
Purnima Madhivanan
· Associate Professor, MPI/Director of Global Health Emerging Scholars Program, Director for Fogarty-Fulbright FellowshipVerifiedUniversity of Arizona · Pharmacology and Toxicology
Active 2000–2026
About
Purnima Madhivanan is an Associate Professor in Health Promotion Sciences at the Mel & Enid College of Public Health at the University of Arizona. She is a physician scientist with an MPH and PhD in Epidemiology from the University of California, Berkeley. She is the Founder of the Public Health Research Institute of India (PHRII) and serves as the Director of the Global Health Emerging Scholars (GHES) Training Program in collaboration with Stanford, Yale, and UC Berkeley. Additionally, she is the Director for the Fogarty-Fulbright Fellowship program at the University of Arizona. Her work over the past 25 years has focused on disadvantaged populations, exploring the dynamics of poverty, gender, and the social and environmental determinants of health, particularly on women and children living in rural communities. She has conducted research in India, Peru, Haiti, Dominican Republic, Colombia, Nigeria, Ethiopia, South Africa, and the US. She established a clinical site in Mysore, India in 2005, where she has delivered low-cost, high-quality reproductive health services to low-income women through initiatives like the Prerana Women’s Health Initiative and the Saving Children Improving Lives Program. Her current research examines the intersection of infectious and chronic diseases with a focus on cancer. Dr. Madhivanan has published over 250 peer-reviewed articles and has been supported by various foundations, biotech companies, and federal and international funding organizations. She has received numerous awards, including the International Leadership Award from the Elizabeth Glaser Pediatric AIDS Foundation, the Maria Valdez Mentoring Award, the Outstanding Mentorship Award from the American College of Epidemiology, the Gamechanger Award by NAACP, and the Fulbright-Nehru Distinguished Scholar Award. She serves as an advisor to multiple public health departments and research organizations and has been a principal investigator on numerous grants and clinical trials. Her research areas include the intersection of infectious disease and cancer, women’s health across the lifespan, global health, social determinants of health, and vaccine-preventable diseases.
Research topics
- Political Science
- Medicine
- Artificial Intelligence
- Computer Science
- Machine Learning
- Social Science
- Data Mining
- Sociology
- Internal medicine
- Nursing
- Family medicine
- Psychology
- Developmental psychology
- Public relations
- Pediatrics
- Economics
- Communication
Selected publications
medRxiv · 2026-05-04
articleOpen accessBackground: Mobile health programs (MHPs) provide essential preventive services to uninsured and underserved communities. Following the 2024 regulatory approval of human papillomavirus (HPV) self-collection for cervical cancer screening, MHPs represent an access point for healthcare-based self-collection. However, little is known about patient perceptions of this approach in MHP and other healthcare settings. Methods: From May - August 2025, we surveyed individuals aged 25-65 years with a cervix who attended MHPs in Southern Arizona. The survey assessed interest in HPV self-collection, preferred locations, instructional preferences, and facilitators to attend follow-up after a positive result. Descriptive statistics summarized demographic characteristics and survey responses. Results: Fifteen female participants completed the survey (mean age 36 years). Ten (67%) identified as Hispanic or Latino, nine (60%) preferred Spanish, and 14 (93%) were uninsured. Interest in HPV self-collection was high, with ten (67%) very or extremely interested. Among those interested, nine (69%) preferred home-based self-collection, and four (31%) preferred clinic or MHP-based self-collection. Most common concerns regarding self-collection on the MHP were ensuring privacy (n=7; 47%) and knowing how to perform the test correctly (n=5; 33%). Most participants (n=11; 73%) reported being very or extremely confident they would attend follow-up after a positive result; language-concordant support, reminder calls, and scheduling assistance were the most endorsed facilitators. Conclusion: HPV self-collection was highly acceptable among MHP attendees, although home-based self-collection was most preferred. Addressing privacy concerns, providing multiple modes of instruction, and offering navigation support may improve implementation success and ensure timely follow-up care in MHP settings.
Characterization of household microbiomes from three unique cities around the world
bioRxiv (Cold Spring Harbor Laboratory) · 2026-04-12
articleOpen accessAbstract Characterizing the household bacterial microbiome allows for a stronger understanding of the various microbes that a person is exposed to everyday in their home. Exploring household microbiomes in different countries around the world increases - our understanding of the impact cultural differences might have on niche microbial communities in the house. The goal of this study was to use shotgun metagenomics to characterize the microbiome for ten locations around the home in ten different houses from three different countries (Mysuru, India; Dubai, United Arab Emirates (UAE); and Tucson, United States of America (USA)). There was a significant difference in alpha diversity between the three countries (ANOVA, p<0.05) with homes in Mysuru, India showing significantly higher bacterial diversity compared to Dubai, UAE and Tucson, AZ, USA. Beta diversity analysis of the homes found that bacterial communities significantly differed between cities (PERMANOVA, p<0.01) and within cities by household locations (PERMANOVA, p<0.001). Locations such as underneath the toilet rim, bathroom and kitchen sinks had the highest levels of bacterial diversity across the three cities compared to other sampling areas. A core microbiome of Actinomycetes and Gammaproteobacteria was found in all homes in all three cities. Within each city, a core microbiome was identified at the species level within specific household locations in each city. Over 90% of bacterial taxa found in the homes were a part of the human-associated phyla Actinomycetes (eg. genera Brevibacterium, Corynebacterium, and Microbacterium) , Pseudomonadota (eg. genera Acinetobacter, Moraxella, Pantoea, Paracoccus, and Psuedomonas) , and Bacillota (genus Streptococcus) , which was comparable to previous studies. The household microbiome is variable in different locations in the house and on a global scale. Factors such as human activity, cultural practices, climate, and surface type and use may drive this diversity. Characterizing the household microbiome on a global scale allows for a better understanding of what drives microbial diversity, increasing our understanding of how microbial communities are shaped by the environment and how humans influence their dynamics, as well as any risks to human health that the built microbiome may potentially pose. Impact Statement This research contributes to the understanding of the built microbiome, specifically how it varies within the house, within cities, and across the globe. This can aid in our understanding of microbial dynamics in environments with heavy human influence and help develop and improve hygiene habits and products which are mindful of the existing microbiome. Data Summary DNA sequence data from this research is publicly available on the NCBI’s Sequence Read Archive under BioProject PRJNA1416920. Data was analyzed using python and R code. Analysis protocols and information on software versions, packages, and more can be found within the text and in the following github repository: https://github.com/carolinescranton01/Global_Household_Microbiome . The authors confirm all supporting data, code and protocols have been provided within the article or through supplementary data files.
Clinical Epidemiology and Global Health · 2026-03-09
articleOpen accessSenior author<h2>Abstract</h2><h3>Background</h3> Cardiovascular disease (CVD) is a leading cause of mortality among women, and the COVID-19 pandemic has disrupted healthcare continuity. This research explores healthcare providers' (HCPs) perspectives on challenges in providing cardiac care to women during the pandemic. <h3>Methods</h3> A qualitative inquiry was conducted through in-depth interviews among 11 HCPs at a tertiary care hospital in South India. <h3>Results</h3> The thematic analysis revealed several concepts. Women with CVD were less health literate and often presented late. They relied on family support for care continuity. Family decision-making, pandemic restrictions, and personal hesitancy delayed care-seeking. Women faced lower prioritization within families and depended on male members for healthcare decisions. This reflects societal and cultural gender disparities. Organized services were present, but long waiting periods and rushed consultations, especially during follow-up visits, affected satisfaction and continuity of care. Language barriers and low literacy hindered doctor–patient communication. HCPs tried to learn the local language to improve interactions. Access to health-financing mechanisms and social support networks helped treatment compliance. During the second wave, heightened health consciousness led more women to seek care. However, strained resources caused rushed care and limited patient–HCP interactions. <h3>Conclusion</h3> The study highlights gender-specific challenges that affect women's access to and continuation of cardiac care. Pragmatic measures should aim to increase the doctor–patient ratio to reduce rushed consultations. Employing counselors or social workers can also help bridge communication and cultural gaps.
medRxiv · 2026-04-23
articleOpen accessABSTRACT Women living with HIV face about a six-fold higher risk of cervical cancer, yet screening uptake remains low in many sub-Saharan African settings. We explored factors influencing repeated decisions to decline cervical cancer screening during routine HIV care among women living with HIV at a large HIV clinic in Jos, Nigeria. Between September and December 2024, we conducted an exploratory qualitative study at the AIDS Prevention Initiative in Nigeria Clinic in Jos, Nigeria. We purposively recruited 27 women living with HIV aged 21 to 65 years who had never undergone cervical cancer screening and had repeatedly declined screening offers during routine HIV care, including at the current clinic visit. Semi-structured in-depth interviews were conducted in English or Hausa, audio-recorded, transcribed verbatim, and translated into English where needed. Data were analyzed thematically using theory-informed coding based on the Health Belief Model and Social Ecological Model. Among 27 women living with HIV who had repeatedly declined screening, perceived susceptibility was often low or uncertain despite recognition of cervical cancer severity. Perceived benefits were acknowledged but were frequently outweighed by overlapping barriers, including knowledge gaps and misinformation, indirect and downstream costs, emotional barriers, logistical constraints, clinic-flow and service-delivery barriers, and anticipated stigma. Education, reminders, and supportive clinic processes acted as cues to action, and most participants expressed willingness to screen in future. Among women living with HIV at this clinic who repeatedly declined screening when it was offered, perceived benefits were often outweighed by multilevel barriers. Screening programs may integrate fear-reduction and stigma-sensitive counseling with practical service delivery improvements, including shorter waiting times, reduced indirect costs, predictable and streamlined clinic flow, and consistent provider invitations and reminders, while addressing misinformation through community-embedded, culturally tailored messaging. These strategies may improve screening uptake and support more equitable cervical cancer prevention for women living with HIV in similar HIV-care settings.
PLoS ONE · 2026-04-16
articleOpen accessBACKGROUND: India rolled out COVID-19 vaccinations for adults in January 2021 and children aged 12-18 in early 2022. A 2021 survey indicated that 63% of Indian parents were willing to vaccinate their children against COVID-19, with few studies examining vaccine hesitancy and acceptability. The the Behavioral and Social Drivers of Vaccination (BeSD) framework helps demonstrate which factors may affect vaccination uptake. Our study examined parents' intentions-to-vaccinate their children below 18 years of age against COVID-19 in Mysore, India and their decision-making process using the BeSD framework. METHODS: From November 2021 to May 2022, 506 parents/guardians of children below 18 years of age living in Mysore district, India were consented and interviewed by phone or face-to-face. We assessed their own COVID-19 vaccination status, vaccine confidence (Vaccine Confidence Index), intention-to-vaccinate their child against COVID-19, and other factors affecting vaccination such as demographic variables. Multivariable ordinal logistic regression was conducted to examine the association of influencing factors based on the literature and BeSD framework using Stata version 16.1. Intention-to-vaccinate was presented as odds ratios (OR) with associated 95% confidence intervals (95%CI). RESULTS: The majority (91.3%) of the 506 participants fully trusted COVID-19 vaccines for their children. The same number (91.3%) had been fully vaccinated themselves, and 78.3% reported being (very) likely to vaccinate their children against COVID-19. Vaccine-hesitant and vaccine-confident groups were not significantly different socio-demographically. As parental age increased, parents had higher odds to express intention-to-vaccinate their child (OR: 1.04, 95%CI: 1.01-1.08). Parents from urban Mysore had lower odds to vaccinate their child compared to those from rural areas (OR: 0.53, 95%CI: 0.35-0.82). CONCLUSION: Most parents expressed vaccine confidence and intention-to-vaccinate their child against COVID-19. Exploring decision-making processes among parents is a crucial strategy to ensure effective implementation of vaccination programs.
PLOS Global Public Health · 2026-05-20
articleOpen accessSenior authorAdverse childhood mental health outcomes have emerged as a significant public health concern, with an increasing body of evidence linking children's obesity with increased risk of mental health outcomes. This is a cross-sectional study of 40,820 U.S. children aged 6-17 used survey-weighted logistic regression on the 2021-22 National Survey of Children's Health (NSCH) data. The study examined whether interpersonal factors such as bullying, poor mothers' or fathers' mental health, poor family resilience and greater difficulty in making or keeping friends modified the associations between BMI category and parent-reported lifetime depression (LDD) or anxiety (LDA) mental health outcomes, using interaction terms and adjusting for age, sex, race/ethnicity and federal poverty levels. Obesity was significantly associated with higher odds of both LDD and LDA in children aged 6-17 years. Obese children had 2.08 times higher odds of LDD (aOR 2.08; 95% CI: 1.64-2.64) and 1.48 times higher odds of LDA (aOR 1.48; 95% CI: 1.25-1.76) compared to normal-weight peers. Significant effect modification in the statistical model was observed for LDD: never bullied (aOR = 2.12; 95% CI: 1.45-3.11), mother's mental health (aOR = 1.70; 95% CI: 1.70- 2.70), and father's mental health (aOR = 2.54; 95% CI: 1.51-4.29). For LDA, effect modification in the statistical model was seen for making friends (aOR = 1.91; 95% CI: 1.13-3.22) and father's mental health (aOR = 2.14; 95% CI: 1.34-3.41). In this cross-sectional sample, obesity was associated with higher LDD and LDA, with associations varying by interpersonal and family factors. Given parent-reported, cross-sectional data, findings are associative and not causal. The results emphasize integrating mental health screening into obesity programs, strengthening anti-bullying efforts, and adopting family-centered approaches; future research should use longitudinal, multi-informant designs to establish temporal relationships and reduce bias.
BMJ Open · 2026-05-01
articleOpen accessSenior authorOBJECTIVE: The goal of this study was to identify strategies and assess priorities to increase human papillomavirus (HPV) vaccination among unvaccinated young adults using a concept mapping approach. DESIGN: The concept mapping process was conducted in two phases. In phase 1, eligible participants generated qualitative statements in response to a topic prompt. In phase 2, participants organised and grouped the statements by perceived similarity, and then rated each statement on a scale of perceived effectiveness. Multidimensional scaling and hierarchical cluster analysis were conducted to develop a conceptual map of the data. SETTING: This study was conducted at a university in the southwestern USA. PARTICIPANTS: Eligibility criteria for participation included individuals (1) aged 18-26, (2) who had not received any dose of the HPV vaccine or were unsure if they had received the vaccine and (3) who were enrolled students at the study site institution. 24 participants engaged in the concept mapping process; five participated in phase 1 only, five participated in phase 2 only and 14 participated in both phases. RESULTS: The 41 statements generated were organised into five cluster concepts: media and messaging, information and education, promotion, legal and accessibility. Accessibility was the highest-rated cluster for effectiveness followed by information and education. Exploratory trends across participant demographics were also identified. Differences in perceived effectiveness of the cluster concepts were observed by gender, race, political affiliation and vaccination status. CONCLUSION: This study provides valuable preliminary insights into strategies and factors perceived influential in enhancing HPV vaccination from the perspective of unvaccinated young adults. Using concept mapping, multiple factors were identified that varied in their degree of perceived effectiveness across different groups. Future HPV vaccination interventions should consider multi-component elements to ensure their success and reduce the burden of HPV-related disease.
medRxiv · 2026-02-23
articleOpen accessABSTRACT Introduction Childhood immunization is highly cost-effective, yet uptake is shaped by sociocultural and religious influences. In Bauchi State, Nigeria, coverage remains low (Penta3 58.2%; fully vaccinated 22.5% among children aged 12–23 months). Religious leaders shape community norms, but their perspectives on immunization in Bauchi are not well characterized. Guided by Oman and Syme’s religion/spirituality and health model, we explored religious leaders’ knowledge, beliefs, attitudes, practices and recommendations regarding childhood immunization. Methods Between December 2022 and January 2023, we conducted semi-structured interviews with 22 religious leaders (all men; 21 Muslim, 1 Christian) purposively sampled across Bauchi State’s Local Government Areas. Interviews were conducted in Hausa or English, audio recorded, translated where necessary and transcribed. Sampling continued until thematic saturation. Data were analyzed using codebook thematic analysis informed by Braun and Clarke’s analytic phases and organized according to the pre-specified domains of knowledge, beliefs, attitudes, practices and recommendations. Ethical approval was obtained, and all participants provided verbal informed consent. Results Most leaders described immunization as preventive and compatible with religious teachings. Many reported that observed child health benefits reinforced support and that earlier skepticism had shifted after religious and scientific explanation and lived experience. Persistent misinformation was reported, especially fertility-related and population control narratives. Leaders described three recurring influence practices: visible role modelling, sermon-based messaging aligned with scripture, and community mobilization through religious gatherings and support during outreach activities. Respectful health worker engagement and reliable service delivery appeared to strengthen trust and community uptake. Conclusions Religious leaders in Bauchi State may be strategic partners for improving vaccine acceptance. Programs should consider structured engagement with religious leaders, bidirectional rumor tracking and response, and support for frontline health workers. Future research should include more diverse leaders and link engagement to measurable outcomes. KEY MESSAGES What is already known on this topic Childhood immunization coverage remains suboptimal in northern Nigeria, and religious leaders can influence vaccine-related beliefs and uptake, yet their perspectives and practical roles are not well characterized in Bauchi State. What this study adds Among 22 interviewed religious leaders in Bauchi State, most viewed childhood immunization as compatible with religious teachings and described using role modelling, sermon-based messaging, and community mobilization to support uptake, while also reporting persistent fertility-related and population control rumors and service delivery barriers. How this study might affect research, practice or policy Immunization programs may benefit from structured engagement with religious leaders, locally credible rumor response systems, and parallel improvements in respectful and reliable service delivery.
BMJ Open · 2026-05-01
articleOpen accessSenior authorBACKGROUND: HIV is a major health challenge in Kenya, where prevalence exceeds global averages. Achieving viral suppression depends on consistent adherence to antiretroviral therapy (ART), but individuals in neighbourhoods perceived as disorderly often show low self-efficacy for ART adherence. Despite the importance of neighbourhood dynamics in shaping health behaviours, this area is under-explored in low- and middle-income countries (LMICs), especially regarding transportation barriers. Grounded in Social-Ecological Theory (SET) and the 'Broken Windows' Theory (BWT), SET suggests that health outcomes are influenced by environmental factors, while BWT posits visible signs of neighbourhood disorder, such as neglect and decay, can lead to a decline in healthy behaviours, creating an environment conducive to negative health outcomes. This protocol describes a multimodal qualitative study designed to examine how transportation challenges and perceived neighbourhood dynamics influence HIV care among people living with HIV (PLWH). This intersection of structural barriers, neighbourhood dynamics and HIV outcomes in LMIC settings remains under-researched. METHODS: This theory-informed multimodal qualitative study, grounded in a Community-Based Participatory Research framework, integrates individual in-depth interviews (IDIs) and community-based photovoice focus group discussions (FGDs). 20 PLWH participated in IDIs accompanied by a survey with validated scales (~ 10 min) assessing perceived neighbourhood disorder, defined as visible physical and social signs of neglect such as crime, vandalism and deteriorated infrastructure, ART adherence self-efficacy, transportation, access to HIV care and fear of crime. An additional 20 PLWH took part in four photovoice FGD sessions. Photovoice FGD sessions were guided by the SHOWeD questioning technique, a structured reflection method that prompts participants to discuss what they see, what is happening, how it relates to their lives, why it exists and what can be done. In each component, participants were purposively sampled and stratified to ensure approximately equal representation by viral suppression status (10 suppressed, 10 unsuppressed), gender (10 women, 10 men) and age group (10 aged 18-24, 10 older than 24). Interviews and photovoice discussions were transcribed and are being analysed thematically using MAXQDA qualitative analysis software. Participant-generated photographs will be analysed alongside accompanying narratives using an integrated visual and textual coding approach combining inductive and theory-informed deductive analysis. Triangulation across interviews and validated survey measures will be conducted. ETHICS AND DISSEMINATION: This study has received ethical approval from the KNH-UoN Ethics and Research Committee (P635/08/2024) and the Stanford University Institutional Review Board (eProtocol #: 77260). Written informed consent was obtained from all participants. Findings will be disseminated through peer-reviewed publications, conference presentations and a photo exhibition. DISCUSSION: This study will contribute to an understudied body of research on how socio-environmental conditions influence HIV care engagement in LMICs. Through the integration of individual-focused in-depth interviews and community-centred photovoice FGD sessions, the study captures both personal perceptions and shared neighbourhood realities. Findings will inform interventions and policy adjustments to improve support for PLHIV in disordered environments.
bioRxiv (Cold Spring Harbor Laboratory) · 2026-04-10
articleOpen accessAbstract This study assessed the prevalence of antibiotic resistance genes (ARGs) and virulence factor genes (VFs), DNA viruses, and medically-relevant pathogens in three major cities around the globe – Mysuru (India), Dubai (United Arab Emirates), and Tucson (Arizona, United States of America). Ten households were sampled in each city, at ten sites in the bathroom, kitchen, and living spaces. The alpha diversity of ARGs significantly differed between household locations in each country (ANOVA, p<0.05) and beta diversity (dissimilarity) analysis showed a significant association between the ARGs and the geographic locations (PERMANOVA, p<0.01). A set of ARGs were found in every location across the dataset (the core ARG profile) included 25 different genes. The alpha diversity of virulence factors differed across the household locations within the three cities (ANOVA, p<0.01). The beta diversity of VFs was not well explained by geographic location or location within the household (PERMANOVA, p=0.129 (geographic), p=0.127 (household)). There were 341 unique VFs found in the study, but only 5 core VFs across the dataset. Bacterial pathogens detected across the household included Escherichia coli , Acinetobacter baumanii , Klebsiella pneumoniae , and more. The DNA (and bacteriophage) virome varied between countries and was more diverse in Tucson and Dubai (top viral families included Poxviridae and Orthoherpesviridae - two families which contain human pathogens - and Steitzviridae, a family of bacteriophages) compared to Mysuru, where nearly all viruses were a part of the Muvirus genus (a bacteriophage which contributes to horizontal gene transfer by phage transduction). Importance The diversity of the built environment microbiome is not well characterized globally. Household occupants interact with the built microbiome on a daily basis, and the built microbiome may have the potential to influence human health. The presence of pathogens in the built environment and the key genes contributing to microorganism pathogenicity were investigated in this study, as information on this is lacking on an international scale. The diversity of ARG and VFs across the globe, as well as the presence of medically relevant pathogens within the house that were found in this study highlights the need to explore further the factors which influence the household microbiome, virome, and resistome. This may aid in identify how the build microbiome may be shaped by humans and influence human health. Impact Statement This research contributes to the understanding of the built microbiome, specifically how it varies within the house, within cities, and across the globe. This can aid in our understanding of microbial dynamics in environments with heavy human influence and help develop and improve hygiene habits and products which are mindful of the existing microbiome.
Recent grants
Longitudinal Study of Vaginal Microbiota and Persistent Human Papillomavirus Detection
NIH · $440k · 2017–2021
NIH · $5.2M · 2018
Global Health Emerging Scholars Program
NIH · $13.1M · 2017–2027
Frequent coauthors
- 355 shared
Karl Krupp
University of Arizona
- 106 shared
Vijaya Srinivas
Public Health Research Institute Of India
- 106 shared
Anjali Arun
- 61 shared
Jeffrey D. Klausner
University of Southern California
- 56 shared
Prajakta Adsul
University of New Mexico
- 49 shared
Kavitha Ravi
Rajalakshmi Engineering College
- 46 shared
Dionne P. Stephens
Florida International University
- 46 shared
Poornima Jaykrishna
Public Health Research Institute Of India
Education
M.P.H., Ph.D., Epidemiology
University of California Berkeley
- 1993
MBBS, Medicine & Surgery
Mysore Medical College
Awards & honors
- International Leadership Award from the Elizabeth Glaser Ped…
- Maria Valdez Mentoring Award at the University of Arizona
- Outstanding Mentorship Award from the American College of Ep…
- Gamechanger Award by NAACP
- Fulbright-Nehru Distinguished Scholar Award
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