scholarly journals 574. High Acceptance and Rapid Implementation of COVID-19 Vaccine in a Public HIV Clinic in Northern California: An Initial Analysis of Social Determinants

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S389-S389
Author(s):  
Jennifer Lin ◽  
Frank Oi-Shan Wong ◽  
Christopher Thibodeaux ◽  
Moon Choi-McInturff ◽  
Aracely Tamayo ◽  
...  
Keyword(s):  
Safety Net ◽  
Vaccine Hesitancy ◽  
Multivariable Logistic Regression Analysis ◽  
Medical Mistrust ◽  
Northern California ◽  
Hiv Patients ◽  
Clinic Staff ◽  
Series Completion ◽  
Race Ethnicity ◽  
Care Relationships

Abstract Background Safety net HIV providers face operational challenges during the COVID pandemic with services often transformed to telehealth. HIV infected persons are a priority population for SARS CoV-2 vaccination. Medical mistrust of COVID vaccines has been cited as a contributor to vaccine hesitancy. Data on efficient and successful vaccination efforts of HIV infected persons in safety net health systems is needed. In San Mateo County, Latino persons comprised 42% of all COVID cases, Whites 16%, and African Americans 2%. Methods SARS CoV2 vaccination with BNT162b2 (Pfizer–BioNTech), mRNA-1273 (Moderna) or Ad26.COV2.S (Janssen) vaccine were offered beginning February 2, 2021 through May 28, 2021 in a northern California public County HIV clinic. Clinic patients were contacted by bilingual English/Spanish speaking HIV clinic staff and appointments scheduled at County affiliated vaccination sites. Clinic staff followed up by phone with patients who did not initially accept vaccine. We calculate the percentage of patients who completed vaccine series and use multivariable logistic regression analysis to estimate the odds of series completion by patient race/ethnicity, gender and age. Results Virtually all, 95% (349/365) of HIV patients in our County HIV clinic were offered vaccine during a 17 week period. Among those, 86% (313/365) accepted and received at least one dose and 80% completed the series (292/365) at time of this analysis. Janssen vaccine was given to only 2% (7/313) patients. Series completion was highest among Latinos and Asians. Latinos had the highest odds of vaccine series completion (OR = 4.12; 95% CI 1.71 - 9.93). COVID-19 Vaccine Series Completion in a California Public HIV Clinic by Race/Ethnicity, Age and Sexual Orientation, n=364 Conclusion HIV patients offered SARS CoV2 vaccine by County HIV clinic staff with established patient care relationships had high vaccine acceptance (80%), comparable to 68% series completion in the county overall and 56% in the health equity quartile county census tracts. Latino HIV infected persons were most likely to complete the COVID vaccine series. Ryan White funded HIV clinics are ideal hubs to coordinate HIV patient COVID vaccination efforts. Adding COVID vaccine completion to HIV clinic performance measures would likely be beneficial. Disclosures All Authors: No reported disclosures

scholarly journals Factors associated with COVID-19 vaccine acceptance and hesitancy among residents of Northern California jails

2021 ◽  
Author(s):  
Yiran E Liu ◽  
Jillian Oto ◽  
John Will ◽  
Christopher LeBoa ◽  
Alexis Doyle ◽  
...  
Keyword(s):  
Side Effects ◽  
High Risk ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Medical Mistrust ◽  
Northern California ◽  
Older Individuals ◽  
Sources Of Information ◽  
Vaccine Acceptance ◽  
Factors Associated

Background: Carceral facilities are high-risk settings for COVID-19 transmission. Understanding of factors associated with COVID-19 vaccine acceptance and hesitancy among incarcerated individuals is incomplete, especially for people living in jails. Methods: We conducted a retrospective review of COVID-19 vaccination data from the electronic health record (EHR) of residents in two Northern California county jails to examine factors associated with vaccine uptake in this population. We additionally administered a survey in four jails to assess reasons for vaccine hesitancy, sources of COVID-19 information, and medical mistrust. We performed multivariate logistic regression to determine associations with vaccine uptake or hesitancy. Results: Of 2,584 jail residents offered a COVID-19 vaccine between March 19, 2021 and June 30, 2021, 1,464 (56.7%) accepted at least one dose. Among vaccinated residents, 538 (36.7%) initially refused the vaccine. Vaccine uptake was higher among older individuals, women, those with recent flu vaccination, and those living in shared cells or open dorms. Leading reasons for vaccine hesitancy included concerns around side effects and suboptimal efficacy. Television and friends/family were the most commonly cited and the most trusted sources of COVID-19 information, respectively. Vaccine acceptance was associated with increased trust in COVID-19 information sources and in medical personnel both in and out of jail. Conclusion: Ongoing evidence-based COVID-19 vaccination efforts are needed in high-risk carceral settings. Effective interventions to improve vaccination rates in this population should utilize accessible and trusted sources of information to address concerns about vaccine side effects and efficacy and foster medical trust.

scholarly journals SARS-CoV-2: Vaccine Hesitancy among Underrepresented Racial and Ethnic Groups with HIV in Miami, Florida

2021 ◽  
Author(s):  
Deborah L Jones ◽  
Ana S Salazar ◽  
Violeta J Rodriguez ◽  
Raymond R Balise ◽  
Claudia Uribe Starita ◽  
...  
Keyword(s):  
Race And Ethnicity ◽  
Cross Sectional Study ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Baseline Survey ◽  
Advisory Group ◽  
Medical Mistrust ◽  
Cross Sectional ◽  
Exact Test ◽  
Novel Coronavirus

Abstract Background SARS-CoV-2 and HIV disproportionally affect underrepresented ethnoracial groups in the US. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. Methods We conducted a cross-sectional study of adults ≥18 years with HIV residing in Miami, FL. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April-August 2020 and followed by a COVID-19 vaccine hesitancy survey from August-November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of Fisher’s exact test Results A total of 94 participants were enrolled, mean age 54.4 years, 52% female, 60% Black non-Latinx, and 40% non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, p=0.009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, p=0.029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, p=0.002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, p=0.049). Conclusion Medical mistrust, vaccine hesitancy and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.

scholarly journals Remembering the Children: Implementation and Success of a Robust Method for Identifying and Testing Children of HIV Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Christopher Darlow ◽  
Peter Tovey ◽  
Fiona Wallis ◽  
Clare Knowles ◽  
Ian Fairley ◽  
...  
Keyword(s):  
At Risk ◽  
Healthcare Providers ◽  
Safety Net ◽  
Robust Method ◽  
Children At Risk ◽  
Hiv Patients ◽  
Hiv Services ◽  
Undiagnosed Hiv ◽  
User Friendly ◽  
Hiv Negative

Background. Children of HIV patients are a historically neglected demographic by HIV services. It has been recommended by CHIVA that HIV services have a robust method of detecting and testing untested children. We note that no such method is either in widespread use or in the literature. Method. In December 2011, a one-page proforma to identify HIV untested children and a clear multidisciplinary pathway to test them were implemented. Twelve months later the uptake of the proforma and pathway, the numbers of patients and children identified for testing, and their outcomes were audited. Results. The proforma was completed in 192/203 (94.6%) eligible patients. Twenty-five (21.5%) of 118 identified offspring had not been tested. Ten (8.5%) of these were <18 years old. All were reported to be clinically well. Ten children were referred for testing, seven were tested immediately, and three were tested within 18 months of identification. All children were tested HIV negative. Discussion. We have identified a method of identification that is easy and robust and provides a user-friendly safety net to empower healthcare providers to identify and test children at risk. We recommend the implementation of such strategies nationwide to prevent death due to undiagnosed HIV in children.

Patient-reported unfair treatment within the health care system.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 115-115
Author(s):  
Nicole E. Caston ◽  
Courtney Williams ◽  
Kathleen D. Gallagher ◽  
Rebekah Angove ◽  
Eric Anderson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Categorical Variables ◽  
Medical Mistrust ◽  
Insurance Company ◽  
Medical Providers ◽  
Unfair Treatment ◽  
Patient Reported ◽  
Race Ethnicity ◽  
Care System

115 Background: Patients with cancer who perceive discrimination and unfair treatment from the health care system are at risk for lower health-related quality of life. This study seeks to better understand the characteristics of under-resourced patients who report unfair treatment from the health care system and providers. Methods: This cross-sectional analysis used data from a nationwide survey distributed in December 2020 by Patient Advocate Foundation (PAF), a US non-profit organization providing case management and financial aid to individuals with chronic illness. The survey was fielded via email to those who received PAF services from July 2019-April 2020. Inclusion criteria included a valid e-mail address, aged ≥ 19, and either current or previous cancer treatment. Respondents reported unfair treatment in connection to their health care. Age, sex, race/ethnicity, and annual household income were abstracted from the PAF database. The validated Group-Based Medical Mistrust Scale was used to assess respondents’ level of mistrust in medical providers as it relates to their ethnic group. Scores range from 12-60 and were categorized based on tertiles as high mistrust (scores ≥ 29), neutral (21-28), and low mistrust (≤ 20). Frequencies and percentages were calculated for categorical variables. Results: There were a total of 429 survey respondents with cancer. Most respondents were female (73%) and aged 56-75 (57%); 31% were Black, Indigenous, or Persons of Color (BIPOC). The most common cancer types were hematologic (33%) and breast (33%). Overall, 20% (n = 86) of respondents reported having received unfair treatment. Of those reporting unfair treatment, 56% reported receipt from their doctor, nurse, or health care provider, 51% insurance company, 38% the health care system, and 14% pharmacist. When asked why they felt unfairly treated, the most common responses were related to insurance status (51%), disease or condition (45%), and income (35%). Notably, unfair treatment due to race/ethnicity (6%), sex (9%), and sexual orientation/gender expression (3%) were uncommon. When compared to those who reported objective treatment, respondents reporting unfair treatment were more often unemployed/other (28% vs 11%), privately insured (38% vs 27%), having income < $23,000 (40% vs 25%), having 3+ comorbidities (40% vs 23%) and reporting more mistrust in medical providers (53% vs 27%). There did not appear to be a difference in reporting of unfair treatment by race/ethnicity. Of BIPOC respondents, 51% reported high mistrust in medical providers. Conclusions: This under-resourced population of respondents with cancer reported unfair treatment related to their finances, insurance, and disease status. Our data suggest health care-associated discrimination may occur based on socioeconomic resources. This work identifies a novel equity consideration warranting further evaluation.

Hesitancy and malignancy: Vaccine hesitancy among individuals with cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 148-148
Author(s):  
Stacey A. Ingram ◽  
Nicole E. Caston ◽  
Courtney J. Andrews ◽  
Rebecca England ◽  
Courtney Williams ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Vaccine Development ◽  
Severe Disease ◽  
Nationwide Survey ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Medical Mistrust ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
The Media

148 Background: The World Health Organization cited vaccine hesitancy as one of 2019’s top ten threats to global health, a threat that has been further exacerbated by COVID-19 pandemic. Existing COVID-19 vaccine hesitancy research focuses on the general population, but less is known about the specific concerns of medically vulnerable populations, including individuals with cancer. Methods: This cross-sectional analysis used data that assessed likelihood of COVID-19 vaccination (likely vs unlikely/unsure) among past or current patients with cancer from a nationwide survey administered in December 2020 by the Patient Advocate Foundation (PAF), a non-profit organization that provides case management and financial aid to patients diagnosed with a chronic illness. Inclusion criteria included previous or current cancer treatment, aged ≥ 19, and a valid e-mail address. Age, sex, race/ethnicity, and urban/rural residence were abstracted from the PAF database. Respondents self-reported education level, employment status, trust in media regarding COVID-19 pandemic, and media viewership on COVID-19 vaccine development. The Group-Based Medical Mistrust Scale assessed respondents’ level of mistrust in medical providers based on ethnicity. Likelihood of COVID-19 vaccine acceptance was evaluated using risk ratios (RR) and 95% confidence intervals (CI) from modified Poisson regression models with robust error variance. All variables were included in our model. Results: Of 429 respondents, 48% were unlikely/unsure about accepting the COVID-19 vaccine, primarily due to concerns about vaccine safety (32%) and worry about health conditions (12%). When compared to those likely to accept COVID-19 vaccine, respondents who were unlikely/unsure were more often Black, Indigenous, or People of Color (40% vs. 23%), aged 36-55 (40% vs. 29%), and female (80% vs. 65%). In adjusted analysis, Black respondents were 55% less likely to accept a COVID-19 vaccine, when compared to White respondents (RR 0.55; 95% CI 0.4-0.8). When compared to those who did not follow the media regarding COVID-19 vaccine development, those who followed the media very closely were 4.5 times more likely to accept a COVID-19 vaccine (RR 4.5; 95% CI 1.6-13.2). Respondents who reported below average trust in the media were 60% less likely to accept a COVID-19 vaccine (RR 0.6; 95% CI 0.5-0.8), compared to those who reported above average trust in the media. Conclusions: Despite being at high risk of COVID-19 morbidity and mortality, a substantial proportion of under-resourced individuals with cancer were unlikely/unsure about vaccination, exposing a significant disconnect between risk of severe disease and vaccine acceptance. Our analysis also reveals a need to assess for and debunk misinformation to increase vaccine enthusiasm among medically vulnerable populations.

scholarly journals Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective

2019 ◽  
Vol 134 (6) ◽  
pp. 617-625 ◽  
Author(s):  
Lila J. Finney Rutten ◽  
Kelly D. Blake ◽  
Alexandra J. Greenberg-Worisek ◽  
Summer V. Allen ◽  
Richard P. Moser ◽  
...  
Keyword(s):  
Health Information ◽  
Information Source ◽  
Healthy People ◽  
Easy Access ◽  
The Internet ◽  
Online Health Information ◽  
Multivariable Logistic Regression Analysis ◽  
Annual Household Income ◽  
Healthy People 2020 ◽  
Race Ethnicity

Objective: During the past decade, the availability of health information online has increased dramatically. We assessed progress toward the Healthy People 2020 (HP2020) health communication and health information technology objective of increasing the proportion of health information seekers who easily access health information online. Methods: We used data from 4 administrations of the Health Information National Trends Survey (HINTS 2008-2017) (N = 18 103). We conducted multivariable logistic regression analysis to evaluate trends over time in experiences with accessing health information and to examine differences by sociodemographic variables (sex, age, race/ethnicity, education, income, metropolitan status) separately for those who used the internet (vs other information sources) during their most recent search for health information. Results: Among US adults who looked for health information and used the internet for their most recent search, the percentage who reported accessing health information without frustration was stable during the study period (from 37.2% in 2008 to 38.5% in 2017). Accessing information online without frustration was significantly and independently associated with age 35-49 (vs age 18-34) (odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.03 -1.73), non-Hispanic black (vs non-Hispanic white) race/ethnicity (OR = 2.15; 95% CI, 1.55-2.97), and annual household income <$20 000 (vs >$75 000) (OR = 0.66; 95% CI, 0.47-0.93). The percentage of adults who used an information source other than the internet and reported accessing health information online without frustration ranged from 31.3% in 2008 to 42.7% in 2017. Survey year 2017 (vs 2008) (OR = 1.61; 95% CI, 1.09-2.35) and high school graduate education (vs college graduate) (OR = 0.69; 95% CI, 0.49-0.97) were significantly and independently associated with accessing health information without frustration from sources other than the internet. Conclusions: The percentage of online health information seekers reporting easily accessing health information did not meet the HP2020 objective. Continued efforts are needed to enable easy access to online health information among diverse populations.

Impact of dual anti-HER2 therapy on pathologic complete response rate in breast cancer in a minority-enriched population.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18111-e18111 ◽  
Author(s):  
Jenny Jing Li ◽  
Hsiao Ching Li ◽  
Ang Gao ◽  
Samira K. Syed ◽  
Nisha Unni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Complete Response Rate ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Safety Net ◽  
Her2 Breast Cancer ◽  
Race Ethnicity ◽  
Pathologic Complete Response Rate ◽  
Racial Ethnic

e18111 Background: The addition of pertuzumab (P) to a neoadjuvant trastuzumab (H) plus chemotherapy combination has been shown to significantly improve the pathologic complete response rate (pCR) in localized HER2+ breast cancer; however, minorities have been under-represented in these trials. Racial/ethnic disparities have also been shown to affect outcomes of cancer treatment. This study is aimed to assess the impact of neoadjuvant dual HER2-blockade in an unselected minority-enriched population. Methods: A retrospective chart review was conducted of women with stage I to III HER2+ breast cancer who received neoadjuvant treatment between 2007 and 2017 at an academic institution and its affiliated safety net health system. Data on stage, chemotherapy, race/ethnicity, site of therapy (academic vs safety net hospital), and hormone receptor status were collected. All patients underwent surgery after completion of neoadjuvant chemotherapy. pCR was defined as ypT0/is, ypN0. Chi-squared test and univariate/multivariate logistic regression were used for statistical analysis. Results: The study population included 261 women with the following race/ethnic distribution: 37.7% Non-Hispanic Whites, 34.6% Hispanics, 20.6% Blacks, and 7% other racial/ethnic origin. Ninety-five patients (36%) received chemotherapy-H vs 166 patients (64%) received chemotherapy-HP. Patients at the safety net health system had higher stage at diagnosis compared to the academic site. Site of care and race/ethnicity did not impact the choice of neoadjuvant treatment. The pCR rate was significantly higher for the chemotherapy-HP group (55.4%) compared to the chemotherapy-H group (34.7%) (p = 0.001). There was no association between race/ethnicity, or site of treatment (academic vs safety net), and the probability of achieving pCR. Multivariate analysis showed only dual anti-HER2 therapy (OR: 2.67, CI: 1.55-4.59, p = 0.0004) and hormone-receptor negative status (OR: 2.18, CI: 1.30-3.67, p = 0.0031) to correlate with pCR. Conclusions: Neoadjuvant dual anti-HER2 therapy was more likely to result in a pCR in our minority enriched population. Our data also suggests the combination of chemotherapy-HP confers similar benefit irrespective of race/ethnicity or site of care.

Parental Vaccine Hesitancy and Risk of Pediatric Influenza Undervaccination in a Safety-Net Healthcare System

2021 ◽  
Author(s):  
Joshua TB Williams ◽  
John D Rice ◽  
Yingbo Lou ◽  
Taylor K Soderborg ◽  
Elizabeth A Bayliss ◽  
...  
Keyword(s):  
Healthcare System ◽  
Safety Net ◽  
Vaccine Hesitancy

scholarly journals Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Divya A. Parikh ◽  
Rani Chudasama ◽  
Ankit Agarwal ◽  
Alexandar Rand ◽  
Muhammad M. Qureshi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Primary Language ◽  
Breast Cancer Patients ◽  
Patient Demographics ◽  
Academic Medical ◽  
Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

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