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Attitudes and Misconceptions of Coronavirus Disease and Vaccination Among African Americans in Rural Mississippi. HEALTH COMMUNICATION 2024; 39:1358-1370. [PMID: 37190668 DOI: 10.1080/10410236.2023.2212443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Despite the recommendations for COVID-19 preventive health behaviors, it continues to increase alarmingly. This study examined how media coverage, myths, political leaders, and community leaders influence the attitudes and misconceptions about COVID-19 and COVID-19 vaccination uptake in the Mississippi Delta region. This qualitative study employed focus group discussions (FDGs) with representatives from three rural counties in the Mississippi Delta. A thematic analysis approach was used for data analysis. Participants were aware of how COVID-19 is transmitted, the preventative measures that can be used to mitigate the spread of the virus, and misconceptions and beliefs that lingered in their communities. Participants were uncertain about the need for the COVID-19 vaccine in terms of perceived risks (e.g., side effects, efficacy, and safety) and its novelty. Participants also discussed a wide range of COVID-19 misinformation that resulted in distress and distrust of the vaccine and health behavior recommendations. There are varying misconceptions and beliefs about COVID-19 and COVID-19 vaccine among communities in the rural Mississippi Delta. Thus, multi-sectoral collaborations between agencies that can use risk communication frameworks to deliver accurate health information that can resolve misinformation about COVID-19 in rural communities are needed.
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A New Model for Engagement and Action Mitigating COVID-19 Harm in Vulnerable Communities: The Work of Collaborative Community Engagement Alliance (CEAL) Initiatives in Three Southern States. Am J Public Health 2024; 114:S33-S36. [PMID: 38207244 PMCID: PMC10785159 DOI: 10.2105/ajph.2023.307486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 01/13/2024]
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Family-Related Factors and HIV-Related Outcomes Among Black Young Men Who Have Sex with Men in Mississippi. AIDS Behav 2022; 27:1548-1563. [PMID: 36318432 PMCID: PMC9628553 DOI: 10.1007/s10461-022-03889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
Abstract
Given their disproportionate HIV incidence, there is a critical need to identify factors related to HIV risk among Black young men who have sex with men (YMSM) in the southeastern United States. This study investigated the association of family factors and HIV-related outcomes among Black YMSM in Mississippi ages 14-20 (n = 72). Multivariable regression models evaluated associations of family factors and outcomes. Greater parent/child communication about sex was associated with fewer lifetime male sex partners and lower odds of lifetime anal sex. Greater parental monitoring was associated with greater likelihood of future condom use. Sexual orientation disclosure was associated with more lifetime male sex partners. Parental monitoring and parent/child communication about sex were protective, suggesting that family-based interventions are promising for HIV prevention among Black YMSM in Mississippi. Results also indicated that YMSM who are "out" to family are important to reach, and families could be useful in encouraging healthy behaviors.
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Meet Me Where I Am: An Evaluation of an HIV Patient Navigation Intervention to Increase Uptake of PrEP Among Black Men Who Have Sex with Men in the Deep South. J Racial Ethn Health Disparities 2021; 9:103-116. [PMID: 33403654 DOI: 10.1007/s40615-020-00933-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
The southern region of the USA is the epicenter of the HIV epidemic. HIV disproportionately affects African Americans, particularly Black men who have sex with men (Black MSM). Given the alarming rates of new infections among Black MSM, there is an urgent need for culturally competent healthcare professionals who are trained to address the unique needs and barriers to uptake and adherence to HIV prevention, care, and treatment services. Utilizing a mixed method research approach, we conducted a process evaluation of Meet Me Where I Am, a 6-month, 6-session HIV/AIDS patient navigation training program for healthcare professionals and patient navigators working in organizations that provide HIV services to residents of central Mississippi, an area with high incidence and prevalence rates of HIV. A self-administered questionnaire after each session was given to participants to assess the acceptability, quality, and translational aspects of the training program. The overall positive feedback on the MMWIA training reflects the program's acceptability and feasibility. Participants found that the training was effective in providing the necessary knowledge and skills to deliver patient-centered HIV prevention-related navigation services. A majority (67%) of participants indicated that they felt they could apply the lessons learned within their healthcare settings to improve access to HIV prevention, care, and treatment services. If we are to reduce racial and ethnic disparities in HIV/AIDS, there is a critical need for culturally appropriate training programs designed to improve the ability of healthcare professionals and health systems to deliver culturally competent HIV prevention, care, and treatment services.
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Who mixes with whom among men who have sex with men? Implications for modelling the HIV epidemic in southern India. J Theor Biol 2014; 355:140-50. [PMID: 24727187 PMCID: PMC4064301 DOI: 10.1016/j.jtbi.2014.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/19/2022]
Abstract
In India, the identity of men who have sex with men (MSM) is closely related to the role taken in anal sex (insertive, receptive or both), but little is known about sexual mixing between identity groups. Both role segregation (taking only the insertive or receptive role) and the extent of assortative (within-group) mixing are known to affect HIV epidemic size in other settings and populations. This study explores how different possible mixing scenarios, consistent with behavioural data collected in Bangalore, south India, affect both the HIV epidemic, and the impact of a targeted intervention. Deterministic models describing HIV transmission between three MSM identity groups (mostly insertive Panthis/Bisexuals, mostly receptive Kothis/Hijras and versatile Double Deckers), were parameterised with behavioural data from Bangalore. We extended previous models of MSM role segregation to allow each of the identity groups to have both insertive and receptive acts, in differing ratios, in line with field data. The models were used to explore four different mixing scenarios ranging from assortative (maximising within-group mixing) to disassortative (minimising within-group mixing). A simple model was used to obtain insights into the relationship between the degree of within-group mixing, R0 and equilibrium HIV prevalence under different mixing scenarios. A more complex, extended version of the model was used to compare the predicted HIV prevalence trends and impact of an HIV intervention when fitted to data from Bangalore. With the simple model, mixing scenarios with increased amounts of assortative (within-group) mixing tended to give rise to a higher R0 and increased the likelihood that an epidemic would occur. When the complex model was fit to HIV prevalence data, large differences in the level of assortative mixing were seen between the fits identified using different mixing scenarios, but little difference was projected in future HIV prevalence trends. An oral pre-exposure prophylaxis (PrEP) intervention was modelled, targeted at the different identity groups. For intervention strategies targeting the receptive or receptive and versatile MSM together, the overall impact was very similar for different mixing patterns. However, for PrEP scenarios targeting insertive or versatile MSM alone, the overall impact varied considerably for different mixing scenarios; more impact was achieved with greater levels of disassortative mixing. Different mixing scenarios are explored for 3 groups of role-segregated MSM. Models show that the mixing scenario affects both R0 and endemic HIV prevalence. When models are fit to data, predicted HIV trends are unaffected by mixing. Impact of targeted (but not non-targeted) interventions can be affected by mixing.
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O13.3 Estimating the Epidemiological Impact of Antiretroviral Treatment on Heterosexual HIV Epidemics in South India: A Modeling Study. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P6.004 The Prevalence of Sexually Transmitted Infections Among Clients of Female Sex Workers in Karnataka, South India: An Analysis by Places of Solicitation of Sex Workers. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P3.419 Effect of Intervention Exposure on Self-Reported Condom Use Among Men Who Have Sex with Men in Southern India. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Author's Response * Female sex worker typology: too complicated to be used pragmatically. Int J Epidemiol 2011. [DOI: 10.1093/ije/dyr072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Intrauterine device use in an inner city university clinic: a retrospective analysis. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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O1-S09.01 Increased condom use and decreased HIV & STI prevalence among female sex workers following a targeted HIV prevention program in Karnataka, South India. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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P2-S7.04 Maximising the impact of positive prevention practices in people living with HIV: learning's from Karnataka, South India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P1-S6.26 Modelling the impact of rapid treponemal tests on syphilis prevalence among female sex workers in India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P1-S2.01 Prevalence of HIV and sexually transmitted infections among clients of female sex workers in Karnataka, South India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O1-S11.01 Time evolution of the fraction of new HIV infections due to primary infection among high risk groups in southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P1-S4.18 Using mathematical modelling to investigate the role of the hidden "population of men who have sex with men (MSM) on the HIV epidemic in Southern India". Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P2-S2.12 Condom use within intimate partnerships of female sex workers in Southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P2-S2.23 Measuring the impact of HIV prevention programme on HIV/STI prevalence and condom use in Karnataka: a case-control approach. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P1-S4.24 Balancing the "supply and demand" of sex acts: implications for modelling the HIV epidemic among men who have sex with men in Southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P5-S6.28 HIV prevention based on the static modes of transmission synthesis for two Indian districts: insights from dynamical modelling. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O2-S6.03 Heterogeneity of HIV risk: female sex worker clients and their non-commercial sexual partners in south India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P1-S5.20 Multi-level analysis of the predictors of HIV prevalence among pregnant women enrolled in sentinel surveillance in four Southern India states. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O1-S08.06 Variability in the numbers and types of sex partners of female sex workers and its impact on HIV prevalence in southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P5-S6.24 Comprehensive, competent and compassionate care for people living with HIV in coastal Andhra Pradesh. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O2-S6.05 Sexual violence against men who have sex with men and transgenders (MSM-T) in southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O2-S1.06 Community responses to an HIV epidemic in South India: knowledge, moral panic and cultural inertia. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P2-S2.11 Focused and early intervention in rural areas can impact on HIV transmission in Southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P2-S6.15 Investigating the critical programme components of HIV prevention programme among MSM-Ts in Bangalore, Karnataka. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P2-S2.16 Impact of duration of exposure to sex work on HIV prevalence in 23 districts of Southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S7.3 Impact of the Avahan intervention on HIV/STI transmission amongst high and low-risk groups: an interim modelling assessment. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050102.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P1-S4.05 Quantifying social desirability biases in reported condom use among female sex workers in Southern India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P1-S5.15 Contribution of condom breakage to the HIV epidemic among men who have sex with men in Karnataka, India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Devising a female sex work typology using data from Karnataka, India. Int J Epidemiol 2009; 39:439-48. [DOI: 10.1093/ije/dyp351] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Syphilis screening among female sex workers in Bangalore, India: comparison of point-of-care testing and traditional serological approaches. Sex Transm Infect 2009; 86:193-8. [DOI: 10.1136/sti.2009.038778] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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35
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Impact of changes in atmospheric conditions in modulating summer dust concentration at Barbados: A back-trajectory analysis. ACTA ACUST UNITED AC 2009. [DOI: 10.1029/2008jd011180] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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36
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Quantifying uncertainty in estimates of mineral dust flux: An intercomparison of model performance over the Bodélé Depression, northern Chad. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2008jd010476] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Evaluating large-scale HIV prevention interventions: study design for an integrated mathematical modelling approach. Sex Transm Infect 2007; 83:582-9. [PMID: 17942574 DOI: 10.1136/sti.2007.027516] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is an urgent need to evaluate HIV prevention interventions, thereby improving our understanding of what works, under what circumstances and what is cost effective. OBJECTIVES To describe an integrated mathematical evaluation framework designed to assess the population-level impact of large-scale HIV interventions and applied in the context of Avahan, the Indian AIDS Initiative, in southern India. The Avahan Initiative is a large-scale HIV prevention intervention, funded by the Bill & Melinda Gates Foundation, which targets high-risk groups in selected districts of the six states most affected by the HIV/AIDS epidemic (Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh, Nagaland and Manipur) and along the national highways. METHODS One important component of the monitoring and evaluation of Avahan relies on an integrated mathematical framework that combines empirical biological and behavioural data from different subpopulations in the intervention areas, with the use of tailor-made transmission dynamics models embedded within a Bayesian framework. RESULTS An overview of the Avahan Initiative and the objectives of the monitoring and evaluation of the intervention is given. The rationale for choosing this evaluation design compared with other possible designs is presented, and the different components of the evaluation framework are described and its advantages and challenges are discussed, with illustrated examples. CONCLUSIONS This is the first time such an approach has been applied on such a large scale. Lessons learnt from the CHARME project could help in the design of future evaluations of large-scale interventions in other settings, whereas the results of the evaluation will be of programmatic and public health relevance.
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Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association. Circulation 1998; 97:1876-87. [PMID: 9603549 DOI: 10.1161/01.cir.97.18.1876] [Citation(s) in RCA: 324] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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The Africentric Transtheoretical model in a school-based pregnancy prevention program. THE ABNF JOURNAL : OFFICIAL JOURNAL OF THE ASSOCIATION OF BLACK NURSING FACULTY IN HIGHER EDUCATION, INC 1998; 9:40-4. [PMID: 9677866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article describes the use of a socio-culturally specific framework for a pregnancy prevention program for low income 10 to 12 year old African American middle school girls. The framework expands earlier (Johnson, 1995) conceptualizations by combining African and African American frames of reference with behavior change processes to influence sexual decision-making among young adolescents.
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5 ways to build lasting interracial friendships. J Christ Nurs 1997; 13:19. [PMID: 9362811 DOI: 10.1097/00005217-199613030-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Guide to primary prevention of cardiovascular diseases. A statement for healthcare professionals from the Task Force on Risk Reduction. American Heart Association Science Advisory and Coordinating Committee. Circulation 1997; 95:2329-31. [PMID: 9142014 DOI: 10.1161/01.cir.95.9.2329] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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42
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When to start cholesterol-lowering therapy in patients with coronary heart disease. A statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction. Circulation 1997; 95:1683-5. [PMID: 9118557 DOI: 10.1161/01.cir.95.6.1683] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
At present a large number of patients with atherosclerotic disease are not receiving aggressive cholesterol-lowering therapy. Consequently they are being deprived of a cost-effective, risk-reducing treatment. Every physician who treats patients with clinical atherosclerotic disease should become fully informed about the results of cholesterol-lowering trials in patients at high risk. All physicians who care for high-risk patients should take responsibility for cholesterol management, including primary care physicians and cardiovascular specialists. Highly effective and generally safe drugs for cholesterol lowering are available. The benefits of therapy for reducing recurrent CHD and prolonging life are considerable. There is no justification for unduly delaying institution of therapy for the majority of patients. The many advantages of nonpharmaceutical therapy call for its use in almost all patients, but drug treatment should not be postponed if the target for LDL cholesterol lowering (< or = 100 mg/dL) is unlikely to be achieved in the near term by a nonpharmaceutical approach alone. The view that patients with CHD or other forms of atherosclerotic disease do not receive substantial clinical benefits from aggressive cholesterol-lowering therapy is no longer warranted. Intensive cholesterol reduction, initiated immediately, has the potential to significantly reduce both morbidity and mortality. Cholesterol-lowering therapy thus should become a routine part of clinical management to reduce risk of future coronary events and to prolong life in patients with CHD or other forms of atherosclerotic disease.
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CNS microvascular pericytes express macrophage-like function, cell surface integrin alpha M, and macrophage marker ED-2. Microvasc Res 1996; 52:127-42. [PMID: 8901442 DOI: 10.1006/mvre.1996.0049] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CNS pericytes are an integral part of the blood-brain (BBB), but their function is not well understood. We questioned whether primary cultured CNS pericytes have immune potential. Primary cultured pericytes exhibit phagocytic activity when exposed to fluorochrome-conjugated polystyrene beads and antibody-coated zymosan. Maximum phagocytic activity occurred by 3 hr. Pericytes were found to express the macrophage markers ED-2 and the integrin subunit CD11b (alpha M) in culture as well as on isolated microvessels. Pericytes did not express the macrophage marker ED-1. We confirm the heterogeneity of cultured CNS pericytes with regard to expression of alpha-smooth muscle actin. In conclusion, pericytes express macrophage surface antigens and have the ability to perform at least some immune function. CNS pericytes may therefore have a role in neuroimmune networks at the BBB.
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Decision making with multiple goals: extending the threshold approach. PROCEEDINGS : A CONFERENCE OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION. AMIA FALL SYMPOSIUM 1996:214-8. [PMID: 8947659 PMCID: PMC2233217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given a set of conditions that may be present in a patient, this paper presents a methods for choosing the optimal combination of treatment actions, taking into account interactions among the available therapeutic and diagnostic procedures. The multiple-threshold approach is an extension of the threshold approach for individual conditions, and it offers a precise way of computing the optimal actions. In addition, tests for an example case show a 11-29% increase in the expected utility of treatments using this method.
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Color Doppler sonography of groin complications following femoral artery catheterization. AJR Am J Roentgenol 1995; 165:439-44. [PMID: 7618573 DOI: 10.2214/ajr.165.2.7618573] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Color Doppler sonography has proved to be an excellent technique for the evaluation of groin complications following femoral artery catheterization [1-4]. With the widespread use of fibrinolytic therapy, anticoagulants, and large-diameter vascular sheaths, a marked increase has been noted in the number of such complications [5, 6]. Accurate diagnosis of groin injuries is critical for establishing whether surgical or nonsurgical treatment is required. In this pictorial essay we review the color Doppler sonography findings of these complications, emphasizing unusual complications such as pseudoaneurysms coincident with arteriovenous fistulas, multilobulated pseudoaneurysms, ruptured pseudoaneurysms, and patent needle tracts. We also discuss the diagnostic pitfalls and mimics of groin injuries, including lymphadenopathy, varicosities, true aneurysms, and atypical but normal branch vessels.
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Inventory control and purchasing at reduced cost. MLO: MEDICAL LABORATORY OBSERVER 1994; 26:42-6. [PMID: 10138503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Role of cytoskeletal elements in expression of monocyte urokinase plasminogen activator receptor, activation-associated antigen Mo3. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1994; 1:714-21. [PMID: 8556526 PMCID: PMC368399 DOI: 10.1128/cdli.1.6.714-721.1994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Peripheral blood monocytes exposed to bacterial products, phorbol esters, cyclic AMP, and cyclic AMP analogs express cell surface activation protein Mo3, which is the human urokinase plasminogen activator receptor (uPA-R). uPA-R is expressed by circulating monocytes from patients with multiple sclerosis (MS). We examined the role of cytoskeletal elements in the surface expression and subcellular distribution of uPA-R in nonactivated and lipopolysaccharide-activated monocytes and in monocytes from patients with MS. By using immunofluorescence techniques and confocal laser microscopy, we found that in unactivated monocytes, cytoplasmic uPA-R is found to one side of the nucleus, colocalizing with the Golgi. Upon activation with lipopolysaccharide, cytoplasmic Mo3-uPA-R becomes dispersed throughout the cytoplasm and projections concomitant with an increase in the monocyte perimeter (spreading). Cytoplasmic dispersion, as well as cell surface deposition, is dependent on microtubule integrity. Cell surface deposition of uPA-R upon activation is reduced by colchicine, which disrupts microtubules; however, once associated at the cell surface, uPA-R becomes associated with microfilaments via vinculin. Disruption of microfilaments with cytochalasin also alters surface expression of immunologically reactive uPA-R, as well as the distribution pattern. Monocytes from patients with MS display the uPA-R distribution pattern characteristic of an activated monocyte.
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CNS vascular pericytes have immune potential. J Neuroimmunol 1994. [DOI: 10.1016/0165-5728(94)90291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Transforming growth factor beta 1 inhibits cytokine-induced CNS endothelial cell activation. MOLECULAR AND CHEMICAL NEUROPATHOLOGY 1994; 22:161-75. [PMID: 7993525 DOI: 10.1007/bf03160103] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Postcapillary endothelium at the sites of inflammation undergoes a series of changes collectively termed endothelial cell activation. Activated endothelium expresses immunologically relevant surface proteins that include MHC class II antigens (Ags) and adhesion proteins, as well as exhibits a number of functional changes. Endothelial activation has not been thoroughly studied in CNS endothelium. We have examined cytokine-mediated endothelial activation in isolated rat CNS microvessels. Freshly isolated rat CNS microvessels are viable in culture for at least 72 h. Untreated microvessels express no endothelial activation antigens, but do exhibit constitutive expression of the transferrin receptor (tfR). INF gamma induces a dose-dependent increase in both MHC class II antigens and tfR measured by immunofluorescent staining and quantitated by laser cytometry. IFN gamma-mediated endothelial cell activation could be inhibited with as little as 2 ng/mL TGF-beta 1. although 100% inhibition was seen with 10 ng/mL TGF-beta 1. Cytokine-preactivated endothelial expression of class II Ag and tfR could also be inhibited by TGF-beta 1. TGF-beta 1-treated microvessels become anergic to IFN gamma stimulation. Results suggest that TGF-beta 1 may have a regulatory role in endothelial activation.
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Expression of the VLA beta 1 integrin family in bladder cancer. THE AMERICAN JOURNAL OF PATHOLOGY 1994; 144:1016-22. [PMID: 8178925 PMCID: PMC1887346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Integrins are a family of transmembrane heterodimers, many of which function as receptors for extracellular matrix molecules and play a role in adherence to and motility on matrix components. Because of these functions, integrins are suspected of participating in metastatic processes. We investigated the expression of beta 1 integrins in human bladder cancer cell lines and tissues. Expression of beta 1 integrins on cultured bladder cancer cell lines was evaluated by flow cytometry, of 8 cell lines tested, alpha 1 was found in 4, alpha 2 and alpha 3 in all 8, alpha 4 in 1, and alpha 5 in 3. These results were in sharp contrast to the expression detected by immunostaining tissues containing normal urothelium and low stage (noninvasive) and high stage (invasive) bladder cancers. All normal urothelial tissues tested expressed alpha 2 and alpha 3 and none expressed alpha 1, alpha 4, or alpha 5. Similarly, a majority (77%) of low stage (noninvasive) bladder cancers stained positively for alpha 3, whereas only 6 of 13 expressed alpha 2 and none expressed alpha 1, alpha 4, or alpha 5. Among invasive bladder cancers, alpha 1 was detected in 7%, alpha 2 in 24%, alpha 3 in 68%, alpha 5 in 10%, and alpha 4 was not found in any samples. These results indicate that integrin expression in cultured human bladder cancer cell lines does not represent expression observed in tissue samples and may reflect adaption to or selection during tissue culture conditions. A progressive loss of alpha 2 expression is seen from normal urothelial cells through invasive bladder cancers. This loss may contribute to an invasive phenotype by a loss of the cell-cell adherence function mediated by the alpha 2 beta 1 and alpha 3 beta 1 integrins.
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