Krishna C. Poudel

• PhD, MHS
• Professor (Associate) at University of Massachusetts Amherst

Background Mental health problems are high among refugees due to their traumatic experiences of fleeing war and witnessing disasters and deaths due to violence and conflict. Refugees are exposed to various socio-cultural stressors during their migration journey before, during, and after arriving at the host country, which may increase their risk of...

HIV infection has been linked to selenium deficiency and chronic inflammation. Both selenium deficiency and inflammation have been associated with poor health outcomes among individuals with HIV. However, the role of serum selenium levels in inflammation has not been studied among individuals with HIV. We assessed the relationship of serum selenium...

Despite the evidence of the disproportionate burden of tobacco use among people with HIV (PWH), little effort has been made to design and test smoking cessation interventions for PWH in resource-limited countries. We assessed the feasibility, acceptability, and preliminary effects of a video-based smoking cessation intervention consisting of eleven...

Getting a PhD is the highest possible education qualification which only a small proportion of all students achieve. As a consequence, examining PhD research in the form of a doctoral thesis is specialist work. This paper highlights the different options that are available for PhD examiners. There are four general options: (1) pass, (2) rewrite and...

Recent evidence suggests that 44.8% of women of reproductive age (WRA) in Tanzania suffer from anemia. Addressing this public health challenge calls for local evidence of its burden and determinants thereof for policy and tailored interventions. This secondary data analysis used Tanzania Demographic and Health Surveys (TDHS) 2004–2005 and 2015–2016...

Objectives Refugees bear a high burden of diet-related chronic diseases due to unhealthy eating habits. Culture strongly influences their dietary behavior; however, culturally tailored nutrition education intervention targeted at refugees is limited. We assessed the effect of culturally-tailored nutrition intervention to promote healthy dietary beh...

Introduction Research is needed to investigate preventive strategies to reduce mental health burden and assess effective implementation among immigrants. Problem management plus (PMP) is a low-intensity multicomponent psychological intervention developed by the World Health Organization (WHO) that trained laypeople can deliver. PMP has been adapted...

Family-centred interventions addressing sociocultural and emotional stressors promise to prevent mental health problems among refugees in the United States. Peer-led strategies are highly valued, as they engage communities and promote the sustainability of interventions. We assessed the effects of a peer-led family-centred Social and Emotional Well...

Background Eswatini has the highest global prevalence of HIV despite decades of universal access to free antiretroviral therapy (ART). We conducted a mixed methods study to investigate barriers to ART adherence among women living with HIV (WLHIV) in rural communities of Eswatini. Qualitative findings were reported in our previous publication. This...

Limited studies have examined the role of a parent’s involvement in their child’s daily life as it relates to cigarette smoking among adolescents in low- and middle-income countries (LMICs). We examined the role of parental involvement with current smoking among 6,105 adolescents using a nationally representative sample from the 2015– 2016 Global S...

Objectives Chronic inflammation and selenium deficiency are common in persons infected with the human immunodeficiency virus (HIV). Both C-reactive protein, a pro-inflammatory biomarker, and selenium deficiency have been associated with accelerated disease progression and poorer survival among persons infected with HIV-infection. However, research...

This study investigates the efficacy of a nurse-led mobile phone voice call reminder intervention in improving on-time antiretroviral (ARV) pills collection in Nepal. Between October and December 2017, 468 HIV-positive individuals were recruited randomly and assigned to either nurse-led mobile phone voice call reminder (intervention) group or voice...

Introduction: Smoking prevalence is disproportionately high among Asian American immigrant men with limited English proficiency. Understanding the role of family support may provide insights on culturally acceptable strategies to promote smoking cessation. Aims: This study examined how family support was associated with readiness to consider smo...

Background Hepatitis C virus (HCV) co-infection is still a significant cause of morbidity and mortality among HIV-positive individuals in many resource-limited countries. As prevalence rates of co-infection using the serological diagnosis of HCV infection might be imprecise, estimates of prevalence using polymerase chain reaction (PCR) confirmed di...

Both inflammation and smoking are independent predictors of morbidity and mortality among people living with HIV (PLHIV). As smoking burden is likely to exacerbate inflammation, we tested the hypothesis that higher intensity and longer duration of smoking are positively associated with C-reactive protein (CRP, an inflammatory marker) among 284 PLHI...

In the U.S., cigarette smoking is increasingly concentrated in disadvantaged and vulnerable populations, such as populations with lower income and with mental health needs. Food insecurity is linked with psychological distress and is an independent risk factor for smoking. We prospectively examined how cigarette smoking, food insecurity, and psycho...

Background Despite access to free antiretroviral therapy (ART) for all people living with human immunodeficiency virus (HIV), noncompliance to treatment continues to be a significant challenge in Eswatini. Yet studies investigating barriers to ART adherence in Eswatini are scarce. Most notably, there is a lack of research regarding rural women in E...

Introduction There is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not r...

People living with HIV often experience mental health disorders and engage in substance use. Evidence, however, is limited about the influence of mental health disorders and substance use on non-adherence to ART. We conducted a cross-sectional study among 682 HIV-positive people on ART in Nepal. We measured their depressive symptoms, anxiety, stres...

Background Menstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent gir...

Study tools in Nepali. (PDF)

Unofficial English translation of study tools. (PDF)

Men who have sex with men (MSM) are considered to be one of the groups most at risk of contracting HIV. However, to date, information regarding MSM’s sexual behaviors and the risk factors for their concurrent sexual partnerships (CSP) have not been known in Myanmar. This study aimed to identify factors associated with CSP among MSM.A cross-sectiona...

When intimate partner violence (IPV) data are collected from only one partner, they are often subject to considerable reporting bias. However, it is not easy to collect such data from couples, and inaccuracies might result in discrepancies, which needs a resolution. We assessed the concordance on reports of lifetime and previous year physical, sexu...

Perceived social support, coping strategy, and internalized stigma have been linked with the quality of life (QOL) among people living with HIV (PLHIV). However, little is known about how these psychosocial factors interact with each other and affect QOL. This study incorporated a moderated mediation model to investigate whether coping strategy med...

Abstract Background HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-...

Background: Lower serum albumin levels and depression are common among HIV-infected persons. High serum albumin levels may provide protection against depression through its defensive role in inflammation and infection. We tested the hypothesis of an independent relationship between serum albumin levels and depressive symptoms in a cohort of HIV-in...

In Asian concentrated HIV epidemics, data on coinfection of sexually transmitted infections (STIs) among HIV-positive individuals are limited. The authors measured the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and syphilis, and their correlates among 319 HIV-positive individuals in Kathmandu, Nepal. The authors tested bloo...

Youth Leaders Program (YLP) is a health intervention implemented in a rural Alaskan school district, which utilizes natural helpers and peer leaders to increase protective factors such as school engagement and personal/cultural identities, and to reduce risks associated with drug/alcohol abuse, violence, and bullying. Through these means, the progr...

Abstract Background Nutrition training can boost competence of health workers to improve children’s feeding practices. In this way, child undernutrition can be ameliorated in general populations. However, evidence is lacking on efficacy of such interventions among Human Immunodeficiency Virus (HIV)-positive children. We aimed to examine the efficac...

Antiretroviral therapy has dramatically improved the survival rate of perinatally HIV-infected children. For them to thrive, it is necessary to understand better their mental health issues. Caregivers play an important role in children's daily care and caregiver mental health may relate to children's mental health. However, this association has rar...

Youth Leaders Program (YLP) is a health intervention implemented in a rural Alaskan school district, which utilizes natural helpers and peer leaders to increase protective factors such as school engagement and personal/cultural identities, and to reduce risks associated with drug/alcohol abuse, violence, and bullying. Through these means, the progr...

Background Sex trading is a recognized risk factor for human immune deficiency virus infection and other sexually transmitted infections among non-injecting drug users (NIDUs). However, very little research has addressed the factors associated with sex trading among male NIDUs in Myanmar. MethodsA cross-sectional study was conducted from January to...

Objectives Appropriate infant and young child feeding (IYCF) for children aged 6–23 months includes adequate dietary diversity, appropriate meal frequency, and continued breastfeeding. Mothers receiving antenatal care (ANC) and postnatal care (PNC) may adopt better IYCF. This study examined the association of ANC or PNC attendance with IYCF and chi...

Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolesce...

Introduction: HIV-positive people's clinic attendance for medication pick-up is critical for successful HIV treatment. However, limited evidence exists on it especially in low-income settings such as Nepal. Moreover, the role of family support in clinic attendance remains under-explored. Therefore, this study was conducted to examine the associati...

Survey Questionnaire. (DOCX)

Background: Lack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was o...

Low zinc levels and chronic inflammation are common in individuals infected with human immunodeficiency virus (HIV). Zinc deficiency may promote systemic inflammation, but research on the role of zinc in inflammation among HIV-positive individuals taking account of anti-retroviral therapy is lacking. We assessed the association between serum zinc a...

Low levels of serum zinc concentrations and depression are common in persons infected with Human Immunodeficiency Virus (HIV). Low levels of serum zinc concentrations may increase risk of depression in general population. However, research on the role of zinc in depression among HIV- infected person is limited. We assessed the association between s...

Background: In Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developi...

Background and objectives: In spite of increased gambling opportunities, risk factors associated with recreational gambling remain poorly understood. This study assessed behavioral risk factors associated with frequency of recreational gambling. Methods: Data were derived from the 2013 Massachusetts Behavioral Risk Factor Surveillance System. Ga...

Background: Infection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are estimated to affect 185 and 35 million of the world’s population, respectively. Due to share transmission routes, co-infection is common and can negatively affect the natural course of chronic hepatitis C infection as well as accelerate liver toxicity in H...

The purpose of this study was to examine the association between perceived family support, either positive or negative, and adherence to antiretroviral medication regimens among HIV-positive individuals in the Kathmandu Valley, Nepal. We measured past 3-month antiretroviral adherence among 233 HIV-positive individuals, in relation to perceived fami...

For-hire three-wheeler crashes are a growing burden in Sri Lanka. We conducted this study to examine the factors associated with road traffic crashes (RTCs) among for-hire three-wheeler drivers in Sri Lanka. We conducted a case-control study in Kandy, Sri Lanka between August 2008 and March 2009. Cases were all the for-hire three-wheeler drivers in...

We evaluated the efficacy of a sexual risk reduction intervention utilizing protection motivation and social cognitive theories to address knowledge, threat and coping appraisals, and condom use intentions among HIV-positive individuals in Nepal. Using a quasi-experimental research design, we assigned 277 participants to intervention (n = 146) and...

Weight concerns and dieting are prevalent among female adolescents both in Western and Asian countries. They can result in negative psychological and physiological consequences. This study aimed to examine the relative importance of social and personal factors in the decision to diet among female adolescent students in Japan, applying the Theory of...

In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance mo...

Background: In many developing countries, intimate partner violence (IPV) training is not available for health providers. As a pioneer among developing countries, in 2009, the Sri Lankan Ministry of Health trained a group of community health providers known as public health midwives (PHMs) on IPV. We evaluated that training program's efficacy in i...

Background HIV infection has been frequently associated with zinc deficiency and depression. Zinc deficiency may increase the risk of depression in people without HIV. However, research on the role of zinc in depression among HIV‐positive people is limited. We assessed the association between serum zinc concentrations and depression in HIV‐positive...

Previous research has reported high rates of anemia in people living with HIV/AIDS (PLWHA) in hospital or tertiary care settings. The objective of this community-based study was to measure the prevalence of anemia and describe the risk factors, with a specific emphasis on HIV symptom burden, in PLWHA in the Kathmandu Valley, Nepal. We conducted a c...

Every year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because...

Massachusetts (MA) passed an Act Establishing Expanded Gaming in the Commonwealth in 2011. Increased prevalence of gambling disorders and co-occurring behavioral health addictions is associated with greater availability and proximity of gambling venues. This study evaluates prevalence of gambling and risk factors of co-occurring behavioral health a...

Introduction: HIV/AIDS remains a very serious public health problem, affecting over 33 million people globally. Because its route of transmission is similar to hepatitis C virus (HCV), co-infection is often common. In highly endemic populations such as Africa where the extent of HCV and HIV/AIDS co-infection remains unknown, a quantitative estimate...

Background India accounts for the highest number of malaria cases outside of Africa. Eighty per cent of India’s population lives in malaria-risk areas, with cases increasing in urban areas. Mumbai, India, one of the most populous cities in the world, has experienced such an increase. To be successful, many malaria control efforts require community...

Background Methamphetamine (MA) use has a strong correlation with risky sexual behaviors, and thus may be triggering the growing HIV epidemic in Myanmar. Although methamphetamine use is a serious public health concern, only a few studies have examined HIV testing among young drug users. This study aimed to examine how predisposing, enabling and nee...

Background: Human Immunodeficiency Virus (HIV) infection has been frequently associated with chronic inflammation as well as depression. C-reactive protein (CRP) is positively associated with depression in people without HIV infection. We tested the hypothesis of an independent relationship between CRP and depression in a cohort of HIV-positive pe...

Methods: We conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32 care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and qualitative data through seven focus group discussions (FGDs). Results: HIV-positive children had high magnitu...

Background: Depression is emerging as a highly prevalent psychiatric condition among people living with HIV/AIDS (PLWHA). Perceived family support (PFS) buffers depression among chronic disease patients. However, a similar relationship among PLWHA is unexplored. Objective: To examine the relationship between PFS and depression among PLWHA in the...

Background: Previous research has studied the rate of hepatitis C virus (HCV) coinfection among HIV-positive people regardless of their antiretroviral therapy (ART) status. Our objectives were to measure the seroprevalence of HCV both in HIV-positive people receiving ART and in those not receiving ART and to describe the characteristics of coinfec...

Intimate partner violence (IPV) is a serious global public health issue. Acceptance of wife beating is known to be associated with IPV, but few studies have analysed the acceptance of wife beating from both women and men's points of view. The objective of this study was to examine whether acceptance of wife beating among couples is associated with...

Depression and suicidal thinking occur frequently alongside HIV/AIDS, triggering profound detrimental impacts on quality of life, treatment adherence, disease progression, and mortality. Yet the psychosocial factors contributing to these psychiatric comorbidities remain underexplored, particularly in the developing country context. This study thus...

Depression rates are high among college students in Turkey, but often students do not seek mental health care. This study aimed to examine the association between attitudes toward seeking professional psychological help and intention to seek professional psychological help among such college students. We also examined the factors associated with st...

BACKGROUND: Cambodia recently achieved universal access to ART. Estimated new HIV infections decreased from 20,000 in 1995 to 1,500 in 2011. To move towards zero new HIV infections, we investigated progress and challenges of continuum of care, particularly HIV case detection and retention in care. METHODS: Using programmatic data up to December 201...

Background: Suicidal ideation is common among HIV-positive people. Although various correlates, such as demographic, psychosocial, and life-style factors of suicidal ideation have been investigated, the role of family support is still unknown. We assessed the relationship between perceived family support and suicidal ideation among HIV-positive peo...

Background: Highly Active Antiretroviral Therapy (HAART) reduces serum 25-hydroxyvitamin D (25[OH]D) levels in people with Human Immunodeficiency Virus (HIV) infection. Though the effect of different anti-retroviral drugs on serum 25(OH)D levels has been investigated, the effect of time spent on HAART on serum 25(OH)D levels has received less atten...

Background: Feeding practices and child undernutrition can be improved when trained health workers provide proper nutrition counseling to caregivers. However, this important management component is difficult to achieve in countries where trained health workers are limited; Tanzania is no exception. In rural and semi-urban areas, mid-level provider...

Background: Medical and nursing education lack adequate practical nutrition training to fit the clinical reality that health workers face in their practices. Such a deficit creates health workers with poor nutrition knowledge and child undernutrition management practices. In-service nutrition training can help to fill this gap. However, no systemat...

Background Although antiretroviral therapy (ART) has significantly slowed disease progression and increased longevity among people living with HIV/AIDS (PLWHA), the potential impact on psychological variables is yet poorly understood. Profound changes in the lived experience and perception of illness resulting from ART introduction could potentiall...

Objectives HIV testing is an effective intervention for reducing HIV risk and providing information on HIV status. However, uptake of HIV testing is a major challenge within the drug-using population due to the stigma and discrimination associated with their illegal drug use behaviours. This study thus aimed to identify factors associated with HIV...

Background Nutrition training of health workers can help to reduce child undernutrition. Specifically, trained health workers might contribute to this end through frequent nutrition counseling of caregivers. This may improve child-feeding practices and thus reduce the risk of undernutrition among children of counseled caregivers. Although studies h...

Background Pelvic organ prolapse (POP) is a common gynecological condition that can affect quality of life (QOL) in women. In Nepal, the prevalence of POP is high, but many affected women are still deprived of treatment. Vaginal hysterectomy with pelvic floor repair is one of the common treatment options for advanced POP. However, QOL outcomes afte...

Background C‐reactive protein (CRP) has been associated with disease progression in HIV‐positive people. Polyunsaturated fatty acids (PUFA) are known to be inversely related to CRP in people without HIV. We tested the hypothesis of an independent relationship between PUFA and CRP in a HIV‐positive people. Methods A cross‐sectional study was conduc...

Background C‐reactive protein (CRP) has been associated with survival of HIV‐positive people. B ‐vitamin such as B‐6, B‐12 and folic acid are known to be inversely associated to CRP in people without HIV‐infection. We tested the hypothesis that higher intakes of B‐vitamin are associated with lower levels of CRP in a HIV‐positive people. Methods A...

Background School-based sex education is an effective medium to convey health information and skills about preventing sexually transmitted infections (STIs) and unwanted pregnancies among adolescents. However, research on school-based sex education is limited in many developing countries, including Nepal. This study thus had two main objectives: (1...

Student Questionnaire. The student questionnaire included questions on socio-demographic characteristics of students, their perceptions about sex education in their schools, and their attitudes toward abstinence and intentions for safer sex.

Human immunodeficiency virus (HIV) infection has frequently been associated with vitamin D deficiency as well as chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D [25(OH)D] and high-sensitivity C-reactive protein (CRP) in a cohort of HIV-positive people. A cros...

This study examines the acculturation effects on metabolic syndrome (MetS), and its related factors, among immigrant Japanese-Brazilian men in Japan. Quantitative and qualitative approaches were utilized. In the quantitative study (n = 149), multiple logistic regression analyses estimated the impact of length of residence and arrival age on MetS. F...

Background Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. Methods A cross-sectional study was conducted in the Lalitpur and Kathmandu district...

Background The global initiative ‘Treatment 2.0’ calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectednes...

Background The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotecte...

Objective: To evaluate the relationship between arsenic exposure and oral cavity lesions among an arsenic-exposed population in Bangladesh. Methods: We carried out an analysis utilizing the baseline data of the Health Effects of Arsenic Exposure Longitudinal Study, which is an ongoing population-based cohort study to investigate health outcomes...

Interest in the role of polyunsaturated fatty acids (PUFAs), particularly long-chain n-3 PUFAs, in mental health is increasing. Epidemiologic and case-control data suggest that increased dietary intake of n-3 PUFAs may be of benefit in alleviating different mental health problems. However, the results of randomized controlled trials are inconsisten...

Background Buses are the main mode of passenger transport in Sri Lanka operated by both government and private sectors. However, private sector buses carry a greater risk of crashes than the government sector buses. Objectives This study aimed to explore the driver factors for private bus crashes in Kandy District, Sri Lanka and the effects of work...

Background Intimate partner violence (IPV) is a global public health problem that has several associations. Objectives We conducted this study to examine the association between wives’ attitudes towards gender roles and their experience of different types of IPV in Central province, Sri Lanka. Methods We carried out a community-based cross sectiona...

Contamination of groundwater by inorganic arsenic is one of the major public-health problems in Bangladesh. This cross-sectional study was conducted (a) to evaluate the quality of life (QOL) and mental health status of arsenic-affected patients and (b) to identify the factors associated with the QOL. Of 1,456 individuals, 521 (35.78%) were selected...

HIV/AIDS is associated with an increased burden of undernutrition among children even under antiretroviral therapy (ART). To treat undernutrition, WHO endorsed the use of Ready to Use Therapeutic Foods (RUTF) that can reduce case fatality and undernutrition among ART-naïve HIV-positive children. However, its effects are not studied among ART-treate...

Cambodia has been investing in Village Malaria Workers (VMWs) to improve malaria case management in rural areas. This study assessed the quality of the VMWs' services compared to those by a government-run health center from the perspective of community members. We focused on VMWs' contribution to promote their action to control malaria. A community...