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Featured researches published by David Kleinbaum.


BMJ Open | 2012

Promotion of couples' voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents

Kristin M. Wall; Williams Kilembe; Azhar Nizam; Cheswa Vwalika; Michelle Kautzman; Elwyn Chomba; Amanda Tichacek; Gurkiran Sardar; Deborah Casanova; Faith Henderson; Joseph Mulenga; David Kleinbaum; Susan Allen

Objectives Hypothesising that couples’ voluntary counselling and testing (CVCT) promotions can increase CVCT uptake, this study identified predictors of successful CVCT promotion in Lusaka, Zambia. Design Cohort study. Setting Lusaka, Zambia. Participants 68 influential network leaders (INLs) identified 320 agents (INAs) who delivered 29 119 CVCT invitations to heterosexual couples. Intervention The CVCT promotional model used INLs who identified INAs, who in turn conducted community-based promotion and distribution of CVCT invitations in two neighbourhoods over 18 months, with a mobile unit in one neighbourhood crossing over to the other mid-way through. Primary outcome The primary outcome of interest was couple testing (yes/no) after receipt of a CVCT invitation. INA, couple and invitation characteristics predictive of couples’ testing were evaluated accounting for two-level clustering. Results INAs delivered invitations resulting in 1727 couples testing (6% success rate). In multivariate analyses, INA characteristics significantly predictive of CVCT uptake included promoting in community-based (adjusted OR (aOR)=1.3; 95% CI 1.0 to 1.8) or health (aOR=1.5; 95% CI 1.2 to 2.0) networks versus private networks; being employed in the sales/service industry (aOR=1.5; 95% CI 1.0 to 2.1) versus unskilled manual labour; owning a home (aOR=0.7; 95% CI 0.6 to 0.9) versus not; and having tested for HIV with a partner (aOR=1.4; 95% CI 1.1 to 1.7) or alone (aOR=1.3; 95% CI 1.0 to 1.6) versus never having tested. Cohabiting couples were more likely to test (aOR=1.4; 95% CI 1.2 to 1.6) than non-cohabiting couples. Context characteristics predictive of CVCT uptake included inviting couples (aOR=1.2; 95% CI 1.0 to 1.4) versus individuals; the woman (aOR=1.6; 95% CI 1.2 to 2.2) or couple (aOR=1.4; 95% CI 1.0 to 1.8) initiating contact versus the INA; the couple being socially acquainted with the INA (aOR=1.6; 95% CI 1.4 to 1.9) versus having just met; home invitation delivery (aOR=1.3; 95% CI 1.1 to 1.5) versus elsewhere; and easy invitation delivery (aOR=1.8; 95% CI 1.4 to 2.2) versus difficult as reported by the INA. Conclusions This study demonstrated the ability of influential people to promote CVCT and identified agent, couple and context-level factors associated with CVCT uptake in Lusaka, Zambia. We encourage the development of CVCT promotions in other sub-Saharan African countries to support sustained CVCT dissemination.


Vaccine | 2013

Nonmedical exemptions to immunization requirements in California: A 16-year longitudinal analysis of trends and associated community factors

Jennifer L. Richards; Bradley H. Wagenaar; Joshua Van Otterloo; Rahul Gondalia; Jessica E. Atwell; David Kleinbaum; Daniel A. Salmon; Saad B. Omer

BACKGROUND Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994-2009 in California, and associated school and community characteristics. METHODS We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates. RESULTS Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8-9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55-2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1-11.1%) than among public schools (8.8%, 95% CI: 8.4-9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26-2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income. CONCLUSIONS This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.


Journal of Acquired Immune Deficiency Syndromes | 2013

Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV positive couples in Lusaka, Zambia

Kristin M. Wall; Bellington Vwalika; Lisa Haddad; Naw Htee Khu; Cheswa Vwalika; William Kilembe; Elwyn Chomba; Rob Stephenson; David Kleinbaum; Azhar Nizam; Ilene Brill; Amanda Tichacek; Susan Allen

Objectives:To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of prevention of mother-to-child transmission of HIV. Design:We conducted a factorial randomized controlled trial of 2 video-based interventions. Methods:“Methods” and “Motivational” messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia. Results:Among couples not using contraception before randomization (n = 782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the “Methods video” which focused on the intrauterine device and contraceptive implant was associated with a significantly lower pregnancy incidence [hazard ratio (HR) = 0.38; 95% confidence interval (CI): 0.19 to 0.75] relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR = 0.22; 95% CI: 0.08 to 0.58) and couples with HIV-positive women (HR = 0.23; 95% CI: 0.09 to 0.55). Conclusions:The “Methods video” intervention was previously shown to increase uptake of long-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the intrauterine device and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV-positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods.


PLOS Neglected Tropical Diseases | 2014

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

Katherine E. Mues; Michael S. Deming; David Kleinbaum; Philip J. Budge; Mitch Klein; Juan S. Leon; Aishya Prakash; Jonathan Rout; LeAnne M. Fox

Background Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. Methodology/Principal Findings A lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Churchs Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. Conclusions/Significance These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.


PLOS ONE | 2016

Minimum acceptable diet at 9 months but not exclusive breastfeeding at 3 months or timely complementary feeding initiation is predictive of infant growth in rural Bangladesh

Aatekah Owais; Benjamin Schwartz; David Kleinbaum; Parminder S. Suchdev; A. S. G. Faruque; Sumon Kumar Das; Aryeh D. Stein

The association between suboptimal infant feeding practices and growth faltering is well-established. However, most of this evidence comes from cross-sectional studies. To prospectively assess the association between suboptimal infant feeding practices and growth faltering, we interviewed pregnant women at 28–32 weeks’ gestation and followed-up their offspring at postnatal months 3, 9, 16 and 24 months in rural Bangladesh. Using maternal recall over the past 24 hours, exclusive breastfeeding (EBF) status at 3 months, age at complementary feeding (CF) initiation, and receipt of minimum acceptable diet (MAD; as defined by WHO) at 9 months were assessed. Infant length and weight measurements were used to produce length-for-age (LAZ) and weight-for-length (WLZ) z-scores at each follow-up. Generalized estimating equations were used to estimate associations of LAZ and WLZ with infant feeding practices. All models were adjusted for baseline SES, infant sex, maternal height, age, literacy and parity. Follow-up was completed by 2189, 2074, 1969 and 1885 mother-child dyads at 3, 9, 16 and 24 months, respectively. Stunting prevalence increased from 28% to 57% between infant age 3 and 24 months. EBF at 3 months and age at CF initiation were not associated with linear infant growth, but receipt of MAD at 9 months was. By age 24 months, infants receiving MAD had attained a higher LAZ compared to infants who did not receive MAD (adjusted β = 0.25, 95% CI: 0.13–0.37). Although prevalence of stunting was already high at age 3 months, ensuring infants receive a diverse, high quality diet from 6 months onwards may reduce rates of stunting in the second year of life.


Journal of Medical Internet Research | 2014

Assessment of a New Web-Based Sexual Concurrency Measurement Tool for Men Who Have Sex With Men

Eli S. Rosenberg; Richard Rothenberg; David Kleinbaum; Rob Stephenson; Patrick S. Sullivan

Background Men who have sex with men (MSM) are the most affected risk group in the United States’ human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations. Objective The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM. Methods In an online study of MSM aged ≥18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (κ), and matched odds ratios at the individual, dyad, and triad levels of analysis. Results Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, κ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, κ=.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, κ=.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes. Conclusions The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis.


Retrovirology | 2012

Promotion of couples’ voluntary HIV counseling and testing in Lusaka, Zambia by influence network leaders and agents

Kristin M. Wall; William Kilembe; Azhar Nizam; Cheswa Vwalika; Michele Kautzman; Elwyn Chomba; Amanda Tichacek; Gurkiran Sardar; D. Casanova; Faith Henderson; Joseph Mulenga; David Kleinbaum; Susan Allen

K. Wall, Emory University W. Kilembe, Rwanda Zambia HIV Research Group Azhar Nizam, Emory University C. Vwalika, Rwanda Zambia HIV Research Group M. Kautzman, Rwanda Zambia HIV Research Group E. Chomba, Rwanda Zambia HIV Research Group A. Tichacek, Rwanda Zambia HIV Research Group G. Sardar, Rwanda Zambia HIV Research Group D. Casanova, Rwanda Zambia HIV Research Group F. Henderson, Rwanda Zambia HIV Research Group


Retrovirology | 2012

Effect of an intervention to promote contraceptive uptake on incident pregnancy: a randomized controlled trial among HIV positive couples in Zambia

Kristin M. Wall; Bellington Vwalika; Lisa Haddad; Naw Htee Khu; Cheswa Vwalika; William Kilembe; Elwyn Chomba; Rob Stephenson; David Kleinbaum; Azhar Nizam; Ilene Brill; Amanda Tichacek; Susan Allen

Results Couple baseline serostatus and contraception usage were both individual effect measure modifiers (p<0.0001). Among couples in which the woman was not using a contraceptive method at baseline (N=782), there was no significant effect of the interventions overall or when stratifying by couple serostatus on incident pregnancy. Among couples in which the woman was using a contraceptive method at baseline, concordant positive couples (HR = 0.20; 95%CI: 0.08-0.53), and couples in which the woman was HIV positive at baseline (HR = 0.21; 95%CI: 0.09-0.51) who received “Methods + Both” interventions which combined information on contraceptive methods and motivational messages for future planning behaviors were at significantly decreased hazard for pregnancy relative to those receiving “Motivational + Control” interventions – which provided motivational messages for future planning but not information on contraceptive methods.


Journal of Acquired Immune Deficiency Syndromes | 2013

The implications of respondent concurrency on sex partner risk in a national, web-based study of men who have sex with men in the United States.

Eli S. Rosenberg; Richard Rothenberg; David Kleinbaum; Rob Stephenson; Patrick S. Sullivan


Water | 2015

Spatial Variability of Escherichia coli in Rivers of Northern Coastal Ecuador.

Gouthami Rao; Joseph N. S. Eisenberg; David Kleinbaum; William Cevallos; Gabriel Trueba; Karen Levy

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