CSDE Affiliate Dr. Alison Fohner (Epidemiology) and co-authors recently published their research in Critical Care Explorations, titled “Pharmacologic and Genetic Downregulation of Proprotein Convertase Subtilisin/Kexin Type 9 and Survival From Sepsis“. Circulating lipid and protein assemblies—lipoproteins play critical roles in clearing pathogens from the bloodstream. Authors investigated whether early inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) may accelerate bloodstream clearance of immunogenic bacterial lipids and improve sepsis outcomes.
Their research design included genetic and clinical epidemiology, and experimental models. Nine human cohorts with sepsis (total n = 12,514) were assessed for an association between sepsis mortality and PCSK9 loss-of-function (LOF) variants. Across human cohort studies, the effect estimate for 28-day mortality after sepsis diagnosis associated with genetic PCSK9 LOF was odds ratio = 0.86 (95% CI, 0.67–1.10; p = 0.24). A significant association was present in antibiotic-treated patients. Sepsis therapies are urgently needed and further investigation into the role of PCSK9 in sepsis is needed.
CSDE Trainee Courtney Hill (Epidemiology), CSDE Affiliate Dr. Donald Chi (Health Systems and Population Health, Oral Health Sciences), and co-authors published their research in the Maternal and Child Health Journal, titled “A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs”, where they aimed to understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). They used an explanatory sequential mixed methods study, including a survey and interviews with children’s caregivers. While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride.
CSDE is excited to welcome CSDE Affiliate Dr. Stipica Mudrazija with co-sponsor The Population Health Initiative. Dr. Mudrazija’s presentation will take place in 360 PAR and on Zoom from 12:30-1:30PM on Dec 1st. Stipica Mudrazija is an Assistant Professor in the Department of Health Systems and Population Health at the University of Washington and a Non-Resident Fellow at the Urban Institute in Washington, DC. He studies issues related to population aging, intergenerational support, and health and wellbeing of older adults in the United States and internationally, and is an elected member of the National Academy of Social Insurance.
His research has been supported by the National Institutes of Health and other federal agencies, as well as major foundations and philanthropic organizations. It has been published in leading peer-reviewed journals and edited volumes and featured in media outlets including CNBC, Daily Mail, The Economist, Forbes, Reuters, The New York Times, and The Wall Street Journal, among others. Prior to joining the University of Washington, Dr. Mudrazija was a Principal Research Associate at the Urban Institute and an Adjunct Professor at Georgetown University. Previously, he was a postdoctoral scholar at the Edward R. Roybal Institute on Aging at the University of Southern California. Dr. Mudrazija holds a doctorate in public policy from The University of Texas at Austin, where he was a graduate research trainee in the Population Research Center, a master’s degree in public policy from Georgetown University, and a bachelor’s degree in economics from the University of Zagreb.
CSDE Affiliates Dr. Alison Drake (Global Health), Dr. Grace John-Stewart (Global Health, Epidemiology, Medicine, and Pediatrics), and co-authors published their research in JAIDS, “HIV viral load patterns and risk factors among women in prevention of mother-to-child transmission (PMTCT) programs to inform differentiated service delivery (DSD)”. This research was led by Dr. Wenwen Jiang (recent PhD graduate) as part of her PhD dissertation at UW and by Dr. John Kinuthia (Global Health), who led the team in Kenya. Differentiated service delivery (DSD) approaches decrease frequency of clinic visits for individuals who are stable on antiretroviral therapy (ART). It is unclear how to optimize DSD models for postpartum women living with HIV (PWLH). Authors evaluated longitudinal HIV viral load (VL) and cofactors, and modeled DSD eligibility with virologic failure (VF) among PWLH in PMTCT programs.
This analysis used programmatic data from participants in the Mobile WAChX trial (NCT02400671). Women were assessed for DSD-eligibility using the WHO criteria among general people living with HIV (receiving ART for ≥6 months and having at least one suppressed VL [<1,000 copies/mL] within the past 6 months). Longitudinal VL patterns were summarized using group-based trajectory modeling (GBTM). VF was defined as having a subsequent VL ≥1,000 copies/mL after being assessed as DSD-eligible. Predictors of VF were determined using log-binomial models among DSD-eligible PWLH.
Among 761 women with 3,359 VL results (median 5 VL per woman), a three-trajectory model optimally summarized longitudinal VL, with most (80.8%) women having sustained low probability of unsuppressed VL. Among women who met DSD criteria at 6 months postpartum, most (83.8%) maintained viral suppression until 24 months. Residence in Western Kenya, depression, reported interpersonal abuse, unintended pregnancy, nevirapine-based ART, low-level viremia (VL 200-1,000 copies/mL), and drug resistance were associated with VF among DSD-eligible PWLH. Most postpartum women maintained viral suppression from early postpartum to 24 months and may be suitable for DSD referral. Women with depression, drug resistance and detectable VL need enhanced services.