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Biomedical subjects

L Sherr

Publications and source records attributed to L Sherr.

At least 19 recordsLinked to original sources
PubMed2002

Assessment of health-related quality-of-life in males with Anderson Fabry Disease before therapeutic intervention.

Anderson Fabry Disease (AFD) is an extremely painful and debilitating multi-system X-linked disorder due to alpha-galactosidase enzyme deficiency. To date, no baseline data on health-related quality-of-life (HR-QoL) have been reported in males affected with this condition. In this study, 38 males with AFD completed Medical Outcomes Study Short Form, EuroQoL questionnaires and an AFD-specific questionnaire prior to the start of a trial involving replacement therapy with alpha-galactosidase. Results from these questionnaires were compared to the results from a similar HR-QoL study in males with severe haemophilia (factor VIII/IX deficiency) that used the same questionnaires and to the results of two large normative studies. The results on both questionnaires showed that in most instances males with AFD recorded significantly lower HR-QoL compared with males in the general population and individuals with severe haemophilia after adjusting for differences in age. These findings suggest therefore, that the scope for improvement in HR-QoL as a result of treatment with an appropriate agent is extremely large.

Adult↗
PubMed2002

An assessment of current HIV treatment adherence services in the UK.

The aim of this study was to examine current approaches to supporting adherence to antiretroviral therapy in UK HIV clinics. One hundred HIV/AIDS/GUM physicians were interviewed: 97% were personally involved in discussing adherence, spending 22% of consultation time on this issue and assessing adherence most commonly by patient self-report (88%). Other personnel involved included nurses (74%), other doctors (56%), health advisers (54%) and pharmacists (48%). Among criteria for achieving treatment success, adherence support ranked fourth after 'treatment fitting well into patient's lifestyle', regular viral load monitoring and the 'experience of the clinician/healthcare team'. A variety of tools were used to support adherence including dosette boxes (53%), written information (44%) and verbal communication (42%). Only 20% of physicians followed adherence protocols or formal guidelines. Three-quarters of physicians had received no training on adherence issues. The most common ways physicians kept informed about adherence matters were by attending conferences (87%), reading literature (71%) and learning from colleagues (51%). Eighty-seven per cent of physicians believed national adherence guidelines would be valuable. In conclusion, there is a need for training and direction within current adherence support services. National guidelines could provide a valuable framework for health care professionals.

Ambulatory Care↗
PubMed2002

Peer-led HIV prevention among gay men in London: process evaluation.

A peer-led HIV prevention initiative, based on a diffusion of innovation model, was developed for gay men attending gyms in central London. Peer educators were recruited from people who used the gym regularly according to standard selection criteria. After initial training, peer educators agreed to talk to gay men at their gym about HIV prevention, focusing on sexual risk and steroid injecting behaviour. Outcome evaluation revealed that the peer education programme had no significant impact on the risk behaviours of gay men using the gyms. Process evaluation, based on interviews with peer educators, the health promotion team and gym managers threw light on this finding. While it was feasible to set up a peer education programme among gay men in central London gyms, attrition was an important factor. Only one in five potential peer educators initially identified remained with the project throughout, thus limiting the potential for diffusion. Those who did work as peer educators reported barriers to communication within the gyms further limiting the extent to which diffusion occurred. In fact, it appears that the critical mass required for diffusion was never established. This could explain why the intervention had no significant impact on gay men's risk behaviours. A person-time analysis demonstrated that the peer education programme required a substantial input from the health promotion team, equivalent to one team member devoting 2.5 days a week to recruit, train and support peer educators over 18 months. Peer education should not, therefore, be viewed as a low-cost approach to prevention. Many of the insights gained through this process evaluation can inform others planning peer education programmes in other settings.

HIV Infections↗
PubMed2001

Seeking sex on the Internet and sexual risk behaviour among gay men using London gyms.

OBJECTIVE: To examine the association between seeking sex on the Internet and sexual risk behaviour among gay men in London. METHODS: In January-February 2000, gay men in London gyms were asked to complete self-administered questionnaires concerning use of the Internet, history of sexually transmitted diseases (STD) and recent unprotected anal intercourse (UAI). Internet sex seekers were compared with other men, also with Internet access, who did not seek sex in this way. RESULTS: Of 743 gay men included in the analysis (121 HIV-positive, 465 HIV-negative, 157 never-tested), 80.9% (601) had access to the Internet. Among those who had access, 34.4% (207) had used the Internet to find a sexual partner; this did not vary significantly by HIV status (P = 0.3). Internet sex seekers were more likely to have had an STD (HIV-negative men, 26.9 versus 17.5%, P = 0.04) or gonorrhoea (HIV-positive men, 22.2 versus 5.8%, P = 0.04) in the previous year than other men with Internet access. HIV-negative Internet sex seekers were also more likely to report non-concordant UAI in the previous 3 months [23.1 versus 11.8%; adjusted odds ratio (aOR), 1.9; 95% confidence interval (CI), 1.2--3.5; P = 0.01]. HIV-positive Internet sex seekers were more likely to report UAI with another positive man (37.8 versus 7.4%; aOR, 7.9; 95% CI, 1.8--34.6; P = 0.006). CONCLUSION: Seeking sex on the Internet was associated with recent STD and high-risk sexual behaviour among HIV-positive and -negative gay men in London. The contribution of seeking sex on the Internet to the recent increase in high-risk behaviour among London gay men merits further investigation.

Adult↗
PubMed2001

Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information.

OBJECTIVE: To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics. DESIGN: An observational study followed by a randomised trial. SETTING: Colposcopy Clinic, Royal Free Hospital, London. PARTICIPANTS: Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis. MAIN OUTCOME MEASURE: The level of anxiety measured by the Spielberger State Anxiety Inventory. CONCLUSION: Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one-stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.

Anxiety↗
PubMed2000

Cost effectiveness of expanded antenatal HIV testing in London.

BACKGROUND: Recently the Department of Health announced the introduction in England of voluntary universal HIV screening in early pregnancy to prevent vertical transmission. New data have shown the importance of HIV infection in infants born to mothers who were HIV-negative in early pregnancy and who acquired HIV later in pregnancy or during lactation. This requires consideration of repeat testing in late pregnancy and testing of partners of pregnant women (expanded antenatal HIV testing). OBJECTIVE: To estimate cost effectiveness of expanded antenatal HIV testing in London (England) within the framework of universal voluntary HIV screening in early pregnancy. DESIGN: Incremental cost-effectiveness analysis. METHODS: Cost estimates of service provision for HIV-positive children and adults by stage of HIV infection were combined with estimates of health benefits for infants and parents and with costs of counselling and testing (testing costs). In a pharmacoeconomic model cost effectiveness was estimated for expanded antenatal HIV testing in London for universal and selective strategies. RESULTS: Testing costs in the plausible range of pounds sterling 4 to pounds sterling 40 translate into favourable incremental cost-effectiveness estimates for expanded antenatal HIV testing in London which is already at low numbers of vertical transmissions averted per 100000 pregnant women who test HIV-negative in early pregnancy. Favourable cost effectiveness for universal expanded testing would require testing costs in the lower range, whereas selective expanded testing may produce favourable cost effectiveness at testing costs close to pounds sterling 40. CONCLUSION: Based on pharmaco-economic considerations, the authors believe that implementation of expanded HIV testing in London should be considered.

Adult↗
PubMed2000

Repeat HIV testing: high-risk behaviour or risk reduction strategy?

OBJECTIVE: To examine the characteristics of repeat and first-time HIV testers and consider their implications for HIV test counselling. METHODS: An anonymous questionnaire was completed by nearly 1500 people seeking an HIV test between September 1997 and July 1998 at a same-day HIV testing clinic in London, United Kingdom. Repeat testers were those people who had previously tested HIV negative and were returning for another test. Information was collected on self-reported unprotected penetrative sex (UPS) in the previous 3 months and reasons for seeking the present test. RESULTS: Overall, 50.6% (721/1446) of all clinic attenders were repeat testers: gay men 71.7% (337/470), heterosexual men 42.1% (208/494) and heterosexual women 38.6% (186/482). No significant differences were found between repeat and first time testers in the frequency of UPS (P > or = 0.06). However, gay men (but not heterosexual men and women) reporting three or more previous HIV tests were significantly more likely to report higher-risk UPS (i.e. with a partner whose HIV status was either positive or unknown) (42.2%) than those who had had one-two or no previous tests (25.3 and 25.4%, respectively; P = 0.002). Over half the heterosexual men and women, and one third of gay men said they were seeking the current HIV test in preparation for a new relationship; these proportions did not differ significantly between repeat and first-time testers (P > 0.1). CONCLUSION: In this London HIV testing clinic, no significant differences were found in the frequency of UPS between repeat and first-time testers with the exception of gay men with a history of three or more previous HIV tests, who reported elevated levels of high-risk sexual behaviour. For many people, repeat HIV testing has become part of a risk reduction strategy to establish seroconcordance with a regular partner. HIV test counselling provides the opportunity both to address high-risk behaviour and to reinforce personal risk-reduction strategies.

Female↗
PubMed2000

Combination therapies for HIV and sexual risk behavior among gay men.

OBJECTIVE: To examine optimism in the light of recent advances in HIV treatment among gay men and its association with sexual risk behavior. METHODS: An anonymous questionnaire was completed by gay men who visited gyms in central London in March and April 1998 regarding their HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and their response on a five-point linear scale to two measures of optimism: "I am less worried about HIV now that treatments have improved," and "I believe that new drug therapies make people with HIV less infectious." RESULTS: Two thirds of the men (67.5%, 522 of 773) did not agree with the statement, "I am less worried about HIV now that treatments have improved," and only 42 (5.4%) said they agreed quite a lot or a lot. HIV-positive men were more likely to agree with this statement than HIV-negative men (p = .001) and men who had never been tested (p < .001). There was no association between agreement with this statement and frequency of UAI among HIV-positive or never-tested men (p > .3); there was, however, a positive association among HIV-negative men who reported UAI with a partner of unknown or discordant status (p = .003). The vast majority of men (81.4%; 634 of 779) did not agree with the statement, "I believe that new drug therapies make people with HIV less infectious." Regardless of HIV status, no significant association was seen between agreement with this statement and frequency of UAI (p > .1 for all comparisons). CONCLUSION: Most gay men surveyed in central London gyms did not endorse the optimism statements concerning improved treatments or reduced infectivity. Although HIV-positive gay men were more likely to be optimistic than other men, there was no association between their optimism and sexual risk behavior. Among HIV-negative men, optimism around improved treatments (but not around reduced infectivity) was associated with UAI with a partner of unknown or discordant HIV status. For some HIV-negative men in London, optimism in the light of recent advances in HIV treatment may have triggered, or have been used as a justification for, sexual risk-taking.

Adult↗
PubMed2000

Adherence to HIV combination therapy.

The emergence of drug-resistant strains of HIV virus and treatment failure can result from non-adherence to antiretroviral therapy. While non-adherence to therapy is not a new issue or specific to HIV/AIDS, it has received renewed attention because of the complicated combination treatment regimens being prescribed. This paper reviews the relevant background literature on the contributions of social and behavioural science to non-adherence to HIV medications. Data indicating problems with adherence prior to combination therapy are reported. Despite limitations, even self-report assessments have already succeeded in showing that adherence to combination therapy is significantly related to HIV viral load. Recent research data are discussed. Implications of findings for counselling patients to increase their adherence are presented.

Anti-HIV Agents↗
PubMed2000

A review of HIV testing policies and procedures for pregnant women in public maternity units of Porto Alegre, Rio Grande do Sul, Brazil.

HIV/AIDS is considered one of the major public health issues in Brazil, with 120,399 notified AIDS cases by 1998 (Aristedes Barbosa et al., 1998). Rio Grande do Sul (RS) reports the highest HIV prevalence in women in the country (Louireiro et al., 1998) and local sero-surveillance studies note an increase in HIV prevalence in pregnancy from 2.6% in 1996 (Buchalter et al., 1996) to 3.3% in 1997 (Ferreira & Valente, 1997). As a result, the Ministry of Health has recommended that all pregnant women are offered an HIV test. This study reviewed HIV testing policies and procedures, reported by obstetric staff in public health care centres in Porto Alegre. The beliefs and practices of obstetric health care professionals towards HIV testing and prevention for pregnant women were also examined, given the crucial role of obstetric staff in the implementation of successful antenatal HIV testing procedures. In total, 106 (69.3%) of eligible obstetric health care professionals responded to a postal questionnaire during April and June 1998. Eighty-six (83.5%) of respondents reported a policy of universal offer of HIV testing. A few reported selective offer (n = 9, 8.7%) and eight (7.8%) reported a policy of testing on request only. When selection was operational, respondents reported aiming at women who disclosed intravenous drug use (88.9%), women whose partner had a history of injecting drugs (77.8%), recipients of blood products prior to 1985 (66.7%), women who reported one or more sexually transmitted diseases (STDs) (88.9%) and women whose current or previous partner ever had sex with a man (77.8%). Respondents reported that consent for an HIV test was acquired 'verbally' by the majority (n = 90, 88.2%), whilst ten (9.8%) acquired consent in writing. Two (2.0%) reported that women's consent for an HIV test was not asked for. Units with universal antenatal HIV testing policy were significantly more likely to have had pregnant women test HIV-positive compared with non-universal policy units (U = 13.500, p = 0.050). It appears that whilst the majority of the public health centres were offering an HIV test to all pregnant women in Porto Alegre by 1998, a lack of structured auditing of the actual uptake of HIV testing by pregnant women still remains. Local HIV testing strategy would greatly benefit from such data.

Brazil↗
PubMed2000

Do gay men discuss HIV risk reduction with their GP?

In September/October 1997, 1,004 gay men using one of five gyms in central London completed a confidential anonymous questionnaire which included items on sexual as well as steroid-related injecting behaviour and whether they had ever discussed these behaviours with friends, sexual partners or a general practitioner (GP). Nearly all the men reported having had sex with another man in the previous six months, while a quarter had had unprotected anal intercourse in the previous three months. Less than one-third of the men (30%) had discussed safer sex with their GP, compared with 92% who had talked about it with friends and 87% with lovers (p < 0.001). Of those who had discussed safer sex with their GP, one in six (17%) had not found it easy--this was significantly higher than the proportion who had not found it easy to discuss safer sex with friends, lovers or casual partners (3-9%, p < 0.01). More than 10% of the men had ever injected anabolic steroids. Of those who had injected anabolic steroids, just over one-third (36%) had ever discussed this with their GP. It appears that the majority of gay men in this study had not discussed HIV risk reduction with their GP. Until obstacles to discussing risk reduction and HIV prevention are overcome, the routine consultation in general practice will not be able to fulfill its potential for health promotion.

Adult↗