Margaret L. McNairy's research while affiliated with Weill Cornell Medical College and other places

Publications (105)

Article
Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associa...
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Background Multidrug therapy is a World Health Organization “best buy” for the prevention and control of noncommunicable diseases. CVD polypills, including ≥2 blood pressure medications, and a statin with or without aspirin, are an effective, scalable strategy to close the treatment gap that exists in many low- and middle-income countries, includin...
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Globally, non-communicable diseases (NCDs) or chronic conditions account for one-third of disability-adjusted life-years among children and adolescents under the age of 20. Health systems must adapt to respond to the growing burden of NCDs among children and adolescents who are more likely to be marginalised from healthcare access and are at higher...
Preprint
Importance Routine case surveillance data for SARS-CoV-2 are incomplete, biased, missing key variables of interest, and may be unreliable for both timely surge detection and understanding the burden of infection. Objective To determine the prevalence of SARS-CoV-2 infection during the Omicron BA.2/BA.2.12.1 surge in relation to official case count...
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Haiti is a low-income country whose population lives under repeated and chronic stress from multiple natural disasters, civil unrest, and extreme poverty. Stress has been associated with cardiovascular (CVD) risk factors including hypertension, and the impact of stress on blood pressure may be moderated by support. The distribution of stress, suppo...
Article
Aims: Modeling estimates indicate that heart failure (HF) prevalence may be lowest in low-income (LICs). Conversely, HF has been shown to be the leading cause of hospital admission in hospitals in many LICs. This disconnect between estimates and hospital-based observations may be explained by the underlying data. Modeling studies may have selection...
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Background: Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian risk profiles from high-in...
Article
Background Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA...
Article
Introduction: Neighborhood social context including violence and cohesion may impact cardiovascular disease risk factors in countries like Haiti with high civil unrest. We describe these factors using validated instruments (Neighborhood Collective Efficacy, City Stress Inventory), and hypothesized higher cohesion and lower violence were associated...
Article
Introduction: Stress is associated with multiple adverse health outcomes, including hypertension. The impact of stress on health may be moderated by social support. The distribution of stress, support, and their association with hypertension have not been well described in low-income countries that face severe poverty. Over the past decade, Haiti h...
Article
Introduction: Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries. Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in lower-income coun...
Article
Introduction: Cardiovascular disease is the leading cause of death in Haiti and many low-middle income countries. Environmental lead exposure is associated with higher blood pressure (BP) and cardiovascular disease mortality in high income countries but has not been systematically evaluated in lower income countries where 6.5 billion people reside....
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Introduction Diabetes mellitus is a chronic noncommunicable disease associated with death and major disability, with increasing prevalence in low- and middle-income countries. There is limited population-based data about diabetes in Haiti. The objective of this study was to assess the prevalence of diabetes and associated factors among adults in Po...
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Poor diets are responsible for a large burden of noncommunicable disease (NCD). The prevalence of modifiable dietary risk factors is rising in lower-income countries such as Haiti, along with increasing urbanization and shifts to diets high in sugar, salt, and fat. We describe self-reported dietary patterns (intake of fruits, vegetables, fried food...
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Cardiovascular disease (CVD) is the number one cause of death in low‐income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population‐b...
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Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternal‐to‐child transmiss...
Article
Background: The long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers. Objective: To assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infection DESIGN: Retrospective...
Article
Cardiovascular disease is the leading cause of death in lower-income countries including Haiti. Environmental lead exposure is associated with high blood pressure and cardiovascular mortality in high-income countries but has not been systematically measured and evaluated as a potential modifiable cardiovascular risk factor in lower-income countries...
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HIV viral load (VL) monitoring can reinforce antiretroviral therapy (ART) adherence. Standard VL testing requires high laboratory capacity and coordination between clinic and laboratory which can delay results. A randomized trial comparing point-of-care (POC) VL testing to standard VL testing among 150 adolescents and young adults, ages 10-24 years...
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Background People living with HIV (PLWH) are at increased risk of cardiovascular disease (CVD) and death, with greater burdens of both HIV and CVD in lower-middle income countries. Treating prehypertension in PLWH may reduce progression to hypertension, CVD risk and potentially mortality. However, no trial has evaluated earlier blood pressure treat...
Preprint
Full-text available
Background Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populat...
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Introduction Long-term mortality among TB survivors appears to be higher than control populations without TB in many settings. However, data are limited among persons with HIV (PWH). We assessed the association between cured TB and long-term mortality among persons with PWH in Haiti. Methods A prospective cohort of PWH from the CIPRA HT-001 trial...
Article
Background: The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of out...
Preprint
Full-text available
Background People living with HIV (PLWH) are at increased risk of cardiovascular disease (CVD) and death, with greater burdens of both HIV and CVD in lower-middle income countries. Treating prehypertension in PLWH may reduce progression to hypertension, CVD risk and potentially mortality. However, no trial has evaluated earlier blood pressure treat...
Article
A virtual hospitalist program expanded our ability to confront the challenges of the COVID-19 crisis at the epicenter of the pandemic in New York City. In concert with on-site hospitalists and redeployed physicians, virtual hospitalists aimed to expand capacity while maintaining high-quality care and communication. The program addressed multiple ch...
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Background Cardiovascular disease (CVD) is the leading cause of mortality among Haitians, having surpassed HIV in the last decade. Understanding the natural history of CVD in Haitians, including the age of onset, prevalence, incidence, and role of major risk factors and social determinants, is urgently needed to develop prevention and treatment int...
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Adolescents and youth living with HIV have poorer antiretroviral treatment (ART) adherence and viral suppression outcomes than all other age groups. Effective interventions promoting adherence are urgently needed. We reviewed and synthesized recent literature on interventions to improve ART adherence among this vulnerable population. We focus on st...
Article
The COVID-19 pandemic has fundamentally transformed doctor-patient communication, stripping away moments of connection that define the humanism of medicine. The barrier of isolation has impacted patients and patient care, and has also affected the experience of the physician. Though in-person connection is impossible to replicate digitally, technol...
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Introduction Adolescents living with HIV have poor antiretroviral therapy (ART) adherence and viral suppression outcomes. Viral load (VL) monitoring could reinforce adherence but standard VL testing requires strong laboratory capacity often only available in large central laboratories. Thus, coordinated transport of samples and results between the...
Article
Objectives: 1) To compare the prevalence of myocardial diastolic dysfunction (DD) in ART-naïve people living with HIV (PLWH) to HIV-uninfected adults in East Africa and 2) to determine the association between serum concentration of the cardiac biomarker ST2 and DD. Methods/study population: In this cross-sectional study we enrolled PLWH and unin...
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OBJECTIVES/GOALS: To determine the prevalence of myocardial diastolic dysfunction (DD) and association of serum concentration of the cardiac biomarker serum soluble ST2 in HIV-infected as compared to uninfected Tanzanian adults at the time of HIV diagnosis. METHODS/STUDY POPULATION: In this cross-sectional study we consecutively enrolled HIV-infect...
Article
Background: Cardiovascular disease is the leading cause of mortality among Haitian adults, having surpassed HIV in the last decade. The natural history of CVD in Haitians including the age of onset, incidence, and role of major risk factors and social determinants is urgently needed to develop prevention and treatment interventions. Objective: This...
Article
Background: Cardiovascular disease is the leading cause of mortality among Haitian adults, and hypertension (HTN) is the most important CVD risk factor, as in other resource-poor countries. The majority of Haitians have never been screened for hypertension and access to clinic-based services is limited. Methods: Twenty-eight Haitian community healt...
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Background: Adolescent girls and young women living with HIV in resource-limited settings have the poorest health outcomes of any age group, due in part to poor retention in care. Differentiated models of HIV care that target the specific challenges of young people living with HIV are urgently needed. Methods: The FANMI study is an unblinded ran...
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Prior HIV testing and awareness of HIV-positive status were assessed among HIV-positive adults at 20 clinics in Eswatini. Of 2196 HIV-positive adults, 1183 (53.8%) reported no prior HIV testing, and 1948 (88.7%) were unaware of their HIV-positive status. Males [adjusted odds ratio, AOR, (95% confidence interval): 0.7 (0.5-0.9)], youth 18-25 years [...
Article
Background: Almost one billion people live in slum environments across low- and middle-income countries. Little is known about the mental health status of slum residents or its associations with living conditions. Methods: A cross-sectional, population-representative survey was conducted among 892 adults in four slum communities in Port-au-Princ...
Article
HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long‐term AIDS survivors in resource‐limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of...
Article
The objective of this study was to characterize the demographics and population health of four slum communities in Port-au-Prince, Haiti, including population density and the burden of communicable and non-communicable diseases. Four urban slums were surveyed using a population-representative design between July and October 2016. A multistage clust...
Article
Objective: To compare the prevalence and predictors of myocardial dysfunction in HIV-infected and HIV-negative Tanzanian adults. Methods: A cross-sectional study including 256 HIV-infected, ART-naïve and 263 HIV-negative Tanzanian adults. Traditional cardiovascular risk factors for myocardial dysfunction (age, sex, hypertension, body mass index, ab...
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Background: HIV programs are often assessed by the proportion of patients who are alive and retained in care; however some patients are categorized as lost to follow-up (LTF) and have unknown vital status. LTF is not an outcome but a mixed category of patients who have undocumented death, transfer and disengagement from care. Estimating vital stat...
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Background HIV-positive individuals are at significantly increased risk of depression. In low- and middle-income countries, depression is frequently under-detected, hampered by a lack of data regarding available screening tools. The 5-item World Health Organization Well-Being Index (WHO-5) is widely used to screen for depression, yet its validity i...
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INTRODUCTION: The CD4 cell count and percent at initiation of combination antiretroviral therapy (cART) are measures of advanced HIV disease and thus are important indicators of programme performance for children living with HIV. In particular, World Health Organization (WHO) 2017 guidelines on advanced HIV disease noted that >80% of children aged...
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Objectives: The aim of this study was to estimate the prevalence of hypertension and its risk factors among adults in four slum communities in Port-au-Prince. Methods: Cluster area random sampling was used to select adults for a health and demographic survey, including anthropometric measurements. Hypertension was defined as SBP at least 140 mmH...
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HIV‐positive adults with hypertension have increased risk of mortality but HIV clinics often do not provide hypertension care. The authors integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV‐positive adults presenting for care at the GHESKIO HIV clinic between March and July 2016, 551 scr...
Article
Setting: GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) clinic, Port-au-Prince, Haiti. Objective: To evaluate tuberculosis (TB) care continuum outcomes among adolescents. Design: Among a retrospective cohort of 10-24 year olds diagnosed with active TB, we report completion of the following steps of the TB care...
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Introduction Link4Health, a cluster-RCT, demonstrated the effectiveness of a combination strategy targeting barriers at various HIV continuum steps on linkage to and retention in care; showing effectiveness in achieving linkage to HIV care within 1 month plus retention in care at 12 months after HIV testing for people living with HIV (RR 1.48, 95%...
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Background Over 18 million adults have initiated life-saving antiretroviral therapy (ART) in resource-poor settings; however, mortality and lost-to-follow-up rates continue to be high among patients in their first year after treatment start. Clinical decision tools are needed to identify patients at high risk for poor outcomes in order to provide i...
Data
Probability of death during the first year after ART initiation by age, weight and CD4 count. (DOCX)
Data
Nomogram for predicting risk of dying within 12 months after starting ART using values of 6 predictor variables. (DOCX)
Article
Objective: To study the feasibility of cardiovascular disease risk factor (CVDRF) screening at an HIV clinic in Swaziland. Methods: A sample of HIV-positive patients at least 40 years on antiretroviral treatment was screened for hypertension, diabetes, hyperlipidemia, and tobacco smoking. Results: A total of 1826 patients were screened; 684 (3...
Article
Objective To evaluate mother and infant outcomes in the largest prevention of mother‐to‐child‐transmission (PMTCT) program in Haiti in order to identify gaps towards elimination of HIV and syphilis. Methods Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999‐2014, we assessed maternal enrolment i...
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Introduction: Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urb...
Article
Purpose of review: Outcomes among young people living with HIV (YPLWH) remain disturbingly poor. We summarize recent research on youth-friendly services (YFS) and adolescent-specific differentiated care models, which may improve outcomes across the HIV care continuum for this vulnerable population. We further emphasize unique complexities that cha...
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In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,3...
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Background: Gaps in the HIV care continuum contribute to poor health outcomes and increase HIV transmission. A combination of interventions targeting multiple steps in the continuum is needed to achieve the full beneficial impact of HIV treatment. Methods and findings: Link4Health, a cluster-randomized controlled trial, evaluated the effectivene...
Data
Consolidated Standards of Reporting Trials (CONSORT) statement. (DOCX)
Data
Primary outcome by prespecified participant subgroup. (DOCX)