Papers by Joshua Mendelsohn
In response to a major gap in evidence regarding treatment outcomes among asylum-based refugees. ... more In response to a major gap in evidence regarding treatment outcomes among asylum-based refugees. the primary objective of the thesis was to investigate adherence to highly active antiretroviral therapy (HAART) and virological outcomes among refugees and to compare these outcomes with local host communities in one urban, Southeast Asia setting (Sungai Buloh, Kuala Lumpur, Malaysia) and one remote sub-Saharan refugee camp (Kakuma. Kenya) setting. Given limited resources for expanding treatment, questions have been raised as to whether refugees can achieve sufficient levels of adherence and viral suppression to justify sustaining and expanding access. Data sources included a structured questionnaire with self-reported adherence measures, a pharmacy-based prescription refill measure, HIV viral loads, and indepth interviews. Analyses made use of quantitative and qualitative approaches. The thesis begins by presenting the rationale, aims, research questions, and a description of preparato...
Additional file 2: Figure S2. Sample "large" (42 × 60 inches) poster used to promote an... more Additional file 2: Figure S2. Sample "large" (42 × 60 inches) poster used to promote an intervention among migrant construction workers in Shanghai, China.
Association of adherence measures (action state factors) with viral suppression among refugees an... more Association of adherence measures (action state factors) with viral suppression among refugees and host nationals on ART for â Ľ25 weeks at baseline (Round One) in Kakuma, Kenya (N=128a). (DOC 38 kb)
Conflict and health, 2017
Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in... more Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011-2013) were compared on outcome measures that included viral suppression and adherence to ART. This study used a repeated cross-sectional design (Round One and Round Two). All adults (≥18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ≥30 days were invited to participate. Adherence was measured by self-report and monthly pharmacy refills. Whole blood was measured on dried blood spots. HIV-1 RNA was quantified and treatment failures were submitted for drug resistance testing. A remedial intervention was implemented in response to baseline testing. The primary outcome was viral load <5000 copies/mL. The two study rounds took place in 2011-2013. Among eligible adults, 86% (73/85) of refugees and 84% (86/102) of Kenyan host nationals participated in the Round One survey; 60% (44/73) and 58% (50/86) of Round One participan...
BMC public health, Jan 14, 2015
Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. ... more Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. The intervention improved consistent condom use with any par...
of Low levels of viral suppression among refugees and host nationals accessing antiretroviral the... more of Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp
Emerging Microbes & Infections
Background: Novel coronavirus pneumonia (COVID-19) is prevalent around the world. We aimed to des... more Background: Novel coronavirus pneumonia (COVID-19) is prevalent around the world. We aimed to describe epidemiological features and clinical course in Shanghai. Methods: We retrospectively analysed 325 cases admitted at Shanghai Public Health Clinical Center, between January 20 and February 29, 2020. Results: 47.4% (154/325) had visited Wuhan within 2 weeks of illness onset. 57.2% occurred in 67 clusters; 40% were situated within 53 family clusters. 83.7% developed fever during the disease course. Median times from onset to first medical care, hospitalization and negative detection of nucleic acid by nasopharyngeal swab were 1, 4 and 8 days. Patients with mild disease using glucocorticoid tended to have longer viral shedding in blood and feces. At admission, 69.8% presented with lymphopenia and 38.8% had elevated D-dimers. Pneumonia was identified in 97.5% (314/322) of cases by chest CT scan. Severe-critical patients were 8% with a median time from onset to critical disease of 10.5 days. Half required oxygen therapy and 7.1% high-flow nasal oxygen. The case fatality rate was 0.92% with median time from onset to death of 16 days. Conclusion: COVID-19 cases in Shanghai were imported. Rapid identification, and effective control measures helped to contain the outbreak and prevent community transmission.
Social Aspects of HIV, 2016
Emerging themes in epidemiology, 2015
China's growing population of internal migrants has exceeded 236 million. Driven by rapid dev... more China's growing population of internal migrants has exceeded 236 million. Driven by rapid development and urbanization, this extreme population mobility creates opportunities for transmission of HIV and sexually-transmitted infections (STI). Large numbers of rural migrants flock to megacities such as Shanghai in search of employment. Although migrants constitute a key population at heightened risk of acquiring HIV or an STI, there is a lack of easily accessible sexual health services available for them. In response, we designed a short, inexpensive sexual health intervention that sought to improve HIV and STI knowledge, while reducing stigma, risky sexual behaviour, and sexual transmission of HIV and STI among migrant construction workers (MCW) situated in Shanghai, China. We implemented a three-armed, community-randomized trial spread across three administrative districts of Shanghai. The low-intensity intervention included educational pamphlets. The medium-intensity interventi...
Demography, 2015
China&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s HIV prevalence is low, mainly concentrate... more China&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s HIV prevalence is low, mainly concentrated among female sex workers (FSWs), their clients, men who have sex with men, and the stable partners of members of these high-risk groups. We evaluate the contribution to the spread of HIV of China&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s regime of heterosexual relations, of the structure of heterosexual networks, and of the attributes of key population groups with simulations driven by data from a cross-sectional survey of egocentric sexual networks of the general population of Shanghai and from a concurrent respondent-driven sample of FSWs. We find that the heterosexual network generated by our empirically calibrated simulations has low levels of partner change, strong constraints on partner selection by age and education, and a very small connected core, mainly comprising FSWs and their clients and characterized by a fragile transmission structure. This network has a small HIV epidemic potential but is compatible with the transmission of bacterial sexually transmitted infections (STIs), such as syphilis, which are less susceptible to structural breaks in transmission of infection. Our results suggest that policies that force commercial sex underground could have an adverse effect on the spread of HIV and other STIs.
BMC Public Health, 2015
Background: While HIV incidence has stabilized in many settings, increases in health and wellbein... more Background: While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs.
Five week cross-sectional survey was conducted in Feb-Mar 2011. Clients who were >18 years, on HA... more Five week cross-sectional survey was conducted in Feb-Mar 2011. Clients who were >18 years, on HAART for at least 30 days, not lost to follow-up, and not exclusively on ART for prevention of mother-to-child transmission (PMTCT), were systematically recruited at time of regular clinic appointment or through an active recruitment protocol implemented by home-based care workers. Data sources included structured questionnaire with self-reported adherence measures, pharmacy-based measure of HAART prescription (Rx) refills over 24 months prior to study start, and HIV viral loads measured on dried blood spots. Primary outcome were unsuppressed viral load (cut-off <1000 copies/mL). Socio-demographic characteristics were compared between host and refugee groups using Mann-Whitney tests for continuous variables, Chi-square or Fisher's exact test for categorical variables, and Chisquare test for trend for ordered categorical variables. Risk factors for unsuppressed viral load were evaluated using unconditional logistic regression; effect estimates were odds ratios and corresponding 95% confidence intervals (CI).
PLoS medicine, 2014
Debates over the merits of providing ART to refugees and IDPs have echoed earlier discussions on ... more Debates over the merits of providing ART to refugees and IDPs have echoed earlier discussions on treatment scale-up Policy Forum articles provide a platform for health policy makers from around the world to discuss the challenges and opportunities in improving health care to their constituencies.
Social science & medicine (1982), 2014
HIV-positive refugees confront a variety of challenges in accessing and adhering to antiretrovira... more HIV-positive refugees confront a variety of challenges in accessing and adhering to antiretroviral therapy (ART) and attaining durable viral suppression; however, there is little understanding of what these challenges are, how they are navigated, or how they may differ across humanitarian settings. We sought to document and examine accounts of the threats, barriers and facilitators experienced in relation to HIV treatment and care and to conduct comparisons across settings. We conducted semi-structured interviews among a purposive sample of 14 refugees attending a public, urban HIV clinic in Kuala Lumpur, Malaysia (July-September 2010), and 12 refugees attending a camp-based HIV clinic in Kakuma, Kenya (February-March 2011). We used framework methods and between-case comparison to analyze and interpret the data, identifying social and environmental factors that influenced adherence. The multiple issues that threatened adherence to antiretroviral therapy or precipitated actual adhere...
International Journal of Hygiene and Environmental Health, 2008
A cholera epidemic that took place in KwaZulu-Natal, South Africa (2000 was employed to investiga... more A cholera epidemic that took place in KwaZulu-Natal, South Africa (2000 was employed to investigate the impact of climatic and environmental drivers on cholera dynamics. Precipitation (PRE), sea surface temperature (SST) and chlorophyll-a (CHL-a) data acquired from publicly available satellite and ground measurements were analysed together with disease incidence in an effort to assess the environmental contribution to the outbreak. SST (r 2 ¼ 0.749, lag ¼ 0 months) and PRE (r 2 ¼ 0.744, lag ¼ 2 months) showed strong associations with incidence. CHL-a showed a moderately strong (r 2 ¼ 0.656, lag ¼ 6 months) association with incidence while sea surface height (SSH) demonstrated a weak relationship with incidence (r 2 ¼ 0.326, lag ¼ 5 months). Our analysis tentatively supports a coastal transmission hypothesis, heavily influenced by localized PRE extremes. The role of SSH is likely attenuated by local coastal topography. Future work should clarify the mechanism linking coastal cholera reservoirs and the regional climate system to outbreaks in this region. Finally, we discuss benefits of further research in this area using extended remotely sensed and epidemiological datasets towards the development of early-warning systems and enhanced epidemic preparedness.
Conflict and Health, 2012
Background: Optimal adherence to highly active antiretroviral therapy (HAART) is required to prom... more Background: Optimal adherence to highly active antiretroviral therapy (HAART) is required to promote viral suppression and to prevent disease progression and mortality. Forcibly displaced and conflict-affected populations may face challenges succeeding on HAART. We performed a systematic review of the literature on adherence to HAART and treatment outcomes in these groups, including refugees and internally-displaced persons (IDPs), assessed the quality of the evidence and suggest a future research program. Methods: Medline, Embase, and Global Health databases for 1995-2011 were searched using the Ovid platform. A backward citation review of subsequent work that had cited the Ovid results was performed using the Web of Science database. ReliefWeb and Médecins Sans Frontières (MSF) websites were searched for additional grey literature.
AIDS and Behavior, 2014
In response to an absence of studies among refugees and host communities accessing highly active ... more In response to an absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (C18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral Electronic supplementary material The online version of this article (giados en situaciones de asilo prolongados son capaces de mantener buenos resultados del tratamiento, y deberían explícitamente incluirse en los planes estratégicos de VIH de los países de acogida con el fin de ampliar el acceso de acuerdo con las directrices nacionales de TARGA.
BMC public health, 2015
Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. ... more Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. The intervention improved consistent condom use with any par...
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Papers by Joshua Mendelsohn