Social and Behavioral Sciences Commons^™

A Mixed Methods Evaluation Of A World Health Organization Competency-Based Training Package For Foundational Helping Skills Among Pre-Service And In-Service Health Workers In Nepal, Peru And Uganda, Gloria A. Pedersen, Pragya Shrestha, Josephine Akellot, Alejandra Sepulveda, Nagendra P. Luitel, Rosco Kasujja, Carmen Contreras, Jerome T. Galea, Leydi Moran, Vibha Neupane, Damodar Rimal, Alison Schafer, Brandon A. Kohrt

Social Work Faculty Publications

No abstract provided.

Perinatal Depression And Implementation Of The “Thinking Healthy Program” Support Intervention In An Impoverished Setting Of Lima, Peru: Assessment Before And During The Covid-19 Pandemic, Margot Aguilar, Carmen Contreras, Giuseppe Raviola, Alejandra Sepúlveda, Maricielo Espinoza, Leydi Moran, Lourdes Ramos, Jesús Peinado, Leonid Lecca, Gloria A. Pedersen, Brandon A. Kohrt, Jerome T. Galea

Social Work Faculty Publications

Socios En Salud (SES) implemented the Thinking Healthy program (THP) to support women with perinatal depression before and during the COVID-19 pandemic in Lima Norte. We carried out an analysis of the in-person (5 modules) and remote (1 module) THP intervention. Depression was detected using PHQ-9, and THP sessions were delivered in women with a score (PHQ-9 ≥ 5). Depression was reassessed and pre- and post-scores were compared. In the pre-pandemic cohort, perinatal depression was 25.4% (47/185), 47 women received THP and 27 were reassessed (57.4%), and the PHQ-9 score median decreased from 8 to 2, p < 0.001. In the pandemic cohort, perinatal depression was 47.5% (117/247), 117 women received THP and 89 were reassessed (76.1%), and the PHQ-9 score median decreased from 7 to 2, p < 0.001. THP’s modalities helped to reduce perinatal depression. Pregnant women who received a module remotely also reduced depression.

Lessons Learned In Co-Creating A Virtual Village For People Ageing With Hiv, Jasmine L. Lopez, Andrea N. Polonijo, Annie L. Nguyen, Karah Y. Greene, Jerome T. Galea, Moka Yoo-Jeong, Jeff Taylor, Brandon J. Brown

Social Work Faculty Publications

No abstract provided.

Adolescent, Caregiver And Provider Perspectives On Tuberculosis Treatment Adherence: A Qualitative Study From Lima, Peru, Silvia S. Chiang, Liz Senador, Elmer Altamirano, Milagros Wong, Catherine B. Beckhorn, Stephanie Roche, Julia Coit, Victoria Elena Rapoport, Leonid Lecca, Jerome T. Galea

Social Work Faculty Publications

Objectives: To understand the perspectives of adolescents (10–19 years old), their caregivers and healthcare providers regarding factors that impact adherence to tuberculosis (TB) treatment among adolescents.

Design: We conducted in-depth interviews using semistructured interview guides based on the World Health Organization (WHO)’s Five Dimensions of Adherence framework, which conceptualises adherence as being related to the health system, socioeconomic factors, patient, treatment and condition. We applied framework thematic analysis.

Setting: Between August 2018 and May 2019, at 32 public health centres operated by the Ministry of Health in Lima, Peru.

Participants: We interviewed 34 adolescents who completed or were lost to …

Retention And Viral Suppression Among Adolescents Newly Initiating Antiretroviral Therapy In Adult Hiv Care In Lima, Peru: A Retrospective Cohort Study, Miyu Niwa, Eduardo Matos, Carly Rodriguez, Milagros Wong, Renato A. Errea, Alicia Ramos, Liz Senador, Carmen Contreras, Jerome T. Galea, Andrew Lindeborg, Carlos Benites, Sonya S. Shin, Leonid Lecca, Molly F. Franke

Social Work Faculty Publications

Purpose: Published data on outcomes among adolescents newly initiating antiretroviral treatment in the Latin American context are sparse. We estimated the frequency of sustained retention with viral load suppression (i.e., successful transition) and identified predictors of successful transition into adult care among youth (aged 14–21 years) with recently acquired HIV in Lima, Peru.

Methods: A retrospective cohort study was conducted among 184 adolescents and young adults who initiated antiretroviral therapy in an adult public sector HIV clinic between June 2014 and June 2019. Sustained retention (no loss-to-follow-up or death) with viral suppression was calculated for the first 12 and 24 …

Editorial: Noncommunicable Diseases And Mental Health Experiences Before And After The Covid-19 Pandemic, Rahul Shidhaye, Annika C. Sweetland, Jerome T. Galea, Mir Nabila Ashraf, Malay K. Mridha, Hannah Maria Jennings, Aliya Naheed

Social Work Faculty Publications

No abstract provided.

Development Of A Conversational Agent For Individuals Ambivalent About Quitting Smoking: Protocol For A Proof-Of-Concept Study, Uma S. Nair, Karah Yeona Greene, Stephanie Marhefka, Kristin A. Kosyluk, Jerome T. Galea

Social Work Faculty Publications

Background: Cigarette smoking is the leading preventable cause of disease and death in the United States. Despite the availability of a plethora of evidence-based smoking cessation resources, less than one-third of individuals who smoke seek cessation services, and individuals using these services are often those who are actively contemplating quitting smoking. There is a distinct dearth of low-cost, scalable interventions to support smokers not ready to quit (ambivalent smokers). Such interventions can assist in gradually promoting smoking behavior changes in this target population until motivation to quit arises, at which time they can be navigated to existing evidence-based smoking cessation …

The Covid-19 Pandemic As A Catalyst For Integrated Global Mental Healthcare And Tuberculosis Care, Alexander L. Chu, Aneeta Pasha, Carmen Contreras, Leonid Lecca, Annika C. Sweetland, Jerome T. Galea

Social Work Faculty Publications

Mental disorders are common among persons with tuberculosis (TB), and the COVID-19 pandemic has only amplified the mental and physical health consequences of this deadly synergy. Here, we call to attention the immense vulnerability of people with TB to mental disorders during the pandemic and highlight the unique challenges and opportunities that the pandemic brings to the future integration of global TB and mental healthcare. We argue that the pandemic era is an ideal period to accelerate this integration and we provide research and policy recommendations to actualise this urgent need.

Numeracy And Financial Wellbeing During The Covid-19 Pandemic, Nora Wikoff

Numeracy

This paper examines the role of numeracy in smoothing financial difficulties during the COVID-19 pandemic. The results show that numeracy was associated with a 30% reduction in late or non-payment of bills and a 20% reduction in the odds of feeling financially squeezed. The effect of numeracy on financial wellbeing was remarkably consistent across levels of education, ethnicity, and gender, suggesting that improving numeracy levels in the population may be an effective strategy to increase financial capability across the board. However, while numerate individuals were less likely to experience financial difficulty, high numeracy did not predict narrower gaps between Whites …

Understanding Linkage To Biopsy And Treatment For Breast Cancer After A High-Risk Telemammography Result In Peru: A Mixed-Methods Study, Renato A. Errea, Patricia J. Garcia, Lydia E. Pace, Jerome T. Galea, Molly F. Franke

Social Work Faculty Publications

Objectives: This mixed-method study aimed to understand the effectiveness of linkage to biopsy and treatment in women with a high-risk mammography result (Breast Imaging Reporting and Data System, BI-RADS 4 and 5) in the national telemammography programme and to explore women’s experiences during this process.

Setting: Quantitative component: we collected and linked health data from the telemammography reading centre, the national public health insurance, the national centre for disease control and the national referral cancer centre. Qualitative component: we interviewed participants from different regions of the country representing diverse social and geographical backgrounds.

Participants: Quantitative: women who underwent telemammography between …

Community-Based Accompaniment For Adolescents Transitioning To Adult Hiv Care In Urban Peru: A Pilot Study, Valentina Vargas, Milagros Wong, Carly A. Rodriguez, Hugo Sanchez, Jerome T. Galea, Alicia Ramos, Liz Senador, Lenka Kolevic, Eduardo Matos, Eduardo Sanchez, Renato A. Errea, Karen Ramos, Catherine Beckhorn, Andrew Lindeborg, Carlos Benites, Leonid Lecca, Sonya Shin, Molly F. Franke

Social Work Faculty Publications

We piloted a community-based intervention to improve outcomes among adolescents living with HIV who were transitioning to adult-oriented care in Lima, Peru. We assessed feasibility and potential effectiveness, including within-person changes in self-reported adherence, psychosocial metrics (NIH Toolbox), and transition readiness (“Am I on TRAC” questionnaire, “Got Transition” checklist). From October 2019 to January 2020, we enrolled 30 adolescents (15–21 years). The nine-month intervention consisted of logistical, adherence and social support delivered by entry-level health workers and group sessions to improve health-related knowledge and skills and social support. In transition readiness, we observed within-person improvements relative to baseline. We also …

Geographic Accessibility To Health Facilities Predicts Uptake Of Community-Based Tuberculosis Screening In An Urban Setting, Helen E. Jenkins, Sally Ayuk, Daniela Puma, Meredith B. Brooks, Ana Karina Millones, Judith Jimenez, Leonid Lecca, Jerome T. Galea, Mercedes Becerra, Salmaan Keshavjee, Courtney M. Yuen

Social Work Faculty Publications

Objectives: Annually, more than 30% of individuals with tuberculosis (TB) remain undiagnosed. We aimed to assess whether geographic accessibility measures can identify neighborhoods that would benefit from TB screening services targeted toward closing the diagnosis gap.

Methods: We used data from a community-based mobile TB screening program in Carabayllo district, Lima, Peru. We constructed four accessibility measures from the geographic center of neighborhoods to health facilities. We used logistic regression to assess the association between these measures and screening uptake in one's residential neighborhood versus elsewhere, with quasi-information criterion values to assess the association.

Results: We analyzed the screening locations …

Attitudes Toward Payment For Research Participation: Results From A U.S. Survey Of People Living With Hiv, Andrea N. Polonijo, Karine Dubé, Jerome T. Galea, Karah Yeona Greene, Jeff Taylor, Christopher Christensen, Brandon Brown

Social Work Faculty Publications

Little is known about how payment affects individuals' decisions to participate in HIV research. Using data from a U.S. survey of people living with HIV (N = 292), we examined potential research participants’ attitudes toward payment, perceived study risk based on payment amount, and preferred payment forms, and how these factors vary by sociodemographic characteristics. Most respondents agreed people should be paid for HIV research participation (96%) and said payment would shape their research participation decisions (80%). Men, less formally educated individuals, and members of some minoritized racial-ethnic groups were less likely to be willing to participate in research …

Feasibility Of A School-Based Mental Health Program Implementation To Improve The Status Of Depression And Quality Of Life Of Mothers Of Children With Autism Spectrum Disorders In Urban Bangladesh: Menthol Study, Aliya Naheed, Saimul Islam, Meredith B. Brooks, Mary C. Smith Fawzi, Mir Nabila Ashraf, Helal Uddin Ahmed, M. M. Jalal Uddin, Kamrun Nahar Koly, Jerome T. Galea, Shaheen Akhter, Charles Nelson, Saima Wazed Hossain, Kerim M. Munir

Social Work Faculty Publications

Background: We assessed the feasibility of implementing psychological counseling services (PCS) for mothers of children with autism spectrum disorders (ASD) integrated within special education settings in urban Bangladesh. Method: In two special education schools for ASD in Dhaka City, trained female psychologists screened mothers using the Patient Health Questionnaire (PHQ-9). PCS was administered to all the mothers irrespective of a diagnosis of depression. Mothers with a PHQ-9 score >4 who met criteria for a major depressive episode (MDE) based on the DSM-IV Structured Interview Axis I Disorders (SCID-I) were also administered skill-building training through monthly home visits to support ASD …

Higher Native Peruvian Genetic Ancestry Proportion Is Associated With Tuberculosis Progression Risk, Samira Asgari, Yang Luo, Chuan-Chin Huang, Zibiao Zhang, Roger Calderon, Carmen Contreras, Jerome T. Galea, Leonid Lecca, David Jones, D. Branch Moody, Megan B. Murray, Soumya Raychaudhuri

Social Work Faculty Publications

No abstract provided.

Impact Of Prolonged Isolation On Adolescents With Drug-Susceptible Tuberculosis In Lima, Peru: A Qualitative Study, Victoria Elena Rapoport, Elmer Altamirano, Liz Senador, Milagros Wong, Catherine B. Beckhorn, Julia Coit, Stephanie D. Roche, Leonid Lecca, Jerome T. Galea, Silvia S. Chiang

Social Work Faculty Publications

Objectives Patients with tuberculosis (TB) generally are instructed to isolate at the beginning of treatment in order to prevent disease transmission. The duration of isolation varies and may be prolonged (ie, lasting 1 month or more). Few studies have examined the impact of isolation during TB treatment on adolescents, who may be more vulnerable to its negative effects.

Methods This study took place from 2018 through 2019 in Lima, Peru, where the Ministry of Health mandates the exclusion of patients with TB from educational institutions for at least 2 months. Using semi-structured guides, we conducted individual in-depth interviews with adolescents …

Considerations For Partnering With Ryan White Case Managers To Create Equitable Opportunities For People With Hiv To Participate In Research, Elizabeth Lockhart, Deanne Turner, Jerome T. Galea, Stephanie L. Marhefka

Social Work Faculty Publications

Many research studies focus on recruitment from one or few HIV clinics or internet-engaged populations, but this may result in inequitable representation of people with HIV (PWH), across the rural/urban/suburban continuum. Ryan White Case Managers (RWCM) meet regularly with PWH, potentially positioning them as partners in gathering research-related data from diverse groups of low-income, marginalized, PWH. Yet, data collection in partnership with RWCM, particularly over large geographic areas, has been under-explored. We partnered with RWCM and their organizations throughout Florida to administer a 10-item technology use and willingness survey to clients living with HIV; RWCMs provided process-oriented feedback. Among 382 …

A Role For Community-Level Socioeconomic Indicators In Targeting Tuberculosis Screening Interventions, Meredith B. Brooks, Helen E. Jenkins, Daniela Puma, Christine Tzelios, Ana Karina Millones, Judith Jimenez, Jerome T. Galea, Leonid Lecca, Mercedes C. Becerra, Salmaan Keshavjee, Courtney M. Yuen

Social Work Faculty Publications

Tuberculosis screening programs commonly target areas with high case notification rates. However, this may exacerbate disparities by excluding areas that already face barriers to accessing diagnostic services. We compared historic case notification rates, demographic, and socioeconomic indicators as predictors of neighborhood-level tuberculosis screening yield during a mobile screening program in 74 neighborhoods in Lima, Peru. We used logistic regression and Classification and Regression Tree (CART) analysis to identify predictors of screening yield. During February 7, 2019–February 6, 2020, the program screened 29,619 people and diagnosed 147 tuberculosis cases. Historic case notification rate was not associated with screening yield in any …

Patient And Provider Perceptions Of A Community-Based Accompaniment Intervention For Adolescents Transitioning To Adult Hiv Care In Urban Peru: A Qualitative Analysis, Jerome T. Galea, Milagros Wong, Brennan Ninesling, Alicia Ramos, Liz Senador, Hugo Sanchez, Lenka Kolevic, Eduardo Matos, Eduardo Sanchez, Renato A. Errea, Andrew Lindeborg, Carlos Benites, Leonid Lecca, Sonya Shin, Molly F. Franke

Social Work Faculty Publications

Introduction: Adolescents living with HIV (ALWH) experience higher mortality rates compared to other age groups, exacerbated by the suboptimal transition from paediatric to adult HIV care, during which decreased adherence to antiretroviral therapy (ART) and unsuppressed viremia are frequent. Care transition—a process lasting months or years—ideally prepares ALWH for adult care and can be improved by interventions that are youth-friendly and address psychosocial issues affecting ART adherence; however, such interventions are infrequently operationalized. Community-based accompaniment (CBA), in which laypeople provide individualized support and health system navigation, can improve health outcomes among adults with HIV. Here, we describe patient and provider …

Ongoing Genocides And The Need For Healing: The Cases Of Native And African Americans, Benjamin P. Bowser, Carl O. Word, Kate Shaw

Genocide Studies and Prevention: An International Journal

The elimination of Native peoples and the enslavement of Africans in the U.S. more than qualify as acts of historical state sponsored genocide. A feature of both genocides is that they ended as institutional practices but have continued culturally and psychologically. The primary contemporary legacy of these genocides is racism which reinforces historical trauma and grief. Suggestions are made for how healing for Native and African Americans can begin despite ongoing racism. This includes psychological counseling for White Americans with beliefs in White supremacy. Suggestions are also made for how reconciliation can begin at the county-level between descendants of slave …

An Evaluation Of Peace Building Strategies In Southwestern Nigeria: Quantitative And Qualitative Examples, Kazeem Oyedele Lamidi

Journal of African Conflicts and Peace Studies

This paper evaluated the peace building architecture by United Nations using Southwestern Nigeria as a reference point. Quantitative data were generated from responses to the questionnaire. In addition, the qualitative data were gathered from two sources: interview response and theme coding of Focus Group Discussion. Data collected were analysed using frequency, percentage, mean value and standard deviation as well as content analysis methods. From the descriptive statistics, this paper found out that quick intervention, cross-examination, negotiation, and mediation of differences were evaluated to be the key building strategies adopted for the enhancement of peaceful co-existence in local communities within Southwestern …

How Social Workers Count: Numbers And Social Issues Came To Be, Michael A. Lewis

Numeracy

Lewis, Michael Anthony. 2019. Social Workers Count: Numbers and Social Issues (New York: Oxford University Press) 224 pp. ISBN 978-0190467135.

This essay introduces Social Workers Count: Numbers and Social Issues by Michael Anthony Lewis. Inspired by the seminal work of Bennett and Briggs, Lewis shares how he came to write a math book for social workers to meet new demands as the field has developed to include more quantitative concepts. The result is a book that may be of interest to many in the quantitative reasoning movement in the social sciences and beyond.

Incident Tuberculosis Diagnoses In Children At High Risk For Disease, Milagros Wong, Julia M. Coit, Milagros Mendoza, Silvia S. Chiang, Helen Marin, Jerome T. Galea, Leonid Lecca, Molly F. Franke

Social Work Faculty Publications

We followed 35 children meeting a research definition for unconfirmed tuberculosis (TB) but in whom a pediatric pulmonologist did not diagnose or treat TB. After a median follow-up of 16.4 months, most children were not diagnosed with TB following a comprehensive evaluation. However, 2 were diagnosed with TB, demonstrating high TB risk (6%; exact 95% CI, 1%–19%). In some contexts, researchers may wish to supplement these research definitions with clinical decision data and longitudinal follow-up in order to improve specificity.

Prediction Tool To Identify Children At Highest Risk Of Tuberculosis Disease Progression Among Those Exposed At Home, Meredith B. Brooks, Leonid Lecca, Carmen Contreras, Roger Calderon, Rosa Yataco, Jerome Galea, Chuan-Chin Huang, Megan B. Murray, Mercedes C. Becerra

Social Work Faculty Publications

Background: There is a dearth of research to understand which children, among those who are exposed at home to tuberculosis (TB), are at the highest risk of TB disease, to tailor care. We sought to identify predictors of TB progression in children.

Methods: We conducted a prospective cohort study of children living with adults with pulmonary TB in Lima, Peru (2009–2012). We applied classification and regression tree analysis to examine potential predictors of incident TB disease during 12 months in 3 age groups (0–4, 5–9, and 10–14 years). We calculated the relative risk (RR) for top predictors in each age …

Evaluating The Impact Of Incentives On Clinical Trial Participation: Protocol For A Mixed Methods, Community-Engaged Study, Jerome T. Galea, Karah Y. Greene, Brandon Nguyen, Andrea N. Polonijo, Karine Dubé, Jeff Taylor, Christopher Christensen, Zhiwei Zhang, Brandon Brown

Social Work Faculty Publications

Background: Monetary incentives in research are frequently used to support participant recruitment and retention. However, there are scant empirical data regarding how researchers decide upon the type and amount of incentives offered. Likewise, there is little guidance to assist study investigators and institutional review boards (IRBs) in their decision-making on incentives. Monetary incentives, in addition to other factors such as the risk of harm or other intangible benefits, guide individuals’ decisions to enroll in research studies. These factors emphasize the need for evidence-informed guidance for study investigators and IRBs when determining the type and amount of incentives to provide to …

Closing Delivery Gaps In The Treatment Of Tuberculosis Infection: Lessons From Implementation Research In Peru, Courtney M. Yuen, Ana Karina Millones, Daniela Puma, Judith Jimenez, Jerome T. Galea, Roger Calderon, Gabriela S. Pages, Meredith B. Brooks, Leonid Lecca, Tom Nicholson, Mercedes C. Becerra, Salmaan Keshavjee

Social Work Faculty Publications

Background: Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens.

Methods: We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level …

Toward Patient-Centered Tuberculosis Preventive Treatment: Preferences For Regimens And Formulations In Lima, Peru, Courtney M. Yuen, Ana K. Millones, Jerome T. Galea, Daniela Puma, Judith Jimenez, Leonid Lecca, Mercedes C. Becerra, Salmaan Keshavjee

Social Work Faculty Publications

Background: To ensure patient-centered tuberculosis preventive treatment, it is important to consider factors that make it easier for patients to complete treatment. However, there is little published literature about patient preferences for different preventive treatment regimen options, particularly from countries with high tuberculosis burdens.

Methods: We conducted a qualitative research study using a framework analysis approach to understand tuberculosis preventive treatment preferences among household contacts. We conducted three focus group discussions with 16 members of families affected by tuberculosis in Lima, Peru. Participants were asked to vote for preferred preventive treatment regimens and discuss the reasons behind their choices. Coding …

Adapting Problem Management Plus For Implementation: Lessons Learned From Public Sector Settings Across Rwanda, Peru, Mexico And Malawi, Sarah F. Coleman, Hildegarde Mukasakindi, Alexandra L. Rose, Jerome T. Galea, Beatha Nyirandagijimana, Janvier Hakizimana, Robert Bienvenue, Priya Kundu, Eugenie Uwimana, Anathalie Uwamwezi, Carmen Contreras, Fátima G. Rodriguez-Cuevas, Jimena Maza, Todd Ruderman, Emilia Connolly, Mark Chalamanda, Waste Kayira, Kingsley Kazoole, Ksakrad K. Kelly, Jesse H. Wilson, Amruta A. Houde, Elizabeth B. Magill, Giuseppe J. Raviola, Stephanie L. Smith

Social Work Faculty Publications

Problem Management Plus (PM+) is a low-intensity psychological intervention developed by the World Health Organization that can be delivered by nonspecialists to address common mental health conditions in people affected by adversity. Emerging evidence demonstrates the efficacy of PM+ across a range of settings. However, the published literature rarely documents the adaptation processes for psychological interventions to context or culture, including curriculum or implementation adaptations. Practical guidance for adapting PM+ to context while maintaining fidelity to core psychological elements is essential for mental health implementers to enable replication and scale. This paper describes the process of contextually adapting PM+ for …

A Non-Specialist Depression Care Pathway For Adolescents Living With Hiv And Transitioning Into Adult Care In Peru: A Nested, Proof Of Concept Pilot Study, Jerome T. Galea, Carmen Contreras, Milagros Wong, Karen Ramos, Valentina Vargas, Hugo Sánchez, Renato A. Errea, Leonid Lecca, Molly F. Franke

Social Work Faculty Publications

Background: Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru.

Methods: ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services.

Results: Twenty-eight (11 female, …

Identifying Barriers And Facilitators To Implementation Of Community-Based Tuberculosis Active Case Finding With Mobile X-Ray Units In Lima, Peru: A Re-Aim Evaluation, Courtney M. Yuen, Daniela Puma, Ana Karina Millones, Jerome T. Galea, Christine Tzelios, Roger I. Calderon, Meredith B. Brooks, Judith Jimenez, Carmen Contreras, Tim C. Nichols, Tom Nicholson, Leonid Lecca, Mercedes C. Becerra, Salmaan Keshavjee

Social Work Faculty Publications

Objectives: Identify barriers and facilitators to integrating community tuberculosis screening with mobile X-ray units into a health system.

Methods: Reach, effectiveness, adoption, implementation and maintenance evaluation.

Setting: 3-district region of Lima, Peru.

Participants: 63 899 people attended the mobile units from 7 February 2019 to 6 February 2020.

Interventions: Participants were screened by chest radiography, which was scored for abnormality by computer-aided detection. People with abnormal X-rays were evaluated clinically and by GeneXpert MTB/RIF (Xpert) sputum testing. People diagnosed with tuberculosis at the mobile unit were accompanied to health facilities for treatment initiation.

Primary and secondary outcome measures: Reach was …