Young adult males’ perceptions about gender equity in La Romana, Dominican Republic
Baez P, Messina L, Halpern M, Amesty S (2024) Young adult males’ perception about gender equity in La Romana, Dominican Republic. Discovery Global Society, Volume 2, 42 doi.org/10.1007/s44282-024-00074-4
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Objective: To assess adolescent and young adult males’ perceptions regarding gender equity in La Romana, Dominican Republic. Metòd: We used the Gender Equitable Men (GEM) scale among males aged 15–24, who reported level of agreement with gender equity attitudes, establishing 0.01–0.5 = “low gender equitable”, 0.51–0.79 = “medium gender equitable” and 0.8–1 = “high gender equitable”. We established p < 0.05 for statistical significance, using Chi square for bivariate analysis and binary logistic regression to analyze predictors. Rezilta: A total of 358 males participated; one-fourth (n = 95, 26.5%) reported high GEM scores. The reproductive health and violence subscales presented higher distribution of high GEM scores (69.3% and 66.2%). Predictors for high GEM scores included high school or higher education for self (OR: 6.1 CI 2.9–12.7, p < 0.01) or mother (OR 14 CI 1.8–11.8 p = 0.01), being married/cohabitating predicted lower gender equitable scores (OR: 0.1 CI 0.1–0.7 p = 0.01). Konklizyon: Male Dominican adolescent and young adults present mixed attitudes about gender equity, reporting gender equitable mindset for violence and reproductive health. Further research should explore how perceptions of gender roles impact family planning decisions, pregnancy prevention, STIs, and gender-based violence.

 

Comparison of evaluation methods for improving the usability of a Spanish mHealth tool
Alexandria L. Hahn a, Claudia L. Michaels a b, Gabriella Khawly a b, Tyler K. Nichols a, Pamela Baez c, Sergio Ozoria Ramirez a, Janeth Juarez Padilla d, Samantha Stonbraker e, Susan Olender MD, MS f, Rebecca Schnall a b April 2024 Comparison of evaluation methods for
improving the usability of a Spanish mHealth tool. International Journal of Medical Informatics. doi:10.1016/j.ijmedinf.2024.105355.
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Objective: Mobile health (mHealth) technology is now widely used across health conditions and populations. The rigorous development of these tools has yielded improved health outcomes, yet the ideal approach for developing mHealth tools continues to evolve, indicating the need for rigorous usability evaluation methods. This study compares two usability evaluation methods – cognitive interviews and usability assessments employing a think-aloud approach – for adapting an evidence-based mHealth tool from English into Spanish. Metòd: We conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City, NY, and La Romana, Dominican Republic. The Health IT Usability Evaluation Model (Health-ITUEM) was used to guide the analysis of qualitative data collected from each method. Results: Participants (N = 40) averaged 43 years old (SD = 12.26; range 20–79), identified primarily Hispanic/Latino (92.5 %), and resided in La Romana (50 %) or New York City (50 %). Both usability evaluation methods yielded similar findings, highlighting learnability and information needs as crucial components of participant feedback for the mHealth application. Cognitive interviews captured participants' perspectives on the app’s interface and design. On the other hand, results from usability assessments offered insights into participants' competency while interacting with the mHealth tool. Conclusión: Findings from this study highlight the contributions and limitations of including cognitive interviews and task-based usability assessments using a think-aloud approach in mHealth usability testing. Future research should employ a multi-method approach, incorporating complementary usability evaluation methods and engaging participants in multiple assessments. Using complementary usability evaluation methods may provide a more comprehensive understanding of the usability and participant experience aspects of a mHealth tool compared to using a single usability evaluation method.

 

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol (2024). Olaya, F., Brin, M., Caraballo, P.B. et al. A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol. BMC Public Health 24, 201 (2024).A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-
speakers living with HIV study protocol. BMC Public Health. doi:10.1186/s12889-023-17538-y. 
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Background: While there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic. Methods: The WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint. Discussion: The use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole. Trial registration: This trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

 

Thoughts of self-harm in adolescents: Relationship with violence in the Dominican Republic(2024).
Badger K, Baez Caraballo P, Gibbs A, Messina L, Halpern M, Amesty S (2024) Thoughts of self-harm in adolescents: Relationship with violence in the Dominican Republic.PLOS Global Public Health, 4(1), e0002711. doi:10.1371/journal.pgph.0002711.
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Violence against adolescents is a pressing health problem with long-term implications for future physical and mental well-being, such as thoughts of self-harm, which have been associated with suicidal ideation and completion. However, much of the research has been conducted only in high-income countries. This study aimed to examine the correlation between violence against adolescents and self-harm thoughts in La Romana, Dominican Republic (DR). Cross-sectional survey data was collected at a community-based clinic from participants aged 13–20. Participants were recruited through the clinic’s adolescent program and peer referral, and verbal consent was obtained. A survey solicited information about each participant’s demographics, experiences with violence, and thoughts of harm to self or others. The survey was completed by 49 adolescents. The mean age was 16.78 (SD 2.34); 65% were female. We performed t-tests and Fisher’s exact to investigate the relationship between demographics, reported violence experiences and having self-harm thoughts. About half (45%) had experienced physical violence, 76% had experienced emotional violence, and 12% had experienced sexual violence. The most common perpetrators of physical and emotional violence were classmates (12% and 24%), and the most common perpetrator of sexual violence was an ex-partner (4.1%). Ten participants (20.4%) had thought about harming themselves. Self-harm thoughts were significantly associated with being female (p = 0.025), employed (p = 0.05), and a higher number of experiences of physical (0.029) and sexual violence (p = 0.023). The results of this study suggest a high prevalence of both violence and self-harm thoughts in adolescents in the DR. Interventions that address physical and sexual violence against adolescents may be particularly important. Particular attention should also be paid to screening for self-harm thoughts in female-identifying adolescents. Further research is needed to better understand the relationship between violence and self-harm thoughts in adolescents in the DR.

 

Reaching “covidianidad”: A qualitative study of the impact of the COVID-19 pandemic on the perceived mental health of health care workers in the Dominican Republic (2023).Báez Caraballo P, Schriger S, Escober J, Acevedo A, García Alejandro A, Halpern M, et al. (2023) Reaching “covidianidad”: A qualitative study of the impact of the COVID-19 pandemic on the perceived mental health of health care workers in the
Dominican Republic. PLOS Global Public Health. doi:10.1371/journal.pgph.0002652.
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We aimed to explore how the COVID-19 pandemic affected the lives of healthcare workers (HCWs) in the Dominican Republic. We also aimed to identify the types of resources that HCWs felt were needed to support their mental health. We used purposive and convenience sampling in four health centers in the eastern Dominican Republic to recruit 28 HCWs (doctors, nurses, psychologists, and community health workers) between April 2021 and August 2021. Through semi-structured interviews, we elicited HCWs experiences during the pandemic and how they felt these experiences impacted their mental health. Interview transcripts were analyzed using an inductive/deductive thematic approach. Main stressors experienced during the pandemic by HCWs and their sequelae included anxiety due to misinformation and uncertainty, fear of the disease, the robustness of pandemic-related changes they faced in their work and daily life, and COVID-19’s economic impact. HCWs reflected on protective factors that transformed their acute sense of crisis felt at the beginning of the pandemic into what HCWs referred to as “covidianidad [everyday COVID]”, a situation that became manageable through mechanisms including social support, professional motivation, positive work environment and resilience. Lastly, HCWs identified stigmatization of and limited access to mental health services as challenges to supporting their mental health. While Dominican HCWs were vulnerable to the challenges posed by COVID-19 in sustaining their mental health, for many, the situation became manageable through the evolution of “covidianidad.” Further research and interventions are needed to reduce stigmatization of mental health services and foment a positive environment for HCWs’ mental health, to promote resiliency to future challenges.

 

Impact of an STI Diagnosis on People Living With HIV in La Romana, Dominican Republic: A Cross-Sectional, Qualitative, Descriptive Study, J Assoc Nurses AIDS Care 2023. Sanabria G, Stonbraker S, Bateman M, Halrpern M, Amesty S.
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Objektif etid sa a se te pou eksplore kijan li resevwa yon enfeksyon seksyèlman transmisib (STI) dyagnostik ki afekte konesans STI ak konpòtman risk seksyèl nan mitan popilasyon kle nan La Romana, Repiblik Dominikèn (DR) ki te patisipe nan yon etid 12 a 24 mwa anvan etid aktyèl la. Nèf patisipan yo, ak yon laj mwayen de 37 ane (ranje 20-54 ane) ak yon majorite fi (89%), ki te rekrite nan etid la paran ki te konplete nan entèvyou pwofondè, kesyonè evalye konesans STI, epi yo te resevwa tès STI. Entèvyou yo te analize lè l sèvi avèk metodoloji deskriptif kalitatif ak done kesyonè, konpare repons endividyèl ant paran an ak syans aktyèl yo. Patisipan yo rapòte pi an sekirite konpòtman seksyèl apre dyagnostik orijinal STI, tankou itilizasyon kapòt pi souvan. Kesyonè yo te montre amelyorasyon nan konesans STI ant paran an ak etid aktyèl yo. Twa patisipan yo te gen yon renfeksyon STI. Jwenn manda plis eksplorasyon nan pi konplè ak vize metòd tretman STI pou popilasyon kle nan DR la.

 

Segondè chay nan enfeksyon seksyèlman transmisib nan mitan popilasyon ki anba-resous nan Repiblik Dominikèn.2023
Amesty S, Perez-Figueroa R, Stonbraker S, Halpern M, Donastorg Y, Perez-Mencia M, Lantigua F, Soriano L, Baez-Caraballo P, Gilbert J, Buccini F, Sharp J, Hernandez B, Gelfond J, Cardwell E, Nicholas C, Egan KA, Gomes A, Van Dyke E, Nicholas SW, Grodman M, Taylor BS, et al. (2023). High burden of sexually transmitted infections among under-resourced populations in the Dominican Republic. Therapeutic Advances in Infectious Disease. doi:10.1177/20499361231193561.
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Segondè chay nan enfeksyon seksyèlman transmisib nan mitan popilasyon ki anba-resous nan Repiblik Dominikèn. Istorik: Enfeksyon seksyèlman transmisib (STIs) se yon gwo pwoblèm sante, agrave pa resous finansye limite ak enfrastriktirèl nan peyi devlope yo. Metòd: Prevalans nan STIS te evalye nan de sant iben nan Repiblik Dominikèn (DR) nan mitan popilasyon ki gen gwo risk pou STIS: jèn gason ki fè sèks ak gason (MSM), fanm (TG), rezidan batey, travayè sèks fi, ak moun k ap viv ak viris iminodefisyans iminodefisyans (VIH). Nou fè yon sondaj kwa-seksyonèl ak byolojik koleksyon echantiyon echantiyon pou ekran pou trakomatis Klamidya, Neisseria gonorea, Mycoplasma genitalium, Trichomonas vajinal (trichomoniasis), Treponema pallidum (sifilis), VIH, epatit B ak C, ak papillomavirus imen (HPV) nan mitan popilasyon ki gen risk ant 2015 ak 2018. Tès ureaplasma urealyticum te fèt tou menm si li pa konsidere kòm yon STI. Yon echantiyon kominote ki pa pwobabilite te rekrite. Estatistik deskriptif yo te egzamine prévalence de STIs pa popilasyon. Rezilta: Yon total de matyè 1991 yo te patisipe nan etid la. Laj medyan an te 26years (ranje: 18–65). Pifò patisipan yo te fi (65.3%), etewoseksyèl (76.7%), epi yo pa te asosye (55.7%). Pifò nan patisipan yo rapòte sèks vajen san pwoteksyon nan dènye 6months yo (54%); pami MSM ak TG prèske mwatye nan patisipan yo rapòte sèks san pwoteksyon nan dènye 6months yo ak 17.6% rapòte itilizasyon dwòg nan dènye 6months yo. Prèske mwatye nan patisipan yo (49%) teste pozitif pou youn oswa plis STIs. STI ki pi répandus sti te Klamidya trakomatis (12.8%), ak papillomavirus imen (11.9%). Pami fanm transganr, 65.3% teste pozitif pou yon STI, 64.8% nan travayè sèks fi teste pozitif pou yon STI, ak 53.8% nan adolesan ansent teste pozitif pou yon STI. Konklizyon: Gen yon gwo prévalence de STIs nan mitan kle ak anba popilasyon resous nan DR La rezilta nou yo mete aksan sou bezwen an fè plis rechèch pou optimize prevansyon ak estrateji swen pou estriktirèl vilnerab ak anba popilasyon resous nan DR la.

 

Mixed method evaluation of a clinic waiting room–based health education program in the Dominican Republic(2023).S Cohen, M Halpern, S Stonbraker, Health Education Research, Volume 38, Issue 2, April 2023, Pages 177–191,Mixed method evaluation of a clinical waiting room-based health education program in the Dominican Republic. Health Education Research. doi:https://doi.org/10.1093/her/cyad001.
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Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room–based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees’ change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room–based education talks improve knowledge and provide suggestions for similar interventions.

 

The impact of expedited third semester viral load testing on the proportion of vaginal deliveries in HIV-positive pregnant women in the Dominican Republic 2022. Nimalendran R, Egan KA, Dyke EV, Amesty S, Halpern M, Hod E, Lerebours L, Nicholas SW, Spitalnik S, Whittier S, Stotler B. (2022). The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIV-positive pregnant women in the Dominican Republic. Integrative Gynecology and Obstetrics Journal. doi:10.31038/IGOJ.2022523

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Objective: Advances in HIV treatment have led to a significant decrease in vertical transmission. Lack of adequate viral load testing capabilities inhibited the ability to follow national and international guidelines for obstetric care in the Dominican Republic (DR). The objective of this study was to determine if expedited third trimester viral load testing in HIV-positive pregnant women led to an increase in vaginal deliveries at a clinic in the DR, thus demonstrating the ability to follow national guidelines for obstetric delivery of HIV-positive women on antiretroviral therapy (ART).
Study Design: This study enrolled pregnant HIV-positive patients at a clinic in the DR October 2014-July 2015. Viral load testing was performed 34-36-weeks gestation and results were available within 48 hours. Demographic information, clinical factors, and obstetric outcomes were collected and compared to patients in a retrospective cohort, who delivered January 2012-December 2012 when expedited viral load testing was unavailable.
Results: Of the 20 women in the study, 17 (85%) had viral loads <1000 and seven women (35%) delivered vaginally. In the comparison retrospective cohort, of 41 women, three women (7%) had vaginal deliveries. Comparing the two groups, there was a statistically significant increase in vaginal deliveries from 7% to 35% (p=0.02) after expedited viral load testing was made available. All infants born in the study were HIV-negative.
Conclusion: The study with expedited viral load testing available had an increased number of vaginal deliveries of HIV-positive women on ART. The majority of these patients were on ART with HIV viral loads.

Power and respect in global health research collaboration: Perspectives from research partners in the United States and the Dominican Republic(2023). Green C, Scharf J, Jiménez‐Bautista A, Halpern M. (2023). Power and respect in global health research collaboration: Perspectives from research partners in the United States and the Dominican Republic. Developing World Bioethics, 1–10 Journal Title TBD.
doi:10.1111/dewb.12384.
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Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South-North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi-structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with decades of experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships.

 

Sèvi ak plizyè metòd pou mezire Adherence nan Tretman antiretwoviral nan La Romana, Repiblik Dominikèn, Repiblik Dominikèn Panam Salud Piblik 2022. Báez P, Tiburcio A, Alba N, Mateo F, Grullon E, Cordero S, Fernández A, Reinoso J, Cruz D, Gómez K, Vargas N, Saint-Hilaire C, Abreu OL, Acosta G, Halpern M, Stonbraker S, et al. (2022). Medición de adherencia a antirretrovirales con métodos múltiples en La Romana, República Dominicana. Revista Panamericana de Salud Pública. doi:https://doi.org/10.26633/RPSP.2022.207.
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Objective:To develop a tool that measures levels of adherence to antiretroviral treatment (ART) in resour ce-poor settings, based on a combination of four methods for measuring adherence. Methods. Retrospective review of 500 medical records of people living with HIV, randomly selected from October 2017 to January 2020. Adherence to ART was measured by combining four measurement methods (coverage of prescribed ART, ART picked up at pharmacies, viral load, and self-reported adherence). Chi squared tests were performed with p<0.05 for statistically significant differences and logistic binary regression to identify the probability of optimal and suboptimal adherence. Spearman tests were performed for correlation of categories, and Cronbach’s alpha was used to measure the internal consistency of the tool. Results. We obtained 497 adherence scores. Of these, 307 (61.8%) users qualified as adherent, 141 (28.4%) as semi-adherent, and 49 (9.8%) as non-adherent. A higher probability of optimal adherence was found in groups aged 60 years and older (odds ratio [OR]: 1.6; CI95%: 0.8–3.5), with no difference between men and women (OR: 0.9; CI95%: 0.7–1.4). Spearman’s test reported a relationship (r = 0.8) between viral load levels and final score, and Cronbach’s alpha yielded modest internal consistency (α = 0.7). Conclusions. A tool was developed to measure adherence to ART in a resource-poor environment. The tool shows modest levels of internal consistency and a strong correlation between viral load and adherence.

If the give their mind to HIV, the don’t last long”: An explanatory model of HIV infection in a limited-resource setting informs person-centered care 2022.Stonbraker S, Sanabria G, Cunto-Amesty S, Alcantara C, Abraido-Lanza AF, Rowell-Cunsolo T, Halpern M, Bakken S, Schnall R, George M. (2022). “If they give mind to HIV, they don’t last as long”: An explanatory model of HIV infection in a limited-resource setting informs Persons-Centered care. Global Qualitative Nursing Research, doi:https://doi.org/10.1177/23333936221097112
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Explanatory models describe individuals’ perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman’s explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman’s framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients’ illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.

Pwofesi pre-ekspozisyon viris: Evalyasyon akseptabilite nan mitan manm serodiscordant/serostatus enkoni. Jounal Entènasyonal STD &aids, Vol 0 (0) 1-7, 2022. Bracho-Sanchez E, Stonbraker S, Halpern M, Wood S, Lowenthal E. (2022). HIV pre-exposure prophylaxis: assessment of acceptability among members of HIV serodiscordant/serostatus unknown couples. International Journal of STD & AIDS. doi:10.1177/09564624221097753.
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Background: Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection but is not yet widely available in resource-limited settings such as the Dominican Republic. We aimed to ascertain PrEP acceptability among people living with HIV in the Dominican Republic who are part of HIV serodiscordant partnerships and understand relationships between PrEP acceptability, HIV stigma, and intimate partner violence.
Methods: A cross-sectional survey of people in care for HIV infection included acceptability-related questions and assessments of HIV stigma and intimate partner violence. We also explored the expected impact of PrEP on HIV disclosure rates and fertility intentions.
Results: Of the 100 participants, 74% had been in their current partnership for >1 year; 38% had not disclosed to their partner; 29% reported condomless sex, and 23% reported sex with multiple partners. PrEP was highly acceptable with 84% of participants saying they were “very likely” to offer PrEP to their partner if available and 21% stating it would allow them to have more children. Of those who had not disclosed to their partner, 71% stated PrEP would help them do so. No relationship was found between PrEP acceptability, HIV stigma, and intimate partner violence. However, higher than expected rates of PrEP acceptability limited the power of these analyses. 
Conclusion: Pre-exposure prophylaxis was considered to be highly acceptable among people living with HIV in the Dominican Republic who are part of serodiscordant partnerships.

Gwo prévalence de laklamidya reyèl pami gwo adolesan ki ansent nan La Romana, repiblik Dominikèn garanti tès STI. Jounal Entènasyonal STD &aids, Vol 0 (0) 1-7, 2021. Bancalari P, Nicholas C, Halpern M, Stonbraker S, Taylor B, Soriano L, Ljubicic D, Amesty S. (2021). High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing. International Journal of STD & AIDS. doi:10.1177/09564624211043082.
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Nan konesans nou, pa gen okenn etid ki estime prévalence de ekstraksyon enfeksyon seksyèlman transmisib (STIs) nan mitan adolesan ki gwo vant nan Karayib la. Etid sa a te chèche ranpli espas sa a lè li evalye prévalence ak korelasyon nan oral, jenital, ak klamidya reyèl (CT) nan mitan yon echantiyon adolesan ansent nan La Romana, Repiblik Dominikèn. De san jèn ansent, ki gen laj 15-24 ane, yo te rekrite pa echantiyon sistematik pandan premye vizit prenatal yo nan yon inite swen matènèl. Yon kesyonè sosyodemografik ak konpòtman te administre ak pipi ak pipi / swabs yo te ranmase ak teste pou CT. Analiz deskriptif ak tès egzak Fisher a te fèt. Prévalence de oral, jenital, ak reyèl CT te 6%, 15%, ak 23%, respektivman, byenke mwens pase 5% nan patisipan yo rapòte tout tan angaje nan kouche reseptif. Eksplikasyon sa a ta ka eksplike pa otoinoculation, transmisyon konkouran pandan sèks, anba tretman nan CT reyèl, oswa soupòte nan fè sèks. Prèske mwatye nan enfeksyon CT ta te rate si sèlman echantiyon jenital yo te ranmase, kòm pwotokòl aktyèl la dikte. Plis rechèch nesesè pou konprann konpòtman seksyèl ak faktè risk reyèl nan mitan fanm etewoseksyèl adolesan. STI pwosedi depistaj pou adolesan ansent ak seksyèlman aktif ta dwe gen ladan tès woutin nan sit ekstraòdinè.

Itilizasyon klinisyen ki gen rapò ak VIH/SIDA pandan vizit klinik nan Repiblik Dominikèn ki asosye ak Lower Charles Viral ak lòt amelyorasyon nan rezilta Sante. SIDA ak konpòtman, 2021.Stonbraker S, Liu J, Sanabria G, George M, Cuanto-Amesty S, Alcantara C, Abraído-Lanza A, Halpern M, Rowel-Cunsolo T, Bakken S, Schnall R. (2021). Clinician use of HIV-related infographics during clinic visits in the Dominican Republic is Associated with Lower Viral Loads and other improvements in Health Outcomes. AIDS and Behavior. doi:https://doi.org/10.1007/s10461-021-03331-8.
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Nou fèt yon entèvansyon infographic pou ede klinisyen bay enfòmasyon sou sante bay moun k ap viv ak VIH.IN. Nan etid sa a, nou evalye nan ki limit entèvansyon nou ka amelyore objektivman ak sibjektivman mezire rezilta sante (CD4 count, chaj viral, ak angajman ak klinisyen pami lòt moun) lè entegre nan vizit woutin nan Repiblik Dominikèn. Nan etid sa a pretest –pòs, nou swiv patisipan yo pou 9 mwa nan entèval 3-mwa. Doktè yo te administre entèvansyon an pandan premye 3 vizit patisipan yo. Mezi rezilta, chwazi lè l sèvi avèk yon modèl konseptyèl, yo te evalye nan 4 pwen. Nou evalye chanjman nan rezilta sou tan ak retou lineyè jeneral ak Wilcoxon siyen-Rank tès yo. Patisipan yo (N = 50) yo te sitou fi (56%) epi yo te viv ak VIH pou yon mwayen de 6.3 ane (SD = 6.1). Tout rezilta yo, eksepte CD4 konte, demontre estatistik amelyorasyon siyifikatif pa etid. Sa bay prèv preliminè entèvansyon nou ka amelyore rezilta, men plis tès ki nesesè.

Baryè pou tretman sida nan mitan granmotan k ap viv avèk VIH nan lès Repiblik Dominikèn. Jounal entènasyonal stD ak sida. VOL0(0) 1-6, 2021. Bast E, Stonbraker S, Halpern M, Lowenthal E, Gross R. (2021). Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic. International Journal of STD & AIDS, 2021. doi:10.1177/09564624211014102.
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Malgre aksè nasyonalman apwovizyone tretman antiretwoviral, pousantaj sipresyon viral rete soupresyon nan Repiblik Dominikèn. Konsèy ak sèvis sipò yo disponib men sitou vize a moun ki idantifye kòm gen bezwen ki pi. Nan Clínica de Familia La Romana (CFLR) nan La Romana, tout pasyan sibi yon entèvyou debaz estriktire ki gen ladan eksplorasyon nan baryè espere pran swen. Nou fè yon etid kowòdone retrospektiv nan yon echantiyon o aza nan pasyan nan CFLR ak inisyasyon tretman ant 1 janvye 2015 ak 1 Desanm 2017 pou detèmine si baryè pwòp tèt ou-idantifye nan swen viris predi sipresyon chaj viral. Sipresyon chaj viral te fèt nan 63% nan pasyan yo 203 evalye. Mank manje (n = 19) te siyifikativman ki asosye ak mank de represyon viral (OR 3.0, 95% CI 1.14–7.87). Estati ki pa Fèt nan estati VIH (n = 24) te montre prèv pou yon efè pwoteksyon (OR 0.33; 95% CI 0.11–1.0). Pli lwen etap yo ta dwe pran nan adrès ensekirite manje kòm byen ke yo konprann baryè ki asosye yo pran swen nan mitan moun ki gen ensekirite manje.

Posibilite ak akseptabilite pou itilize enfòmasyon vizyalizasyon pou amelyore kominikasyon ki gen rapò ak VIH nan yon anviwònman resous limite: yon rapò kout. Swen sida, 2021.Stonbraker S, Flynn G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza A, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. (2021). Feasibility and acceptability of using information visualizations to improve HIV-related communication in a limited-resource setting: a short report. AIDS Care. doi:https://doi.org/10.1080/09540121.2021.1883517.
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Infographics (vizyalizasyon ki prezante enfòmasyon) ka ede klinisyen yo ofri enfòmasyon sou sante bay pasyan ki gen alfabetizasyon sante ki ba nan yon fòma aksesib. Kòm repons, nou devlope yon entèvansyon infographic amelyore klinik, kominikasyon ki gen rapò ak VIH. Etid sa a rapòte sou posibilite li ak akseptabilite nan yon anviwònman klinik nan Repiblik Dominikèn. Nou te fè entèvyou an pwofondè ak doktè ki te administre entèvansyon an ak pasyan ki te resevwa li. Nou fè entèvyou odyo-anrejistre nan lang panyòl lè l sèvi avèk gid entèvyou semi-estriktire. Anrejistreman yo te pwofesyonèl transkri vèbatim Lè sa a, analize lè l sèvi avèk analiz kontni deskriptif. Transkripsyon doktè yo te dedwi selon konstriktè kad Bowen et al.al.a., relve ak transkripsyon pasyan yo te endikivman kòde. Twa doktè ak 26 pasyan te patisipe. Posibilite konstwi andose pa doktè yo endike ke infographics yo te fasil yo sèvi ak, amelyore ansèyman, epi yo ka fasilman enkòpore nan travay yo. Kodaj transkripsyon pasyan yo idantifye kat kategori ki endike entèvansyon an te akseptab ak itil, ofri fidbak konsènan kominikasyon klinik efikas, ak rekòmande amelyorasyon nan infographics. Ansanm, done sa yo endike entèvansyon nou an se te yon fason posib ak akseptab bay enfòmasyon ki gen rapò ak klinik, VIH epi bay rekòmandasyon enpòtan pou konsepsyon vizyalizasyon nan lavni kòm byen ke kominikasyon klinik efikas ak popilasyon pasyan ki sanble.

Digital Educational Support Groups Administered through WhatsApp Messenger Improve Health-Related Knowledge and Health Behaviors of New Adolescent Mothers in the Dominican Republic: A Multi-Method Study. Informatics. 2020; 7(4):51. Stonbraker S, Haight E, Lopez A, Guijosa L, Davison E, Bushley D, Aquino Peguero K, Araujo V, Messina L, Halpern M. (2020). Digital Educational Support Groups
Administered through WhatsApp Messenger Improve Health-Related Knowledge and Health Behaviors of New Adolescent Mothers in the Dominican Republic: A Multi-Method Study. Informatics. doi:https://doi.org/10.3390/informatics7040051.
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 (1) Background: In limited-resource settings such as the Dominican Republic, many factors contribute to poor health outcomes experienced by adolescent mothers, including insufficient support and/or health knowledge. In response, we designed a digital educational support group, administered through WhatsApp Messenger, for new adolescent mothers. The purpose of this study was to assess if participation in this digital support group could improve health outcomes and health behaviors. (2) Methods: Participants completed questionnaires with a health literacy screener, demographic items, knowledge questions, the Index of Autonomous Functioning, and five Patient Reported Outcomes Measurement Information System scales before and after the moderator-led intervention. Differences between pre- and post-intervention scores were calculated and perceptions of the intervention were explored through in-depth interviews analyzed with content analysis. Participants’ well-baby visit attendance and contraceptive use were compared to that of controls and a national sample. (3) Results: Participants’ (N = 58) knowledge scores increased (p < 0.05). Participants were 6.58 times more likely to attend well-baby visits than controls (95% CI: 2.23–19.4) and their contraceptive use was higher than that of the national sample (p < 0.05). Participants indicated the intervention was enjoyable and beneficial. (4) Conclusion: This adolescent-centered digital intervention is a promising method to improve health outcomes and health behaviors of young mothers in limited-resource settings.

Etabli kontni pou yon gwoup sipò edikasyon dijital pou nouvo manman adolesan nan Repiblik Dominikèn: yon konsepsyon itilizatè ki santre. Jounal Entènasyonal pou Adolesan Sante Medikal, 2020. Stonbraker S, Haight E, Soriano L, Guijosa L, Davison E, Bushley D, Messina L, Halpern M, et al. (2020). Establishing content for a digital educational support group for new adolescent mothers in the Dominican Republic: a user-centered design. International Journal of Adolescent Medical Health. doi:10.1515/ijamh-2020-0054.
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Orijin
Kòm entèvansyon dijital amelyore sante vin gaye toupatou globalman, li enpòtan pou enkli itilizatè sib fen-itilizatè yo nan konsepsyon yo. Sa ka ede asire entèvansyon yo maksimòm benefisye nan mitan popilasyon ki gen entansyon.
objektif yo
Pou jenere kontni an nan yon gwoup sipò edikasyon dijital, administre nan WhatsApp, pou nouvo manman adolesan ak etabli aksè selilè patisipan yo ak itilizasyon WhatsApp.
Patisipan yo
Manman adolesan ki gen tibebe ki fèk fèt.
Metòd
Nou ranpli yon pwosesis konsepsyon itilizatè de-santre. Nan faz mwen konsepsyon sesyon, patisipan yo diskite eksperyans apre yo ak ranpli yon aktivite pou elimine sante yo ak byennèt enfòmasyon yo bezwen. Nan sesyon faz II, patisipan yo endividyèlman idantifye ki sijè enfòmasyon sou sante yo te enpòtan pou yo, Lè sa a, tout sijè yo te priyorize kòm yon gwoup. Faz II patisipan yo tou ranpli yon sondaj tou kout sou aksè telefòn selilè ak itilizasyon WhatsApp.
Rezilta
Faz mwen enkli 24 patisipan yo, 21 nan yo ki te konplete faz II. Yo te idantifye sijè enfòmasyon priyoritè ak byennèt enfòmasyon nan peryòd apre akouchman yo te idantifye kòm: kwasans timoun ak devlopman, konprann tibebe w la, maladi timoun nan, bay tete, nitrisyon timoun, planin familyal, ak swen pwòp tèt ou. Nan faz II patisipan yo, 45% te gen aksè telefòn selilè ak okenn pa te gen yon plan done. Sèvis selilè te konsistan jwenn ak pakè done oswa Wi-Fi. 30% nan patisipan yo pa te gen okenn eksperyans lè l sèvi avèk WhatsApp.
Konklizyon
Patisipan yo idantifye anpil bezwen enfòmasyon sou sante, ki pral sèvi kòm kontni an pou gwoup sipò dijital planifye nou yo epi li bay bonjan Sur pou founisè swen sante globalman. Mwens pase mwatye nan patisipan yo te gen aksè telefòn selilè ki konsistan, e okenn nan yo pa te gen aksè serye nan sèvis selilè.

Faktè ki gen rapò ak gwosès adolesan ki vin apre nan Repiblik Dominikèn. Jounal Adolesan ak Sante Fanmi, 2020; 11(1).
Fay CJ, Fay KE, Messina LA, Halpern M, Stonbraker SB, et al. (2020). Factors related to subsequent adolescent pregnancy in the Dominican Republic. Journal of Adolescent and Family Health. https://scholar.utc.edu/jafh/vol11/iss1/8.
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Objectives: Adolescents with subsequent pregnancies in the Dominican Republic represent a significant but poorly understood population with little available data to inform health care services. The objective of this exploratory study was to begin to characterize this important cohort. Methods: A survey of demographic items and a sexual and obstetrical history was administered to 50 adolescents with subsequent pregnancies in La Romana, Dominican Republic. Results: Most participants were married (78%) and exclusively economically dependent on their partner (72%) and nearly half (48%) stopped attending school. Twelve percent reported having intended their current pregnancy. Conclusions: Adolescents with subsequent pregnancies were dependent on partners in the form of living conditions and marriage, economic dependence and unemployment, and lack of education.

Pèsepsyon ak atitid nan direksyon sante mobil nan devlopman nan yon zouti bay tete san konte: Konsantre gwoup etid ak moun kap bay swen ak Pwomotè Sante nan Repiblik Dominikèn. JMIR Pedyatrik ak Paran, 2020; 3(2). Casilang CG, Stonbraker S, Japa I, Halpern M, Messina L, Steenhoff AP, Lowenthal ED, Fleisher L, et al. (2020). Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic. JMIR Pediatrics and Parenting. doi:10.2196/20312.Gade sou entènèt Abstrè

Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide.
Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs.
Methods: Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes.
Results: All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding.
Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.

Itilizasyon dwòg, risk seksyèl, ak frajilite estriktirèl nan mitan travayè sèks fi nan de sant iben nan Repiblik Dominikèn: Etid EPIC la. Dwòg ak Alkòl, Avril 2020. Pérez-Figueroa R, Mittal I, Halpern M, Pérez-Mencia M, Donastorg Y, Taylor BS, Amesty
S, et al. (2020). Drug use, sexual risk, and structural vulnerability among female sex workers in two urban centers of the Dominican Republic: The EPIC study. Drug andAlcohol Dependence. doi:10.1016/j.drugalcdep.2020.108039.
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Background: Evidence in different countries suggest an association between sex work and drug use. In the Dominican Republic an estimated 60,000–100,000 women work in the sex industry. However, little is known about their drug use behaviors. Objective: To characterize the burden of drug use and examine correlates of these behaviors among female sex workers in the Dominican Republic. Metòd: Data for this analysis comes from a cross-sectional study among key populations at risk for HIV. A community sample of female sex workers (N = 389) was recruited using passive and active recruitment strategies. Participants completed a behavioral survey between 2015 and 2016. Logistic regression models were constructed to examine predictors of drug use. Rezilta: Protective factors against marijuana and crack or cocaine use included being heterosexual, having a higher level of education, regular employment, and fewer male sexual partners. Increased odds of crack or cocaine use were associated with incarceration, having slept in a place not meant for human habitation in the last six months, and having ever lived in a batey (a community around a sugar mill where workers and their families live). Participants that used marijuana were generally younger, while those that used crack or cocaine were older. Conclusions: Our findings highlight characteristics of the social and economic environment that require further research to optimize prevention and care strategies for this population. Public health interventions are needed that address drug use, sexual risk-taking, and helping female sex workers and their families achieve a healthy life.

Devlope infographics fasilite kominikasyon pasyan VIH nan yon anviwònman limite-resous. Aplike Infographics Klinik, 2019. 10(4): p. 597-609. Stonbraker S, Halpern M, Bakken S, Schnall R, et al. (2019). Developing infographics to facilitate HIV patient-provider communication in a limited-resource setting. Applied Clinical Infographics. doi:10.1055/s-0039-1694001.
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Background: Productive patient–provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present.
Objectives: This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient–provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context. Methods: We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session. Results: Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way. Conclusion: Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.

Evalyasyon yon pwogram edikasyon seksyalite konplè nan La Romana, Repiblik Dominikèn. Jounal Entènasyonal nan Medsin Adolesan ak Sante (pibliye sou entènèt devan yo nan enprime 2019), 20190017. Richards SD, Mendelson E, Flynn G, Messina L, Bushley D, Halpern M, Amesty S, Stonbraker S, et al. (2019). Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic. International Journal of Adolescent Medicine and Health. doi:https://doi.org/10.1515/ijamh-2019-0017.
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Background: The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic’s CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation. Methods: A mixed methods study was conducted among students aged 11–25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar’s test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time. Result: Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic. Conclusion: Improvement in test scores supports MAMI CSEP’s efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP.

Sijè priyoritè pou edikasyon sou lasante pou sipòte viris ki gen viris nan anviwònman resous limite. Jounal nan Bous detid Enfimyè, 2018. 
Stonbraker S, Richards S, Halpern M, Bakken S, Schnall R, et al. (2018). Priority topics for health education to support HIV self-management in limited-resource settings. Journal of Nursing Scholarship. doi:https://doi.org/10.1111/jnu.12448.
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Purpose: The purpose of this study was to identify and prioritize the information that persons living with HIV (PLWH) in a limited-resource setting need to effectively manage their health. Design and Methods: A data sources triangulation method was used to compare data from three separate sources: (a) 107 interviews with Spanish-speaking PLWH being seen at a healthcare clinic in the Dominican Republic (DR); (b) 40 interviews with Spanish-speaking healthcare providers from the same clinic in the DR; and (c) an integrative literature review of English- and Spanish-language articles that assessed the health information needs of PLWH in Latin America and the Caribbean. We compared information needs across sources and developed a prioritized list of the topics important to provide PLWH in a clinical setting. Findings: Triangulation identified the most important topics for HIV-related health education for PLWH as medication and adherence, followed by transmission, including risks and prevention strategies, mental health management, and knowledge of HIV in general. Conclusions: The identification of evidence-based health education priorities establishes a guide that healthcare providers may use to help PLWH effectively manage their health and creates a foundation from which further studies on improving clinical interactions may be generated. Clinical Relevance: Using the priorities identified, nurses and other health educators can improve patient education, and consequently self-management, by making evidence-based choices about what information to provide to their patients.

Tès depifikasyon kansè nan pami travayè tranzaksyon travayè sèks nan Repiblik Dominikèn. Jounal Entènasyonal STD &aids sida, 2018. Richards SD, Stonbraker S, Halpern M, Amesty S, et al. (2018). Cervical cancer screening among transactional female sex workers in the Dominican Republic.International Journal of STD & AIDS. doi:10.1177/0956462418779662.
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Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18–54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8–14.5) or daily (AOR 4.9, 95% CI: 1.5–16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0–1.5) were significantly associated (p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.

 

Asosyasyon ant alfabetizasyon sante, konesans ki gen rapò ak VIH, ak konpòtman enfòmasyon nan mitan moun k ap viv avèk VIH nan Repiblik Dominikèn. Enfimyè sante piblik, 2017. 35(3): p. 166-175.Stonbraker S, Smaldone A, Luft H, Cushman LF, Lerebours Nadal L, Halpern M, Larson E, et al. (2017). Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nursing. doi:https://doi.org/10.1111/phn.12382.
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objektif yo
Pou detèmine nivo alfabetizasyon sante moun k ap viv ak viris iminodefisyans iminodefisyans (VIH) (PLWH) nan yon klinik sante nan Repiblik Dominikèn (DR) epi evalye asosyasyon ant alfabetizasyon sante, konesans ki gen rapò ak VIH,VIH,AK KONpòtman enfòmasyon sou sante (kijan pasyan bezwen, resevwa, resevwa, ak itilize enfòmasyon).
Konsepsyon ak echantiyon
Kwa-seksyonèl, deskriptif. Patisipan yo te 107 PLWH ale nan Klinik la.
Mezi
Yon sondaj teyorikman ki baze sou, 64-atik sondaj evalye enfòmasyon konpòtman ak VIH ki gen rapò ak VIH te administre an Panyòl atravè entèvyou endividyèl. Alfabè sante te evalye lè l sèvi avèk Evalyasyon kout nan alfabèt sante-panyòl ak Angle.
Rezilta
An mwayèn, patisipan yo te gen 40.8 an e yo te viv ak VIH pandan 7.7 ane. Majorite a (69.2%) te gen alfabè sante ki ba. Konesans ki gen rapò ak VIH ak enfòmasyon ki varye pa nivo alfabetizasyon sante ak ensèten konsènan yon endikatè prensipal nan pwogresyon maladi, chaj viral, te demontre kèlkeswa nivo alfabetizasyon sante. Patisipan ki gen alfabetizasyon sante ki ba yo te mwens chans reponn kesyon oswa reponn kesyon kòrèkteman ak anpil patisipan (39.2%) endike transmisyon viral ka rive nan mwayen Supernatural.
Konklizyon
Rezilta yo demontre bezwen enfòmasyon ki pa gen enfòmasyon e enfòmasyon nou resevwa yo ka pa toujou konprann. Metòd pou amelyore edikasyon sou lasante yo bezwen pou asire pasyan yo resevwa enfòmasyon sou sante nan yon fason ki konprann.

 

Ranfòse Kontinwite Swen VIH nan Repiblik Dominikèn: Aplikasyon yon Fondasyon Triyadik pou rankontre UNAIDS 90-90-90-90-90. Swen pasyan SIDA ak STD, 2017. 31(10): p. 407-412. Bowman AS, Mehta M, Lerebours Nadal L, Halpern M, Nicholas SW, Amesty S, et al. (2017). Strengthening the HIV Care Continuum in the Dominican Republic: Application of a Triadic Implementation Framework to Meet the UNAIDS 90-90-90 Treatment Goal. AIDS Patient Care and STDs. doi:https://doi.org/10.1089/apc.2017.0118.
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Innovative empirical frameworks to evaluate progress in efforts addressing HIV treatment and prevention barriers in resource-limited areas are sorely needed to achieve the UNAIDS 90-90-90 goal (90% diagnosed, 90% on treatment, and 90% virally suppressed). A triadic implementation framework (TIF) is a comprehensive conceptual tool for (1) monitoring attrition, (2) evaluating operational programs, and (3) measuring the impact of specific implementation goals within the care continuum. TIF will assess the effects of enhanced programs on adherence and virologic suppression within the HIV care continuum at a regional clinic in the Dominican Republic (Clínica de Familia La Romana [CFLR]) and its program serving high-risk, migratory batey (sugarcane cultivation) communities. A retrospective cohort study completed during 2015 collected deidentified data from a CFLR chart review of adult HIV patients diagnosed in 2013. The results were quantitatively analyzed and compared to 2011 cohort data. In 2013, 310 patients were diagnosed HIV positive. The results demonstrated 73% enrolling in care, 28% adhering to care, and 16% achieving viral load suppression. Engagement increased across all steps of the care continuum compared to a 2011 cohort, culminating in a significant increase in undetectable viral load from 4% to 16% (p < 0.001). The batey program showed significant increases in patient enrollment compared to the 2011 cohort (p < 0.001). Meeting the UNAIDS 90-90-90 goal requires enhanced services in high-burden, resource-limited regions. CFLR employs TIF to assess progress and programmatic areas in need of strengthening. Data suggest enhanced CFLR services improve outcomes. Given improvements, maintenance and expansion of similar programs are warranted to achieve the 90-90-90 goal.

"... tankou paske ou se yon grandi, ou pa bezwen èd": Eksperyans nan Tranzisyon soti nan pedyatrik pou granmoun swen nan mitan jèn ki gen enfeksyon VIH, moun kap bay swen sante yo, ak Founisè Swen Sante nan Repiblik Dominikèn. Jounal nan Asosyasyon Entènasyonal founisè swen sida (JIAPAC), 2017: p. 2325957417729749.  Pinzón-Iregui MC, Ibanez G, Beck-Sagué C, Halpern M, Mendoza RM, et al. (2017). “… like because you are a grownup, you do not need help”: Experiences of Transition from Pediatric to Adult Care among Youth with Perinatal HIV Infection, Their Caregivers, and Health Care Providers in the Dominican Republic. Journal of the International Association of Providers of AIDS Care (JIAPAC). doi:https://doi.org/10.1177%2F2325957417729749.
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Avèk entwodiksyon de terapi antiretwoviral antiretwoviral (ART) atravè lemanantye, jèn yo ak enfeksyon viris viris yo de pli zan pli siviv timoun ak tranzisyon nan swen granmoaj. Malgre ke yon span lavi nòmal antisipe postransis, tranzisyon siksè nan swen pou granmo ankouraje te pwouve difisil, ak pi mal rezilta postransis pase nan pedyatrik ak swen granmoin. Etid sa a se yon analiz kalitatif nan done ki sòti nan 4 gwoup konsantre nan pre- ak postransition pasyan, moun kap bay swen sante, ak founisè swen sante nan Repiblik Dominikèn nan yon enstitisyon ki bay tretman konplè ki gen ladan ART pou moun ki enfekte VIH nan tout laj. Tout gwoup diskite sou pwoblèm yo ak defi ki pasyan, moun kap bay swen, ak founisè eksperyans pandan y ap viv pwosesis tranzisyon an ak pi lwen pase. Senk tèm pi gwo parèt: chòk nan tranzisyon tèt li, Atizay Atizay, eksperyans ak enpak nan stigma, sipò sosyal ak baryè, ak rekòmandasyon pou amelyore rezilta yo. Sur patisipan yo ofri apwòch pou yon pwosesis tranzisyon versatile estriktire.

 

Ki sa rès mond lan ta dwe konnen sou VIH: pèsepsyon nan granmotan k ap viv ak VIH nan Repiblik Dominikèn. Journal of Asosyasyon Enfimyè nan swen sida, 2017. 28(6): p. 977. Stonbraker S, Arcia A, Halpern M, Larson E, et al. (2017). What the rest of the world
should know about HIV: Perceptions from adults living with HIV in the Dominican Republic. Journal of the Association of Nurses in AIDS Care.
doi:10.1016/j.jana.2017.06.009.
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Pa gen abstrè

Evalye sèvis piblik la nan estati klinik founisè-anrejistre nan dosye medikal granmoun viris ki pozitif nan yon anviwònman resous limite. Jounal entènasyonal stD ak SIDA, 2016. 28(7). Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E, et al. (2016).
Evaluating the utility of provider-recorded clinical status in the medical records of HIV positive adults in a limited-resource setting. International Journal of STD and AIDS. doi:10.1177/0956462416663990.
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Founisè ki rapòte rezime estati klinik yo ka ede avèk jesyon klinik VIH nan anviwònman pòv yo si yo reflete pwosesis byolojik ki asosye ak pwogresyon maladi VIH. Sepandan, kapasite yo genyen pou yo fè sa raman evalye. Se poutèt sa, nou vize evalye relasyon ki genyen ant yon rezime founisè-anrejistre nan estati klinik ak enditatè nan pwogresyon VIH. Done yo te abstrè nan 2011 dosye medikal owaza chwazi nan yon gwo klinik VIH nan Repiblik Dominikèn. Regresyon lojistik multivariable yo te itilize pou egzamine relasyon ki genyen ant founisè-asiyen estati klinik ak demografik (sèks, laj, nasyonalite, edikasyon) ak faktè klinik (rapòte aderans medikaman, CD4 konte, chaj viral). Laj vle di nan pasyan te 41.2 (SD = ±10.9) ane ak pifò te fi (n = 115, 57%). Okenn nan karakteristik yo egzamine yo te siyifikativman ki asosye ak founisè-anrejistre estati klinik. Pi wo konte CD4 yo te gen plis chans pou fanm (OSWA = 2.2 CI: 1.12–4.31) ak mwens charj pou moun ki gen pi wo charj viral (OSWA = 0.33 CI: 0.15–0.72). Pi pòv adorasyon ak pi ba konte CD4 yo te siyifikativman ki asosye ak pi wo charj viral (OR = 4.46 CI: 1.11–20.29 ak 6.84 CI: 1.47–37.23, respektivman). Klinik lè l sèvi avèk founisè-rapòte rezime nan estati klinik yo ta dwe evalye pèfòmans nan evalyasyon sa yo asire yo ki asosye ak endikatè byolojik nan pwogresyon maladi.

 

Evalyasyon nan kaskad swen pasyan pou pasyan ki pozitif dyagnostike nan La Romana, Repiblik Dominikèn nan 2011: yon etid kowòdone retrospektiv. Jounal Entènasyonal STD &aids sida, 2016. 27 (5): p. 394-401. Bowman AS, Lerebours L, Amesty S, de la Rosa M, Gil E, Halpern M, Nicholas S, Lamb MR, et al. (2016). Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study. International Journal of STD & AIDS. doi:10.1177/0956462415584487.
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The Caribbean has the highest adult HIV prevalence in the world after sub-Saharan Africa (2011). One sub-population in the Dominican Republic is the migratory Batey community primarily comprised of Haitian immigrants with limited access to healthcare and HIV prevalence rates of between 3.0% and 9.0%, compared to 0.7% nationally. This retrospective cohort study describes the cumulative retention from diagnosis to virological suppression for newly-diagnosed HIV-infected adults presenting to the Clínica de Familia and its Batey programme in La Romana, during 2011. Of the patients diagnosed with HIV, 65% entered into care, 59% completed immunologic testing, 53% were eligible for antiretroviral therapy (ART) initiation, 36% initiated ART within three months of eligibility and 27% were retained in care. Seventeen per cent of those retained on ART with a 12-month viral load measure had undetectable viral load. Attrition primarily occurred before ART initiation. The Batey programme had a first step lost-to-follow-up of 88% compared to 20% at the clinic (p < 0.001). This retrospective study details the continuum of care and indicates where structural changes must occur to increase continuity between steps. The manuscript results are important to help implement programmes to enhance engagement and retention in HIV primary care.

Faktè ki asosye ak enfòmasyon sou sante k ap chèche, pwosesis, ak itilize nan mitan granmoaj pozitif nan Repiblik Dominikèn. SIDA ak konpòtman, 2016. 21(6): p. 1588–1600. Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E, et al. (2016). Factors associated with health information seeking, processing, and use among HIV positive adults in the Dominican Republic. AIDS and Behavior. doi:10.1007/s10461-016-1569-5..
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Tretman efikas ak jesyon viris iminodefisyans iminodefisyans iminodefisyans imen (VIH) depann de kapasite pasyan yo pou lokalize, comprehend, ak aplike enfòmasyon sou sante. Objektif etid sa a se te pou idantifye karakteristik ki asosye ak ladrès sa yo nan mitan granmou pozitif nan Repiblik Dominikèn. Yon sondaj konpòtman enfòmasyon te administre a 107 patisipan Lè sa a, twa retou lojistik yo te fè yo idantifye karakteristik ki asosye ak enfòmasyon k ap chèche, pwosesis, ak itilize. Pa janm gen swen yon moun ki te malad te siyifikativman ki asosye ak mwens enfòmasyon k ap chèche, pwosesis, ak itilize. Gason yo te gen plis chans pou yo te aktif enfòmasyon ak moun ki te asiste klinik la pou sis oswa mwens ane yo te mwens chans pou yo chèche enfòmasyon aktivman. Moun ki pi piti yo te ogmante chans nan pi wo pwosesis enfòmasyon ak moun ki pa gen komorbidit yo te ogmante chans nan plis itilizasyon enfòmasyon. Rezilta yo ka enfòme chèchè, òganizasyon, ak founisè sou ki jan pasyan yo kominike avèk enfòmasyon sante nan anviwònman resous limite

 

Yon jijman klinik pou prezante sikonsizyon medikal volontè pou prevansyon VIH nan domèn segondè nan Repiblik Dominikèn. Plos youn, 2015. 10(9): p. e0137376. Brito MO, Lerebours L, Volquez C, Basora E, Khosla S, Lantigua F, Flete R, Rosario R, Rodriguez LA, Fernandez M, Donastorg Y, Bailey RC, et al. (2015). A clinical trial to introduce voluntary medical male circumcision for HIV prevention in areas of high prevalence in the Dominican Republic. PloS One. doi:10.1371/journal.pone.0137376.
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Orijin
Volontè medikal Sikonsizyon Medikal Gason (VMMC) se yon estrateji efikas pou diminye risk pou enfeksyon VIH. Etid ki fèt nan Repiblik Dominikèn (DR) sijere ke akseptabilite nan VMMC nan mitan gason ka kòm wo 67%. Objektif esè klinik sa a se te evalye akseptabilite a, konsome ak sekirite pou sèvis VMMC nan de zòn nan gwo prévalence VIH nan peyi a.
Metòd
Sa a te yon sèl-bra, ki pa owaza, pratik esè klinik. Pèsonèl etid te resevwa enfòmasyon background sou risk ak benefis nan VMMC ak fòmasyon pratik sou teknik chirijikal la. Yon asistan rechèch natif natal pale administre yon kesyonè demografik, pratik seksyèl ak konesans sou VMMC. Yon semèn apre operasyon an, patisipan yo te retounen pou enspeksyon blese ak reponn kesyon sou eksperyans pòs-chirijikal yo.
Rezilta
539 gason konsantman pou etid la. Senkant sèt te eskli nan patisipasyon pou rezon medikal oswa anatomik ak 28 deside pa gen pwosedi a apre yo fin bay konsantman. Yon total de 454 gason te sikonsi lè l sèvi avèk Metòd Fòs Gide anba Anestezi lokal yo. Pousantaj evènman piblisite (AE) te 4.4% (20% modere, 80%twò grav). Pa te gen okenn AES grav ak tout konplikasyon rezoud rapidman ak tretman. Katreven pousan nan kliyan rapòte ke yo te "trè satisfè" ak 12% yo te "yon ti jan satisfè" ak rezilta a nan yon sèl-semèn vizit poto- semèn.
Konklizyon
Rekritman ak konsekans yo te satisfezan. Satisfaksyon kliyan ak VMMC te wo ak pousantaj la nan AES te ba. Woule soti nan VMMC nan zòn vize nan DR la se posib epi yo ta dwe konsidere.

 

Divilgasyon sou sitiyasyon VIH yo pou enfekte jèn yo lè l sèvi avèk modèl divilgasyon Blasini an Ayiti ak Repiblik Dominikèn: rezilta preliminè yo. SIDA (London, Angletè), 2015. 29(0 1): p. S91. Beck-Sagué CM, Dévieux J, Pinzón-Iregui MC, Lerebours-Nadal L, Abreu-Pérez R, Bertrand R, Rouzier V, Gaston S, Ibanez G, Halpern M, Pape JW, Dorceus P, Preston SM, Dean AG, Nicholas SW, Blasini I, et al. (2015). Disclosure of their HIV status to perinatally infected youth using the adapted Blasini disclosure model in Haiti and the Dominican Republic: preliminary results. AIDS (London, England. doi:10.1097/QAD.0000000000000665.
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Objectives:
To assess the safety, acceptability, and preliminary efficacy of a culturally-adapted disclosure intervention for perinatally HIV-infected combined antiretroviral therapy patients in Haiti and the Dominican Republic.
Design: 
A quasi-experimental trial was conducted comparing caregiver–youth pairs who completed the intervention [adapted Blasini disclosure model (aBDM)] to pairs who discontinued aBDM participation before disclosure. aBDM consists of five components: structured healthcare worker training; one-on one pre-disclosure intervention/education sessions for youth (describing pediatric chronic diseases including cancer, diabetes and HIV) and for caregivers (strengthening capacity for disclosure); a scheduled supportive disclosure session; and one-on-one postdisclosure support for caregivers and youth.
Methods: 
Caregivers of nondisclosed combined antiretroviral therapy patients aged 10.0–17.8 years were invited to participate. Data were collected by separate one-on-one face-to-face interviews of caregivers and youth by study staff and medical record review by pediatricians at enrollment and 3 months after disclosure or after intervention discontinuation.
Results:
To date, 65 Dominican Republic and 27 Haiti caregiver–youth pairs have enrolled. At enrollment, only 46.4% of youth had viral suppression and 43.4% of caregivers had clinically significant depressive symptomatology. To date, two serious study-related adverse events have occurred. Seven of the 92 (7.6%, 6 in the Dominican Republic) enrolled pairs discontinued participation before disclosure and 39 had completed postdisclosure participation. Median plasma HIV-RNA concentration was lower in youth who completed aBDM than in youth who discontinued participation before aBDM disclosure (<40 versus 8673 copies/ml; P = 0.027). Completers expressed considerable satisfaction with aBDM.
Conclusion:
Preliminary results suggest safety, acceptability, and possible effectiveness of the aBDM.

 

Divilgasyon sou estati yo pou jèn yo ak enfeksyon viris iminodefisyans iminodefisyans nan Repiblik Dominikèn: yon melanje-metòd etid. SIDA ak konpòtman, 2015. 19(2): p. 302-310. Beck-Sagué C, Pinzón-Iregui MC, Abreu-Pérez R, Lerebours-Nadal L, Navarro CM, Ibanez G, Soto S, Halpern M, Nicholas SW, Malow R, Dévieux JG, et al. (2015). Disclosure of their status to youth with human immunodeficiency virus infection in the Dominican Republic: a mixed-methods study. AIDS and Behavior. doi:10.1007/s10461-014-0888-7.
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Yon metòd melanje te fèt pou detèmine pwopòsyon timoun ki enfekte VIH ki te konnen estati yo, idantifye karakteristik ki asosye avèk konesans timoun yo nan estati yo, epi dekri eksperyans moun kap bay swen yo ak eksperyans adolesan ki enpòtan pou divilge nan Repiblik Dominikèn (DR). Nan 327 pasyan ki gen laj 6-18 ane trete nan enstalasyon direktè lekòl DR Pedyatrik VIH, 74 (22.6%) te konnen estati yo. Pasyan ki gen laj 13 zan oswa plis ak/ oswa ki te patisipe nan aktivite ki pa klinik pou timoun ki enfekte VIH yo te gen plis chans pou konnen estati yo. Moun kap bay swen ki te divilge konsèy swen sante yo, dezi timoun yo pou konnen ak enkyetid ke timoun yo ta ka kòmanse aktivite seksyèl anvan yo konnen oswa dekouvri estati yo pa aksidan oswa move divilgasyon. Moun ki pa divilge moun ki pa divilge yo enkyete ke timoun yo ta twomatize pa divilgasyon ak / oswa stigmatize si yo revele li bay lòt moun. Adolesan yo te sipòte divilgasyon pa 10-12 ane ki gen laj, konsidere prelèvman dyagnostik VIH timoun malad-konseye, epi rekòmande yon pwosesis divilgasyon ki konsantre okòmansman sou fè pwomosyon atitid ki pa stigmatize sou VIH.

 

G6PD se yon anviwònman klinik VIH nan Repiblik Dominikèn. Jounal Ameriken an nan medikaman twopikal ak ijyèn, 2015. 93(4): p. 722-729. Xu JZ, Francis RO, Lerebours Nadal LE, Shirazi M, Jobanputra V, Hod EA, Jhang JS, Stotler BA, Spitalnik SL, Nicholas SW, et al. (2015). G6PD deficiency in an HIV clinic setting in the Dominican Republic. The American Journal of Tropical Medicine and Hygiene, 93(4), 722-729. doi:https://doi.org/10.4269/ajtmh.14-0295.
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Paske viris iminodefisyans iminodefisyans (VIH)-enfekte resevwa pwofesyonèl ki gen dwòg oksidantal, moun ki gen glikoz-6-fosfò dezidrogenase (G6PD) ka fè eksperyans emolysi. Sepandan, defisyans G6PD pa te etidye nan Repiblik Dominikèn, kote anpil moun gen zansèt Afriken. Objektif nou se te pou detèmine prévalence deficiency G6PD nan pasyan VIH-enfekte ak eseye devlope yon algorithm pri-efikas pou idantifye moun sa yo. Pou sa a, istwa, revize tablo, ak tès G6PD te fèt pou 238 pasyan ki konsekitif VIH ki enfekte. Prevalans an jeneral nan defisyans G6PD (8.8%) te menm jan ak gason (9.3%) ak fanm (8.5%), ak pi wo an Ayisyen (18%) pase Dominiken (6.4%; P = 0.01). Pa retou lojistik, twa varyab klinik prevwa Estati G6PD: peyi matènèl nan nesans (P = 0.01) ak yon istwa de emolysi (P = 0.01) oswa anemi grav (P = 0.03). Sèvi ak kritè sa yo, yon algorithm te devlope, nan ki yon subset pasyan te idantifye ki ta benefisye pi fò nan tès depistaj G6PD, sede yon sansiblite nan 94.7% ak yon espesifik nan 97.2%, ogmante pwobabilite ki pi pre a (8.8-15.1%), ak halving kantite pasyan ki bezwen tès. Algorithm sa a ka bay yon estrateji pri-efikas pou amelyore swen nan anviwònman resous limite.

 

Evalyasyon yon Pwogram Konseye POU VIH nan La Romana, Repiblik Dominikèn. J Int Assoc Bay swen sida, 2014. 
Winter MC, Halpern M, Brozovich A, Neu N, et al. (2014). Evaluation of an HIV Adherence Counseling Program in La Romana, Dominican Republic. Journal of the International Association of Providers of AIDS Care. doi:https://doi.org/10.1177%2F2325957413514630.
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Rechèch te demontre ke respekte terapi antiretwoviral (ART) rezilta nan pi ba pousantaj mòbidite ak mòtalite ki asosye avèk enfeksyon VIH, men aderans rete yon defi nan anviwònman resous limite tankou Repiblik Dominikèn. Clínica de Familia La Romana te adrese pwoblèm sa a avèk yon pwogram adesans ki baze sou edikasyon pou pasyan granmoin nouvo nan ART, ak etid kowòdone retrospektiv sa a ki vize evalye enpak entèvansyon sa a. Adezif randevou ak makè byolojik yo te evalye nan ka ak kontwòl nan 12 mwa. Yon total de 101 patisipan yo te enkli, ak 61 kontwòl ak 40 ka. Konte debaz CD4 a te 162 ak 157 selil / mm³ nan kontwòl ak ka, respektivman. Ka yo te montre yon ogmantasyon 15-pliye nan CD4 konte konpare ak yon ogmantasyon 2.5-pliye nan kontwòl. Ka yo te gen plis chans yo konfòme yo ak randevou ak pousantaj administrasyon nan 86% kont 76% nan kontwòl. Pa te gen okenn diferans ant pousantaj yo nan abandone tretman, transfè swen, oswa lanmò.

 

Faktè enfliyan Sèvis Planin familyal nan mitan fanm pozitif nan Pwogram PMTCT nan Clínica de Familia La Romana nan Repiblik Dominikèn. Rechèch seksyalite ak Règleman Sosyal, 2013. 10(3): p. 200-207. McKinney JR, Halpern M, Levison J, Callender G, Lerebours L, Fernandez-Esquer ME, et al. (2013). Factors Influencing Use of Family Planning Services among HIV-positive Women in the PMTCT Program at Clínica de Familia La Romana in the Dominican Republic. Sexuality Research and Social Policy. doi:10.1007/s13178-013-0115-8.
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Diminye planin familyal ki pat bezwen zewo se yon pati entegral nan Plan Global UNAIDS la nòmalman elimine enfeksyon VIH pa 2015. Etid sa a gen pou objaktif pou konprann kwayans ak atitid ki enfliyanse planin familyal nan mitan fanm pozitif nan prevansyon transmisyon manman-a-timoun (PMTCT) nan Clínica de Familia La Romana, Repiblik Dominikèn, ak pou detèmine ki baryè pou itilize yo pi enpòtan nan popilasyon sa a epi priyorize yo kòm sib pou entèvansyon. Done yo te ranmase nan yon gwoup konsantre ak 21 sèl envestigatè-administre entèvyou ak fanm nan pwogram PMTCT nan Clínica de Familia La Romana, Repiblik Dominikèn. Majorite fanm yo te deklare ke dènye gwosès yo pat ansent, byenke yo pa t ap itilize planin nan moman gwosès la. Konesans sou metòd yo, enfliyans sosyal (fanmi, zanmi), ak lojistik pa t 'baryè enpòtan nan popilasyon sa a. De baryè yo ki te pi souvan rapòte kòm rezon pou yo pa itilize, oswa sispann itilize nan, yon metòd planin familyal yo te atitid ak kwayans nan patnè a ak chanjman règleman sòti nan senyen iregilye nan amenajman. Etid sa a sijere de kategori prensipal nan entèvansyon diminye bezwen planifikasyon fanmi san limit nan popilasyon PMTCT sa a. Premyèman, nou bezwen plis rechèch pou pwouve atitid planin ak kwayans nan mitan patnè yo nan fanm pozitif. Se sèlman pa eksplore tou de kwayans patnè yo ak atant yo ka kiltirèlman entèvansyon sansib yo dwe devlope pou ogmante akseptabilite planin nan mitan patnè yo, e konsa potansyèlman ogmante itilize nan mitan fanm yo. Dezyèmman, konsèy espesifik nesesè pou mande ak adrese enkyetid fi yo. Sa ki enpòtan, fanm bezwen konprann ke chanjman règ se nòmal ak sèten metòd epi yo pa endike yon bès nan estati sante yo. Ki enplike patnè nan edikasyon planin ak amelyore konpreyansyon fanm sou ki jan metòd, travay ak efè segondè yo atann ka amelyore kontrasepsyon nan popilasyon sa a.

Pwogrè nan direksyon pou Eliminasyon TRANSmisyon MANMAN VIH-a-Timoun nan Repiblik Dominikèn soti nan 1999 a 2011. Maladi enfeksyon nan Obstetrik ak Gynecology, 2012.Lorenzo O, Beck-Sagué CM, Bautista-Soriano C, Halpern M, Roman-Poueriet J, Henderson N, Perez-Then E, Abreu-Perez R, Soto S, Martínez L, Rives-Gray S, Veras B, et al. (2012). Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011. Infectious Diseases in Obstetrics and Gynecology. doi:10.1155/2012/543916.
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Nan lane 1999, prevansyon transmisyon manman-a-timoun (pmtct) lè l sèvi avèk antiretwoviral yo te prezante nan Repiblik Dominikèn (DR). Terapi antiretroviral trè aktif (HAART) te prezante pou moun immunosuppressed nan 2004 ak pou pMTCT nan 2008. Pou evalye pwogrè nan direksyon pou eliminasyon MTCT, done ki sòti nan requisitions pou tès anplifikasyon nikleyik VIH pou dyagnostik enfeksyon VIH nan perinativman ekspoze tibebe ki fèt nan DR a soti nan 1999 a 2011 yo te analize. To MTCT a te 142/1,274 (11.1%) nan 1999-2008 ak 12/302 (4.0%) nan 2009-2011 (), ak yon pousantaj de 154/1,576 (9.8%) pou tou de peryòd konbine. N bès sa a te asosye ak ogmantasyon enpòtan nan pwopòsyon fanm ki te resevwa PREnatal HAART (ki soti nan 12.3% a 67.9%) ak tibebe ki te resevwa manje fòmil san konte (ki soti nan 76.3% a 86.3% a 86.1%) ak refize nan pwopòsyon de fanm ki pa te resevwa okenn antiretwoviral prenatal (ki soti nan 31.9% a 12.2%) oswa te resevwa sèlman yon sèl dòz nevirapi (ki soti nan 39.5% a 19.5%). Nan 2007, plis pase 95% nan fanm DR ansent te resevwa swen prenatal, tès VIH, ak pwofesyonèl ale nan livrezon. Sepandan, sèlman 58% nan fanm nan kominote plantasyon sik ki defavorize (2007) ak 76% nan lopital siveyans VIH (2003-2005) te resevwa rezilta tès VIH yo. Eliminasyon VIH-MTCT se posib men ki pèsistan mank de aksè nan mezi kritik pMTCT yo dwe adrese.

 

Depans ak benefis nan miltidwong, terapi antiretwoviral pou prevansyon manman‐to‐transmisyon timoun nan VIH nan Repiblik Dominikèn. Jounal Entènasyonal nan Gynecology & obstetrik, 2012. 116(3): p. 219-222.Schmidt NC, Roman-Pouriet J, Fernandez AD, Beck-Sagué CM, Leonardo-Guerrero J, Nicholas SW, et al. (2012). Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother‐to‐child transmission of HIV in the Dominican Republic. International Journal of Gynecology & Obstetrics. doi:https://doi.org/10.1016/j.ijgo.2011.10.028.
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Objektif
Pou mennen ankèt sou si wi ou non depans nan plizyè rejim antiretwoviral (MD-ARVs), ki gen ladan terapi antiretroviral trè aktif (HAART), pou prevansyon nan transmisyon manman-a-timoun (PMTCT) nan VIH ka koupe pa ekonomi te pran nan trete mwens enfeksyon akeri.
Metòd
Pousantaj MTCT rapòte nan Repiblik Dominikèn nan mitan pè manman-tibebe yo trete ak yon sèl dòz nevirapi (SD-NVP ; n = 39) ak MD-ARVs (n = 91) pou PMTCT yo te konpare. Yo te estime nesans chak ane pou fanm ki enfekte ak VIH te estime nan etid seroprevalans. Depans antiretroviral pou tou de PMTCT ak pou HAART pandan premye 2 ane yo nan lavi (nan ka enfeksyon pèsonèl) yo te baze sou 2008 estimasyon pri ki pa gen anpil revni.
Rezilta
Pousantaj nan MTCT yo te 3.3% ak 15.4% pou gwoup yo MD-ARV ak SD-NVP, respektivman (P = 0.02). Asepte ke 5775 nan 231 000 nesans anyèl (2.5%) yo te nan fanm viris-pozitif, li te estime ke 191 enfeksyon akeri ta rive lè l sèvi avèk MD-ARVs ak 889 lè l sèvi avèk SD-NVP. Gwo depans nan matènèl MD-ARVs (HAART, US $ 914,760 kont SD-NVP, $1155) ta dwe koupe pa pi ba depans 2-ane HAART ($ 250,344 kont $ 1,168,272 pou tibebe nan gwoup SD-NVP) pou pi ba kantite timoun ki gen enfeksyon prenatman (191 kont 889) ki asosye ak itilizasyon MD-ARVs pou PMTCT (nasyonal ekonomize $ 3168).
Konklizyon
Malgre gwo depans yo, itilize nan MD-ARVs, tankou HAART, pou PMTCT ofri ekonomi sosyete paske mwens enfeksyon pèsonèlman akeri yo antisipe mande pou tretman.

  

ENfeksyon VIH ak prevansyon transmisyon manman-a-timoun nan fanm: La Womena, Repiblik Dominikèn, 2002-2006. Pan Ameriken Journal of Health, 2009. 26(4): p. 315-323. Román-Poueriet J, Fernandez AD, Beck-Sagué CM, Szabó RG, Mercedes F, Duke W, Martinez A, Nicholas S, et al. (2009). HIV infection and prevention of mother-to-child transmission in childbearing women: La Romana, Dominican Republic, 2002-2006. Revista Panamericana de Salud Pública, 26(4), 315-323. Enlace: https://iris.paho.org/handle/10665.2/9764
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OBJEKTIF: Pou ranfòse prevansyon transmisyon VIH manman-a-pitit (pmtCT) nan Pwovens La Romana (LR) pwovens, pa estime prevalans VIH ak idantifye karakteristik ki asosye ak enfeksyon VIH nan pati.
METÒD: Echantiyon kòd lonbrit yo te ranmase nan sèt sit obstetrik kote plis pase 95 pousan nan livrezon LR a rive pandan kat faz (pilòt, elaji pilòt, etid plen, ak siveyans pwogram pMTCT) soti nan 2 out 2002 a 30 septanm 2006. Rezilta yo te lye nan done abstrè nan dosye livrezon.
REZILTA: Seroprevalence VIH te 2.6 pousan (263/10,040 an jeneral; 114/4,452, faz plen etid (95 pousan entèval konfyans = 2.1 pousan-3.1 pousan). Pifò patizan viris ki enfekte yo te Dominiken (68.9 pousan) ak iben (64.0 pousan). Sepandan, prévalence te pi wo pami Ayisyen (3.7 pousan) pase Dominiken yo (2.3 pousan (p 0.001), espesyalman moun ki gen laj 21-25 ane (5.2 pousan vs. 2.3 pousan (p 0.001), ak nan mitan riral, batey, ak peryòd iben (vs iben) pati (3.4 pousan vs 2.3 pousan, (p = 0.003)) ... Prevalans VIH te asosye ak travay sèks komèsyal (rapòte pa sèlman 0.4 pousan), ak ansent anvan ansent. Nan analiz retou lojistik, travay sèks komèsyal, nasyonalite ayisyen, ak anvan gwosès la te poukont li ki asosye ak enfeksyon VIH. Livrezon Seza yo te pi souvan, epi leve nan dènye ane yo nan etid la, nan mitan seropozitif VIH; sepandan, pifò livrezon nan mitan seropozitif (57.5 pousan) te vajen.
KONKLIZYON: Prévalence VIH nan mitan patizan LR te pi wo pase prévalence de estime nan Repiblik Dominikèn (0.8 pousan), epi, nan contrast nan syans sot pase yo, majorite dominiken yo afekte dominiken. Prévalence viris pami patizan Ayisyen LR te pi wo pase pami tokay Dominiken yo ak patisipan klinik prenatal an Ayiti (ki te gen yon pousantaj de 3.1 pousan). Toujou aplike, entèvansyon pmtct vize yo nesesè. (AU)

Depresyon, abi sibstans ak antiretwoviral ki pa adezif nan mitan granmotan ak VIH nan swen nan Clínica de Familia nan La Romana, Repiblik Dominikèn. Jounal sante mondyal, 2016.  Fay, C., En Sus Palabras. 2017, Raleigh, North Carolina: Lulu: Online Self Publishing.
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Background: People living with HIV/AIDS (PLWHA) are more likely to experience a psychiatric disorder in their lifetime when compared to the general population. is can greatly a ect adherence to the centerpiece of HIV treatment, antiretroviral therapy (ART), and the course that the illness can take. Depression and substance use are the two most common psychiatric disorders in PLWHA. is cross-sectional study examined rates of depression, substance use, adherence to ART and HIV biomarkers on a sample of HIV-positive patients serviced by a general medical clinic, Clinica de Familia La Romana (CFLR) in the Dominican Republic (DR).
Methods: A cross-sectional, questionnaire-based study was conducted in a clinic with a special program for PLWHA in La Romana, DR, over four weeks in Fall 2015. The questionnaire included demographic information and scales for assessing adherence, depression and substance use: the Morisky Medication Adherence Scale (MMAS- 4), Patient Health Questionnaire-2 and -9 (PHQ-2 and -9) and CAGE-AID, respectively. Open-ended, exploratory questions on the experience of living with HIV/AIDS were posed to every fourth or fifth participant. Additionally, two important biomarkers for measuring HIV progression and severity, CD4 cell counts and HIV-RNA viral loads (most recent value within the last six months), were extracted from the medical chart. Data analysis was carried out using the Statistical Package of Social Sciences (SPSS) software.
Results: 89 participants were involved in the study. The mean age was 40.0 years old (SD 10.9) with an almost equal distribution of women and men; two participants self-identified as transgender. 80 participants (89.9%) scored positively on the PHQ-2, which means they met at least one of the two major criteria for depression: loss of interest in activities and depressed mood. The mean PHQ-9 for those who scored positive on the PHQ-2 was 10.6 (SD 4.7; threshold of 10 for major depression). Those with good ART adherence had a mean PHQ-9 of 9.4 (SD 5.0) while the mean for those with poor ART adherence was 11.2 (SD: 4.4). 27 participants (30.3%) fit criterion for severe alcohol or drug use (> 2). Participants endorsing drug use in their lifetime used marijuana (n=8) and cocaine (n=5). Based on the MMAS-4, 41.3% of those on ART had good adherence (score=0), whereas 58.7% had poor adherence (score > 1). Dominican origin and the completion of at least primary school were associated with good adherence (p-value = 0.04 and p-value = 0.03, respectively). Being female was associated with increased PHQ-9 scores (p-value = 0.01) as well as undetectable viral loads (p-value = 0.03); being male was associated with increased alcohol or drug use (p-value < 0.01). In the exploratory questions, most individuals reported acquiring HIV from a spouse or known romantic partner and reported being diagnosed after personally falling ill or witnessing their partner do so. Major concerns were inability to nd work, loneliness and fear of discrimination.
Conclusions: Depressive symptoms and substance use were common factors that impacted ART adherence in a sample of PLWHA treated at Clinica de Familia La Romana in the Dominican Republic. Using validated measures to implement screening for depression and substance use could help identify those requiring diagnosis and appropriate care within the constraints of this low-resource clinic.

 

Itilizasyon sibstans ak kapòt pami popilasyon VIH nan Clínica de Familia La Romana, Repiblik Dominikèn. Jounal sante mondyal, 2016.
Isabel del Canto, Mina Halpern, Silvia Cunto-Amesty, Leo Lerebours Nadal, Mireya Cruz, Alexander Bowman.
Gade sou entènèt Abstrè

Objektif prensipal envestigasyon kwa-seksyonèl sa a te pou kalkile itilizasyon sibstans ilegal pami popilasyon pozitif VIH nan Clínica de Familia La Romana nan Repiblik Dominikèn. Objektif segondè a se te pou idantifye si gen yon relasyon ant konsomasyon alkòl ak itilizasyon kapòt. Nan 97 patisipan yo ki te fè entèvyou nan etid la, 49% pwòp tèt ou-rapòte alkòl oswa tabak itilize nan twa dènye mwa yo. Baze sou nòt la asistan kalkile, 20% nan patisipan yo te klase kòm "modere" oswa "gwo risk," ki mande yon entèvansyon. Anplis de sa, 51% nan echantiyon an rapòte gen kouche seksyèl nan dènye 30 jou yo. Soti nan patisipan yo 49 ki te seksyèlman aktif, 67% rapòte lè l sèvi avèk yon kapòt pandan dènye eksperyans seksyèl yo, 31% rapòte pa lè l sèvi avèk yon kapòt ak rès la 2% te refize reponn. Kontrèman ak rechèch anvan, pa gen okenn asosyasyon yo te jwenn ant konsomasyon alkòl ak sèks san pwoteksyon nan Clínica de Familia La Romana, petèt akòz pousantaj ki ba nan pasyan ki rapòte konsome alkòl souvan

 

ENfeksyon VIH ak prevansyon transmisyon manman-a-timoun nan fanm: La Womena, Repiblik Dominikèn, 2002-2006. Pan Ameriken Journal of Health, 2009. 26(4): p. 315-323.
José Román-Poueriet, Aracelis Fernandez, Consuelo Beck-Sagué, René García Szabó, Fermín Mercedes, William Duke, Anny Martinez, Stephen Nicholas.
Gade sou entènèt Abstrè

OBJEKTIF: Pou ranfòse prevansyon transmisyon VIH manman-a-pitit (pmtCT) nan Pwovens La Romana (LR) pwovens, pa estime prevalans VIH ak idantifye karakteristik ki asosye ak enfeksyon VIH nan pati.
METÒD: Echantiyon kòd lonbrit yo te ranmase nan sèt sit obstetrik kote plis pase 95 pousan nan livrezon LR a rive pandan kat faz (pilòt, elaji pilòt, etid plen, ak siveyans pwogram pMTCT) soti nan 2 out 2002 a 30 septanm 2006. Rezilta yo te lye nan done abstrè nan dosye livrezon.
REZILTA: Seroprevalence VIH te 2.6 pousan (263/10,040 an jeneral; 114/4,452, faz plen etid (95 pousan entèval konfyans = 2.1 pousan-3.1 pousan). Pifò patizan viris ki enfekte yo te Dominiken (68.9 pousan) ak iben (64.0 pousan). Sepandan, prévalence te pi wo pami Ayisyen (3.7 pousan) pase Dominiken yo (2.3 pousan (p 0.001), espesyalman moun ki gen laj 21-25 ane (5.2 pousan vs. 2.3 pousan (p 0.001), ak nan mitan riral, batey, ak peryòd iben (vs iben) pati (3.4 pousan vs 2.3 pousan, (p = 0.003)) ... Prevalans VIH te asosye ak travay sèks komèsyal (rapòte pa sèlman 0.4 pousan), ak ansent anvan ansent. Nan analiz retou lojistik, travay sèks komèsyal, nasyonalite ayisyen, ak anvan gwosès la te poukont li ki asosye ak enfeksyon VIH. Livrezon Seza yo te pi souvan, epi leve nan dènye ane yo nan etid la, nan mitan seropozitif VIH; sepandan, pifò livrezon nan mitan seropozitif (57.5 pousan) te vajen.
KONKLIZYON: Prévalence VIH nan mitan patizan LR te pi wo pase prévalence de estime nan Repiblik Dominikèn (0.8 pousan), epi, nan contrast nan syans sot pase yo, majorite dominiken yo afekte dominiken. Prévalence viris pami patizan Ayisyen LR te pi wo pase pami tokay Dominiken yo ak patisipan klinik prenatal an Ayiti (ki te gen yon pousantaj de 3.1 pousan). Toujou aplike, entèvansyon pmtct vize yo nesesè. (AU)

Depresyon, abi sibstans ak antiretwoviral ki pa adezif nan mitan granmotan ak VIH nan swen nan Clínica de Familia nan La Romana, Repiblik Dominikèn. Jounal sante mondyal, 2016.
Maya Koenig-Dzialowski, Milton Wainberg, Mina Halpern, Andrea Norcini-Pala, Rosanna Matic, Wendy Galvez-Castro.
Gade sou entènèt Abstrè

Background: People living with HIV/AIDS (PLWHA) are more likely to experience a psychiatric disorder in their lifetime when compared to the general population. is can greatly a ect adherence to the centerpiece of HIV treatment, antiretroviral therapy (ART), and the course that the illness can take. Depression and substance use are the two most common psychiatric disorders in PLWHA. is cross-sectional study examined rates of depression, substance use, adherence to ART and HIV biomarkers on a sample of HIV-positive patients serviced by a general medical clinic, Clinica de Familia La Romana (CFLR) in the Dominican Republic (DR).
Methods: A cross-sectional, questionnaire-based study was conducted in a clinic with a special program for PLWHA in La Romana, DR, over four weeks in Fall 2015. The questionnaire included demographic information and scales for assessing adherence, depression and substance use: the Morisky Medication Adherence Scale (MMAS- 4), Patient Health Questionnaire-2 and -9 (PHQ-2 and -9) and CAGE-AID, respectively. Open-ended, exploratory questions on the experience of living with HIV/AIDS were posed to every fourth or fifth participant. Additionally, two important biomarkers for measuring HIV progression and severity, CD4 cell counts and HIV-RNA viral loads (most recent value within the last six months), were extracted from the medical chart. Data analysis was carried out using the Statistical Package of Social Sciences (SPSS) software.
Results: 89 participants were involved in the study. The mean age was 40.0 years old (SD 10.9) with an almost equal distribution of women and men; two participants self-identified as transgender. 80 participants (89.9%) scored positively on the PHQ-2, which means they met at least one of the two major criteria for depression: loss of interest in activities and depressed mood. The mean PHQ-9 for those who scored positive on the PHQ-2 was 10.6 (SD 4.7; threshold of 10 for major depression). Those with good ART adherence had a mean PHQ-9 of 9.4 (SD 5.0) while the mean for those with poor ART adherence was 11.2 (SD: 4.4). 27 participants (30.3%) fit criterion for severe alcohol or drug use (> 2). Participants endorsing drug use in their lifetime used marijuana (n=8) and cocaine (n=5). Based on the MMAS-4, 41.3% of those on ART had good adherence (score=0), whereas 58.7% had poor adherence (score > 1). Dominican origin and the completion of at least primary school were associated with good adherence (p-value = 0.04 and p-value = 0.03, respectively). Being female was associated with increased PHQ-9 scores (p-value = 0.01) as well as undetectable viral loads (p-value = 0.03); being male was associated with increased alcohol or drug use (p-value < 0.01). In the exploratory questions, most individuals reported acquiring HIV from a spouse or known romantic partner and reported being diagnosed after personally falling ill or witnessing their partner do so. Major concerns were inability to nd work, loneliness and fear of discrimination.
Conclusions: Depressive symptoms and substance use were common factors that impacted ART adherence in a sample of PLWHA treated at Clinica de Familia La Romana in the Dominican Republic. Using validated measures to implement screening for depression and substance use could help identify those requiring diagnosis and appropriate care within the constraints of this low-resource clinic.

 

Itilizasyon sibstans ak kapòt pami popilasyon VIH nan Clínica de Familia La Romana, Repiblik Dominikèn. Jounal sante mondyal, 2016. Isabel del Canto I, Halpern M, Cunto-Amesty S, Lerebours Nadal L, Cruz M, Bowman A, et al. (2016). Substance Use and Condom Use Among the HIV population at Clínica de Familia La Romana, Dominican Republic. The Journal of Global Health. doi:https://doi.org/10.7916/thejgh.v5i1.5295.
Gade sou entènèt Abstrè

Objektif prensipal envestigasyon kwa-seksyonèl sa a te pou kalkile itilizasyon sibstans ilegal pami popilasyon pozitif VIH nan Clínica de Familia La Romana nan Repiblik Dominikèn. Objektif segondè a se te pou idantifye si gen yon relasyon ant konsomasyon alkòl ak itilizasyon kapòt. Nan 97 patisipan yo ki te fè entèvyou nan etid la, 49% pwòp tèt ou-rapòte alkòl oswa tabak itilize nan twa dènye mwa yo. Baze sou nòt la asistan kalkile, 20% nan patisipan yo te klase kòm "modere" oswa "gwo risk," ki mande yon entèvansyon. Anplis de sa, 51% nan echantiyon an rapòte gen kouche seksyèl nan dènye 30 jou yo. Soti nan patisipan yo 49 ki te seksyèlman aktif, 67% rapòte lè l sèvi avèk yon kapòt pandan dènye eksperyans seksyèl yo, 31% rapòte pa lè l sèvi avèk yon kapòt ak rès la 2% te refize reponn. Kontrèman ak rechèch anvan, pa gen okenn asosyasyon yo te jwenn ant konsomasyon alkòl ak sèks san pwoteksyon nan Clínica de Familia La Romana, petèt akòz pousantaj ki ba nan pasyan ki rapòte konsome alkòl souvan