PhD, University of Cincinnati, 2015, Nursing: Nursing - Doctoral Program

Background: Despite tremendous advances in HIV treatment, less than 30% of the more than 1 million people living with HIV in the US are achieving optimal treatment outcomes. Researchers have recognized that there is an urgent need to understand factors and processes that influence individuals with HIV to initiate HIV care. Purpose: The specific aims of the study were to develop a theoretical framework to explain the psychosocial process of care initiation in individuals living with HIV to identify the critical junctures, defined as pivotal events reported by study participants, that influence individuals living with HIV in their decision to initiate HIV care Methods: Grounded theory was the method used to analyze in-depth interviews with individuals living with HIV. A team of IRB-approved researchers analyzed the data using three levels of coding: Open coding, selective coding, and theoretical coding. Analysis was conducted with an aim of identifying the psychosocial process of care initiation by individuals living with HIV. Results: 30 individuals living with HIV (28 men, 2 women) participated in the study. Participants shared their stories about how they went from learning that they had HIV to the point of HIV care initiation. The core category discovered in the data was concept of HIV as news. News, by definition, is impactful information that was not previously known that is delivered by one party and received by another. Participants described a process in which they progressed through five distinct stages: a) receiving the news, b) interpreting the news, c) incorporating the news, d) acting on the news, and e) moving beyond the news. Each stage was moderated by influential factors including perceived susceptibility to HIV infection, symptoms, HIV information, and feedback from others. The initial receipt of the news was typically interpreted as `bad news'. However, through reflection, interaction with others, and information seeking, participants l (open full item for complete abstract)

Committee: Donna Martsolf Ph.D. R.N. (Committee Chair); Judith Feinberg M.D. Ph.D. (Committee Member); Donna Shambley-Ebron Ph.D. (Committee Member) Subjects: Nursing

MS, University of Cincinnati, 2019, Medicine: Biostatistics (Environmental Health)

In Ghana, men who have sex with men (MSM) are 15 times more likely to live with HIV compared to the general adult population, and rates of engagement in medical care for HIV are low among MSM diagnosed with HIV. Using structured survey interviews, we investigated the impact of HIV-related stigma (deconstructed into four components: enacted, felt normative, vicarious, and internalized HIV stigmas), same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care in 225 MSM living with HIV in Ghana. We found that vicarious HIV stigma (i.e., hearing stories of HIV discrimination) positively predicted linkage to care, such that MSM were three times more likely to be linked to care for each unit increase in vicarious stigma scale. Conversely, we found felt normative HIV stigma (i.e., perception of pervasiveness of HIV stigmatization) to negatively predict linkage to care, such that odds of being linked to care were decreased by 37% for each unit increase in felt normative scale. Perceived autonomy-supportive healthcare climate was a positive predictor of linkage to care, such that MSM were twice as likely to be linked to care for each unit increase in healthcare climate score. Finally, we identified locational differences in linkage to care, such that MSM in Takoradi were over three to four times more likely to be linked to care compared to MSM in Greater Accra or Kumasi. Ultimately, our findings highlight the nuanced roles that stigmas can play in shaping care-seeking behaviors and illustrate the need for open-minded perspectives of inquiry towards understanding engagement in the HIV care cascade for marginalized populations.

Committee: Marepalli Rao Ph.D. (Committee Chair); LaRon E. Nelson Ph.D. (Committee Member); Jun Ying Ph.D. (Committee Member); Nanhua Zhang Ph.D. (Committee Member) Subjects: Public Health

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2015, American Culture Studies

Offline racial health and health care disparities have been well documented and researched. However there has not been as much research into how these offline disparities have translated into online environments. Specifically, this study examines health websites, with a focus primarily on WebMD.com, that have become ubiquitous to the process of obtaining health information which has become self-propelled by the consumer. The model of health care where by the medical professional serves a patient their knowledge in a one-way model has largely been phased out in favor of a fluid exchange in which patients also bring medical knowledge and information to the table. Overwhelmingly, the information that the patient contributes comes from cyber research from websites such as WebMD.com. The Health 2.0 movement has furthered the expectation of patients to be proactive members of their health care who should research their conditions, symptoms, and treatments in addition to seeking medical professionals advice. Health 2.0 is predicated on users data input into online health care environments. Users interact with each other to exchange information and provide medical support to each other in what seems to be a radical departure from a traditional paternalistic model of health care that helps to reinforce institutional racism that perpetuates racial health and health care disparities. However examining a health website such as WebMD.com reveals that not only has cyberspace not created a radical egalitarian arena for health information exchange, health care websites have largely perpetuated the same model of health care information exchange that information exchange in cyberspace in general and Health 2.0 specifically attempts to circumvent. Using Michel Foucault's idea of the medical gaze, I analyzed WebMD.com as a site in which patients can learn the medical gaze and thus procure medical knowledge the same way that was previously limited to those entering medical school. As su (open full item for complete abstract)

Committee: Radhika Gajjala (Advisor); Ellen Berry (Committee Member); Angela Nelson (Committee Member); Lessie Cochran (Other) Subjects: African American Studies; American Studies; Ethnic Studies

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2021, Health Programs

Globally, 37.8 million people were living with human immunodeficiency virus and acquire immunodeficiency syndrome (HIV/AIDS) in 2018, with 1.7 million new cases reported and 57% receiving antiretroviral therapies. Nearly 76,000,000 people have been diagnosed with HIV and an estimated 33,000,000 people have died of HIV/AIDS since the beginning of the epidemic. The focus of this research was to investigate the perspective of persons living with HIV in respect to their relationship with their provider, provider communication, accessibility, and their perceived quality of care before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic using a cross-sectional quantitative analysis. This cross-sectional quantitative study was conducted to ascertain whether a relationship exists between provider patient relationship, communication, accessibility and convenience, and perceived quality of care from the perspective of patients living with HIV before and during the SARS-CoV-2 pandemic using a regression analysis. Fifty-eight individuals participated in the study and their responses were anonymous. The study was guided by a patient-centered care model as an approach to inform health care providers who are providing services in HIV care.

Committee: JoAnn Jordan (Committee Chair); Karen Lankisch (Committee Member); David Meckstroth (Committee Member) Subjects: Health Care; Health Care Management; Public Health; Public Health Education

MS, University of Cincinnati, 2008, Medicine : Epidemiology (Environmental Health)

Objective: To determine factors associated with adolescent HIV testing and preferences for different testing methods.Methods: Sexually active 13-22 year-olds (N=200) completed a theory-based survey and were offered HIV testing. Those who agreed chose one of three HIV tests. Chi-square and logistic regression were performed to determine factors associated with testing. Results: Half of participants (49.5%) agreed to HIV testing: 51% chose rapid oral, 30% venipuncture, and 19% rapid fingerstick. Male gender (OR 3.52; 95% CI 1.35-9.21), parental completion of high school (OR 2.69; 95% CI 1.15-6.31), intention to test for HIV if offered by clinician (OR 6.78; 95% CI 2.01-22.92), and higher perceived likelihood of current HIV infection (OR 10.0; 95% CI 2.9-33.3) were independently associated with testing. Conclusions: Intention to test if offered by a clinician and perceived likelihood of current HIV infection appear to be important factors in decision to test.

Committee: Paul Succop PhD (Committee Chair); Lorah Dorn PhD (Committee Member); Jessica Kahn MD, MPH (Committee Member) Subjects: Biomedical Research; Epidemiology; Health Care; Public Health

Master of Social Work, The Ohio State University, 2012, Social Work

Mortality and morbidity rates are higher among people with severe mental illnesses than the general population. While many studies have examined this phenomenon from the perspective of the provider, few researchers have worked with consumers to gain their perspective on this issue. As pointed out by researchers who have examined this from the perspective of the providers, there are clear structural (e.g. access to care) disparities in care for consumer diagnosed with schizophrenia. Nonetheless, research demonstrates other barriers to essential care such as consumer perceptions of health care and its providers. There is a need for additional research to examine perceptions of quality of care from the viewpoint of the consumer. This study used both qualitative and quantitative methodologies to examine how twenty-five consumers at a local community mental health center diagnosed with both schizophrenia and a chronic physical illness (heart disease, diabetes, hepatitis C, HIV, or obesity) perceive the physical medical care they receive from their primary care physicians. The study was designed to gain more information about what these consumers define as high-quality medical care, and to determine in which areas they may perceive barriers to care. The study was both quantitative and qualitative. The quantitative portion was composed of questions regarding five dimensions of care: communication, empathy, the doctor's perception of schizophrenia, the doctor's medical knowledge, and the patient's perception of their own health. The quantitative results were analyzed in SPSS using nonparametric tests due to the small sample size. The qualitative portion asked the respondents to describe good and bad experiences they had with their primary care physicians. The qualitative results were obtained using Grounded Theory. During data analysis, an overarching theme emerged: respondents connect high quality health care with good communication, empathy, accessibility, and provision (open full item for complete abstract)

Committee: Joseph Guada PhD (Advisor); Mo Yee Lee PhD (Committee Member) Subjects: Social Work

Doctor of Philosophy, The Ohio State University, 2004, English

In my project, I argue that rigid representational constructs move narrators of HIV/AIDS literature away from a position of ethical care in descriptions of illness and the ill, and towards three deliberately assumed subject positions: hero, artist, and prophet. I argue that many narrators assume these roles to achieve some very calculated effects (punitive, dichotomizing, normalizing, socially sanctioning) and that these effects are only eroded when the roles themselves are dismantled. Finally, I examine what such a process of dismantling would look like, and how it would lead to a greater ethics of narrative care. Throughout my argument, I suggest that the unique rhetorical environment of care-taking dictated by HIV/AIDS (such as the undefined nature of the disease and the specter of homophobia which has surrounded discussion of the illness) contributes to a move away from an ethical concerns, and towards a narratorial concern with the control of representations. First, and primarily through the use of Abraham Verghese's HIV/AIDS narrative My Own Country: A Doctor's Story (1995), I suggest that the narrator fashions himself as a hero, and explore the implications of such self-fashioning for the plot-line of a text. I then conduct a close examination of Allan Gurganus's Plays Well With Others (1999), with an accompanying discussion of the normalizing work done by the representations within the text. In an examination of Randy Shilts's And the Band Played On (1987), I argue that the narrator attempts to deliver the message of illness from “on high” through establishing a position for himself as prophet, and through the use of a religiously-inflected language. After examining the means by which the representational strategies used within AIDS narratives cause a narrator or a text to abandon an ethics of care, I turn in the final portion of my project to an inquiry into how an ethics of care might be enacted, and what it might look like, largely within the context of T (open full item for complete abstract)

Committee: Debra Moddelmog (Advisor) Subjects: Literature, American

Doctor of Philosophy, Case Western Reserve University, 2013, Epidemiology and Biostatistics

Point-of-care (POC) devices for HIV Early Infant Diagnosis (EID) will soon become available in resource-limited settings. During the scaling-up process, it will be important to determine the types of facilities in which implementation of the device is likely to be more cost-effective. The main objective of this dissertation was to develop a model to determine the cost-effectiveness of POC device allocation strategies in Uganda's HIV EID network. We accounted for turnaround time changes that may occur with progressive POC scale-up among facilities that perform centralized testing. In Aim 1, we evaluated the association between turnaround time and result receipt under centralized testing. Data were obtained from 703 infant HIV test records for tests performed between January 2008 and February 2009 in two health facilities in Uganda. We performed multivariable modified Poisson regression with robust standard errors and included other population and health system factors. We accounted for within-clinic correlation using generalized estimating equations. We found that caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days in a pooled sample from both facilities (RR = 0.83; p = 0.006). In Aim 2, we developed an illustrative model comprising four health facilities that conducted centralized testing among HIV-exposed infants. We used discrete-event simulation to model centralized testing, the allocation of POC devices among the facilities, and to generate turnaround time distributions for each allocation scenario. We used individual level Markov modeling to simulate caregiver return for test results and infant HIV disease progression based on findings from Aim 1 and the turnaround time distributions. We demonstrated that our model can be used at the small-scale level to select the most cost-effective allocation strategy and scale-up approach. Our model can be extended to include a larger numb (open full item for complete abstract)

Committee: Mendel Singer PhD, MPH (Committee Chair); Sarang Deo PhD (Committee Member); Roger Bielefeld PhD (Committee Member); Kathleen Smyth PhD (Committee Member) Subjects: Biostatistics; Economics; Health Care; Public Health