BACKGROUND: Men in sub-Saharan Africa have lower rates of HIV treatment initiation and retention than women. In this mixed-methods study, we created a structured decision-making framework comparing the three interventions tested in the Identifying Efficient Linkage Strategies for Men (IDEaL) trial in Malawi: 1) home-based counseling with lay cadre healthcare workers (HCWs); 2) home-based counseling with lay cadre HCWs plus home-based ART initiation; and 3) stepped interventions deployed sequentially until ART initiation occurred (home-based lay cadre counseling, motivational interviewing with a psychosocial counselor, and home-based ART initiation). METHODS: This study was guided by the Assessing Cost-Effectiveness (ACE) framework. First, we conducted in-depth interviews with high-level international and Malawi-based stakeholders to understand their perceptions and priorities. We analyzed transcripts using thematic content analysis. Next, we conducted an incremental cost-effectiveness analysis of the IDEaL interventions. Finally, we created a decision-making framework for stakeholders deciding whether to adopt and implement the IDEaL interventions. The framework included trial data on the following criteria: effectiveness, intervention cost, feasibility, equity, acceptability, sustainability, and “other considerations.” RESULTS: Both international and Malawi-based stakeholders prioritized client acceptability but diverged elsewhere: international stakeholders prioritized effectiveness while Malawi-based stakeholders prioritized long-term costs, feasibility, and sustainability. Both groups prioritized facility-based interventions and highly valued person-centered care. Average incremental costs per client were higher for the home-based ART ($44) and stepped ($35) interventions than for the counseling-only intervention ($28). The most expensive aspect of the interventions was HCW travel to community-based settings. All three interventions performed better than a standard of care comparison on 6-month retention in HIV care; differences in retention across arms were not statistically significant. The incremental cost-effectiveness ratio (ICER) for the stepped arm compared to the counseling-only arm was $101/participant with a successful outcome (95% CI: -$219, $1,284). The lay cadre counseling-only intervention was the most acceptable, feasible and sustainable option. CONCLUSION: Person-centered, male-tailored counseling with HCWs contributed to the success of the IDEaL interventions and was highly valued by clients and healthcare workers. Counseling with lay cadre HCWs should be prioritized over more expensive interventions, such as community-based psychosocial counseling and ART dispensation for increasing men’s engagement in HIV care.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women worldwide. PCOS involves chronic anovulation causing menstrual irregularity and hormone imbalances. The symptoms PCOS patients encounter can vary greatly by individual, making inaccurate diagnosis of the disease common. A delayed or missed diagnosis is emotionally taxing on patients and can increase their risk of long-term comorbidities. Unclear diagnostic guidelines, inconsistency between providers, and lack of public awareness all contribute to an unsatisfactory diagnostic experience for patients. This study proposes to identify women in the community that could potentially have undiagnosed PCOS and educate them about the condition. Hirsutism is an exceedingly common symptom of PCOS but relatively rare in the general population and, therefore, has been chosen as the indicator for potentially undiagnosed PCOS. The study will take place at laser hair removal facilities, in order to maximize the chances of recruiting participants with hirsutism. Six months after receiving PCOS education, participants will be contacted to record if they scheduled a medical consultation for PCOS diagnosis. This community outreach will hopefully bring PCOS awareness to those at risk to encourage earlier diagnosis and treatment.

The foundation of emergency medical services is based on a system that allows emergency personnel to respond to medical and surgical emergencies in an efficient manner. However, the system we know today hasn’t always been as efficient. There have been numerous advances that have shaped the EMS system today including training dispatch operations, creating a national scope of practice and guidelines for emergency medical technician and paramedics, as well as standardizing training for EMS personnel. 1 In countries around the world, EMTs and paramedics are not the only personnel responding to calls, more advanced personnel, including physicians, on EMS vehicles are a standard practice unlike in the United States. The objective of this study is to investigate whether the implementation of physician assistants on emergency medical service vehicles affects patient outcomes. The emergency type that was selected for this study was an out-of-hospital cardiac arrest as they are one of the most well-studied emergencies in the United States. The development of EMS guidelines has helped target out-of-hospital emergencies including cardiac arrests. The implementation of the “chain of survival” has been shown to have higher survival rates when implemented early and optimized. The proposal of this study entails physician-assistant EMS vehicles to respond to cardiac arrests in the Boston area over a twelve-month period with follow-up for at three end points including three, six, and twelve months. The goal for the patient population is approximately 2,000 participants and utilizes software that will dispatch either a physician assistant-EMS or a paramedic unit that will practice under their scopes of practice and under the Massachusetts State protocols for cardiac arrests. The study will use electronic medical records from the Boston EMS EMR as well as from the receiving facility and will determine if there is a statistical difference in patient outcomes between the physician assistant unit and the traditional paramedic unit. This study is novel in that it is the first of its kind to study the utilization of physician assistants in the pre-hospital emergency medical setting. This study would explore the idea of integrating PAs in more capabilities than those in the hospital setting and how this could affect patient outcomes overall.

<p> Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew&rsquo;s health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (<i>p</i> &lt; .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.</p>

Thesis (M.S.P.H.)--University of Michigan, 1935.

Thesis--University of Florida. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 176-184).

Thesis (M.S.P.H.)--University of Michigan, 1935.

Thesis (D.P.H.)--University of Michigan.

Thesis (doctoral)--Münster in Westfalen, 1934.

Thesis (doctoral)--Münster in Westfalen, 1934.