Purnima Madhivanan

Interests

Research

Intersection of Infectious Diseases and Chronic Diseases, Women's Health across Lifespan, Global Health, Health Inequities, Cancer Prevention, HIV Prevention, Health Outcomes of Medical Marijuana, Maternal Child Health, Microbiome, Viral Infections, Sexually Transmitted Infections

Teaching

Reproductive Health, HIV/AIDS Epidemiology, Systematic Reviews & Meta-analysis, Clinical Trials

Courses

Scholarly Contributions

Journals/Publications

• Kimaru, L. J., Habila, M. A., Mantina, N. M., Madhivanan, P., Connick, E., Ernst, K., & Ehiri, J. (2024). Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS global public health, 4(2), e0002870.
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  Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
• Madhivanan, N., Nivean, P. D., Madanagopalan, V. G., Priya, S., Madhivanan, N., & Arthi, M. (2024). Clinical results after binocular implantation of a unique nondiffractive enhanced monofocal intraocular lens designed for enhanced monovision to increase the depth of focus. Indian journal of ophthalmology, 72(1), 63-65.
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  To provide the reports of a pilot study to assess the visual acuity (VA) and contrast sensitivity with RayOne enhanced monovision (EMV), a unique nondiffractive enhanced monofocal intraocular lens (IOL) to increase the range of focus.
• Muralidhar, K., Nishimura, H., Coursey, K., Krupp, K., Jaykrishna, P., Srinivas, V., & Madhivanan, P. (2024). Knowledge and practice of family planning among pregnant tribal women in Southern India: an observational study. Contraception and reproductive medicine, 9(1), 2.
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  There are over 700 Scheduled Tribes (ST) living in 30 Indian states. As with other indigenous groups across the world, Indian ST have some of the poorest infant and child health outcomes of any communities in India. A child born to an ST family is 19% more likely to die in the first month of life and has a 45 percent risk of dying in their first year compared with other Indian populations. Research suggests that early conception, high fertility, and low use of family planning methods are large contributors to these disparities.
• Weaver, L. J., Nanjaiah, S., Begum, F., Ningaiah, N., Krupp, K., & Madhivanan, P. (2024). A Glossary of Distress Expressions Among Kannada-Speaking Urban Hindu Women. Culture, medicine and psychiatry.
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  People's lived experiences of distress are complex, personal, and vary widely across cultures. So, too, do the terms and expressions people use to describe distress. This variation presents an engaging challenge for those doing intercultural work in transcultural psychiatry, global mental health, and psychological anthropology. This article details the findings of a study of common distress terminology among 63 Kannada-speaking Hindu women living in Mysuru, the second largest city in the state of Karnataka, South India. Very little existing scholarship focuses on cultural adaptation for speakers of Dravidian languages like Kannada; this study aims to fill this gap and support greater representation of this linguistic family in research on mental health, idioms of distress, and distress terminology. Between 2018 and 2019, we conducted a 3-phase study consisting of interviews, data reduction, and focus group discussions. The goal was to produce a non-exhaustive list of common Kannada distress terms that could be used in future research and practice to translate and culturally adapt mental health symptom scales or other global mental health tools.
• Woodson, L. L., Garcia Saldivar, A., Brown, H. E., Magrath, P. A., Farland, L. V., Blas, M. M., & Madhivanan, P. (2024). 'You have a lot of mirrors': structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study. Culture, health & sexuality, 1-17.
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  Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders ( = 12) and adolescent participants between 15 and 17 years of age (pregnant girls,  = 11; never pregnant girls,  = 9; and boys,  = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups,  = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.
• Block Ngaybe, M., Schmitt, H. J., Mallahan, S., Sena, R., Werts, S., Rooney, B., Magrath, P., & Madhivanan, P. (2023). Qualitative assessment of COVID-19 vaccination acceptance among healthcare workers in Pima County. Human vaccines & immunotherapeutics, 19(1), 2211464.
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  In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.
• Celaya, M. F., Madhivanan, P., McClelland, J., Zahlan, A., Rock, C., Nathan, A., & Acharya, A. (2023). Individual and community-level risk factors for maternal morbidity and mortality among Native American women in the USA: protocol for systematic review. BMJ open, 13(12), e072671.
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  Incidents of maternal morbidity and mortality (MMM) continue to rise in the USA. Significant racial and ethnic health inequities exist, with Native American (NA) women being three to four times more likely to die than white, non-Hispanic women, and three to five times more likely to experience an incident of severe maternal morbidity. Few studies have identified individual and community-level risk factors of MMM experienced by NA women. Therefore, this systematic review will identify said risk factors of MMM experienced by NA women in the USA.
• Escoffery, C., Petagna, C., Agnone, C., Perez, S., Saber, L. B., Ryan, G., Dhir, M., Sekar, S., Yeager, K. A., Biddell, C. B., Madhivanan, P., Lee, S., English, A. S., Savas, L., Daly, E., Vu, T., & Fernandez, M. E. (2023). A systematic review of interventions to promote HPV vaccination globally. BMC public health, 23(1), 1262.
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  Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is suboptimal in the United States (U.S.). Previous research has found a variety of intervention strategies (environmental and behavioral) to increase its uptake. The purpose of the study is to systematically review the literature on interventions that promote HPV vaccination from 2015 to 2020.
• Fisher, C., Bragard, E., & Madhivanan, P. (2023). COVID-19 Vaccine Hesitancy among Economically Marginalized Hispanic Parents of Children under Five Years in the United States. Vaccines, 11(3).
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  Hispanic children in the US have high rates of COVID-19-related hospitalizations and deaths. Following FDA emergency approval, COVID-19 vaccination rates for young children under five years have been alarmingly low, especially in border states with significant Hispanic populations. This study identified social and cultural determinants of COVID-19 vaccine hesitancy among economically marginalized Hispanic parents of children under five. In 2022, following FDA approval, 309 Hispanic female guardians in US border states responded to an online survey assessing parental intent to vaccinate their child, demographic characteristics, COVID-19 health and vaccine beliefs, trust in traditional sources of health information, physician and community support, and acculturation to Anglo American norms. The majority (45.6%) did not intend to vaccinate their child or were unsure (22.0%). Kendall's indicated vaccine acceptance was negatively associated with COVID-19 specific and general vaccine distrust, belief the vaccine was unnecessary, time living in the U.S., and language acculturation (range = -0.13 to -0.44; = 0.05-0.001) and positively related to trust in traditional resources, doctor's recommendation, child's age, household income and parent education (range = 0.11 to 0.37; = 0.05-0.001). This research highlights the importance of COVID-19 vaccination public health strategies that draw on Hispanic cultural values, community partnerships and enhanced pediatrician communication regarding routine and COVID-19-specific vaccinations.
• Habila, M. A., Obeng-Kusi, M., Ali, M. J., Magaji, F. A., Shambe, I. H., Daru, P. H., Jacobs, E. T., Madhivanan, P., Sagay, A. S., & Musa, J. (2023). The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria. BMC women's health, 23(1), 640.
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  Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria.
• Habila, M. A., Sagay, E., Obeng-Kusi, M., Ali, M. J., Magaji, F. A., Shambe, I. H., Daru, P. H., Jacobs, E. T., Madhivanan, P., Sagay, A. S., & Musa, J. (2023). Utilization of opportunistic cervical cancer screening in Nigeria. Cancer causes & control : CCC.
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  While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria.
• Hirschey, R., Rohweder, C., Zahnd, W. E., Eberth, J. M., Adsul, P., Guan, Y., Yeager, K. A., Haines, H., Farris, P. E., Bea, J. W., Dwyer, A., Madhivanan, P., Ranganathan, R., Seaman, A. T., Vu, T., Wickersham, K., Vu, M., Teal, R., Giannone, K., , Hilton, A., et al. (2023). Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment. Cancer causes & control : CCC, 1-11.
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  The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans.
• Krupp, K., Rao, A. P., Pope, B., Ravi, K., Khan, A., Srinivas, V., Madhivanan, P., & Srinivas, A. (2023). Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India. PLOS global public health, 3(7), e0000846.
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  Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.
• Krupp, K., Segar, J. M., Fernández-Martínez, J. L., & Madhivanan, P. (2023). MicroRNAs: Emerging as Highly Promising Biomarkers for Early Breast Cancer Screening. Journal of clinical and laboratory medicine, 6(3).
• Madhivanan, P., Kano, M., Stimatze, T., Nair, U., Tawfik, B., Mishra, S., Pankratz, V. S., McClain, M., Wu, E., Kanda, D., & Adsul, P. (2023). Abstract A097: Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors. Cancer Epidemiology, Biomarkers & Prevention, 32(1_Supplement), A097-A097. doi:10.1158/1538-7755.disp22-a097
• Mantina, N. M., Nakayima Miiro, F., Smith, J., McClelland, D. J., Magrath, P. A., & Madhivanan, P. (2023). Perspectives of HPV vaccination among young adults: a qualitative systematic review and evidence synthesis protocol. BMJ open, 13(12), e076234.
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  Human papillomavirus (HPV) is the causative agent of nearly all cervical cancers. Despite the proven safety and efficacy of HPV vaccines in preventing HPV-related cancers, the global vaccine coverage rate is estimated to only be 15%. HPV vaccine coverage rates are more actively tracked and reported for adolescents 17 years and younger but there is still a critical window of opportunity to intervene and promote HPV vaccination among young adults aged 18-26 years who are still eligible to be vaccinated. This protocol for a qualitative evidence synthesis aims to review perspectives of HPV vaccination among young adults (18-26 years) and identify facilitators and barriers that influence HPV vaccination uptake and decision-making.
• Muralidhar, K., & Madhivanan, P. (2023). Letter to the Editor: Clarity and quality assessment of epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism: clinical and experimental, 144, 155561.
• Muralidhar, K., & Madhivanan, P. (2023). Systematic review of determinants and interventions of areca nut cessation: curbing a public health menace. Journal of public health (Oxford, England).
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  This letter presents a critical appraisal of a recent systematic review article published in Journal of Public Health. Systematic reviews are particularly important research articles that can meaningfully influence policy and research in the field due to their scientific value. We aimed to bring attention to certain methodological issues in this review that affect the validity of the findings on the very important topic of areca nut use and cessation.
• Ravi, K., Kaur, T., Khan, A. S., Pope, B., Nguyen, K. Y., Muralidhar, K., Krupp, K., Hernandez, B. Y., Angela, S., Madhivanan, P., & Nerurkar, V. R. (2023). Oral Human Papillomavirus Infection among Smokeless Tobacco-using Tribal Women in Mysuru, India. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 48(5), 775-780.
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  Smokeless tobacco (SLT) is consumed by more than 300 million people worldwide. Studies show high use among Indian indigenous women who are also at high risk for oral cancers. Both human papillomavirus infection (HPV) and SLT have been associated with oral cancer, this study examined the presence of high-risk HPV in oral samples collected from tribal smokeless tobacco users in Mysuru, India. Between June and August 2019, 100 tribal females (50 SLT-users and 50 non-users) from rural Mysuru District, Karnataka, were enrolled in a cross-sectional study. Following informed consent, demographic data and oral samples were collected and processed using a digene HC2 High-Risk HPV DNA test (Qiagen, USA). On average participants were 45.5 (SD: ±6.6) years. Chronic SLT users were mostly married (73%), Hindu (100%), illiterate (62%), and employed (90%). One woman was positive for high-risk HPV infection. Oral HPV infection was low in this sample and this is consistent with the literature from other low and middle-income countries. SLT use is high in this group so interventions to reduce tobacco use are warranted.
• Robles-Morales, R., Morrill, K. E., Lopez-Pentecost, M., & Madhivanan, P. (2023). Arizona-Sonora binational data sharing: the missing piece to the cervical cancer puzzle. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.
• Samsamshariat, T., Madhivanan, P., Reyes Fernández Prada, A., Moya, E. M., Meza, G., Reinders, S., & Blas, M. M. (2023). Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research. BMJ global health, 8(10).
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  The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic.
• Semprini, J. T., Biddell, C. B., Eberth, J. M., Charlton, M. E., Nash, S. H., Yeager, K. A., Evans, D., Madhivanan, P., Brandt, H. M., Askelson, N. M., Seaman, A. T., & Zahnd, W. E. (2023). Measuring and addressing health equity: an assessment of cancer center designation requirements. Cancer causes & control : CCC.
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  By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements.
• Wickersham, K. E., Morrill, K. E., Lopez-Pentecost, M., Heiney, S. P., King, J. J., Madhivanan, P., & Hirschey, R. (2023). Losing a part of life: experiences of cancer survivors accessing treatment and sheltering in place during the COVID-19 pandemic. Cancer causes & control : CCC.
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  To explore experiences of sheltering in place and accessing treatment during the initial stages of the COVID-19 pandemic among survivors with cancer receiving tyrosine kinase inhibitor (TKI) therapy.
• Adsul, P., de Cortina, S. H., Pramathesh, R., Jayakrishna, P., Srinivas, V., Nethan, S. T., Dhanasekaran, K., Hariprasad, R., & Madhivanan, P. (2022). Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore. PLOS global public health, 2(6), e0000570.
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  Cervical cancer is the second most common cancer among Indian women. Screening is an effective prevention strategy, but achieving high screening rates depend upon identifying barriers at multiple levels of healthcare delivery. There is limited research on understanding the perspectives of providers who deliver cancer prevention services. The objective of this study was to explore physician perspectives on cervical cancer prevention, barriers to effective implementation, and strategies to overcome these barriers in India. Guided by the "Multilevel influences on the Cancer Care Continuum" theoretical framework, we conducted semi-structured interviews with physicians in Mysore, India. From November 2015- January 2016, we interviewed 15 (50.0%) primary care physicians, seven (23.3%) obstetrician/gynecologists, six (20.0%) oncologists, and two (6.7%) pathologists. We analyzed interview transcripts in Dedoose using a grounded theory approach. Approximately two-thirds (n = 19, 63.3%) of the participants worked in the public sector. Only seven (23.3%) physicians provided cervical cancer screening, none of them primary care physicians. Physicians discussed the need for community-level, culturally-tailored education to improve health literacy and reduce stigma surrounding cancer and gynecologic health. They described limited organizational capacity in the public sector to provide cancer prevention services, and emphasized the need for further training before they could perform cervical cancer screening. Physicians recommend an integrated strategy for cervical cancer prevention at multiple levels of uptake and delivery with specific efforts focused on culturally-tailored stigma-reducing education, community-level approaches utilizing India's community health workers, and providing physician training and continuing education in cancer prevention.
• Burns, J., Rivers, P., LeClair, L. B., Jovel, K. S., Rai, R. P., Lowe, A. A., Edwards, L. J., Khan, S. M., Mathenge, C., Ferraris, M., Kuntz, J. L., Lamberte, J. M., Hegmann, K. T., Odean, M. J., McLeland-Wieser, H., Beitel, S., Odame-Bamfo, L., Schaefer Solle, N., Mak, J., , Phillips, A. L., et al. (2022). Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR research protocols, 11(7), e37929.
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  Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2.
• Coudray, M. S., Degarege, A., Khan, A., Ravi, K., Srinivas, V., Klausner, J. D., Madhivanan, P., & Placek, C. D. (2022). Partner age difference and sociodemographic correlates of herpes simplex virus type 2 seropositivity: A community-based study in South India. Indian journal of sexually transmitted diseases and AIDS, 41(2), 219-221.
• Fantry, L. E., Bedrick, E. J., Madhivanan, P., Fisher, J. M., Lim, J. R., Sadoway, D., Gupte, R., Nandamuri, P., Joseph, M., Loveland, M. G., & Guido, A. A. (2022). 2092. Update on PrEP Knowledge and Attitudes Among Adults Attending Public Health Clinics in Southern Arizona. Open Forum Infectious Diseases, 9(Supplement_2). doi:10.1093/ofid/ofac492.1714
• Fowlkes, A. L., Yoon, S. K., Lutrick, K., Gwynn, L., Burns, J., Grant, L., Phillips, A. L., Ellingson, K., Ferraris, M. V., LeClair, L. B., Mathenge, C., Yoo, Y. M., Thiese, M. S., Gerald, L. B., Solle, N. S., Jeddy, Z., Odame-Bamfo, L., Mak, J., Hegmann, K. T., , Gerald, J. K., et al. (2022). Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR. Morbidity and mortality weekly report, 71(11), 422-428.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine was recommended by CDC's Advisory Committee on Immunization Practices for persons aged 12-15 years (referred to as adolescents in this report) on May 12, 2021, and for children aged 5-11 years on November 2, 2021 (1-4). Real-world data on vaccine effectiveness (VE) in these age groups are needed, especially because when the B.1.1.529 (Omicron) variant became predominant in the United States in December 2021, early investigations of VE demonstrated a decline in protection against symptomatic infection for adolescents aged 12-15 years and adults* (5). The PROTECT prospective cohort of 1,364 children and adolescents aged 5-15 years was tested weekly for SARS-CoV-2, irrespective of symptoms, and upon COVID-19-associated illness during July 25, 2021-February 12, 2022. Among unvaccinated participants (i.e., those who had received no COVID-19 vaccine doses) with any laboratory-confirmed SARS-CoV-2 infection, those with B.1.617.2 (Delta) variant infections were more likely to report COVID-19 symptoms (66%) than were those with Omicron infections (49%). Among fully vaccinated children aged 5-11 years, VE against any symptomatic and asymptomatic Omicron infection 14-82 days (the longest interval after dose 2 in this age group) after receipt of dose 2 of the Pfizer-BioNTech vaccine was 31% (95% CI = 9%-48%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. Among adolescents aged 12-15 years, adjusted VE 14-149 days after dose 2 was 87% (95% CI = 49%-97%) against symptomatic and asymptomatic Delta infection and 59% (95% CI = 22%-79%) against Omicron infection. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
• Gonzalez, M., Boonya-Ananta, T., Madhivanan, P., & Ramella-Roman, J. C. (2022). Cervical Imaging in the Low Resource Setting: A Review. Biosensors, 12(10).
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  Cervical cancer is one of the most significant global health inequities of our time and is the fourth most common cancer in women worldwide, disproportionally affecting developing countries where the disease burden is 84%. Sometimes referred to as preventable cancer, it progresses slowly, providing a window of time for routine screening in which pre-cancerous lesions can be identified and treated. The high mortality rate can be attributed to many reasons, including the high cost of cytology-based screening, lack of human resources to conduct screening, and inadequate preventive medicine services and systems. Due to its slow progression, early intervention is feasible with appropriate screening. However, the standard screening procedures require access to lab-based tests and physician expertise. Several imaging devices have been introduced in the literature to aid cervical screening in low-resource settings. This review details the instrumentation and clinical testing of devices currently deployed in low-resource locations worldwide. The devices' imaging, portability, illumination, and power requirements (among other metrics) are documented with specifics of human pilot studies conducted with these tools.
• Hilton, C. B., Moser, C. J., Bertolo, M., Lee-Rubin, H., Amir, D., Bainbridge, C. M., Simson, J., Knox, D., Glowacki, L., Alemu, E., Galbarczyk, A., Jasienska, G., Ross, C. T., Neff, M. B., Martin, A., Cirelli, L. K., Trehub, S. E., Song, J., Kim, M., , Schachner, A., et al. (2022). Acoustic regularities in infant-directed speech and song across cultures. Nature human behaviour, 6(11), 1545-1556.
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  When interacting with infants, humans often alter their speech and song in ways thought to support communication. Theories of human child-rearing, informed by data on vocal signalling across species, predict that such alterations should appear globally. Here, we show acoustic differences between infant-directed and adult-directed vocalizations across cultures. We collected 1,615 recordings of infant- and adult-directed speech and song produced by 410 people in 21 urban, rural and small-scale societies. Infant-directedness was reliably classified from acoustic features only, with acoustic profiles of infant-directedness differing across language and music but in consistent fashions. We then studied listener sensitivity to these acoustic features. We played the recordings to 51,065 people from 187 countries, recruited via an English-language website, who guessed whether each vocalization was infant-directed. Their intuitions were more accurate than chance, predictable in part by common sets of acoustic features and robust to the effects of linguistic relatedness between vocalizer and listener. These findings inform hypotheses of the psychological functions and evolution of human communication.
• Kaleem Ullah, M., Malamardi, S., Siddaiah, J. B., A, T., Prashant, A., Vishwanath, P., Riley, L. W., Madhivanan, P., & Mahesh, P. A. (2022). Trends in the Bacterial Prevalence and Antibiotic Resistance Patterns in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Hospitalized Patients in South India. Antibiotics (Basel, Switzerland), 11(11).
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  Exacerbation due to antimicrobial-drug-resistant bacteria among chronic obstructive pulmonary disease (AECOPD) patients contributes to mortality and morbidity. We examined the prevalence of the bacterial organisms and trends in drug resistance in AECOPD. In this retrospective study, between January 2016 to December 2020, among 3027 AECOPD patients, 432 (14.3%) had bacteria isolated. The regression and generalized estimating equations (GEE) were used for trends in the resistance patterns over five years, adjusting for age, gender, and comorbidities. (32.4%), (17.8%), (14.4%), (10.4%), and (2.5%) were common. We observed high levels of drug resistance in AECOPD patients admitted to ICU (87.8%) and non-ICU (86.5%). A Cox proportional hazard analysis, observed infection with and female sex as independent predictors of mortality. had 2.64 (95% confidence interval (CI): 1.08-6.43) higher odds of death, compared to . Females had 2.89 (95% CI: 1.47-5.70) higher odds of death, compared to males. A high proportion of bacterial AECOPD was due to drug-resistant bacteria. An increasing trend in drug resistance was observed among females.
• Kiplagat, S., Khan, A., Sheehan, D. M., Jaykrishna, P., Ravi, K., Jo Trepka, M., Bursac, Z., Stephens, D., Krupp, K., & Madhivanan, P. (2022). Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 34, 100787.
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  The Indian government established the Accredited Social Health Activists (ASHA) program in 2006 to improve access and healthcare coverage in rural regions. The objective of this study was to examine the moderating role of ASHA home visits and ASHA-accompanied antenatal care visits (ANC) on the relationship between sociodemographic latent classes of pregnant women and preterm birth and low birth weight infants in rural Mysore District, India.
• Kiplagat, S., Ravi, K., Sheehan, D. M., Srinivas, V., Khan, A., Trepka, M. J., Bursac, Z., Stephens, D., Krupp, K., & Madhivanan, P. (2022). Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis. Journal of biosocial science, 1-15.
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  Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.
• Krupp, K., Galea, J., Madhivanan, P., & Gerald, L. (2022). Conversational artificial intelligence: A new approach for increasing influenza vaccination rates in children with asthma?. Vaccine, 40(23), 3087-3088.
• Krupp, K., Pope, B., Srinivas, A., Ravi, K., Khan, A., Srinivas, V., Madhivanan, P., & Bastida, E. (2022). Parity and later life risk for coronary heart disease among slum-dwelling women in Mysore, India. Indian heart journal, 73(5), 622-628.
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  To examine the role of parity in coronary heart disease (CHD) among middle-aged Indian women living in government-designated slums in Mysore, India.
• Lee, S., Madhivanan, P., Yeager, K. A., Sekar, S., Escoffery, C., Petagna, C., Agnone, C., Perez, S., Saber, L., Ryan, G., Dhir, M., Biddell, C. B., English, A. S., Savas, L., Daly, E., Vu, T., & Fernandez, M. E. (2022). A Systematic Review of Interventions to promote HPV Vaccination Globally. BMC Public Health. doi:10.21203/rs.3.rs-2094231/v1
• Madhivanan, P., Adsul, P., Myers, K. J., Kanda, D., Jaffe, T., Tawfik, B., Wu, E., McClain, M., Pankratz, S., Mishra, S. I., Nair, U., Stimatze, T., & Kano, M. A. (2022). Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors.. Journal of Clinical Oncology, 40(16_suppl), 5533-5533. doi:10.1200/jco.2022.40.16_suppl.5533
• Madhivanan, P., Helpingstine, C. E., Stephens, D. P., Jayakrishna, P., Pramathesh, R., & Ramarao, I. (2022). Anti-human Trafficking Service Professionals in India: Challenges and Barriers to Service Provision. Journal of Human Trafficking, 1-16. doi:10.1080/23322705.2022.2066874
• Mantina, N. M., Block Ngaybe, M., Johnson, K., Velickovic, S., Magrath, P., Gerald, L. B., Krupp, K., Krauss, B., Perez-Velez, C. M., & Madhivanan, P. (2022). Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona. Human vaccines & immunotherapeutics, 18(7), 2154506.
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  While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona's racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.
• Myers, K. J., Jaffe, T., Kanda, D. A., Pankratz, V. S., Tawfik, B., Wu, E., McClain, M. E., Mishra, S. I., Kano, M., Madhivanan, P., & Adsul, P. (2022). Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Frontiers in oncology, 12, 841951.
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  Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state.
• Placek, C. D., Jaykrishna, P., Srinivas, V., & Madhivanan, P. (2022). Pregnancy Fasting in Ramadan: Toward a Biocultural Framework. Ecology of food and nutrition, 60(6), 785-809.
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  Pregnancy fasting poses a paradox: why would a woman restrict her diet during a period of increased nutritional need? This qualitative, cross-sectional study applied biological and cultural evolutionary theories of pregnancy diet to emic models of fasting with the aim of establishing a testable biocultural framework of pregnancy fasting. The research took place with Muslim women residing in Mysore, India. In-depth interviews were conducted with pregnant women who have experience and knowledge of fasting during during the holy month of Ramadan. Our findings indicate that pregnancy fasting is socially acquired via multiple modes of transmission and that women do not fast according to mainstream evolutionary theories of pregnancy diet, but perhaps to gain moral capital.
• Weaver, L. J., Krupp, K., & Madhivanan, P. (2022). Conceptual and methodological challenges in idioms of distress research: Common questions and a step-by-step guide. Transcultural psychiatry, 13634615211042235.
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  Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts.
• Zahnd, W. E., Del Vecchio, N., Askelson, N., Eberth, J. M., Vanderpool, R. C., Overholser, L., Madhivanan, P., Hirschey, R., & Edward, J. (2022). Definition and categorization of "rural" and assessment of realized access to care. Health services research.
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  To examine how three measures of realized access to care vary by definitions and categorizations of "rural".
• Aceves, B., Denman, C. A., Ingram, M., Torres, J. F., Nuño, T., Garcia, D. O., Madhivanan, P., & Rosales, C. B. (2021). Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach. Frontiers in public health, 9, 617468.
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  Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups- (GAMs) located within health centers. From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process. All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding. Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico. www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&draw=2&rank=1, identifier: NCT02804698.
• Aceves, B., Ruiz, M., Ingram, M., Denman, C., Garcia, D. O., Madhivanan, P., & Rosales, C. (2021). Mental health and diabetes self-management: assessing stakeholder perspectives from health centers in Northern Mexico. BMC health services research, 21(1), 177.
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  People living with diabetes have an increased risk of developing mental health issues. Mexico has observed a high prevalence of people living with diabetes suffering from mental health issues, such as anxiety and depression. Self-management programs have demonstrated promise in helping participants address and prevent not only physiological health complications but mental health issues as well. This qualitative study aimed to understand the mental health benefits of a diabetes self-management intervention for health centers in Northern Mexico and opportunities for improvement through assessing stakeholder perspectives.
• Cyrus, E., Sanchez, J., Madhivanan, P., Lama, J. R., Bazo, A. C., Valencia, J., Leon, S. R., Villaran, M., Vagenas, P., Sciaudone, M., Vu, D., Coudray, M. S., & Atice, F. L. (2021). Prevalence of Intimate Partner Violence, Substance Use Disorders and Depression among Incarcerated Women in Lima, Perú. International journal of environmental research and public health, 18(21).
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  Globally, there is evidence supporting the co-occurrence of intimate partner violence (IPV), substance use disorders (SUD) and mental health disorders among women in prisons, however, there is limited research investigating these domains in the Andean region where rates of female incarceration have increased. The study objective was to explore the prevalence of IPV, SUD and depression among incarcerated women in a Peruvian prison and explore associations among these variables and related correlates.
• Grandner, M., Madhivanan, P., Isalva, L., Valencia, D., Ghani, S., Delgadillo, M., Bastien, C., Krupp, K., Ruiz, J., Killgore, W., & Wills, C. (2021). 199 COVID-19 Pandemic Sleep and Dreams at the US-Mexico Border. Sleep, 44(Supplement_2), A80-A80. doi:10.1093/sleep/zsab072.198
• Habila, M. A., Kimaru, L. J., Mantina, N., Valencia, D. Y., McClelland, D. J., Musa, J., Madhivanan, P., Sagay, A., & Jacobs, E. T. (2021). Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review. Frontiers in global women's health, 2, 697607.
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  Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality. Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control. We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed. Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15-65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities. The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.
• Jeffries, A., Beck-Sagué, C. M., Marroquin-Garcia, A. B., Dean, M., McCoy, V., Cordova-Toma, D. A., Fenkl, E., & Madhivanan, P. (2021). Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA. International journal of environmental research and public health, 18(23).
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  Single-visit "screen-and-treat" strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3-8 September 2017, trained nurses examined 222 women aged 23-58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 "…using HPV DNA detection as the primary screening test rather than VIA or cytology".
• Krupp, K., Adsul, P., Wilcox, M. L., Srinivas, V., Frank, E., Srinivas, A., & Madhivanan, P. (2021). Prevalence and correlates of metabolic syndrome among rural women in Mysore, India. Indian Heart Journal, 72(6), 582-588.
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  Metabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India.
• Krupp, K., Madhivanan, P., Killgore, W. D., Ruiz, J. M., Carvajal, S., Coull, B. M., & Grandner, M. A. (2021). Neurological Manifestations in COVID-19: An Unrecognized Crisis in Our Elderly?. Advances in geriatric medicine and research, 3(3).
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  As of December 2020, there were more than 900,000 COVID-19 hospitalizations in the US with about 414,000 among individuals aged 65 years and older. Recent evidence suggests a growing number of older patients continue to suffer serious neurological comorbidities including polyneuropathy, cerebrovascular disease, central nervous system infection, cognitive deficits, and fatigue following discharge. Studies suggest that complaints manifest late in disease and persist beyond resolution of acute COVID-19 symptoms. Recent research reports that neurocognitive symptoms are correlated with severe disease, older age, male gender, and comorbidities including hypertension, renal failure, and neoplastic disease. The underlying causes are unclear, but current hypotheses include hypoxic-ischemic brain injury, immunopathological mechanisms, and neurotropism of SARS-CoV-2 infection. There is a pressing need for more research into the underlying mechanisms of post-COVID-19 neurological sequela, particularly in the elderly, a population already burdened with neurocognitive disorders.
• Lott, B. E., Halkiyo, A., Kassa, D. W., Kebede, T., Dedefo, A., Ehiri, J., Madhivanan, P., Carvajal, S., & Soliman, A. (2021). Health workers' perspectives on barriers and facilitators to implementing a new national cervical cancer screening program in Ethiopia. BMC women's health, 21(1), 185.
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  Cervical cancer disproportionately affects women in sub-Saharan Africa, compared with other world regions. In Ethiopia, a National Cancer Control Plan published in 2015, outlines an ambitious strategy to reduce the incidence and mortality of cervical cancer. This strategy includes widespread screening using visual inspection with acetic acid (VIA). As the national screening program has rolled out, there has been limited inquiry of provider experiences. This study aims to describe cancer control experts' perspectives regarding the cancer control strategy and implementation of VIA.
• Lutrick, K., Rivers, P., Yoo, Y. M., Grant, L., Hollister, J., Jovel, K., Khan, S., Lowe, A., Baccam, Z., Hanson, H., Olsho, L. E., Fowlkes, A., Caban-Martinez, A. J., Porter, C., Yoon, S., Meece, J., Gaglani, M., Burns, J., Mayo Lamberte, J., , Nakayima Miiro, F., et al. (2021). Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12-17 Years - Arizona, July-December 2021. MMWR. Morbidity and mortality weekly report, 70(5152), 1761-1765.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed
• Madhivanan, P., Krupp, K., Coudray, M., Colbert, B., Ruiz-Perez, D., Cui, H., Bokulich, N., Narasimhan, G., Mathee, K., Cook, R. L., Schwebke, J., & Roe, D. (2021). Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities. Vaccine, 39(34), 4810-4816.
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  Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States.
• Madhivanan, P., Krupp, K., Waechter, R., & Shidhaye, R. (2021). Yoga for Healthy Aging: Science or Hype?. Advances in geriatric medicine and research, 3(3).
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  Yoga, one of the world's oldest health systems is receiving new attention for claims that it can contribute to healthy aging. Until recently, scientific evidence for its efficacy has relied heavily on small and poorly-designed research, but this is changing. Multiple, well-designed studies provide data showing that yoga practice has positive effects on cellular aging, mobility, balance, mental health, and prevention of cognitive decline-all areas of concern for older adults. Since the cost of implementing yoga-based community and home-based interventions is low-policymakers are also eyeing yoga practice as a cost-effective way to reduce medical costs and improve outcomes among a growing aging population. This commentary reviews the evidence for both physical and mental health benefits from yoga, as well as concerns about injuries that have been associated with certain types of yoga practice. It reveals a surprising range of yoga programs and difficulty levels that provide opportunities for almost anyone to participate and gain health benefits with practice.
• Madhivanan, P., Placek, C. D., Jaykrishna, P., & Srinivas, V. (2021). Pregnancy Fasting in Ramadan: Toward a Biocultural Framework. Ecology of Food and Nutrition, 60(6), 785-809. doi:10.1080/03670244.2021.1913584
• Mahesh, P. A., Madhivanan, P., Parthasarathi, A., Shankar, M., Lokesh, K. S., Undela, K., & Krishna, M. T. (2021). Determinants of Tobacco Use and Nicotine Dependence Among Healthcare Students and Their Undergraduate Peers. Current Respiratory Medicine Reviews, 17(3), 139-150. doi:10.2174/1573398x17666210713163954
• Mantina, N. M., & Madhivanan, P. (2021). Comment on: Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection. SN comprehensive clinical medicine, 1-2.
• Placek, C. D., Magnan, R. E., Srinivas, V., Jaykrishna, P., Ravi, K., Khan, A., Madhivanan, P., & Hagen, E. H. (2021). The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions. Evolutionary human sciences, 3.
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  Smokeless tobacco use among Indian women is increasing despite prevention efforts. Evolutionary theories suggest that reproductive-aged women should be more concerned about immediate threats to reproduction than threats to survival occurring late in life. This study therefore compared an anti-tobacco intervention that emphasized near-term reproductive harms to one involving general harms occurring later in life. Scheduled Tribal women ( = 92) from Karnataka, India participated in this study. At baseline, women reported tobacco use and knowledge of harms, provided a saliva sample to assess use, and randomly viewed either a general harms presentation (GHP) or reproductive harms presentation (RHP). At followup, women reported their use, knowledge of harms and intentions to quit, and provided another saliva sample. At baseline, participants were aware of general harms but not reproductive harms. Both interventions increased knowledge of harms. Women in the RHP condition did not list more harms than women in the GHP condition, however, and the RHP was not more effective in reducing tobacco use than the GHP. In the RHP condition fetal health was particularly salient. In the GHP condition, oral health was highly salient, aligning with the local disease ecology and research on tobacco use and attractiveness.
• Pope, B., Madhivanan, P., Nishimura, H., Ravi, K., Srinivas, V., Krupp, K., Jaykrishna, P., & Arun, A. (2021). Performance and Acceptability of Self- Versus Clinician-Collected Swabs for Testing of High-Risk HPV DNA among Women in Mysore, India: Diagnostic Study. Asian Pac J Cancer Prev.. doi:10.22541/au.159932495.53321090
• Ruiz-Perez, D., Coudray, M. S., Colbert, B., Krupp, K., Kumari, H., Stebliankin, V., Mathee, K., Cook, R. L., Schwebke, J., Narasimhan, G., & Madhivanan, P. (2021). Effect of metronidazole on vaginal microbiota associated with asymptomatic bacterial vaginosis. Access microbiology, 3(5), 000226.
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  Vaginal dysbiosis-induced by an overgrowth of anaerobic bacteria is referred to as bacterial vaginosis (BV). The dysbiosis is associated with an increased risk for acquisition of sexually transmitted infections. Women with symptomatic BV are treated with oral metronidazole (MET), but its effectiveness remains to be elucidated. This study used whole-genome sequencing (WGS) to determine the changes in the microbiota among women treated with MET. WGS was conducted on DNA obtained from 20 vaginal swabs collected at four time points over 12 months from five randomly selected African American (AA) women. The baseline visit included all women who were diagnosed with asymptomatic BV and were untreated. All subjects were tested subsequently once every 2 months and received a course of MET for each BV episode during the 12 months. The BV status was classified according to Nugent scores (NSs) of vaginal smears. The microbial and resistome profiles were analysed along with the sociodemographic metadata. Despite treatment, none of the five participants reverted to normal vaginal flora - two were consistently positive for BV, and the rest experienced episodic cases of BV. WGS analyses showed spp. as the most abundant organism. After treatment with MET, there was an observed decline of and species. One participant had a healthy vaginal microbiota based on NS at one follow-up time point. Resistance genes including and were detected. Though limited in subjects, this study shows specific microbiota changes with treatment, presence of many resistant genes in their microbiota, and recurrence and persistence of BV despite MET treatment. Thus, MET may not be an effective treatment option for asymptomatic BV, and whole metagenome sequence would better inform the choice of antibiotics.
• Shidhaye, R., Shukla, S., & Madhivanan, P. (2021). Practice and Acceptability of Yoga Among Pregnant Women in India: A Cross-Sectional Survey. International journal of yoga therapy, 31(1).
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  The practice of yoga is beneficial during pregnancy, but we do not know what proportion of pregnant women in India practice yoga. To address this research gap, we conducted a study to address following research questions: (1) What proportion of pregnant women in rural Maharashtra practice yoga? (2) Which sociodemographic factors are associated with the practice of yoga among these women? and (3) What is the perceived acceptability of integrating yoga-based intervention into routine antenatal care? A consecutive sample of pregnant women attending the antenatal clinic of a tertiary care hospital, who could fluently communicate in Marathi and who did not have any serious physical illness or cognitive impairment, were included in this cross-sectional survey. A total of 228 subjects were included in our study. Yoga was practiced by 38 of them (16.7%, 95% confidence interval 12.1-22.1) during the current pregnancy. Older age, higher education, and being a professional (teacher, healthcare provider, or bank official) were associated with practice of yoga. More than half of the participants (53.9%) thought that yoga should be included as part of their antenatal care; this perceived acceptability of yoga was not associated with any of the sociodemographic factors except for the participants' occupation. This study provides information about the prevalence and sociodemographic factors associated with the practice of yoga among pregnant women in a rural setting in India. It also explores the perceived acceptability of yoga-based interventions among this group. Findings from this study can inform design of future studies to evaluate the effect of yoga-based interventions during pregnancy.
• Srinivas, V., Herbst De Cortina, S., Nishimura, H., Krupp, K., Jayakrishna, P., Ravi, K., Khan, A., Madhunapantula, S. V., & Madhivanan, P. (2021). Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation. Asian Pacific journal of cancer prevention : APJCP, 22(5), 1393-1400.
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  The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India.
• Srinivas, V., Nishimura, H. M., Jayakrishna, P., Krupp, K., Madhivanan, P., & Madhunapantula, S. V. (2021). Evaluating the feasibility of utilizing Gynocular-triage-to-diagnose application with VIA (Visual inspection with Acetic acid) in community cervical cancer screening programs in rural Mysore, India. Indian journal of cancer.
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  Cervical cancer is the third most common cancer among women in India. The aim of the study is to determine the feasibility of using the Gynocular-triage-to-diagnose (Gynocular T2D/GT2D) in conjunction with visual inspection with acetic acid (VIA) in community-based cervical cancer screening programs in rural Mysore, India.
• Valencia, D. Y., Habila, M., McClelland, D. J., Degarege, A., Madhivanan, P., & Krupp, K. (2021). Infection-associated biofilms and statins: protocol for systematic review. BMJ open, 11(5), e046290.
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  Owing to their propensity for being associated with infections, biofilms have become a focus in infectious disease research. There is evidence suggesting that statins, which are commonly used for prevention of cardiovascular disease, may prevent biofilm-associated infections, but this association has not been well-understood.
• Weaver, L. J., Krupp, K., & Madhivanan, P. (2021). The Hair in the Garland: Hair Loss and Social Stress Among Women in South India. Culture, medicine and psychiatry.
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  Generations of scholars have debated hair's significance as a symbol of womanhood, fertility, and spiritual morality in South India. For contemporary Indian women, hair is a site of concern, often expressed as an everyday preoccupation with hair loss or "hair fall," as it is known in the subcontinent. This exploratory study investigated hair fall among Kannada-speaking Hindu women in the South Indian city of Mysuru, Karnataka. It used a series of focus group discussions to explore how women talk about the causes and consequences of hair fall, and how women cope with hair-related distress. Participants articulated clear, shared ideas about why hair falls and how it can be managed. They connected hair fall to broader stressors in their lives both directly and symbolically. Hair fall, therefore, appears to function idiomatically in this context, both as an idiom of distress in its own right, and as a symptom of other idioms and forms of distress. Additional research is needed to establish the importance of hair fall relative to other distress constructs, and to more directly assess its potential value in research and intervention.
• Adsul, P., Nayaka, S., Pramathesh, R., Gowda, S., Jaykrishna, P., Srinivas, V., & Madhivanan, P. (2020). Using photovoice to understand the context of cervical cancer screening for underserved communities in rural India. Global health promotion, 1757975920915677.
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  Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30-51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women's health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.
• Bhushan, N. L., Krupp, K., Jaykrishna, P., Ravi, K., Khan, A., Shidhaye, R., Kiplagat, S., Srinivas, V., & Madhivanan, P. (2020). The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study. Social psychiatry and psychiatric epidemiology, 55(10), 1323-1333.
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  In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety.
• Chandrashekarappa, S. M., Krishna, M., Krupp, K., Jaykrishna, P., Urs, C. V., Goswami, S. P., Ravi, K., Khan, A., Arun, A., Dawes, P., Newall, J., & Madhivanan, P. (2020). Size at birth and cognitive function among rural adolescents: a life course epidemiology study protocol of the Kisalaya cohort in Mysuru, South India. BMJ paediatrics open, 4(1), e000789.
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  It is proven that adverse intrauterine environment results in 'early life programming,' alterations in metabolism and physiological development of the fetus, often termed as 'Developmental Origins of Health and Disease' (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.
• Chandrashekarappa, S., Modi, K., Krupp, K., Ravi, K., Khan, A., Srinivas, V., Jaykrishna, P., Arun, A., Krishna, M., & Madhivanan, P. (2020). Cohort profile: the Kisalaya cohort of mother-infant dyads in rural south India (2008-2012). Epidemiology and health, 42, e2020010.
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  The Kisalaya cohort was established in 2008, providing integrated antenatal care (ANC) and human immunodeficiency virus (HIV) testing in order to reduce adverse birth outcomes and pediatric HIV infections. The program used a mobile clinic model to deliver health education, ANC, and HIV/sexually transmitted infection testing and management to pregnant women in rural communities in southern India. This cohort includes pregnant women residing in 144 villages of the Mysuru taluk (a rural region) who received ANC through the mobile clinic and delivered their infants between 2008 and 2011. Of the 1,940 women registered for ANC at primary healthcare centers during this time period, 1,675 (75.6%) were enrolled in the Kisalaya cohort. Once women enrolled in the Kisalaya cohort gave birth, the cohort expanded to include the mother-infant dyads with a retention rate of 100% at follow-up visits at 15 days and at 6 months post-delivery. The baseline data collected during the Kisalaya study included both questionnaire-based data and laboratory-based investigations. Presently, a study entitled "Early life influences on adolescent mental health: a life course study of the Kisalaya birth cohort in south India" is in the process of data collection (2019-2020).
• Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis-A brief synopsis of the literature. European journal of obstetrics, gynecology, and reproductive biology, 245, 143-148.
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  Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Approximately 50 % of women are symptomatic and experience vaginal malodor, discharge, itching and increased vaginal pH. BV can increase the risk of contracting many sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and herpes simplex virus-2 (HSV-2). Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term. The purpose of this review is to summarize current literature on the epidemiology of BV and highlight areas of deficiency in current clinical practice with respect to BV. BV recurrence rates are high, approximately 80 % three months after effective treatment. Furthermore, in some instances treatment is ineffective and BV persists. Literature also documents the relationship between BV and human papillomavirus (HPV). HPV is the most common sexually transmitted infection among young adult women while BV is the most common cause of vaginal symptoms among women of reproductive age. BV is associated with high levels of anaerobic organisms which can damage the vaginal epithelium and increase the risk of HPV infection. Recent research also highlights the role of the vaginal microbiome in BV. The results of this review warrant further exploration into the etiology of BV as well as exploration of more long-term effective treatment and the investigation of prognostic indicators. Additionally, the need for a standard definition of recurrent and persistent BV is recognized.
• Coudray, M. S., Sheehan, D. M., Li, T., Cook, R. L., Schwebke, J., & Madhivanan, P. (2020). Factors Associated With the Recurrence, Persistence, and Clearance of Asymptomatic Bacterial Vaginosis Among Young African American Women: A Repeated-Measures Latent Class Analysis. Sexually transmitted diseases, 47(12), 832-839.
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  Although risk factors of recurrent and persistent bacterial vaginosis (BV) have been explored in the literature, the longitudinal incidence patterns of BV remain elusive.
• Degarege, A., Krupp, K., Srinivas, V., Ibrahimou, B., & Madhivanan, P. (2020). Structural equation modeling to detect correlates of childhood vaccination: A moderated mediation analysis. PloS one, 15(10), e0240749.
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  This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination.
• Gonzalez, M., Montejo, K. A., Krupp, K., Srinivas, V., DeHoog, E., Madhivanan, P., & Ramella-Roman, J. C. (2020). Design and implementation of a portable colposcope Mueller matrix polarimeter. Journal of biomedical optics, 25(11).
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  Mueller matrix polarimetry can provide useful information about the function and structure of the extracellular matrix. A portable and low-cost system could facilitate the clinical assessment of cervical anomalies in low-resource settings.
• Kiplagat, S., Coudray, M. S., Ravi, K., Jayakrishna, P., Krupp, K., Arun, A., & Madhivanan, P. (2020). Evaluating a Conditional Cash Transfer Scheme in a Maternal Health Care Utilization Program Among Rural Pregnant Women in Mysore District, India. Women's health reports (New Rochelle, N.Y.), 1(1), 159-166.
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  According to the World Bank report in 2015, the maternal death rate in India was 174 per 100,000, which is among the highest in the world. The Indian Government launched the (JSY) conditional cash transfer program in 2005 to curb the adverse birth outcomes by promoting institutional delivery and providing antenatal care (ANC) services for pregnant women. This study evaluates the factors associated with JSY conditional cash transfer program in rural Mysore, India. Between 2011 and 2014, a prospective cohort study was conducted to examine the feasibility and acceptability of integrated ANC and HIV testing using mobile clinics in rural Mysore. Pregnant women in the provided an informed consent and answered an interviewer-administered questionnaire in local language, . All women underwent routine ANC services and were followed-up immediately after delivery, and 6 months and 12 months after delivery. Binary logistic regression was performed to identify factors associated with JSY benefits. The mean age of the 1,806 mothers was 21.2 ± 2.2 years and 58.9% of the mothers had primary education. Nearly half (51.6%) of the women reported having received JSY benefits. Factors associated with receiving JSY benefits included pregnant woman's partner not having any formal education (adjusted odds ratio [AOR]: 1.35; 95% confidence interval [CI]: 1.01-1.80), having income ≤4,000 Indian Rupees (AOR: 1.47; 95% CI: 1.04-2.09), rare visits (once in 3 months visit) with Accredited Social Health Activists (AOR: 3.55; 95% CI: 1.55-8.51), and delivery in a public institution (AOR: 1.23; 95% CI: 1.01-1.51). While JSY has been operational in India since 2005, there continue to remain major gaps in the receipt of JSY services in rural India. Future interventions should include targeted services and expansion of JSY scheme, specifically among rural pregnant women, who are most at need of these services.
• Kiplagat, S., Coudray, M. S., Taskin, T., Dawit, R., Gbadamosi, S., & Madhivanan, P. (2020). Methodological Evaluation of Antipsychotic Use During Pregnancy and Gestational Diabetes Mellitus. Journal of clinical psychopharmacology, 40(3), 319-320.
• Krupp, K., Madhivanan, P., & Perez-Velez, C. M. (2020). Should qualitative RT-PCR be used to determine release from isolation of COVID-19 patients?. The Journal of infection, 81(3), 452-482.
• Krupp, K., Wilcox, M. L., Srinivas, A., Srinivas, V., Madhivanan, P., & Bastida, E. (2020). Cardiovascular Risk Factor Knowledge and Behaviors Among Low-Income Urban Women in Mysore, India. The Journal of cardiovascular nursing, 35(6), 588-598.
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  Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease-related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries.
• Krupp, K., Wilcox, M., Srinivas, A., Srinivas, V., Madhivanan, P., & Bastida, E. (2020). Snoring is associated with obesity among middle aged Slum-dwelling women in Mysore, India. Lung India : official organ of Indian Chest Society, 37(3), 210-219.
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  Globally, rates of obesity have trebled in the past four decades. India has more than 9.8 million men and 20 million women classified as obese. While poor diet and sedentary lifestyles are major causes, growing evidence suggests other factors like sleep-disordered-breathing may also be contributors.
• Lokesh, K. S., Chaya, S. K., Jayaraj, B. S., Attahalli Shivanarayanprasad, P., Krishna, M., Madhivanan, P., & Padukudru, M. A. (2020). Vitamin D deficiency is associated with chronic obstructive pulmonary disease and exacerbation of COPD. The clinical respiratory journal.
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  Low Vitamin D levels have been associated with Chronic Obstructive Pulmonary Disease (COPD) and acute exacerbations.
• Lott, B. E., Trejo, M. J., Baum, C., McClelland, D. J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC public health, 20(1), 654.
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  Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work.
• Morris, S. R., Bristow, C. C., Wierzbicki, M. R., Sarno, M., Asbel, L., French, A., Gaydos, C. A., Hazan, L., Mena, L., Madhivanan, P., Philip, S., Schwartz, S., Brown, C., Styers, D., Waymer, T., & Klausner, J. D. (2020). Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study. The Lancet. Infectious diseases.
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  Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device.
• Ruiz-Perez, D., Guan, H., Madhivanan, P., Mathee, K., & Narasimhan, G. (2020). So you think you can PLS-DA?. BMC bioinformatics, 21(Suppl 1), 2.
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  Partial Least-Squares Discriminant Analysis (PLS-DA) is a popular machine learning tool that is gaining increasing attention as a useful feature selector and classifier. In an effort to understand its strengths and weaknesses, we performed a series of experiments with synthetic data and compared its performance to its close relative from which it was initially invented, namely Principal Component Analysis (PCA).
• Shidhaye, R., Madhivanan, P., Shidhaye, P., & Krupp, K. (2020). An Integrated Approach to Improve Maternal Mental Health and Well-Being During the COVID-19 Crisis. Frontiers in psychiatry, 11, 598746.
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  The ongoing COVID-19 pandemic has led to disruption of normal life across the globe, severely affecting the already vulnerable populations such as the pregnant women. Maternal mental health and well-being is a public health priority and the evidence about the impact of COVID-19 on mental health status of pregnant women is gradually emerging. The findings of the recently published studies suggest that increased risk perception about contracting COVID-19, reduced social support, increase in domestic violence, disruption of antenatal care, and economic consequences of COVID-19 mitigation strategies can lead to adverse mental health outcomes in antenatal period. There is a significant increase in antenatal depression and anxiety since the onset of COVID-19 and social determinants of health (e.g., younger age, lower education, lower income) are associated with these poor outcomes. In this paper, we propose an integrated approach to improve the mental health and well-being of pregnant women. Physical activity and/or mind-body interventions like yoga can be practiced as self-care interventions by pregnant women. Despite social distancing being the current norm, efforts should be made to strengthen social support. Evidence-based interventions for perinatal depression should be integrated within the health system and stepped, collaborative care using non-specialist health workers as key human resource be utilized to improve access to mental health services. Use of digital platforms and smartphone enabled delivery of services has huge potential to further improve the access to care. Most importantly, the COVID-19 related policy guidelines should categorically include maternal mental health and well-being as a priority area.
• Ward-Peterson, M., Fennie, K., Baird, S., Coxe, S., Trepka, M. J., & Madhivanan, P. (2020). Multilevel influences of women's empowerment and economic resources on risky sexual behaviour among young women in Zomba district, Malawi. Journal of biosocial science, 1-21.
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  Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15-49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study's objective was to explore associations between multilevel measures of economic resources and women's empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl's level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels.
• Zohourian, T., Hakim, N., Dorcius, P. M., Shaheen, R., Rao, I. R., Carter, R., Krupp, K., & Madhivanan, P. (2020). Attitudes, beliefs, and norms about sex and sexuality among young Indian male adults: A qualitative study. Indian journal of sexually transmitted diseases and AIDS, 41(1), 35-38.
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  Little is known about the risky sexual behaviors, attitudes, beliefs, and sources of information regarding sexual health among young adult Indian males. Currently, students in Indian secondary schools do not receive a structured comprehensive sexual health education. This qualitative study explored the sources of information, knowledge, and attitudes around sexual behaviors among young men in Mysore, India.
• Adsul, P., Srinivas, V., Gowda, S., Nayaka, S., Pramathesh, R., Chandrappa, K., Khan, A., Jayakrishna, P., & Madhivanan, P. (2019). A community-based, cross-sectional study of hrHPV DNA self-sampling-based cervical cancer screening in rural Karnataka, India. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.
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  To examine the feasibility of implementing a high-risk HPV (hrHPV) DNA-based screening program for cervical cancer and the prevalence of hrHPV DNA-positive women in a community setting in rural India.
• Agarwal, R., Bravo, E. I., Madhivanan, P., & Taylor-Amador, S. (2019). A response to the recent well-being systematic review. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 32(5), 353.
• Coudray, M., Kiplagat, S., & Madhivanan, P. (2019). Does Zika Virus lead to Microcephaly in Organoids?. The Journal of infectious diseases.
• Coudray, M., Kiplagat, S., Saumell, F., & Madhivanan, P. (2019). Sexually transmitted infections among high-risk populations that use treatment as prevention or pre-exposure prophylaxis: a protocol for a systematic review. BMJ open, 9(12), e032054.
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  Among men who have sex with men, pre-exposure prophylaxis (PrEP) reduces the risk of HIV by 95%. Based on the documented benefits, the Centre for Disease Control and Prevention has recommended PrEP as a prevention method for high-risk groups. Moreover, for those HIV-infected individuals, antiretroviral therapy has been shown to serve as both as a treatment and prevention method for HIV.
• Degarege, A., Fennie, K., Degarege, D., Chennupati, S., & Madhivanan, P. (2019). Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis. PloS one, 14(1), e0211205.
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  A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA).
• Degarege, A., Gebrezgi, M. T., Beck-Sague, C. M., Wahlgren, M., de Mattos, L. C., & Madhivanan, P. (2019). Effect of ABO blood group on asymptomatic, uncomplicated and placental Plasmodium falciparum infection: systematic review and meta-analysis. BMC infectious diseases, 19(1), 86.
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  Malaria clinical outcomes vary by erythrocyte characteristics, including ABO blood group, but the effect of ABO blood group on asymptomatic, uncomplicated and placental Plasmodium falciparum (P. falciparum) infection remains unclear. We explored effects of ABO blood group on asymptomatic, uncomplicated and placental falciparum infection in the published literature.
• Degarege, A., Gebrezgi, M. T., Ibanez, G., Wahlgren, M., & Madhivanan, P. (2019). Effect of the ABO blood group on susceptibility to severe malaria: A systematic review and meta-analysis. Blood reviews, 33, 53-62.
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  Understanding how ABO blood group interacts with Plasmodium falciparum (P. falciparum) infection may facilitate development of antimalarial treatments and vaccines. This study systematically summarizes information on the relationship of ABO blood group with severe P. falciparum infection, level of parasitemia and haemoglobin. A total of 1923 articles were retrieved from five databases. After removal of duplicates, and two levels of screening, 21 articles were selected for inclusion in the meta-analysis. A meta-analysis of the studies showed an increased odds of severe P. falciparum infection among individuals with blood group A, B, AB or non-O compared with blood group O. However, the difference in the level of P. falciparum parasitemia was not significant among individuals with blood group A or non-O compared with blood group O. The difference in haemoglobin level among P. falciparum infected individuals was also not significant between those with blood group A, B or AB versus those with blood group O.
• Degarege, A., Krupp, K., Fennie, K., Srinivas, V., Li, T., Stephens, D. P., & Madhivanan, P. (2019). An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling. Vaccine, 37(7), 945-955.
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  The study examined factors that affect parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1609 parents of adolescent girls attending schools in Mysore District between February 2010 and October 2011. A validated questionnaire was used to assess parental attitudes, beliefs related with HPV infection, cervical cancer, HPV vaccine and vaccination in general. Structural equation modeling was used to estimate parameters and assess whether a model based on the integrative behavior theory would fit the current data. More than two-thirds (78.0%) of parents would accept vaccinating their daughters with HPV vaccine. Intention to HPV vaccination significantly increased with increase in the perception of parents about the benefits (standardized regression coefficient (β) = 0.39) or sources of information about HPV vaccine (β = 0.24), but intention decreased significantly with an increase in the perception about barriers to HPV vaccination β = -0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β = 0.20), and beliefs about benefits (β = 0.20) or barriers (β = -0.25) to vaccination in general on intention to HPV vaccination were significantly mediated by parental attitudes and source of information about the vaccine. Geographical location significantly moderated the awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β = 0.33), and the effect of religion on norms related to HPV vaccination (β = 0.19). Fit of the model to the data was acceptable. This study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their daughters with HPV vaccine in India. Health education interventions tailored to counter parental negative attitudes and beliefs about HPV vaccine and vaccination in general would be important for the community to promote HPV vaccination.
• Garmendia, C. A., & Madhivanan, P. (2019). Correcting Meta-analyses and Reviews Affected by Retracted Research-Reply. JAMA internal medicine, 179(7), 1006.
• Garmendia, C. A., Nassar Gorra, L., Rodriguez, A. L., Trepka, M. J., Veledar, E., & Madhivanan, P. (2019). Evaluation of the Inclusion of Studies Identified by the FDA as Having Falsified Data in the Results of Meta-analyses: The Example of the Apixaban Trials. JAMA internal medicine.
• Gbadamosi, S. O., Dawit, R., Jebai, R., Kiplagat, S., Taskin, T., & Madhivanan, P. (2019). Review on knee and hip arthroplasty outcomes in sub-Saharan Africa. Tropical doctor, 49475519875366.
• Jebai, R., Gbadamosi, S. O., Nassar Gorra, L., & Madhivanan, P. (2019). Comment on: Non-Cholesterol Sterol Concentrations as Biomarkers for Cholesterol Absorption and Synthesis in Different Metabolic Disorders: A Systematic Review. Nutrients, 11(4).
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  The use of non-cholesterol sterols as biomarkers for cholesterol metabolism is well established in health-related topics [...].
• Jebai, R., Gbadamosi, S. O., Nassar Gorra, L., & Madhivanan, P. (2019). Letter to the editor: Weight-loss interventions in older persons. Obesity reviews : an official journal of the International Association for the Study of Obesity.
• Krupp, K., & Madhivanan, P. (2015). Antibiotic resistance in prevalent bacterial and protozoan sexually transmitted infections. Indian Journal of Sexually Transmitted Diseases and AIDS, 36(1), 3-8.
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  The emergence of multi-drug resistant sexually transmitted infections (STIs) is causing a treatment crisis across the globe. While cephalosporin-resistant gonorrhea is one of the most pressing issues, extensively antibiotic resistant Chlamydia trachomatis and Mycoplasma hominis are also becoming commonplace. Experts have suggested that the failure of current treatment regimens are "largely inevitable" and have called for entirely new classes of antimicrobial agents. With the exception of several new classes of drugs primarily targeting nosocomial infections, progress has been slow. While pharmaceutical companies continue to introduce new drugs, they are based on decade-old discoveries. While there is disagreement about what constitutes new classes of antibiotics, many experts suggest that the last truly new family of antimicrobials was discovered in 1987. This review summarizes the existing literature on antibiotic resistance in common bacterial and protozoal STIs. It also briefly discusses several of the most promising alternatives to current therapies, and further examines how advances in drug delivery, formulation, concentration, and timing are improving the efficacy of existing treatments. Finally, the paper discusses the current state of pharmaceutical development for multidrug-resistant STI.
• Madhivanan, P., & Krupp, K. (2009). Doesn't the public have the right to know that male circumcision protects against HIV?. Indian journal of Medical Ethics, 6(1), 5-6.
• Madhivanan, P., Chen, Y. H., Krupp, K., Arun, A., Klausner, J. D., & Reingold, A. L. (2011). Incidence of herpes simplex virus type 2 in young reproductive age women in Mysore, India. Indian Journal of Pathology & Microbiology, 54(1), 96-9.
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  There are sparse data on herpes simplex virus type 2 (HSV-2) infection in India. HSV-2 is one of the most common sexually transmitted infections and the primary cause of genital ulcer disease worldwide.
• Madhivanan, P., Krupp, K., Chandrasekaran, V., Karat, C., Arun, A., Cohen, C. R., Reingold, A. L., & Klausner, J. D. (2008). Prevalence and correlates of bacterial vaginosis among young women of reproductive age in Mysore, India. Indian journal of medical microbiology, 26(2), 132-7.
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  Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age and is associated with STI/HIV and adverse birth outcomes. The objective of this study was to determine the prevalence and correlates of BV among young women of reproductive age in Mysore, India.
• Magariño, L. S., & Madhivanan, P. (2019). Cognitive fatigue effects on physical performance: A systematic review and meta-analysis - Correspondence. Physiology & behavior, 198, 159-160.
• Mindthoff, A., Stephens, D. P., & Madhivanan, P. (2018). Using bystander programs to tackle college sexual violence: A critical evaluation of a meta-analysis. Journal of American college health : J of ACH, 67(2), 85-87.
• Mukherjee, S., Coxe, S., Fennie, K., Madhivanan, P., & Trepka, M. J. (2017). Stressful Life Event Experiences of Pregnant Women in the United States: A Latent Class Analysis. Women's Health Issues : official publication of the Jacobs Institute of Women's Health, 27(1), 83-92.
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  Nearly 65% to 70% of pregnant women in the United States experience one or more stressful life events (SLEs), which can lead to adverse maternal and/or fetal outcomes. This study aimed to identify groups of women with similar patterns of antenatal SLE experiences, and to examine their sociodemographic correlates.
• Mukherjee, S., Madhivanan, P., Li, T., Albatineh, A., Srinivas, V., Jaykrishna, P., Arun, A., & Krupp, K. (2014). Correlates of completing routine vaccination among children in Mysore, India. Journal of Infection and Public Health, 8(1), 62-71.
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  More than half of the over 18 million incompletely vaccinated children worldwide in 2011 lived in India (32%), Nigeria (14%) and Indonesia (7%). Overall immunization coverage in India was 61% in 2009. Few studies have explored the role of parental attitudes in children's vaccination.
• Placek, C. D., Nishimura, H., Hudanick, N., Stephens, D., & Madhivanan, P. (2019). Reframing HIV Stigma and Fear : Considerations from Social-ecological and Evolutionary Theories of Reproduction. Human nature (Hawthorne, N.Y.), 30(1), 1-22.
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  HIV stigma and fears surrounding the disease pose a challenge for public health interventions, particularly those that target pregnant women. In order to reduce stigma and improve the lives of vulnerable populations, researchers have recognized a need to integrate different types of support at various levels. To better inform HIV interventions, the current study draws on social-ecological and evolutionary theories of reproduction to predict stigma and fear of contracting HIV among pregnant women in South India. The aims of this study were twofold: compare the social-ecological model to a modified maternal-fetal protection model and test a combined model that included strong predictors from each model. The study took place in 2008-2011 in Mysore District, Karnataka, India. Using data from a cross-sectional survey and biological indicators of health, we statistically modeled social-ecological variables representing individual, interpersonal, and community/institutional levels. Participants were 645 pregnant women. The social-ecological and combined models were the best-fitting models for HIV-related stigma, and the combined model was the best fit for HIV-related fear. Our findings suggest that combining reproductive life history factors along with individual, interpersonal, and community/institutional factors are significant indicators of HIV-related stigma and fear. Results of this study support a multifaceted approach to intervention development for HIV-related stigma and fear. The combined model in this study can be used as a predictive model for future research focused on HIV stigma and fear, with the intent that dual consideration of social-ecological and evolutionary theories will improve public health communication efforts.
• Placek, C., Roulette, C., Hudanick, N., Khan, A., Ravi, K., Jayakrishna, P., Srinivas, V., & Madhivanan, P. (2019). Exploring biocultural models of chewing tobacco and paan among reproductive-aged women: Self-medication, protection, or gender inequality?. American journal of human biology : the official journal of the Human Biology Council, 31(5), e23281.
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  Tobacco and areca nut are two of the most widely used psychoactive plant substances worldwide, yet the biocultural factors that account for variation in use patterns are not well understood. Here we attempt to understand the high prevalence of, and variation in, tobacco and areca nut use among reproductive-aged women.
• Rodriguez, A. L., Stephens, D. P., Brewe, E., Ramarao, I., & Madhivanan, P. (2019). A Network Analysis of Domestic Violence Beliefs Among Young Adults in India. Journal of interpersonal violence, 886260519889923.
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  This study sought to describe the system of beliefs on gender, attitudes toward women, and wife beating, in young adults who live in Mysore, India. Furthermore, it identified structural sex differences in the interplay of values among these matters that can affect individual and community views toward domestic violence. Drawing from survey data gathered from 265 young adult Indian men and women, this study used network analysis to graph a correlation network of beliefs and attitudes toward domestic violence. Node, scale, and network structure descriptions allowed for comparisons among male and female participant responses. The findings support the assertion that there are sex differences among the system of beliefs toward wife beating among Indian young adults. Gender ideology, masculine role in relationships, and legal and social consequences of wife beating emerged as the most important values to focus on when addressing young men's beliefs of domestic violence and attitudes toward women. In contrast, values influencing women's perceptions of domestic violence are more complex and related to multiple beliefs about women's power, family structure, and social and legal implications of domestic violence. The results highlight the importance of recognizing gender differences in the connectivity between gender and wife beating beliefs when designing interventions. There is a need for efforts to accurately target these values and attitudes to more effectively address gendered attitudes and beliefs about domestic violence in this population.
• Tamir, H., Krupp, K., Stephens, D. P., Zohourian, T., Dorcius, P. M., Arun, A., Fisher, C. B., & Madhivanan, P. (2018). Addressing Prevention Among HIV-Uninfected Women in PMTCT Programs in South India. The Journal of the Association of Nurses in AIDS Care : JANAC, 29(1), 45-52.
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  With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (PMTCT) programs serve an important role. While PMTCT programs focus on mothers living with HIV infection, offering them to uninfected pregnant women may prevent maternal HIV infections. To inform future efforts to offer PMTCT programs to uninfected women, we conducted focus groups with 24 uninfected women in the South Indian state of Karnataka who had given birth within the previous 2 years to explore their perceptions and experiences about HIV education and screening during pregnancy. Although all the participants had undergone HIV testing at a public health facility during pregnancy, they reported little knowledge about HIV transmission or prevention. Revisions are needed in existing PMTCT program curricula and instruction methods before they can be offered to uninfected women as an HIV prevention strategy.
• Taskin, T., Gbadamosi, S. O., Kiplagat, S., Dawit, R., & Madhivanan, P. (2019). Methodological Assessment in a Systematic Review for Anal Human Papillomavirus among Men. The Journal of infectious diseases.
• Taskin, T., Ibañez, G., & Madhivanan, P. (2019). Quality Assessment of a Systematic Review for HIV Infection and Advanced-Stage Cancer. JAMA oncology.
• Taveras, J., Trepka, M. J., Madhivanan, P., Gollub, E. L., Dévieux, J. G., & Ibrahimou, B. (2019). HIV risk and testing behaviors among pregnant women tested for HIV in Florida by site type, 2012. Women & health, 1-13.
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  The numbers of perinatal human immunodeficiency virus (HIV) infections in the United States have continued to decline, but the prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Opportunities still exist to prevent mother-to child HIV transmission. The objective of this study was to identify demographics, HIV risk, and testing behaviors among pregnant women and to compare these characteristics by HIV testing site type. Multivariable analyses were conducted to examine demographics, HIV risk, and testing behaviors among 24,836 records of pregnant women publicly tested for HIV in the state of Florida in 2012. The testing records indicated that Latina and non-Hispanic black (NHB) women had decreased odds of reporting partner risk compared to those from non-Hispanic white women (Latina: adjusted odds ratio [AOR] 0.20, 95 percent confidence interval [CI]: 0.14-0.28; and NHB AOR 0.14, 95 percent CI: 0.10-0.21), and women tested in prisons/jails had higher odds of reporting previous HIV testing compared to those tested in prenatal care sites (AOR 1.86, 95 percent CI: 1.03-3.39). An understanding of HIV risk and testing behaviors among pregnant women by site type may enhance current targeted testing and prevention strategies for pregnant women and facilitate timely linkage to care.
• Veeranki, S. P., Nishimura, H., Krupp, K., Gowda, S., Arun, A., & Madhivanan, P. (2017). Suboptimal Breastfeeding Practices among Women in Rural and Low-Resource Settings: a Study of Women in Rural Mysore, India. Annals of global health, 83(3-4), 577-583.
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  Breastfeeding rates are progressively increasing worldwide while optimal breastfeeding practices are lagging behind, especially in rural and low resource settings like India.
• Degarege, A., Krupp, K., Fennie, K., Li, T., Stephens, D. P., Marlow, L. A., Srinivas, V., Arun, A., & Madhivanan, P. (2018). Urban-Rural Inequities in the Parental Attitudes and Beliefs Towards Human Papillomavirus Infection, Cervical Cancer, and Human Papillomavirus Vaccine in Mysore, India. Journal of pediatric and adolescent gynecology, 31(5), 494-502.
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  The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India.
• Degarege, A., Krupp, K., Fennie, K., Srinivas, V., Li, T., Stephens, D. P., Marlow, L. A., Arun, A., & Madhivanan, P. (2018). Human Papillomavirus Vaccine Acceptability among Parents of Adolescent Girls in a Rural Area, Mysore, India. Journal of pediatric and adolescent gynecology, 31(6), 583-591.
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  The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India.
• Degarege, A., Krupp, K., Srinivas, V., Ibrahimou, B., Marlow, L. A., Arun, A., & Madhivanan, P. (2018). Determinants of attitudes and beliefs toward human papillomavirus infection, cervical cancer and human papillomavirus vaccine among parents of adolescent girls in Mysore, India. The journal of obstetrics and gynaecology research, 44(11), 2091-2100.
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  This study examined the determinants of attitudes and beliefs about human papillomavirus (HPV) infection, cervical cancer and HPV vaccine among parents of adolescent girls in Mysore, India.
• Garmendia, C. A., Bhansali, N., & Madhivanan, P. (2018). Research Misconduct in FDA-Regulated Clinical Trials: A Cross-sectional Analysis of Warning Letters and Disqualification Proceedings. Therapeutic innovation & regulatory science, 52(5), 592-605.
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  The US Food and Drug Administration (FDA) ensures that clinical trials meet regulatory and ethical standards through inspections of researchers, also known as clinical investigators. Inspections with significant regulatory/ethical violations may result in regulatory actions, such as a warning letter or a Notice of Initiation of Disqualification Proceedings and Opportunity to Explain (NIDPOE). Objectives included the standardization of regulatory violation themes cited by the FDA for novel analysis of published regulatory actions rate issued by study intervention type, violation theme by intervention type, and violation theme variation between regulatory action type.
• Krupp, K., Placek, C. D., Wilcox, M., Ravi, K., Srinivas, V., Arun, A., & Madhivanan, P. (2018). Financial decision making power is associated with moderate to severe anemia: A prospective cohort study among pregnant women in rural South India. Midwifery, 61, 15-21.
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  According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India.
• Magariño, L. S., & Madhivanan, P. (2018). Letter to the Editor Regarding "Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke Under General Anesthesia Versus Conscious Sedation: A Systematic Review and Meta-Analysis". World neurosurgery, 115, 488.
• Mahesh, P. A., Lokesh, K. S., Madhivanan, P., Chaya, S. K., Jayaraj, B. S., Ganguly, K., & Krishna, M. (2018). The Mysuru stUdies of Determinants of Health in Rural Adults (MUDHRA), India. Epidemiology and health, 40, e2018027.
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  Between 2006 and 2010, in 16 randomly selected villages in rural areas of Mysore district, in south India, 8,457 subjects aged 30 and above were screened for symptoms of chronic respiratory disease. Of the 8,457 subjects, 1,692 were randomly invited for further evaluation of lung function and chronic obstructive pulmonary disease (COPD) by spirometry, and 1,085 of these subjects underwent lung function assessments for prevalent COPD and its risk factors. These 1,085 subjects, who were then aged between 35 and 80 years, constituted the Mysuru stUdies of Determinants of Health in Rural Adults (MUDHRA) cohort. Among other findings, threshold of biomass fuel smoke exposure suitable for use as a dichotomous risk factor for the diagnosis of chronic bronchitis was established, with a minimum biomass smoke exposure index of 60 found to be significantly associated with an elevated risk of developing chronic bronchitis. Five years later (between 2014 and 2016), 869 of the 1,085 participants were followed up with repeat lung function assessments for incident COPD and all-cause mortality. A subset of these participants (n=200) underwent blood tests for vitamin D levels, antioxidant activity, an assessment for anxiety and depression, and another subset (n=98) underwent a bioplex assay for 40 serum cytokines.
• Mukherjee, S., Fennie, K., Coxe, S., Madhivanan, P., & Trepka, M. J. (2018). Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the United States: does provider communication on perinatal depression minimize the risk?. Ethnicity & health, 23(5), 542-565.
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  Multi-state population-based studies exploring the racial/ethnic differences in the prevalence and correlates of postpartum depression (PPD), which affects 10-20% of women in the US, are rare. The aim of this study was to examine the racial/ethnic disparities in the relationship between antenatal stressful life events and PPD among US women and to explore whether antenatal health care provider communication on perinatal depression was associated with a lower risk.
• Nishimura, H., Krupp, K., Gowda, S., Srinivas, V., Arun, A., & Madhivanan, P. (2018). Determinants of exclusive breastfeeding in rural South India. International breastfeeding journal, 13, 40.
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  While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India.
• Pierre-Victor, D., Stephens, D. P., Omondi, A., Clarke, R., Jean-Baptiste, N., & Madhivanan, P. (2018). Barriers to HPV Vaccination Among Unvaccinated, Haitian American College Women. Health equity, 2(1), 90-97.
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  Haitian women residing in the United States are disproportionately affected by cervical cancer. Human papillomavirus (HPV) vaccine has been licensed in the United States since 2006. Vaccination rates are less than optimal overall, and the rates are particularly low among young black women. We investigated barriers to HPV vaccination in a sample of Haitian American college women. Thirty self-identified Haitian American women, aged 17-26 years, were recruited from a large university campus in southeastern United States (=30). They completed in-depth face-to-face interviews. The research team analyzed the transcripts using thematic analysis. More than half of the participants (=18) had not yet initiated the HPV vaccine series. Most of the unvaccinated participants stated that they had received a provider recommendation for the vaccine. Lack of provider recommendation, negative vaccine perception and attitudes, and side effect concerns constituted barriers to vaccination. Haitian American college women at high risk of cervical cancer have cited several barriers to HPV vaccination, with the most prominent being lack of physician recommendation. Healthcare providers should continue recommending the vaccine to college women as many of them may not have received a recommendation. When recommending the HPV vaccine, discussions should be framed with the intent to positively influence HPV vaccine perceptions and ultimately vaccine attitudes.
• Pierre-Victor, D., Stephens, D., Gabbidon, K., Jean-Baptiste, N., Clarke, R., & Madhivanan, P. (2018). Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake. Ethnicity & health, 1-14.
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  Parents play an integral role in young adults' sexual health including human papillomavirus (HPV) vaccine decision-making. The objective of this study was to explore conversations regarding sexual activity in Haitian households and the influence of such conversations on young Haitian women's HPV vaccine discussion with their parents.
• Ward-Peterson, M., Fennie, K., Baird, S., Coxe, S., Trepka, M. J., & Madhivanan, P. (2018). ASSOCIATION BETWEEN HIV AWARENESS FACTORS, HEALTH FACILITY CHARACTERISTICS AND RISKY SEXUAL BEHAVIOUR AMONG YOUNG WOMEN IN ZOMBA DISTRICT, MALAWI. Journal of biosocial science, 50(6), 853-867.
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  The objective of this study was to examine the association between multilevel factors related to HIV awareness and risky sexual behaviour among young women in Zomba district, Malawi. Secondary analyses of the Schooling, Income, and Health Risk (SIHR) study were undertaken. Four outcomes related to risky sexual behaviour were examined among young women: if participants had ever had sex, consistent condom use and two scores measuring risk related to partner history and age during sexual activity. Independent variables included individual-level factors such as education and rural/urban residence, as well as higher-level factors such as household's highest level of education and health facility characteristics. Regression models with cluster-robust standard errors and multilevel regression models were used to estimate associations; analyses were stratified into two strata by school enrolment status, i.e. whether the women were in school (N=1407) or had dropped out of school (N=407) at baseline of the SIHR study. For both strata, increasing age and residing within 16 km of an urban centre ('near rural' residence) increased the odds of ever having sex; lower educational achievement was associated with lower age during sexual activity. A history of pregnancy was associated with lower odds of condom use and riskier partner history. For women in school at baseline, lower household education was associated with higher odds of ever having sex (OR=1.48; 95% CI: 1.06, 2.07); near-rural and far-rural (≤16 km and >16km from urban centre, respectively) residence were associated with decreased odds of condom use (OR=0.47; 95% CI: 0.28, 0.78; and OR=0.27; 95% CI: 0.11, 0.65, respectively). For those not in school at baseline, lower household education was associated with lower age during sexual activity (β=0.31, 95% CI: 0.05, 0.58). Also for women not in school, the use of private or non-governmental health facilities was associated with decreased odds of condom use (OR=0.51, 95% CI: 0.39, 0.67) and higher age during sexual activity (β=-0.30, 95% CI: -0.52, -0.09). While individual factors were associated with risky sexual behaviour in both strata, contextual factors differed.
• Ward-Peterson, M., Fennie, K., Mauck, D., Shakir, M., Cosner, C., Bhoite, P., Trepka, M. J., & Madhivanan, P. (2018). Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, sexually transmitted infections, and risky sexual behavior in sub-Saharan Africa: a systematic review. Annals of epidemiology, 28(2), 119-134.
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  To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa.
• Zhao, X., & Madhivanan, P. (2018). Comments on platelet-rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials (Int J Surg 2018;53:279-87). International journal of surgery (London, England), 55, 51-52.
• Zhao, X., & Madhivanan, P. (2018). Is Platelet-Rich Plasma Suitable for Patellar Tendinopathy? Letter to the Editor. The American journal of sports medicine, 46(11), NP52-NP53.
• Zhao, X., & Madhivanan, P. (2018). Letter to the Editor Regarding "Minimally Invasive Alternative Approaches to Pterional Craniotomy: A Systematic Review of the Literature". World neurosurgery, 114, 429.
• Adsul, P., Manjunath, N., Srinivas, V., Arun, A., & Madhivanan, P. (2017). Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review. Cancer epidemiology, 49, 161-174.
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  The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged from 82.1-96.8%. Women between age groups of 30-59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.
• Cristillo, A. D., Bristow, C. C., Peeling, R., Van Der Pol, B., de Cortina, S. H., Dimov, I. K., Pai, N. P., Jin Shin, D., Chiu, R. Y., Klapperich, C., Madhivanan, P., Morris, S. R., & Klausner, J. D. (2017). Point-of-Care Sexually Transmitted Infection Diagnostics: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting. Sexually transmitted diseases, 44(4), 211-218.
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  The goal of the point-of-care (POC) sexually transmitted infection (STI) Diagnostics meeting was to review the state-of-the-art research and develop recommendations for the use of POC STI diagnostics. Experts from academia, government, nonprofit, and industry discussed POC diagnostics for STIs such as Chlamydia trachomatis, human papillomavirus, Neisseria gonorrhoeae, Trichomonas vaginalis, and Treponema pallidum. Key objectives included a review of current and emerging technologies, clinical and public health benefits, POC STI diagnostics in developing countries, regulatory considerations, and future areas of development. Key points of the meeting are as follows: (i) although some rapid point-of-care tests are affordable, sensitive, specific, easy to perform, and deliverable to those who need them for select sexually transmitted infections, implementation barriers exist at the device, patient, provider, and health system levels; (ii) further investment in research and development of point-of-care tests for sexually transmitted infections is needed, and new technologies can be used to improve diagnostic testing, test uptake, and treatment; (iii) efficient deployment of self-testing in supervised (ie, pharmacies, clinics, and so on) and/or unsupervised (ie, home, offices, and so on) settings could facilitate more screening and diagnosis that will reduce the burden of sexually transmitted infections; (iv) development of novel diagnostic technologies has outpaced the generation of guidance tools and documents issued by regulatory agencies; and (v) questions regarding quality management are emerging including the mechanism by which poor-performing diagnostics are removed from the market and quality assurance of self-testing is ensured.
• Degarege, A., Yimam, Y., Madhivanan, P., & Erko, B. (2017). The relationship between helminth infections and low haemoglobin levels in Ethiopian children with blood type A. Journal of helminthology, 91(3), 278-283.
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  The current study was conducted to evaluate the nature of association of ABO blood type with helminth infection and related reduction in haemoglobin concentration. Stool samples were collected from 403 school-age children attending Tikur Wuha Elementary School from February to April 2011. Helminth infection was examined using formol-ether concentration and thick Kato-Katz (two slides per stool specimen) techniques. Haemoglobin level was determined using a HemoCue machine and ABO blood type was determined using the antisera haemagglutination test. Nutritional status was assessed using height and weight measurements. Out of 403 children examined, 169, 120, 96 and 18 had blood type O, A, B and AB, respectively. The prevalences of helminth infections were 46.9% for hookworm, 24.6% for Schistosoma mansoni, 4.2% for Ascaris lumbricoides, 1.7% for Trichuris trichiura and 58.3% for any helminth species. The relative odds of infection with at least one helminth species was significantly higher among children with blood type A (adjusted odds ratio (AOR), 2.10; 95% confidence interval (CI), 1.28-3.45) or blood type B (AOR, 2.08; 95% CI, 1.22-3.56) as compared to children with blood type O. Among children infected with helminths, mean haemoglobin concentration was lower in those with blood type A than those with blood type O (β, -0.36; 95% CI, -0.72 to -0.01). The relative odds of hookworm infection (AOR, 1.78; 95% CI, 1.08-2.92) and related reduction in haemogobin levels (β, -0.45; 95% CI, -0.84 to -0.04) was higher among children with blood type A as compared to those with blood type O. Although the difference was not significant, the relative odds of S. mansoni or A. lumbricoides infections and related reduction in haemoglobin levels was also higher in children with blood type A or B as compared to children with blood type O. In conclusion, children with blood type A are associated with an increased risk of helminth, particularly hookworm, infection and related reduction in haemoglobin level. The mechanisms by which blood type A makes children susceptible to helminth infection and a related reduction in haemoglobin level ought to be investigated.
• Griffin, I., & Madhivanan, P. (2017). A systematic review: Childhood cancer survivors and gastrointestinal cancer. Cancer treatment reviews, 55, 209.
• Kojima, N., Krupp, K., Ravi, K., Gowda, S., Jaykrishna, P., Leonardson-Placek, C., Siddhaiah, A., Bristow, C. C., Arun, A., Klausner, J. D., & Madhivanan, P. (2017). Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India. BMC infectious diseases, 17(1), 189.
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  In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.
• Krupp, K., Veledar, E., & Madhivanan, P. (2017). Elevated fibroblast growth factor-23 and risk for cardiovascular disease or mortality in the general population: A meta-analysis. International journal of cardiology, 235, 194.
• Mukherjee, S., Coxe, S., Fennie, K., Madhivanan, P., & Trepka, M. J. (2017). Antenatal Stressful Life Events and Postpartum Depressive Symptoms in the United States: The Role of Women's Socioeconomic Status Indices at the State Level. Journal of women's health (2002), 26(3), 276-285.
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  Approximately 10%-20% of women suffer from postpartum depression (PPD), important predictors of which are antenatal stressful life event (SLE) experiences. The association between women's state-level socioeconomic status (SES) and PPD has not been explored. This study aimed to examine whether the association between antenatal SLE and PPD symptoms was moderated by women's state-level SES.
• Osibogun, O., Ogunmoroti, O., Michos, E. D., Spatz, E. S., Olubajo, B., Nasir, K., Madhivanan, P., & Maziak, W. (2017). HIV/HCV coinfection and the risk of cardiovascular disease: A meta-analysis. Journal of viral hepatitis, 24(11), 998-1004.
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  The emergence of improved antiretroviral therapy has increased the life expectancy of human immunodeficiency virus (HIV)-infected individuals, although there is an increased susceptibility to developing cardiovascular diseases (CVD). The risk for CVD is purported to be even higher among people with HIV and hepatitis C virus (HCV) coinfection because of the increased inflammatory response, which may synergistically impact CVD risk. However, studies comparing CVD outcomes between HIV alone and HIV/HCV individuals have been discordant. Accordingly, we conducted a meta-analysis to clarify and quantify the association between HIV/HCV coinfection and the risk for CVD. We searched EMBASE, CINAHL, Google Scholar, PubMed, and Web of Science from inception to December 2016 to identify studies that provided information on HIV/HCV coinfection and CVD, defined as coronary artery disease, congestive heart failure and stroke. We used a random-effects model to abstract and pool data on the hazard ratios (HRs) for CVD. HRs were adjusted for traditional CVD risk factors including age, sex, smoking, hypertension, diabetes and LDL cholesterol. Among the 283 articles reviewed, four cohort studies met inclusion criteria with a total of 33 723 participants. The pooled adjusted HRs for the association between HIV/HCV coinfection and CVD were 1.24 (95% CI: 1.07-1.40) compared to HIV monoinfection. The test for heterogeneity was not statistically significant (I =0.0%, P=.397). In conclusion, individuals with HIV/HCV coinfection had an increased CVD risk compared to those with HIV monoinfection. More research is needed to further examine the nature of this association, and response to traditional risk-reduction therapies.
• Pandya, S., Ravi, K., Srinivas, V., Jadhav, S., Khan, A., Arun, A., Riley, L. W., & Madhivanan, P. (2017). Comparison of culture-dependent and culture-independent molecular methods for characterization of vaginal microflora. Journal of medical microbiology, 66(2), 149-153.
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  To date, molecular methods that circumvent the limitations of traditional culture methods have not been used to describe the vaginal microflora in India. Here, we compared culture and culture-independent molecular methods in characterizing the vaginal microbiota in Indian women.
• Pierre-Victor, D., Page, T. F., Trepka, M. J., Stephens, D. P., Li, T., & Madhivanan, P. (2017). Impact of Virginia's School-Entry Vaccine Mandate on Human Papillomavirus Vaccination Among 13-17-Year-Old Females. Journal of women's health (2002), 26(3), 266-275.
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  The link between human papillomavirus (HPV) and anogenital cancers is well established in the literature. Many states have passed laws requiring funding for HPV education or vaccination. Mandatory HPV vaccination policies have been considered and passed in several states; yet their effectiveness has not been evaluated. This study sought to assess the impact of Virginia's HPV vaccine mandate for school-entry on HPV vaccine uptake among females aged 13-17 years.
• Pierre-Victor, D., Trepka, M. J., Page, T. F., Li, T., Stephens, D. P., & Madhivanan, P. (2017). Impact of Louisiana's HPV Vaccine Awareness Policy on HPV Vaccination Among 13- to 17-Year-Old Females. Health education & behavior : the official publication of the Society for Public Health Education, 44(4), 548-558.
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  The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana's policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.
• Placek, C. D., & Madhivanan, P. (2017). Exploring the perceptions of pregnancy loss between two populations of South Indian women: a pilot study. Public health, 148, 9-12.
• Placek, C. D., Madhivanan, P., & Hagen, E. H. (2017). Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: separate systems to protect the fetus?. Evolution and human behavior : official journal of the Human Behavior and Evolution Society, 38(6), 714-728.
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  Pregnancy increases women's nutritional requirements, yet causes aversions to nutritious foods. Most societies further restrict pregnant women's diet with food taboos. Pregnancy food aversions are theorized to protect mothers and fetuses from teratogens and pathogens or increase dietary diversity in response to resource scarcity. Tests of these hypotheses have had mixed results, perhaps because many studies are in Westernized populations with reliable access to food and low exposure to pathogens. If pregnancy food aversions are adaptations, however, then they likely evolved in environments with uncertain access to food and high exposure to pathogens. Pregnancy food taboos, on the other hand, have been theorized to limit resource consumption, mark social identity, or also protect mothers and fetuses from dangerous foods. There have been few tests of evolutionary theories of culturally transmitted food taboos. We investigated these and other theories of psychophysiological food aversions and culturally transmitted food taboos among two non-Western populations of pregnant women in Mysore, India, that vary in food insecurity and exposure to infectious disease. The first was a mixed caste rural farming population ( = 72), and the second was the , a resettled population of former hunter-gatherers ( = 30). Women rated their aversions to photos of 31 foods and completed structured interviews that assessed aversions and socially learned avoidances of foods, pathogen exposure, food insecurity, sources of culturally acquired dietary advice, and basic sociodemographic information. Aversions to spicy foods were associated with early trimester and nausea and vomiting, supporting a protective role against plant teratogens. Variation in exposure to pathogens did not explain variation in meat aversions or avoidances, however, raising some doubts about the importance of pathogen avoidance. Aversions to staple foods were common, but were not associated with resource stress, providing mixed support for the role of dietary diversification. Avoided foods outnumbered aversive foods, were believed to be abortifacients or otherwise harmful to the fetus, influenced diet throughout pregnancy, and were largely distinct from aversive foods. These results suggest that aversions target foods with cues of toxicity early in pregnancy, and taboos target suspected abortifacients throughout pregnancy.
• Sheehan, D. M., Trepka, M. J., Fennie, K. P., Prado, G., Madhivanan, P., Dillon, F. R., & Maddox, L. M. (2017). Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007-2011. Journal of immigrant and minority health, 19(4), 825-834.
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  The objective of this study was to examine individual and neighborhood determinants of late HIV diagnosis by gender and birthplace among Latinos. Florida HIV surveillance data for 2007-2011 were merged with American Community Survey data to estimate the odds of late HIV diagnosis (AIDS within 3 months of HIV diagnosis). Of 5522 HIV-positive Latinos, 26.5 % were diagnosed late. The odds ratio (OR) for late diagnosis was 1.39 times higher for males than females [95 % confidence interval (CI) 1.14-1.69]. Neighborhood-level factors associated with late diagnosis included residing in the 3 highest quartiles of neighborhood unemployment for males. The OR was 1.22 times higher for foreign- than US-born Latinos (95 % CI 1.07-1.40). Among foreign-born, residing in areas in the 2nd and 3rd quartiles of unemployment, in rural areas, and areas with
• Taveras, J., Trepka, M. J., Madhivanan, P., Gollub, E. L., Devieux, J., & Ibrahimou, B. (2017). HIV Testing Behaviors Among Latina Women Tested for HIV in Florida, 2012. Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 15(1), 27-34.
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  Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection but also underuse HIV prevention services, such as HIV testing.
• Bhoite, P., Griffin, I., & Madhivanan, P. (2016). Letter to the Editor: Robotic assisted hysterectomy in obese patients: a systematic review. Archives of gynecology and obstetrics, 294(2), 433-4.
• Boyd, B., Madhivanan, P., & Stephens, D. P. (2016). Child and youth experiences and perspectives of cerebral palsy: a qualitative systematic review: letter to the editor. Child: care, health and development, 42(5), 768.
• Degarege, A., Degarege, D., Veledar, E., Erko, B., Nacher, M., Beck-Sague, C. M., & Madhivanan, P. (2016). Plasmodium falciparum Infection Status among Children with Schistosoma in Sub-Saharan Africa: A Systematic Review and Meta-analysis. PLoS neglected tropical diseases, 10(12), e0005193.
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  It has been suggested that Schistosoma infection may be associated with Plasmodium falciparum infection or related reduction in haemoglobin level, but the nature of this interaction remains unclear. This systematic review synthesized evidence on the relationship of S. haematobium or S. mansoni infection with the occurrence of P. falciparum malaria, Plasmodium density and related reduction in haemoglobin level among children in sub-Saharan Africa (SSA).
• Degarege, A., Veledar, E., Degarege, D., Erko, B., Nacher, M., & Madhivanan, P. (2016). Plasmodium falciparum and soil-transmitted helminth co-infections among children in sub-Saharan Africa: a systematic review and meta-analysis. Parasites & vectors, 9(1), 344.
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  The epidemiology of soil-transmitted helminth (STH) and Plasmodium co-infections need better understanding. The findings of the individual studies are inconclusive. A systematic review was conducted to synthesize evidence on the association of STH infection with the prevalence and density of Plasmodium falciparum infection, and its effect on anaemia among children in sub-Saharan Africa (SSA).
• Jaber, R., Mzayek, F., Madhivanan, P., Khader, Y., & Maziak, W. (2016). Predictors of Cigarette Smoking Progression Among a School-Based Sample of Adolescents in Irbid, Jordan: A Longitudinal Study (2008-2011). Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 18(4), 403-9.
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  Little evidence regarding longitudinal predictors of cigarette smoking progression is available from developing countries. This study aimed to identify gender-specific individual and social predictors of cigarette smoking progression among a school-based sample of adolescents in Irbid, Jordan.
• Jaber, R., Taleb, Z. B., Bahelah, R., Madhivanan, P., & Maziak, W. (2016). Perception, intention and attempts to quit smoking among Jordanian adolescents from the Irbid Longitudinal Study. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 20(12), 1689-1694.
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  To describe important tobacco cessation indicators among adolescent smokers from Irbid, Jordan.
• Madhivanan, P., Pierre-Victor, D., Mukherjee, S., Bhoite, P., Powell, B., Jean-Baptiste, N., Clarke, R., Avent, T., & Krupp, K. (2016). Human Papillomavirus Vaccination and Sexual Disinhibition in Females: A Systematic Review. American journal of preventive medicine, 51(3), 373-83.
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  Some parents believe human papillomavirus (HPV) vaccination increases the chance of risky sexual behaviors among adolescents. This review summarizes the evidence available on adolescent girls and women engaging in risky sexual activity following HPV vaccination.
• Madhivanan, P., Valderrama, D., Krupp, K., & Ibanez, G. (2016). Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County, USA. Culture, health & sexuality, 18(6), 710-22.
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  Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.
• Myers, K., Osibogun, O., & Madhivanan, P. (2016). Errors in Assessing Race and Ethnicity in Clinical Trial Enrollment. Journal of the National Medical Association, 108(4), 194.
• Osibogun, O., Campa, A., & Madhivanan, P. (2016). Literature Review and Meta-Analysis on Micronutrient Fortified Condiments and Noodles: Reduction of Anemia in Children and Adults. Nutrients, 8(4), 240.
• Sheehan, D. M., Trepka, M. J., Fennie, K. P., Dillon, F. R., Madhivanan, P., & Maddox, L. M. (2016). Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005-2008. Ethnicity & health, 21(3), 268-83.
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  Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos.
• Taveras, J., Trepka, M. J., Khan, H., Madhivanan, P., Gollub, E. L., & Devieux, J. (2016). HIV Risk Behaviors Among Latina Women Tested for HIV in Florida by Country of Birth, 2012. Journal of immigrant and minority health, 18(5), 1104-14.
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  Latina women in the United States (US) are disproportionately affected by human immunodeficiency virus (HIV) infection. Data are limited on the risk differences in HIV among Latinas by country of birth. This paper describes the risk behaviors among Latina women tested for HIV at public sites in Florida. Multivariate logistic regression was used to assess the demographic characteristics associated with the report of specific risk behaviors. Results indicate that foreign-born Latina women were 54 % less likely to report partner risk [95 % confidence interval (CI) 0.40, 0.54] than US-born Latina women. Reported risk behaviors varied by race/ethnicity, US-born versus foreign-born status, and by Latina country of origin. Knowledge of these differences can aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.
• Wilcox, M. L., Krupp, K., Niranjankumar, B., Srinivas, V., Jaykrishna, P., Arun, A., & Madhivanan, P. (2016). Birth preparedness and place of birth in rural Mysore, India: A prospective cohort study. Midwifery, 34, 245-252.
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  India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India.
• Dévieux, J. G., Saxena, A., Rosenberg, R., Klausner, J. D., Jean-Gilles, M., Madhivanan, P., Gaston, S., Rubens, M., Theodore, H., Deschamps, M. M., Koenig, S. P., & Pape, J. W. (2015). Knowledge, Attitudes, Practices and Beliefs about Medical Male Circumcision (MMC) among a Sample of Health Care Providers in Haiti. PloS one, 10(8), e0134667.
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  Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC) has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti.
• Jaber, R., Madhivanan, P., Khader, Y., Mzayek, F., Ward, K. D., & Maziak, W. (2015). Predictors of waterpipe smoking progression among youth in Irbid, Jordan: A longitudinal study (2008-2011). Drug and alcohol dependence, 153, 265-70.
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  The predictors of waterpipe smoking progression are yet to be examined using a longitudinal study that is guided by a theoretical model of behavioral change. This study identifies the gender-specific predictors of waterpipe smoking progression among adolescents in Irbid, Jordan.
• Jaber, R., Madhivanan, P., Veledar, E., Khader, Y., Mzayek, F., & Maziak, W. (2015). Waterpipe a gateway to cigarette smoking initiation among adolescents in Irbid, Jordan: a longitudinal study. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 19(4), 481-7.
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  According to anecdotal evidence, waterpipe smoking may lead to the initiation of cigarette smoking among young people. This hypothesis is yet to be examined using an appropriate study design and a theoretical model for behavioral change.
• Madhivanan, P., Alleyn, H. N., Raphael, E., Krupp, K., Ravi, K., Nebhrajani, R., Arun, A., Reingold, A. L., Riley, L. W., & Klausner, J. D. (2015). Identification of culturable vaginal Lactobacillus species among reproductive age women in Mysore, India. Journal of medical microbiology, 64(6), 636-41.
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  A healthy vaginal environment is predominated by certain Lactobacillus species, which lead to the prevention of infections of the reproductive tract. This study examined the characteristics of cultivable Lactobacillus species in both healthy women and women with bacterial vaginosis (BV). Between November 2011 and September 2013, 139 women attending a women's clinic in Mysore, India, were evaluated for BV in a cross-sectional study. BV was diagnosed using Amsel's criteria: homogeneous vaginal discharge, vaginal pH >4.5, production of amines, and presence of "clue" cells. Those with three or more of the characteristics were considered to have BV. Vaginal swabs were then cultured in Rogosa agar and de Man-Rogosa-Sharpe broth. Gram-positive lactobacilli generating 600-800 bp amplicons by 16 sRNA were further characterized by sequencing. Cultivable vaginal samples were obtained from 132 women (94.9%). According to the Amsel criteria, 83 women (62.1%) were healthy, and 49 (37.1%) had BV. Eleven different Lactobacillus species were isolated from 47 women. The common lactobacilli species found in this sample included L. crispatus (39.6%), L. gasseri (45.8%), and L. jensenii (14.6%). Lactobacilli were isolated from 39 healthy women and eight with BV. L. gasseri was cultured from 18.8% of healthy women and 6.1% with BV. The presence of L. reuteri was significantly associated with normal vaginal microbiota (P-value = 0.026). These results further our understanding of vaginal lactobacilli colonization and richness in this particular population. Our findings showed that lactobacilli species present in the vaginas of healthy women in India do not differ from those reported from other countries.
• McKelvey, K., Attonito, J., Madhivanan, P., Yi, Q., Mzayek, F., & Maziak, W. (2015). Determinants of cigarette smoking initiation in Jordanian schoolchildren: longitudinal analysis. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 17(5), 552-8.
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  To identify determinants of cigarette smoking initiation, by gender, among schoolchildren in Irbid, Jordan.
• Rathod, S. D., Li, T., Klausner, J. D., Hubbard, A., Reingold, A. L., & Madhivanan, P. (2015). Logic regression-derived algorithms for syndromic management of vaginal infections. BMC medical informatics and decision making, 15, 106.
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  Syndromic management of vaginal infections is known to have poor diagnostic accuracy. Logic regression is a machine-learning procedure which allows for the identification of combinations of variables to predict an outcome, such as the presence of a vaginal infection.
• Sheehan, D. M., Trepka, M. J., Fennie, K. P., Prado, G., Madhivanan, P., Dillon, F. R., & Maddox, L. M. (2015). Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011. Drug and alcohol dependence, 154, 243-50.
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  The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors.
• Wilcox, M. L., Acuña, J. M., Rodriguez de la Vega, P., Castro, G., & Madhivanan, P. (2015). Factors Associated with Compliance of Blood Stool Test and Use of Colonoscopy in Underserved Communities of North Miami-Dade County, Florida. Journal of health care for the poor and underserved, 26(4), 1319-35.
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  Only two-thirds of U.S. adults are compliant with screening for colorectal cancer. This study identified factors of blood stool test (BST) compliance and colonoscopy use among randomly selected households in Miami-Dade County, Florida.
• Wilcox, M. L., Acuña, J. M., de la Vega, P. R., Castro, G., & Madhivanan, P. (2015). Factors affecting compliance with colorectal cancer screening among households residing in the largely Haitian community of Little Haiti, Miami-Dade County, Florida: an observational study. Medicine, 94(18), e806.
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  The United States Black population is disproportionately affected by colorectal cancer (CRC) in terms of incidence and mortality. Studies suggest that screening rates are lower among Blacks compared with non-Hispanic Whites (NHWs). However, studies on CRC screening within Black subgroups are lacking. This study examined disparities in blood stool test (BST) compliance and colonoscopy use by race/ethnicity (Haitian, NHW, non-Hispanic Black [NHB], and Hispanic) among randomly selected households in Little Haiti, Miami-Dade County, Florida.This study used cross-sectional, health and wellness data from a random-sample, population-based survey conducted within 951 households in Little Haiti between November 2011 and December 2012. BST compliance and colonoscopy use were self-reported and defined, conservatively, as the use of BST within the past 2 years and the ever use of colonoscopy by any household member. Factors associated with BST compliance and colonoscopy use were identified using logistic regression models. Analyses were restricted to households containing at least 1 member ≥50 years (n = 666).Nearly half of the households were compliant with BST (rate [95% confidence interval (CI)] = 45% [41%-49%]) and completed colonoscopy (rate [95% CI] = 53% [49%-58%]). Compliance with BST was not associated with race/ethnicity (P = 0.76). Factors independently associated with BST compliance included low educational attainment (adjusted odds ratio [AOR] = 0.63, P = 0.03), being single (AOR = 0.47, P = 0.004), retirement (AOR = 1.96, P = 0.01), and the presence of diagnosed health problems (AOR = 1.24, P = 0.01). Colonoscopy use was lower among Haitian households (46%) compared with NHW (63%), NHB (62%), and Hispanic households (54%) (P = 0.002). Factors independently associated with colonoscopy use included identifying as NHB (compared with Haitian) (AOR = 1.80, P = 0.05), being single (AOR = 0.44, P = 0.001), retirement (AOR = 1.86, P = 0.02), lack of continuous insurance (AOR = 0.45, P 
• Garmendia, C. A., de Los Reyes, M., & Madhivanan, P. (2014). Systematic review and meta-analysis on iron and cancer risk-letter. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(7), 1435.
• Krupp, K., & Madhivanan, P. (2014). FGF23 and risk of all-cause mortality and cardiovascular events: a meta-analysis of prospective cohort studies. International journal of cardiology, 176(3), 1341-2.
• Madhivanan, P., Krupp, K., & Reingold, A. (2014). Correlates of intimate partner physical violence among young reproductive age women in Mysore, India. Asia-Pacific journal of public health, 26(2), 169-81.
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  Few studies have examined intimate partner physical violence (IPPV) in south India. This article examines the frequency and correlates of IPPV among 898 young married women from urban, rural, and periurban areas of Mysore, India. Most (69.2%) of the participants were Hindus and 28.7% were Muslims. Overall, 50% of participants reported some type of IPPV. Factors that were independently associated with IPPV included being younger than 18 years at the time of marriage, contributing some household income, having anal sex, reporting sexual violence, and having a sex partner who drinks alcohol and smokes cigarettes. Women with skilled occupation were at reduced odds of experiencing IPPV compared with women who did not work. These findings suggest that IPPV is highly prevalent in this setting and that additional interventions are needed to reduce morbidity particularly among young women. These data also suggest that more studies are needed among men who perpetrate IPPV in south India.
• Madhivanan, P., Krupp, K., Kulkarni, V., Kulkarni, S., Vaidya, N., Shaheen, R., Philpott, S., & Fisher, C. (2014). HIV testing among pregnant women living with HIV in India: are private healthcare providers routinely violating women's human rights?. BMC international health and human rights, 14, 7.
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  In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While the government of India has made progress increasing the availability of prevention of mother-to-child transmission of HIV (PMTCT) services, only about one quarter of pregnant women received an HIV test in 2010, and about one-in-five that were found positive for HIV received interventions to prevent vertical transmission of HIV.
• Madhivanan, P., Krupp, K., Li, T., Ravi, K., Selezneva, J., Srinivas, V., Arun, A., & Klausner, J. D. (2014). Performance of BVBlue rapid test in detecting bacterial vaginosis among women in Mysore, India. Infectious diseases in obstetrics and gynecology, 2014, 908313.
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  Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in reproductive age women. It is associated with increased susceptibility to HIV/STI and adverse birth outcomes. Diagnosis of BV in resource-poor settings like India is challenging. With little laboratory infrastructure there is a need for objective point-of-care diagnostic tests. Vaginal swabs were collected from women 18 years and older, with a vaginal pH>4.5 attending a reproductive health clinic. BV was diagnosed with Amsel's criteria, Nugent scores, and the OSOM BVBlue test. Study personnel were blinded to test results. There were 347 participants enrolled between August 2009 and January 2010. BV prevalence was 45.1% (95% confidence interval (CI): 41.5%-52.8%) according to Nugent score. When compared with Nugent score, the sensitivity, specificity, positive predictive value, negative predictive value for Amsel's criteria and BVBlue were 61.9%, 88.3%, 81.5%, 73.7% and 38.1%, 92.7%, 82.1%, 63.9%, respectively. Combined with a "whiff" test, the performance of BVBlue increased sensitivity to 64.4% and negative predictive value to 73.8%. Despite the good specificity, poor sensitivity limits the usefulness of the BVBlue as a screening test in this population. There is a need to examine the usefulness of this test in other Indian populations.
• Madhivanan, P., Li, T., Srinivas, V., Marlow, L., Mukherjee, S., & Krupp, K. (2014). Human papillomavirus vaccine acceptability among parents of adolescent girls: obstacles and challenges in Mysore, India. Preventive medicine, 64, 69-74.
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  Worldwide, 530,000 women are diagnosed with cervical cancer and 275,000 die annually. India bears the greatest burden of the disease with 132,000 cases and 74,000 deaths yearly. Widespread uptake of human papillomavirus (HPV) vaccine could reduce incidence and mortality by two-thirds. This study explored obstacles and facilitators of parental acceptability of HPV vaccine.
• Madhivanan, P., Niranjankumar, B., Shaheen, R., Jaykrishna, P., Ravi, K., Gowda, S., Srinivas, V., Arun, A., & Krupp, K. (2014). Erratum to "Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India". Journal of sexually transmitted diseases, 2014, 964269.
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  [This corrects the article DOI: 10.1155/2013/971458.].
• Madhivanan, P., Raphael, E., Rumphs, A., Krupp, K., Ravi, K., Srinivas, V., Arun, A., Reingold, A. L., Klausner, J. D., & Riley, L. W. (2014). Characterization of culturable vaginal Lactobacillus species among women with and without bacterial vaginosis from the United States and India: a cross-sectional study. Journal of medical microbiology, 63(Pt 7), 931-5.
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  Lactobacillus species play an integral part in the health of the vaginal microbiota. We compared vaginal Lactobacillus species in women from India and the USA with and without bacterial vaginosis (BV). Between July 2009 and November 2010, a cross-sectional study was conducted among 40 women attending a women's health clinic in Mysore, India, and a sexually transmitted diseases clinic in San Francisco, USA. Women were diagnosed with BV using Amsel's criteria and the Nugent score. Lactobacillus 16S rDNA was sequenced to speciate the cultured isolates. Ten Indian and 10 US women without BV were compared with an equal number of women with BV. Lactobacilli were isolated from all healthy women, but from only 10% of Indian and 50% of US women with BV. 16S rDNA from 164 Lactobacillus colonies was sequenced from healthy women (126 colonies) and women with BV (38 colonies). Seven cultivable Lactobacillus species were isolated from 11 Indian women and nine species from 15 US women. The majority of Lactobacillus species among Indian women were L. crispatus (25.0%), L. jensenii (25.0%) and L. reuteri (16.7%). Among US women, L. crispatus (32.0%), L. jensenii (20.0%) and L. coleohominis (12.0%) predominated. L. jensenii and L. crispatus dominated the vaginal flora of healthy Indian and US women. Indian women appeared to have a higher percentage of obligate heterofermentative species, suggesting the need for a larger degree of metabolic flexibility and a more challenging vaginal environment.
• Madhivanan, P., Srinivas, V., Marlow, L., Mukherjee, S., Narayanappa, D., Mysore, S., Arun, A., & Krupp, K. (2014). Indian parents prefer vaccinating their daughters against HPV at older ages. Asian Pacific journal of cancer prevention : APJCP, 15(1), 107-10.
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  Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countries since they suffer 88% of the world's cervical cancer burden. In many countries studies show that age at vaccination is an important determinate of parental acceptability. This study explores parental preferences on age-to-vaccinate for adolescent school-going girls.
• McKelvey, K., Attonito, J., Madhivanan, P., Jaber, R., Yi, Q., Mzayek, F., & Maziak, W. (2014). Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis. Drug and alcohol dependence, 142, 307-13.
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  Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.
• Mukherjee, S., Pierre-Victor, D., Bahelah, R., & Madhivanan, P. (2014). Mental health issues among pregnant women in correctional facilities: a systematic review. Women & health, 54(8), 816-42.
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  Incarceration-induced stress makes pregnant women in correctional facilities a high-risk group for mental health problems, resulting in adverse maternal and fetal outcomes. A systematic review was conducted to examine the prevalence and correlates of mental health issues among pregnant inmates. Databases searched included PubMed, Medline, CINAHL Plus, PsycINFO, National Criminal Justice Reference System, Social Work Abstracts, Cochrane and Campbell libraries, which were searched for studies published in English from 1950 till July 2013. Eleven studies were included of pregnant women in correctional facilities and addressed at least one mental illness. Quality score was assigned to these eligible articles. Due to heterogeneity, a narrative review was performed. All of the studies were conducted in the United States, with quality scores ranging from 7 to 10 out of 10. Only one of these studies used mixed methods, the rest were quantitative. Tobacco use among pregnant inmates exceeded 50%, with some studies reporting as high as 84%. Alcohol use was common; 36% of the inmates used illicit drugs in one study. Depression and anxiety levels were high-some studies reported depression among 80% of inmates. Findings suggest that mental health among pregnant prisoners is a huge concern that has not been adequately addressed.
• Pierre-Victor, D., Mukherjee, S., Bahelah, R., & Madhivanan, P. (2014). Human papillomavirus vaccine uptake among males 11-26 years in United States: findings from the National Health and Nutrition Examination Survey, 2011-2012. Vaccine, 32(49), 6655-8.
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  Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.
• Bochner, A. F., Madhivanan, P., Niranjankumar, B., Ravi, K., Arun, A., Krupp, K., & Klausner, J. D. (2013). The Epidemiology of Herpes Simplex Virus Type-2 Infection among Pregnant Women in Rural Mysore Taluk, India. Journal of sexually transmitted diseases, 2013, 750415.
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  Objectives. To assess the prevalence and determinants of herpes simplex virus type 2 (HSV-2) infections among pregnant women attending mobile antenatal health clinic in rural villages in Mysore Taluk, India. Methods. Between January and September 2009, 487 women from 52 villages participated in this study. Each participant consented to provide a blood sample for HSV-2 and HIV testing and underwent an interviewer-administered questionnaire. Results. HSV-2 prevalence was 6.7% (95% confidence interval (CI) 4.4-9.0), and one woman tested positive for HIV. The median age of women was 20 years and 99% of women reported having a single lifetime sex partner. Women whose sex partner traveled away from home had 2.68 (CI: 1.13-6.34) times the odds of being HSV-2 seropositive compared to women whose sex partner did not travel. Having experienced genital lesions was also associated with HSV-2 infection (P value = 0.08). Conclusion. The 6.7% HSV-2 prevalence was similar to results obtained in studies among pregnant women in other parts of India. It appeared that most women in this study contracted HSV-2 from their spouses and few regularly used condoms. This finding highlights the need for public health policies to increase awareness and education about prevention methods among women and men living in rural India.
• Madhivanan, P., Barreto, G. A., Revawala, A., Anderson, C., McKinney, S., & Pierre-Victor, D. (2013). Where are we with partner treatment in bacterial vaginosis? A critical appraisal of the latest systematic review. Sexually transmitted diseases, 40(6), 518.
• Madhivanan, P., Li, T., Trammell, S., Desai, C., Srinivas, V., Arun, A., Klausner, J. D., & Krupp, K. (2013). Performance of the OSOM Trichomonas Rapid Test for diagnosis of Trichomonas vaginalis infection among women in Mysore, India. Sexual health, 10(4), 320-4.
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  Background Trichomonas vaginalis is the world's most common treatable sexually transmissible infection. Currently, wet mount microscopy and syndromic management based on vaginal discharge are the most widely used methods for diagnosing and treating trichomoniasis in resource-constrained settings. Wet mount microscopy requires equipment and trained technicians, who are in short supply. We examined the diagnostic accuracy of the OSOM Trichomonas Rapid Test for detecting T. vaginalis vaginal infection among women in Mysore, India.
• Madhivanan, P., NiranjanKumar, B., Shaheen, R., Jaykrishna, P., Ravi, K., Gowda, S., Srinivas, V., Arun, A., & Krupp, K. (2013). Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India. Journal of sexually transmitted diseases, 2013, 971458.
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  Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+) intervention of community mobilization strategy providing conditional cash transfers (CCT) to women's SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3%) women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5%) received ANC in the SCIL+ arm (P < 0.001); 175 (97%) in the SCIL and 366 (98.6%) in the SCIL+ arm consented to HIV testing (P < 0.001). HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women's microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages.
• McKelvey, K. L., Wilcox, M. L., Madhivanan, P., Mzayek, F., Khader, Y. S., & Maziak, W. (2013). Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008-11. European journal of public health, 23(5), 862-7.
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  Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting.
• Adamson, P. C., Krupp, K., Niranjankumar, B., Freeman, A. H., Khan, M., & Madhivanan, P. (2012). Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India. BMC public health, 12, 30.
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  While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations.
• Chibber, K. S., Krupp, K., Padian, N., & Madhivanan, P. (2012). Examining the determinants of sexual violence among young, married women in Southern India. Journal of interpersonal violence, 27(12), 2465-83.
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  The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple sex partners. Women's contribution to household income also increases their odds of experiencing sexual violence by almost twofold; however, if they are solely responsible for "all" household income, the relationship is found to be protective. Physical violence modifies the determinants of sexual violence, and among women not experiencing physical violence, husbands' primary education and employment as drivers increase women's odds of experiencing sexual violence nearly threefold, and women who contribute "all" the household income (n = 62) do not experience sexual violence. These relationships are not significant among women experiencing physical violence. Study findings improve the understanding of the determinants of sexual violence. Future research is needed to examine the risk factors for different types of GBV independently and to tease apart the differences in risk factors depending on women's experiences. The significance of male partners' characteristics warrants in-depth research, and in order to promote gender-equitable norms, future interventions need to focus on male behaviors and men's day-to-day survival challenges, all of which likely influence conflicts in marital relationships.
• Rathod, S. D., Klausner, J. D., Krupp, K., Reingold, A. L., & Madhivanan, P. (2012). Epidemiologic features of Vulvovaginal Candidiasis among reproductive-age women in India. Infectious diseases in obstetrics and gynecology, 2012, 859071.
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  Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs.
• Adamson, P. C., Krupp, K., Freeman, A. H., Klausner, J. D., Reingold, A. L., & Madhivanan, P. (2011). Prevalence & correlates of primary infertility among young women in Mysore, India. The Indian journal of medical research, 134, 440-6.
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  There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India.
• Madhivanan, P., Krupp, K., Kulkarni, V., Kulkarni, S., & Klausner, J. D. (2011). Acceptability of male circumcision for HIV prevention among high-risk men in Pune, India. Sexually transmitted diseases, 38(6), 571.
• Rathod, S. D., Krupp, K., Klausner, J. D., Arun, A., Reingold, A. L., & Madhivanan, P. (2011). Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. Sexually transmitted diseases, 38(9), 882-6.
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  Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) have been estimated to affect one-quarter to one-third of sexually active women worldwide, and are often found concurrently. Few studies have examined this relationship longitudinally to better understand the direction and temporality of this association.
• Krupp, K., Marlow, L. A., Kielmann, K., Doddaiah, N., Mysore, S., Reingold, A. L., & Madhivanan, P. (2010). Factors associated with intention-to-recommend human papillomavirus vaccination among physicians in Mysore, India. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 46(4), 379-84.
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  This qualitative study investigated physician intention-to-recommend the human papillomavirus (HPV) vaccine to parents of adolescent girls in India. There are currently no data on attitudes to HPV vaccination among healthcare providers in India.
• Madhivanan, P., Kumar, B. N., Adamson, P., & Krupp, K. (2010). Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India. BMC public health, 10, 570.
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  There is little research on HIV awareness and practices of traditional birth attendants (TBA) in India. This study investigated knowledge and attitudes among rural TBA in Karnataka as part of a project examining how traditional birth attendants could be integrated into prevention-of-mother-to-child transmission of HIV (PMTCT) programs in India.
• Krupp, K., & Madhivanan, P. (2009). Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?. Human resources for health, 7, 18.
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  Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services - interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India--Gujarat and Tamil Nadu--have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.
• Madhivanan, P., Bartman, M. T., Pasutti, L., Krupp, K., Arun, A., Reingold, A. L., & Klausner, J. D. (2009). Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications for treatment and prevention. Sexual health, 6(4), 339-44.
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  Trichomonas vaginalis infection is the most common curable sexually transmissible infection (STI) worldwide. The present study describes the burden and correlates of T. vaginalis infection among young reproductive age women in Mysore, India.
• Madhivanan, P., Krupp, K., Hardin, J., Karat, C., Klausner, J. D., & Reingold, A. L. (2009). Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Tropical medicine & international health : TM & IH, 14(6), 703-8.
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  Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings.
• Madhivanan, P., Krupp, K., Yashodha, M. N., Marlow, L., Klausner, J. D., & Reingold, A. L. (2009). Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India. Vaccine, 27(38), 5203-8.
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  This study investigates attitudes toward human papillomavirus (HPV) vaccination among parents of adolescent girls in Mysore, India. Seven focus group discussions were held among parents of adolescent girls stratified by sex, religion and region to explore attitudes about cervical cancer and HPV vaccination. The study found that while parents have limited knowledge about HPV or cervical cancer, most are still highly accepting an HPV vaccine. In addition, high acceptability levels appear to reflect positive attitudes toward the government universal immunization program in general, rather than to the HPV vaccine in particular. The results highlight the need for additional education and health promotion regarding HPV and cervical cancer prevention in India.
• Madhivanan, P., Krupp, K., Chandrasekaran, V., Karat, S. C., Reingold, A. L., & Klausner, J. D. (2008). Acceptability of male circumcision among mothers with male children in Mysore, India. AIDS (London, England), 22(8), 983-8.
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  There is currently little information on the acceptability of male circumcision in India. This study investigated the acceptability of male circumcision among Indian mothers with male children.
• Van Rompay, K. K., Madhivanan, P., Rafiq, M., Krupp, K., Chakrapani, V., & Selvam, D. (2008). Empowering the people: development of an HIV peer education model for low literacy rural communities in India. Human resources for health, 6, 6.
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  Despite ample evidence that HIV has entered the general population, most HIV awareness programs in India continue to neglect rural areas. Low HIV awareness and high stigma, fueled by low literacy, seasonal migration, gender inequity, spatial dispersion, and cultural taboos pose extra challenges to implement much-needed HIV education programs in rural areas. This paper describes a peer education model developed to educate and empower low-literacy communities in the rural district of Perambalur (Tamil Nadu, India).
• Chandrasekaran, V., Krupp, K., George, R., & Madhivanan, P. (2007). Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India. Indian journal of medical sciences, 61(5), 253-62.
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  Violence against women is a global phenomenon that cuts across all social and economic classes.
• Krupp, K., Madhivanan, P., Karat, C., Chandrasekaran, V., Sarvode, M., Klausner, J., & Reingold, A. (2007). Novel recruitment strategies to increase participation of women in reproductive health research in India. Global public health, 2(4), 395-403.
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  In India, care seeking for reproductive health among women is inadequate. This poses a unique challenge to researchers recruiting cohorts for studies in clinic-based settings. The purpose of this paper is to describe the recruitment process used in a prospective cohort study investigating the relationship between bacterial vaginosis and acquisition of HSV-2 among sexually active women in Mysore, India. Participants were initially recruited from an obstetrics/gynaecology outpatient clinic. Results were compared with a 'community supported' enrolment process, which included community preparation and reproductive health education followed by screening of potential participants. During November 2005, 1,054 women were screened in the clinic. Of the total screened, 246 (23%) were eligible and only 78 (7%) enrolled. Between December 2005 and April 2006, investigators adopted a community supported enrolment process. During that period, 1,077 potential participants were screened, 947 were eligible, and 918 (85%) enrolled. Fifty-six (72%) participants recruited from the clinic returned for their first follow-up visit, compared with 795 (97%) participants recruited using the community supported enrolment process. Since obstetrics/gynaecology departments in India are poor places to recruit non-pregnant women of reproductive age, a community supported process yields more eligible potential participants to screen, and results in significantly better study retention.
• Madhivanan, P., & Krupp, K. (2007). Technological challenges in diagnosis and management of HIV infection in resource limited settings. BMJ (Clinical research ed.), 335(7612), 165-6.
• Madhivanan, P., Krupp, K., Chandrasekaran, V., Karat, C., Arun, A., Klausner, J. D., & Reingold, A. L. (2007). The epidemiology of herpes simplex virus type-2 infection among married women in Mysore, India. Sexually transmitted diseases, 34(11), 935-7.
• Hernandez, A. L., Lindan, C. P., Mathur, M., Ekstrand, M., Madhivanan, P., Stein, E. S., Gregorich, S., Kundu, S., Gogate, A., & Jerajani, H. R. (2006). Sexual behavior among men who have sex with women, men, and Hijras in Mumbai, India--multiple sexual risks. AIDS and behavior, 10(4 Suppl), S5-16.
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  We describe the same-sex partnerships and sexual risk behavior of men attending sexually transmitted infection (STI) clinics in Mumbai, India. The HIV prevalence among 2,381 men sampled was 14%; 62% had a documented STI. Almost all men reported sex with women; additionally, 13% also reported having sex with other men, 13% reported sex with Hijras (male-to-female transgenders), and 11% had sex with all 3 genders. Men who had sex with men and/or Hijras as well as women, reported having greater numbers of partners, including female sex workers (FSW), and were more likely to engage in insertive anal and oral sex with women. The prevalence of HIV was higher among men having sex with Hijras (14%) or with all 3 genders (13%) than among men having sex with men and women (8%). A high proportion of men who attend STI clinics in Mumbai are behaviorally bi- or tri-sexual and have multiple partners with whom they engage in risky sex. STI/HIV prevention programs should not assume that men only have sex with women.
• Karat, C., Madhivanan, P., Krupp, K., Poornima, S., Jayanthi, N. V., Suguna, J. S., & Mathai, E. (2006). The clinical and microbiological correlates of premature rupture of membranes. Indian journal of medical microbiology, 24(4), 283-5.
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  Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
• Madhivanan, P., Hernandez, A., Gogate, A., Stein, E., Gregorich, S., Setia, M., Kumta, S., Ekstrand, M., Mathur, M., Jerajani, H., & Lindan, C. P. (2005). Alcohol use by men is a risk factor for the acquisition of sexually transmitted infections and human immunodeficiency virus from female sex workers in Mumbai, India. Sexually transmitted diseases, 32(11), 685-90.
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  We investigated whether men who were under the influence of alcohol when visiting female sex workers (FSW) were at greater risk for sexually transmitted infections (STI) and human immunodeficiency virus (HIV).
• Madhivanan, P., Mothi, S. N., Kumarasamy, N., Yepthomi, T., Venkatesan, C., Lambert, J. S., & Solomon, S. (2003). Clinical manifestations of HIV infected children. Indian journal of pediatrics, 70(8), 615-20.
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  Heterosexual contact is the predominant mode of transmission among adults in India with an increasing number of women of childbearing age becoming infected with HIV. Consequently, children in India increasingly getting infected, primarily from vertical transmission. A retrospective review of the profile of HIV infected children attending an HIV clinic in South India is reported.
• Madhivanan, P., Mothi, S. N., Kumarasamy, N., Yepthomi, T., Lambert, J., & Solomon, S. (2001). Regression of attained milestones in an HIV infected infant. Indian journal of pediatrics, 68(10), 991-3.
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  We report a case of an 18-month-old child with regression of attained developmental milestones as a manifestation of HIV encephalopathy. This is the first such report in Indian literature. Commencing antiretroviral therapy in this child resulted in arrest of further regression of milestones. This alerts pediatricians to be aware that early developmental delay and regression may be a presenting manifestation of HIV infection in a child.
• Kumarasamy, N., Solomon, S., Madhivanan, P., Ravikumar, B., Thyagarajan, S. P., & Yesudian, P. (2000). Dermatologic manifestations among human immunodeficiency virus patients in south India. International journal of dermatology, 39(3), 192-5.
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  Human immunodeficiency virus (HIV) may be associated with a large number of dermatologic manifestations, which may at times constitute the presenting symptoms. These skin lesions are well delineated in the Western literature, but there is a paucity of information from the southern part of the Indian subcontinent. Objective We evaluated 833 persons with HIV to determine the types of dermatologic lesions present.
• Newmann, S., Sarin, P., Kumarasamy, N., Amalraj, E., Rogers, M., Madhivanan, P., Flanigan, T., Cu-Uvin, S., McGarvey, S., Mayer, K., & Solomon, S. (2000). Marriage, monogamy and HIV: a profile of HIV-infected women in south India. International journal of STD & AIDS, 11(4), 250-3.
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  A retrospective study was conducted on 134 HIV-infected females evaluated at an HIV/AIDS centre in south India to characterize their sociodemographics, HIV risk factors and initial clinical presentations. The mean age was 29 years; 81% were housewives; 95% were currently or previously married; 89% reported heterosexual sex as their only HIV risk factor; and 88% reported a history of monogamy. The majority were of reproductive age, thus the potential for vertical transmission of HIV and devastating impacts on families is alarming. Nearly half of these women initially presented asymptomatically implying that partner recruitment can enable early HIV detection. Single partner heterosexual sex with their husband was the only HIV risk factor for the majority of women. HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands.

Poster Presentations

• Fantry, L. E., Bedrick, E. J., Madhivanan, P. P., Guido, A., Loveland, M., Joseph, M., Nandemi, P., Gupte, R., Sadoway, D., Fisher, J. M., & Lim, J. (2022, Fall semester). Update on PrEP Knowledge and Attitudes Among Adults Attending Public Health Clinics in Southern Arizona. ID Week. Washington, DC: Infectious Disease Society of America.
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  Study of PrEP knowledge
• Lim, J., Lim, J., Fisher, J. M., Fisher, J. M., Sadoway, D., Sadoway, D., Gupte, R., Gupte, R., Nandemi, P., Nandemi, P., Joseph, M., Joseph, M., Loveland, M., Loveland, M., Guido, A., Guido, A., Madhivanan, P., Madhivanan, P. P., Bedrick, E. J., , Bedrick, E. J., et al. (2022, Fall semester). Update on PrEP Knowledge and Attitudes Among Adults Attending Public Health Clinics in Southern Arizona. ID Week. Washington, DC: Infectious Disease Society of America.
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  Study of PrEP knowledge

Others

• Lin, L., & Madhivanan, P. (2022, November). Introduction to Systematic Review and Meta-Analysis. One-day workshop.