Doctor of Philosophy

dissertationHuman Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be major global health priorities. Although forced displacement is believed to fuel HIV/AIDS epidemic in countries affected by conflict, factors associated with forced displacement and HIV risk in conflict-affected populations are not well understood. The aims of this study were therefore (1) to describe factors that influence risk for HIV infection in a Utah-based Burundi refugee population and (2) explore relationship between Knowledge, Attitudes, and Behavior/Practices (KABP) in order design targeted HIV/AIDS prevention interventions for the population. We conducted a systematic review of studies on HIV/AIDS risk and protective factors and interventions that target HIV risk factors. Although the review found a plethora of data collection tools, there was marked shortage of culturally appropriate instruments with demonstrated reliability or validity. We therefore designed a valid, reliable, culturally appropriate questionnaire for use in assessing HIV/AIDS knowledge, attitudes, and behavior/practices. The questionnaire was administered in a cross-sectional study to a random sample (with replacement) of 215 Burundi refugees (n = 76 and age ≥ 12). The main outcome measure was behavior/practices. Predictor variables were: (1) knowledge; (2) Attitude; (3) selfefficacy. Univariate, bivariate, and multivariate analyses were performed. Regression models were developed to highlight significant predictors of HIV infection in the population. Results were controlled for known confounders. Questionnaire reliability was satisfactory (Cronbach's Alpha ≥ 0.70). A 97.36% response rate was achieved. Significant predictors of protective HIV/AIDS behavior/practices were self-efficacy (b = 0.248, p = 0.027) and HIV/AIDS-knowledge (b = 0.454, p < 0.001). Attitude towards HIV/AIDS (b = 0.5071, p < 0.001) was a significant predictor of HIV/AIDS knowledge. Behavior/ practices were strongly associated with knowledge, attitudes, self-efficacy, gender, and household size. Overall, men were more knowledgeable than women iv and had higher self-efficacy. Women had more positive attitudes and scored higher behavior/practices. These findings create foundational HIV/AIDS KABP as a basis for designing targeted, culturally-tailored HIV/AIDS interventions strategies for the population

Evaluating a Social Network Analytic Tool to Support Outbreak Management and Contact Tracing in an Outbreak of Pertussis

OBJECTIVE: To determine the feasibility and value of a social network analysis tool to support pertussis outbreak management and contact tracing in the state of Utah. INTRODUCTION: Pertussis (i.e., whooping cough) is on the rise in the US. To implement effective prevention and treatment strategies, it is critical to conduct timely contact tracing and evaluate people who may have come into contact with an infected person. We describe a collaborative effort between epidemiologists and public health informaticists at the Utah Department of Health (UDOH) to determine the feasibility and value of a network-analytic approach to pertussis outbreak management and contact tracing. METHODS: The partnership: In early 2012, epidemiologists from UDOH’s Vaccine Preventable Disease Program and UDOH’s public health informaticists formed a partnership to determine the feasibility and value of the Organizational Risk Analyzer (ORA) in pertussis outbreak management and contact tracing (1). Both entities have a longstanding partnership. A characteristic that has made the collaboration particularly strong and mutually beneficial is that both partners have expertise in disease surveillance and outbreak management. In addition, the informaticists have expertise in devising systems that help frontline healthcare providers. The Organizational Risk Analyzer (ORA): ORA is a computational tool that extends network analysis by using a meta-matrix model. A meta-matrix is defined as a network of connecting entities. The tool uses one or more matrices in an organization’s meta-matrix as input. From this input the tool calculates measures that describe the relationships and ties among the entities. ORA contains over 50 network and node level measures which are categorized by the type of risk they detect (1). Procedures: Following approval from UDOH’s Institutional Review Board, we analyzed records from 629 deidentified pertussis patients from the UT-NEDSS database from January 2011 to December 2011. The test data included demographics and epidemiological information. We used Excel to create .csv data files, uploaded the data into ORA, and displayed the data in meta-matrices consisting of nodes (cases/contacts) and edges (relationships). We used ORA’s visualizer to check for data-entry errors before performing the network analysis. Data Analysis: ORA’s centrality measures (degree, closeness, betweenness, hub, and eigenvector) were used to identify geographic locations with high infection rates and the patients who were central to sustaining the outbreak. Next, we applied a concor algorithm to find groups in the meta-network that might be hard to spot visually. Visualizations were used to supplement the metrics. RESULTS: The ORA analysis identified 5 individuals who were central to perpetuating the outbreak in that their centrality measures were higher than other patients in the network. The index patient (Fig 1) was traced back to Utah County and was linked to 6 direct contacts in the same county and several indirect ties in adjacent counties. The individual was highly connected to others within the network (hub centrality = 1.41 and eigenvector centrality = 1.00). Salt Lake County had the highest number of cases, followed by Utah County and Weber County. The concor analysis revealed hidden networks, including a cluster of patients grouped by age group and case status (Fig 2). CONCLUSIONS: The ORA was found to be a valuable tool for supporting pertussis outbreak management and contact tracing. Although network analysis is relatively new to public health, it can increase public health’s understanding of how patterns of social relationships can aid or inhibit the spread of communicable diseases and provide the information needed to target intervention efforts effectively

Evaluating a Social Network Analytic Tool to Support Outbreak Management and Contact Tracing in an Outbreak of Pertussis

Pertussis (i.e., whooping cough) is on the rise in the US. To implement effective prevention and treatment strategies, it is critical to conduct timely contact tracing and evaluate people who may have been exposed to pertussis. We describe a collaborative effort between epidemiologists and public health informaticists at the Utah Department of Health (UDOH) to determine the feasibility and value of a network-analytic approach to pertussis outbreak management and contact tracing

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya

Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews