Judith Harbertson

Prevalence of PTSD and Depression, and Associated Sexual Risk Factors, among Male Rwanda Defense Forces Military Personnel

To assess depression and PTSD prevalence among the Rwanda Defense Forces (RDF) and evaluate whether sexual risk behaviour, STIs, HIV and alcohol use were significantly higher among those who screened positive.

South-to-North, Cross-Disciplinary Training in Global Health Practice: Ten Years of Lessons Learned from an Infectious Disease Field Course in Jamaica

Global commerce, travel, and emerging and resurging infectious diseases have increased awareness of global health threats and opportunities for collaborative and service learning. We review course materials, knowledge archives, data management archives, and student evaluations for the first 10 years of an intensive summer field course in infectious disease epidemiology and surveillance offered in Jamaica. We have trained 300 students from 28 countries through collaboration between the University of the West Indies and U.S. partner universities. Participants were primarily graduate students in public health, but also included health professionals with terminal degrees, and public health nurses and inspectors. Strong institutional synergies, committed faculty, an emphasis on scientific and cultural competencies, and use of team-based field research projects culminate in a unique training environment that provides participants with career-developing experiences. We share lessons learned over the past decade, and conclude that South-to-North leadership is critical in shaping transdisciplinary, cross-cultural, global health practice.

Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis

Objectives Sexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. Methods Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. Results Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). Conclusions Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.

Pre-deployment alcohol misuse among shipboard active-duty U.S. military personnel

INTRODUCTION The burden of alcohol misuse is unknown among shipboard U.S. Navy and Marine Corps military personnel immediately prior to deployment and may be elevated. METHODS Anonymous survey data on hazardous, dependent, and binge alcohol misuse and involuntary drug consumption were collected during 2012-2014 among shipboard personnel within approximately 2 weeks of deployment. Using the Alcohol Use Disorders Identification Test Consumption (AUDIT-C), hazardous alcohol misuse was defined using two cut-point scoring criteria: (1) ≥3 for women and ≥4 for men; and (2) ≥4 for women and ≥5 for men; binge drinking as ≥4 drinks for women and ≥5 drinks for men on a typical day in past 30 days; and dependent alcohol misuse as an AUDIT-C score of ≥8. Demographic- and sex-stratified self-reported alcohol misuse prevalence was reported for analysis conducted during 2014-2015. RESULTS Among 2,351 male and female shipboard personnel, 39%-54% screened positive for hazardous, 27% for binge, and 15% for dependent alcohol use. Seven percent reported involuntary drug consumption history. A larger proportion of those aged 17-20 years screened positive for dependent alcohol use compared with the overall study population prevalence. CONCLUSIONS A large proportion of shipboard personnel screened positive for hazardous and dependent alcohol use (18% among those aged <21 years) at deployment onset. These data can inform interventions targeting shipboard personnel engaging in hazardous use before progression to dependent use and enable early identification and care for dependent users. Future studies should include more comprehensive assessment of factors associated with involuntary drug consumption.

Population-based Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis prevalence using discarded, deidentified urine specimens previously collected for drug testing

We used a novel method to test for STIs among a non–healthcare-seeking military population in the San Diego region of California. Active-duty US Navy and Marine Corps personnel were randomly selected to provide urine specimens to Navy Drug Screening Laboratory, San Diego in October and November 2013 for the Department of Defense drug testing programme. If specimens screened negative for drugs (>99% of samples), urine specimens were discarded, deidentified and subsequently tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV) using the Aptima Combo 2 and TV assay as specified by the manufacturer (Hologic, San Diego, CA, USA). The Tigris direct tube sampling system was used for high-throughput nucleic acid amplification testing (NAAT). Urine specimens older than 6 days were not tested due to sample degradation concerns. The overall prevalence of CT was 2.1% (95% CI 1.79 …

Self-Reported HIV-Positive Status But Subsequent HIV-Negative Test Result Using Rapid Diagnostic Testing Algorithms Among Seven Sub-Saharan African Military Populations

HIV rapid diagnostic tests (RDTs) combined in an algorithm are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs have excellent sensitivity and specificity. However, false-positive RDT algorithm results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results. We conducted HIV serosurveys in seven sub-Saharan African military populations and recorded the frequency of personnel self-reporting HIV positivity, but subsequently testing HIV-negative during the serosurvey. The frequency of individuals who reported they were HIV-positive but subsequently tested HIV-negative using RDT algorithms ranged from 3.3 to 91.1%, suggesting significant rates of prior false-positive HIV RDT algorithm results, which should be confirmed using biological testing across time in future studies. Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization’s HIV testing guidelines. Other measures to improve RDT algorithm specificity include classifying individuals with weakly positive test lines as HIV indeterminate and retesting. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results are needed to prevent the significant medical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.