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
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.Countdown to 2015 country case studies : What have we learned about processes and progress towards MDGs 4 and 5?
AbstractMoucheraud, C., Owen, H., Singh, N. S., Ng, C. K., Requejo, J., Lawn, J. E., Berman, P., Salehi, A., Hong, Z., Ronsmans, C., Yanqiu, G., Kebede, H., Mann, C., Ruducha, J., Tadesse, M., Ngugi, A., Keats, E., Macharia, W., Ravishankar, N., … Msemo, G. (n.d.).Publication year
2016Journal title
BMC public healthVolume
16AbstractBackground: Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Methods: Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). Results: The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns - which require higher-level health workers, more infrastructure, and increased community engagement - showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. Conclusions: These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.Do Price Subsidies on Artemisinin Combination Therapy for Malaria Increase Household Use? : Evidence from a Repeated Cross-Sectional Study in Remote Regions of Tanzania
AbstractCohen, J. L., Yadav, P., Moucheraud, C., Alphs, S., Larson, P. S., Arkedis, J., Massaga, J., & Sabot, O. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
7AbstractBackground:The Affordable Medicines Facility-malaria (AMFm) is a pilot program that uses price subsidies to increase access to Artemisinin Combination Therapies (ACTs), currently the most effective malaria treatment. Recent evidence suggests that availability and affordability of ACTs in retail sector drug shops (where many people treat malaria) has increased under the AMFm, but it is unclear whether household level ACT use has increased.Methods and Findings:Household surveys were conducted in two remote regions of Tanzania (Mtwara and Rukwa) in three waves: March 2011, December 2011 and March 2012, corresponding to 3, 13 and 16 months into the AMFm implementation respectively. Information about suspected malaria episodes including treatment location and medications taken was collected. Respondents were also asked about antimalarial preferences and perceptions about the availability of these medications. Significant increases in ACT use, preference and perceived availability were found between Rounds 1 and 3 though not for all measures between Rounds 1 and 2. ACT use among suspected malaria episodes was 51.1% in March 2011 and increased by 10.9 percentage points by Round 3 (p =. 017). The greatest increase was among retail sector patients, where ACT use increased from 31% in Round 1 to 49% in Round 2 (p =. 037) and to 61% (pDoes health worker performance affect clients' health behaviors? A multilevel analysis from Bangladesh
AbstractEpstein, A., Moucheraud, C., Sarma, H., Rahman, M., Tariqujjaman, M., Ahmed, T., Glenn, J., Bossert, T., & Kruk, M. E. (n.d.).Publication year
2019Journal title
BMC health services researchVolume
19Issue
1AbstractBackground: Suboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants. Methods: We use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance. Results: Health worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge. Conclusions: We find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.Effects of spousal migration on access to healthcare for women left behind : A cross-sectional follow-up study
AbstractWest, H. S., Robbins, M. E., Moucheraud, C., Razzaque, A., & Kuhn, R. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
12 DecemberAbstractBackground Women left behind by migration represent a unique and growing population yet remain understudied as key players in the context of migration and development. Using a unique longitudinal survey of life in Bangladesh, the Matlab Health and Socioeconomic Surveys, we examined the role of spousal migration in healthcare utilization for women. The objective of this study was to assess realized access to care (do women actually get healthcare when it is needed) and consider specific macrostructural, predisposing, and resource barriers to care that are related to migration. Methods and findings In a sample of 3,187 currently married women, we estimated multivariate logistic and multinomial regression models controlling for a wide range of baseline sociodemographic factors measured as far back as 1982. Our analyses also controlled for selection effects and explored two mechanisms through which spousal migration can affect healthcare utilization for women, remittances and frequent contact with spouses. We found that women with migrant spouses were approximately half as likely to lack needed healthcare compared to women whose spouses remained in Bangladesh (predicted probability of not getting needed healthcare 11.7% vs. 21.8%, pEffects of the COVID-19 pandemic on antenatal care utilisation in Kenya : A cross-sectional study
AbstractLandrian, A., Mboya, J., Golub, G., Moucheraud, C., Kepha, S., & Sudhinaraset, M. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
4AbstractObjective The aim of this study was to assess the effects of COVID-19 on antenatal care (ANC) utilisation in Kenya, including women's reports of COVID-related barriers to ANC and correlates at the individual and household levels. Design Cross-sectional study. Setting Six public and private health facilities and associated catchment areas in Nairobi and Kiambu Counties in Kenya. Participants Data were collected from 1729 women, including 1189 women who delivered in healthcare facilities before the COVID-19 pandemic (from September 2019-January 2020) and 540 women who delivered during the pandemic (from July through November 2020). Women who delivered during COVID-19 were sampled from the same catchment areas as the original sample of women who delivered before to compare ANC utilisation. Primary and secondary outcome measures Timing of ANC initiation, number of ANC visits and adequate ANC utilisation were primary outcome measures. Among only women who delivered during COVID-19 only, we explored women's reports of the pandemic having affected their ability to access or attend ANC as a secondary outcome of interest. Results Women who delivered during COVID-19 had significantly higher odds of delayed ANC initiation (ie, beginning ANC during the second vs first trimester) than women who delivered before (aOR 1.72, 95% CI 1.24 to 2.37), although no significant differences were detected in the odds of attending 4-7 or ≥8 ANC visits versusEngagement in Agriculture Protects Against Food Insecurity and Malnutrition in Peri-Urban Nepal
AbstractMoucheraud, C., Chandyo, R. K., Henjum, S., Strand, T. A., Ulak, M., Fawzi, W. W., Locks, L. M., Webb, P., & Thorne-Lyman, A. L. (n.d.).Publication year
2019Journal title
Current Developments in NutritionVolume
3Issue
1AbstractBackground: Urbanization is occurring rapidly in many low- and middle-income countries, which may affect households' livelihoods, diet, and food security and nutritional outcomes. Objective: The main objective of our study was to explore whether agricultural activity among a peri-urban population in Nepal was associated with better or worse food household security, household and maternal dietary diversity, and nutritional outcomes for children and women. Methods: A cross-sectional survey was administered to 344 mother-child pairs in Bhaktapur district, Nepal, including data on household agricultural practices, livestock ownership, food security, dietary diversity and expenditures, anthropometric measurements of children (aged 5-6 y), maternal body mass index (BMI), and maternal anemia. Multivariable adjusted odds ratios (AORs) and unadjusted odds ratios were calculated using logistic regression. Results: Our findings suggest that in this sample, cultivation of land was associated with lower odds of child stunting (AOR: 0.55; 95% CI: 0.33, 0.93) and household food insecurity (AOR: 0.33; 95% CI: 0.18, 0.63), but not low (or high) maternal BMI or anemia. Livestock ownership (mostly chickens) was associated with lower food insecurity (AOR: 0.34; 95% CI: 0.16, 0.73) but not with nutrition outcomes. Women in farming households were significantly more likely to eat green leafy vegetables than were women in nonfarming households, and children living in households that grew vegetables had a lower odds of stunting than children in households that cultivated land but did not grow vegetables (AOR: 0.49; 95% CI: 0.25, 0.98). Conclusions: Our study suggests that households involved in cultivation of land in peri-urban Bhaktapur had lower odds of children's stunting and of food insecurity than noncultivating households, and that vegetable consumption is higher among those households. Given Nepal's rapid urbanization rate, more attention is needed on the potential role of peri-urban agriculture in shaping diets and nutrition.Erratum : Correction to: Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi (AIDS and behavior (2022) 26 2 (478-486))
AbstractMoucheraud, C., Hoffman, R. M., Balakasi, K., Wong, V., Sanena, M., Gupta, S., & Dovel, K. (n.d.).Publication year
2022Journal title
AIDS and BehaviorVolume
26Issue
2Page(s)
487Abstract~Essential medicines for universal health coverage
AbstractWirtz, V. J., Hogerzeil, H. V., Gray, A. L., Bigdeli, M., de Joncheere, C. P., Ewen, M. A., Gyansa-Lutterodt, M., Jing, S., Luiza, V. L., Mbindyo, R. M., Möller, H., Moucheraud, C., Pécoul, B., Rägo, L., Rashidian, A., Ross-Degnan, D., Stephens, P. N., Teerawattananon, Y., Hoen, E. F., … Reich, M. R. (n.d.).Publication year
2017Journal title
The LancetVolume
389Issue
10067Page(s)
403-476Abstract~Evaluating the quality and use of economic data in decisions about essential medicines
AbstractMoucheraud, C., Wirtz, V. J., & Reich, M. R. (n.d.).Publication year
2015Journal title
Bulletin of the World Health OrganizationVolume
93Issue
10Page(s)
693-699AbstractObjective To evaluate the quality of economic data provided in applications to the World Health Organization (WHO) Model List of Essential Medicines and to evaluate the role of these data in decision-making by the expert committee that considers the applications. Methods We analysed applications submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines between 2002 and 2013. The completeness of data on the price and cost–effectiveness of medicines was extracted from application documents and coded using a four-point scale. We recorded whether or not the expert committee discussed economic information and the outcomes of each application. Associations between the completeness of economic data and application outcomes were assessed using χ2 tests. Findings The expert committee received 134 applications. Only eight applications (6%) included complete price data and economic evaluation data. Many applicants omitted or misinterpreted the economic evaluation section of the application form. Despite the lack of economic data, all applications were reviewed by the committee. There was no significant association between the completeness of economic information and application outcomes. The expert committee tried to address information gaps in applications by further review and analysis of data related to the application. Conclusion The World Health Organization should revise the instructions to applicants on economic data requirements; develop new mechanisms to assist applicants in completing the application process; and define methods for the use of economic data in decision-making.Experiences with telemedicine for HIV care in two federally qualified health centers in Los Angeles : a qualitative study
AbstractWalker, D., Moucheraud, C., Butler, D., de Vente, J., Tangonan, K., Shoptaw, S., Currier, J. S., Gladstein, J., & Hoffman, R. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1AbstractBackground: The SARS-CoV-2 pandemic has resulted in an increase in telemedicine utilization for routine HIV care. However, there is limited information on perceptions of and experiences with telemedicine from United States (U.S.) federally qualified health centers (FQHCs) offering HIV care. We sought to understand telemedicine experiences of stakeholders with various roles: people living with HIV (PLHIV), clinical (clinicians and case managers), programmatic (clinic administrators), and policy (policymakers). Methods: Qualitative interviews about benefits and challenges of telemedicine (telephone and video) for HIV care were conducted with 31 PLHIV and 23 other stakeholders (clinicians, case managers, clinic administrators, and policymakers). Interviews were transcribed, translated to English if conducted in Spanish, coded, and analyzed for major themes. Results: Almost all PLHIV felt capable of engaging in telephone visits, with some expressing interest in learning how to use video visits as well. Nearly all PLHIV wanted to continue telemedicine as part of their routine HIV care, and this was also endorsed by clinical, programmatic and policy stakeholders. Interviewees agreed that telemedicine for HIV care has benefits for PLHIV, especially savings of time and transportation costs, which also reduced stress. Clinical, programmatic, and policy stakeholders expressed concerns around patients’ technological literacy and resources, as well as their access to privacy, and some felt that PLHIV strongly preferred in-person visits. These stakeholders also commonly reported clinic-level implementation challenges, including integrating telephone and video telemedicine into workflows and difficulty with video visit platforms. Conclusions: Telemedicine for HIV care, largely delivered via telephone (audio-only), was highly acceptable and feasible for both PLHIV, clinicians, and other stakeholders. Addressing barriers for stakeholders in incorporating video visits will be important for the successful implementation of telemedicine with video as part of routine HIV care at FQHCs.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.Gendered differences in perceptions and reports of wellbeing : A cross-sectional survey of adults on ART in Malawi
AbstractMoucheraud, C., Paul-Schultz, J., Mphande, M., Banda, B. A., Sigauke, H., Kumwenda, V., Dovel, K., Moses, A., Gupta, S., & Hoffman, R. M. (n.d.).Publication year
2022Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
34Issue
12Page(s)
1602-1609AbstractFew studies have examined gender differences in reported quality of life among persons living with HIV (PLWH) in low-income countries. We conducted a cross-sectional survey of adults on antiretroviral therapy in Malawi, including questions focused on wellbeing, and collected clinical data on these respondents. We compared men’s and women’s self-reported health and wellbeing using Poisson models that included socio-demographic covariates. Approximately 20% of respondents reported at least one physical functioning problem. In multiple variable models, men were significantly more likely to have a high viral load (≥200 copies/mL; aIRR 2.57), consume alcohol (aIRR 12.58), receive no help from family or friends (aIRR 2.18), and to feel worthless due to their HIV status (aIRR 2.40). Men were significantly less likely to be overweight or obese (aIRR 0.31), or report poor health (health today is not “very good;” aIRR 0.41). Taken together, despite higher prevalence of poor self-rated health, women were healthier across a range of objective dimensions, with better viral suppression, less alcohol use, and less social isolation (although they were more likely to have an unhealthy BMI). Research that includes multi-dimensional and gender-specific measurement of physical, mental and social health is important for improving our understanding of well-being of PLWH.Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy : A qualitative study
AbstractMoucheraud, C., Phiri, K., & Hoffman, R. M. (n.d.).Publication year
2022Journal title
Global Public HealthVolume
17Issue
5Page(s)
688-699AbstractIn order to understand HIV-positive Malawian adults’ experiences with hypertension management, we conducted qualitative interviews with 30 hypertensive adults who were also taking antiretroviral therapy. These interviews regarding hypertension management behaviours and beliefs were audio-recorded, transcribed, translated into English, and coded in Atlas.ti. Despite acknowledging the dangers of hypertension and the benefits of medication, many respondents missed their antihypertensive medication. Primary reasons included feeling healthy, health workers’ advice to stop taking medicine when blood pressure normalised, side effects, and using herbs or non-prescription medicines to manage hypertension. Women highlighted difficulties with dietary modifications, and changes in their social relationships. Both men and women spoke about hypertension-related challenges with employment and household economics. These results suggest numerous challenges among adults managing hypertension and HIV in Malawi, and frequent suboptimal adherence to medication. We identified new key themes–the quality of adherence counselling for antihypertensive medication, the effects of hypertension on financial stability, and the role of social relationships in self-care–and encourage further investigation into these topics in low-income, high-burden countries.Health care workers’ experiences with implementation of “screen and treat” for cervical cancer prevention in Malawi : A qualitative study
AbstractMoucheraud, C., Kawale, P., Kafwafwa, S., Bastani, R., & Hoffman, R. M. (n.d.).Publication year
2020Journal title
Implementation Science CommunicationsVolume
1Issue
1AbstractBackground: Cervical cancer remains a major cause of mortality and morbidity in low- and middle-income countries, despite the availability of effective prevention approaches. “Screen and treat” (a single-visit strategy to identify and remove abnormal cervical cells) is the recommended secondary prevention approach in low-resource settings, but there has been relatively scarce robust implementation science evidence on barriers and facilitators to providing “screen and treat” from the provider perspective, or about thermocoagulation as a lesion removal technique. Methods: Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted interviews with ten experienced “screen and treat” providers in Malawi. We asked questions based on the CFIR Guide, used the CFIR Guide codebook for a descriptive analysis in NVivo, and added recommended modifications for studies in low-income settings. Results: Seven CFIR constructs were identified as positively influencing implementation, and six as negatively influencing implementation. The two strong positive influences were the relative advantage of thermocoagulation versus cryotherapy (Innovation Characteristics) and respondents’ knowledge and beliefs about providing “screen and treat” (Individual Characteristics). The two strong negative influences were the availability of ongoing refresher trainings to stay up-to-date on skills (Inner Setting, Implementation Climate) and insufficient resources (staffing, infrastructure, supplies) to provide “screen and treat” to all women who need it (Inner Setting, Readiness for Implementation). Weak positive factors included perceived scalability and access to knowledge/information, as well as compatibility, leadership engagement, and team characteristics, but these latter three were mixed in valence. Weak negative influences were structural characteristics and donor priorities; and mixed but weakly negative influences were relative priority and engaging clients. Cross-cutting themes included the importance of broad buy-in (including different cadres of health workers and leadership at the facility and in the government) and the opportunities and challenges of offering integrated care (screening plus other services). Conclusions: Although “screen and treat” is viewed as effective and important, many implementation barriers remain. Our findings suggest that implementation strategies will need to be multi-level, include a diverse set of stakeholders, and explicitly address both screening and treatment.High rate of left ventricular hypertrophy on screening echocardiography among adults living with HIV in Malawi
AbstractHoffman, R. M., Chibwana, F., Banda, B. A., Kahn, D., Gama, K., Boas, Z. P., Chimombo, M., Kussen, C., Currier, J. S., Namarika, D., Van Oosterhout, J., Phiri, S., Moses, A., Currier, J. W., Sigauke, H., Moucheraud, C., & Canan, T. (n.d.).Publication year
2022Journal title
Open HeartVolume
9Issue
1AbstractBackground There are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent. Methods We performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram. Results A total of 202 individuals were enrolled with a median age of 45 years (IQR 39-52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (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.High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension
AbstractHoffman, R. M., Chibwana, F., Kahn, D., Banda, B. A., Phiri, L., Chimombo, M., Kussen, C., Sigauke, H., Moses, A., Van Oosterhout, J. J., Phiri, S., Currier, J. W., Currier, J. S., & Moucheraud, C. (n.d.).Publication year
2021Journal title
Global HeartVolume
16Issue
1AbstractBackground: Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population. Objective: We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications. Methods: We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined asHuman 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.Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County : The Importance of Rapid Return to Normalcy
AbstractLiang, C., Suen, S. C., Nguyen, A., Moucheraud, C., Hsu, L., Holloway, I. W., Charlebois, E. D., & Steward, W. T. (n.d.).Publication year
2023Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
92Issue
5Page(s)
370-377AbstractBackground: In response to the COVID-19 pandemic, San Francisco County (SFC) had to shift many nonemergency health care resources to COVID-19, reducing HIV control resources. We sought to quantify COVID-19 effects on HIV burden among men who have sex with men (MSM) as SFC returns to pre-COVID service levels and progresses toward the Ending the HIV Epidemic (EHE) goals. Setting: Microsimulation model of MSM in SFC tracking HIV progression and treatment. Methods: Scenario analysis where services affected by COVID-19 [testing, care engagement, pre-exposure prophylaxis (PrEP) uptake, and retention] return to pre-COVID levels by the end of 2022 or 2025, compared against a counterfactual where COVID-19 changes never occurred. We also examined scenarios where resources are prioritized to reach new patients or retain of existing patients from 2023 to 2025 before all services return to pre-COVID levels. Results: The annual number of MSM prescribed PrEP, newly acquired HIV, newly diagnosed, and achieving viral load suppression (VLS) rebound quickly after HIV care returns to pre-COVID levels. However, COVID-19 service disruptions result in measurable reductions in cumulative PrEP use, VLS person-years, incidence, and an increase in deaths over the 2020-2035 period. The burden is statistically significantly larger if these effects end in 2025 instead of 2022. Prioritizing HIV care/prevention initiation over retention results in more person-years of PrEP but less VLS person-years and more deaths, influencing EHE PrEP outcomes. Conclusions: Earlier HIV care return to pre-COVID levels results in lower cumulative HIV burdens. Resource prioritization decisions may differentially affect different EHE goals.Implementation of two policies to extend maternity leave and further restrict marketing of breast milk substitutes in Vietnam : a qualitative study
AbstractPayán, D. D., Zahid, N., Glenn, J., Tran, H. T., Huong, T. T., & Moucheraud, C. (n.d.).Publication year
2022Journal title
Health Policy and PlanningVolume
37Issue
4Page(s)
472-482AbstractPolicy research can reveal gaps and opportunities to enhance policy impact and implementation. In this study, we use a theoretically informed qualitative approach to investigate the implementation of two policies to promote breastfeeding in Vietnam. We conducted semi-structured interviews with national and local policy stakeholders (n = 26) in 2017. Interviews were audio-recorded, transcribed verbatim and then translated to English by certified translators. Transcript data were analysed using an integrated conceptual framework of policy implementation. Respondents identified several positive outcomes resulting from implementation of an extended maternity leave policy (Labour Code No. 10/2012/QH13) and further restrictions on marketing of breast milk substitutes (Decree No. 100/2014/ND-CP). Decree No. 100, in particular, was said to have reduced advertising of breast milk substitutes in mass media outlets and healthcare settings. Key implementation actors were national-level bureaucratic actors, local organizations and international partners. Findings reveal the importance of policy precedence and a broader set of policies to promote the rights of women and children to support implementation. Other facilitators were involvement from national-level implementing agencies and healthcare personnel and strength of government relationships and coordination with non-governmental and international organizations. Implementation challenges included insufficient funding, limited training to report violations, a cumbersome reporting process and pervasive misinformation about breast milk and breast milk substitutes. Limited reach for women employed in the informal labour sector and in rural communities was said to be a compatibility issue for the extended maternity leave policy in addition to the lack of impact on non-parental guardians and caretakers. Recommendations to improve policy implementation include designating a role for international organizations in supporting implementation, expanding maternity protections for all working women, building local-level policy knowledge to support enforcement, simplifying Decree No. 100 violation reporting processes and continuing to invest in interventions to facilitate a supportive policy environment in Vietnam.Improving quality of care for maternal and newborn health : A pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh
AbstractNababan, H. Y., Islam, R., Mostari, S., Tariqujjaman, M., Sarker, M., Islam, M. T., & Moucheraud, C. (n.d.).Publication year
2017Journal title
BMC Pregnancy and ChildbirthVolume
17Issue
1AbstractBackground: Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices. Method: The SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives. Result: After checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61-1.81). Conclusion: Implementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation.Integrated care experiences and out-of-pocket expenditures : A cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi
AbstractMoucheraud, C., Hing, M., Seleman, J., Phiri, K., Chibwana, F., Kahn, D., Schooley, A., Moses, A., & Hoffman, R. (n.d.).Publication year
2020Journal title
BMJ openVolume
10Issue
2AbstractObjectives As HIV-positive individuals' life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi. Design, setting and participants A cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using a € integrated care' if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017. Results Only half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US21 in integrated care vs US90 for non-integrated care) - mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all. Conclusions Individuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.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.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).