Imperial College London

ProfessorHelenWard

Faculty of MedicineSchool of Public Health

Professor of Public Health
 
 
 
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Contact

 

+44 (0)20 7594 3303h.ward Website

 
 
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Location

 

158Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

230 results found

Day S, Coombes RC, McGrath-Lone L, Schoenborn C, Ward Het al., 2016, Stratified, precision or personalised medicine? Cancer services in the “real world” of a London hospital, Sociology of Health & Illness, Vol: 39, Pages: 143-158, ISSN: 0141-9889

We conducted ethnographic research in collaboration with a large research-intensive London breast cancer service in 2013-14 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision-making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already-complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.

Journal article

Davies B, Turner K, Frolund M, Ward H, May M, Rasmussen S, Benfield T, Westh H, Danish Chlamydia Study Groupet al., 2016, Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark, Lancet Infectious Diseases, Vol: 16, Pages: 1057-1064, ISSN: 1473-3099

Background: Uncertainty in the risk of reproductive complications (pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI)) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital healthcare (in-patient, out-patient and emergency department) for a reproductive complication.Methods: We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012). Findings: The 516,720 women (103,344 positive, 182,879 negative, 230,497 never-tested) had a mean follow-up of 7.96 years. Compared to women with only negative tests, the risk of each complication was 30% higher in women with ≥1 positive test (adjusted hazard ratios (AHRs) PID 1·50(1·43-1·57); EP 1·31(1·25-1·38); TFI 1·37(1·24-1·52)) and 60% lower in women who were never-tested (AHRs PID 0·33(0·31-0·35); EP 0·42(0·39-0·44); TFI 0·29(0·25-0·33)). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (PID 0.6%; EP 0.2%; TFI 0·1%). Repeat infections increased the risk of PID by a further 20% (AHR 1·20(1·11-1·31)). Interpretation: A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of PID. Therefore control programmes must prevent first and repeat infections to improve women’s reproductive health.

Journal article

Majeed F, Hansell A, Saxena S, Millett C, Ward H, Harris M, Hayhoe B, Car J, Easton G, Donnelly CA, Perneczky R, Jarvelin MR, Ezzati M, Rawaf S, Vineis P, Ferguson N, Riboli E, Majeed FA, Hansell A, Saxena S, Millett C, Ward H, Harris M, Hayhoe B, Car J, Easton G, Donnelly CA, Perneczky R, Jarvelin M-R, Ezzati M, Rawaf S, Vineis P, Ferguson N, Riboli Eet al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095

Journal article

Bruton J, Norton C, Smyth N, Ward H, Day Set al., 2016, Nurse handover: patient and staff experiences, British Journal of Nursing, Vol: 25, Pages: 386-393, ISSN: 0966-0461

AIM AND OBJECTIVES: to understand the purpose, impact and experience of nurse handover from patient and staff perspectives. BACKGROUND: poor communication is increasingly recognised as a major factor in healthcare errors. Handover is a key risk point. Little consensus exists regarding the practice in nursing but the trend is towards bedside handover. Research on patient and staff experiences of handover is limited. DESIGN: a qualitative and observational study on two acute wards in a large urban hospital in the UK. METHODS: interviews conducted with patients and staff and observation of handovers, ward rounds and patient-staff interactions. RESULTS: diverse forms of nurse handover were found, used in combination: office based (whole nursing team), nurse in charge (NIC) to NIC, and bedside. Patients' and nurses' views concurred on the purpose of bedside handover-transference of information about the patient between two nurses-and about the medical ward round, which was seen as a discussion with the patient. Views diverged regarding the purpose and value of office handover. Bedside handover differed in style, content, and place of delivery, often driven by concerns regarding confidentiality and talking over patients, and there were varied views on the benefits of patient involvement in bedside handover. Nurses worked beyond their shift end to complete handover. Communication problems within the clinical team were identified by staff and patients. CONCLUSIONS: while it is important to agree the purpose of handover and develop appropriate structure, content and style, it need not be a uniform process in all clinical areas. Nurse training to deliver bedside handover and patient information on the purpose of handover and the patient's role would be beneficial.

Journal article

Ward H, Bruton J, Rai T, Higgs C, Rowlands Jet al., 2016, "Clean" or "dirty": the changing experiences of care and support among MSM diagnosed with HIV, Publisher: WILEY-BLACKWELL, Pages: 61-61, ISSN: 1464-2662

Conference paper

Ward H, Bruton J, Rai T, Higgs C, Rowlands Jet al., 2016, Patient perspectives on the HIV treatment cascade in the United Kingdom, Publisher: WILEY-BLACKWELL, Pages: 66-67, ISSN: 1464-2662

Conference paper

Rai T, Lambert H, Ward H, 2016, Migration as a risk and a livelihood strategy: HIV across the life course of migrant families in India, Global Public Health, Vol: 12, Pages: 381-395, ISSN: 1744-1706

Migrant workers are understood to be vulnerable to HIV. However, little is known about the experience of migration-based households following HIV infection. This qualitative study examined the migration-HIV relationship beyond the point of infection, looking at how it affects livelihood choices, household relationships and the economic viability of migrant families. We conducted semi-structured interviews with 33 HIV-positive migrant men and women recruited from an anti-retroviral therapy (ART) centre in north India. Following infection among the migrant men, contact with free, public-sector HIV services was often made late, after the development of debilitating symptoms, abandonment of migrant work and return to native villages. After enrolment at the ART centre participants’ health eventually stabilised but they now faced serious economic debt, an inflexible treatment regimen and reduced physical strength. Insecure migrant job markets, monthly drug collection and discriminatory employment policies impeded future migration plans. HIV-positive wives of migrants occupied an insecure position in the rural marital household that depended on their husbands’ health and presence of children. The migration-HIV relationship continued to shape the life course of migrant families beyond the point of infection, often exposing them again to the economic insecurity that migration had helped to overcome, threatening their long-term survival.

Journal article

Davies B, Ward H, 2016, A pathway to chlamydia control: updated ECDC guidance, Sexually Transmitted Infections, Vol: 92, Pages: 483-484, ISSN: 1472-3263

In 2009, the European Centre for Disease Prevention and Control (ECDC) published guidance on chlamydia (Chlamydia trachomatis) control in Europe.1 In it we recommended that EU/EEA member states ensure the provision of basic resources and systems (for diagnosis, case and partner management) before embarking on any expanded screening programme. This guidance was based on evidence first that there was a huge variation in availability of clinical services for chlamydia across member states, and second that the evidence for population level programmes was missing.1 ,2 This month ECDC has released updated guidance that we developed with the support of ECDC experts following a programme of work to update the evidence, including an extensive review of the epidemiology and natural history of chlamydia and the clinical and cost-effectiveness of screening programmes.3 The team also repeated the survey of member states, and assessed the impact of the original guidance.4 ,5The survey showed that more countries had established essential diagnostic and management facilities and guidelines;6 it was hard to attribute this …

Journal article

Davies B, Ward H, 2016, Guidance on chlamydia control in Europe 2015, Stockholm, Sweden, Publisher: European Centre for Disease Prevention and Control, TQ-01-16-029-EN-N

Executive summaryThis evidence-based guidance updates the 2009 ECDC Chlamydia control in Europe guidance [5]. It was developed by a technical expert group using evidence gathered by the Chlamydia control in Europe programme of work, which ECDC commissioned in 2011 and presented in three accompanying technical reports in 2014 and 2015. The work included a critical review and update of the scientific evidence on the epidemiology and natural history of chlamydia and the clinical and cost-effectiveness of screening programmes, an update of information aboutchlamydia prevention and control activities in EU/EEA Member States, and a review of the impact of the 2009 ECDC chlamydia control guidance. In 2014, an expert consultation provided in-depth information about the use of the 2009 guidance within countries and made suggestions for the revision of the guidance.The aim of this guidance is to support Member States to develop, implement or improve national or local strategies for chlamydia control. This guidance sets out the current evidence base behind the proposed options, highlights key gaps in knowledge, and suggests effective options for national chlamydia control strategies. It is directedprimarily at policy advisors but should be useful for programme managers and experts in sexual health, especially those at the European or national levels.The evidence-based options presented here should be interpreted and applied according to clinical, epidemiological, healthcare and resource environments: there is marked variation in current chlamydia controlstrategies across EU/EEA Member States which reflects differences in available resources, health priorities and uncertainties in the evidence-base for chlamydia control interventions. The evidence base for primary prevention activities is still deficient but expert opinion is that it is prudent to offer these interventions to all at-risk individuals.Diagnosing and treating cases of chlamydia can improve the health of the affect

Report

Trenchard L, Mc Grath-Lone L, Ward H, 2016, Ethnic variation in cancer patients’ ratings of information provision, communication and overall care, Ethnicity & Health, Vol: 21, Pages: 515-533, ISSN: 1465-3419

Objective. Ethnic inequalities in cancer patient experience exist but variation within broad ethnic categories is under-explored. This study aimed to describe variation by ethnic sub-category in experiences of information provision and communication (key domains of patient experience) using National Cancer Patient Experience Survey (NCPES) data.Design. The NCPES 2012–2013 contained responses from 68,737 cancer patients treated at 155 NHS Trusts in England. Multivariate logistic regression was used to investigate associations between ethnicity and patients’ ratings of overall care, information provision and communication.Results. Variation by and within broad ethnic categories was evident. Non-White patients (particularly Asian patients (ORadj:0.78; 95%CI:0.67-0.90, p=0.001)) were less likely than White patients to receive an understandable explanation of treatment side effects. Among Asian patients, those of Bangladeshi ethnicity were least likely to receive an understandable explanation.Conclusions. Effective communication and information provision are important to ensure patients are well informed, receive the best possible care and have a positive patient experience. However, ethnic inequalities exist in cancer patients’ experiences of information provision and communication with variation evident both between and within broad ethnic categories. Further work to understand the causes of this variation is required to address ethnic inequalities at practice and policy level.

Journal article

Rai T, Lambert HS, Ward H, 2015, Complex routes into HIV care for migrant workers: a qualitative study from north India, Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv, Vol: 27, Pages: 1418-1423, ISSN: 1360-0451

Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and tr

Journal article

Gregson S, Schur N, Mylne A, Mushati P, Takaruza A, Ward H, Nyamukapa Cet al., 2015, The effects of household wealth on HIV prevalence in Manicaland, Zimbabwe - a prospective household census and population-based open cohort study, Journal of the International AIDS Society, Vol: 18, ISSN: 1758-2652

Introduction: Intensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalencein Zimbabwe.Objectives: To assess the impact of the economic decline on household wealth and prevalent HIV infection using data from apopulation-based open cohort.Methods: Household wealth was estimated using data from a prospective household census in Manicaland Province (1998 to2011). Temporal trends in summed asset ownership indices for sellable, non-sellable and all assets combined were compared forhouseholds in four socio-economic strata (small towns, agricultural estates, roadside settlements and subsistence farmingareas). Multivariate logistic random-effects models were used to measure differences in individual-level associations betweenprevalent HIV infection and place of residence, absolute wealth group and occupation.Results: Household mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below0.35 thereafter. Sellable assets fell substantially from 2004 while non-sellable assets continued increasing until 2008. Small-townhouseholds had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets.Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better-off locations (small towns) butdiffered little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households andlower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest householdshad lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.Conclusions: The economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio-economiclocations and sub-groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.

Journal article

van den Broek IV, Sfetcu O, van der Sande MA, Andersen B, Herrmann B, Ward H, Götz HM, Uusküla A, Woodhall SC, Redmond SM, Amato-Gauci AJ, Low N, van Bergen JEet al., 2015, Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey, European Journal of Public Health, Vol: 26, Pages: 382-388, ISSN: 1464-360X

BACKGROUND: In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS: Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS: In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION: Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.

Journal article

Thom SAM, Ward H, Wood F, Salam A, Singh K, Day S, Jan S, Prabhakaran D, Rodgers R, Patel Aet al., 2015, Process evaluation of the impact and acceptability of a polypill for prevention of cardiovascular disease, BMJ Open, Vol: 9, ISSN: 2044-6055

Importance The Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial has shown improved adherence with the use of a polypill strategy when compared with usual medications for cardiovascular disease (CVD) prevention. To advance from efficacy to impact, we need a better understanding of why and how such a strategy might be deployed in complex health systems.Objective To understand, from the perspective of UMPIRE trial participants and professionals, how and why a polypill strategy improves adherence compared with usual care, why improvement is greater in some subgroups, and to explore the acceptability of a polypill strategy among trial participants and healthcare professionals.Design, setting and participants A preplanned process evaluation, based on qualitative interviews, was conducted with a subsample of 102 trial participants and 41 healthcare professionals at the end of the UMPIRE trial in India and Europe.Results Most patients contrasted the simplicity of the polypill with usual medications that they found complex and, for many in India, expensive. Patients with low baseline adherence struggled most with complex medication lists, and those without established disease described less motivation to adhere when compared with people who had already been diagnosed with CVD; people in the latter group had already undertaken self-directed measures to adhere to CVD preventive medicines prior to entering the trial. Taking medication was one of many adaptations described by patients; these included dietary changes, stopping smoking and maintaining exercise. Most patients liked the polypill strategy, although some participants and health professionals were concerned that it would provide less tailored therapy for individual needs.Conclusions Adherence to treatment lists with multiple medications is complex and influenced by several factors. Simplifying medication by using a once-daily polypill is one approach to CVD prevention that may enhance adherence.

Journal article

Turner KME, Froland M, Davies B, Benfield T, Rasmussen S, May M, Ward H, Westh Het al., 2015, Epidemiological trends in chlamydia testing in denmark 1991 to 2011 and formation of a retrospective, population-based cohort: the danish chlamydia study, ISSTDR 2015

Poster

Mc Grath-Lone L, Day S, Schoenborn C, Ward Het al., 2015, Exploring research participation among cancer patients: analysis of a national survey and an in-depth interview study., BMC Cancer, Vol: 15, ISSN: 1471-2407

BACKGROUND: Inequalities in cancer research participation are thought to exist with certain groups under-represented in research populations; however, much of the evidence is based on small-scale studies. The aim of this study was to explore data from in-depth interviews with cancer patients and a large national survey to investigate variation in who is asked to participate in research and who takes part. METHODS: Factors associated with research discussion and participation were explored in National Cancer Patient Experience Survey data using multivariate logistic regression and during in-depth interviews with 25 breast cancer patients. RESULTS: Survey data were available for 66,953 cancer patients; 30.4 % reported having discussions about, and 18.9 % took part in, research. Barriers to participation at staff, patient and trust level were evident; for example, staff were less likely to discuss research with older patients, Asian and black patients were less likely to take part and patients treated at specialist or teaching trusts had higher levels of discussion and participation. Interviews showed that patients' willingness to participate changed over time and was not synonymous with participation as some were ineligible. CONCLUSION: Some patient groups were less likely to have discussions about or participate in research. Analysis of this variation vis-à-vis the composition of the patient population may be useful to ensure that there is equity regarding the potential benefits of research participation and that research findings are applicable to target populations in the translational model.

Journal article

McGrath-Lone L, Ward H, Schoenborn C, Day Set al., 2015, The effects of cancer research participation on patient experience: a mixed-methods analysis., European Journal of Cancer Care, Vol: 25, Pages: 1056-1064, ISSN: 1365-2354

Patient-reported benefits of research participation have been described by study participants; however, many studies have small sample sizes or are limited to patient groups with poor prognoses. The purpose of this study was to explore the effects of research participation on patient experience using survey responses from a large, national sample of cancer patients (N = 66 462) and interviews with breast cancer patients attending a London trust. Multivariate logistic regression was used to investigate associations between taking part in research and positive patient experience. Based on our analysis, patients who participated in research were more likely to rate their overall care and treatment as 'very good/excellent' (ORadj :1.64, 95%CI: 1.53-1.76, P < 0.001) and to describe positive patient experiences, such as better access to non-standard care, better interactions with staff and being treated as an individual. However, findings from our interviews indicated that there was no common understanding of what constitutes cancer research and no clear delineation between research participation and standard care, from the patient perspective. Further work to explore how participation positively influences patient experience would be useful to develop strategies to improve care and treatment for all patients regardless of whether or not they choose, or have the opportunity, to take part in research.

Journal article

Ward H, Davies B, Ronn M, 2015, Chlamydia control in Europe: Qualitative evaluation of the impact of the2009 ECDC guidance document Chlamydia control in Europe, Stockholm, Sweden, Publisher: European Centre for Disease Prevention and Control, TQ-02-15-038-EN-N

In 2011, the European Centre for Disease Prevention and Control (ECDC) commissioned a programme of work to improve knowledge about the impact of chlamydia and chlamydia control in Europe. The aim of this project was to critically review and update the scientific evidence on the epidemiology and natural history of chlamydia and the clinical and cost-effectiveness of screening, update information about chlamydia prevention and control activities in EU/EEA Member States, and review the impact of the 2009 ECDC chlamydia control guidance. This technical report describes the evaluation of the impact of the 2009 guidance document on policymaking in Member States and presents recommendations for a revised version of the guidance. It includes an overview of the responses collected during the 2012 survey on chlamydia control activities in EU/EEA Member States. Different user types – with regard to the guideline document – were identified and described in this report. In addition, a qualitative analysis of the discussions at the March 2014 meeting was conducted. The meeting had brought together experts from Member States who discussed their experiences with the guidance document.This report concludes with evidence-based recommendations for the revision of the 2009 guidance document.

Report

Redmond SM, Alexander-Kisslig K, Woodhall SC, van den Broek IVF, van Bergen J, Ward H, Uuskula A, Herrmann B, Andersen B, Gotz HM, Sfetcu O, Low Net al., 2015, Genital Chlamydia Prevalence in Europe and Non-European High Income Countries: Systematic Review and Meta-Analysis, PLOS One, Vol: 10, ISSN: 1932-6203

Journal article

Davies B, 2014, The association between Chlamydia trachomatis and pelvic inflammatory disease: findings from observational studies

Thesis dissertation

Rai T, Lambert HS, Borquez AB, Saggurti N, Mahapatra B, Ward Het al., 2014, Circular Labor Migration and HIV in India: Exploring Heterogeneity in Bridge Populations Connecting Areas of High and Low HIV Infection Prevalence, Journal of Infectious Diseases, Vol: 210, Pages: S556-S561, ISSN: 1537-6613

BACKGROUND:The emerging human immunodeficiency virus (HIV) epidemics in rural areas of India are hypothesized to be linked to circular migrants who are introducing HIV from destination areas were the prevalence of HIV infection is higher. We explore the heterogeneity in potential roles of circular migrants in driving an HIV epidemic in a rural area in north India and examine the characteristics of the "sustaining bridge population", which comprises individuals at risk of HIV acquisition at destination and of HIV transmission into networks at origin capable of sustaining an epidemic.METHODS:Results of a behavioral survey of 639 male migrants from Azamgarh district, India, were analyzed using χ(2) tests and logistic regression.RESULTS:We estimated the size of various subgroups defined by specific sexual behaviors across different locations and over time. Only 20% fit our definition of a sustaining bridge population, with the majority making no apparent contribution to geographical connectedness between high- and low-prevalence areas. However, we found evidence of sexual contacts at origin that could potentially sustain an epidemic once HIV is introduced. Variables associated with sustaining bridge population membership were self-perceived HIV risk, current migrant status, and age.CONCLUSIONS:Circular migrants represent a heterogeneous population in terms of their role as a bridge group. Self-perception of heightened risk could be exploited in designing prevention programs.

Journal article

Elmes J, Nhongo K, Ward H, Hallett T, Nyamukapa C, White PJ, Gregson Set al., 2014, The Price of Sex: Condom Use and the Determinants of the Price of Sex Among Female Sex Workers in Eastern Zimbabwe, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S569-S578, ISSN: 0022-1899

Journal article

Aral SO, Ward H, 2014, Behavioral Convergence: Implications for Mathematical Models of Sexually Transmitted Infection Transmission, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S600-S604, ISSN: 0022-1899

Journal article

Davies B, Ward H, Leung S, Turner KME, Garnett GP, Blanchard JF, Yu BNet al., 2014, Heterogeneity in Risk of Pelvic Inflammatory Diseases After Chlamydia Infection: A Population-Based Study in Manitoba, Canada, Journal of Infectious Diseases, Vol: 210, Pages: S549-S555, ISSN: 1537-6613

Background. The association between chlamydia infection and pelvic inflammatory disease (PID) is a key parameterfor models evaluating the impact of chlamydia control programs. We quantified this association using aretrospective population-based cohort.Methods. We used administrative health data sets to construct a retrospective population-based cohort ofwomen and girls aged 12–24 years who were resident in Manitoba, Canada, between 1992 and 1996. We performedsurvival analysis on a subcohort of individuals who were tested for chlamydia to estimate the risk of PID diagnosed ina primary care, outpatient, or inpatient setting after ≥1 positive chlamydia test.Results. A total of 73 883 individuals contributed 625 621 person years of follow-up. Those with a diagnosis ofchlamydia had an increased risk of PID over their reproductive lifetime compared with those who tested negative(adjusted hazard ratio [AHR], 1.55; 95% confidence interval [CI], 1.43–1.70). This risk increased with each subsequentinfection: the AHR was 1.17 for first reinfection (95% CI, 1.06–1.30) and 1.35 for the second (95% CI,1.04–1.75). The increased risk of PID from reinfection was highest in younger individuals (AHR, 4.55 (95% CI,3.59–5.78) in individuals aged 12–15 years at the time of their second reinfection, compared with individualsolder than 30 years).Conclusions. There is heterogeneity in the risk of PID after a chlamydia infection. Describing the progression toPID in mathematical models as an average rate may be an oversimplification; more accurate estimates of the costeffectivenessof screening may be obtained by using an individual-based measure of risk. Health inequalities may bereduced by targeting health promotion interventions at sexually active girls younger than 16 years and those with ahistory of chlamydia.

Journal article

White PJ, Fox J, Weber J, Fidler S, Ward Het al., 2014, How Many HIV Infections May Be Averted by Targeting Primary Infection in Men Who Have Sex With Men? Quantification of Changes in Transmission-Risk Behavior, Using an Individual-Based Model, Journal of Infectious Diseases, Vol: 210, Pages: S594-S599, ISSN: 1537-6613

In the United Kingdom, human immunodeficiency virus (HIV) transmission among men who have sex with men(MSM) is not under control, despite readily available treatment, highlighting the need to design a cost-effectivecombination prevention package. MSM report significantly reduced transmission risk behavior following HIVdiagnosis. To assess the effectiveness of HIV diagnosis in averting transmission during highly infectious primaryHIV infection (PHI), we developed a stochastic individual-based model to calculate the number of HIVtransmissionevents expected to occur from a cohort of recently infected MSM with and those without the behaviorchanges reported after diagnosis. The model incorporates different types of sex acts, incorporates condom use,and distinguishes between regular and casual sex partners. The impact on transmission in the 3 months afterinfection depends on PHI duration and testing frequency. If PHI lasts for 3 months and testing is performedmonthly, then behavior changes after diagnosis would have reduced estimated transmission events by 49%–52%,from 31–45 to 15–23 events; a shorter duration of PHI and/or a lower testing frequency reduces the number ofinfections averted. Diagnosing HIV during PHI can markedly reduce transmission by changing transmissionriskbehavior. Because of the high infectivity but short duration of PHI, even short-term behavior change cansignificantly reduce transmission. Our quantification of the number of infections averted is an essential componentof assessment of the cost-effectiveness of strategies to increase detection and diagnoses of PHI.

Journal article

Ward H, Gregson S, Watts C, Garnett GPet al., 2014, Translational Epidemiology: Developing and Applying Theoretical Frameworks to Improve the Control of HIV and Other Sexually Transmitted Infections, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S547-S548, ISSN: 0022-1899

Journal article

Rönn M, White PJ, Hughes G, Ward Het al., 2014, Developing a Conceptual Framework of Seroadaptive Behaviors in HIV-Diagnosed Men Who Have Sex With Men, Journal of Infectious Diseases, Vol: 210, Pages: S586-S593, ISSN: 1537-6613

Background. Seroadaptive behaviors are strategies employed by men who have sex with men (MSM) to reduce the transmission risk for human immunodeficiency virus (HIV). It has been suggested that they contribute to the increasing diagnoses of sexually transmitted infections in HIV-diagnosed MSM. To understand the context in which the reemerging sexually transmitted infections appear, we developed a social epidemiological model incorporating the multiple factors influencing seroadaptive behaviors. Methods. A literature review of seroadaptive behaviors in HIV-diagnosed MSM was conducted. The literature was synthesized using a social epidemiological perspective. Results. Seroadaptive behaviors are adopted by MSM in high-income countries and are a way for HIV-diagnosed men to manage and enjoy their sexual lives. Influences are apparent at structural, community, interpersonal, and intrapersonal levels. There is little evidence of whether and when the behavior forms part of a premeditated strategy; it seems dependent on the social context and on time since HIV diagnosis. Social rules of HIV disclosure and perception of risk depend on the setting where partners are encountered. Conclusions. Seroadaptive behaviors are strongly context dependent and can reduce or increase transmission risk for different infectious diseases. Further data collection and mathematical modeling can help us explore the specific conditions in more detail.

Journal article

Gomez GB, Ward H, Garnett GP, 2014, Risk Pathways for Gonorrhea Acquisition in Sex Workers: Can We Distinguish Confounding From an Exposure Effect Using A Priori Hypotheses?, Journal of Infectious Diseases, Vol: 210, Pages: S579-S585, ISSN: 1537-6613

The population distribution of sexually transmitted infections (STIs) varies broadly across settings. Althoughthere have been many studies aiming to define subgroups at risk of infection that should be a target for preventioninterventions by identifying risk factors, questions remain about how these risk factors interact, how theireffects jointly influence the risk of acquisition, and their differential importance across populations. Theoreticalframeworks describing the interrelationships among risk determinants are useful in directing both the designand analysis of research studies and interventions. In this article, we developed such a framework from a reviewlooking at determinants of risk for STI acquisition, using gonorrhea as an index infection. We also propose ananalysis strategy to interpret the associations found to be significant in uniform analyses of observational data.The framework and the hierarchical analysis strategy are of particular relevance in the understanding of riskformation and might prove useful in identifying determinants that are part of the causal pathway and thereforeamenable to prevention strategies across populations.

Journal article

Trenchard L, McGrath-Lone L, Ward H, 2014, Ethnic variation in patients' ratings of communication: analysis of National Cancer Patient Experience Survey data, European Public Health Science Conference, Publisher: ELSEVIER SCIENCE INC, Pages: 79-79, ISSN: 0140-6736

Conference paper

Chandrasekaran L, Davies B, Eaton JW, Ward Het al., 2014, Evaluation of diagnosed incidence rate as a measure of performance: an ecological study of England's national chlamydia screening programme, European Public Health Science Conference

Poster

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