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Patel S.V.,Medical College Baroda | Baxi R.K.,Medical College Baroda | Patel S.N.,Unc Cecil eps Center For Health Services Research | Golin C.E.,Unc Cecil eps Center For Health Services Research | And 8 more authors.
Indian Journal of Sexually Transmitted Diseases | Year: 2012

Objectives: To know the perceptions regarding barriers and facilitators to cART adherence among people living with HIV/AIDS ( PLWHA). Materials and Methods: To adapt U.S. based SAFETALK "prevention with positives" intervention to be culturally relevant in Gujarat, India in assisting PLWHA, a formative study was conducted. We conducted 30 in-depth interviews with PLWHA in the local language, assessing the experiences, perceived barriers, and facilitators to combination antiretroviral therapy (cART) among PLWHA in Gujarat. PLWHA were selected from the Voluntary Counseling and Testing Centre (VCTC) in Gujarat. To triangulate interview findings, we conducted two focus group discussions (FGDs) with medical and non-medical providers, respectively. Results: Travel and commuting to clinic, fear of possible physical reactions, high cost of ART from private practitioners, CD4 count being in normal limits and resistance to medication acted as barriers to cART adherence. Initiation of cART was facilitated by family members' suggestion, advice of treating doctors and counselors, appropriate counseling before starting cART, belief that cART would aid in living a better and longer life and due to lowering of the CD4 count. Interpretation and Conclusions: Our study suggests that several issues need to be considered when providing cART. Further research is needed to study interactions between patients and their health care providers. Source

Do Y.K.,University of North Carolina at Chapel Hill | Do Y.K.,National University of Singapore | Carpenter W.R.,University of North Carolina at Chapel Hill | Carpenter W.R.,Lineberger Comprehensive Cancer Center | And 8 more authors.
Cancer Causes and Control | Year: 2010

Objective: To study the effect of healthcare access and other characteristics on physician trust among black and white prostate cancer patients. Methods: A three-timepoint follow-up telephone survey after cancer diagnosis was conducted. This study analyzed data on 474 patients and their 1,320 interviews over three time periods. Results: Among other subpopulations, black patients who delayed seeking care had physician trust levels that were far lower than that of both Caucasians as well as that of the black patients overall. Black patients had greater variability in their levels of physician trust compared to their white counterparts. Conclusions: Both race and access are important in explaining overall lower levels and greater variability in physician trust among black prostate cancer patients. Access barriers among black patients may spill over to the clinical encounter in the form of less physician trust, potentially contributing to racial disparities in treatment received and subsequent outcomes. Policy efforts to address the racial disparities in prostate cancer should prioritize improving healthcare access among minority groups. © 2009 Springer Science+Business Media B.V. Source

Carpenter W.R.,University of North Carolina at Chapel Hill | Carpenter W.R.,Unc Cecil eps Center For Health Services Research | Carpenter W.R.,Shaw University | Howard D.L.,Shaw University | And 5 more authors.
Cancer Causes and Control | Year: 2010

Objectives This study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis. Methods SEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening interval, and stage at diagnosis. Analysis also controlled for age, marital status, comorbidity, diagnosis year, geographic region, income, and receipt of surgery. Results Compared to whites, blacks diagnosed with prostate cancer were more likely to have had a longer PSA screening interval prior to diagnosis, including a greater likelihood of no pre-diagnosis use of PSA screening. Controlling for PSA screening interval was associated with a reduction in blacks' relative odds of being diagnosed with advanced (stage III or IV) prostate cancer, to a point that the stage at diagnosis was not statistically different from that of whites (OR=1.12, 95% CI=0.98-1.29). Longer intra-PSA intervals were systematically associated with greater odds of diagnosis with advanced disease. Conclusions More frequent or systematic PSA screening may be a pathway to reducing racial differences in prostate cancer stage at diagnosis, and, by extension, mortality. © Springer Science+Business Media B.V. 2010. Source

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