Optimal public health policies in vulnerable populations worldwide

Clinicians and policy makers face enormous challenges in the treatment and prevention of people from vulnerable populations, such as people from resources-limited areas, rural areas, or those that use injection drugs.

The goal of this project was to investigate factors related to specific behaviors and evaluate the impact of public health policies to reduce risk behaviors in vulnerable populations.

To better improve prevention of infectious diseases spread (such as HIV and Hepatitis C) among people who inject drugs, I designed and analyzed a retrospective observational study using Swedish data over a 10-year period and a logistic regression model to evaluate the most important factors related to risk behaviors, such as having shared injection drug solution; and having lent out or having received already used drug injection equipment. I found that women, early drug debut, amphetamine users and homeless people had a significantly higher level of injection risk behavior. By knowing what are the most important factors that lead to risk behavior, better targeted policies toward these people can be developed.

People who live with HIV in resources-limited areas that do not disclose their positive status are more likely to not adhere to the prescribed treatment and consequently spread the virus. To identify factors related to HIV disclosure I designed a cross-sectional study and identify factors by using a multivariable logistic regression model with stepwise backward-forward algorithm for variable selections. I found that being employed, gender and income imposed a risk factor for HIV status disclosure.

People who live with HIV in resources-limited areas are more at risk of spreading HIV because they may not adhere to the treatment due to the fact that they have access to limited health-care systems and drug supplies. Because mobile phones are valid tools to remind HIV treatment, I designed a cross-sectional study to identify patient demographic groups least likely to use mobile phones as reminder tools in HIV care in rural areas. I found that older women, with low education and low income did not use mobile phone tools in HIV care.

Because birth delivery at home is a risk for both the baby and the mother, I investigated and described the effect of a program aimed at boosting birth delivery at a healthcare center. I found that the delivery program increased the likelihood of deliver at the hospital.

Because antibacterial drugs are crucial to treat infections during delivery and postpartum period to reduce maternal mortality in rural areas, I designed a cross-sectional study and applied bivariate and multivariable logistic regression to describe antibiotic prescribing among inpatients during and after birth delivery in rural India. I found that antibiotic prescriptions were higher during delivery at health care facilities.