Corrina Moucheraud
Corrina Moucheraud
Scroll
Associate Professor of Public Health Policy and Management
Co-Director of the Global Center for Implementation Science
-
Professional overview
-
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.
-
Education
-
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
-
Honors and awards
-
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)
-
Publications
Publications
Malawian caregivers’ experiences with HPV vaccination for preadolescent girls : A qualitative study
AbstractMoucheraud, C., Whitehead, H. S., Songo, J., Szilagyi, P. G., Hoffman, R. M., & Kaunda-Khangamwa, B. N. (n.d.).Publication year
2023Journal title
Vaccine: XVolume
14AbstractIntroduction: Many low- and middle-income countries have introduced the human papillomavirus (HPV) vaccine, but uptake remains extremely low. Malawi has the second-highest incidence of cervical cancer globally, and launched a national HPV vaccination program in 2019. We sought to understand attitudes about, and experiences with, the HPV vaccine among caregivers of eligible girls in Malawi. Methods: We conducted qualitative interviews with 40 caregivers (parents or guardians) of preadolescent girls in Malawi to understand their experiences with HPV vaccination. We coded the data informed by the Behavioural and Social Drivers of vaccine uptake model and recommendations from WHO's Strategic Advisory Group of Experts Working Group on Vaccine Hesitancy. Results: In this sample, 37% of age-eligible daughters had not received any HPV vaccine doses, 35% had received 1 dose, 19% had received 2 doses, and 10% had an unknown vaccination status. Caregivers were aware of the dangers of cervical cancer, and understood that HPV vaccine is an effective prevention tool. However, many caregivers had heard rumors about the vaccine, particularly its alleged harmful effect on girls’ future fertility. Many caregivers, especially mothers, felt that school-based vaccination was efficient; but some caregivers expressed disappointment that they had not been more engaged in the school-based delivery of HPV vaccine. Caregivers also reported that the COVID-19 pandemic has been disruptive to vaccination. Conclusions: There are complex and intersecting factors that affect caregivers’ motivation to vaccinate their daughters against HPV, and the practical challenges that caregivers may encounter. We identify areas for future research and intervention that could contribute to cervical cancer elimination: better communicating about vaccine safety (particularly to address concerns about loss of fertility), leveraging the unique advantages of school-based vaccination while ensuring parental engagement, and understanding the complex effects of the COVID-19 pandemic (and vaccination program).Maternal Health Behaviors and Outcomes in a Nomadic Tibetan Population
AbstractMoucheraud, C., Gyal, L., Gyaltsen, K., Tsering, L., Narasimhan, S., & Gipson, J. (n.d.).Publication year
2018Journal title
Maternal and Child Health JournalVolume
22Issue
2Page(s)
264-273AbstractIntroduction Despite significant global improvements in maternal health, large disparities persist. In China, rural women and women who live in western regions experience lower rates of maternal healthcare utilization and higher rates of maternal mortality than women elsewhere in the country. This paper examines maternal health care-seeking among nomadic Tibetan women in rural western China, a particularly understudied group. Methods Secondary data analysis was conducted with survey data collected in 2014 in Qinghai Province, China. Participants (rural, nomadic, adult women) provided birth histories and information on care received during antenatal, intrapartum and/or postpartum period(s). Using bivariate and multivariable logistic regression models, these outcomes were explored in relation to maternal characteristics (e.g., educational attainment and parity), use of health insurance, and time. Results Approximately half of all women had ever used antenatal care, institutional delivery, and/or skilled birth attendance. The utilization of these services has increased over time, from 10% of births prior to the year 2000, to approximately 50% since 2000. Utilization increased by year (odds ratios ranging from 1.1 to 1.3) even after controlling for covariates. Women with health insurance coverage were significantly more likely to use these services than women without insurance, although less than 20% of women reported that insurance paid for any antenatal and/or childbirth care. Discussion Utilization of maternal care is improving among this population but rates remain low in comparison to other women in rural, western China. Further targeted interventions may be needed to reach and adequately address the maternal health needs of this unique population.Nomadic Tibetan women’s reproductive health : findings from cross-sectional surveys with a hard-to-reach population
AbstractGipson, J. D., Moucheraud, C., Gyaltsen, K., Tsering, L., Nobari, T. Z., & Gyal, L. (n.d.).Publication year
2021Journal title
Reproductive HealthVolume
18Issue
1AbstractBackground: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. Methods: We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). Results: On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (< 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p < 0.05). Conclusions: We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population. Plain English Summary: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (less than 40 years old) were more likely to report having had had an STI symptom, as compared to women over 40 years old (84% versus 71%; p < 0.05). We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.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.PEPFAR investments in governance and health systems were one-fifth of countries' budgeted funds, 2004-14
AbstractMoucheraud, C., Sparkes, S., Nakamura, Y., Gage, A., Atun, R., & Bossert, T. J. (n.d.).Publication year
2016Journal title
Health AffairsVolume
35Issue
5Page(s)
847-855AbstractLaunched in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) is the largest disease-focused assistance program in the world. We analyzed PEPFAR budgets for governance and systems for the period 2004-14 to ascertain whether PEPFAR's stated emphasis on strengthening health systems has been manifested financially. The main outcome variable in our analysis, the first of its kind using these data, was the share of PEPFAR's total annual budget for a country that was designated for governance and systems. The share of planned PEPFAR funding for governance and systems increased from 14.9 percent, on average, in 2004 to 27.5 percent in 2013, but it declined in 2014 to 20.8 percent. This study shows that the size of a country's PEPFAR budget was negatively associated with the share allocated for governance and systems (compared with other budget program areas); it also shows that there was no significant relationship between budgets for governance and systems and HIV prevalence. It is crucial for the global health policy community to better understand how such investments are allocated and used for health systems strengthening.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 and acceptability for long-acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya
AbstractWara, N. J., Mvududu, R., Marwa, M. M., Gómez, L., Mashele, N., Orrell, C., Moucheraud, C., Kinuthia, J., John-Stewart, G., Myer, L., Hoffman, R., Pintye, J., & Davey, D. L. (n.d.).Publication year
2023Journal title
Journal of the International AIDS SocietyVolume
26Issue
5AbstractIntroduction: Long-acting pre-exposure prophylaxis (PrEP) options could overcome barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, countries with high PrEP coverage with pending regulatory approvals for long-acting injectable cabotegravir and the dapivirine vaginal ring (approved in South Africa, under review in Kenya). Methods: From September 2021 to February 2022, we surveyed pregnant and postpartum women enrolled in oral PrEP studies in South Africa and Kenya. We evaluated oral PrEP attitudes and preferences for long-acting PrEP methods in multivariable logistic regression models adjusting for maternal age and country. Results: We surveyed 190 women in South Africa (67% postpartum; median age 27 years [IQR = 22–32]) and 204 women in Kenya (79% postpartum; median age 29 years [IQR = 25–33]). Seventy-five percent of participants reported oral PrEP use within the last 30 days. Overall, forty-nine percent of participants reported negative oral PrEP attributes, including side effects (21% South Africa, 30% Kenya) and pill burden (20% South Africa, 25% Kenya). Preferred PrEP attributes included long-acting method, effectiveness, safety while pregnant and breastfeeding, and free medication. Most participants (75%, South Africa and Kenya) preferred a potential long-acting injectable over oral PrEP, most frequently for a longer duration of effectiveness in South Africa (87% South Africa, 42% Kenya) versus discretion in Kenya (5% South Africa, 49% Kenya). Eighty-seven percent of participants preferred oral PrEP over a potential long-acting vaginal ring, mostly due to concern about possible discomfort with vaginal insertion (82% South Africa, 48% Kenya). Significant predictors of long-acting PrEP preference included past use of injectable contraceptive (aOR = 2.48, 95% CI: 1.34, 4.57), disliking at least one oral PrEP attribute (aOR = 1.72, 95% CI: 1.05, 2.80) and preferring infrequent PrEP use (aOR = 1.58, 95% CI: 0.94, 2.65). Conclusions: Oral PrEP-experienced pregnant and postpartum women expressed a theoretical preference for long-acting injectable PrEP over other modalities, demonstrating potential acceptability among a key population who must be at the forefront of injectable PrEP rollout. Reasons for PrEP preferences differed by country, emphasizing the importance of increasing context-specific options and choice of PrEP modalities for pregnant and postpartum women.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.Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa
AbstractMoucheraud, C., McBride, K., Heuveline, P., & Shah, M. (n.d.).Publication year
2022Journal title
Journal of Adolescent HealthVolume
71Issue
2Page(s)
210-216AbstractPurpose: There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (Provider experiences with three- and six-month antiretroviral therapy dispensing for stable clients in Zambia
AbstractPhiri, K., McBride, K., Siwale, Z., Hubbard, J., Bardon, A., Moucheraud, C., Haambokoma, M., Pisa, P. T., Moyo, C., & Hoffman, R. M. (n.d.).Publication year
2021Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
33Issue
4Page(s)
541-547AbstractMulti-month dispensing of antiretroviral therapy (ART) has been taken to scale in many settings in sub-Saharan Africa with the benefits of improved client satisfaction and decreased client costs. Six-month ART dispensing may further increase these benefits; however, data are lacking. Within a cluster-randomized trial of three- versus six-month dispensing in Malawi and Zambia, we performed a sub-study to explore Zambian provider experiences with multi-month dispensing. We conducted 18 in-depth interviews with clinical officers and nurses dispensing ART as part of INTERVAL in Zambia. Interview questions focused on provider perceptions of client acceptability, views on client sharing and selling of ART, and perceptions on provider workload and clinic efficiency, with a focus on differences between three- and six-month dispensing. Interviews were analyzed using inductive thematic analysis to identify key themes and patterns within the data. Providers perceived significant benefits of multi-month dispensing, with advantages of six-month over three-month dispensing related to a reduced burden on clients, and for reductions in their own workload and clinic congestion. Among nearly all providers, the six-month dispensing strategy was perceived as ideal. Further research is needed to quantify clinical outcomes of six-month dispensing and feasibility of scaling-up this intervention in resource-limited settings. Clinical Trial Number: NCT03101592.Recent Alcohol Use Is Associated with Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence among Pregnant and Postpartum Women in South Africa
AbstractMiller, A. P., Shoptaw, S., Moucheraud, C., Mvududu, R., Essack, Z., Gorbach, P. M., Myer, L., & Davey, D. L. (n.d.).Publication year
2023Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
92Issue
3Page(s)
204-211AbstractBackground:South African women experience high levels of alcohol use and HIV infection during the perinatal period. Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV risk. We examined associations between alcohol use and PrEP use during pregnancy and postpartum.Methods:The PrEP in Pregnant and Postpartum women study is a prospective observational cohort of 1200 HIV-negative pregnant women enrolled at first antenatal care visit and followed through 12 months' postpartum in Cape Town, South Africa. The analytic sample comprised pregnant women who initiated PrEP at baseline and were not censored from study follow-up before 3-month follow-up. We examined associations between any or hazardous alcohol use (Alcohol Use Disorders Identification Test - Consumption score ≥3) in the year before pregnancy and PrEP continuation and adherence during pregnancy (self-report of missingRemoval of long-acting reversible contraceptive methods and quality of care in Dar es Salaam, Tanzania : Client and provider perspectives from a secondary analysis of cross-sectional survey data from a randomized controlled trial
AbstractWollum, A., Moucheraud, C., Sabasaba, A., & Gipson, J. D. (n.d.).Publication year
2024Journal title
PLOS global public healthVolume
4Issue
1AbstractAccess to removal of long-acting reversible contraception (LARCs) (e.g., implants and intrauterine devices (IUDs)) is an essential part of contraceptive care. We conducted a secondary analysis of cross-sectional survey data from a randomized controlled trial. We analyzed 5,930 client surveys and 259 provider surveys from 73 public sector facilities in Tanzania to examine the receipt of desired LARC removal services among clients and the association between receipt of desired LARC removal and person-centered care. We used provider survey data to contextualize these findings, describing provider attitudes and training related to LARC removals. All facilities took part in a larger randomized controlled trial to assess the Beyond Bias intervention, a provider-focused intervention to reduce provider bias on the basis of age, marital status, and parity. Thirteen percent of clients did not receive a desired LARC removal during their visit. Clients who were young, had lower perceived socioeconomic status, and visited facilities that did not take part in the Beyond Bias intervention were less likely to receive a desired removal. Clients who received a desired LARC removal reported higher levels of person-centered care (β = .07, CI: .02 - .11, p = < .01). Half of providers reported not being comfortable removing a LARC before its expiration (51%) or if they disagreed with the client’s decision (49%). Attention is needed to ensure clients can get their LARCs removed when they want to ensure patient-centered care and protect client autonomy and rights. Interventions like the Beyond Bias intervention, may work to address provider-imposed barriers to LARC removals.Rethinking integrated service delivery for malaria
AbstractAnsah, E. K., Moucheraud, C., Arogundade, L., & Rangel, G. W. (n.d.).Publication year
2022Journal title
PLOS Global Public HealthVolume
2Issue
6 JuneAbstractDespite worldwide efforts and much progress toward malaria control, declines in malaria morbidity and mortality have hit a plateau. While many nations achieved significant malaria suppression or even elimination, success has been uneven, and other nations have made little headway—or even lost ground in this battle. These alarming trends threaten to derail the attainment of global targets for malaria control. Among the challenges impeding success in malaria reduction, many strategies center malaria as a set of technical problems in commodity development and delivery. Yet, this narrow perspective overlooks the importance of strong health systems and robust healthcare delivery. This paper argues that strategies that move the needle on health services and behaviors offer a significant opportunity to achieve malaria control through a comprehensive approach that integrates malaria with broader health services efforts. Indeed, malaria may serve as the thread that weaves integrated service delivery into a path forward for universal health coverage. Using key themes identified by the "Rethinking Malaria in the Context of COVID-19" effort through engagement with key stakeholders, we provide recommendations for pursuing integrated service delivery that can advance malaria control via strengthening health systems, increasing visibility and use of high-quality data at all levels, centering issues of equity, promoting research and innovation for new tools, expanding knowledge on effective implementation strategies for interventions, making the case for investing in malaria among stakeholders, and engaging impacted communities and nations.Rural–Urban Differences : Using Finer Geographic Classifications to Reevaluate Distance and Choice of Health Services in Malawi
AbstractMcBride, K., & Moucheraud, C. (n.d.).Publication year
2022Journal title
Health Systems and ReformVolume
8Issue
1AbstractThere is no universal understanding of what defines urban or rural areas nor criteria for differentiating within these. When assessing access to health services, traditional urban–rural dichotomies may mask substantial variation. We use geospatial methods to link household data from the 2015–2016 Malawi Demographic Health Survey to health facility data from the Malawi Service Provision Assessment and apply a new proposed four-category classification of geographic area (urban major metropolitan area, urban township, rural, and remote) to evaluate households’ distance to, and choice of, primary, secondary, and tertiary health care in Malawi. Applying this new four-category definition, approximately 3.8 million rural- and urban-defined individuals would be reclassified into new groups, nearly a quarter of Malawi’s 2015 population. There were substantial differences in distance to the nearest facility using this new categorization: remote households are (on average) an additional 5 km away from secondary and tertiary care services versus rural households. Health service choice differs also, particularly in urban areas, a distinction that is lost when using a simple binary classification: those living in major metropolitan households have a choice of five facilities offering comprehensive primary care services within a 10-km zone, whereas urban township households have no choice, with only one such facility within 10 km. Future research should explore how such expanded classifications can be standardized and used to strengthen public health and demographic research.Scaling up diagnostic-driven management of sexually transmitted infections in pregnancy
AbstractWynn, A., Moucheraud, C., Morroni, C., Ramogola-Masire, D., Klausner, J. D., & Leibowitz, A. (n.d.).Publication year
2019Journal title
The Lancet Infectious DiseasesVolume
19Issue
8Page(s)
809-810Abstract~Screening Adults for HIV Testing in the Outpatient Department : An Assessment of Tool Performance in Malawi
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)
478-486AbstractLittle is known about screening tools for adults in high HIV burden contexts. We use exit survey data collected at outpatient departments in Malawi (n = 1038) to estimate the sensitivity, specificity, negative and positive predictive values of screening tools that include questions about sexual behavior and use of health services. We compare a full tool (seven relevant questions) to a reduced tool (five questions, excluding sexual behavior measures) and to standard of care (two questions, never tested for HIV or tested > 12 months ago, or seeking care for suspected STI). Suspect STI and ≥ 3 sexual partners were associated with HIV positivity, but had weak sensitivity and specificity. The full tool (using the optimal cutoff score of ≥ 3) would achieve 55.6% sensitivity and 84.9% specificity for HIV positivity; the reduced tool (optimal cutoff score ≥ 2) would achieve 59.3% sensitivity and 68.5% specificity; and standard of care 77.8% sensitivity and 47.8% specificity. Screening tools for HIV testing in outpatient departments do not offer clear advantages over standard of care.Service readiness for noncommunicable diseases was low in five countries in 2013-15
AbstractMoucheraud, C. (n.d.).Publication year
2018Journal title
Health AffairsVolume
37Issue
8Page(s)
1321-1330AbstractThe growing burden of noncommunicable diseases (NCDs) may pose challenges for resource-limited health systems. This study used standardized, nationally representative data from Service Provision Assessments conducted in 2013-15 and the Service Availability and Readiness Assessment methodology to examine NCD service availability and readiness in Bangladesh, Haiti, Malawi, Nepal, and Tanzania. Both service availability and readiness were found to be very low: Very few facilities were fully "ready" to provide any one NCD service. Shortages of trained health workers and essential medicines were critical limitations to readiness. Rural and free facilities had lower availability and readiness, which may present access barriers. Policy makers should draw on decades of experience with global health initiatives to close these service gaps through the training of health workers on NCD screening and treatment, engaging the private sector on NCDs, and ensuring access to NCD medicines. Such efforts must be attentive to distributional equity and the multiple dimensions of care quality.Simple screening tool to help identify high-risk children for targeted HIV testing in malawian inpatient wards
AbstractMoucheraud, C., Chasweka, D., Nyirenda, M., Schooley, A., Dovel, K., & Hoffman, R. M. (n.d.).Publication year
2018Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
79Issue
3Page(s)
352-357AbstractBackground: To meet global AIDS goals, pediatric HIV diagnosis must be strengthened. Provider-initiated testing and counseling, which is recommended by the WHO, faces persistent implementation challenges in low-resource settings. Alternative approaches are needed. Setting: Malawi has achieved high coverage of HIV diagnosis and treatment, but there are gaps among pediatric populations. This study assessed the sensitivity and specificity of a brief screening tool to identify at-risk pediatric patients for targeted HIV testing in Malawi. Methods: A tool containing 6 yes/no items was used for children (aged 1-15 years) in the inpatient pediatric wards at 12 hospitals in Malawi (July 2016-July 2017). Questions were based on an established tool, translated to Chichewa, and implemented by HIV diagnostic assistants. All participating children were provided HIV testing and counseling per Ministry of Health guidelines. Analysis estimated the tool's characteristics including sensitivity, specificity, negative, and positive predictive values. Results: HIV prevalence among the 8602 participants was 1.1% (n = 90). Children with a screening tool score of 1 had double the odds of being HIV positive than those with a score of 0. Frequent sickness was the most sensitive predictor of HIV status (55.1%), and having a deceased parent was the most specific (96.7%). False classification of HIV-negative status was rare (n = 14) but occurred more often among boys and younger children. Conclusions: A brief screening tool for pediatric inpatients helped target HIV testing in those most at risk in a low-pediatric-prevalence, resource-constrained setting. Future research should include a direct, rigorous comparison with PITC including comparative effectiveness, efficiency, and cost effectiveness.Sustainability of health information systems : A three-country qualitative study in southern Africa
AbstractMoucheraud, C., Schwitters, A., Boudreaux, C., Giles, D., Kilmarx, P. H., Ntolo, N., Bangani, Z., St Louis, M. E., & Bossert, T. J. (n.d.).Publication year
2017Journal title
BMC health services researchVolume
17Issue
1AbstractBackground: Health information systems are central to strong health systems. They assist with patient and program management, quality improvement, disease surveillance, and strategic use of information. Many donors have worked to improve health information systems, particularly by supporting the introduction of electronic health information systems (EHIS), which are considered more responsive and more efficient than older, paper-based systems. As many donor-driven programs are increasing their focus on country ownership, sustainability of these investments is a key concern. This analysis explores the potential sustainability of EHIS investments in Malawi, Zambia and Zimbabwe, originally supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR). Methods: Using a framework based on sustainability theories from the health systems literature, this analysis employs a qualitative case study methodology to highlight factors that may increase the likelihood that donor-supported initiatives will continue after the original support is modified or ends. Results: Findings highlight commonalities around possible determinants of sustainability. The study found that there is great optimism about the potential for EHIS, but the perceived risks may result in hesitancy to transition completely and parallel use of paper-based systems. Full stakeholder engagement is likely to be crucial for sustainability, as well as integration with other activities within the health system and those funded by development partners. The literature suggests that a sustainable system has clearly-defined goals around which stakeholders can rally, but this has not been achieved in the systems studied. The study also found that technical resource constraints - affecting system usage, maintenance, upgrades and repairs - may limit EHIS sustainability even if these other pillars were addressed. Conclusions: The sustainability of EHIS faces many challenges, which could be addressed through systems' technical design, stakeholder coordination, and the building of organizational capacity to maintain and enhance such systems. All of this requires time and attention, but is likely to enhance long-term outcomes.Telemedicine for HIV care : a cross-sectional survey of people living with HIV receiving care at two federally qualified health centers in Los Angeles during a mature phase of the COVID-19 pandemic
AbstractWalker, D., Moucheraud, C., Butler, D., Takayama, C., Shoptaw, S., Currier, J. S., Gladstein, J., & Hoffman, R. (n.d.).Publication year
2024Journal title
BMC Infectious DiseasesVolume
24Issue
1AbstractBackground: The COVID-19 pandemic resulted in the rapid implementation of telemedicine for HIV care at federally qualified health centers (FQHCs) in the United States. We sought to understand use of telemedicine (telephone and video) at two FQHCs in Los Angeles, and the client attitudes towards and experiences with telemedicine as part of future HIV care. Methods: We conducted surveys with 271 people living with HIV (PLHIV), with questions covering sociodemographic factors, telemedicine attitudes and experiences, technological literacy, and access to technological resources and privacy. Survey data were analyzed utilizing summary statistics, chi-square analyses, and Fisher’s exact test to understand associations between sociodemographic factors and telemedicine attitudes and experiences. Results: Sixty percent of the sample had used any telemedicine and, of these, 93% utilized only telephone visits. Almost all respondents (95%, n = 257) had access to a functioning smartphone and self-rated their technological literacy as high. Most had consistent access to privacy (88%, n = 239), and those without privacy noted this as a barrier to the use of telemedicine. The main benefits of telemedicine (compared to in person) were savings of time and money, convenience, and ability to complete appointments as scheduled. Just over half of PLHIV said they would feel more comfortable discussing sensitive topics (e.g., substance use, relationship issues) in person than over telephone (60%, n = 164) or video (55%, n = 151). Despite limited experience with video telemedicine, half of all participants desired a mix of telephone and video visits as part of their future HIV care. Conclusions: During a mature phase of the COVID-19 pandemic, PLHIV in our study showed high satisfaction with telemedicine, largely conducted as telephone visits, and high interest in telemedicine visits as a component of their future HIV care. Future studies should explore barriers to implementing video telemedicine in FQHCs and determine telemedicine’s impact on clinical outcomes, including engagement and viral suppression.The 10th Annual Symposium on Global Cancer Research : New Models for Global Cancer Research, Training, and Control
AbstractJallow, F., Bourlon, M. T., Cira, M. K., Duncan, K., Eldridge, L., Elibe, E., Estes, T., Frank, A., Gravitt, P., Llera, A. S., Moucheraud, C., Mulherkar, R., Musonda, W., Ogembo, J. G., Pearlman, P., Phiri, S., Sivaram, S., Stern, M., & Gopal, S. (n.d.).Publication year
2022Journal title
JCO Global OncologyVolume
8Page(s)
1-3Abstract~The costs of diabetes treatment in low- A nd middle-income countries : A systematic review
AbstractMoucheraud, C., Lenz, C., Latkovic, M., & Wirtz, V. J. (n.d.).Publication year
2019Journal title
BMJ Global HealthVolume
4Issue
1AbstractIntroduction The rising burden of diabetes in low- A nd middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- A nd middle-income countries. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$). Results The search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types. Conclusion This review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- A nd middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania : A Cohort Study
AbstractFinlay, J. E., Moucheraud, C., Goshev, S., Levira, F., Mrema, S., Canning, D., Masanja, H., & Yamin, A. E. (n.d.).Publication year
2015Journal title
Maternal and Child Health JournalVolume
19Issue
11Page(s)
2393-2402AbstractObjectives: The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman’s death during or shortly after childbirth, and survival outcomes for her children. Methods: The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996–2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived. Results: There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday—a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p valueThe impact of primary health care on AIDS incidence and mortality : A cohort study of 3.4 million Brazilians
AbstractPinto, P. F., Macinko, J. A., Silva, A. F., Lua, I., Jesus, G., Magno, L., Teles Santos, C. A., Ichihara, M. Y., Barreto, M. L., Moucheraud, C., Souza, L. E., Dourado, I., & Rasella, D. (n.d.).Publication year
2024Journal title
PLoS MedicineVolume
21Issue
7 JulyAbstractBackground AU Primary: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly Health Care (PHC) is essential for effective, efficient, : and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods and findings A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. Conclusions AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic
AbstractCambou, M. C., David, H., Moucheraud, C., Nielsen-Saines, K., Comulada, W. S., & Macinko, J. A. (n.d.).Publication year
2024Journal title
Scientific reportsVolume
14Issue
1AbstractThe effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.