Corrina Moucheraud
Corrina Moucheraud
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Associate Professor of Public Health Policy and Management
Co-Director of the Global Center for Implementation Science
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Professional overview
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Corrina Moucheraud, ScD, MPH is an Associate Professor in the Department of Public Health Policy & Management, and Co-Director of the Global Center for Implementation Science. As a global health researcher and implementation scientist, she seeks to improve outcomes by strengthening health systems and enabling the delivery of effective, equitable health services. Much of Dr. Moucheraud’s focus is on meeting the needs of women and young people, particularly in low- and middle-income countries. Dr. Moucheraud is currently leading efforts for cervical cancer prevention, including HPV vaccination, in Kenya and Malawi. She also researches HIV & non-communicable disease prevention and treatment internationally and in the U.S.
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Education
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MPH, Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NCScD, Global Health & Population, Harvard T.H. Chan School of Public Health, Cambridge, MA
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Honors and awards
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Visiting Scholar, Clinical and Translational Science Awards Program (NCATS, NIH) (2021)Delta Omega Honorary Society (2020)Faculty Career Development Award (UCLA) (2017)Hellman Fellowship (UCLA) (2017)Maternal Health Task Force award (Harvard University) (2013)
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Publications
Publications
Kenyan Men and Cervical Cancer Prevention: Insights from a National Survey
AbstractMoucheraud, C., Ochieng, E., Golub, G., Navario, P., Sacks, E., Abdillahi, H., & Hoffman, R. M. (n.d.).Publication year
2026Journal title
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive OncologyVolume
35Issue
1Page(s)
156-164AbstractEngaging men may contribute to cervical cancer prevention; however, little is known about what factors may be associated with men's engagement in cervical cancer prevention and therefore where interventions should focus.Preferences for HIV prevention conditional cash transfers among Black/African American and Latinx cisgender MSM in Los Angeles
AbstractMoucheraud, C., Trujillo, D., Wagner, Z., Garland, W., Smith, T., Hoffman, R. M., & Landovitz, R. J. (n.d.).Publication year
2026Journal title
AIDS (London, England)Volume
40Issue
1Page(s)
64-69AbstractIn Los Angeles, cisgender men who have sex with men (MSM) - particularly Black/African American and Latinx individuals - are a high-priority population for new HIV prevention interventions. Incentive programs that pay people for engaging in healthy behaviors, also known as "conditional cash transfers" (CCTs), are a promising strategy, but there is little evidence about their use in Black/African American and Latinx cisgender MSM.Strategies to integrate non-communicable disease interventions in HIV and tuberculosis care contexts in low- and middle-income countries: a scoping review
AbstractLuo, L., Kapur, R., Armstrong-Hough, M., Alvarez, G. G. G., Moucheraud, C., Purtle, J., Namusisi, K. N. N., Yang, L., Raghavan, R., Lappen, H., & Shelley, D. (n.d.).Publication year
2026Journal title
BMJ global healthVolume
11Issue
2AbstractIntegration of management of tuberculosis (TB) and HIV with prevention and treatment of non-communicable diseases (NCDs) is a global priority. However, delivering the full spectrum of HIV/TB and NCD services is hindered by a lack of evidence regarding effective models and strategies for integrating NCDs and HIV/TB care services in varying contexts and across interventions. We conducted a scoping review to describe service delivery models and strategies used to facilitate integration of NCD care in HIV and/or TB care settings in low- and middle-income countries (LMICs).A cross-country analysis of the effects of spousal migration on health care access for families left behind
AbstractWest, H., Kuhn, R., Macinko, J., & Moucheraud, C. (n.d.).Publication year
2025Journal title
Health affairs scholarVolume
3Issue
8Page(s)
qxaf150AbstractHealth care utilization is affected by outmigration in communities around the world.Factors associated with cervical cancer screening : results from cross-sectional surveys in Kenya and Malawi
AbstractMoucheraud, C., Chibaka, S., Golub, G., Kalande, P., Makwaya, A., Ochieng, E., Ogutu, V., Phiri, K., Phiri, S., & Hoffman, R. M. (n.d.).Publication year
2025Journal title
BMC public healthVolume
25Issue
1AbstractBackground: Cervical cancer screening is an essential public health intervention, and critical to meeting the Global Strategy for Cervical Cancer Elimination goals – yet most women in low- and middle-income countries are never screened. There is a need to understand context-specific factors that facilitate or prevent women from engaging in screening. Methods: This analysis leverages data collected in 2022–2023 from a national mobile phone-based survey in Kenya and from a household survey conducted in three districts of Malawi. Informed by the Health Belief Model, we assess whether women’s reported cervical cancer screening history (ever or never screened) was associated with their perceived susceptibility (awareness of cervical cancer risk factors), perceived severity (knowing someone who was affected by cervical cancer), perceived barriers (access to services), perceived benefits (trust in information about cervical cancer prevention), self-efficacy (engagement in other preventive health behaviors), and cues to action (speaking with others about cervical cancer prevention). Results: Ever-screening for cervical cancer was reported by 49.7% of the 736 Kenyan respondents and 42.5% of the 261 Malawian respondents. There were few associations between women’s demographic or socioeconomic characteristics and screening history. The strongest associations were seen for cues to action (women who had spoken about cervical cancer with health workers had 1.88 the adjusted risk ratio for screening in Kenya [95% CI 1.59, 2.24] and 1.89 the adjusted risk in Malawi [95% CI 1.41, 2.54] compared to women who never had these conversations); and for knowing someone who had, or who had died due to, cervical cancer (aRR 1.34 and 1.30 respectively in Kenya, and aRR 2.03 and 1.46 respectively in Malawi). In both countries, self-efficacy was also associated with screening, as was perceived severity in both countries (i.e., knowing someone who had, or who had died due to cervical cancer, which was reported by many Kenyan and Malawian respondents). In Kenya, knowledge of cervical cancer risk factors was also associated with women’s screening history, as was access to other preventive health services in Malawi. Conclusions: These results suggest promising areas for interventions aiming to increase cervical cancer screening in these contexts: encouraging health workers to discuss screening with eligible women, leveraging women’s peers who have been affected by cervical cancer, and promoting screening during other preventive health services.Factors associated with cervical cancer screening: results from cross-sectional surveys in Kenya and Malawi
AbstractMoucheraud, C., Chibaka, S., Golub, G., Kalande, P., Makwaya, A., Ochieng, E., Ogutu, V., Phiri, K., Phiri, S., & Hoffman, R. M. (n.d.).Publication year
2025Journal title
BMC public healthVolume
25Issue
1Page(s)
1956AbstractCervical cancer screening is an essential public health intervention, and critical to meeting the Global Strategy for Cervical Cancer Elimination goals - yet most women in low- and middle-income countries are never screened. There is a need to understand context-specific factors that facilitate or prevent women from engaging in screening.Healthcare provider and health system leader perspectives on barriers to hypertension care in Malawi: insights from integrated and non-integrated HIV care settings
AbstractHagstrom, C., Kalande, P., Aryal, A., Phiri, K., van Oosterhout, J. J., Talama, G., Lungu, E., Phiri, S., Moucheraud, C., & Hoffman, R. (n.d.).Publication year
2025Journal title
Global health actionVolume
18Issue
1Page(s)
2575569AbstractMalawi has a significant burden of hypertension, including for people with HIV. The World Health Organization recommends integrated HIV-hypertension care, but such integration is not widely implemented in resource-constrained settings.Human papillomavirus vaccination in rural Malawi : Identifying factors associated with vaccine uptake using a community-based household survey
AbstractMoucheraud, C., Kalande, P., Chibaka, S., Phiri, K., Makwaya, A., Duah, M., Li, M., Liu, M., Hoffman, R. M., & Phiri, S. (n.d.).Publication year
2025Journal title
Human Vaccines and ImmunotherapeuticsVolume
21Issue
1AbstractUptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9–13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls’ HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9–13 years, of whom 39.0% (n = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine’s safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50–0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters’ HPV vaccination status (aOR 2.03 [95% CI 1.59–2.62] and 3.68 [95% CI 1.97–7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine’s safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.Human papillomavirus vaccination in rural Malawi: Identifying factors associated with vaccine uptake using a community-based household survey
AbstractMoucheraud, C., Kalande, P., Chibaka, S., Phiri, K., Makwaya, A., Duah, M., Li, M., Liu, M., Hoffman, R. M., & Phiri, S. (n.d.).Publication year
2025Journal title
Human vaccines & immunotherapeuticsVolume
21Issue
1Page(s)
2485651AbstractUptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9-13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls' HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9-13 years, of whom 39.0% ( = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine's safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50-0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters' HPV vaccination status (aOR 2.03 [95% CI 1.59-2.62] and 3.68 [95% CI 1.97-7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine's safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.Integrating implementation science and intervention optimization
AbstractGuastaferro, K., Moucheraud, C., Purtle, J., Collins, L. M., & Shelley, D. (n.d.).Publication year
2025Journal title
Implementation science : ISVolume
20Issue
1Page(s)
41AbstractImplementation scientists increasingly recognize the value of multiple strategies to improve the adoption, fidelity, and scale up of an evidence-based intervention (EBI). However, with this recognition comes the need for alternative and innovative methods to ensure that the package of implementation strategies work well within constraints imposed by the need for affordability, scalability, and/or efficiency. The aim of this article is to illustrate that this can be accomplished by integrating principles of intervention optimization into implementation science.Lessons Learned in Engaging Adolescents and Young Adults to End the US HIV Epidemic
AbstractMacapagal, K., Stoner, M. C., Guss, C. E., Sukhija-Cohen, A. C., Moucheraud, C., Saberi, P., & Maragh-Bass, A. C. (n.d.).Publication year
2025Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
98Issue
5Page(s)
e88-e97AbstractBackground: Adolescents and young adults (AYA) in the United States are disproportionately affected by HIV. Few interventions are designed to reduce new HIV infections for AYA populations or take AYA's developmental state into consideration. Setting: Ending the HIV Epidemic in the US (EHE) priority areas in California, Florida, Illinois, Massachusetts, and North Carolina. Methods: Thematic synthesis of 5 EHE projects was completed. Methodologic commonalities were identified and summarized across projects to identify key lessons learned. Results: Engaging methods used by and accessible to AYA were central to study recruitment, and to the dissemination of health information for educational purposes. Lessons learned included use of social media and other creative methods for recruitment, retention, and dissemination of study activities; engaging AYA virtually and face-to-face; and ensuring equitable, timely monetary compensation and meaningful benefits to AYA participants. Conclusions: Researchers and public health officials should incorporate AYA developmental context and experiences throughout the research and implementation process. This necessitates community and AYA-engaged research, intervention development, implementation, and dissemination. Future directions include expanding these efforts to communities outside of EHE areas and outside the United States, and ensuring that HIV research and interventions focus not just on individual AYA, but also on the systems and people that bear on their health and well-being (eg, health care providers, supportive adults, schools, laws, and policies).Parent-daughter agreement about HPV vaccination status in Kenya and Malawi
AbstractMoucheraud, C., Ochieng, E., Kweka, A., Wang, P., Xie, S., Ototo, J., Golub, G., Kapindo, E., Banda, E., Abdillahi, H., Szilagyi, P. G., & Heng, S. (n.d.).Publication year
2025Journal title
VaccineVolume
55AbstractBackground: As more countries introduce the HPV vaccine, it is important to understand the validity of vaccination measures. This is especially true in low- and middle-income countries (LMICs) where public health monitoring of vaccination data may have delays or gaps, so alternative measurement approaches are often necessary. Parental report is a common approach for measuring routine childhood vaccination, but it has not been evaluated for HPV vaccination in LMICs. Methods: We conducted household surveys in Kenya (n = 146) and Malawi (n = 98) with parents/guardians and their daughters who were age-eligible for HPV vaccination. We compared parents'/guardians' reports of HPV vaccination status to daughters' reports; the latter was assumed to be the “gold standard” measure. Results: 88 % of Kenyan parents/guardians and 82 % of Malawian parents/guardians agreed with their daughters' reported HPV vaccination status. It was more common for parents/guardians to under-report (i.e., to say their daughter was unvaccinated but the girl said she had received dose(s)) than the inverse. Agreement with one's daughter was higher among parents/guardians who reported data from vaccination cards versus using recall, and among parents/guardians who expressed more versus less confidence in their knowledge. We did not find many differences in accuracy of report by parent/guardian characteristics, although in Kenya there were small and statistically significant negative associations with parental age, household income, and more girls in the household (the latter was also significantly negatively associated with report accuracy in Malawi). Conclusions: In countries where surveys will commonly be used to measure HPV vaccination status, we found very high agreement of parents/guardians with their daughters' reported receipt of the vaccine. These results are similar to findings from the literature about routine childhood vaccination measurement. This suggests that researchers, clinicians, and practitioners can use parent/guardian-reported HPV vaccination of their daughter as a relatively good proxy of her own reported immunization status especially in settings without universal use of vaccination cards or registries.Parent-daughter agreement about HPV vaccination status in Kenya and Malawi
AbstractMoucheraud, C., Ochieng, E., Kweka, A., Wang, P., Xie, S., Ototo, J., Golub, G., Kapindo, E., Banda, E., Abdillahi, H., Szilagyi, P. G., & Heng, S. (n.d.).Publication year
2025Journal title
VaccineVolume
55Page(s)
127025AbstractAs more countries introduce the HPV vaccine, it is important to understand the validity of vaccination measures. This is especially true in low- and middle-income countries (LMICs) where public health monitoring of vaccination data may have delays or gaps, so alternative measurement approaches are often necessary. Parental report is a common approach for measuring routine childhood vaccination, but it has not been evaluated for HPV vaccination in LMICs.Populations and Health Domains Served by Direct-to-Consumer Digital Health Companies in the United States, 2011-2023: Cross-Sectional Study
AbstractNagappan, A., Zhu, X., Moucheraud, C., & Jung, O. S. (n.d.).Publication year
2025Journal title
JMIR formative researchVolume
9Page(s)
e78431AbstractDirect-to-consumer (DTC) digital health companies, offering services such as on-demand prescriptions, mental health apps, fertility tracking, and at-home diagnostics, have become more common in the United States. These companies represent a shift in health care delivery by engaging consumers directly and operating largely outside of traditional health care systems. Despite their increasing presence, little is known about the populations that these companies serve, the health domains they address, and the technologies they use. Understanding these characteristics is critical for evaluating the quality of services provided, implications for health care costs, and impact on health equity.Preferences for Hypertension Care in Malawi: A Discrete Choice Experiment Among People Living with Hypertension, With and Without HIV
AbstractHoffman, R., Phiri, K., Kalande, P., Whitehead, H., Moses, A., Rockers, P. C., Tseng, C.-H. H., Talama, G., Banda, J. C. C., van Oosterhout, J. J., Phiri, S., & Moucheraud, C. (n.d.).Publication year
2025Journal title
AIDS and behaviorVolume
29Issue
1Page(s)
246-256AbstractHypertension is the most common non-communicable disease diagnosed among people in sub-Saharan Africa. However, little is known about client preferences for hypertension care. We performed a discrete choice experiment in Malawi among people with hypertension, with and without HIV. Participants were asked to select between two care scenarios, each with six attributes: distance, waiting time, provider friendliness, individual or group care, antihypertensive medication supply, and antihypertensive medication dispensing frequency (three versus one month). Eight choice sets (each with two scenarios) were presented to each individual. Mixed effects logit models quantified preferences for each attribute. Estimated model coefficients were used to predict uptake of hypothetical models of care. Between July 2021 and April 2022 we enrolled 1003 adults from 14 facilities in Malawi; half were living with HIV and on ART for a median of 11 years. Median age of respondents was 57 years (IQR 49-63), 58.2% were female, and median duration on antihypertensive medications was 4 years (IQR 2-7). Participants strongly preferred seeing a provider alone versus in a group (OR 11.3, 95% CI 10.4-12.3), with stronger preference for individual care among those with HIV (OR 15.4 versus 8.6, pUptake of the COVID-19 vaccine and its association with vaccine information and misinformation in Malawi
AbstractSongo, J., Whitehead, H. S., Phiri, K., Kalande, P., Lungu, E., Phiri, S., van Oosterhout, J., Moses, A., Hoffman, R. M., & Moucheraud, C. (n.d.).Publication year
2025Journal title
Communications MedicineVolume
5Issue
1AbstractBackground: The information environment may be an important determinant of vaccination and other health behaviors including in low-income countries. Methods: We administered a survey to 895 Malawian adults, asking about people’s COVID-19 vaccination history and their exposure to information (information sources and tone of this information) and misinformation (exposure to and belief in conspiracy theories) about the COVID-19 vaccine. Results: Just under half (43%) of respondents had received at least one dose of the COVID-19 vaccine. Respondents heard about the COVID-19 vaccine from a median of 7 sources, most commonly from friends and neighbors, health care workers, and radio (each reported by >90%). Social media are the least positively- or neutrally-framed sources of information; and traditional medicine practitioners are the most common negatively-framed source of information. There is less information access among women, rural residents, and people with lower educational attainment. Many people hear conspiracy theories but say that they do not believe them. Hearing more COVID-19 vaccine information is positively associated with COVID-19 vaccination (aOR 1.09, 95% CI [1.03–1.15]), while believing COVID-19 vaccine misinformation is negatively associated (aOR 0.78, 95% CI [0.68–0.89]). Conclusions: Vaccination programs should communicate through multiple information sources and find ways to reach groups with less information exposure.Uptake of the COVID-19 vaccine and its association with vaccine information and misinformation in Malawi
AbstractSongo, J., Whitehead, H. S., Phiri, K., Kalande, P., Lungu, E., Phiri, S., van Oosterhout, J., Moses, A., Hoffman, R. M., & Moucheraud, C. (n.d.).Publication year
2025Journal title
Communications medicineVolume
5Issue
1Page(s)
244AbstractThe information environment may be an important determinant of vaccination and other health behaviors including in low-income countries.A multi-component intervention to reduce bias during family planning visits : qualitative insights on implementation from Burkina Faso, Pakistan and Tanzania
AbstractMoucheraud, C., Wollum, A., Awan, M. A., Dow, W. H., Friedman, W., Koulidiati, J. L., Sabasaba, A., Shah, M., & Wagner, Z. (n.d.).Publication year
2024Journal title
Contraception and Reproductive MedicineVolume
9Issue
1AbstractBeyond Bias was an intervention introduced in Burkina Faso, Pakistan and Tanzania, with the aim of reducing health worker bias toward young, unmarried and nulliparous women seeking family planning services. This study used qualitative methods – based on interviews with health workers who participated in the intervention, managers at health facilities that participated in the intervention, and policy and program stakeholders at the national level – to understand implementation experiences with the intervention. The results offer insights for organizations or countries seeking to implement Beyond Bias or similar programs, and point to some other key implementation challenges for multi-component interventions in lower-resource settings. The intervention, developed using a human-centered design approach, was seen as key for successful implementation but there were logistical challenges. The digital intervention was disruptive and distracting to many. In addition, the non-financial rewards intervention was perceived as complex, and some participants expressed feeling discouraged when they did not receive a reward. Beyond Bias did not sufficiently attend to the “outer setting,” and this was perceived as a major implementation barrier as it limited individuals’ capacity to fully achieve the desired behavior change; for example, space constraints meant that some health facilities could not ensure private services for all clients. There were scalability concerns related to cost, and there is uncertainty whether diversity of contexts (within and across countries) might constrain implementation of Beyond Bias at scale.Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso : A mixed-methods study
AbstractWollum, A., Moucheraud, C., Gipson, J. D., Friedman, W., Shah, M., & Wagner, Z. (n.d.).Publication year
2024Journal title
Social Science and MedicineVolume
348AbstractProvider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care. First, we surveyed providers in Tanzania and Burkina Faso (N = 295) to assess provider attitudes about young, unmarried, and nulliparous clients. Second, mystery clients anonymously visited providers for contraceptive care and we randomly assigned the reported age, marital status, and parity of each visit (N = 306). We used data from these visits to investigate contraceptive care disparities across 3 domains: information provision and counseling quality, contraceptive method provision, and perceived treatment. Third, we complemented mystery client data with client exit surveys (N = 31,023) and client in-depth interviews (N = 36). In surveys, providers reported biased attitudes against young, unmarried, and nulliparous clients seeking contraceptives. Similarly, we found disparities according to these characteristics in the reporting of contraceptive care quality; however, we found that each characteristic affected a different quality of care domain. Among mystery clients we found age-related disparities in the provision of methods; 16/17-year-old clients were 18 and 11 percentage points less likely to perceive they could take a contraceptive method relative to 24-year-old clients in Tanzania and Burkina Faso, respectively. Unmarried mystery clients perceived worse treatment from providers compared to married clients. Nulliparous mystery clients reported lower quality contraceptive counseling than their parous counterparts. These results suggest that clients of different characteristics likely experience bias across different elements of care. Improving care quality and reducing disparities will require attention to which elements of care are deficient for different types of clients.Contraceptive Care Visit Objectives and Outcomes : Evidence From Burkina Faso, Pakistan, and Tanzania
AbstractMoucheraud, C., Wollum, A., Brooks, M. A., Shah, M., Gipson, J., & Wagner, Z. (n.d.).Publication year
2024Journal title
Studies in family planningVolume
55Issue
4Page(s)
315-332AbstractGlobally, care experiences of the growing population of contraceptive users are not well-understood. We leverage a large client dataset (n = 71,602) from three countries (Burkina Faso, Pakistan, and Tanzania) to characterize contraceptive services sought (visit objective and method preference), assess whether these visit objectives were met and for whom, and explore if visit objective fulfillment was associated with care quality. Most people in all three countries said they were seeking to continue their current method or adopt a method for the first time. Clients seeking to change their method were least likely to have their objective met: 63.7 percent of clients in Burkina Faso, 73.3 percent in Pakistan, and 61.1 percent in Tanzania who wanted to switch actually achieved this during the visit. In Burkina Faso, people with lower socioeconomic standing, lower educational attainment, and lower parity less commonly had their switching objective, fulfilled. Method preference fulfillment was generally high, although approximately 15 percent of Tanzanian clients were given implants despite wanting another method. Among those seeking to adopt or restart a method in Pakistan and Tanzania, having this visit objective fulfilled, was correlated with better perceived treatment and higher person-centeredness of care.Cost-effectiveness of approaches to cervical cancer screening in Malawi : comparison of frequencies, lesion treatment techniques, and risk-stratified approaches
AbstractRasmussen, P. W., Hoffman, R. M., Phiri, S., Makwaya, A., Kominski, G. F., Bastani, R., Moses, A., & Moucheraud, C. (n.d.).Publication year
2024Journal title
BMC health services researchVolume
24Issue
1AbstractBackground: Recently-updated global guidelines for cervical cancer screening incorporated new technologies—most significantly, the inclusion of HPV DNA detection as a primary screening test—but leave many implementation decisions at countries’ discretion. We sought to develop recommendations for Malawi as a test case since it has the second-highest cervical cancer burden globally and high HIV prevalence. We incorporated updated epidemiologic data, the full range of ablation methods recommended, and a more nuanced representation of how HIV status intersects with cervical cancer risk and exposure to screening to model outcomes of different approaches to screening. Methods: Using a Markov model, we estimate the relative health outcomes and costs of different approaches to cervical cancer screening among Malawian women. The model was parameterized using published data, and focused on comparing “triage” approaches—i.e., lesion treatment (cryotherapy or thermocoagulation) at differing frequencies and varying by HIV status. Health outcomes were quality-adjusted life years (QALYs) and deaths averted. The model was built using TreeAge Pro software. Results: Thermocoagulation was more cost-effective than cryotherapy at all screening frequencies. Screening women once per decade would avert substantially more deaths than screening only once per lifetime, at relatively little additional cost. Moreover, at this frequency, it would be advisable to ensure that all women who screen positive receive treatment (rather than investing in further increases in screening frequency): for a similar gain in QALYs, it would cost more than four times as much to implement once-per-5 years screening with only 50% of women treated versus once-per-decade screening with 100% of women treated. Stratified screening schedules by HIV status was found to be an optimal approach. Conclusions: These results add new evidence about cost-effective approaches to cervical cancer screening in low-income countries. At relatively infrequent screening intervals, if resources are limited, it would be more cost-effective to invest in scaling up thermocoagulation for treatment before increasing the recommended screening frequency. In Malawi or countries in a similar stage of the HIV epidemic, a stratified approach that prioritizes more frequent screening for women living with HIV may be more cost-effective than population-wide recommendations that are HIV status neutral.High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi-month dispensing in Malawi : results from a cross-sectional survey and retrospective chart review
AbstractWhitehead, H. S., Phiri, K., Kalande, P., van Oosterhout, J. J., Talama, G., Phiri, S., Moucheraud, C., Moses, A., & Hoffman, R. M. (n.d.).Publication year
2024Journal title
Journal of the International AIDS SocietyVolume
27Issue
9AbstractIntroduction: People living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication. Methods: We conducted a cross-sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year. Results: We surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0−1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0−1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year. Conclusions: Uncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.Intervention-amenable factors associated with lack of HPV vaccination in Kenya : Results from a large national phone survey
AbstractMoucheraud, C., Ochieng, E., Ogutu, V., Chang, L. C., Golub, G., Crespi, C. M., & Szilagyi, P. G. (n.d.).Publication year
2024Journal title
VaccineVolume
42Issue
26AbstractBackground: Coverage of human papillomavirus (HPV) vaccination remains suboptimal in many countries, but the determinants are not well-understood particularly in low- and middle-income countries. We undertook a random digit dialed phone survey across Kenya between July–October 2022, with parents/caregivers of preadolescent girls, to identify intervention-amenable factors associated with respondents' daughter's HPV vaccination status. Methods: Informed by the World Health Organization Behavioral and Social Drivers of Vaccination framework, we collected information about respondents' knowledge about and hesitancy toward HPV vaccine, perceived risk of cervical cancer, social norms around HPV vaccination, trust in institutions, and access to HPV vaccination services. Results: 1416 parents/caregivers completed the survey (97.4 % of those eligible), of whom 38.2 % said that age-eligible girl(s) in their household had received any doses of the HPV vaccine. Knowledge/perceptions: In multivariable models adjusted for sociodemographic characteristics, respondents with less HPV vaccine hesitancy and fewer concerns about safety were more likely to have vaccinated daughter(s), as were those with greater knowledge about HPV vaccine and knowing someone who had died from cervical cancer. Social norms: Having spoken with others about HPV vaccination, although reported by less than half of respondents, and believing that other parents have vaccinated their daughters were associated with having vaccinated daughter(s). Respondents with more trust in information about HPV vaccination from health systems, and with higher trust in institutions, had greater odds of having vaccinated daughter(s). Access: One-fifth of respondents had experienced, or anticipated experiencing, challenges accessing HPV vaccination services, and these respondents had approximately half the odds of having a vaccinated daughter compared to their counterparts. Conclusions: Promising areas for intervention include: targeted messaging about safety of the HPV vaccine, increasing parents'/caregivers' knowledge about the vaccine, and leveraging trusted messengers including health workers, faith leaders, and peer parents/caregivers.Precious Information : Getting Interpretable, Actionable Health Communications Data
AbstractLanthorn, H., Moucheraud, C., & Sheely, R. (n.d.).Publication year
2024Journal title
Journal of Health CommunicationVolume
29Issue
6Page(s)
407-408AbstractDoing high-quality health communications requires high-quality data, both to describe information environments and diets and as outcomes for program evaluations that seek to change them and the behaviors they foster. When we understand where people gather information, what they learn there, and how it encourages them to act, we can better diagnose where to focus energy and resources—for example, whether to amplify high-quality sources, address low-quality information, or fill information voids with actionable ideas. Too often, however, researchers collect data in ways that conflate the sources of information, the channels through which information is communicated, and the content of that information. This thwarts opportunities to identify specific problems and opportunities. We call for conceptual precision to make good use of respondents’ time, to be good stewards of funders’ money, and to effectively address the large challenges we face in encouraging protective, pro-social health behaviors.Preferences for Hypertension Care in Malawi : A Discrete Choice Experiment Among People Living with Hypertension, With and Without HIV
AbstractHoffman, R., Phiri, K., Kalande, P., Whitehead, H., Moses, A., Rockers, P. C., Tseng, C. H., Talama, G., Banda, J. C., van Oosterhout, J. J., Phiri, S., & Moucheraud, C. (n.d.).Publication year
2024Journal title
AIDS and BehaviorAbstractHypertension is the most common non-communicable disease diagnosed among people in sub-Saharan Africa. However, little is known about client preferences for hypertension care. We performed a discrete choice experiment in Malawi among people with hypertension, with and without HIV. Participants were asked to select between two care scenarios, each with six attributes: distance, waiting time, provider friendliness, individual or group care, antihypertensive medication supply, and antihypertensive medication dispensing frequency (three versus one month). Eight choice sets (each with two scenarios) were presented to each individual. Mixed effects logit models quantified preferences for each attribute. Estimated model coefficients were used to predict uptake of hypothetical models of care. Between July 2021 and April 2022 we enrolled 1003 adults from 14 facilities in Malawi; half were living with HIV and on ART for a median of 11 years. Median age of respondents was 57 years (IQR 49–63), 58.2% were female, and median duration on antihypertensive medications was 4 years (IQR 2–7). Participants strongly preferred seeing a provider alone versus in a group (OR 11.3, 95% CI 10.4–12.3), with stronger preference for individual care among those with HIV (OR 15.4 versus 8.6, p < 0.001). Three-month versus monthly dispensing was also strongly preferred (OR 4.2; 95% CI 3.9–4.5). 72% of respondents would choose group care if all other facility attributes were favorable, although PLHIV were less likely to make this trade-off (66% versus 77%). These findings have implications for the scale-up of hypertension care in Malawi and similar settings.