Papers by Kenneth Dominguez
LGBT Health, 2014
Hispanics represent the fastest growing ethnic segment of the lesbian, gay, bisexual, and transge... more Hispanics represent the fastest growing ethnic segment of the lesbian, gay, bisexual, and transgender (LGBT) community in the United States and are disproportionately burdened by LGBT-related health issues and limited political support from Hispanic medical organizations. Recently, the Latino Medical Student Association, the National Hispanic Medical Association, and the Hispanic Serving Health Professions Schools, representing over 60,000 Hispanic students and providers and 35 institutions, collaborated to support a resolution opposing discrimination based on sexual orientation or gender identity and recognizing the obstacles encountered by LGBTQ Hispanics. The resolution provides an important framework for organizational members and leaders to address LGBT health issues and serve to support a more positive sociopolitical climate for the Hispanic LGBT community nationally and internationally.
Background: Three infants were recently reported to have been HIV-infected through eating food pr... more Background: Three infants were recently reported to have been HIV-infected through eating food prechewed by HIV-infected caregivers. We examined the prevalence of and factors influencing maternal premastication feeding practices amongst U.S. mothers in the Infant Feeding Practices Study II (IFPS II). Methods: The IFPS II was a longitudinal study following women from late pregnancy through their infant's first year of life. It surveyed expectant mothers once during late pregnancy, monthly for the first seven months after birth and then every seven weeks until the infant was 12 months old. This univariate analysis includes mothers who responded to≥1 premastication-related question. Results: The prevalence of prechewing food among female caregivers was 27% (376 of 1387). Those who were black non-Hispanic (OR=10.4; 95% CI 5.1, 21.2), living in poverty (OR=1.8; 95% CI 1.2, 2.7), residing in the Western U.S. (OR=2.3; 95% CI 1.6, 3.3), or had not graduated from high school (OR=3.3; 95%...
Advances in Experimental Medicine and Biology, 2012
While breastfeeding remains a significant source of mother-to-child HIV transmission (MTCT) globa... more While breastfeeding remains a significant source of mother-to-child HIV transmission (MTCT) globally, it is the recommended infant feeding option for HIV-infected women in resource-limited settings [1]. However, HIV-infected women in the USA—where breast milk alternatives are acceptable, feasible, affordable, sustainable, and safe—have been counseled to avoid all breastfeeding since 1985 [2]. A number of studies have found that despite such recommendations against breastfeeding by HIV-infected women, a very small proportion of HIV-infected women in the USA continue to breastfeed their infants [3–5] for various reasons. Many of these women received late or no prenatal care, inadequate antiretroviral (ARV) prophylaxis, or were not diagnosed with HIV until at or after labor and delivery. While breastfeeding has never been a major source of perinatal HIV infections in the USA, studies have identified the practice as a risk factor for MTCT in the USA [4]. Complete avoidance remains the only sure way to prevent late postnatal HIV transmission through breastfeeding.
Atlas of Sexually Transmitted Diseases and AIDS, 2010
Pediatric Clinics of North America, 2000
In the United States, advances in the care of HIV-infected children, especially the use of combin... more In the United States, advances in the care of HIV-infected children, especially the use of combination antiretroviral therapy, have resulted in decreases in the morbidity of children with AIDS and related opportunistic infections and a corresponding increase in life expectancy.73, lZ9 The estimated number of children living with AIDS in the United States increased 35% from 2654 children in 1992 to 3573 children in 1997.48 A higher percentage of children with HIV infection are surviving to ages at which they can be cared for in day-care centers, are attending schools, and are reaching adolescence. These children are being cared for mainly by their biologic parents and extended family members and, to a lesser extent, by foster parents!z HIV-infected children benefitting from such advances are leading increasingly normal lives and are interfacing with the general population in a variety of settings. This article summarizes and builds on previously published 57 Its main objectives are to discuss (1) considerations for preventing transmission of HIV and other infections in settings where all children are cared for, (2) generic considerations in the care of HIV-infected or exposed children regardless of location, and (3) the special
Journal of Women's Health, 2004
During the 1990s, a 58% increase in the Hispanic/Latino population, fueled by the century's large... more During the 1990s, a 58% increase in the Hispanic/Latino population, fueled by the century's largest immigration wave and the highest fertility of any group, resulted in Hispanics becoming the largest U.S. minority group. To assess use of preventive services by Hispanics in Atlanta, Georgia, the largest Hispanic new destination, and Miami, Florida, the largest established Hispanic community in the Southeast, survey data were analyzed. Methods: Miami-Ft. Lauderdale and Atlanta metropolitan area data from the 2000 National Health Interview Survey (NHIS) and from anonymous surveys conducted at health festivals in Miami and Atlanta in 2001 were analyzed. Results: Female non-Hispanic white and black NHIS respondents were more likely than Hispanic counterparts to report annual household income Ͼ$20,000 (77.3%, 70.8% vs. 67.7%), usual source of healthcare (61.5%, 56.4% vs. 50.2%), or ever having had Pap screening (88.8%, 86.7% vs. 80.7%) or oral contraceptive use (55.7%, 59.7% vs. 33.7%). Miami-Ft. Lauderdale Hispanics were less likely than Atlanta respondents to be monolingual Spanish speakers, to lack usual source of healthcare, or to have less than 12 years of education. Of 295 female health festival respondents, the 160 Miami participants were more likely than Atlanta participants to have health insurance, monthly income Ͼ$1000, and prior Pap screening (p Ͻ 0.01) but less likely to have used contraception (p ؍ 0.07). Most Hispanics felt they had inadequate healthcare; 15.0% reported being denied healthcare because of inability to pay. Conclusions: Low income, uninsured status, and language barriers were associated with lower use of preventive services among Hispanics in these Southeastern communities, particularly Atlanta, a new destination.
PEDIATRICS, 2004
Objective. Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmissi... more Objective. Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmission in the United States, obstacles to perinatal HIV prevention that include lack of prenatal care; failure to test pregnant women for HIV before delivery; and lack of prenatal, intrapartum, or neonatal antiretroviral (ARV) use remain. The objective of this study was to describe trends in perinatal HIV prevention methods, perinatal transmission rates, and the contribution of missed opportunities for perinatal HIV prevention to perinatal HIV infection. Methods. We analyzed data obtained from infant medical records on 4755 HIV-exposed singleton deliveries in 1996-2000, from 6 US sites that participate in the Centers for Disease Control and Prevention's Pediatric Spectrum of HIV Disease Project. HIV-exposed deliveries refer to deliveries in which the mother was known to have HIV infection during the pregnancy. Results. Of the 4287 women with data on prenatal care, 92% had prenatal care. From 1996 to 2000, among the 3925 women with prenatal care, 92% had an HIV test before delivery; the use of prenatal zidovudine (ZDV) alone decreased from 71% to 9%, and the use of prenatal ZDV with other ARVs increased from 6% to 70%. Complete data on maternal and neonatal ARVs were available for 3284 deliveries. Perinatal HIV transmission was 3% in 1651 deliveries with prenatal ZDV in combination with other ARVs, intrapartum ZDV, and neonatal ZDV; 6% in 1111 deliveries with prenatal, intrapartum, and neonatal From the
JAMA Pediatrics, 2014
geographic variation in receipt of therapy, despite adjustment for clinical characteristics, may ... more geographic variation in receipt of therapy, despite adjustment for clinical characteristics, may be explained not only by psychologist supply but also by parent, child, or pediatrician preferences for or comfort with nonpharmacologic care. We acknowledge limitations common to analyses of claims data, including no information on services that were not billed to commercial insurance and a limited ability to determine severity of illness or clinical appropriateness for therapy. We cannot comment on therapy receipt in those smaller and more rural counties that we excluded. Nonetheless, our study is the first, to our knowledge, to document the substantial variation in receipt of therapy services among US children treated with ADHD medications and is directly relevant to the ongoing public discourse about how this common condition should be treated.
Pediatric Infectious Disease Journal, Nov 1, 2013
PubMed, Jul 6, 2023
Objectives. To describe HIV testing among clients in the Targeted Highly Effective Interventions ... more Objectives. To describe HIV testing among clients in the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project and evaluate testing frequency. Methods. We identified factors associated with an average testing frequency of 180 days or less compared with more than 180 days using adjusted Poisson regression models. We performed the Kaplan-Meier survival analysis to compare time to diagnosis by testing frequency. Results. Among 5710 clients with 2 or more tests and no preexposure prophylaxis (PrEP) prescription, 42.4% were tested frequently. Black/African American clients were 21% less likely and Hispanic/Latino clients were 18% less likely to be tested frequently than were White clients. Among 71 Black/African American and Hispanic/Latino cisgender men who have sex with men and transgender women with HIV diagnoses, those with frequent testing had a median time to diagnosis of 137 days, with a diagnostic testing yield of 1.5% compared with those tested less frequently, with 559 days and 0.8% yield. Conclusions. HIV testing at least every 6 months resulted in earlier HIV diagnosis and was efficient. Persons in communities with high rates of HIV who are not on PrEP can benefit from frequent testing, and collaborative community approaches may help reduce disparities. (Am J Public Health. 2023;113(9):1019-1027. https://doi.org/10.2105/AJPH.2023.307341).
American Journal of Public Health, Oct 1, 2008
Objectives. We examined trends in perinatal HIV prevention interventions in New York City impleme... more Objectives. We examined trends in perinatal HIV prevention interventions in New York City implemented during 1994 to 2003 to ascertain the success of the interventions in reducing perinatal transmission.Methods. We used data obtained from infant records at 22 hospitals. We used multiple logistic regression to analyze factors associated with prenatal care and perinatal HIV transmission.Results. We analyzed data for 4729 perinatally HIV-exposed singleton births. Of mothers with prenatal care data, 92% had prenatal care. The overall proportion who received prenatal care and were diagnosed with HIV before delivery was 86% in 1994 to 1996 and 90% in 1997 to 2003. Use of prenatal antiretrovirals among mothers who received prenatal care was 63% in 1994 to 1996 and 82% in 1997 to 2003. From 1994 to 2003, cesarean births among the entire sample increased from 15% to 55%. During 1997 to 2003, the perinatal HIV transmission rate among the entire sample was 7%; 45% of mothers of infected infants had missed opportunities for perinatal HIV prevention. During 1997 to 2003, maternal illicit drug use was significantly associated with lack of prenatal care. Lack of prenatal, intrapartum, and neonatal antiretrovirals; maternal illicit drug use; and low birthweight were significantly associated with perinatal HIV transmission.Conclusions. Interventions for perinatal HIV prevention can successfully decrease HIV transmission rates. Ongoing perinatal HIV surveillance allows for monitoring the implementation of guidelines to prevent mother-to-child transmission of HIV and determining factors that may contribute to perinatal HIV transmission.
Clinical Infectious Diseases, Sep 17, 2022
Background Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affec... more Background Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV). In the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project, 7 community collaboratives were developed to provide comprehensive HIV prevention services for these populations. Methods We analyzed National HIV Surveillance System data to determine the number of HIV diagnoses for each year from 2014 to 2019 among Black, Hispanic/Latino, and White MSM in 7 THRIVE-eligible Metropolitan Statistical Areas (MSAs) that were awarded funding and 12 THRIVE-eligible MSAs that were not awarded funding. We used generalized linear Poisson regression models to estimate adjusted estimated annual percentage changes (EAPCs) with 95% confidence intervals for HIV diagnosis rates controlling for HIV prevalence, viral suppression, HIV testing rates, preexposure prophylaxis (PrEP) prescription rates, poverty, education, and insurance status. Results We found larger estimated decreases in HIV diagnosis rates in THRIVE jurisdictions compared with non-THRIVE jurisdictions. The adjusted EAPC among Black MSM was −8.2 (−11.7 to −4.6) in THRIVE MSAs compared with −4.2 (−7.8 to −0.4) in non-THRIVE MSAs. The adjusted EAPC among Hispanic/Latino MSM was −8.6 (−12.2 to −4.8) in THRIVE MSAs compared with −2.6 (−5.1 to −0.1)in non-THRIVE MSAs. The adjusted EAPC among White MSM was −7.6 (−12.0 to −3.1) in THRIVE MSAs compared with 5.9 (1.8-10.1) in non-THRIVE MSAs. Conclusions The THRIVE community collaborative model was associated with a decrease in HIV diagnoses among Black and Hispanic/Latino MSM. To achieve the goals of the US Ending the HIV Epidemic initiative, effective interventions aimed to increase PrEP use need to be focused on Black and Hispanic/Latino MSM.
Archives of pediatrics & adolescent medicine, Dec 1, 2004
Aids Research and Treatment, 2012
Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased ... more Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased in healthy US children. Our objective was to evaluate MRSA incidence and correlates in HIV-infected youth. Methods. The CDC-sponsored LEGACY study is a US multicenter chart abstraction study of HIV-infected youth. We identified MRSA infections among participants with ≥1 visit during 2006. We used bivariate and multivariable analyses to compare sociodemographic and HIV clinical factors between MRSA cases and noncases. Results. Fourteen MRSA infections (1 invasive, 12 soft tissue, 1 indeterminate) occurred among 1,813 subjects (11.1 infections/1,000 patient-years (PY), 95% CI: 11.06-11.14). Most (86%) isolates were clindamycin susceptible. Compared with noncases, MRSA cases were more likely older (17 versus 14 years), black (100% versus 69%), behaviorally HIV infected (43% versus 17%), and in Maryland (43% versus 7%) and had viral loads (VL) >1000 copies/mL (86% versus 51%) and lower mean CD4% (18% versus 27%) (all P < 0.05). In multivariate analysis, independent risk factors were Maryland care site (adjusted odds ratio (aOR) = 9.0), VL >1000 copies/mL (aOR = 5.9), and black race (aOR undefined). Conclusions. MRSA occurred at a rate of 11.1 infections/1,000 PY in HIV-infected youth but invasive disease was uncommon. Geographic location, black race, and increased VL, but not immunosuppression, were independently associated with MRSA risk.
Journal of Pediatric and Adolescent Gynecology, Feb 1, 2012
Objectives-To determine the prevalence of cervical Pap screening (CPAP-S), identify factors assoc... more Objectives-To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. Design-Cross-sectional Setting-LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (≤ age 24 years) managed in 22 HIV specialty clinics in the United States. Participants-Sexually active females aged ≥13-24 years in the LEGACY cohort Main Outcome measures-CPAP-S & abnormal cervical cytology. Results-Of 231 sexually active female participants (>= 13 years) in 2006, 49% had CPAP-S documented since 2001. 58% of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45, 0.96 and APR 0.74, 95% CI 0.56, 0.96, respectively). Presence of any STI was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26, 3.78 & APR 1.94, 95% CI 1.29, 2.92, respectively). Conclusions-Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to
Journal of Acquired Immune Deficiency Syndromes, Feb 1, 2012
Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating fo... more Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown.
American Journal of Preventive Medicine
JAIDS Journal of Acquired Immune Deficiency Syndromes
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Papers by Kenneth Dominguez