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An Epidemic Model Structured By The Time Since Last Infection, Jorge Alturo Alfaro Murillo

Open Access Dissertations

Epidemiological models structured by time since infection have their origin in the seminal work of 1927 by Kermack and McKendrick. Compared to ordinary differential equations (ODE) models, they are able to capture differences in infectivity of the individuals in a more suitable manner. Their use declined in the second half of the 20th century, probably because the theory for ODE models is more robust, complete and has proved successful in providing insights and predictions for many epidemiological problems. Nevertheless, it is important to understand in what occasions the inclusion of time since infection may alter the outcomes in a significant …

Comparison Of Hpv Dna Testing In Cervical Exfoliated Cells And Tissue Biopsies Among Hiv-Positive Women In Kenya, Hugo De Vuyst, Michael Chung, Lacopo Baussano, Nelly R. Mugo, Vanessa Tenet, Folkert J. Van Kemenade, Farzana S. Rana, Samah R. Sakr, Chris J.L.M. Meijer, Peter J.F. Snijders, Silvia Franceschi

Pathology, East Africa

HIV-positive women are infected with human papillomavirus (HPV) (especially with multiple types), and develop cervical intraepithelial neoplasia (CIN) and cervical cancer more frequently than HIV-negative women. We compared HPV DNA prevalence obtained using a GP5+/6+ PCR assay in cervical exfoliated cells to that in biopsies among 468 HIV-positive women from Nairobi, Kenya. HPV prevalence was higher in cells than biopsies and the difference was greatest in 94 women with a combination normal cytology/normal biopsy (prevalence ratio, PR = 3.7; 95% confidence interval, CI: 2.4-5.7). PR diminished with the increase in lesion severity (PR in 58 women with high-grade squamous intraepithelial …

Racial/Ethnic Disparities In Infectious Disease Hospitalizations In Arizona, Laura Callinan, Robert Holman, Douglas Esposito, Marian Mcdonald

Journal of Health Disparities Research and Practice

Infectious disease (ID) hospitalizations in Arizona, a diverse population with nearly complete race/ethnicity data, were analyzed using the State Inpatient Database for 2005-2008. ID hospitalizations rates were calculated and compared by ID group, race/ethnicity, age, and sex. During 2005-2008, there were 383,597 ID hospitalizations reported in Arizona, resulting in an age-adjusted rate of 1498.1 per 100,000 persons. A range of racial/ethnic disparities in ID hospitalization rates were noted. Persons of Native American and black race/ethnicity had overall ID hospitalization rates higher than the rate for persons of white race/ethnicity; persons of Asian or Pacific Islander race/ethnicity had a lower rate. …

Correlates Of Hiv Acquisition In A Cohort Of Black Men Who Have Sex With Men In The United States: Hiv Prevention Trials Network (Hptn) 061, Beryl A. Koblin, Kenneth H. Mayer, Susan H. Eshleman, Lei Wang, Sharon B. Mannheimer, Carlos Del Rio, Steve Shoptaw, Manya Magnus, Susan Buchbinder, Leo Wilton, Ting-Yuan Liu, Vanessa Cummings, Estelle Piwowar-Manning, Sheldon D. Fields, Sam Griffith, Vanessa Elharrar, Darrell Wheeler

Epidemiology Faculty Publications

Background

Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.

Methods

From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional …

Population Cancer Risks Associated With Coal Mining: A Systematic Review, Wiley D. Jenkins, W. Jay Christian, Georgia Mueller, K. Thomas Robbins

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Coal is produced across 25 states and provides 42% of US energy. With production expected to increase 7.6% by 2035, proximate populations remain at risk of exposure to carcinogenic coal products such as silica dust and organic compounds. It is unclear if population exposure is associated with increased risk, or even which cancers have been studied in this regard.

METHODS: We performed a systematic review of English-language manuscripts published since 1980 to determine if coal mining exposure was associated with increased cancer risk (incidence and mortality).

RESULTS: Of 34 studies identified, 27 studied coal mining as an occupational exposure …

The Epidemiology Of Human Herpesvirus-8: Transmission Of Infection To Children In Zambian Households, Kay L. Crabtree

School of Biological Sciences: Dissertations, Theses, and Student Research

Human Herpes virus-8 (HHV-8) is the known etiologic agent for several malignant pathologies, including Kaposi’s sarcoma (KS), the most common tumor in children in sub-Saharan Africa. Saliva is implicated as the culprit of transmission; however there is a paucity of information regarding transmission to young children. In this study, we investigated the hypothesis that household behaviors exposing the susceptible child to saliva increase the risk of transmission of HHV-8 to that child.

To test our hypothesis a large prospective cohort study in Lusaka, Zambia, enrolling 464 young children and their households, was followed for 48 months. Socio-demographics, health histories, feeding …

Maximizing The Delivery Performance Of Point-Of-Care Cd4+ T-Cell Counting Tests In Resource-Limited Settings - A Policy Brief, Nan Kong, J. Paul Robinson, Fenggang Yang

Purdue Policy Research Institute (PPRI) Policy Briefs

Managing HIV/AIDS presents challenges to public health policymakers, frontline workers, and researchers worldwide. A key strategy in the disease management is early diagnosis and rapid treatment initiation. While the technological field of point‐of‐care HIV/AIDS diagnostics has advanced significantly in the past two decades, several critical issues remain that hinder the deployment of point‐of‐care testing devices in resource‐deprived settings. In this policy brief, we discuss these issues, including technological specifics of point‐of‐care CD4⁺ T‐cell counting approaches and requirements of deploying them. We also discuss cultural and religious concerns on the deployment. At the end of the brief, we propose a …

When To Start Antiretroviral Therapy: The Need For An Evidence Base During Early Hiv Infection, James D. Lundgren, Abdel G. Babiker, Fred M. Gordin, Alvaro H. Borges, James D. Neaton

Epidemiology Faculty Publications

Background

Strategies for use of antiretroviral therapy (ART) have traditionally focused on providing treatment to persons who stand to benefit immediately from initiating the therapy. There is global consensus that any HIV+ person with CD4 counts less than 350 cells/μl should initiate ART. However, it remains controversial whether ART is indicated in asymptomatic HIV-infected persons with CD4 counts above 350 cells/μl, or whether it is more advisable to defer initiation until the CD4 count has dropped to 350 cells/μl. The question of when the best time is to initiate ART during early HIV infection has always been vigorously debated. The …

Research Fatigue Among Injecting Drug Users In Karachi, Pakistan, Aysha Zahidie, Arshad Altaf, Adeel Ahsan, Tanzil Jamali

Community Health Sciences

Background

Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study …

Significant Sequelae After Bacterial Meningitis In Niger: A Cohort Study, Jean-François Jusot, Zilahatou Tohon, Abdoul Aziz Yazi, Jean-Marc Collard

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Beside high mortality, acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae. The Sahelian countries belonging to the meningitis belt experience approximately 50% of the meningitis cases occurring in the world. Studies in Africa have shown that N. meningitidis could cause hearing loss in up to 30% of the cases, exceeding sometimes measles. The situation is similar in Niger which experiences yearly meningitis epidemics and where rehabilitation wards are rare and hearing aids remain unaffordable. The aim of this study was to estimate the frequency of neuropsychological sequelae after acute bacterial meningitis in four of the …

National Estimates Of Emergency Department Visits For Pediatric Severe Sepsis In The United States, Sara Singhal, Mathias W. Allen, John-Ryan Mcannally, Kenneth S. Smith, John P. Donnelly, Henry E. Wang

Emergency Medicine Faculty Publications

Objective. We sought to determine the characteristics of children presenting to United States (US) Emergency Departments (ED) with severe sepsis.

Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes), we identified children(triage fever or ICD-9 infection) and organ dysfunction (triage hypotension or ICD-9 organ dysfunction).

Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29-0.39%). Fever and respiratory infection were the most common indicators of …

Do User Fees Increase Tuberculosis Notifications?, Chioma Y. Chukwumah

Economics Honors Projects

Public health sectors around the world strive to provide accessible and affordable care. Tight government budgets and growing populations lead countries to consider adding or raising charges to health care consumers. These user fees may affect the quality, equity and revenue of health care. This paper investigates the impact of user fees on notifications of tuberculosis. In the panel data composed of 176 countries from 1960 to 2012, I find no evidence that suggests user fees increase tuberculosis. In contrast, I find strong and robust evidence suggesting user fees are associated with fewer new cases of tuberculosis.

Assessment Of Introduction Pathway For Novel Avian Influenza Virus Into North America By Wild Birds From Eurasia, Ryan S. Miller, Steven J. Sweeney, Judy E. Akkina, Emi K. Saito

Zoonotics and Wildlife Disease: Publications

A critical question surrounding emergence of novel strains of avian influenza viruses (AIV) is the ability for wild migratory birds to translocate a complete (unreassorted whole genome) AIV intercontinentally. Virus translocation via migratory birds is suspected in outbreaks of highly pathogenic strain A(H5N1) in Asia, Africa, and Europe. As a result, the potential intercontinental translocation of newly emerging AIV (e.g. A(H7N9) from Eurasia to North America via migratory movements of birds) remains a concern. An estimated 1.48 to 2.91 million aquatic birds, principally Anseriformes (ducks, geese, and swans) and Charadriiformes (gulls, terns, and shorebirds) move annually between Eurasia and North …

Landscape Epidemiology And Machine Learning: A Geospatial Approach To Modeling West Nile Virus Risk In The United States, Sean Gregory Young

Graduate Theses and Dissertations

The complex interactions between human health and the physical landscape and environment have been recognized, if not fully understood, since the ancient Greeks. Landscape epidemiology, sometimes called spatial epidemiology, is a sub-discipline of medical geography that uses environmental conditions as explanatory variables in the study of disease or other health phenomena. This theory suggests that pathogenic organisms (whether germs or larger vector and host species) are subject to environmental conditions that can be observed on the landscape, and by identifying where such organisms are likely to exist, areas at greatest risk of the disease can be derived. Machine learning is …

Identifikasi Vektor Malaria, Solikhah Solikhah

Kesmas

Kabupaten Kulonprogo merupakan salah satu daerah endemis malaria di Daerah Istimewa Yogyakarta dan Jawa Tengah. Lonjakan jumlah kasus malaria terjadi hampir dua kali lipat sejak tahun 2010 hingga bulan Agustus 2011. Penelitian ini bertujuan untuk mengetahui jenis Plasmodium pada penyakit malaria. Penelitian eksplorasi ini menggunakan desain studi cross sectional. Diagnosis kasus malaria diperiksa menggunakan pemeriksaan darah tebal secara mikroskopis dan untuk mengetahui faktor sosiodemografi dilakukan wawancara menggunakan kuesioner. Populasi studi adalah penduduk di wilayah Kabupaten Kulonprogo yang diambil secara proporsional pada bulan Januari sampai bulan Juni 2012. Data dianalisis secara univariat dalam bentuk grafik dan tabulasi. Hasil penelitian ini adalah …

Progress Realized: Trends In Hiv-1 Viral Load And Cd4 Cell Count In A Tertiary-Care Center From 1999 Through 2011, Howard B. Gale, Manuel D. Rodriguez, Heather J. Hoffman, Debra A. Benator, Fred M. Gordin, Ann M. Labriola, Virginia L. Kan

Epidemiology Faculty Publications

Abstract

Accumulating evidence suggests that alterations in immune function may be important in the etiology of papillary thyroid cancer (PTC). To identify genetic markers in immune-related pathways, we evaluated 3,985 tag single nucleotide polymorphisms (SNPs) in 230 candidate gene regions (adhesion-extravasation-migration, arachidonic acid metabolism/eicosanoid signaling, complement and coagulation cascade, cytokine signaling, innate pathogen detection and antimicrobials, leukocyte signaling, TNF/NF-kB pathway or other) in a case-control study of 344 PTC cases and 452 controls. We used logistic regression models to estimate odds ratios (OR) and calculate one degree of freedom P values of linear trend (PSNP-trend) for the association …

Impact Of The Tohoku Earthquake And Tsunami On Pneumonia Hospitalisations And Mortality Among Adults In Northern Miyagi, Japan: A Multicentre Observational Study, Hisayoshi Daito, Motoi Suzuki, Jun Shiihara, Paul E. Kilgore, Hitoshi Ohtomo, Konosuke Morimoto, Masayuki Ishida, Taro Kamigaki, Hitoshi Oshitani, Masahiro Hashizume, Wataru Endo, Koichi Hagiwara, Koya Ariyoshi, Shoji Okinaga

Department of Pharmacy Practice

Background On 11 March 2011, the Tohoku earthquake and tsunami struck off the coast of northeastern Japan. Within 3 weeks, an increased number of pneumonia admissions and deaths occurred in local hospitals.

Methods A multicentre survey was conducted at three hospitals in Kesennuma City (population 74000), northern Miyagi Prefecture. All adults aged ≥18 years hospitalised between March 2010 and June 2011 with community-acquired pneumonia were identified using hospital databases and medical records. Segmented regression analyses were used to quantify changes in the incidence of pneumonia.

Results A total of 550 pneumonia hospitalisations were identified, including 325 during the pre-disaster period …

Faktor Risiko Diare Shigellosis Pada Anak Balita, A. Zulkifli Abdullah, A. Arsunan Arsin, Lidyawati Dahlan

Kesmas

Diare shigellosis pada balita merupakan masalah serius sebab dapat menyebabkan kematian. Untuk mengetahui faktor-faktor risiko kejadian shigellosis pada anak balita dilakukan studi kasus kontrol di beberapa rumah sakit di Kota Makassar dengan 68 kasus dan 136 kontrol. Data mengenai jenis kelamin dan status gizi anak balita, pemberian air susu ibu (ASI) eksklusif, status ekonomi, pendidikan ibu, kebiasaan ibu mencuci tangan memakai sabun, kepadatan hunian rumah, sarana air bersih, danjamban keluarga dikumpulkan dengan wawancara dan observasi serta dikategorikan dan disaring (screening) dengan uji chi square. Enam variabel dengan nilai p < 0,25 dimasukkan dalam uji regresi logistik yang menghasilkan variabel dengan nilai p < 0,05 (gizi rendah, ASI tidak eksklusif, dan status ekonomi rendah). Uji regresi logistik tahap kedua dengan 3 variabel ini menghasilkan model shigellosis = 1,47 gizi rendah + 1,471 ASI tidak eksklusif + 1,022 status ekonomi rendah - 2,546 dengan nilai oddsratio (OR) = 4,352 (gizi rendah), 4,353 (ASI tidak eksklusif), dan 2,779 (status ekonomi rendah). Studi ini menyimpulkan bahwa gizi balita yang rendah, pemberian ASI yang tidak eksklusif, dan status ekonomi ibu yang rendah merupakan faktor-faktor risiko penting kejadian diare shigellosis pada balita.

Shigellosis diarrhea is a serious issue to children under five years …

Modeling The Impact And Costs Of Semiannual Mass Drug Administration For Accelerated Elimination Of Lymphatic Filariasis, Wilma A. Stolk, Quirine A. Ten Bosch, Sake J. De Vlas, Peter U. Fischer, Gary J. Weil, Ann S. Goldman

Epidemiology Faculty Publications

The Global Program to Eliminate Lymphatic Filariasis (LF) has a target date of 2020. This program is progressing well in many countries. However, progress has been slow in some countries, and others have not yet started their mass drug administration (MDA) programs. Acceleration is needed. We studied how increasing MDA frequency from once to twice per year would affect program duration and costs by using computer simulation modeling and cost projections. We used the LYMFASIM simulation model to estimate how many annual or semiannual MDA rounds would be required to eliminate LF for Indian and West African scenarios with varied …

Molecular Epidemiology Of Early And Acute Hiv Type 1 Infections In The United States Navy And Marine Corps, 2005–2010, Richard A. Heipertz, Eric Sanders-Buell, Gustavo Kijak, Shana Howell, Michelle Lazzaro, Linda L. Jagodzinski, John Eggleston, Sheila Peel, Jennifer Malia, Adam Armstrong, Nelson L. Michael, Jerome H. Kim, Robert J. O'Connell, Paul T. Scott, David Brett-Major, Sodsai Tovanabutra

Journal Articles: Epidemiology

The U.S. military represents a unique population within the human immunodeficiency virus 1 (HIV-1) pandemic. The last comprehensive study of HIV-1 in members of the U.S. Navy and Marine Corps (Sea Services) was completed in 2000, before large-scale combat operations were taking place. Here, we present molecular characterization of HIV-1 from 40 Sea Services personnel who were identified during their seroconversion window and initially classified as HIV-1 negative during screening. Protease/reverse transcriptase (pro/rt) and envelope (env) sequences were obtained from each member of the cohort. Phylogenetic analyses were carried out on these regions to determine relatedness within the cohort and …

Combating Sti Epidemic: Community Perspectives Learned From Mixed-Gender Focus Group Study, K. M. M. Islam, Laura C. Vinson, Sherri Nared, Ira Combs, Melissa Tibbits, Shinobu Watanabe-Galloway, Ruth Margalit

Journal Articles: Epidemiology

Background. Since 2004, Douglas County in Nebraska has been experiencing higher rates of sexually transmitted infections (STIs) than the rest of the state. Northern Omaha has been considered to be one of the “hot spots” for STIs in the county. In 2011-2012, a focus group study was conducted to investigate the community’s perception of STIs and to identify strategies to increase the testing and treatment of STIs. Methods. Fourteen young adults were recruited to participate in two mixed-gender focus group sessions, each lasting 1.5 hours. Sessions covered various topics on STIs. Audio-recorded sessions were transcribed and analyzed by …

Comparing Two-Year Community College And Four-Year University Student Social And Behavioral Sexually Transmitted Infection Risk Factors, Oswald M. Attin

Faculty Dissertations

Sexually transmitted infections (STIs) could cause ectopic, cervical cancer, infertility, and organ damage to the heart, kidneys, and brain. This study compared several behavioral risk factors of STIs (condom use, number of sexual partners, type of sex (anal or vaginal) and drinking habits) between two distinct educational settings and their association with socioeconomic risk factors such as low income and parent’s lower level of education that are known to increase the incidence of STIs among college-aged students. This study was based on the precautionary-health-behavior model, where individuals act regardless of consequences, and the health-behavior-change model, where individual behaviors either increase …

Condom Negotiation Across Different Relationship Types By Young Women Engaged In Sex Work In Phnom Penh, Cambodia, Lisa Maher, Julie Mooney-Somers, Pisith Phlong, Marie-Claude Couture, Serey Serey Kien, Ellen Stein, Anna Juong Bates, Neth Sansothy, Kimberly Page, Young Women's Health Study Collaborative

Nursing and Health Professions Faculty Research and Publications

Cambodia’s 100% Condom Use Programme is credited with an increase in consistent condom use in commercial sexual interactions and a decrease in HIV prevalence among female sex workers (FSWs). There has been little improvement in condom use between FSWs and non-commercial partners, prompting calls for more innovative approaches to increasing condom use in these relationships. To understand why condoms are used or not used in sexual interactions involving FSWs, we examined condom negotiation across different types of relationships. We conducted 33 in-depth interviews with young (15 to 29 years) women engaged in sex work in Phnom Penh. There was an …

Information And Communication Technology To Link Criminal Justice Reentrants To Hiv Care In The Community, Ann Kurth, Irene Kuo, James Peterson, Nkiru Azikiwe, Lauri Bazerman, Alice Cates, Curt G. Beckwith

Epidemiology Faculty Publications

The United States has the world’s highest prison population, and an estimated one in seven HIV-positive persons in the USA passes through a correctional facility annually. Given this, it is critical to develop innovative and effective approaches to support HIV treatment and retention in care among HIV-positive individuals involved in the criminal justice (CJ) system. Information and communication technologies (ICTs), including mobile health (mHealth) interventions, may offer one component of a successful strategy for linkage/retention in care. We describe CARE+ Corrections, a randomized controlled trial (RCT) study now underway in Washington, that will evaluate the combined effect of computerized motivational …

Transmission Potential Of Influenza A/H7n9, February To May 2013, China, Gerardo Chowell, Lone Simonsen, Sherry Towers, Mark A. Miller, Cecile G. Viboud

Epidemiology Faculty Publications

Background

On 31 March 2013, the first human infections with the novel influenza A/H7N9 virus were reported in Eastern China. The outbreak expanded rapidly in geographic scope and size, with a total of 132 laboratory-confirmed cases reported by 3 June 2013, in 10 Chinese provinces and Taiwan. The incidence of A/H7N9 cases has stalled in recent weeks, presumably as a consequence of live bird market closures in the most heavily affected areas. Here we compare the transmission potential of influenza A/H7N9 with that of other emerging pathogens and evaluate the impact of intervention measures in an effort to guide pandemic …

A Case–Control Study Of Incident Rheumatological Conditions Following Acute Gastroenteritis During Military Deployment, Kathryn Deyoung, Mark A. Riddle, Larissa S. May, Chad K. Porter

Epidemiology Faculty Publications

Objectives The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis.

Design This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population.

Setting We analysed health records of personnel deployed to Iraq or Afghanistan, including …

Alternative Vaccination Schedules (Avs) : Detection Of Avs In New York State Using Immunization Registry Data, Jessica A. Nadeau

Legacy Theses & Dissertations (2009 - 2024)

Intentional deviation from the recommended childhood vaccine schedule (RVS), referred to as an alternative vaccination schedule (AVS) is becoming increasingly prevalent in the United States. Physicians may accommodate vaccine-hesitant parents with an AVS as a compromise position to allow some vaccinations to be given, but in doing so children remain vulnerable to vaccine-preventable disease for a longer period of time. This research expands upon the nascent literature by proposing a unified definition of AVS, quantifying the prevalence of infants following an AVS in New York State (NYS) (exclusive of New York City) by geographic area and community and medical practice …

Exposure To Persistent Organic Pollutants And Metabolic Diseases, Zafar Zayirovich Aminov

Legacy Theses & Dissertations (2009 - 2024)

Background: The metabolic syndrome (MetS) is a group of diseases that tend to occur together, including diabetes, hypertension, central obesity, cardiovascular disease and hyperlipidemia. Exposure to persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) have been associated with increased risk of development of several of the components of the MetS.

Quantitative Evaluation Of Antibiotic Exposure-Response Relationships Among Patients With Serious Staphylococcal Infections, Thomas Patrick Lodise

Legacy Theses & Dissertations (2009 - 2024)

This dissertation advances our understanding of antimicrobial exposure-response relationships among patients with serious infections due to Staphylococcus aureus. The need is pressing as treatment of this invasive pathogen has been complicated by the development of antibiotic resistance. One antibiotic resistant phenotype of particular concern is methicillin-resistant S. aureus (MRSA). Due to the multi-drug resistant nature of most MRSA strains, vancomycin emerged as the cornerstone of therapy. Although widely used for serious MRSA infections, many clinicians now question its continued utility due to the emergence of MRSA strains with reduced vancomycin susceptibility phenotypes (rVSPs). The literature is developing rapidly, but characterization …

The Potential For Bridging : Hiv Status Awareness And Risky Sexual Behavior Of Injection Drug Users Who Have Non-Injecting Permanent Partners In Ukraine, Alyona Mazhnaya

Legacy Theses & Dissertations (2009 - 2024)

Abstract