Uncovering infectious disease burden and socio-cultural determinants of water use and health in a peri-urban community in the dominican republic

The Dominican Republic is a low-middle income country located in the Caribbean that has been selected to be one of the seven pilot countries for the UN’s Millennium Development Project. Despite the economic growth experienced by this country within recent years, improvements in basic indicators of growth and development, such as water quality, have not been achieved. Given the critical importance of quality of water for community health and economic development, this study aims to describe the burden of infectious diseases associated with water quality, particularly diarrheal disease, in the municipality of Constanza in the Dominican Republic. A convenience sample of 88 households throughout the Constanza municipality was selected. Interviews with heads of households and ethnographic observations were conducted to obtain information about access to safe and clean water and to observe cultural practices surrounding water. A household survey was administered to examine self-reported diarrheal morbidity, water handling practices, and healthcare-seeking behavior. Survey questions were modeled after the Dominican Republic Demographic and Health Survey, and communities were GPS tagged. Water samples were collected from households and selected environmental sources (e.g. aqueducts) were analyzed for E. coli and coliform bacteria. Despite governmental potable water treatment recommendations, the majority (60.2%) of households reported not taking any measures to sanitize their water, which accounted for the majority of individuals self-reporting diarrheal disease (59.8%). Logistic regression analysis indicates that adults aged 65+ are at highest risk for diarrheal disease. Although aqueducts carrying potable water to the communities lacked measurable coliform bacteria contamination, most households (90.1%) had some contamination in the drinking water. This study revealed poor water quality and sanitation practices surrounding drinking water. Findings from this study will be utilized for an education program to encourage proper water storage and sanitation with the goal of increasing access to safe and clean water.Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Public Health in the Department of Applied Health Science Indiana University May 2010 Accepted by the Graduate Faculty, Indiana University, in partial fulfillment of the requirements for the degree of Master of Public Health in Applied Health Scienc

Contingency Management for Integrated Harm Reduction Among Men Who Have Sex with Men Who Use Methamphetamine in Los Angeles: A Pilot Assessment

Methamphetamine (MA) use is associated with HIV transmission among men who have sex with men (MSM) and lapses in medication adherence. Contingency Management (CM) is effective in reducing MA use, but studies of CM to support adherence to HIV prevention or treatment are limited. We conducted a pilot trial of a CM intervention to reduce MA use and improve PrEP/ART adherence among MSM prescribed a tenofovir (TFV)-based regimen for HIV prevention or treatment. Participants were randomly assigned to receive escalating incentives for either MA abstinence or TFV adherence (based on point-of-care urine testing), and to a monitoring schedule of either 2 or 3 visits/week for 4 weeks. 19 MSM were randomized to either CM for MA use or CM for PrEP/ART adherence (median age: 38; IQR: 28-46) and 15 were living with HIV. Participants attended 95.7% (67/70) of scheduled visits in the 2x/week arm and 74.8% (74/99) in the 3x/week arm. TFV adherence was higher among participants in the TFV adherence arm with 93.5% (n = 72/77) of urine samples positive for TFV, compared to 76.6% (n = 49/64) in the MA abstinence arm (p = 0.007). Participants in the MA abstinence arm had more urine samples negative for MA metabolites (20.3%, n = 13/64) than those receiving CM for TFV adherence (6.5%, n = 5/77; p = 0.021). A CM model for MA abstinence and PrEP/ART adherence using twice-weekly visits and urine testing for MA and TFV for MSM who use MA is feasible and potentially effective as an integrated harm reduction strategy