Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

Objective: Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. Methods: We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. Results: PrIDE jurisdictions implemented multiple health equity–focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP ( z = −33.57; P < .001). Conclusions: PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity–focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.

Increased mask adherence after important politician infected with COVID-19

Objectives To quantify changes in adherence to mask and distancing guidelines in outdoor settings in Philadelphia, PA before and after President Trump announced he was infected with COVID-19. Methods We used Systematic Observation of Masking Adherence and Distancing (SOMAD) to assess mask adherence in parks, playgrounds, and commercial streets in the 10 City Council districts in Philadelphia PA. We compared adherence rates between August and September 2020 and after October 2, 2020. Results Disparities in mask adherence existed by age group, gender, and race/ethnicity, with females wearing masks correctly more often than males, seniors having higher mask use than other age groups, and Asians having higher adherence than other race/ethnicities. Correct mask use did not increase after the City released additional mask guidance in September but did after Oct 2. Incorrect mask use also decreased, but the percentage not having masks at all was unchanged. Conclusions Vulnerability of leadership appears to influence population behavior. Public health departments likely need more resources to effectively and persuasively communicate critical safety messages related to COVID-19 transmission.

Containment of a multi-index B.1.1.7 outbreak on a university campus through a genomically-informed public health response

The first cluster of SARS-CoV-2 cases with lineage B.1.1.7 in the state of Michigan was identified through intensive university-led surveillance sampling and targeted sequencing. A collaborative investigation and response was conducted by the local and state health departments, and the campus and athletic medicine COVID-19 response teams, using S-gene target failure screening and rapid genomic sequencing to inform containment strategies. A total of 50 cases of B.1.1.7-lineage SARS-CoV-2 were identified in this outbreak, which was due to three coincident introductions of B.1.1.7-lineage SARS-CoV-2, all of which were genetically distinct from lineages which later circulated in the broader community. This investigation demonstrates the successful implementation of a genomically-informed outbreak response which can be extended to university campuses and other settings at high risk for rapid emergence of new variants.

Prevalence of SARS-CoV-2 Infection in a Sample of Health Workers in Two Health Departments of the Valencian Community in Spain

Health care personnel constitutes the most vulnerable group of professionals, as they are employed in a work context with higher exposure to SARS-CoV-2 infection. This study aims to estimate the prevalence of SARS-CoV-2 infection in health personnel (n = 2858) of two health departments in the Valencian community between March 2020 and April 2021, as well as the sociodemographic and work variables predicting higher infection prevalence in this group. A cross-sectional descriptive study was performed on health workers from the health departments of Torrevieja and Elche-Crevillente of the Valencian Community (Spain). After obtaining the samples, the cases were identified through an active infection diagnostic test (AIDT). The analyzed variables were: sex, age (18–34/35–49/>50 years), professional category, health care, risk service, and AIDT. A total of 2858 staff members were studied. Of them, 55.4% (1582) underwent an AIDT, with 9.7% (277) of positive cases. Infection predominated in the age group of 18 to 34 years, 12.6% (OR = 1.98, 95% CI [1.26, 3.11]); nurses, 12.1% (OR = 1.5, 95% CI [1.00, 2.23]); and at-risk services, 11.4% (OR = 1.3, 95% CI [1.06, 1.81]). A very low positivity rate was identified in the health personnel linked to the health departments analyzed during the 14 months of the study period. Based on our results, prevention strategies could focus more intensively on the most at-risk groups, specifically young nurses who work in at-risk services, mainly in emergency and internal medicine.

COMORBIDADES E ÓBITOS POR COVID-19 NO BRASIL

The new coronavirus outbreak in November 2019 quickly became an international public health emergency. Some studies demonstrate that the poor prognosis of the disease is directly related to the presence of comorbidities, with a risk of death increased by 3.4 times. Thus, the present study aimed to describe the cases of patients with Covid-19 that progressed to death in Brazil, evidencing age, sex, and presence of comorbidities. A retrospective, descriptive study was carried out with secondary data from patients with Covid-19 who progressed to death in Brazil, available on the websites of the health departments of each of the 27 federative units that make up the country. Data were tabulated and frequencies calculated in Microsoft Office Excel® 2007. There were 13,900,091 confirmed cases of Covid-19 until the 59th National Epidemiological Bulletin of 2021, of which 371,678 evolved to death; of them, 61.3% had comorbidities. Among the main comorbidities reported, heart disease (40.1%), diabetes (28.4%), obesity (10.3%), neurological diseases (5.0%), kidney diseases (4.7%) and pneumopathies (4.5%) stand out. In 70% of the cases of patients who died, age equal to or greater than 60 years was observed in males in 55% of the cases. The data obtained corroborate the literature, which indicate a poor prognosis of Covid-19 in patients with one or more comorbidities. Among these, the one that stood out in Brazil during the study period was heart disease.