The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / Public Health / M.A. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / In medical research, data analysis often requires complex statistical methods where no closed-form solutions are available. Under such circumstances, Monte Carlo (MC) methods have found many applications. In this dissertation, we proposed several novel statistical models where MC methods are utilized. For the first part, we focused on semicompeting risks data in which a non-terminal event was subject to dependent censoring by a terminal event. Based on an illness-death multistate survival model, we proposed flexible random effects models. Further, we extended our model to the setting of joint modeling where both semicompeting risks data and repeated marker data are simultaneously analyzed. Since the proposed methods involve high-dimensional integrations, Bayesian Monte Carlo Markov Chain (MCMC) methods were utilized for estimation. The use of Bayesian methods also facilitates the prediction of individual patient outcomes. The proposed methods were demonstrated in both simulation and case studies. For the second part, we focused on re-randomization test, which is a nonparametric method that makes inferences solely based on the randomization procedure used in clinical trials. With this type of inference, Monte Carlo method is often used for generating null distributions on the treatment difference. However, an issue was recently discovered when subjects in a clinical trial were randomized with unbalanced treatment allocation to two treatments according to the minimization algorithm, a randomization procedure frequently used in practice. The null distribution of the re-randomization test statistics was found not to be centered at zero, which comprised power of the test. In this dissertation, we investigated the property of the re-randomization test and proposed a weighted re-randomization method to overcome this issue. The proposed method was demonstrated through extensive simulation studies.

Indiana University-Purdue University Indianapolis (IUPUI) / Currently, 1.2 million people in the United States are living with HIV (Human Immunodeficiency Virus) infection, while one in eight are unaware of their infection status. The purpose of this study was to test the ability of the expanded ARRM to see if the model contributed something to the research of why people protect themselves from HIV. To add to the research regarding motivating factors of HIV protection, we decided to add two concepts to the ARRM; partner protection and relationship preservation. Findings of the study suggest HIV-positive partners are motivated to using condoms to protect their partners especially when they believe their partners are at risk for contracting HIV. Relationship preservation results illustrated that when people fear of losing their relationship they are willing to do whatever it takes to keep the relationship going, even at the cost of contracting HIV. By extending the ARRM, as well as incorporating HIV status, we now can begin understanding the many motivating factors towards why people are and are not using condoms to protect themselves or their partner.

Introduction: Despite being one of the most preventable diseases, TB still remains a serious and largely neglected disease. Nurses as compared to the general population are at greater risk of acquiring nosocomial TB. This study was conducted to describe the perceptions of nurses on the underlying contributory factors that may lead to the spread of TB in the clinics treating TB patients. Methods: Quantitative, non – experimental, descriptive, exploratory and cross sectional design was used. A structured and pretested questionnaire was used. Findings: The key contributory factors identified were insufficient TB training for staff and lack of knowledge on the TB legislative framework and TB policy directives. Conclusion: The findings indicate the need for a comprehensive TB infection prevention and control policy, with associated standards for provision and practice. / Health Studies / M.A. (Public Health)

Introduction: Despite being one of the most preventable diseases, TB still remains a serious and largely neglected disease. Nurses as compared to the general population are at greater risk of acquiring nosocomial TB. This study was conducted to describe the perceptions of nurses on the underlying contributory factors that may lead to the spread of TB in the clinics treating TB patients. Methods: Quantitative, non – experimental, descriptive, exploratory and cross sectional design was used. A structured and pretested questionnaire was used. Findings: The key contributory factors identified were insufficient TB training for staff and lack of knowledge on the TB legislative framework and TB policy directives. Conclusion: The findings indicate the need for a comprehensive TB infection prevention and control policy, with associated standards for provision and practice. / Health Studies / M.A. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / The objective of this research is to examine the development of the California alcohol outlets over time and the relationship between neighborhood characteristics and densities of the alcohol outlets. Two types of advanced analyses were done after the usual preliminary description of data. Firstly, fixed and random effects linear regression were used for the county panel data across time (1945-2010) with a dummy variable added to capture the change in law regarding limitations on alcohol outlets density. Secondly, a Bayesian spatio-temporal Poisson regression of the census tract panel data was conducted to capture recent availability of population characteristics affecting outlet density. The spatial Conditional Autoregressive model was embedded in the Poisson regression to detect spatial dependency of unexplained variance of alcohol outlet density. The results show that the alcohol outlets density reduced under the limitation law over time. However, it was no more effective in reducing the growth of alcohol outlets after the limitation was modified to be more restrictive. Poorer, higher vacancy rate and lower percentage of Black neighborhoods tend to have higher alcohol outlet density (numbers of alcohol outlets to population ratio) for both on-sale general and off-sale general. Other characteristics like percentage of Hispanics, percentage of Asians, percentage of younger population and median income of adjacency neighbors were associated with densities of on-sale general and off sale general alcohol outlets. Some regions like the San Francisco Bay area and the Greater Los Angeles area have more alcohol outlets than the predictions of neighborhood characteristics included in the model.

This study identified pregnancy-related challenges encountered by student nurses at SAMHS Nursing College, with an aim of identify factors contributing to student nurses' pregnancies as well as finding ways to deal and minimize the rate of the pregnancies amongst the student nurses. Thirty (30) structured interviews were conducted with student nurses who were pregnant and those who delivered their babies during the period 2002 to 2007. It has been revealed that ignorance is the major contributing factor for student nurses' pregnancies, 63% of the pregnancies were not planned, 52% of the respondents related their pregnancies to risk taking as they engaged in unprotected sex without the use of contraceptives, and thus it was concluded that student nurses are engaging themselves in risk behaviours and also engaging in unsafe sexual practices. The study also found that student nurses face physical, social, emotional as well as academic problems during pregnancy and after the delivery of their babies. Student nurses should be encouraged to use condoms and other methods of contraception, coupled with educating them on life skills, provision of recreational facilities; provision of counseling and support services may be the tool to minimise the unplanned pregnancies. / Health Studies / (M.A.(Public Health ))

This study identified pregnancy-related challenges encountered by student nurses at SAMHS Nursing College, with an aim of identify factors contributing to student nurses' pregnancies as well as finding ways to deal and minimize the rate of the pregnancies amongst the student nurses. Thirty (30) structured interviews were conducted with student nurses who were pregnant and those who delivered their babies during the period 2002 to 2007. It has been revealed that ignorance is the major contributing factor for student nurses' pregnancies, 63% of the pregnancies were not planned, 52% of the respondents related their pregnancies to risk taking as they engaged in unprotected sex without the use of contraceptives, and thus it was concluded that student nurses are engaging themselves in risk behaviours and also engaging in unsafe sexual practices. The study also found that student nurses face physical, social, emotional as well as academic problems during pregnancy and after the delivery of their babies. Student nurses should be encouraged to use condoms and other methods of contraception, coupled with educating them on life skills, provision of recreational facilities; provision of counseling and support services may be the tool to minimise the unplanned pregnancies. / Health Studies / (M.A.(Public Health ))