2025
Development and evaluation of an online HIV pre-exposure prophylaxis (PrEP) training program for community pharmacists to implement pharmacy-led PrEP services in Malaysia
Gan Y, Zaki R, Hafidzar S, Koh K, Nizaruddin M, Noh R, Khalid K, Yap A, Altice F, Lim S, Azwa I. Development and evaluation of an online HIV pre-exposure prophylaxis (PrEP) training program for community pharmacists to implement pharmacy-led PrEP services in Malaysia. PLOS ONE 2025, 20: e0328713. PMID: 40824910, PMCID: PMC12360552, DOI: 10.1371/journal.pone.0328713.Peer-Reviewed Original ResearchConceptsHIV pre-exposure prophylaxisPre-exposure prophylaxisCommunity pharmacistsTraining programPrEP servicesExploration-Preparation-Implementation-SustainmentKnowledge testOnline training programSimulation-based learningPrEP knowledgeClinical decision-makingPaired t-testKnowledge scoresPatient communicationParticipant feedbackBaseline assessmentDaily PrEPPharmacistsEligibility assessmentPrEP efficacyPrEPScore differencesPercentage scorePatient counselingClinical contraindicationsPilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®
Earnshaw V, Collier Z, Wong P, Saifi R, Chong N, Ng R, Azwa I, Basri S, Hassan A, Mousavi M, Omar S, Walters S, Haddad M, Kamarulzaman A, Altice F. Pilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®. AIDS Care 2025, 37: 1313-1331. PMID: 40736373, DOI: 10.1080/09540121.2025.2534539.Peer-Reviewed Original ResearchConceptsHIV-related stigmaClinical-related outcomesClinical Trial Registration:Scalable interventionsPilot randomized controlled trialQualitative focus groupsFocus group resultsQuantitative survey resultsSubgroup of participantsStigma reductionProject ECHOHIV testingIndividual healthcare facilitiesHIV preventionTrial Registration:Structural stigmaFocus groupsIntervention conditionHealthcare facilitiesStigmaGlobal disparitiesPotential benefitsRegistration:InterventionCliniciansPrescribing methadone in prison predicts linkage to HIV care after release from prison: A randomized and patient preference trial
Mobley A, Wegman M, Bazazi A, Shenoi S, Bromberg D, Ahmad A, Kamarulzaman A, Altice F. Prescribing methadone in prison predicts linkage to HIV care after release from prison: A randomized and patient preference trial. International Journal Of Drug Policy 2025, 137: 104733. PMID: 39923270, PMCID: PMC11875876, DOI: 10.1016/j.drugpo.2025.104733.Peer-Reviewed Original ResearchConceptsLinkage to HIV careHIV careIncrease linkage to HIV careTreatment-as-prevention strategiesHIV treatment cascadeHIV treatment outcomesOpen-label trialCox proportional hazards modelsPatient preference trialOpioid use disorderMalaysia’s largest prison.Impact of methadoneProportional hazards modelTreatment cascadeInverse probability weighted Cox proportional hazards modelAnalytic sampleStudy participantsCareTreatment outcomesPrescribed methadoneOpioidConfounding variablesHIVUse disorderHazards model
2024
HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician’s Propensity Towards HIV Activism in Malaysia
Chong N, Azwa I, Hassan A, Mousavi M, Wong P, Ng R, Saifi R, Basri S, Omar S, Walters S, Collier Z, Haddad M, Altice F, Kamarulzaman A, Earnshaw V. HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician’s Propensity Towards HIV Activism in Malaysia. AIDS And Behavior 2024, 28: 2780-2792. PMID: 38806844, PMCID: PMC11827331, DOI: 10.1007/s10461-024-04381-4.Peer-Reviewed Original ResearchConceptsExploratory factor analysisHIV-related stigmaIntra-class correlation coefficientPrimary care physiciansTest-retest reliabilityCronbach's alpha valuesOrientation ScaleCare physiciansStigma-relatedPsychometric evaluationHIV treatmentHIV activityAlpha valuesPsychometric qualitiesActivist identitiesHIVClinical practiceFactor analysisCliniciansCorrelation coefficientDay-to-dayStructured activitiesCronbachStigmaPhysiciansTesting the Feasibility and Acceptability of Using an Artificial Intelligence Chatbot to Promote HIV Testing and Pre-Exposure Prophylaxis in Malaysia: Mixed Methods Study.
Cheah M, Gan Y, Altice F, Wickersham J, Shrestha R, Salleh N, Ng K, Azwa I, Balakrishnan V, Kamarulzaman A, Ni Z. Testing the Feasibility and Acceptability of Using an Artificial Intelligence Chatbot to Promote HIV Testing and Pre-Exposure Prophylaxis in Malaysia: Mixed Methods Study. JMIR Human Factors 2024, 11: e52055. PMID: 38277206, PMCID: PMC10858413, DOI: 10.2196/52055.Peer-Reviewed Original ResearchConceptsUptake of HIV testingHIV testingPre-exposure prophylaxisUnified Theory of AcceptanceFrequency of HIV testingTheory of AcceptanceAI chatbotsPromote HIV testingMental health supportHIV risk assessmentHIV prevention effortsHIV-related informationMixed methods studyPresence of stigmaUse of technologyConsequences of HIVEffort expectancySexually transmitted infectionsWeb-based surveyEngaging MSMArtificial intelligenceTranscribed verbatimPrEP uptakeHealth supportMental health
2023
Pre-exposure prophylaxis service among men who have sex with men in Malaysia: findings from a discrete choice experiment
Dubov A, Altice F, Gutierrez J, Wickersham J, Azwa I, Kamarulzaman A, Gautam K, Shrestha R. Pre-exposure prophylaxis service among men who have sex with men in Malaysia: findings from a discrete choice experiment. Scientific Reports 2023, 13: 14200. PMID: 37648731, PMCID: PMC10468492, DOI: 10.1038/s41598-023-41264-5.Peer-Reviewed Original ResearchConceptsInjectable PrEPPre-exposure prophylaxis servicesDaily oral PrEPPre-exposure prophylaxisMalaysian MSMPrEP deliveryOral PrEPPrEP uptakeMSMPrEPLatent class analysisDiscrete choice experimentMenDelivery preferencesDelivery programsSexGroupClass analysisType of programPreference groupsOnline surveyProphylaxisInitiation rateHIVDosingBarriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia
Rosen A, Wickersham J, Altice F, Khati A, Azwa I, Tee V, Jeri-Wahrhaftig A, Luces J, Ni Z, Kamarulzaman A, Saifi R, Shrestha R. Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia. International Journal Of Environmental Research And Public Health 2023, 20: 5669. PMID: 37174187, PMCID: PMC10177799, DOI: 10.3390/ijerph20095669.Peer-Reviewed Original ResearchConceptsPre-exposure prophylaxisPrEP providersNominal group techniqueMalaysian MSMEvidence-based HIV prevention strategiesPatient-centered decision aidAwareness of PrEPHIV prevention strategiesPotential new strategyPrEP deliveryPrEP carePrEP initiationPrEP servicesPrEP uptakeDecision aidPrevention strategiesUnderstanding of barriersComplex clinical protocolsClinical protocolsMSMQualitative focus groupsCommunity stakeholdersPrEPProphylaxisMenClinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability
Shrestha R, Altice F, Khati A, Azwa I, Gautam K, Gupta S, Sullivan P, Ni Z, Kamarulzaman A, Phiphatkunarnon P, Wickersham J. Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability. JMIR MHealth And UHealth 2023, 11: e44468. PMID: 36795465, PMCID: PMC9982718, DOI: 10.2196/44468.Peer-Reviewed Original ResearchConceptsHIV prevention servicesINTERNATIONAL REGISTERED REPORT IDENTIFIERPrevention servicesMean ageHIV preventionPre-exposure prophylaxisHIV prevention outcomesHIV self-testing (HIVST) kitsParticipants' mean ageSelf-testing kitsHealth care settingsMobile health platformMalaysian MSMMixed-methods evaluationHIV testingCare settingsLocal clinicSystem Usability ScalePrevention outcomesDays of testingMSMSmartphone appPrEPHIVMean score
2022
Acceptability and Feasibility of Online, Asynchronous Photovoice with Key Populations and People Living with HIV
Earnshaw V, Cox J, Wong P, Saifi R, Walters S, Azwa I, Omar S, Collier Z, Hassan A, Lim S, Wickersham J, Haddad M, Kamarulzaman A, Altice F. Acceptability and Feasibility of Online, Asynchronous Photovoice with Key Populations and People Living with HIV. AIDS And Behavior 2022, 27: 2055-2069. PMID: 36463390, PMCID: PMC9734619, DOI: 10.1007/s10461-022-03938-5.Peer-Reviewed Original ResearchImpact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia
Bazazi A, Culbert G, Wegman M, Heimer R, Kamarulzaman A, Altice F. Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia. BMC Infectious Diseases 2022, 22: 837. PMID: 36368939, PMCID: PMC9652918, DOI: 10.1186/s12879-022-07804-6.Peer-Reviewed Original ResearchConceptsOpioid use disorderOpioid agonist therapyInfectious etiologyMost deathsUse disordersSample of menPrison releaseOpen-label trialT-lymphocyte countsPredictors of mortalityNational death recordsCrude mortality rateProportional hazards modelCovariate-adjusted modelsLow CD4Methadone initiationModified intentionAgonist therapySurvival benefitTreat analysisMethodsThis studyHIVHazards modelMortality rateMethadoneMobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey
Shrestha R, Maviglia F, Altice FL, DiDomizio E, Khati A, Mistler C, Azwa I, Kamarulzaman A, Halim MAA, Wickersham JA. Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey. Journal Of Medical Internet Research 2022, 24: e36917. PMID: 35877172, PMCID: PMC9361153, DOI: 10.2196/36917.Peer-Reviewed Original ResearchConceptsHIV prevention informationHIV preventionDrug usePrevention informationMalaysian menMHealth platformHIV risk-related behaviorsHIV prevention toolHIV prevention servicesSexual activityReceptive anal sexMobile health interventionsHIV prevention effortsUse of mHealthIllicit drug useSexualized drug useCross-sectional surveyAcceptability of mHealthHealth technology useSelf-administered questionnaireRespondent-driven samplingHealth-related informationSuboptimal engagementDearth of evidencePrevention servicesBarriers and Facilitators to Implementing Project ECHO in Malaysia During the COVID-19 Pandemic
Walters SM, Li WP, Saifi R, Azwa I, Omar S, Collier ZK, Hassan A, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. Barriers and Facilitators to Implementing Project ECHO in Malaysia During the COVID-19 Pandemic. Journal Of The International Association Of Providers Of AIDS Care (JIAPAC) 2022, 21: 23259582221128512. PMID: 36177542, PMCID: PMC9528038, DOI: 10.1177/23259582221128512.Peer-Reviewed Original Research
2021
HIV care continuum among cisgender and transgender women sex workers in Greater Kuala Lumpur, Malaysia
Ranjit YS, Gibson BA, Altice FL, Kamarulzaman A, Azwa I, Wickersham JA. HIV care continuum among cisgender and transgender women sex workers in Greater Kuala Lumpur, Malaysia. AIDS Care 2021, 35: 784-790. PMID: 34723714, PMCID: PMC9056582, DOI: 10.1080/09540121.2021.1995839.Peer-Reviewed Original ResearchConceptsTransgender women sex workersHIV care continuumAntiretroviral treatmentSex workersCare continuumWomen sex workersTransgender womenImportant key populationProportion of womenRespondent-driven sampling studyEvidence-based strategiesAntiretroviral therapyHIV careHIV prevalenceHIV epidemicHIVKey populationsWomenKuala LumpurCisgender womenCount testUnique needsSmall proportionTherapyPopulationAssessing mobile technology use and mHealth acceptance among HIV-positive men who have sex with men and transgender women in Malaysia
Krishnan A, Weikum D, Cravero C, Kamarulzaman A, Altice FL. Assessing mobile technology use and mHealth acceptance among HIV-positive men who have sex with men and transgender women in Malaysia. PLOS ONE 2021, 16: e0248705. PMID: 33755693, PMCID: PMC7987189, DOI: 10.1371/journal.pone.0248705.Peer-Reviewed Original ResearchConceptsSuboptimal ART adherenceTransgender womenAntiretroviral therapyART adherenceHIV-positive MSMHIV-positive populationInjection drug useHIV-positive menAcceptability of mHealthRisky sexual behaviorHIV preventionTreatment strategiesUnsafe sexDrug useMHealth acceptanceExcellent accessMHealth platformSexual behaviorMenMobile healthSocietal stigmaSexMSMMHealth researchWomenCorrelates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia
Wang M, Lim SH, Gibson BA, Azwa I, Guadamuz TE, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia. International Journal Of STD & AIDS 2021, 32: 609-619. PMID: 33752518, DOI: 10.1177/0956462420970417.Peer-Reviewed Original ResearchConceptsHIV infectionCisgender women sex workersWomen sex workersSex workersTransgender women sex workersMultivariable logistic regressionCondomless vaginal sexDetection of HIVUnique vulnerabilitiesHIV/Infection screeningHIVVaginal sexInfectionLogistic regressionEcstasy/MDMALower likelihoodLifetime useMost participantsKuala LumpurUnderstudied populationCorrelatesSex workers' experiencesPopulationChlamydia
2020
Using individual stated-preferences to optimize HIV self-testing service delivery among men who have sex with men (MSM) in Malaysia: results from a conjoint-based analysis
Shrestha R, Alias H, Wong LP, Altice FL, Lim SH. Using individual stated-preferences to optimize HIV self-testing service delivery among men who have sex with men (MSM) in Malaysia: results from a conjoint-based analysis. BMC Public Health 2020, 20: 1777. PMID: 33238941, PMCID: PMC7687720, DOI: 10.1186/s12889-020-09832-w.Peer-Reviewed Original ResearchConceptsClinic-based HIV testingHIV testing uptakeMethodsA cross-sectional online surveyCross-sectional online surveyNational AIDS ProgramAcceptability of HIVSTMalaysian MSMHIV testingTesting uptakeService delivery programsKey populationsHIVSTService delivery modelsAIDS ProgramMSMKit deliveryTelephone hotlineService delivery approachHigh acceptabilityDelivery programsMultiple barriersSafe useMean acceptabilityDelivery approachDelivery model
2019
Use of Smartphone to Seek Sexual Health Information Online Among Malaysian Men Who Have Sex with Men (MSM): Implications for mHealth Intervention to Increase HIV Testing and Reduce HIV Risks
Shrestha R, Lim SH, Altice FL, Copenhaver M, Wickersham JA, Saifi R, Ab Halim MA, Naning H, Kamarulzaman A. Use of Smartphone to Seek Sexual Health Information Online Among Malaysian Men Who Have Sex with Men (MSM): Implications for mHealth Intervention to Increase HIV Testing and Reduce HIV Risks. Journal Of Community Health 2019, 45: 10-19. PMID: 31375976, PMCID: PMC6957731, DOI: 10.1007/s10900-019-00713-x.Peer-Reviewed Original ResearchConceptsSexual health informationHIV testingHealth informationOnline sexual health informationSexual partnersRecent HIV testingHigh-risk MSMHIV/STIsHIV risk behaviorsHIV prevention activitiesCross-sectional online surveyHealth Information OnlineMalaysian MSMSTI preventionIndependent correlatesGeosocial networking appsHIV riskMHealth interventionsMHealth strategiesMHealth toolsRisk behaviorsOlder ageLogistic regressionMSMPrevention activitiesRetention in clinical trials after prison release: results from a clinical trial with incarcerated men with HIV and opioid dependence in Malaysia
Chandra DK, Bazazi AR, Solim M, Kamarulzaman A, Altice FL, Culbert GJ. Retention in clinical trials after prison release: results from a clinical trial with incarcerated men with HIV and opioid dependence in Malaysia. HIV Research & Clinical Practice 2019, 20: 12-23. PMID: 31303149, PMCID: PMC6698147, DOI: 10.1080/15284336.2019.1603433.Peer-Reviewed Original ResearchConceptsClinical trialsStudy visitHIV clinical trialsOpioid dependenceMethadone initiationStudy retentionHolistic Health Recovery ProgramPrison releaseHIV risk reduction interventionsRisk reduction interventionsIncarcerated menStandard careMethadone treatmentReduction interventionsStudy participantsFactorial trialHIVBehavioral interventionsTrialsVisitsMost participantsInterventionMenCommunity reentryRecovery program
2018
Evaluating Physicians’ Intention to Discriminate Against Patients Living with HIV in Malaysia
Tee YC, Earnshaw VA, Altice FL, Jin H, Kamarulzaman A, Wickersham JA. Evaluating Physicians’ Intention to Discriminate Against Patients Living with HIV in Malaysia. AIDS And Behavior 2018, 23: 1039-1047. PMID: 30560483, PMCID: PMC6459712, DOI: 10.1007/s10461-018-2362-4.Peer-Reviewed Original ResearchConceptsStigma-related constructsMajor university hospitalClasses of patientsCross-sectional online surveyNon-surgical specialtiesMore HIVSocio-demographic characteristicsUniversity HospitalHIV preventionTreatment strategiesPWHClinical experienceHIVBetter carePhysiciansMultivariate linear regressionMedical settingsInternational HIV preventionMost participantsLinear regressionPatientsCarePresent studyParticipantsStigmaCorrelates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia
Rutledge R, Morozova O, Gibson BA, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia. LGBT Health 2018, 5: 484-493. PMID: 30481120, PMCID: PMC6306652, DOI: 10.1089/lgbt.2018.0021.Peer-Reviewed Original ResearchConceptsPrimary care providersRecent HIV testingHIV testingTransgender womenLogistic regressionHIV/AIDS StrategyCorrelates of HIVPrevious depression diagnosisJoint United Nations ProgrammeHIV testing historyBehavioral risk factorsMultivariate logistic regressionYears of ageMental health functioningBivariate logistic regressionUnited Nations ProgrammeHIV statusHIV treatmentRisk factorsHIV epidemicDepression diagnosisAIDS StrategyAmphetamine useCare providersPrevention services
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