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HARNESSING HIV and SYPHILIS NETWORKS to REDUCE HIV TRANSMISSION in NORTH CAROLINA Rachael Marie Billock a Dissertation Submitted
HARNESSING HIV AND SYPHILIS NETWORKS TO REDUCE HIV TRANSMISSION IN NORTH CAROLINA Rachael Marie Billock A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology in the Gillings School of Global Public Health. Chapel Hill 2020 Approved by: Kimberly A. Powers Jennifer L. Lund Peter J. Mucha Brian W. Pence Erika Samoff © 2020 Rachael Marie Billock ALL RIGHTS RESERVED ii ABSTRACT Rachael Marie Billock: Harnessing HIV and Syphilis Networks to Reduce HIV Transmission in North Carolina (Under the direction of Kimberly Powers) Sexual contact networks containing persons diagnosed with HIV and/or syphilis are efficient platforms for delivery of enhanced HIV treatment support to persons living with HIV (PLWH) and prevention resources to HIV-negative persons. We conducted three inter-related studies among men who have sex with men (MSM) in North Carolina (NC) to assess the potential for network-based interventions to reduce HIV transmission. We first generated independent and combined HIV and syphilis networks using contact tracing data for all MSM diagnosed with HIV or syphilis 2015-2017 in NC. We identified network communities, or clusters of densely connected nodes, in the combined network and evaluated interconnectivity between the syphilis and HIV networks by community. Heightened interconnectivity was associated with younger median age; higher proportions of persons self- identifying as Black, non-Hispanic; and higher proportions of syphilis cases diagnosed at sexually transmitted disease clinics. Next, we used NC surveillance data to identify two types of qualifying “network events” among MSM in NC 01/2013-06/2017: being diagnosed with early syphilis or being named as a recent sexual contact of a person diagnosed with HIV or early syphilis. -
Curriculum Vitae
CURRICULUM VITAE William C. Miller Education 1997 MPH Dept. of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 1989 PhD Dept. of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD 1985 MD The Johns Hopkins University School of Medicine, Baltimore, MD 1981 AB Dept. of Psychology, Princeton University, Princeton, NJ Post-Graduate Training 1995 - 1997 Robert Wood Johnson Clinical Scholar, University of North Carolina at Chapel Hill, Chapel Hill, NC 1991 -1994 Fellow, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC 1991 -1992 Fellow in International Health, Department of Medicine, Muhimbili Medical Center, Dar es Salaam, Tanzania and Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC 1989 -1991 Resident in Medicine, Department of Medicine, The University of Maryland and Baltimore Veterans Administration Hospitals, Baltimore, MD 1988 -1989 Intern in Medicine, Department of Medicine, The University of Maryland and Baltimore Veterans Administration Hospitals, Baltimore, MD 1986 -1988 Postdoctoral Fellow, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 1985 -1986 Postdoctoral Fellow, Interdisciplinary Training Program, Departments of Neuroscience and Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD Professional Positions 2014 - present Professor, Division of Infectious Diseases, Department of Medicine, -
Associations Between Sexual Risk Behaviours, and Certain Beliefs and Perceptions About Antiretroviral Therapy in Botswana
Wilfrid Laurier University Scholars Commons @ Laurier Theses and Dissertations (Comprehensive) 2019 Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana Wayne Gill [email protected] Follow this and additional works at: https://scholars.wlu.ca/etd Part of the Health Policy Commons Recommended Citation Gill, Wayne, "Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana" (2019). Theses and Dissertations (Comprehensive). 2219. https://scholars.wlu.ca/etd/2219 This Dissertation is brought to you for free and open access by Scholars Commons @ Laurier. It has been accepted for inclusion in Theses and Dissertations (Comprehensive) by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. Dissertation Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana Author: Wayne Gill Submitted in partial fulfillment of the requirements for Doctor of Philosophy in Global Governence At The School of International Policy and Governance Wilfred Laurier University © Copyright Wayne Gill 2019 Abstract This study explored the association between sexually risky behaviour among individuals and their beliefs and perceptions regarding antiretroviral therapy or ART. Specifically, the paper examined the treatment optimism aspect of ART- that HIV is a less serious threat due to the availability of ART. In order to test this notion, the paper compared the behavior of those people who were HIV positive with those who were HIV negative. A second population subset also included in the comparative analyses were those aware of their HIV status and those unaware. To underline the prevalence of treatment optimism, the study also considered the link between ART, sexual risk behaviours and circumcision status following the 2009 implementation of the voluntary medical male circumcision (VMMC) programme in Botswana. -
Infectivity, Sexual Partnership Patterns, and the Role of Early Infection
HIV TRANSMISSION DYNAMICS: INFECTIVITY, SEXUAL PARTNERSHIP PATTERNS, AND THE ROLE OF EARLY INFECTION Kimberly Anne Powers A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology. Chapel Hill 2010 Approved by: William C. Miller, MD, PhD Myron S. Cohen, MD Azra C. Ghani, PhD Irving F. Hoffman, PA, MPH Audrey E. Pettifor, PhD © 2010 Kimberly Anne Powers ALL RIGHTS RESERVED ii ABSTRACT Kimberly Anne Powers HIV transmission dynamics: Infectivity, sexual partnership patterns, and the role of early infection (Under the direction of William C. Miller) Although remarkable progress has been made in the diagnosis, treatment, and prevention of HIV, a cure is unavailable and many of the most promising prevention interventions have failed. At this critical juncture in the epidemic, there is a necessity for improved understanding of the fundamental drivers of the epidemic, as well as an urgent need for innovative interventions against HIV. This dissertation focuses on two of these fundamental drivers – the heterosexual infectivity of HIV-1 and the details of sexual partnership patterns – as well as the power of interventions initiated during the highly infectious period of early HIV infection (EHI). We conducted a systematic review and meta-analysis of the heterosexual infectivity of HIV-1, defined as the per-contact probability of HIV-1 transmission in a single heterosexual contact between an infected and a susceptible individual. Infectivity estimates were extremely heterogeneous, ranging from zero transmissions after more than 100 penile-vaginal contacts in some sero-discordant couples to one transmission for every 3.1 episodes of heterosexual anal intercourse.