the network were located in smaller components remote from the largest connected component. CONCLUSION: The isolated position of HIV-positive individuals may serve as a barrier to HIV transmission and may account for the lack of diffusion of HIV in heterosexual populations in this region. Network analysis appears useful for understanding the dynamics of disease transmission and warrants further development as a tool for intervention and control.

Adult↗
PubMed1993

AIDS in Colorado Springs: is there an epidemic?

OBJECTIVE: To analyze trends and patterns of HIV infection in a medium-sized community in the United States. METHODS: Surveillance for AIDS and HIV infection was conducted by private physicians, military and public clinics, and blood and plasma donation centers. HIV-positive individuals were contacted and asked to refer their sex and injection partners for HIV-antibody testing. Prostitutes, injecting drug users and their sex partners were studied. Selected physicians were surveyed to assess under-reporting. RESULTS: The 740 HIV-infected adults (67 with documented seroconversion) included 506 with no evidence of AIDS, 58 living with AIDS, and 176 who had died. Of the 126 patients cared for by local physicians, 107 (85%) had been reported. No major changes in behavioral risk factors or increases in the number of HIV-infected individuals occurred between 1986 (128) and 1992 (95). CONCLUSIONS: Characteristics of individuals at risk and incidence of HIV infection have remained stable from 1981 to 1992. Analysis of data from the comprehensive surveillance and control program established in Colorado Springs in response to the AIDS epidemic suggests that, unlike the nation's epicenters, HIV incidence in this location is neither widespread nor rapidly increasing. The age distribution of reported cases is slowly increasing, and the ratio of newly reported cases to deaths is declining, implying stable or decreasing incidence; deaths may soon exceed new cases. Using data routinely available to public health officials, we conclude that the epidemiologic picture of AIDS--like the clinical one--must be heterogeneous, and that rational planning for the impact of AIDS should be based on the collection and analysis of local data.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Epidemiologic differences between chlamydia and gonorrhea.

To assess the prevalence, demographics, and transmission patterns of genital chlamydia infection, we screened 3,078 patients, and compared identified cases (N = 511) to gonorrhea cases (N = 291) diagnosed in the same setting. Chlamydia cases were younger and more likely to be White than their gonorrhea counterparts. Chlamydia cases were distributed diffusely; geographic overlap between the two diseases was only about 40 percent. Gonococcal coinfection was noted in less than 10 percent of patients with chlamydia. Nearly half of men with chlamydia and four-fifths of women were asymptomatic and most cases were identified through screening or contact tracing. Populations at high risk for chlamydia are seemingly different from those for gonorrhea. Differences may be due to control interventions (active for gonorrhea, passive for chlamydia). Chlamydia case reporting and control initiatives are recommended.

Age Factors↗
PubMed1989

Partner notification in the control of human immunodeficiency virus infection.

Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation.

Acquired Immunodeficiency Syndrome↗