Browsing by Author "Duwve, Joan M."

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    Building Cancer Control Capacity in Health Professionals Through Telementoring: A Survey Study of a Cancer Prevention and Survivorship Care ECHO Program
    (IOS Press, 2022) Milgrom, Zheng Z.; Severance, Tyler S.; Scanlon, Caitlin M.; Carson, Anyé T.; Vik, Terry A.; Duwve, Joan M.; Dixon, Brian E.; Mendonca, Eneida A.; Pediatrics, School of Medicine
    Project Extension for Community Healthcare Outcomes (Project ECHO©) was developed to democratize knowledge among health professionals in underserved communities. Evidence supporting the use of this model for cancer control is limited. Using surveys adapted from Moore’s evaluation framework, we evaluated the training outcomes of an ECHO program on cancer prevention and survivorship care. The study provides preliminary evidence that the ECHO model is a feasible way to build cancer control capacity among the healthcare workforce.
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    Enhancing cancer prevention and survivorship care with a videoconferencing model for continuing education: a mixed-methods study to identify barriers and incentives to participation
    (Oxford University Press, 2022-02-12) Milgrom, Zheng Z.; Severance, Tyler S.; Scanlon, Caitlin M.; Carson, Anyé T.; Janota, Andrea D.; Burns, John L.; Vik, Terry A.; Duwve, Joan M.; Dixon, Brian E.; Mendonca, Eneida A.; Epidemiology, School of Public Health
    Objective: To enhance cancer prevention and survivorship care by local health care providers, a school of public health introduced an innovative telelearning continuing education program using the Extension for Community Healthcare Outcomes (ECHO) model. In ECHO's hub and spoke structure, synchronous videoconferencing connects frontline health professionals at various locations ("spokes") with experts at the facilitation center ("hub"). Sessions include experts' didactic presentations and case discussions led by spoke site participants. The objective of this study was to gain a better understanding of the reasons individuals choose or decline to participate in the Cancer ECHO program and to identify incentives and barriers to doing so. Materials and methods: Study participants were recruited from the hub team, spoke site participants, and providers who attended another ECHO program but not this one. Participants chose to take a survey or be interviewed. The Consolidated Framework for Implementation Research guided qualitative data coding and analysis. Results: We conducted 22 semistructured interviews and collected 30 surveys. Incentives identified included the program's high-quality design, supportive learning climate, and access to information. Barriers included a lack of external incentives to participate and limited time available. Participants wanted more adaptability in program timing to fit providers' busy schedules. Conclusion: Although the merits of the Cancer ECHO program were widely acknowledged, adaptations to facilitate participation and emphasize the program's benefits may help overcome barriers to attending. As the number of telelearning programs grows, the results of this study point to ways to expand participation and spread health benefits more widely.
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    An evaluation of an Extension for Community Healthcare Outcomes (ECHO) intervention in cancer prevention and survivorship care
    (BMC, 2022-05-17) Milgrom, Zheng Z.; Severance, Tyler S.; Scanlon, Caitlin M.; Carson, Anyé T.; Janota, Andrea D.; Vik, Terry A.; Duwve, Joan M.; Dixon, Brian E.; Mendonca, Eneida A.; Pediatrics, School of Medicine
    To improve cancer care in Indiana, a telementoring program using the Extension for Community Healthcare Outcomes (ECHO) model was introduced in September 2019 to promote best-practice cancer prevention, screening, and survivorship care by primary care providers (PCPs). The aim of this study was to evaluate the program's educational outcomes in its pilot year, using Moore's Evaluation Framework for Continuing Medical Education and focusing on the program's impact on participants' knowledge, confidence, and professional practice. We collected data in 22 semi-structured interviews (13 PCPs and 9 non-PCPs) and 30 anonymous one-time surveys (14 PCPs and 16 non-PCPs) from the program participants (hub and spoke site members), as well as from members of the target audience who did not participate. In the first year, average attendance at each session was 2.5 PCPs and 12 non-PCP professionals. In spite of a relatively low PCP participation, the program received very positive satisfaction scores, and participants reported improvements in knowledge, confidence, and practice. Both program participants and target audience respondents particularly valued three features of the program: its conversational format, the real-life experiences gained, and the support received from a professional interdisciplinary community. PCPs reported preferring case discussions over didactics. Our results suggest that the Cancer ECHO program has benefits over other PCP-targetted cancer control interventions and could be an effective educational means of improving cancer control capacity among PCPs and others. Further study is warranted to explain the discrepancies among study participants' perceptions of the program's strengths and the relatively low PCP participation before undertaking a full-scale effectiveness study.
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    HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015
    (New England Journal of Medicine, 2016-07-21) Peters, Philip J.; Pontones, Pamela; Hoover, Karen W.; Patel, Monita R.; Galang, Romeo R.; Shields, Jessica; Blosser, Sara J.; Spiller, Michael W.; Combs, Brittany; Switzer, William M.; Conrad, Caitlin; Gentry, Jessica; Khudyakov, Yury; Waterhouse, Dorothy; Owen, S. Michele; Chapman, Erika; Roseberry, Jeremy C.; McCants, Veronica; Weidle, Paul J.; Broz, Dita; Samandari, Taraz; Mermin, Jonathan; Walthall, Jennifer; Brooks, John T.; Duwve, Joan M.; Indiana HIV Outbreak Investigation Team; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    BACKGROUND: In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. METHODS: We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. RESULTS: From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P<0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. CONCLUSIONS: Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. (Funded by the state government of Indiana and others.).
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    Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana
    (Elsevier, 2018-02) Broz, Dita; Zibbell, Jon; Foote, Carrie; Roseberry, Jeremy C.; Patel, Monita R.; Conrad, Caitlin; Chapman, Erika; Peters, Philip J.; Needle, Richard; McAlister, Cameron; Duwve, Joan M.; Sociology, School of Liberal Arts
    Background Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. Methods Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. Results All 25 participants were non-Hispanic white and the median age was 33 years (range: 19–57). All had ever injected extended-release oxymorphone (Opana® ER) and most (n = 20) described preparing Opana® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2–4 injections during an injection episode resulting from needing >1 mL water to prepare Opana® ER solution using 1 mL syringes and the frequent use of “rinse shots.” MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. Conclusions We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.