Medicine and Health Sciences Commons^™

Access To Hiv Prevention, Care, And Treatment Services In The Us: The Role Of Primary Care, Jessica S. Kiernan

Theses and Dissertations

This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, …

Still, We Thrive: Understanding How Gay, Bisexual, Transgender, And Other Men Who Have Sex With Men (Gbtmsm) Experience Structural Barriers & Facilitators To Wellness, Lucas Gergyek

Theses and Dissertations (Comprehensive)

Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, …

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

Electronic Theses and Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

Emerging Viral Diseases: Generation Z'S Outlook, Ian Mcwhorter

Honors Projects

Generation Z differs notably from previous generations like Baby Boomers or Generation X. In recent years, young adults have been persisting through the COVID-19 pandemic, though not unscathed. This paper seeks to answer the following question: How does Generation Z differ in its outlook on Viral diseases compared to previous generations? Using a series of three surveys conducted on three seperate Viral diseases (HIV, Zika, and COVID 19), it was found that while Generation Z has improved in its ability to combat Viral outbreaks due to factors like high digital literacy, other factors such as poorer mental health show that …

Exploration Of The Complex Relationship Among Multilevel Predictors Of Prep Use Among Men Who Have Sex With Men In The United States, Kristina M. Rodriguez

Dissertations and Theses

Background: Men who have sex with men (MSM) remain the group most heavily affected by HIV in the United States (US), with MSM of color further disproportionately represented. In July 2012, the US Food and Drug Administration (FDA) approved the use of tenofovir disoproxil fumarate plus emtricitabine (TDF-FTC, Truvada) for use as pre-exposure prophylaxis (PrEP) in HIV-negative adults who are at high-risk of HIV infection. Despite its effectiveness, PrEP prescriptions are reaching only a small proportion of those who could benefit from the drug and prescription rates vary both by race and geographic region. The goal of this dissertation was …

“Do You Think I Should Be Worried?” Building A Call Structure For Hiv(-) Callers To The Nightline, Ivy Epstein

Master's Projects and Capstones

Abstract

San Francisco Suicide Prevention’s HIV Nightline provides emotional support to those living with human immunodeficiency virus (HIV) as well as support and basic medical information around relative risk and testing for who may have been exposed to HIV. Nightline counselors use a harm-reduction model, active listening, reflection of emotions, and encouragement to promote health maintenance and mental health self-care behaviors. Until now, there has been no process to assess whether callers had disproportionate anxiety about HIV given their actual risk level. Consequently, HIV(-) anxious callers could receive inconsistent information. The goal of this improvement study was to develop a …

Predictors Of Anemia Among Hiv Patients In Uganda, Catherine Nagawa

Masters Theses

HIV-related anemia is associated with increased risk of death. Prior studies suggest an inverse relationship between CD4 cell count and anemia, and a positive relationship between HIV-clinical stage and anemia. However, none have assessed the role of antiretroviral therapy (ART) treatment combinations in these relationships. Therefore, we conducted a cross-sectional study to evaluate the relationship between CD4 cell count, HIV clinical stage and anemia among 4803 Ugandan HIV-patients, and assessed the role of ART treatment combinations. We included HIV patients (> 15 years) receiving ART therapy combinations between 2010- 2015. We evaluated CD4 cell count and anemia using blood tests, …

Retention In Health: Improving Hiv Retention Within The Sf Community Health Network, Miguel A. Ibarra

Master's Projects and Capstones

Previous work on HIV retention improvement has focused on improving access to care for communities who are either at-risk of falling out of care or who have difficulty engaging in medical care for the first time due to socio-cultural barriers. The San Francisco Department of Public Health (SFDPH), with the support of Project PRIDE, a CDC three-year demonstration project geared towards supporting health departments in implementing public health strategies to reduce new HIV infections within the men who have sex with men (MSM) and transgender communities, is seeking to improve HIV patient retention throughout the San Francisco Community Health Network …

Multilevel Analysis Of Individual, Neighborhood, And Health Care Facility Characteristics Associated With Achievement And Maintenance Of Hiv Viral Suppression Among Persons Newly Diagnosed With Hiv In New York City, Ellen W. Wiewel

Dissertations, Theses, and Capstone Projects

Objective

To investigate the effect of individual, health care facility, and neighborhood characteristics on achievement and maintenance of HIV viral suppression, among New York City residents aged 13 years and older diagnosed with HIV between 2006 and 2012.

Methods

I used individual-level data from the New York City HIV surveillance registry and Case Surveillance-Based Sampling, facility-level data from the surveillance registry, and neighborhood-level data from the U.S. Census and American Community Survey. The outcomes of interest were first viral suppression after diagnosis (Aims 1 and 3; ≤400 copies/mL) and virologic failure after first suppression among persons who achieved suppression (Aim …