Publications (6)9.15 Total impact
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Dataset: Crepaz et al. Am J Public Health 2009
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Article: The efficacy of HIV/STI behavioral interventions for African American females in the United States: a meta-analysis.
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ABSTRACT: We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.American Journal of Public Health 09/2009; 99(11):2069-78. · 3.93 Impact Factor -
Article: Strategies for controlling blood pressure among low-income populations in Georgia.
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ABSTRACT: In Georgia an estimated 32% of blacks and 28% of whites have high blood pressure. In 2004 the rate of death from stroke in Georgia was 12% higher than the national average, and blacks in the state have a 1.4 times greater rate of death from stroke than that of whites. The Georgia legislature funds the Stroke and Heart Attack Prevention Program (SHAPP) to provide treatment and medications for indigent Georgians. The median rate of blood pressure (BP) control among SHAPP enrollees is approximately 60%, compared with the national average of 35%. SHAPP was evaluated through interviews with key health care and administrative staff and through focus groups of patients in two clinics. Outcomes for patients were increased knowledge of their BP and improved compliance with taking medication and keeping clinic appointments. Successful components of SHAPP include an easy enrollment process; affordable medication; use of evidence-based, documented protocols and patient tracking systems; routine follow-up of patients; and effective communication between staff and patients. Challenges and recommendations for improvement are identified.Preventing chronic disease 05/2008; 5(2):A52. · 1.82 Impact Factor -
Article: Adapting evidence-based behavioral interventions for new settings and target populations.
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ABSTRACT: Many HIV prevention funding agencies require the use of evidence-based behavioral interventions (EBIs) previously shown to be effective through rigorous outcome evaluation. Often, the implementing agency's setting or target population is different than those in the original implementation and evaluation. The Centers for Disease Control and Prevention Division of HIV/AIDS Prevention, in collaboration with internal and external partners, developed draft guidance to adapt an EBI to fit the cultural context, risk determinants, risk behaviors, and unique circumstances of the agency without competing with or contradicting the core elements and internal logic. The guidance described in this article provides a systematic approach to help agencies identify the most appropriate intervention for their target population and agency capacity, monitor the process, and evaluate the outcomes of the adapted intervention. This guidance, currently being piloted with five community-based organizations, will be revised and disseminated at the conclusion of project activities.AIDS Education and Prevention 09/2006; 18(4 Suppl A):59-73. · 1.59 Impact Factor -
Article: A cost evaluation of the Georgia Stroke and Heart Attack Prevention Program.
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ABSTRACT: Hypertension is a leading cause of stroke, coronary artery disease, heart attack, and heart and kidney failure in the United States, all of which contribute to the rising costs of health care. The Georgia Stroke and Heart Attack Prevention Program is an education and direct service program for low-income patients with hypertension. This project evaluated the cost-effectiveness of the program compared with the following two alternative scenarios: no treatment for high blood pressure and the typical hypertension treatment received in the private sector nationwide (usual care). We estimated the preventive treatment costs and number of adverse health events averted (hemorrhagic and ischemic stroke, heart disease, and kidney failure) associated with the Georgia Stroke and Heart Attack Prevention Program in two Georgia health districts. We used program cost and service usage data obtained from the Georgia Department of Human Resources and probabilities and costs of expected adverse events published in peer-reviewed sources. We compared program costs and number of expected adverse health events averted with those expected from 1) no preventive care and 2) usual care for high blood pressure. The Georgia Stroke and Heart Attack Prevention Program was less costly and resulted in better health outcomes than either no preventive care or usual care. Compared with no preventive care in the two districts, the program was estimated to result in 54% fewer expected adverse events; compared with usual care, the program was estimated to result in 46% fewer expected adverse events. Combining the costs of preventive treatment with the costs of expected adverse events, the Georgia Stroke and Heart Attack Prevention Program cost an average of 486 dollars per patient annually, compared with average annual costs of 534 dollars for no care and 624 dollars for usual care. Maintaining a publicly financed stroke and heart attack prevention program is more cost-effective and results in greater health benefits than other plausible scenarios. Because the benefits of this program accrue to both the state and federal governments through reduced Medicaid and indigent care expenditures, both the state and federal governments have a financial incentive to support the program.Preventing chronic disease 02/2006; 3(1):A12. · 1.82 Impact Factor -
Article: A Cost Evaluation of the Georgia Stroke and Heart Attack Prevention Program
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ABSTRACT: IntroductionHypertension is a leading cause of stroke, coronary artery disease, heart attack, and heart and kidney failure in the United States, all of which contribute to the rising costs of health care. The Georgia Stroke and Heart Attack Prevention Program is an education and direct service program for low-income patients with hypertension. This project evaluated the cost-effectiveness of the program compared with the following two alternative scenarios: no treatment for high blood pressure and the typical hypertension treatment received in the private sector nationwide (usual care).MethodsWe estimated the preventive treatment costs and number of adverse health events averted (hemorrhagic and ischemic stroke, heart disease, and kidney failure) associated with the Georgia Stroke and Heart Attack Prevention Program in two Georgia health districts. We used program cost and service usage data obtained from the Georgia Department of Human Resources and probabilities and costs of expected adverse events published in peer-reviewed sources. We compared program costs and number of expected adverse health events averted with those expected from 1) no preventive care and 2) usual care for high blood pressure.ResultsThe Georgia Stroke and Heart Attack Prevention Program was less costly and resulted in better health outcomes than either no preventive care or usual care. Compared with no preventive care in the two districts, the program was estimated to result in 54% fewer expected adverse events; compared with usual care, the program was estimated to result in 46% fewer expected adverse events. Combining the costs of preventive treatment with the costs of expected adverse events, the Georgia Stroke and Heart Attack Prevention Program cost an average of $486 per patient annually, compared with average annual costs of $534 for no care and $624 for usual care.ConclusionMaintaining a publicly financed stroke and heart attack prevention program is more cost-effective and results in greater health benefits than other plausible scenarios. Because the benefits of this program accrue to both the state and federal governments through reduced Medicaid and indigent care expenditures, both the state and federal governments have a financial incentive to support the program.Preventing Chronic Disease. 01/2005;
