Medicine and Health Sciences Commons^™

Screening For Legionnaires’ Disease: A Predictive Model For Improving Health And Economic Outcomes, Alyssa K. Amick

Public Health Theses

Introduction: Legionnaires’ disease (LD), caused by the Legionella bacterium, is a rare but serious atypical pneumonia that is often underdiagnosed in the clinical setting. Recent guideline changes by the American Thoracic Society limited use of the urinary Legionella tests, the primary form of diagnosis, due to the excessive costs of regular testing. Delays in testing and diagnosis of LD result in increased cost of treatment and risk of death.

Objective: To develop a predictive model to estimate a patient’s probability of having LD. This model would serve as a screen to better target diagnostic efforts, prevent misdiagnosis, and reduce the …

A Prospective Cohort Study To Evaluate The Efficacy Of A Peer-Led Tuberculosis Education And Counseling Intervention In Kampala, Uganda, Anna Dawn Baker

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and disproportionally burdens low- to middle-income countries (LMICs). Upon initiation of treatment for an active TB diagnosis, universal TB education and counseling (TEC) is recommended to promote knowledge and medication adherence. Though previous studies have shown that there are areas that can be improved when delivering routine TEC, there is limited data on how peer-led TEC can fill these gaps in Kampala, Uganda. Our study evaluated the efficacy of a peer-led TEC intervention among newly diagnosed adults initiating TB treatment in Kampala and assessed capacity for scale-up. We used …

The Impact Of Medicaid Expansion On Childhood Vaccination Rates, 2010-2018, Chandra K. Couzens

Public Health Theses

Background

The relationship between coverage expansions and vaccination coverage is not well characterized, through previous work as linked coverage expansions with insurance rates and insurance rates with vaccination completion. We examined whether Medicaid expansions implemented by the end of 2015 in 29 states and D.C. were associated with changes in MMR vaccination and 7-series vaccination completion among low income children from 2010-2018.

Methods

Changes in mean vaccination coverage were compared between the four years before expansion (2010-2013) and the four years post expansion (2015-2018), using data from the 2010-2018 National Immunization Child Survey. The final study sample (N=36,591) included children …

Evaluation Of Pilot Methadone Treatment Programs For Inmates With Opioid Use Disorder In Connecticut Jails, 2014-2018, Alissa Haas

Public Health Theses

Background and Aims. Methadone treatment is underutilized in correctional facilities, despite high prevalence of opioid use disorder in criminal justice settings. In 2013 and 2014, two pilot programs were established by the Connecticut Department of Corrections in the New Haven and Bridgeport Correctional Centers to provide methadone for inmates who had been in medication-based treatment prior to incarceration. We sought to assess post-release outcomes (non-fatal overdose, fatal overdose, recidivism, and resumption of methadone in the community) associated with implementation of methadone treatment in these correctional centers.

Methods. This was a retrospective observational cohort study, linking datasets from the Connecticut Department …

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …

Geospatial Analysis Of Drug-Resistant Tuberculosis In Santiago De Cali, Colombia, Oscar Norberto Perales

Public Health Theses

Infectious diseases like tuberculosis are undergoing an epidemiological transformation in developing countries such as Colombia and throughout Latin America. Recent economic and social developments may drive heterogeneous burdens of disease in the region, especially in urban settings. Geographic Information Systems (GIS) may allow us to better appreciate the geospatial distributions of TB in these contexts. In this study, we aimed to identify regions in Santiago de Cali facing disproportionate TB burdens and sought to determine whether the distribution of drug resistant TB differed. Additionally, we aimed to identify patient risk factors that could lead to differential drug resistance testing. This …

Hiv Testing During Antenatal Care In Eastern & Southern Africa: How Do Adolescents And Young Women Fare?, Claire Young

Public Health Theses

Background

To validate Elimination of Mother to Child HIV Transmission (eMTCT), pregnant women must receive antenatal care (ANC) HIV testing. Given challenges for adolescent girls in ANC, we hypothesized that adolescents were less likely to receive ANC HIV testing in Eastern and Southern Africa (ESA).

Methods

For 10 ESA countries, we use 2015-2018 Demographic and Health Surveys (DHS) to study 46,056 women attending ANC and giving birth in the last three years. We used age-stratified (15-19, 20-24, and 25-49 years of age at time of delivery) crude and adjusted logistic regressions to assess predictive factors for ANC HIV testing, both …

Assessing The Functional Impact Of Pfrh5 Genetic Diversity On Erythrocyte Invasion Pathway Utilization In Plasmodium Falciparum, Adam Joseph Moore

Public Health Theses

Malaria is still responsible for over 405,000 deaths and 228 million cases of disease globally each year, with the large majority of these cases being caused by the Plasmodium falciparum parasite subspecies1. The RTS,S P. falciparum malaria vaccine, the only malaria vaccine ever licensed, is currently being rolled out in three African countries as part of a pilot implementation program and targets a major circumsporozoite protein (PfCSP). After three doses and a seven-year follow up, the vaccine showed a 7% efficacy on average with a -56.8% efficacy for patients in regions with above average exposure to P. falciparum2. While the …