J. Dennis Fortenberry

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https://hdl.handle.net/1805/6691

A delivery system for expedited partner services to prevent STDs

Reinfection by untreated partners accounts for a substantial proportion of new sexually transmitted infections. Provision to patients of treatment for delivery to partners has been shown to be effective for reducing these repeated infections. Through use of expedited partner treatment, the clinical practice of treating the sex partners of patients diagnosed with an STD without examination of the sex partners by the health care provider, the rates of reinfection can be diminished. Dr. Fortenberry's research used focus groups and individual interviews to inform the design of patient, partner, and clinical staff materials to support implementation of expedited partner services around the country.

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Epidemiology of Sexually Transmitted Infections Among Offenders Following Arrest or Incarceration
(American Public Health Association, 2015-12) Wiehe, Sarah E.; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
OBJECTIVES: We sought to estimate rates of sexually transmitted infections (STIs) among criminal offenders in the 1 year after arrest or release from incarceration. METHODS: We performed a retrospective cohort study of risk of having a positive STI (chlamydia, gonorrhea, or syphilis) or incident-positive HIV test in the 1 year following arrest or incarceration in Marion County (Indianapolis), Indiana. Participants were 247,211 individuals with arrest or incarceration in jail, prison, or juvenile detention between 2003 and 2008. RESULTS: Test positivity rates (per 100,000 and per year) were highest for chlamydia (2968) and gonorrhea (2305), and lower for syphilis (278) and HIV (61). Rates of positive STI and HIV were between 1.5 and 2.8 times higher in female than male participants and between 2.7 and 6.9 times higher for Blacks than Whites. Compared with nonoffenders, offenders had a relative risk of 3.9 for chlamydia, 6.6 for gonorrhea, 3.6 for syphilis, and 4.6 for HIV. CONCLUSIONS: The 1-year period following arrest or release from incarceration represents a high-impact opportunity to reduce STI and HIV infection rates at a population level.
An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women
(Springer-Verlag, 2015-12) Reynolds, Grace L.; Fisher, Dennis G.; Laurenceau, Jean-Philippe; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an "app" created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors.
Diabetes-related quality of life and the demands and burdens of diabetes care among emerging adults with type 1 diabetes in the year after high school graduation
(Wiley Online Library, 2014-10) Hanna, Kathleen M.; Weaver, Michael T.; Fortenberry, J. Dennis; DiMeglio, Linda A.; Department of Biostatistics, School of Public Health
The roles of glycemic control, diabetes management, diabetes care responsibility, living independently of parents, and time since high school graduation in predicting diabetes-related quality of life (DQOL) were examined in 184 emerging adults with type 1 diabetes. Data were collected at graduation and 1 year later. Analyses controlling for selected covariates were completed using generalized linear mixed models. Better diabetes management was associated with more positive responses on all four dimensions of DQOL. Impact and worry of DQOL were greater in the presence of depressive symptoms, and life satisfaction was lower. DQOL life satisfaction was lower in those living independently of parents. Young women reported poorer diabetes-related health status than did young men. Time since graduation was not linked to DQOL. Further research is needed on ways to improve DQOL in conjunction with diabetes management and on ways that families can support DQOL when youth live independently.
Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana
(Wolters Kluwer, 2015-01) Wiehe, Sarah E.; Barai, Nikita; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
BACKGROUND: Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. METHODS: We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics. RESULTS: We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. CONCLUSIONS: This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population.
The Relationship of Worry About Hypoglycemia With Diabetes-specific and Typical Youth Behavior Among Emerging Adults With Type 1 Diabetes
(Sage Publications, 2014-03-27) Hanna, Kathleen M.; Weaver, Michael T.; Stump, Timothy E.; Fortenberry, J. Dennis; DiMeglio, Linda A.; IU School of Nursing
PURPOSE: Little is known about the relationship of worry about hypoglycemia with diabetes-specific and typical youth behaviors among emerging adults with type 1 diabetes. This study's purpose was to examine the relationship among worry about hypoglycemia, diabetes management, and glycemic control within the context of alcohol use, hypoglycemia-related weight control behaviors, depressive symptoms, and impulse control among emerging adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: The sample was 181 emerging adults with type 1 diabetes who were part of a larger study. Path analysis was used to test associations among worry about hypoglycemia, diabetes management, hypoglycemia-related weight control behaviors (WCB), alcohol use, impulse control, depressive symptoms, and glycemic control. RESULTS: Path model fit and modification indices suggested that a feedback loop between worry about hypoglycemia and diabetes management should be incorporated into the original model. Youth with fewer depressive symptoms reported fewer hypoglycemia-related WCB and less worry about hypoglycemia; those with higher impulse control had less alcohol use and better diabetes management; those with lower alcohol use had more worry about hypoglycemia; and better glycemic control was associated with better diabetes management. CONCLUSIONS: Health care professionals need to understand how multiple factors related to worry about hypoglycemia and diabetes management interact in emerging adults. In the context of depressive symptoms, impulse control, alcohol use, and hypoglycemia-related WCB, the path model results suggest several potential avenues for intervening to improve glycemic control in emerging adults.
The IUPUI Center for HPV Research: Updates 2014-2015
(Office of the Vice Chancellor for Research, 2015-04-17) Zimet, Gregory D.; Fortenberry, J. Dennis
Background: Human papillomavirus (HPV) is a very common infection. High risk (HR) HPV types (particularly types 16 & 18) are causally implicated in many cancers, including cervical, anal, vaginal, vulvar, penile, and head and neck cancers. In an effort to address the problems associated with HPV infection and prevention, the Center for HPV Research at IUPUI (Zimet & Fortenberry, Co-Directors) fosters collaboration among investigators from multiple disciplines and departments at IUPUI, IU Bloomington, Purdue University, and University of Notre Dame. There currently are 32 faculty and 8 pre- and post-doctoral fellows who are members of the Center. The Center for HPV Research was established in July, 2012 with funds from the IUPUI Signature Center Initiative, the Department of Pediatrics, and the IU Simon Cancer Center. Over the past year, Center members had 6 external & internal grants funded, 5 additional grants submitted, 8 peer-reviewed articles published, and gave over 20 scientific conference and invited presentations. In this abstract we highlight a study representing a collaboration among 5 center members, with Dr. Marcia Shew as the lead and including an MPH student. Objectives: Most HR HPV infections do not progress to cancer, but progression is associated with persistent infection. HPV was previously thought to "clear" or persist, but newer studies suggest that HPV may be a latent virus that can be re-detected episodically. This study examined the persistence and/or redetection of HR HPV in young women recruited 6 years after identification of a HR HPV infection during their prior involvement in a longitudinal study of adolescent women. Methods: 30 women from the prior study (the Young Women’s Project) were recruited for 2 visits, 6 weeks apart. During Visit 1 they had a Pap test, HPV DNA testing, HPV serology, and were administered a semi-structured interview. During Visit 2, Pap test results were given, a self-swab for HPV testing was obtained, and a qualitative interview was administered. Results: 15 women had normal Pap test results, 2 were ASCUS, and 3 LGSIL. 12 women had a history of colposcopy for a previous abnormal Pap results and 4 had received treatment for cervical dysplasia. 26 of the women had HPV 16 in the original YWP study. 11 had HPV 16 redetected in the present study, including in 6 women who had apparently "cleared" the infection during the original YWP study. Conclusions: High risk HPV may not always (or ever) "clear" Persistent low viral levels may not be detectible. However, some HPV infections may be episodically detected if changes in immune function lead to increases in viral copies. Questions raised by this research include: 1) who is at risk for episodic detection?; 2) what factors are predictive of episodic detection?; 3) how likely is episodically-detect HR HPV to progress to cervical disease?; 4) what is the predictive value of a negative HPV DNA test?; and 5) what do we tell women with a positive HR HPV DNA screen if they have been sexually abstinent or with a life-long partner ... or if they have a new partner?
A mixed methods approach to assess the likelihood of testing for STI using self-collected samples among behaviourally bisexual women
(BMJ, 2015-08) Schick, Vanessa; Van Der Pol, Barbara; Dodge, Brian; Baldwin, Aleta; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Objectives Behaviourally bisexual women (women who have sex with women and men (WSWM)) are more likely to report a history of sexually transmitted infections (STI) than women who have sex exclusively with men or exclusively with women. Barriers to care may prohibit WSWM from seeking STI testing. The present study investigated participant willingness to self-collect oral, vaginal and anal samples for STI testing. Methods Eighty WSWM were recruited from two midwestern locations. After completing an online questionnaire, a subset of the participants were interviewed (n=54) and provided the option to self-collect oral, vaginal and/or anal samples to screen for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Results Over two-thirds (67.5%, n=54) of the participants completed the baseline scheduled and attended the interview. The majority of these participants provided vaginal (87.0%, n=47), oral (85.2%, n=46) and/or anal (61.1%, n=33) samples. Participants with a history of anal play were significantly more likely to provide an anal sample. C. trachomatis infection was identified in the samples of 6.8% (n=3) of the participants including 4.5% (n=2) of the vaginal samples and 3.3% (n=1) of the anal samples. None of the samples were positive for N. gonorrhoeae or T. vaginalis. Participants who reported a recent history of anal sexual behaviour with a male partner were significantly more likely to self-collect an anal sample. Conclusions Given the comparatively high STI rates among WSWM, self-sampling in non-traditional settings may present a unique opportunity to provide needed care to this underserved population of women.
Developmental Trajectories of Religiosity, Sexual Conservatism and Sexual Behavior among Female Adolescents
(Elsevier B.V., 2013-12) Aalsma, Matthew C.; Woodrome, Stacy E.; Downs, Sarah M.; Hensel, Devon J.; Zimet, Gregory D.; Orr, Don P.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Understanding the role of socio-sexual cognitions and religiosity on adolescent sexual behavior could guide adolescent sexual health efforts. The present study utilized longitudinal data from 328 young women to assess the role of religion and socio-sexual cognitions on sexual behavior accrual (measuring both coital and non-coital sexual behavior). In the final triple conditional trajectory structural equation model, religiosity declined over time and then increased to baseline levels. Additionally, religiosity predicted decreased sexual conservatism and decreased sexual conservatism predicted increased sexual behavior. The final models are indicative of young women's increasing accrual of sexual experience, decreasing sexual conservatism and initial decreasing religiosity. The results of this study suggest that decreased religiosity affects the accrual of sexual experience through decreased sexual conservatism. Effective strategies of sexual health promotion should include an understanding of the complex role of socio-sexual attitudes with religiosity.
The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males
(Springer, 2015-04) Arrington-Sanders, Renata; Morgan, Anthony; Ogunbajo, Adedotun; Trent, Maria; Harper, Gary W.; Fortenberry, J. Dennis; Department of Medicine, IU School of Medicine
Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.
Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States
(Springer, 2014-08) Philbin, Morgan M.; Tanner, Amanda E.; DuVal, Anna; Ellen, Jonathan M.; Xu, Jiahong; Kapogiannis, Bill; Bethel, Jim; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Early linkage to care and engagement in care are critical for initiation of medical interventions. However, over 50 % of newly diagnosed persons do not receive HIV-related care within 6 months of diagnosis. We evaluated a linkage to care and engagement in care initiative for HIV-positive adolescents in 15 U.S.-based clinics. Structural and client-level factors (e.g. demographic and behavioral characteristics, clinic staff and location) were evaluated as predictors of successful linkage and engagement. Within 32 months, 1,172/1,679 (69.8 %) of adolescents were linked to care of which 1,043/1,172 (89 %) were engaged in care. Only 62.1 % (1,043/1,679) of adolescents were linked and engaged in care. Linkage to care failure was attributed to adolescent, provider, and clinic-specific factors. Many adolescents provided incomplete data during the linkage process or failed to attend appointments, both associated with failure to linkage to care. Additional improvements in HIV care will require creative approaches to coordinated data sharing, as well as continued outreach services to support newly diagnosed adolescents.

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