Alave Rosas, Jorge Luis

Preferred name

Main Affiliation

jorgealave@upeu.edu.pe

ORCID

0000-0002-1178-2445

Scopus Author ID

36240278600

Mostrando 1 - 10 de 64

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Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial
(2020-04-22)
Gregory P. Bisson
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Lynne Jones
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Johnstone Kumwenda
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Vidya Mave
;
Sandy Pillay
Mortality within the first 6 months after initiating antiretroviral therapy (ART) is common in resource-limited settings and is often due to tuberculosis (TB) among patients with advanced HIV disease. Isoniazid preventive therapy (IPT) is recommended in HIV-infected adults, but sub-clinical TB can be difficult to diagnose. We hypothesized that empiric TB treatment would reduce early mortality compared to IPT in high-burden settings.
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Discrimination and mental health in the minority sexual population: Cross-sectional analysis of the first peruvian virtual survey
(2022-06-03)
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David Saldaña-Cabanillas
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Luigy Vasquez-Yeng
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Javier Antonio Valencia-Huamani
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OBJECTIVE: This study sought to evaluate the association between discrimination and having mental health problems in the past 12 months in the sexual minority population in Peru. METHODS: We conducted a cross-sectional analysis of a secondary database corresponding to the first LGBTI survey in Peru in 2017. We included adults who self-identified their sexual orientation as gay, lesbian, bisexual, pansexual, or asexual/others. Both the exposure and dependent variables were self-reported by the participants. Multivariable Poisson regression was used to determine the association by calculating adjusted prevalence ratios (APR) with 95% confidence intervals (95% CI). RESULTS: Out of 9760 respondents, more than two-thirds of the participants reported having been discriminated against or having experienced violence at some time in their lives (70.3%) and one-fourth reported having mental health problems (23.8%). In the multivariable regression model, the prevalence of mental health problems in the last 12 months was 72% higher for the group of individuals who experienced discrimination when compared with the group that did not experience discrimination (APR = 1.72, 95% CI 1.57-1.88). The association was stronger among who self-identified lesbians (APR = 2.08, 95% CI 1.65-2.64). CONCLUSION: The prevalence of mental health problems and discrimination was high in this population. In addition, we found a statistically significant association between discrimination and the occurrence of mental health problems in the last 12 months.
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Asociación entre preocupación frente a la COVID-19, el apoyo social y el conocimiento sobre tuberculosis con el cumplimiento del tratamiento antituberculoso en Lima, Perú
(2023-06-30)
Yuli L. Quiroz
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Susan O. Choqueza
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;
INTRODUCTION: In the context of the COVID-19 pandemic, information on factors associated with adherence to antituberculosis treatment in areas with high prevalence of tuberculosis is scarce. OBJETIVE: To evaluate whether there is an association between social support, concern about COVID-19 infection and knowledge about tuberculosis, and non-adherence to antituberculosis treatment. MATERIALS AND METHODOS: A cross-sectional study was carried out on patients under antituberculosis treatment, from January to March, 2022, in centers located in areas with a high prevalence of tuberculosis in Lima. We used the Morisky Green-Levine questionnaire to assess adherence to treatment as the dependent variable; the independent variables were evaluated using the Medical Outcomes Study Social Support Survey for perceived social support and concern about COVID-19 infection, and the Battle Test to assess patients’ knowledge about their disease. We used Poisson regression with robust variance to evaluate the association between the independent variables and the dependent one. RESULTS: Out of 101 participants (73.3% male with an average age of 35.1 ± 16 years), 51.5% were non-adherent to antituberculosis treatment. Medium or high level of concern about getting COVID-19 was associated with a higher prevalence of non-adherence to treatment (odds ratio: 1.68; 95 % confidence interval: 1.09-2.57) (adjusted for considered confounding variables). CONCLUSIONS: Non-adherence is a frequent condition among patients living in an area with a high prevalence of tuberculosis in Lima, especially among those with a higher concern for COVID-19 infection.
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HIV & Hepatitis in the Americas 28–30 April 2016, Mexico City, Mexico
(2016-04-28)
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Kenneth Mayer
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Omar Sued
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Néstor Sosa
;
Ricardo Sobhie Diaz
and creative negotiations. Eradication is possible. It is up to us to make it so.
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The Impact of Digital Technologies on HPV Vaccination Uptake and Intention Among Adolescents, Young Adults and their Parents: a Systematic Review
(2025-04-20)
Daniel Bancovsky
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Manjushree Shastry
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Martina Caccamo
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Rebecca Santos Soares
;
Merce Avellanet
Background: Human papillomavirus (HPV) is a preventable sexually transmitted infection and the major risk factor for cervical cancer. The global prevalence of HPV infection is high, especially in low- and mid- income countries (LMIC). HPV immunization has been shown to reduce high-grade cervical cancer lesions and cancer incidence. Despite global HPV vaccination programs initiated in 2006, uptake remains insufficient. Digital media offers a promising avenue to address vaccine hesitancy and improve vaccination rates among adolescents and their parents. Objective: To evaluate the effectiveness of digital media interventions on HPV vaccination rates and intentions. Methods: We undertook a comprehensive search for PubMed, Scopus, Web of Science, Cochrane databases, from inception until May 2024. The review included Randomized Controlled Trials (RCTs) and observational studies focusing on adolescents and young adults (9-26 years) and their parents, and it investigated the impact of digital interventions on vaccination rates and vaccination intention. The quality assessments were assessed using the Cochrane Risk of Bias 2 tool and an adapted Newcastle-Ottawa Scale for RCTs and observational studies respectively, while data extraction focused on study design, demographics, intervention types, and outcomes. Results: From 2350 records, 23 studies (19 RCTs and 4 observational studies) met the inclusion criteria. Digital interventions, including text messages, mobile apps, video content, and web-based platforms, improved HPV vaccination intentions. Narrative-based videos were particularly effective in promoting parents and adolescents’ immunization, especially when the vaccine was offered immediately after the intervention. Nevertheless, barriers such as challenges with access, misconceptions, and socioeconomic factors often hinder translating of intentions into actual uptake. Conclusion: Digital interventions showed great potential in increasing short-term HPV vaccination intentions. Future research should focus on long-term engagements to enhance the effectiveness of digital interventions in promoting HPV immunization uptake. KEYWORDS: Human papillomavirus viruses; Vaccination, Digital Technology, Young adults, Adolescents, Parents;
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2333. Knowledge, attitudes, and practices regarding vaccination against COVID-19 among medical students at a private university in Lima – Peru
(2023-11-27)
Benjamin Ramos-Rojas
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Sebastian Lopez-Rivera
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Karla Tafur Bances
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Jose Armando Gonzales Zamora
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Abstract Background Vaccination against COVID-19 is one of the most important measures to reduce the spread, morbidity, and mortality of the disease. Methods We conducted a cross-sectional study to evaluate knowledge, attitudes, and practices regarding vaccination against COVID-19 in medical students at Universidad Peruana Cayetano Heredia (UPCH), for which an online survey was administered through e-mail and WhatsApp in July 2022. The following independent variables were evaluated: To be in the clinical phase of medical school (last four years), having more online classes ( &gt;= 4 semesters with non-face-to-face classes), having received &gt;= 3 doses of COVID-19 vaccine, and having reliable sources of information (scientific articles, conferences, and seminars). Through linear regression multivariate analysis, we assessed the factors associated with the number of correct answers (knowledge), the standardized attitude index (attitudes), and the number of vaccine doses received (practice). Results A total of 352 medical students completed the survey. 96.6% of participants knew that vaccines improved immunity, and 91.2% believed they were effective in reducing hospitalizations, severe illness, and death. 98% of students agreed that the benefits of vaccination outweighed the risks, 90.9% would recommend the population to get vaccinated, and 59.1% agreed that vaccines were safe. 99.7% of respondents have received at least one dose of vaccine, of which 100% received at least two doses, 88% three, and 4.8% four or more. In the multivariate analysis, we found that being in the clinical phase of medical school was associated with a higher knowledge and a higher standardized attitude index. Having received &gt;=3 doses was associated with a higher standardized attitude index. Lastly, having a higher standardized attitude index was associated with having received more vaccine doses. (Table. 1) Table 1 Conclusion Regarding vaccination against COVID-19, medical students at UPCH have a high level of knowledge, a positive attitude, and good practices. Our study suggests that educational strategies in the pre-clinical phase may be needed to improve knowledge and attitudes regarding vaccination. Also, a higher standardized attitude index may predict a higher number of vaccine doses. Disclosures All Authors: No reported disclosures
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Caracterización epidemiológica, clínica y de laboratorio de esporotricosis en pacientes de un hospital de tercer nivel en Lima-Perú, entre los años 1991 y 2014
(2016-06-01)
James A Oyarce
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Coralith García
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Beatriz Bustamante
BACKGROUND: Sporothricosis is endemic in numerous Latin American countries and the rest of the world. In Peru is concentrated in regions with warm and humid climate being little known in the rest of the country. AIM: To describe the epidemiological, clinical and laboratory characteristics of patients diagnosed of sporotrichosis in a tertiary-care level hospital in Lima, Peru from 1991 to 2014. METHODS: This was a retrospective, case series. RESULTS: Ninety four patients were involved; most of them were male adults. This condition was acquired more frequently in Cajamarca, Apurímac, and Amazonas. Fixed and lymphocutaneous form were the most frequent forms of presentation in adults and were mostly distributed in upper limbs. Lesions located in head and neck were most frequent in children. Comorbidities were present in 15% of patients and were more frequent in those who presented disseminated cutaneous form. Seventy eight percent of cultures from skin lesions were positive within 7 days. The time to positivity of cultures was longer if the sample came from skin biopsies than skin scraping or skin aspiration. CONCLUSIONS: Most cases of sporotrichosis were acquired in areas of extreme poverty in Peru. The clinical, epidemiological and laboratory findings were similar to those reported elsewhere. The time to positivity of cultures varies based on the type of skin sample. This finding needs to be further evaluated in studies with an increased number of cases.
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Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru
(2013-10-01)
Jorge Salinas
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Andrew O. Westfall
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Jorge Paz
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Fiorella Moran
OBJECTIVES: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. DESIGN AND METHODS: Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. RESULTS: 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). CONCLUSIONS: The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
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P-997. Successful Implementation of an Infectious Disease-Led Non-Restrictive Antimicrobial Stewardship Program in a Peruvian Hospital
(2026-01-01)
Xossé Carreras
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Andrea Sofia Salcedo
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Sara Muñoz
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N García Díaz
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Jorge Salinas
Abstract Background Peru reports high carbapenem and vancomycin usage with concerning resistance rates, including 60.6% third-generation cephalosporin resistance in E.coli bloodstream infections. National legislation requires antimicrobial stewardship programs (ASPs) in secondary and tertiary facilities. Methods We implemented an infectious disease physician-led ASP at a 107-bed Peruvian hospital and report 12-month outcomes. Implementation phases included education and guideline development, prospective audit and feedback without restrictions, and data collection. The ASP targeted meropenem, vancomycin, and linezolid in medicine and ICU wards. Medical students conducted chart reviews with recommendations communicated to physicians. Results We audited 191 records of predominantly elderly patients (median 78 years), with meropenem most prescribed (89.4%). Guideline adherence was 84.7%. Common recommendations included limiting duration (39.2%), adjusting based on cultures (31.7%), and de-escalation (18.5%)(Table1). Implementation rate was 78.8%. In medicine, consumption decreased during intervention: meropenem by 57.1% (10.5 to 4.5 DDD/100 patient-days), vancomycin by 76.7% (1.8 to 0.42), and linezolid by 50% (1.0 to 0.5)(Figure1). In ICU, reductions were 48.6% for meropenem, 50% for vancomycin, with continued post-intervention decreases(Figure2). Challenges included physician resistance, risk-averse prescribing, and suboptimal diagnostics. Conclusion ASPs can be effectively implemented in resource-limited settings through leadership, education, and non-restrictive approaches. Success factors included collaborative methods, multimodal communication, continuous education, and transparent reporting. The post-prescription audit and feedback model maintained physician autonomy while reducing broad-spectrum antibiotic use. Disclosures All Authors: No reported disclosures
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Pneumoproteins and biomarkers of inflammation and coagulation do not predict rapid lung function decline in people living with HIV
(2023-03-23)
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Sarah Samorodnitsky
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Chris H. Wendt
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Jason V. Baker
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Gary Collins
Abstract Chronic obstructive pulmonary disease (COPD) is among the leading causes of death worldwide and HIV is an independent risk factor for the development of COPD. However, the etiology of this increased risk and means to identify persons with HIV (PWH) at highest risk for COPD have remained elusive. Biomarkers may reveal etiologic pathways and allow better COPD risk stratification. We performed a matched case:control study of PWH in the Strategic Timing of Antiretoviral Treatment (START) pulmonary substudy. Cases had rapid lung function decline (> 40 mL/year FEV 1 decline) and controls had stable lung function (+ 20 to − 20 mL/year). The analysis was performed in two distinct groups: (1) those who were virally suppressed for at least 6 months and (2) those with untreated HIV (from the START deferred treatment arm). We used linear mixed effects models to test the relationship between case:control status and blood concentrations of pneumoproteins (surfactant protein-D and club cell secretory protein), and biomarkers of inflammation (IL-6 and hsCRP) and coagulation (d-dimer and fibrinogen); concentrations were measured within ± 6 months of first included spirometry. We included an interaction with treatment group (untreated HIV vs viral suppression) to test if associations varied by treatment group. This analysis included 77 matched case:control pairs in the virally suppressed batch, and 42 matched case:control pairs in the untreated HIV batch (n = 238 total) who were followed for a median of 3 years. Median (IQR) CD4 + count was lowest in the controls with untreated HIV at 674 (580, 838). We found no significant associations between case:control status and pneumoprotein or biomarker concentrations in either virally suppressed or untreated PWH. In this cohort of relatively young, recently diagnosed PWH, concentrations of pneumoproteins and biomarkers of inflammation and coagulation were not associated with subsequent rapid lung function decline. Trial registration: NCT00867048 and NCT01797367.

Alave Rosas, Jorge Luis

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