Megan Mahoney

All Publications

• Utilization of health services in a resource-limited rural area in Kenya: prevalence and associated household-level factors PLoS One Ngugi, A., Agoi, F., Mahoney, M., Lakhani, A., Mang’ong’o, D., Nderitu, E., Macfarlane, S. 2017
• Preparing Family Physicians to Care for Underserved Populations: A Historical Perspective Family Medicine Rodgers, D., Wendling, A., Saba, G., Mahoney, M., Brown Speights, J. 2017
• An academic achievement calculator for clinician-educators in primary care Family Medicine Lin, S., Mahoney, M., Singh, B., Schillinger, E. 2017
• Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors. PloS one Ngugi, A. K., Agoi, F., Mahoney, M. R., Lakhani, A., Mang'ong'o, D., Nderitu, E., Armstrong, R., MacFarlane, S. 2017; 12 (2)

  Abstract

  Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services.1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

  View details for DOI 10.1371/journal.pone.0172728

  View details for PubMedID 28241032

  View details for PubMedCentralID PMC5328402

• Community-Oriented Primary Care Curricula in Kenyan Family Medicine Residencies. African Journal of Primary Health Care and Family Medicine Nelligan, I., Shabani, J., Tache, S., Mohamoud, G., Mahoney, M. 2017
• An assessment of implementation of CommunityOriented Primary Care in Kenyan family medicine postgraduate medical education programmes. African journal of primary health care & family medicine Nelligan, I. J., Shabani, J., Taché, S., Mohamoud, G., Mahoney, M. 2016; 8 (1): e1-e4

  Abstract

  Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya.Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed.Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support.Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

  View details for DOI 10.4102/phcfm.v8i1.1064

  View details for PubMedID 28155322

  View details for PubMedCentralID PMC5153406

• "I have it just like you do": voices of HIV-negative partners in serodifferent relationships receiving primary care at a public clinic in San Francisco. AIDS care Mahoney, M., Weber, S., Bien, M., Saba, G. 2015; 27 (3): 401-408

  Abstract

  HIV transmission among serodifferent couples has a significant impact on incidence of HIV worldwide. Antiretroviral interventions (i.e., preexposure prophylaxis, post-exposure prophylaxis, and treatment as prevention) are important aspects of comprehensive prevention and care for serodifferent couples. In this study, HIV-negative members of serodifferent couples were interviewed using open-ended questions to explore their health-care needs, perceptions of clinic-based prevention services, and experience of having an HIV-infected partner. Analysis of interviews with 10 HIV-negative partners revealed the following themes: (1) health needs during joint medical visits; (2) sexual risk reduction strategies; (3) relationship dynamics; and (4) strategies for coping. This study elucidated relationship, health and health care factors that might affect development and implementation of clinic-based prevention interventions for HIV serodifferent couples. The findings point to possible relationship-centered recommendations for health-care providers who serve HIV-affected couples in clinical settings.

  View details for DOI 10.1080/09540121.2014.964659

  View details for PubMedID 25311152

• Global-Local Framework on Medical Vulnerabilities Medical Management of Underserved and Vulnerable Populations Stephanie, T., Sarah, M., Megan, M., Kevin, G. 2015
• AIDS Family Medicine Saberi, P., Mahoney, M., Goldschmidt, R. McGraw-Hill. 2014; 6
• Reversely Innovative Journal for the San Francisco Medical Association Mahoney, M. 2014
• Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response LIVER INTERNATIONAL Lubega, S., Agbim, U., Surjadi, M., Mahoney, M., Khalili, M. 2013; 33 (7): 999-1007

  Abstract

  Formal Hepatitis C virus (HCV) education improves HCV knowledge but the impact on treatment uptake and outcome is not well described. We aimed to evaluate the impact of formal HCV patient education on primary provider-specialist HCV comanagement and treatment.Primary care providers within the San Francisco safety-net health care system were surveyed and the records of HCV-infected patients before and after institution of a formal HCV education class by liver specialty (2006-2011) were reviewed retrospectively.Characteristics of 118 patients who received anti-HCV therapy were: mean age 51, 73% males and ~50% White and uninsured. The time to initiation of HCV treatment was shorter among those who received formal education (median 136 vs 284 days, P < 0.0001). When controlling for age, gender, race and HCV viral load, non-1 genotype (OR 6.17, 95% CI 2.3-12.7, P = 0.0003) and receipt of HCV education (OR 3.0, 95% CI 1.1-7.9, P = 0.03) were associated with sustained virologic treatment response. Among 94 provider respondents (response rate = 38%), mean age was 42, 62% were White, and 63% female. Most providers agreed that the HCV education class increased patients' HCV knowledge (70%), interest in HCV treatment (52%), and provider-patient communication (56%). A positive provider attitude (Coef 1.5, 95% CI 0.1-2.9 percent, P = 0.039) was independently associated with referral rate to education class.Formal HCV education expedites HCV therapy and improves virologic response rates. As primary care provider attitude plays a significant role in referral to HCV education class, improving provider knowledge will likely enhance access to HCV specialty services in the vulnerable population.

  View details for DOI 10.1111/liv.12150

  View details for Web of Science ID 000321344000005

  View details for PubMedID 23509897

• ADAPTATION OF AN EVIDENCE-BASED HIV PREVENTION INTERVENTION FOR WOMEN WITH INCARCERATED PARTNERS: EXPANDING TO COMMUNITY SETTINGS AIDS EDUCATION AND PREVENTION Mahoney, M., Bien, M., Comfort, M. 2013; 25 (1): 1-13

  Abstract

  High rates of incarceration in urban, low income communities may exacerbate women's risk of HIV infection by decreasing the number of available male sexual partners and disrupting long-term partnerships. The Health Access Program for Prevention, Empowerment, and Networking for Women (HAPPEN) was established to address the HIV prevention needs of women partnered with incarcerated or recently released men in community settings. HAPPEN is an adaptation of the evidence-based HIV prevention intervention Health Options Mean Empowerment (HOME) project. HOME was designed specifically for women visiting their incarcerated male partners and was delivered at a prison visiting center. Recruitment and program implementation for HAPPEN occurred at community-based organizations serving women with histories of substance abuse, intimate partner violence and incarceration, and provided health education, HIV testing, and linkage to health care and social services. This paper describes the process of adapting HOME using input from target organization stakeholders and target population members.

  View details for Web of Science ID 000315129800001

  View details for PubMedID 23387947

• Applying HIV Testing Guidelines in Clinical Practice AMERICAN FAMILY PHYSICIAN Mahoney, M. R., Fogler, J., Weber, S., Goldschmidt, R. H. 2009; 80 (12): 1441-1444

  Abstract

  An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission.

  View details for Web of Science ID 000273015000012

  View details for PubMedID 20000306

• Clinicians' knowledge of 2007 Food and Drug Administration recommendation to discontinue nelfinavir use during pregnancy. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002) Fogler, J., Weber, S., Mahoney, M. R., Goldschmidt, R. H. 2009; 8 (4): 249-252

  Abstract

  In 2007, the US Food and Drug Administration (FDA) and Pfizer Inc recommended immediate discontinuation of nelfinavir (NFV) during pregnancy due to contamination with a potential teratogen. A few weeks after the announcement, we surveyed antenatal HIV care providers to determine how widely the warning was disseminated. Overall, 69 of 121 (57.0%) providers knew to discontinue NFV. Callers with more than 50 HIV-infected patients were 2.54 times as likely to be aware as callers with 1-3 HIV-infected patients (P < .01). Only 12 (33.3%) obstetricians were aware, compared to 21 (80.8%) infectious diseases specialists (P < .001). The FDA/Pfizer Inc recommendation to avoid nelfinavir mesylate (NFV) in pregnancy appears to have successfully reached HIV experts. However, not all pregnant women have access to experts and may receive most of their care from providers without extensive HIV experience. More effective dissemination of critical HIV-related information to all antenatal care providers, including general obstetricians, family physicians, and midwives, may be needed.

  View details for DOI 10.1177/1545109709337034

  View details for PubMedID 19506052

• . In Reply to HIV Testing: Removing Barriers Can Lead to Earlier Detection and Reduced Transmission American Family Physician Goldschmidt, R., Mahoney, M., Neff, S., Weber, S. 2009
• Minority Faculty Voices on Diversity in Academic Medicine: Perspectives From One School ACADEMIC MEDICINE Mahoney, M. R., Wilson, E., Odom, K. L., Flowers, L., Adler, S. R. 2008; 83 (8): 781-786

  Abstract

  To examine the perceptions and experiences of ethnic minority faculty at University of California-San Francisco regarding racial and ethnic diversity in academic medicine, in light of a constitutional measure outlawing race- and gender-based affirmative action programs by public universities in California.In 2005, underrepresented minority faculty in the School of Medicine at University of California-San Francisco were individually interviewed to explore three topics: participants' experiences as minorities, perspectives on diversity and discrimination in academic medicine, and recommendations for improvement. Interviews were tape-recorded, transcribed verbatim, and subsequently coded using principles of qualitative, text-based analysis in a four-stage review process.Thirty-six minority faculty (15 assistant professors, 11 associate professors, and 10 full professors) participated, representing diversity across specialties, faculty rank, gender, and race/ethnicity. Seventeen were African American, 16 were Latino, and 3 were Asian. Twenty participants were women. Investigators identified four major themes: (1) choosing to participate in diversity-related activities, driven by personal commitment and institutional pressure, (2) the gap between intention and implementation of institutional efforts to increase diversity, (3) detecting and reacting to discrimination, and (4) a need for a multifaceted approach to mentorship, given few available minority mentors.Minority faculty are an excellent resource for identifying strategies to improve diversity in academic medicine. Participants emphasized the strong association between effective mentorship and career satisfaction, and many delineated unique mentoring needs of minority faculty that persist throughout academic ranks. Findings have direct application to future institutional policies in recruitment and retention of underrepresented minority faculty.

  View details for Web of Science ID 000267654300013

  View details for PubMedID 18667896

• Care of HIV-infected Latinos in the United States: A description of calls to the National HIV/AIDS Clinicians' Consultation Center 20th Annual Conference of the Association-of-Nurses-in-AIDS-Care Mahoney, M. R., Khamarko, K., Goldschmidt, R. H. ELSEVIER SCIENCE INC. 2008: 302–10

  Abstract

  HIV disproportionately affects the Latino population in the United States. Little is known about clinicians who provide HIV care to the Latino community or the types of issues they face. This report presents descriptive analyses of calls made by clinicians who care for HIV-infected Latinos to two lines of the National HIV/AIDS Clinicians' Consultation Center, the National HIV Telephone Consultation Service (Warmline) and the National Perinatal HIV Consultation and Referral Service (Perinatal HIV Hotline). Separate analyses of data from Latino clinicians are also presented. The majority of Warmline calls about Latino patients (81.0%) concerned antiretroviral treatment strategies or HIV-related conditions. More than half (54.3%) of perinatal-specific calls concerned HIV management during pregnancy and the care of HIV-exposed infants. Latino clinicians most frequently called about minority patients. This descriptive study adds to the growing literature about the care of the Latino HIV-infected patient. The Warmline and Perinatal HIV Hotline are resources for HIV care providers in the nursing and medical care of Latinos.

  View details for DOI 10.1016/j.jana.2008.05.002

  View details for Web of Science ID 000257758100007

  View details for PubMedID 18598905

• African-American clinicians providing HIV care: The experience of the national HIV/AIDS clinicians' consultation center JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Mahoney, M. R., Sterkenburg, C., Thom, D. H., Goldschmidt, R. H. 2008; 100 (7): 779-782

  Abstract

  This analysis compares patient and provider characteristics of African-American clinicians and non-African-American clinicians who called the National HIV Telephone Consultation Service (Warmline). In 2004, a total of 2,077 consultations were provided for 1,020 clinicians, 70 (6.9%) of whom were African American. Compared to the non-African-American group, a higher percentage of African-American clinicians were nurses (20.0% vs. 8.8%, p=0.002). A significantly lower percentage of African-American physicians were infectious disease specialists (3.5% vs. 25.6%, p=0.007). African-American clinicians were more likely to work in a community clinic (48.5% vs. 34.1%, p=0.015). Both African-American and non-African American clinicians reported caring for a similar number of HIV-infected patients. Patient-provider racial concordance was common among African-American clinicians (76.4%), whereas non-African-American clinicians called about patients of more diverse racial and ethnic backgrounds. African-American clinicians who called Warmline exhibited differences in patient and provider characteristics when compared to all other clinicians. These findings contribute to the growing body of research on HIV providers in the United States.

  View details for Web of Science ID 000257844700001

  View details for PubMedID 18672554

• Chronic Care Program: Hepatitis C California Department of Corrections and Rehabilitation. Inmate Medical Services Policies and Procedures edited by Mahoney, M. 2008
• Consultation needs in perinatal HIV care: experience of the National Perinatal HIV consultation service AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Fogler, J. A., Weber, S., Goldschmidt, R. H., Mahoney, M. R., Cohan, D. 2007; 197 (3): S137-S141

  Abstract

  This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.

  View details for DOI 10.1016/j.ajog.2007.02.033

  View details for Web of Science ID 000249582700019

  View details for PubMedID 17825645

• Syphilis Taylor's 10-minute diagnosis manual: symptoms and signs in the time-limited encounter Mahoney, M. 2007
• AIDS Family Medicine 5th Edition Cocohoba, J., Mahoney, M., Goldschmidt, R. 2007
• The changing role of family physicians in HIV care AMERICAN FAMILY PHYSICIAN Mahoney, M. R., Goldschmidt, R. H. 2006; 74 (10): 1683-1684

  View details for Web of Science ID 000242144600002

  View details for PubMedID 17136997

• HIV Infection: Clues to Timely Diagnosis. Consultant Mahoney, M., Fogler, J. 2006; 46 (8): 853-860
• Beyond Antiretrovirals Synapse Mahoney, M. 2000