Faculty Bibliography

Objectives: In order to develop effective teaching methods for contraceptive education, researchers require a validated, reliable tool to measure subjects' contraceptive knowledge. However, most widely used indices are outdated and no longer useful. The objective of this study was to create and assess the validity and reliability of a novel assessment tool for measuring contraceptive knowledge. Method: The study tool was validated using both qualitative and quantitative methods. The tool was developed by the research team and then reviewed by a selected group of experts. Participants for testing the tool included English-speaking men and women ages 15- 45 at a single institution. Structured interviews were conducted with a randomly selected group of patients for qualitative feedback regarding the readability and ease of administration and the study tool was adapted accordingly. Quantitative tests included (1) comparison with a gold standard; (2) test-retest reliability; (3) comparison between a group with low contraceptive knowledge and a group with high contraceptive knowledge. Results: Qualitative feedback was obtained on the 25-question knowledge assessment tool from 6 experts and 7 patients. The study tool was administered to a total of 102 patients, with a mean score of 9.0. In comparison with the gold standard, the mean score was significantly higher (new tool 9.1 vs. gold standard 5.8, p<0.001). Test-retest reliability was demonstrated via repeat testing within 2- 4 weeks, demonstrating no difference between test and retest in the same subjects (p=0.667). When compared to medical students, patients' mean scores were significantly lower as expected (patients 9.1 vs. medical students 19.4, p<0.005). Conclusions: We have designed a valid and reliable study tool to measure a person's level of knowledge regarding contraception. This tool will allow the assessment of baseline knowledge, educational gaps, and post-educational knowledge achievements after an intervention

Objectives: Primary objective: to determine the prevalence of prior physical, sexual and emotional abuse among survivors of sex trafficking and sexual violence. Secondary objectives: to determine the prevalence of (1) unplanned pregnancy, (2) sexually transmitted infections (STI), (3) prior obstetrical complications, and (4) uptake of family planning among survivors of sex trafficking and sexual violence. Method: This is a retrospective cohort study with chart review of electronic medical records from the EMPOWER clinic at Gouverneur Health. The EMPOWER clinic for Survivors of Sex Trafficking and Sexual Violence provides integrated psychiatric and gynecologic care to survivors of sex trafficking and sexual violence. Data was collected in a REDCap database and analyzed using Stata v13. Outcomes were evaluated using descriptive statistics. Results: Of 51 women, 76.0% had been trafficked, and 91.9% of those were trafficked for sex work. Most of the women spoke Spanish (68.6%) and nearly half are from Mexico (47.1%). The prevalence of prior physical, sexual or emotional abuse was 38.8%, 32.7%, and 26.5%, respectively. On initial intake, a large majority desired a routine exam (82.3%) and/or reported specific symptoms (74.5%), while 9.8% with unplanned pregnancy at the time of intake. Of the women with prior pregnancies, 28.2% reported prior pregnancy complications and 27.5% of all patients reported a prior STI. Only 19.6% were using effective contraception. Conclusions: Most of the women presenting to EMPOWER are from Mexico or other Latin American countries, but there is a wide geographical range represented in the cohort. Prior history of physical, sexual, or emotional abuse is common. There appears to be a high prevalence of unplanned pregnancy, as well as a high prevalence of reported prior pregnancy complications. While most requested a routine exam, the vast majority also had a specific symptom requiring evaluation. There is a high unmet need for contraception among this population, and although all undergo contraceptive counseling, uptake of effective contraception is still inadequate

Objectives: Intimate partner violence (IPV) is a known public health concern and growing problem. Prevalence may be higher within Latino communities than the general population, which has a number of barriers to reporting IPV. The objective of this study is to determine the prevalence of intimate partner violence among Latina women at Gouverneur Health using ACASI, and to elicit reasons why women do not report domestic violence. Method: Subjects were approached in the waiting room of a women's health clinic of Gouverneur Health, a Medicaid and low-income clinic in New York City. A research assistant demonstrated use of the ACASI on an iPad, which included simple yes/no questions and read the questions aloud as well as displayed them on a screen. Subjects were anonymous and filled out the questionnaire independently. Data was collected automatically from the iPad questionnaire using Google analytics into a csv database, and analyzed using Stata v.13. Results: Physical violence by a current partner has occurred for 16.7%, while 55.5% reporting physical violence by a part partner, though only 37.5% characterized this as physical abuse. Past sexual abuse was reported by 37.5%. Most common reasons for not reporting to a doctor included concerns about being judged and hope that the situation would improve, though 57.1% said that they would have reported if asked. Common reasons for not reporting to police include concerns about being judged, fears about deportation, and financial concerns for the family. Forty percent reported knowing a friend or family member who suffers from domestic violence. Conclusions: Prevalence of intimate partner violence is high, though women may not recognize certain acts by their partners as physical, emotional or sexual abuse. Women would like to report to an authority figure like a doctor, but concerns about being judged by others, as well as practical concerns of deportation and financial concerns, prevent them from reporting the abuse. The ACASI method is a feasible and acceptable method of screening for domestic violence

OBJECTIVE:: Combination antiretroviral therapy (ART) is now the global standard for HIV-infected pregnant and breastfeeding women at all CD4 cell counts. We compared the efficacy and safety of an efavirenz versus lopinavir/ritonavir regimen for HIV-infected pregnant women initiating ART in rural Uganda. DESIGN:: Randomized clinical trial. METHODS:: We performed a planned secondary analysis comparing viral load suppression (HIV-1 RNA