Nancy Budner

Montefiore Medical Center, New York, New York, United States

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Publications (6)14.42 Total impact

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    ABSTRACT: To study attitudes toward menopause in women with or at risk of human immunodeficiency virus (HIV) aged 35 to 60 in New York City, NY, USA. Data were obtained at the baseline interview in a cohort study of menopause. Of 502 participating women, 92 were postmenopausal and 162 were perimenopausal. Overall, 37.5% of women had a relatively favorable attitude toward menopause. African Americans had a 72% greater odds of a positive attitude (OR = 1.72, 95% CI 1.16-2.57) than all other groups after adjusting for covariates. Hispanic women had the least favorable view of menopause. Experience of > 3 menopausal symptoms and negative life events-being a witness to a murder, and the death ofa child-were significantly associated with negative attitudes towards menopause (OR = 0.62, 95% CI 0.42-0.93 and OR = 0.64, 95% CI 0.43-0.93, respectively). Depressive symptoms, street drug use, and having a domestic partner, which is significant in single variable analyses, did not remain independent predictors in multivariate results. HIV status, menopause status, and age at interview were not associated with menopause attitudes. HIV-infected, drug-using, low-income women showed generally unfavorable attitudes towards menopause. High stress life events coupled with a high prevalence of depressive symptoms indicate this population has special needs marked by the menopause transition into older age.
    Clinical Interventions in Aging 08/2008; 3(3):561-6. · 1.82 Impact Factor
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    ABSTRACT: Background: Despite a growing body of knowledge regarding hepatitis C (HCV) care, barriers to care and treatment persist. Although HIV+ persons interface frequently with medical personnel, providers may not prioritize HCV compared to acute, symptomatic co-morbidities. Individuals assume their HCV is monitored, when it may be overlooked until late-stage symptoms appear. This suggests the need for research into factors associated with the actual engagement in HCV clinical care. Methods: Medical charts of participants in a study of HCV+ persons with or at risk for HIV infection in NYC were abstracted using a standardized form, focusing on HCV discussion, harm reduction, alcohol and psychiatric management, HCV screening and treatment. Results: Of 343 HCV+ participants, 278 (81%) reported receiving HCV care, of whom only 212 (62%) were able to identify specific HCV providers. Of these 212, 106 (50%) medical records were abstracted; 67% were HIV+, 43% women, 48% black, 39% Hispanic; mean age was 54 years. Approximately 1/3 received comprehensive HCV care. Thirty-eight charts (36%) noted HCV education, 36 (34%) discussed treatment options. Thirty (28%) participants discussed illicit drug use reduction, 20 (19%) alcohol reduction, and 49 (46%) received psychiatric care and/or medication. Thirty-two (35%) charts noted liver radiology; 38 (36%) had a liver biopsy. Twenty (19%) were treated for HCV in the past; 2 (10%) of those treated had a sustained virologic response. Five (5%) were being treated during the course of the study. Conclusion: Forty percent of all participants could not name their HCV provider. Even among better-informed participants, more than 50% erroneously believed their HCV was adequately monitored. Providers may not prioritize HCV care. Greater attention is warranted to HCV education, harm reduction and liver disease progression screening, particularly within a vulnerable, HIV+ population.
    Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
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    ABSTRACT: Introduction: Access to and engagement in care for chronic hepatitis C virus (HCV) infection, especially for those co-infected with HIV, is an enormous public health problem. Little is known about factors associated with successful management of HCV in co-infected patients, including educational programs, harm reduction, management of psychiatric disease and substance abuse. Methods: Subjects with chronic HCV were recruited from 2 prospective research cohorts of older men and women with, or at risk for, HIV infection in NYC. Interviews regarding engagement in HCV care, relationships with providers, behavior modification, and HCV transmission and disease knowledge were performed at semi-annual study visits. Results: 137 (59%) men and 94 (41%) women with chronic HCV participated; mean age was 53 +/- 5.6 years; 53% black and 31% Hispanic; 58% HIV co-infected. 80% reported they were engaged in HCV care, most at their usual medical venue; 70% did not receive HCV care at any other site; <20% had ancillary services available for HCV. Misinformation was common regarding transmission risk (50% thought HCV cannot be transmitted by sharing toothbrushes or razors; 37% did not know about transmission via drug paraphernalia) and treatment eligibility (50% believed co-infected patients are excluded; 46% thought most MDs would give treatment if cirrhosis was present; 58% did not know that interferon and ribavirin are used in therapy). Co-infected subjects were significantly more informed than HCV mono-infected subjects regarding treatment eligibility [p<.03]. Conclusions: Most participants self-reported receiving HCV care from their providers; this has not yet been validated. There remain substantial gaps in knowledge of those with HCV, especially those without co-infection. Further study of ways to improve knowledge and engagement in care of older persons with HCV with or at risk for HIV infection is warranted, especially for those not receiving co-infection care.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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    ABSTRACT: We examined highly active antiretroviral therapy (HAART) era and pre-HAART era hospitalization rates among 604 HIV-infected drug users in a prospective study in Bronx, New York. Medical history and risk behaviors were elicited by semiannual interviews. Standardized medical record review abstracted discharge diagnoses for all hospitalizations. Hospitalization rates from January 1997 to December 2000 were compared with rates from January 1992 to December 1996. The rate of hospitalizations per 100 patient-years in the HAART era was 49.3 compared with 44.1 in the pre-HAART era (P = 0.13). Among women, the rate was significantly higher in the HAART era than in the pre-HAART era (68.1 vs. 49.4 hospitalizations per 100 patient-years, respectively; P = 0.01). In the second era, HAART users had lower rates than those who did not use HAART (37.2 vs. 83.4 hospitalizations per 100 patient-years, respectively; P < 0.001) for both HIV-associated and non-HIV-associated illnesses. Multivariate analysis revealed that in the HAART era, female gender (relative risk ratio = 1.72, P = 0.03) and not using HAART (relative risk ratio = 1.82, P = 0.02) independently predicted increased hospitalization risk. In the pre-HAART era, women were at independently higher risk of hospitalization (relative risk ratio = 1.36, P = 0.05). Among HIV-infected drug users, those who use HAART have a decreased risk of hospitalization; those who do not use HAART remain at high risk of continuing morbidity from both HIV-related and non-HIV-related illness and have high hospitalization rates.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2003; 34(3):331-7. DOI:10.1097/00126334-200311010-00012 · 4.39 Impact Factor
  • Andrea Gachupin-Garcia, Peter A. Selwyn, Nancy Salisbury Budner
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    ABSTRACT: To study the incidence of AIDS-defining and non-AIDS-defining malignancies in injecting drug users with and without HIV infection in a methadone maintenance treatment program (MMTP). Prospective study within a hospital-affiliated MMTP with on-site primary medical services. The MMTP has been the site of a voluntary longitudinal cohort study of HIV infection since 1985. Active surveillance for all new cancer cases occurring among patients in the MMTP between July 1985 and August 1991. Cancer cases were identified by review of clinic and hospital records, hospital-based tumor registries, and New York City vital records. Cancer incidence was determined for the overall MMTP population and for HIV-seropositive and HIV-seronegative cohort study subgroups. During the study period the MMTP population comprised 2174 patients followed for 5491 person-years; 844 patients (380 HIV-seropositive, 464 HIV-seronegative) also participated in the cohort study. Fifteen non-AIDS-defining malignancies occurred among all MMTP patients (2.73 cases per 1000 person-years); the most frequent sites were lung, larynx, and cervix (n = 6, 2 and 2, respectively). Eighty per cent of patients with these cancer diagnoses and known HIV serologic status were seropositive. Within the cohort study group, six out of 380 HIV-seropositives developed non-AIDS-defining cancers versus one out of 464 HIV-seronegatives (P = 0.05, Fisher's exact test). Lung cancer cases in HIV-seropositive patients tended to occur at an earlier age and was more aggressive than in patients with HIV-seronegative or unknown status. During the same period, two cases of AIDS-defining lymphoma and one case of Kaposi's sarcoma were diagnosed in the MMTP population (0.5 cases per 1000 person-years). Solid neoplasms, while infrequent, were associated with HIV infection and were more common than AIDS-defining cancers in this population of drug injectors. Further study is needed to explore the relationship between HIV, behavioral factors, and cancer risk in injecting drug users.
    AIDS 09/1992; 6(8):843-8. DOI:10.1097/00002030-199208000-00013 · 6.56 Impact Factor
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    ABSTRACT: The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.
    Public Health Reports 108(4):492-500. · 1.64 Impact Factor