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T Kellogg

Publications and source records attributed to T Kellogg.

10 recordsLinked to original sources
PubMed2006

Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?

BACKGROUND: Sexually transmitted infections (STI) and unprotected anal intercourse (UAI) have been increasing among men who have sex with men (MSM) in San Francisco. However, HIV incidence has stabilised. OBJECTIVES: To describe recent trends in sexual risk behaviour, STI, and HIV incidence among MSM in San Francisco and to assess whether increases in HIV serosorting (that is, selective unprotected sex with partners of the same HIV status) may contribute to preventing further expansion of the epidemic. METHODS: The study applies an ecological approach and follows the principles of second generation HIV surveillance. Temporal trends in biological and behavioural measures among MSM were assessed using multiple pre-existing DATA SOURCES: STI case reporting, prevention outreach programmatic data, and voluntary HIV counselling and testing data. RESULTS: Reported STI cases among MSM rose from 1998 through 2004, although the rate of increase slowed between 2002 and 2004. Rectal gonorrhoea cases increased from 157 to 389 while early syphilis increased from nine to 492. UAI increased overall from 1998 to 2004 (p<0.001) in community based surveys; however, UAI with partners of unknown HIV serostatus decreased overall (p<0.001) among HIV negative MSM, and among HIV positive MSM it declined from 30.7% in 2001 to a low of 21.0% in 2004 (p<0.001). Any UAI, receptive UAI, and insertive UAI with a known HIV positive partner decreased overall from 1998 to 2004 (p<0.001) among MSM seeking anonymous HIV testing and at the STI clinic testing programme. HIV incidence using the serological testing algorithm for recent HIV seroconversion (STARHS) peaked in 1999 at 4.1% at the anonymous testing sites and 4.8% at the STI clinic voluntary testing programme, with rates levelling off through 2004. CONCLUSIONS: HIV incidence among MSM appears to have stabilised at a plateau following several years of resurgence. Increases in the selection of sexual partners of concordant HIV serostatus may be contributing to the stabilisation of the epidemic. However, current incidence rates of STI and HIV remain high. Moreover, a strategy of risk reduction by HIV serosorting can be severely limited by imperfect knowledge of one's own and one's partners' serostatus.

Adult↗
PubMed2001

Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons.

BACKGROUND: Although case management has been advocated as a method for improving the care of chronically ill persons, its effectiveness is poorly understood. OBJECTIVE: To assess the effect of case managers on unmet need for supportive services and utilization of medical care and medications among HIV-infected persons. DESIGN: Baseline and follow-up interview of a national probability sample. SETTING: Inpatient and outpatient medical facilities in the United States. PARTICIPANTS: 2437 HIV-infected adults representing 217 081 patients receiving medical care. MEASUREMENTS: Outcomes measured at follow-up were unmet need for supportive services, medical care utilization (ambulatory visits, emergency department visits, and hospitalizations), and use of HIV medication (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis). RESULTS: At baseline, 56.5% of the sample had contact with a case manager in the previous 6 months. In multiple logistic regression analyses that adjusted for potential confounders, contact with a case manager at baseline was associated with decreased unmet need for income assistance (odds ratio [OR], 0.57 [95% CI, 0.36 to 0.91]), health insurance (OR, 0.54 [CI, 0.33 to 0.89]), home health care (OR, 0.29 [CI, 0.15 to 0.56]), and emotional counseling (OR, 0.62 [CI, 0.41 to 0.94]) at follow-up. Contact with case managers was not significantly associated with utilization of ambulatory care (OR, 0.77 [CI, 0.57 to 1.04]), hospitalization (OR, 1.13 [CI, 0.84 to 1.54]), or emergency department visits (OR, 1.30 [CI, 0.97 to 1.73]) but was associated with higher utilization of two-drug (OR, 1.58 [CI, 1.23 to 2.03]) and three-drug (OR, 1.34 [CI, 1.00 to 1.80]) antiretroviral regimens and of treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (OR, 1.29 [CI, 1.02 to 1.64]) at follow-up. CONCLUSIONS: Case management appears to be associated with fewer unmet needs and higher use of HIV medications in patients receiving HIV treatment.

Adult↗
PubMed2001

Differences in the temporal trends of HIV seroincidence and seroprevalence among sexually transmitted disease clinic patients, 1989-1998: application of the serologic testing algorithm for recent HIV seroconversion.

The authors compared temporal trends in the prevalence and incidence of human immunodeficiency virus (HIV) infection based upon 34,866 specimens from patients who attended the San Francisco, California, municipal sexually transmitted disease clinic between 1989 and 1998. HIV infection data were collected during annual blinded HIV serologic surveys. Incidence was determined by applying a serologic testing algorithm for recent HIV seroconversion that uses both a sensitive and a less sensitive enzyme immunoassay to stored HIV positive sera. The HIV seroprevalence declined from 15.2% in 1989 to 7.2% in 1998 (odds ratio per year = 0.92, 95% confidence interval (CI): 0.91, 0.94). Among homosexual men, the HIV prevalence declined from 50.9% in 1989 to 19.9% in 1998 (odds ratio per year = 0.86, 95% CI: 0.85, 0.88). The pooled seroincidence was 1.6% and did not change significantly over time (odds ratio per year = 1.0, 95% CI: 0.98, 1.1). The pooled seroincidence among homosexual men was 6.6% per year and remained steady between 1989 and 1998 (odds ratio per year = 0.99, 95% CI: 0.92, 1.1). During a dramatic, 10-year decline in seroprevalence of HIV infection, the incidence of HIV infection remained remarkably stable.

Adult↗
PubMed2000

Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management.

BACKGROUND: Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood. OBJECTIVES: To assess the prevalence of need and unmet need for supportive services and the impact of case managers on unmet need among HIV-infected persons. RESEARCH DESIGN: National probability sample. PARTICIPANTS: A total of 2,832 HIV-infected adults receiving care. MEASURES: Need and unmet need for benefits advocacy, housing, home health, emotional counseling, and substance abuse treatment services. RESULTS: Sixty-seven percent of the sample had a need for at least one supportive service, and 26.6% had an unmet need for at least one service in the previous 6 months. Contingent unmet need (unmet need among persons who needed the service) was greatest for benefits advocacy (34.6%) and substance abuse treatment (27.6%). Fifty-seven percent of the sample had had contact with their case manager in the previous 6 months. In multiple logistic regression analysis, with adjustment for covariates, having a case manager was associated with decreased unmet need for home healthcare (OR =0.39; 95% CI = 0.25-0.60), emotional counseling (OR = 0.54; 95% CI = 0.38-0.78), and any unmet need (OR = 0.70; 95% CI = 0.54-0.91). An increased number of contacts with a case manager was significantly associated with lower unmet need for home health care, emotional counseling, and any unmet need. CONCLUSIONS: Need and unmet need for supportive services among HIV-infected persons is high. Case management programs appear to lower unmet need for supportive services.

Adult↗
PubMed1998

Continuing high prevalence of HIV and risk behaviors among young men who have sex with men: the young men's survey in the San Francisco Bay Area in 1992 to 1993 and in 1994 to 1995.

Several recent studies have shown high rates of HIV infection and risk behavior among young men who have sex with men (MSM). To assess the direction of the epidemic in this population, we replicated a venue-based study performed in the San Francisco Bay Area during 1992 and 1993. From May 1994 to September 1995, we surveyed 675 MSM aged between 17 and 22. After statistical adjustment for age, ethnicity, residence, and site of recruitment, seroprevalence did not change significantly between the 1992 to 1993 (8.4%) and the 1994 to 1995 (6.7%) surveys. Similarly, no significant changes were found in the rates during the previous 6 months of unprotected receptive anal intercourse (23.4% versus 24.9%), injection drug use (8.0% versus 7.8%), or needle sharing among injection drug users (56.3% versus 64.5%) between the two surveys. Despite the increased attention that the problem of high risk behavior among young MSM has received, effective prevention interventions for MSM are needed as profoundly now as they had been several years ago.

Adolescent↗
PubMed1997

Predictors of human immunodeficiency virus counseling and testing among sexually transmitted disease clinic patients.

OBJECTIVES: To determine the predictors of prior or current, and repeat human immunodeficiency virus (HIV) testing. STUDY DESIGN: Cross-sectional survey. METHODS: Sexually transmitted disease (STD) clinic patients who participated in a blinded HIV seroprevalence survey completed a voluntary questionnaire regarding their reasons for accepting or declining HIV testing. RESULTS: Eighty-seven percent of participants reported a previous HIV test or were HIV testing the day they completed the questionnaire. African Americans were less likely to have been HIV tested (adjusted odds ratio 0.3, 95% confidence limits, 0.1, 0.8). The most common reasons for testing were to be reassured and to receive medical care if infected. The most common reason for not testing was that nontesters did not think that they were infected. Repeated testing was reported by 51% of the participants and was more frequent among patients who were older or members of high-risk groups (P < 0.05). Patients tested repeatedly to confirm a prior HIV test result or because of continued risky behavior. CONCLUSIONS: Testing for HIV is frequent among STD clinic patients but less so among African Americans. Receipt of medical care appears to be an important motivation for HIV testing, whereas lack of perceived risk may discourage testing. Continued high-risk behavior contributes to repeat HIV testing.

AIDS Serodiagnosis↗
PubMed1995

A computational model for electron backscattering in electron dosimetry.

A one-dimensional electron transport algorithm based on the ideas of invariant imbedding has been developed and applied to the problem of electron backscattering in electron dosimetry. Results have been compared with experimental and Monte Carlo results. Agreement appears to be reasonable at low incident energies (0.5 to 10 MeV) and low Z(Z < or = 65) materials.

Electrons↗
PubMed1987

Determination of bile acid pool size, turnover time, and distribution of male broiler chicks during the first 6 weeks posthatch using SEHCAT, a gamma ray-emitting bile acid analogue.

A bile acid analogue, SEHCAT (tauro-23-75SE-selena-homocholic acid), was used to determine bile acid pool size, turnover time, and distribution in the developing broiler chick. Bile acid pool size was significantly affected by age and followed a quintic trend (a fifth degree polynomial). It remained steady until 30 days of age when it decreased significantly and then rose significantly at 37 days of age. The bile acid pool half-life remained constant until 28 days of age when it increased significantly and then held steady until it increased again at 8 wk of age following a quartic trend. The distribution of bile acids was affected by age with the amount in the gizzard, duodenum, cloaca, liver, and gall bladder varying significantly with age. Jejunal, ileal, and cecal bile acids did not vary significantly with age. Liver bile acid levels followed a quintic trend, rising until 23 days of age and dropping sharply at 30 days of age and holding steady.

Animals↗