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43 Changes in the Incidence of Respiratory AIDS-Defining Events Among Persons with HIV Before vs. During the COVID-19 Pandemic
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- Jesse J. Carlson, Megan Turner, Austin Katona, Sean Kelly, Timothy R. Sterling, Peter F. Rebeiro
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue s1 / April 2024
- Published online by Cambridge University Press:
- 03 April 2024, p. 11
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OBJECTIVES/GOALS: The COVID-19 pandemic disrupted HIV care, though it prompted preventive measures for respiratory pathogens, particularly among PWH. We therefore quantified trends in respiratory ADE incidence during vs. before the COVID-19 pandemic to assess effects of these measures on non-COVID-19 illnesses. METHODS/STUDY POPULATION: We included PWH aged ≥18 years in care at the Vanderbilt Comprehensive Care Clinic in Nashville, Tennessee from 2017-2023. Individuals contributed time from the last of March 31, 2017 or clinic enrollment until the first of death, March 31, 2023 (study close), or final clinic visit (if there was no visit ≤12 months before study close). We described respiratory ADE incidences (per 1,000 person-years) in each year of the study; we used Poisson regression with robust variance to estimate the incidence rate ratio (IRR) and 95% confidence interval (CI) for respiratory ADEs in the three years following vs. before the World Health Organization’s pandemic designation for COVID-19 (March 2020). RESULTS/ANTICIPATED RESULTS: Among 4,880 persons contributing 19,510 person-years, 69 (1.4%) developed ≥1 respiratory ADE. Median age at cohort entry was 42.6 (interquartile range [IQR]: 32.1, 52.3) years and at first respiratory ADE was 43.6 (IQR: 36.1, 51.2) years. The overall average respiratory ADE incidence in the pre-pandemic period (March 2017-March 2020) was 4.5 (95% CI: 3.3-6.3) per 1,000 person-years and during the post-pandemic period (April 2020-March 2023) was 4.1 (95% CI: 1.8-9.0) per 1,000 person-years. When accounting for repeated outcomes and annual variation, the modeled respiratory ADE incidence was 10% lower (IRR=0.9, 95% CI: 0.6-1.4) during vs. before the COVID-19 pandemic. DISCUSSION/SIGNIFICANCE: Respiratory ADE incidence dropped 10% following the COVID-19 pandemic declaration, though the confidence interval for this change contains the null. It is plausible that nonpharmaceutical COVID-19 mitigation measures drove a brief but impermanent decline, though further research is needed to assess whether diagnostic biases also played a role.
Chapter 10 - Pervasive Pandemics: Understanding Global Healthand Disease from a World-Systems Perspective
- Edited by Patrick Hayden, University of St Andrews, Scotland, Chamsy el-Ojeili, Victoria University of Wellington
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- Book:
- The Anthem Companion to Immanuel Wallerstein
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- Anthem Press
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- 29 February 2024
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- 01 August 2023, pp 185-206
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Summary
Infectious diseases remain a persistent problem in many poor countries globally and, certainly, affluent countries are not immune to extreme suffering and death from communicable diseases. While the COVID-19 pandemic represents a salient example, “new” disease outbreaks, such as monkeypox (mpox), Zika, Ebola and HIV/AIDS are increasingly making news headlines and posing serious threats to human health globally. Infectious diseases have long been considered “diseases of the poor,” as these pathogens spread easily in crowded conditions, among malnourished populations and among people who lack adequate access to clean water, proper sanitation and other basic public health elements (e.g., Braveman, Egerter, and Williams 2011). While recent examples demonstrate that infectious diseases can infect people in affluent countries as well as impoverished ones, it is clear that the emergence of new infections and persistent suffering from communicable diseases remains concentrated in the Global South (e.g., WHO 2020).
In the field of public health, increased attention toward the social determinants of health sheds light on how various social conditions, such as level of education or income, working conditions and job security, food insecurity, housing, discrimination and access to affordable health services, impact the health of communities and individuals (e.g., Braveman, Egerte, and Williams 2011). While this framework importantly goes beyond biomedical explanations of health, it fails to consider the larger structural factors that impact the commonly articulated social determinants. Indeed, transformations such as colonialism and the establishment and continued expansion of the capitalist world-economy have greatly influenced how income, wealth and social determinants are distributed and used across and within countries. We must engage macro-level theory in order to truly understand the patterns in disease taking shape globally today.
Immanuel Wallerstein's (1974, 2004) articulation of world-systems analysis (WSA) offers meaningful insights on current global health dynamics. Although rarely referring to health or disease directly, his theorization on global inequality and development, including crucial elements such as unequal exchange, has keen relevance for patterns in infectious disease. Reflecting the significance of Wallerstein's articulations, a growing body of scholarship draws on WSA to explain important trends, including in infectious disease outcomes like HIV/AIDS, malaria and tuberculosis (TB), as well as the emergence of new zoonotic diseases (e.g., Austin 2015, 2021; Coburn et al. 2017; Maynard and Ong 2016; Maynard, Shircliff, and Restivo 2012).
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Thermal Stability of Co-Fe and Cu Multilayered Thin Films
- Peter F. Ladwig, Jesse D. Olson, Joseph H. Bunton, David J. Larson, Martin C. Bonsager, Robert M. Ulfig, Richard L. Martens, Y. Austin Chang, Edward Oltman, Tye T. Gribb, Thomas F. Kelly, Allan E. Schultz, Bharat B. Pant
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- Microscopy and Microanalysis / Volume 9 / Issue S02 / August 2003
- Published online by Cambridge University Press:
- 06 August 2003, pp. 48-49
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- August 2003
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