Ensuring high quality primary care for people living with HIV (PLWH) is important. We studied factors associated with meeting Health Resources and Services Administration-identified HIV performance ...measures, among a population-based sample of 376 PLWH in care at 24 Philadelphia clinics. Quality of care was assessed by a patient-level composite of 15 performance measures, focusing on HIV-specific care, vaccinations, and co-morbid condition screening. Adjusted incidence rate ratios (IRR) demonstrated relationships between patient and clinic factors and the performance measures score. The mean number of measures met was 8.52. Older age groups met more measures than 18- to 29-year-olds (age 40-49: adjusted IRR: 1.19, 95% CI: 1.05-1.35; age ≥50: adjusted IRR: 1.19, 95% CI: 1.03-1.35). Higher CD4 counts were associated with meeting more measures compared to CD4 <200 cells/μL (CD4 350-499 cells/μL: adjusted IRR: 1.14, 95% CI: 1.02-1.28; ≥500 cells/μL: adjusted IRR: 1.12, 95% CI: 1.01-1.26). PLWH attending clinics that provide adherence counseling or case management met more measures (adjusted IRR: 1.12, 95% CI: 1.04-1.21; adjusted IRR: 1.08, 95% CI: 1.02-1.14; respectively) than those attending clinics without these services. Limitations include potentially poor performance measure documentation and equal treatment of measures. Future work should focus on improving compliance with performance measures.
Multi-drug resistant trichomoniasis: A case report Seyedroudbari, Sara; McCloskey, Kyle; Momplaisir, Florence
International journal of antimicrobial agents,
September 2021, 2021-09-00, Letnik:
58
Journal Article
Abstract
Background
Decreasing new HIV infections requires reaching populations at increased risk of acquiring HIV who do not access regular testing. Emergency Departments (EDs) provide a ...disproportionate amount of care for socially vulnerable populations and are often the only place uninsured patients obtain healthcare. In Philadelphia, where HIV prevalence is 1.2%, further investigation is needed to optimize EDs as HIV testing venues for vulnerable populations. This study sought to elucidate perceived barriers and facilitators to universal HIV screening in EDs among hospital system stakeholders across Philadelphia.
Methods
We conducted a qualitative study using semi-structured interviews with physicians, administrators, and care navigators across five health systems in Philadelphia. Participants were recruited using snowball sampling. An interview guide based on the Consolidated Framework for Implementation Research explored facilitators and barriers to HIV testing in EDs. Interviews were audio-recorded and transcribed verbatim. We analyzed interviews using a modified grounded theory approach to code interview transcripts. Interrater reliability was assessed between multiple coders.
Results
14 individuals were interviewed: 3 registered nurses, 1 social worker, 2 program managers, and 8 physicians. Participants reported EDs play a critical role in providing care to patients who otherwise do not engage with the health care system, who tend to be of lower socioeconomic status and multiply marginalized. The facilitator that most significantly increases ED provider buy-in is a non-ED provider to follow up on HIV test results. Barriers to robust HIV testing programs included competing priorities, lack of personnel, and lack of sustainable funding.
Conclusion
This contextual inquiry revealed shared barriers and facilitators to HIV testing across multiple health systems in a city with a high burden of HIV. The development of a dedicated staff position to deal with indeterminate and reactive HIV testing (removing this responsibility from ED) is the single most important intervention to facilitate HIV testing in EDs. This study provides a clear target for municipal funding in Philadelphia and may be generalizable to HIV testing implementation in EDs in other urban centers.
Disclosures
All Authors: No reported disclosures
Women with HIV have higher risk of depressive symptoms in the perinatal period. Evidence on how perinatal depressive symptoms affect viral suppression (VS) and adherence to antiretroviral therapy ...(ART) remains limited.
Perinatal depressive symptoms were assessed using 6 items from the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire. VS (viral load <400 copies/mL) was the outcome. Adherence was defined as no missed dose in the past 1-4 weeks using the ACTG Adherence Questionnaire. Generalized mixed-effects structural equation models estimated the association of depressive symptoms on VS and the mediating role of ART adherence among women enrolled in the IMPAACT P1025 Perinatal Core Protocol (2002-2013).
Among 1869 participants, 47.6% were 21-29 years, 57.6% non-Hispanic Black. In the third trimester, the mean depressive symptoms score was 14.0 (±5.2), 68.0% had consistent adherence, and 77.3% achieved VS. At 6 months postpartum, depressive symptoms declined while adherence and VS fell to 59.8% and 53.0%, respectively. In the fully adjusted model, a 1-SD increase in depressive symptoms was associated with a 3.8-percentage-point (95% CI: -5.7, -1.9) decline in VS. This effect is the sum of the indirect effect of depressive symptoms on VS via ART adherence (-0.4; 95% CI: -.7, -.2) and the direct effect through other pathways (-3.4; -5.2, -1.5). The decline in adherence driven by depressive symptoms accounted for ≥11% of the total negative effect of depressive symptoms on VS.
Perinatal depressive symptoms were associated with decreased adherence and VS, highlighting the need to screen for, diagnose, and treat perinatal depression to optimize maternal outcomes.
NCT00028145.
The COVID-19 pandemic halted research operations at academic medical centers. This shutdown has adversely affected research infrastructure, the current research workforce, and the research pipeline. ...We discuss the impact of the pandemic on overall research operations, examine its disproportionate effect on underrepresented minority researchers, and provide concrete strategies to reverse these losses.
An estimated 230,000 Americans are unaware that they have HIV infection. As a result, these individuals have not benefited from treatment for HIV infection and they may continue to spread the ...disease. In 2006, the Centers for Disease Control and Prevention (CDC) reported that 40% of adults aged 18-64 had been tested for HIV but only 10% had been tested within the last 12 months. A national survey conducted by the CDC in 2000 found that only about one-quarter of primary care providers and emergency physicians reported routinely testing their patients for HIV. To improve the performance of HIV testing, in 2006 the CDC issued recommendations that patients in all health care settings be offered universal, opt-out HIV testing. Since that time, several studies have demonstrated the feasibility of opt-out testing but barriers to implementation persist. Many states still require signed consent and counseling and other logistical challenges include: insufficient time, competing priorities, and inadequate reimbursement. Therefore, universal HIV testing remains an unrealized goal.
Abstract
This manuscript conveys the story of the health and economic challenges faced by a coalition of barbershops and salons in West Philadelphia. It is grounded in city and national data that ...illustrate the widening racial and class disparities during coronavirus disease 2019. Ultimately, it is a story of resilience that outlines a budding partnership between barbershop and salon owners, their community, and medical providers.
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