2025
Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda)
Longenecker C, Kiggundu J, Ayebare F, Muddu M, Kayima J, Mutungi G, Ssinabulya I, Schwartz J, Spiegelman D, Tong G, Nugent R, Aifah A, Kagoya F, Cameron D, Hutchinson B, Kamya M, Katahoire A, Semitala F. Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda). BMC Health Services Research 2025, 25: 1060. PMID: 40790739, PMCID: PMC12341278, DOI: 10.1186/s12913-025-13281-9.Peer-Reviewed Original ResearchConceptsCluster randomized trialHypertension careHIV clinicHealth workersWakiso districtStepped-wedge cluster randomized trialRates of HIV viral suppressionImplementation strategiesQuality HIV careClinical health workersBaseline hypertension prevalenceResource intensive strategyFacility-based costsLife expectancy gainsHIV viral suppressionBP controlPatient BP controlHTN careHuman-centered design approachRandomized trialsHIV careImplementation outcomesHypertension prevalencePre-implementationNon-AIDS comorbiditiesEarly findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study
Kiggundu J, Semitala F, Lipoto C, Giibwa L, Twine R, Mwaka S, Ayebare F, Kiwala C, Magambo E, Mutungi G, Ssinabulya I, Spiegelman D, Kayima J, Muddu M, Schwartz J, Katahoire A, Longenecker C. Early findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study. Journal Of The International AIDS Society 2025, 28: e26499. PMID: 40622382, PMCID: PMC12232483, DOI: 10.1002/jia2.26499.Peer-Reviewed Original ResearchConceptsHypertension careHealthcare providersExperiences of healthcare providersDSD modelCluster randomised trialRoutine medical recordsInductive thematic analysisGeneralised estimating equationsTime interaction effectsService delivery modelsMixed-methods studyIntegrated careHypertension visitsImplementation researchThematic analysisDelivery modelsPLHIVWakiso districtHypertension managementConsolidation frameworkNational guidelinesQuantitative outcome variablesUganda national guidelinesCareClient educationSt. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning
Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Spiegelman D, Carter C. St. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning. Frontiers In Public Health 2025, 13: 1589671. PMID: 40567982, PMCID: PMC12187841, DOI: 10.3389/fpubh.2025.1589671.Peer-Reviewed Original ResearchConceptsCommunity health workersNeeds assessmentHealth workersIntegration of community health workersFocus groupsFront-line health workersLack of social supportParticipatory needs assessmentHIV Epidemic initiativeImprove HIV outcomesCommunity engagement principlesContext of HIVDrivers of inequalityPeer specialistsHealth coachingProvider turnoverClinical leadersHealth inequalitiesCare teamHIV/AIDS careHIV outcomesSocial supportCommunity partnersHistory of structural racismOutreach workers
2024
Demonstrating service delivery models for effective initiation and retention on pre-exposure prophylaxis (PrEP) among female bar workers in Dar es Salaam, Tanzania: A double randomized intervention study protocol
Chebet J, Akyoo W, Goymann H, Harling G, Barnhart D, Mosha I, Kamori D, Gandhi M, Mbunda T, Kipeleka J, Sando D, Spiegelman D, Mpembeni R, Bärnighausen T. Demonstrating service delivery models for effective initiation and retention on pre-exposure prophylaxis (PrEP) among female bar workers in Dar es Salaam, Tanzania: A double randomized intervention study protocol. PLOS ONE 2024, 19: e0304077. PMID: 38935796, PMCID: PMC11210872, DOI: 10.1371/journal.pone.0304077.Peer-Reviewed Original ResearchConceptsFemale bar workersPre-exposure prophylaxisIntention-to-treatBar workersPrimary outcomeRisk of HIV infectionAdherence to PrEPRisk of HIV acquisitionImprove PrEP adherenceGerman Clinical Trials RegisterPublic sector clinicsService delivery modelsRandomized trial designHIV negative womenPrevent HIV InfectionHIV infectionPrEP provisionClinical Trials RegisterHIV testingPrEP initiationHealth facilitiesPromote PrEPPrEP adherenceDelivery modelsReduce barriersNavigating grey areas in HIV and mental health implementation science
Harkness A, Giusto A, Hamilton A, Hernandez‐Ramirez R, Spiegelman D, Weiner B, Beidas R, Larson M, Lippman S, Wainberg M, Smith J. Navigating grey areas in HIV and mental health implementation science. Journal Of The International AIDS Society 2024, 27: e26271. PMID: 38923301, PMCID: PMC11197965, DOI: 10.1002/jia2.26271.Peer-Reviewed Original ResearchMeSH KeywordsHIV InfectionsHumansImplementation ScienceMental HealthNational Institute of Mental Health (U.S.)United StatesConceptsImplementation scienceNational Institute of Mental HealthImplementation researchMental healthImplementation strategiesImpact of implementation strategiesHIV Epidemic goalsInstitute of Mental HealthUNAIDS targetsFederal fundersResearch workforceHIV transmissionEvidence-basedGlobal HIVUnited StatesHIVCapacity buildingRecipient's perspectiveNational InstituteHealthExpert guidanceInterventionHigh-impact scienceControl groupOvercome challenges
2023
Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini
Molemans M, Reis R, Shabalala F, Dlamini N, Masilela N, Simelane N, Pell C, Chao A, Spiegelman D, Vernooij E, van Leth F. Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini. BMC Complementary Medicine And Therapies 2023, 23: 350. PMID: 37794359, PMCID: PMC10548651, DOI: 10.1186/s12906-023-04184-5.Peer-Reviewed Original ResearchMeSH KeywordsComplementary TherapiesEswatiniHIV InfectionsHumansSurveys and QuestionnairesTraditional Medicine PractitionersConceptsInterrupted careAntiretroviral therapyType of illnessCurrent usersTCAM providersTCAM usersHIV diagnosisHIV continuumClinic recordsMultivariable analysisComplementary careVisit dateHealth facilitiesAlternative medicineTCAM useBiomedical careCareAdditional careMixed-methods studyHIVTherapyQualitative content analysisOpen-ended questionsMethods studyContextual factors
2022
Iron supplementation and paediatric HIV disease progression: a cohort study among children receiving routine HIV care in Dar es Salaam, Tanzania
Andersen CT, Duggan CP, Manji K, Seage GR, Spiegelman D, Perumal N, Ulenga N, Fawzi WW. Iron supplementation and paediatric HIV disease progression: a cohort study among children receiving routine HIV care in Dar es Salaam, Tanzania. International Journal Of Epidemiology 2022, 51: 1533-1543. PMID: 35167662, PMCID: PMC9557856, DOI: 10.1093/ije/dyac017.Peer-Reviewed Original ResearchMeSH KeywordsAnemiaChildCohort StudiesDietary SupplementsDisease ProgressionHIV InfectionsHumansIronProspective StudiesTanzaniaConceptsDisease stage progressionIron supplementationStage progressionCohort studyDisease progressionRoutine HIV careHIV disease progressionProspective cohort studyManagement of anemiaRisk of anemiaHigher hazard rateProportional hazards modelIron supplement useDar es SalaamHaematological outcomesAntiretroviral therapyHIV careClinic visitsSupportive careAntiretroviral treatmentClinical outcomesClinical visitsAnemia statusSupplement useVital statusUsing Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama
Humphries D, Rhodes E, Simon C, Wang V, Spiegelman D, Ott C, Hicks D, Marcus J, Krakower D, Rana A. Using Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama. Journal Of The International Association Of Providers Of AIDS Care (JIAPAC) 2022, 21: 23259582221144451. PMID: 36537589, PMCID: PMC9772965, DOI: 10.1177/23259582221144451.Peer-Reviewed Original ResearchConceptsCDS toolsHigh HIV incidenceHIV preexposure prophylaxisPre-exposure prophylaxisClinical decision support toolQualified health centersHealth care providersHealth care professionalsElectronic health recordsPrEP deliveryPrEP prescribingPreexposure prophylaxisPrEP prescriptionClinical visitsHIV incidenceCDS toolHealth centersClinic staffCare providersCare professionalsSide effectsProviders' lackImplementation strategiesPrEPHealth records
2021
Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa
Brault MA, Vermund SH, Aliyu MH, Omer SB, Clark D, Spiegelman D. Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. International Journal Of Environmental Research And Public Health 2021, 18: 10751. PMID: 34682492, PMCID: PMC8535610, DOI: 10.3390/ijerph182010751.Peer-Reviewed Original ResearchMeSH KeywordsAfrica South of the SaharaChronic DiseaseCOVID-19HIV InfectionsHumansPandemicsSARS-CoV-2ConceptsNon-communicable diseasesNon-communicable disease careInfectious diseasesHIV care infrastructureTropical infectious diseasesHIV/AIDS epidemicIntegrated service delivery modelCOVID-19Future pandemic threatsLow-cost interventionMinistry of HealthDisease careChronic diseasesCardiovascular diseaseSuch careIntegrated careAIDS ReliefHealth systemSub-Saharan AfricaDiseaseService delivery modelsPandemic threatAIDS epidemicCare infrastructureHealthcare modelLongitudinal analysis of client appointment adherence under Universal Test and Treat strategy: A stepped‐wedge trial
Boeke CE, Khan S, Walsh FJ, Lejeune C, Hettema A, Spiegelman D, Okello V, Bärnighausen T. Longitudinal analysis of client appointment adherence under Universal Test and Treat strategy: A stepped‐wedge trial. HIV Medicine 2021, 22: 854-859. PMID: 34293243, DOI: 10.1111/hiv.13144.Peer-Reviewed Original ResearchConceptsImpact of UTTStepped-wedge trialAntiretroviral therapyAppointment adherencePublic sector health systemJoint United Nations ProgrammeMultivariable-adjusted modelsHIV/AIDSUniversal testClient adherenceUTT strategyVisit adherenceHIV clientsUnited Nations ProgrammeStudy enrollmentClinical benefitTreat strategyHealth facilitiesART statusHealth systemAdherenceMarital statusNations ProgrammeMeasures analysisLongitudinal analysis
2020
Early access to antiretroviral therapy versus standard of care among HIV‐positive participants in Eswatini in the public health sector: the MaxART stepped‐wedge randomized controlled trial
Khan S, Spiegelman D, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Chao A, Bärnighausen T, Okello V. Early access to antiretroviral therapy versus standard of care among HIV‐positive participants in Eswatini in the public health sector: the MaxART stepped‐wedge randomized controlled trial. Journal Of The International AIDS Society 2020, 23: e25610. PMID: 32949103, PMCID: PMC7507004, DOI: 10.1002/jia2.25610.Peer-Reviewed Original ResearchConceptsViral suppressionStandard of careAntiretroviral treatmentCox proportional hazards modelHealth systemART-naïve participantsHIV-positive patientsHIV-positive adultsViral load monitoringHIV-positive participantsAppropriate care managementProportional hazards modelEarly accessPublic sector health facilitiesHealth system effectsPublic health systemHealth system's abilityClinic transitionAntiretroviral therapyCD4 countCare retentionVL monitoringPublic health sectorDisease stageEndpoint rateUniversal test and treat in relation to HIV disease progression: results from a stepped‐wedge trial in Eswatini
Boeke C, Khan S, Walsh F, Hettema A, Lejeune C, Spiegelman D, Okello V, Harwell J, Mazibuko S, Bärnighausen T. Universal test and treat in relation to HIV disease progression: results from a stepped‐wedge trial in Eswatini. HIV Medicine 2020, 22: 54-59. PMID: 32876360, DOI: 10.1111/hiv.12941.Peer-Reviewed Original ResearchConceptsBody mass indexStepped-wedge trialDisease progressionCD4 countSevere diseaseMultivariate Cox proportional hazards modelWorld Health Organization stageCox proportional hazards modelHIV disease progressionMorbidity/mortalityCells/Proportional hazards modelLower ratesIncident tuberculosisCD4 declineMass indexUniversal testHealth facilitiesBaseline valuesHazards modelHealth outcomesCrowded hospitalsWeight lossProgressionHIVImpaired Hematological Status Increases the Risk of Mortality among HIV-Infected Adults Initiating Antiretroviral Therapy in Tanzania
Noor RA, Abioye AI, Hertzmark E, Darling AM, Aboud S, Mugusi FM, Sudfeld CR, Spiegelman D, Fawzi WW. Impaired Hematological Status Increases the Risk of Mortality among HIV-Infected Adults Initiating Antiretroviral Therapy in Tanzania. Journal Of Nutrition 2020, 150: 2375-2382. PMID: 32621487, PMCID: PMC7540061, DOI: 10.1093/jn/nxaa172.Peer-Reviewed Original ResearchConceptsRisk of mortalityPrevalence of anemiaHAART initiationHematological statusIron deficiencyAntiretroviral therapySerum ferritinSevere anemiaIncident clinical outcomesRelation of anemiaTrial of multivitaminsActive antiretroviral therapyHIV disease progressionCase-cohort studyIron deficiency anemiaProportional hazards modelElevated ironNonanemic participantsHIV patientsMultivariate adjustmentClinical outcomesMorbidity outcomesAnemia etiologyDeficiency anemiaIron supplementationGetting to 90–90–90: Experiences from the MaxART Early Access to ART for All (EAAA) Trial in Eswatini
Walsh F, Khan S, Bärnighausen T, Hettema A, Lejeune C, Mazibuko S, Mlambo CK, Reis R, Fleming Y, Khumalo G, Zwane M, Okello V, Spiegelman D. Getting to 90–90–90: Experiences from the MaxART Early Access to ART for All (EAAA) Trial in Eswatini. Current HIV/AIDS Reports 2020, 17: 324-332. PMID: 32474844, DOI: 10.1007/s11904-020-00501-6.Peer-Reviewed Original ResearchConceptsTreatment guidelinesRoutine viral load monitoringNational HIV careViral load monitoringAdolescent malesSystem-level barriersEarly accessInnovative community-based approachesPublic health systemCommunity outreach strategiesImplementation science researchART initiationHIV careHIV testHIV testingMiddle-income countriesUNAIDS 90Adult menMultiple interventionsHealth systemAdolescent femalesEswatini MinistryTrialsFast trackBaseline dataMortality under early access to antiretroviral therapy vs. Eswatini’s national standard of care: the MaxART clustered randomized stepped‐wedge trial
Chao A, Spiegelman D, Khan S, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Bärnighausen T, Okello V. Mortality under early access to antiretroviral therapy vs. Eswatini’s national standard of care: the MaxART clustered randomized stepped‐wedge trial. HIV Medicine 2020, 21: 429-440. PMID: 32458567, DOI: 10.1111/hiv.12876.Peer-Reviewed Original ResearchConceptsAntiretroviral therapyMortality rateDisease-related mortality rateCox proportional hazards modelCause mortality ratesStepped-wedge trialProportional hazards modelStepped-wedge designQuality of lifeEvidence of harmClinic transitionSecondary outcomesSOC participantsHealth clinicsLong-term consequencesImplementation trialHazards modelHIVStudy participantsMortalityHealth systemDecrease infectionEarly accessClinicTherapySocio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review
Dambach P, Mahenge B, Mashasi I, Muya A, Barnhart DA, Bärnighausen TW, Spiegelman D, Harling G. Socio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review. BMC Public Health 2020, 20: 697. PMID: 32414352, PMCID: PMC7227324, DOI: 10.1186/s12889-020-08838-8.Peer-Reviewed Original ResearchConceptsTransactional sexSocio-demographic characteristicsFemale bar workersRisk factorsUnskilled womenSocial marginalizationSex workBar workersSaharan AfricaEconomic needsLow wagesHIV transmissionFinancial independenceSocietal levelHIV risk awarenessSex workersQualitative dataBar workSocial stigmatizationHIV prevention interventionsStructural interventionsLess considerationVulnerable populationsWorkersPeer pressureIntegrating and Interpreting Findings from the Latest Treatment as Prevention Trials
Brault MA, Spiegelman D, Abdool Karim SS, Vermund SH. Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials. Current HIV/AIDS Reports 2020, 17: 249-258. PMID: 32297219, PMCID: PMC7260110, DOI: 10.1007/s11904-020-00492-4.Peer-Reviewed Original Research
2019
On the analysis of two‐phase designs in cluster‐correlated data settings
Rivera‐Rodriguez C, Spiegelman D, Haneuse S. On the analysis of two‐phase designs in cluster‐correlated data settings. Statistics In Medicine 2019, 38: 4611-4624. PMID: 31359448, PMCID: PMC6736737, DOI: 10.1002/sim.8321.Peer-Reviewed Original ResearchConceptsSmall-sample operating characteristicsInverse probability weighting estimatorData settingClosed-form expressionTwo-phase designStatistical efficiencyComprehensive simulation studyWeighting estimatorCovariance structureSandwich estimatorInvalid inferencesValid inferencesSimulation studyCovariate dataInverse probability weightingEstimatorNaïve methodSampling designNovel analysis approachInferenceRobust sandwich estimatorAnalysis methodAnalysis approachNational antiretroviral treatment programmeCategorical risk
2017
Prevalence estimation when disease status is verified only among test positives: Applications in HIV screening programs
Thomas E, Peskoe S, Spiegelman D. Prevalence estimation when disease status is verified only among test positives: Applications in HIV screening programs. Statistics In Medicine 2017, 37: 1101-1114. PMID: 29230839, PMCID: PMC6512805, DOI: 10.1002/sim.7568.Peer-Reviewed Original Research
2013
Clinical malaria diagnosis in pregnancy in relation to early perinatal mother‐to‐child transmission of HIV: a prospective cohort study
Ezeamama A, Duggan C, Manji K, Spiegelman D, Hertzmark E, Bosch R, Kupka R, Okuma J, Kisenge R, Aboud S, Fawzi W. Clinical malaria diagnosis in pregnancy in relation to early perinatal mother‐to‐child transmission of HIV: a prospective cohort study. HIV Medicine 2013, 15: 276-285. PMID: 24215465, PMCID: PMC4299572, DOI: 10.1111/hiv.12111.Peer-Reviewed Original ResearchConceptsPregnant HIV-positive womenHIV-positive womenRelative riskFever symptomsHIV MTCTHIV infectionPolymerase chain reactionHIV-positive pregnant womenMultivariable logistic regression modelCent of HIVChild's HIV statusHIV MTCT riskInfants of womenPerinatal HIV infectionChild HIV infectionLaboratory-confirmed diagnosisConfidence intervalsPrenatal health careWeeks of lifeLogistic regression modelsHIV motherMaternal malariaMTCT programmeMTCT riskChild transmission
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