Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban–rural differences

Abstract Background In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). Methods We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities. Quantitative data from a facility survey and health service delivery data were gathered and combined with data from two rounds of interviews and focus group discussions (FGDs) conducted at national and sub-national level to document the design and implementation of GP. The survey included 230 health facilities across 10 counties, and 59 interviews and 22 FGDs were conducted with government officials, health facility providers, patients, and civil society. Results We found that PEPFAR moved quickly from announcing the GP to implementation. Despite extensive conversations between the US government and the Government of Kenya, there was little consultation with sub-national actors even though the country had recently undergone a major devolution process. Survey and qualitative data identified a number of effects from GP, including discontinuation of certain services, declines in quality and access to HIV care, loss of training and financial incentives for health workers, and disruption of laboratory testing. Despite these reports, service coverage had not been greatly affected; however, clinician strikes in the post-transition period were potential confounders. Conclusions This study found similar effects to earlier research on transition and provides additional insights about internal country transitions, particularly in decentralized contexts. Aside from a need for longer planning periods and better communication and coordination, we raise concerns about transitions driven by epidemiological criteria without adaptation to the local context and their implication for priority-setting and HIV investments at the local level.

Download Full-text

High Rates of Retention and Viral Suppression in the US HIV Safety Net System: HIV Care Continuum in the Ryan White HIV/AIDS Program, 2011

Clinical Infectious Diseases ◽

10.1093/cid/ciu722 ◽

2014 ◽

Vol 60 (1) ◽

pp. 117-125 ◽

Cited By ~ 66

Author(s):

R. K. Doshi ◽

J. Milberg ◽

D. Isenberg ◽

T. Matthews ◽

F. Malitz ◽

...

Keyword(s):

Viral Suppression ◽

Safety Net ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Ryan White ◽

The Us ◽

Aids Program ◽

Hiv Aids

Download Full-text

Mental health in 2020 for men who have sex with men in the United States

Sexual Health ◽

10.1071/sh16083 ◽

2017 ◽

Vol 14 (1) ◽

pp. 59 ◽

Cited By ~ 19

Author(s):

Abigail W. Batchelder ◽

Steven Safren ◽

Avery D. Mitchell ◽

Ivan Ivardic ◽

Conall O'Cleirigh

Keyword(s):

Mental Health ◽

Hiv Prevention ◽

The United States ◽

Hiv Care ◽

Hiv Care Cascade ◽

Age Related ◽

The Us ◽

Prevention And Treatment ◽

Sex With Men ◽

Hiv Aids

Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

Download Full-text

Implementing TB preventive treatment within differentiated HIV service delivery models in global programs

Public Health Action ◽

10.5588/pha.20.0014 ◽

2020 ◽

Vol 10 (3) ◽

pp. 104-110

Author(s):

A. T. Boyd ◽

B. Moore ◽

M. Shah ◽

C. Tran ◽

H. Kirking ◽

...

Keyword(s):

Service Delivery ◽

Care Delivery ◽

Scale Up ◽

Preventive Treatment ◽

Hiv Care ◽

People Living With Hiv ◽

Emergency Plan ◽

The Us ◽

Living With Hiv ◽

Delivery Models

Global HIV program stakeholders, including the US President’s Emergency Plan for AIDS Relief (PEPFAR), are undertaking efforts to ensure that eligible people living with HIV (PLHIV) receiving antiretroviral treatment (ART) receive a course of TB preventive treatment (TPT). In PEPFAR programming, this effort may require providing TPT not only to newly diagnosed PLHIV as part of HIV care initiation, but also to treatment-experienced PLHIV stable on ART who may not have been previously offered TPT. TPT scale-up is occurring at the same time as a trend to provide more person-centered HIV care through differentiated service delivery (DSD). In DSD, PLHIV stable on ART may receive less frequent clinical follow-up or receive care outside the traditional clinic-based model. The misalignment between traditional delivery of TPT and care delivery in innovative DSD may require adaptations to TPT delivery practices for PLHIV. Adaptations include components of planning and operationalization of TPT in DSD, such as determination of TPT eligibility and TPT initiation, and clinical management of PLHIV while on TPT. A key adaptation is alignment of timing and location for TPT and ART prescribing, monitoring, and dispensing. Conceptual examples of TPT delivery in DSD may help program managers operationalize TPT in HIV care.

Download Full-text

Distribution and Geographic Accessibility of Lung Cancer Screening Centers in the US

Annals of the American Thoracic Society ◽

10.1513/annalsats.202010-1313rl ◽

2021 ◽

Author(s):

Soumya J Niranjan ◽

William Opoku-Agyeman ◽

Nathaniel W Carroll ◽

Amanda Dorsey ◽

Meghan Tipre ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Geographic Accessibility ◽

The Us

Download Full-text

51. Patient Reported Outcomes Collection: A Mixed Methods Study at an urban HIV Clinic associated with a Historically Black Medical College in the Southern United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.051 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S35-S36

Author(s):

Paul Parisot ◽

Facerlyn Wheeler ◽

Kemberlee Bonnet ◽

Peter F Rebeiro ◽

Korlu McCainster ◽

...

Keyword(s):

Mental Health ◽

Data Collection ◽

Historically Black ◽

Patient Reported Outcomes ◽

Determinants Of Health ◽

Hiv Care ◽

Behavioral Determinants ◽

Medical College ◽

Patient Reported ◽

The Us

Abstract Background Black Americans, particularly in the South, are disproportionately affected by the US HIV epidemic. We piloted the use of an electronic tablet to collect patient reported outcomes (PRO) data on social and behavioral determinants of health among people with HIV (PWH) at the Meharry Community Wellness Center (MCWC), an HIV clinic affiliated with a Historically Black Medical College in Nashville, Tennessee. Studies have shown PRO collection can improve patient outcomes and provide oft-overlooked data on mental health, substance use, and patient adherence to ART. Methods We enrolled 100 PWH in care at the MCWC consecutively to complete validated PRO tools (Table 1) using the Research Electronic Data Capture (REDCap) platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the Cognitive Behavioral Model in which thoughts, feelings, and behaviors are inter-related. IDIs were audio recorded, transcribed, de-identified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach. Results Among 100 PWH enrolled, median age was 50 years, 89% were Black, 60% were male, and 82% were living below 100% of the Federal Poverty Level. IDI participants felt the tablet was easy to use and the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful and most would complete these surveys without compensation at future visits if offered. Conclusion The use of an electronic tablet to complete PRO data collection was feasible and well received by this cohort of vulnerable persons in HIV care in the US South. Despite some discomfort, our cohort overwhelmingly believed this was a valuable part of their medical experience. Real-time PRO data collection allows providers to screen for and act on social and behavioral determinants of health. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner. Disclosures Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel)

Download Full-text