Scholars@Duke
Jan Ostermann

Jan Ostermann

Adjunct Associate Professor of Global Health
Duke Global Health Institute
Box 90392, Durham, NC 27708
310 Trent Drive, #313, Durham, NC 27708

Selected Publications

Design of an Automated Mobile Phone-Based Reminder and Incentive System: Application in a Quasi-Randomized Controlled Trial to Improve the Timeliness of Childhood Vaccinations in Tanzania.

Journal Article JMIR Form Res · September 10, 2025 BACKGROUND: The global penetration of mobile phones has offered novel opportunities for communicating health-related information to individuals. A low-cost system that facilitates autonomous communication with individuals via mobile phones holds potential ... Full text Link to item Cite

What drives advanced practice nurses to stay in rural America? Insights from the 2022 National Survey of Registered Nurses.

Journal Article The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · September 2025 PurposeRecruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to wor ... Full text Cite

To Whom Will You Send Automated Confidential SMS Invitations to Test for HIV? Results From an Acceptability Pilot Study in Northern Tanzania.

Journal Article Sex Transm Dis · August 1, 2025 The Confidential Social Network Referrals for HIV Testing (CONSORT) intervention leverages the ubiquity of mobile phones and social networks to nudge at-risk populations to test for HIV. Pilot results suggest that confidential SMS testing invitations are a ... Full text Link to item Cite

Telehealth or in-person HIV care? Qualitative study findings on decision-making from people with HIV and HIV care providers in South Carolina during the COVID-19 pandemic.

Journal Article PLOS digital health · April 2025 The COVID-19 pandemic disrupted HIV care services across the United States. Telehealth was rapidly implemented to ensure HIV care continuity. Despite the evidence of unequal telehealth uptake among some people with HIV (PWH), the decision-making processes ... Full text Cite

Rural-urban disparities in human papillomavirus vaccination: Findings from a cross-sectional survey of 13 southern US states, December 2019-January 2020.

Journal Article J Rural Health · March 2025 BACKGROUND: Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural-urban disparities in HPV vaccination coverage ... Full text Link to item Cite

Exploring perceptions of the services offered in Tanzanian sober houses: a mixed- methods study among service users and providers.

Journal Article BMC Health Serv Res · February 14, 2025 BACKGROUND: In Tanzania, residential treatment centers for alcohol and other drugs, locally known as "sober houses," play a critical role in the treatment of people living with a substance use disorder (SUD), but little is known about the services they off ... Full text Link to item Cite

A discrete choice experiment with health professions trainees to improve the urban-rural health care access disparity in Appalachia: Study protocol.

Journal Article PloS one · January 2025 Globally, those who live in rural areas experience significant barriers to accessing health care due to a maldistribution of health care providers. Those who live in rural areas in the Appalachian region of the United States face one of the worst shortages ... Full text Cite

Variation in subsequent viral load testing and outcomes by visit type patterns in the first year of the COVID-19 pandemic at a large academic medical center in North Carolina.

Journal Article Mhealth · 2025 While telehealth was widely used to provide human immunodeficiency virus (HIV) care during the coronavirus disease 2019 (COVID-19) pandemic, research evaluating viral suppression by visit type is conflicting. This study assessed variation in viral load (VL ... Full text Link to item Cite

Telehealth and in-person HIV care during the COVID-19 pandemic at a large academic medical center in North Carolina.

Journal Article PLoS One · 2025 BACKGROUND: To maintain HIV care during the COVID-19 pandemic, many HIV clinics across the United States adopted telehealth. However, not everyone participated in telehealth equally. This study assessed the use and disparities in telehealth and in-person H ... Full text Link to item Cite

A qualitative study about the public's perception of primary care providers.

Journal Article JAAPA : official journal of the American Academy of Physician Assistants · December 2024 ObjectiveWith the growth of physician associates/assistants (PAs) and NPs providing primary care services, we sought to understand the public's perception of the different types of healthcare providers (HCPs) they might encounter in a clinical set ... Full text Cite

Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia.

Journal Article AIDS care · June 2024 This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. ... Full text Cite

Disparities in Telehealth Use in HIV Care During the COVID-19 Pandemic: Study Findings from South Carolina.

Journal Article Telemedicine journal and e-health : the official journal of the American Telemedicine Association · June 2024 Background: Telehealth was adopted to maintain HIV care continuity during the COVID-19 pandemic; however, its use was unequally distributed. This study examined variation in HIV care visit patterns and whether telehealth use was associated wi ... Full text Cite

Mobile Phone-Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial.

Journal Article JMIR Res Protoc · May 30, 2024 BACKGROUND: Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social n ... Full text Link to item Cite

Physician-Patient Interaction Quality Mediates the Association Between HIV-Related Stigma and HIV-Prevention Behaviors Among Sexual Minority Men in Zambia.

Journal Article AIDS and behavior · May 2024 HIV-related stigma is a major challenge to HIV prevention for sexual minority men (SMM) in Zambia, but little is known about the underlying mechanisms. This study aimed to investigate whether physician-patient interaction quality mediates the relationship ... Full text Cite

Which Features of Telehealth in HIV Care Are Most Important? A Mixed-Methods Study With HIV Care Providers and People Living With HIV in South Carolina.

Journal Article Sexually transmitted diseases · May 2024 AbstractTelehealth was rapidly implemented in HIV care during COVID-19 yet remains understudied. To assess the importance of telehealth features, we conducted a mixed-methods study with HIV care providers and people living with HIV. Qualitative in ... Full text Cite

Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia.

Journal Article Archives of psychiatric nursing · February 2024 Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, subs ... Full text Cite

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study.

Journal Article JMIR Res Protoc · January 12, 2024 BACKGROUND: Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with child ... Full text Link to item Cite

Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research.

Conference Patient · January 2024 Health preference research (HPR) is being increasingly conducted to better understand patient preferences for medical decisions. However, patients vary in their desire to play an active role in medical decisions. Until now, few studies have considered pati ... Full text Link to item Cite

Predictors of prior HIV testing and acceptance of a community-based HIV test offer among male bar patrons in northern Tanzania.

Journal Article PLOS Glob Public Health · 2024 Community-based HIV testing offers an alternative approach to encourage HIV testing among men in sub-Saharan Africa. In this study, we evaluated a community-based HIV testing strategy targeting male bar patrons in northern Tanzania to assess factors predic ... Full text Link to item Cite

A comparison of assessment tools for childcare centers in high vs. low resource settings.

Journal Article Frontiers in public health · January 2024 Studies suggest issues may arise when using childcare setting assessment tools designed for high-resource settings in low-resource settings to assess and improve the quality of care, including placing disproportionate weight on features of the childcare en ... Full text Cite

The Future of Telehealth in Human Immunodeficiency Virus Care: A Qualitative Study of Patient and Provider Perspectives in South Carolina.

Journal Article AIDS patient care and STDs · October 2023 To ensure care continuity during the COVID-19 pandemic, telehealth has been widely implemented in human immunodeficiency virus (HIV) care. However, participation in and benefits from telehealth were unequal. This study aims to assess the willingness of peo ... Full text Cite

Divergent preferences for enhanced HIV testing options among high-risk populations in northern Tanzania: a short report.

Journal Article AIDS Care · September 2023 To achieve the UNAIDS target of diagnosing 95% of all persons living with HIV, enhanced HIV testing services with greater attractional value need to be developed and implemented. We conducted a discrete choice experiment (DCE) to quantify preferences for e ... Full text Link to item Cite

American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018.

Journal Article Cancer causes & control : CCC · September 2023 Purpose(1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in ... Full text Cite

Associations Between Clinic-Based HIV Testing Guidelines and Population-Level HIV Testing Rates in the United States.

Journal Article The Journal of the Association of Nurses in AIDS Care : JANAC · July 2023 AbstractBetween 2005 and 2006, the United States Preventive Services Task Force and the Centers for Disease Control and Prevention revised their risk-based HIV testing guidelines to include universal HIV testing in routine health care. We examined ... Full text Cite

How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples.

Journal Article Glob Health Sci Pract · April 28, 2023 BACKGROUND: Asset-based indices of living standards, or wealth indices, are widely used proxies for economic status; however, such indices are not readily available for small and nonrepresentative samples. METHODS: We describe a simple out-of-sample predic ... Full text Link to item Cite

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania.

Journal Article Vaccine: X · April 2023 BackgroundGlobally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers ... Full text Cite

Ageing with HIV in the United States: Changing trends in inpatient hospital stays and comorbidities, 2003-2015.

Journal Article HIV medicine · January 2023 IntroductionAs people with HIV (PWH) age, they experience prolonged exposure to HIV and antiretroviral therapy, increased risks of developing age-related HIV-associated non-AIDS (HANA) comorbidities and higher rates of hospitalization. Few studies ... Full text Cite

Patient attitudes and beliefs associated with self-referral to physical therapy for musculoskeletal complaints: a qualitative study.

Journal Article BMC health services research · January 2023 BackgroundNon-pharmacologic treatments such as physical therapy (PT) are advocated for musculoskeletal pain. Early access to PT through self-referral has been shown to decrease costs and improve outcomes. Although self-referral is permitted in mos ... Full text Cite

The association between urban greenspace and psychological health among young adults in Addis Ababa, Ethiopia.

Journal Article Environmental research · December 2022 IntroductionPsychological disorders are emerging as health priorities in Sub-Saharan Africa, specifically Ethiopia. Urban greenspace - parks, trees, and other vegetation integrated into urban form - may facilitate population psychological health, ... Full text Cite

Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania.

Journal Article Sex Transm Dis · November 1, 2022 Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of t ... Full text Link to item Cite

Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania.

Journal Article Vaccine · September 2022 BackgroundTimely vaccination maximizes efficacy for preventing infectious diseases. In the absence of national vaccination registries, representative sample survey data hold vital information on vaccination coverage and timeliness. This study char ... Full text Cite

Job attributes valued by physicians, PAs, and NPs: A cross-sectional survey.

Journal Article JAAPA : official journal of the American Academy of Physician Assistants · September 2022 ObjectiveThis study evaluated the relative importance of job-, community-, and individual-related factors that contribute to job choice among physicians, physician assistants (PAs), and NPs, to inform policy options to recruit clinicians to rural ... Full text Cite

Association of caregiver attitudes with adolescent HPV vaccination in 13 southern US states.

Journal Article Vaccine X · August 2022 BACKGROUND AND OBJECTIVES:  HPV vaccination coverage is lower than that of other adolescent vaccines in the southern US. This study sought to characterize caregiver attitudes associated with adolescent HPV vaccination in the southern US and to inform inter ... Full text Link to item Cite

A discrete choice experiment investigating HIV testing preferences in South Africa.

Journal Article Journal of medical economics · January 2022 BackgroundSouth Africa (SA) has the world's highest burden of HIV infection, with an estimated 13.7% of the population living with HIV (PLWH/Persons Living With HIV). The early identification of PLWH and rapid engagement of them in HIV treatment a ... Full text Cite

A Cross-Sectional, Mixed-Methods Analysis to Identify the Relative Importance of Factors Students and Providers Evaluate When Making a Job Choice.

Journal Article Journal of health care for the poor and underserved · January 2022 Little is known about the relative importance of factors that contribute to job choices among health care providers. A convenience sample of 173 health care providers (N=134) and physician assistant students (N=39) completed a cross-sectional survey. Parti ... Full text Cite

Predictors of HPV vaccination in the southern US: A survey of caregivers from 13 states.

Journal Article Vaccine · December 17, 2021 BACKGROUND AND OBJECTIVES: Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the so ... Full text Link to item Cite

Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment.

Journal Article Journal of the International AIDS Society · October 2021 IntroductionNo studies from sub-Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community ("releasees"). We conducted a discrete choice exper ... Full text Cite

Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ).

Journal Article Am J Health Behav · September 30, 2021 Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human ... Full text Link to item Cite

What factors influence HIV testing? Modeling preference heterogeneity using latent classes and class-independent random effects.

Journal Article J Choice Model · September 2021 Efforts to eliminate the HIV epidemic will require increased HIV testing rates among high-risk populations. To inform the design of HIV testing interventions, a discrete choice experiment (DCE) with six policy-relevant attributes of HIV testing options eli ... Full text Link to item Cite

Increasing the Uptake of HIV Testing among Men in Tanzania: A Novel Intervention for Bar Patrons.

Journal Article AIDS Behav · July 2021 We investigated a novel community-based HIV testing and counseling (HTC) strategy by recruiting men from bars in northern Tanzania in order to identify new HIV infections. All bars in the town of Boma Ng'ombe were identified and male patrons were systemati ... Full text Link to item Cite

Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries.

Journal Article Int J Public Health · 2021 Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes. Methods: We used the longitudinal, m ... Full text Link to item Cite

Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations.

Journal Article BMJ Open · November 6, 2020 INTRODUCTION: Approximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk po ... Full text Link to item Cite

Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study.

Journal Article BMC public health · October 2020 BackgroundVaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was t ... Full text Cite

Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

Journal Article Open Forum Infect Dis · September 2020 BACKGROUND: The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. METHODS: PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospe ... Full text Open Access Link to item Cite

Health Preference Research in Europe: A Review of Its Use in Marketing Authorization, Reimbursement, and Pricing Decisions-Report of the ISPOR Stated Preference Research Special Interest Group.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · July 2020 ObjectiveThis study examines European decision makers' consideration and use of quantitative preference data.MethodsThe study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbur ... Full text Cite

Heterogeneous Patient Preferences for Modern Antiretroviral Therapy: Results of a Discrete Choice Experiment.

Journal Article Value Health · July 2020 OBJECTIVE: Limited data describe patient preferences for the growing number of antiretroviral therapies (ARTs). We quantified preferences for key characteristics of modern ART deemed relevant to shared decision making. METHODS: A discrete choice experiment ... Full text Link to item Cite

Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey.

Journal Article JMIR mHealth and uHealth · April 2020 BackgroundThere is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions.ObjectiveThe aim of this study is to assess patterns of mobile phone owne ... Full text Cite

Predictors of mortality in treatment experienced HIV-infected patients in northern Tanzania.

Journal Article PLoS One · 2020 BACKGROUND: While factors that drive early mortality among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in sub-Saharan Africa (SSA) have been described, less is known about the predictors of long-term mortality for those with ART e ... Full text Link to item Cite

Do mobile phone-based reminders and conditional financial transfers improve the timeliness of childhood vaccinations in Tanzania? Study protocol for a quasi-randomized controlled trial.

Journal Article Trials · July 2019 BackgroundVaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. To be fully protected from diseases such as tuberculosis, diphtheria, pertussis, and polio, children must receive all recomme ... Full text Cite

A discrete choice experiment to investigate patient preferences for HIV testing programs in Bogotá, Colombia.

Journal Article Expert review of pharmacoeconomics & outcomes research · April 2019 BackgroundTo assess patients' preferences for HIV testing in Colombia.MethodsA discrete choice experiment was used to assess preferences of patients diagnosed with HIV, for HIV testing in two HIV clinics in Bogotá, Colombia. Patients were ... Full text Cite

Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies.

Journal Article Open Forum Infect Dis · October 2018 Study participants were asked about their interest in switching to novel drug delivery systems that reduce the dosing frequency of antiretroviral regimens. Across a diverse, treatment-experienced cohort, we describe greatest interest in switching to an ora ... Full text Link to item Cite

A Mixed Methods Approach to Understanding Antiretroviral Treatment Preferences: What Do Patients Really Want?

Journal Article AIDS Patient Care STDS · September 2018 As the number of effective antiretroviral therapy (ART) options increases, there is greater opportunity to involve HIV patients in ART selection. To establish the parameters for a shared ART decision-making process, we sought to identify ART characteristic ... Full text Link to item Cite

Sociocultural and health system factors associated with mortality among febrile inpatients in Tanzania: a prospective social biopsy cohort study.

Journal Article BMJ Glob Health · 2018 INTRODUCTION: Communicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Ta ... Full text Link to item Cite

Health Preference Research: An Overview.

Journal Article The patient · August 2017 Full text Cite

Civic engagement among orphans and non-orphans in five low- and middle-income countries.

Journal Article Global Health · October 11, 2016 BACKGROUND: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable popula ... Full text Open Access Link to item Cite

Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania.

Journal Article BMC Infect Dis · September 20, 2016 BACKGROUND: Linkage to HIV care is crucial to the success of antiretroviral therapy (ART) programs worldwide, loss to follow up at all stages of the care continuum is frequent, and long-term prospective studies of care linkage are currently lacking. METHOD ... Full text Open Access Link to item Cite

Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries.

Journal Article AIDS Care · July 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millio ... Full text Link to item Cite

Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania.

Journal Article Health Econ Rev · December 2015 OBJECTIVES: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we ... Full text Link to item Cite

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

Journal Article Glob Health Sci Pract · August 25, 2015 BACKGROUND: Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care s ... Full text Link to item Cite

One size does not fit all: HIV testing preferences differ among high-risk groups in Northern Tanzania.

Journal Article AIDS Care · 2015 In order to maximize the effectiveness of "Seek, Test, and Treat" strategies for curbing the HIV epidemic, new approaches are needed to increase the uptake of HIV testing services, particularly among high-risk groups. Low HIV testing rates among such group ... Full text Link to item Cite

HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania.

Journal Article AIDS Care · 2015 HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatmen ... Full text Link to item Cite

Adverse childhood experiences, psychosocial well-being, and cognitive development among orphans and abandoned children in five low income countries

Chapter · January 1, 2015 The plight of orphansa and abandoned children (OAC) is an increasing global problem that is particularly pervasive in Southeast Asia and sub-Saharan Africa [1]. Improving the educational attainment of the 153 million orphans and other vulnerable children w ... Full text Cite

Enhancing linkage and retention in HIV care: a review of interventions for highly resourced and resource-poor settings.

Journal Article Curr HIV/AIDS Rep · December 2014 Given the widespread availability of effective antiretroviral therapy, engagement of HIV-infected persons in care is a global priority. We reviewed 51 studies, published in the past decade, assessing strategies for improving linkage to and retention in HIV ... Full text Link to item Cite

Treating maladaptive grief and posttraumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive-behavioral therapy.

Journal Article Journal of traumatic stress · December 2014 This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic s ... Full text Cite

HIV testing preferences in Tanzania: a qualitative exploration of the importance of confidentiality, accessibility, and quality of service.

Journal Article BMC Public Health · August 12, 2014 BACKGROUND: HIV counseling and testing (HCT), an effective preventive strategy and an entry point for care, remains under-utilized in Tanzania. Limited uptake of HCT, despite the widespread availability of varied testing options, suggests that existing opt ... Full text Link to item Cite

Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer.

Journal Article J Acquir Immune Defic Syndr · March 1, 2014 : The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo ... Full text Link to item Cite

Adverse childhood experiences, psychosocial well-being and cognitive development among orphans and abandoned children in five low income countries.

Journal Article BMC international health and human rights · March 2014 BackgroundDevelopment policymakers and child-care service providers are committed to improving the educational opportunities of the 153 million orphans worldwide. Nevertheless, the relationship between orphanhood and education outcomes is not well ... Full text Cite

Child and Caregiver Concordance of Potentially Traumatic Events Experienced by Orphaned and Abandoned Children.

Journal Article Vulnerable Child Youth Stud · 2014 Exposure to trauma is associated with significant emotional and behavioral difficulties among children (Perepletchikova & Kaufman, 2010). Overall, reports of trauma and violence experienced by children are discrepant from those of their caregivers (Lewis e ... Full text Link to item Cite

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania.

Journal Article AIDS Care · 2014 Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and trea ... Full text Link to item Cite

Heterogeneous HIV testing preferences in an urban setting in Tanzania: results from a discrete choice experiment.

Journal Article PLoS One · 2014 BACKGROUND: Efforts to reduce Human Immunodeficiency Virus (HIV) transmission through treatment rely on HIV testing programs that are acceptable to broad populations. Yet, testing preferences among diverse at-risk populations in Sub-Saharan Africa are poor ... Full text Link to item Cite

Three-year change in the wellbeing of orphaned and separated children in institutional and family-based care settings in five low- and middle-income countries.

Journal Article PLoS One · 2014 BACKGROUND: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. METHODS: ... Full text Link to item Cite

Low rates of child testing for HIV persist in a high-risk area of East Africa.

Journal Article AIDS Care · 2014 Children in low- and middle-income countries (LMIC) are the least touched by recent successes in the diagnosis and treatment of HIV/AIDS globally. Early treatment is essential for a child's longer and higher quality of life; however, by 2011, only a small ... Full text Link to item Cite

Trauma History and Depression Predict Incomplete Adherence to Antiretroviral Therapies in a Low Income Country

Journal Article Plos One · October 4, 2013 Background:As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the ... Full text Cite

Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

Journal Article BMC Public Health · December 5, 2012 BACKGROUND: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of ... Full text Open Access Link to item Cite

A brief assessment of learning for orphaned and abandoned children in low and middle income countries.

Journal Article AIDS Behav · February 2012 Assessment of children's learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was desig ... Full text Link to item Cite

Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania.

Journal Article AIDS care · January 2012 It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to ... Full text Open Access Cite

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania.

Journal Article AIDS Care · 2012 While HIV counseling and testing (HCT) has been considered an HIV preventive measure in Africa, data are limited describing behavior changes following HCT. This study evaluated behavior changes and estimated HIV seroincidence rate among returning HCT clien ... Full text Open Access Link to item Cite

Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health.

Journal Article PLoS One · 2012 BACKGROUND: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregive ... Full text Open Access Link to item Cite

A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.

Journal Article J Acquir Immune Defic Syndr · April 15, 2011 BACKGROUND: Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations. METHODS: We designed a mathematical model to ... Full text Link to item Cite

Prevalence and correlates of intimate partner violence among women attending HIV voluntary counseling and testing in northern Tanzania, 2005-2008.

Journal Article Int J Gynaecol Obstet · April 2011 OBJECTIVE: To investigate the prevalence and correlates of intimate partner violence (IPV) among women at an HIV voluntary counseling and testing (VCT) center in northern Tanzania. METHODS: In a cross-sectional study, the lifetime history of IPV experience ... Full text Link to item Cite

More than the loss of a parent: potentially traumatic events among orphaned and abandoned children.

Journal Article J Trauma Stress · April 2011 This study examines rates of potentially traumatic events and associated anxiety and emotional/behavioral difficulties among 1,258 orphaned and abandoned children in 5 low- and middle-income countries. The study quantifies the types of events the children ... Full text Link to item Cite

Who tests, who doesn't, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania.

Journal Article PLoS One · January 31, 2011 BACKGROUND: Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) ca ... Full text Open Access Link to item Cite

Child work and labour among orphaned and abandoned children in five low and middle income countries.

Journal Article BMC Int Health Hum Rights · January 13, 2011 BACKGROUND: The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC) worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs), yet little is known abou ... Full text Open Access Link to item Cite

Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries.

Journal Article BMC Public Health · August 19, 2010 BACKGROUND: In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little r ... Full text Open Access Link to item Cite

WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study.

Journal Article BMJ · March 30, 2010 OBJECTIVES: To assess the performance of WHO's "Guidelines for care at the first-referral level in developing countries" in an area of intense malaria transmission and identify bacterial infections in children with and without malaria. DESIGN: Prospective ... Full text Open Access Link to item Cite

A comparison of the wellbeing of orphans and abandoned children ages 6-12 in institutional and community-based care settings in 5 less wealthy nations.

Journal Article PLoS One · December 18, 2009 BACKGROUND: Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possibl ... Full text Open Access Link to item Cite

Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up in Moshi, Tanzania.

Journal Article J Acquir Immune Defic Syndr · December 2009 OBJECTIVES: We evaluated changes in characteristics of clients presenting for voluntary counseling and testing (VCT) before and during care and treatment center (CTC) scale-up activities in Moshi, Tanzania, between November 2003 and December 2007. METHODS: ... Full text Link to item Cite

Morbidity and mortality among a cohort of HIV-infected adults in a programme for community home-based care, in the Kilimanjaro Region of Tanzania (2003-2005).

Journal Article Ann Trop Med Parasitol · April 2009 Community home-based care (CHBC) plays an integral role in the care of HIV-infected patients living in resource-limited regions. A longitudinal cohort study has recently been conducted, in the Kilimanjaro Region of northern Tanzania, in order to identify t ... Full text Link to item Cite

Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes.

Journal Article BMC Public Health · March 4, 2009 BACKGROUND: Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes ... Full text Link to item Cite

Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast.

Journal Article AIDS Patient Care STDS · November 2008 Alcohol and drug use are common among HIV-infected patients and are important determinants of secondary transmission risk and medication adherence. As part of the Coping with HIV/AIDS in the Southeast (CHASE) Study, 611 HIV-infected patients were consecuti ... Full text Link to item Cite

Trauma, anxiety and reported health among HIV-positive persons in Tanzania and the US Deep South.

Journal Article AIDS care · November 2008 Little research has been conducted in less wealthy nations to evaluate the prevalence of severe life traumas in general population groups and the impact of such traumas. Previous studies in wealthy nations have found that experiencing severe traumas can ca ... Full text Cite

Low sensitivity of T-cell based detection of tuberculosis among HIV co-infected Tanzanian in-patients.

Journal Article East Afr Med J · September 2008 OBJECTIVE: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting among patients with and without HIV infection. DESIGN: Cross-sectional study. SETTING: Two hospitals in Northern Tanzania. SUBJECTS: Eighty three adult male and ... Full text Link to item Cite

Gender differences in the risk of HIV infection among persons reporting abstinence, monogamy, and multiple sexual partners in northern Tanzania.

Journal Article PLoS One · August 27, 2008 BACKGROUND: Monogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the ri ... Full text Open Access Link to item Cite

Effect of trimethoprim-sulfamethoxazole prophylaxis on antimicrobial resistance of fecal Escherichia coli in HIV-infected patients in Tanzania.

Journal Article J Acquir Immune Defic Syndr · April 15, 2008 BACKGROUND: Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected persons in Africa, but its impact on antimicrobial resistance is of concern. METHODS: HIV-uninfected (group A), HIV-infected but not requiring SXT (group B), ... Full text Link to item Cite

The influence of psychosocial characteristics and race/ethnicity on the use, duration, and success of antiretroviral therapy.

Journal Article J Acquir Immune Defic Syndr · February 1, 2008 BACKGROUND: Expanded access to antiretroviral therapy (ART) has produced dramatic reductions in HIV-associated morbidity and mortality. Disparities in access to and benefit from ART have been observed by race, gender, and mental health status, however. MET ... Full text Link to item Cite

Trends in HIV testing and differences between planned and actual testing in the United States, 2000-2005.

Journal Article Archives of internal medicine · October 2007 BackgroundIncreasing the rates of human immunodeficiency virus (HIV) testing among groups not traditionally perceived as being at high risk has been advanced as a primary strategy in the effort to combat the HIV epidemic.MethodsWe conduct ... Full text Cite

What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?

Journal Article Soc Sci Med · October 2007 Hospices have been expected to reduce health expenditures since their addition to the US Medicare benefit package in the early-1980s, but the literature on their ability to do so is mixed. The contradictory findings noted in previous studies may be due to ... Full text Link to item Cite

Designating places and populations as medically underserved: a proposal for a new approach.

Journal Article Journal of health care for the poor and underserved · August 2007 This article describes the development of a theory-based, data-driven replacement for the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation systems. Data describing utilization of primary medical care and the distrib ... Full text Cite

Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events.

Journal Article AIDS Patient Care STDS · June 2006 Among HIV-infected persons, high-level adherence to antiretroviral medications (>90%-95%) is associated with improved immunologic, virologic, and clinical outcomes, and is necessary to prevent the emergence of viral resistance. This study examines whether ... Full text Link to item Cite

Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States.

Journal Article AIDS care · May 2006 Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet ps ... Full text Cite

The return on investment in health care: from 1980 to 2000.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · May 2006 ObjectiveTo estimate the return on US investment (ROI) in overall health as well as four specific conditions.MethodsThe study utilized three distinct approaches to "triangulate" the evidence as related to ROI in health care: 1) an estimat ... Full text Cite

Exploring lack of trust in care providers and the government as a barrier to health service use.

Journal Article Am J Public Health · April 2006 OBJECTIVES: We examined associations between trust of health care providers and the government and health service use and outcomes. METHODS: Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs conce ... Full text Link to item Cite

Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison.

Journal Article AIDS care · January 2006 Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use ... Full text Cite

Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania.

Journal Article Am J Public Health · January 2006 OBJECTIVES: We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. METHODS: We waived the usual f ... Full text Link to item Cite

Improving health outcomes among individuals with HIV, mental illness, and substance use disorders in the Southeast.

Journal Article AIDS Care · 2006 Providing behavioral treatment for mental health and substance use disorders among HIV-infected individuals is critical because these disorders have been associated with negative outcomes such as poorer medication adherence. This study examines the effecti ... Full text Link to item Cite

Racial differences in glaucoma care: the longitudinal pattern of care.

Journal Article Arch Ophthalmol · December 2005 OBJECTIVE: To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma. METHODS: We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare ben ... Full text Link to item Cite

Heavy alcohol use and marital dissolution in the USA.

Journal Article Social science & medicine (1982) · December 2005 Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (comb ... Full text Cite

Effects of changes in self-reported vision on cognitive, affective, and functional status and living arrangements among the elderly.

Journal Article American journal of ophthalmology · October 2005 PurposeTo study effects of changes in self-reported vision on functional status, cognition, depressive symptoms, and living arrangements.DesignLongitudinal analysis of household survey data.MethodsA total of 6234 sample persons o ... Full text Cite

Sociodemographic and clinical characteristics of clients presenting for HIV voluntary counselling and testing in Moshi, Tanzania.

Journal Article Int J STD AIDS · October 2005 HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. Factors associated with HIV infection in VCT clients have not been well characterized in northern Tanzania. We prospectively surveyed 813 VCT clients in Moshi, Tanzania. Client ... Full text Link to item Cite

Do seniors understand their risk of moving to a nursing home?

Journal Article Health Serv Res · June 2005 OBJECTIVE: To determine whether seniors understand their risk of moving to a nursing home. Data Sources. We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,20 ... Full text Link to item Cite

Net Effect of an Alcohol Tax Increase on Death Rates in Middle Age

Journal Article American Economic Review · May 2005 Full text Cite

The impact of Blue Cross conversions on health spending and the uninsured.

Journal Article Health affairs (Project Hope) · March 2005 Using statewide data on health spending and uninsurance rates, we investigate the impact of Blue Cross conversions on health care costs and coverage. We find mixed results, with some conversion states improving their performance on either or both measures ... Full text Cite

A brief mental health and substance abuse screener for persons with HIV.

Journal Article AIDS Patient Care STDS · February 2005 Mental illness and substance abuse are common among HIV-infected individuals and are associated with negative outcomes, including poor medication adherence. Therefore, quick and effective methods for detecting these co-occurring disorders are necessary for ... Full text Link to item Cite

The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits.

Journal Article The Milbank quarterly · January 2004 This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alc ... Full text Cite

Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases.

Journal Article Ophthalmology · October 2003 ObjectiveTo assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases.DesignLongitudinal analysis of Medicare claims data.ParticipantsRandom sample of Medicare beneficiaries ... Full text Cite

Estimates of incidence rates with longitudinal claims data.

Journal Article Archives of ophthalmology (Chicago, Ill. : 1960) · October 2003 ObjectiveTo estimate incidence rates of the 3 major chronic eye diseases--diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD)--by using longitudinal claims data from Medicare.MethodsLongitudinal cases were asc ... Full text Cite

Longitudinal prevalence of major eye diseases.

Journal Article Archives of ophthalmology (Chicago, Ill. : 1960) · September 2003 ObjectiveTo describe the prevalence across time of 3 chronic eye diseases among a representative cohort of elderly subjects.Study designLongitudinal observation of Medicare claims. Population A random sample of Medicare beneficiaries 65 y ... Full text Cite

Rates of return from hospital conversions.

Journal Article Health care management review · April 2003 This article presents information on the rates of return obtained by purchasers of U.S. hospitals since the mid 1980s. The key hypothesis tested in this study was whether for-profit acquirers are able to purchase hospitals at below-market prices. We test t ... Full text Cite

Antecedents of hospital ownership conversions, mergers, and closures.

Journal Article Inquiry : a journal of medical care organization, provision and financing · January 2003 This study assesses the determinants of conversions in hospital ownership from 1986 through 1996. To place such changes in context, we also analyze causes of hospital mergers and closures, which are often alternatives to hospital ownership conversion. A co ... Full text Cite

Effects of alcohol consumption on disability among the near elderly: a longitudinal analysis.

Journal Article The Milbank quarterly · January 2001 Data from four waves of the Health and Retirement Study are used to analyze the effects of alcohol use on disability, mortality, and income transfers from public programs. Cross-sectional analysis reveals a complex relationship, with a history of problem d ... Full text Cite