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1.  Implementation and Operational Research: CD4 Count Monitoring Frequency and Risk of CD4 Count Dropping Below 200 Cells Per Cubic Millimeter Among Stable HIV-Infected Patients in New York City, 2007–2013 
The evidence has begun to mount for diminishing the frequency of CD4 count testing. To determine whether these observations were applicable to an urban US population, we used New York City (NYC) surveillance data to explore CD4 testing among stable patients in NYC, 2007–2013.
We constructed a population-based retrospective open cohort analysis of NYC HIV surveillance data. HIV+ patients aged ≥13 years with stable viral suppression (≥1 viral load the previous year; all <400 copies per milliliter) and immune status (≥1 CD4 the previous year; all ≥200 cells per cubic millimeter) entered the cohort the following year beginning January 1, 2007. Each subsequent year, eligible patients not previously included entered the cohort on January 1. Outcomes were annual frequency of CD4 monitoring and probability of maintaining CD4 ≥200 cells per cubic millimeter. A multivariable Cox model identified factors associated with maintaining CD4 ≥200 cells per cubic millimeter.
During 1.9 years of observation (median), 62,039 patients entered the cohort. The mean annual number of CD4 measurements among stable patients was 2.8 and varied little by year or characteristic. Two years after entering, 93.4% and 97.8% of those with initial CD4 350–499 and CD4 ≥500 cells per cubic millimeter, respectively, maintained CD4 ≥200 cells per cubic millimeter. Compared to those with initial CD4 ≥500 cells per cubic millimeter, those with CD4 200–349 cells per cubic millimeter and CD4 350–499 cells per cubic millimeter were more likely to have a CD4 <200 cells per cubic millimeter, controlling for sex, race, age, HIV risk group, and diagnosis year.
In a population-based US cohort with well-controlled HIV, the probability of maintaining CD4 ≥200 cells per cubic millimeter for ≥2 years was >90% among those with initial CD4 ≥350 cells per cubic millimeter, suggesting that limited CD4 monitoring in these patients is appropriate.
PMCID: PMC4770377  PMID: 26536317
HIV; monitoring; CD4 count; cohort; New York City
3.  Effect of HIV Housing Services on Engagement in Care and Treatment, New York City, 2011 
AIDS and Behavior  2015;19(11):2087-2096.
The federal Housing Opportunities for Persons with AIDS (HOPWA) program addresses housing needs of low-income persons living with HIV/AIDS (PLWHA). The New York City (NYC) Department of Health and Mental Hygiene oversees 22 HOPWA contracts for over 2,400 clients, and manages the NYC HIV Registry. HOPWA clients (N = 1,357) were matched to a random 20 % sample of other PLWHA (N = 13,489). Groups were compared on HIV care retention, viral suppression, and rebound. HOPWA clients were, on average, 3 years younger and more likely to be concurrently diagnosed with HIV and AIDS. While HOPWA clients were more likely to be retained in care (94 vs. 82 %; mOR = 2.97, 95 % CI 2.35–3.74), they were no more likely to achieve suppression (84 vs. 86 %; mOR = 0.85, 95 % 0.70–1.03) and were more likely to rebound (11 vs. 7 %; mOR = 1.45; 95 % CI 1.10–1.91). HIV care retention does not fully translate to virologic suppression in this low-income service population.
PMCID: PMC4598342  PMID: 25631320
Public health surveillance; Housing; Epidemiology; HIV infection/prevention and control; Engagement in care
4.  Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence 
Emerging Infectious Diseases  2002;8(10):1124-1132.
We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine—a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events.
PMCID: PMC2730317  PMID: 12396927
Anthrax; Bacillus anthracis; antimicrobial prophylaxis; adverse events; adherence
6.  Novel Use of Surveillance Data to Detect HIV-Infected Persons with Sustained High Viral Load and Durable Virologic Suppression in New York City 
PLoS ONE  2012;7(1):e29679.
Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL).
Methods/Principal Findings
Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average.
Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.
PMCID: PMC3265470  PMID: 22291892
7.  First Case of Bioterrorism-Related Inhalational Anthrax in the United States, Palm Beach County, Florida, 2001 
Emerging Infectious Diseases  2002;8(10):1029-1034.
On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient’s workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.
PMCID: PMC2730309  PMID: 12396910
Anthrax; Bacillus anthracis; bioterrorism; nasal swab cultures; environmental cultures

Results 1-7 (7)