COVID-19: A Vaccine Priority Index Mapping Tool for Rapidly Assessing Priority Populations in North Carolina

Background: The initial limited supply of COVID-19 vaccine in the U.S. presented significant allocation, distribution, and delivery challenges. Information that can assist health officials, hospital administrators and other decision makers with readily identifying who and where to target vaccine resources and efforts can improve public health response. Objective: The objective of this project was to develop a publicly available geographical information system (GIS) web mapping tool that would assist North Carolina health officials readily identify high-risk, high priority population groups and facilities in the immunization decision making process. Methods: Publicly available data were used to identify 14 key health and socio-demographic variables and 5 differing themes (social and economic status; minority status and language; housing situation; at risk population; and health status). Vaccine priority population index (VPI) scores were created by calculating a percentile rank for each variable over each N.C. Census tract. All Census tracts (N = 2,195) values were ranked from lowest to highest (0.0 to 1.0) with a non-zero population and mapped using ArcGIS. Results: The VPI tool was made publicly available (https://enchealth.org/) during the pandemic to readily assist with identifying high risk population priority areas in N.C. for the planning, distribution, and delivery of COVID-19 vaccine.Discussion: While health officials may have benefitted by using the VPI tool during the pandemic, a more formal evaluation process is needed to fully assess its usefulness, functionality, and limitations. Conclusion: When considering COVID-19 immunization efforts, the VPI tool can serve as an added component in the decision-making process.

Stakeholder Insights Into a Systems-Based Suicide Prevention Program Implemented in Regional and Rural Tasmanian Communities

Purpose: Emerging evidence indicates that systems-based suicide prevention programs can help optimise suicide prevention activities, with the National Suicide Prevention Trial using these approaches in regional and community contexts throughout Australia. The Tasmanian arm of the Trial adopted the LifeSpan systems framework to deliver suicide prevention activities across three distinct geographical areas, focusing on high-risk populations of men aged 40-64 and people 65 and over. The University of Tasmania’s Centre for Rural Health undertook a local-level evaluation of the Trial in Tasmania.Aims: To explore key stakeholder perceptions of the implementation of a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia.Method: Focus groups and interviews with 46 participants, comprising Working Group members (n=25), Tasmania’s Primary Health Network employees (n=7), and other key stakeholders (n=14), with the majority (53.3%) reporting a lived experience of suicide. Thematic analysis was used to explore data and study aims.Results: Key themes centred on how the National Suicide Prevention Trial was understood and established in Tasmania; Working Group governance structures and processes; communication and engagement processes; reaching priority population groups; the LifeSpan model and activity development; and the effectiveness and sustainability of activities.Discussion: Findings showed communities were wary of suicide and wanted to engage to take action and the Trial provided the resources and coordination to do so. Perceived limitations implementing the Trial included varied involvement of key stakeholders, and lack of role clarity within Working Groups. Barriers delivering activities to the priority population groups suggested a strict adherence to the Lifespan model was challenging. Working Groups embraced a pragmatic approach, preferring activities that best utilised available capital and resources to meet perceived needs within communities. While a focus on effectiveness and sustainability of activities was seen as important, barriers at the community-level, i.e. nobody to run them, hindered these efforts. Analysis of stakeholder perceptions provides crucial insights for guiding future community-based suicide prevention efforts in regional and rural areas, and with high-risk groups.

Barriers and Facilitators to Community Health Worker Outreach and Engagement in Detroit, Michigan: A Qualitative Study

An effective approach to engaging populations who face health care access barriers is support from community health workers (CHWs). There is little research, however, on specific barriers and facilitators related to two key areas of CHW practice: outreach, defined as the ability to make any initial contact with the priority population, and engagement, defined as the ability to continue to work with the priority population after initial contact is made. The current qualitative study is ancillary to a randomized evaluation of a CHW-led program for Medicaid Health Plan enrollees. Implementation experiences with outreach and engagement led the evaluators to develop the current study in which health plan and nonhealth plan CHWs (n = 12) serving low-income, predominantly Black populations in Detroit participated in qualitative semistructured interviews to elucidate barriers and facilitators to outreach and engagement. All audio recordings were transcribed verbatim. The study team used inductive qualitative data analysis techniques. Barriers to outreach included inaccurate contact information and mistrust. Barriers to engagement included lack of ability to provide needed resources, leading to hopelessness and diminished trust, and discontinuity of services due to eligibility changes and terminated programs. Facilitators included adapting outreach schedules and strategies to community needs, availability of resources, and relational strategies that leveraged CHW social proximity. Further research should systematically investigate the relative success of different CHW-led outreach and engagement strategies for specific populations so as to better design and implement CHW programs.

COVID-19 Vaccine Uptake Among People Living With HIV

People living with HIV (PLWH) are at greater risk for severe COVID-19 and are a priority population for COVID-19 vaccination. As of June 15, 2021, 61.5% of PLWH in Oregon received ≥ 1 COVID-19 vaccine dose. Younger PLWH, Hispanic/Latinx PLWH and PLWH who inject drugs or reside in rural and frontier areas had low vaccine uptake while PLWH who were engaged in care, enrolled in the AIDS Drug Assistance Program, and vaccinated against influenza had high vaccine uptake. Greater advocacy, education, and care navigation are required to increase COVID-19 vaccine access and uptake among PLWH.

HIV-Related Stigma Moderates the Relation Between Perceived Susceptibility and HIV Testing Intention Among Heterosexual (but Not Sexual Minority) College Students

HIV-related stigma remains a considerable barrier to engaging at-risk populations in HIV testing and prevention programs. We assessed the moderating role of HIV-related stigma on the relation between perceived susceptibility to HIV and HIV testing intention among college students. We hypothesized that the moderating role of HIV-related stigma would be differential between heterosexual and sexual minority college students. We administered a survey focused on HIV-related knowledge, attitudes, and behaviors in spring 2016 ( N = 2,159). We used multigroup path analysis to analyze the hypothesized moderation. HIV-related stigma moderated the relation between perceived susceptibility and testing intention for heterosexual but not sexual minority college students. Specifically, higher HIV-related stigma decreased the association between perceived susceptibility and testing intention. These results demonstrate the importance of priority population segmentation for HIV testing campaigns.

Development of the Croatian Version of the MRNI-A-r Scale: A Self-Reported Measure of Traditional Masculinity for Adolescents

The concept of masculinity is particularly challenging to measure across cultures, given the lack of scales in languages other than English. This study describes the adaptation for Croatian adolescents of the MRNI-A-r scale, which measures the endorsement of traditional masculinity. We organized the process into two segments. Segment 1 described the step-by-step adaptation process showing evidence of face and content validity. Segment 2 examined the factorial structure, internal consistency, and construct and criterion-related validity of the scores of the Croatian version in a large sample of adolescents ( n = 4116) attending schools in Zagreb. As hypothesized, higher scores were associated with lower support for gender equality, males reported higher scores than females, and the internal consistency of the scores was good. The development of scales in the language of the priority population with a demonstrated cultural equivalence of terms is a fundamental step toward understanding the impact of masculinity in a global context.

A preliminary report of the pattern of ear disease among students attending a school for people with disabilities in Samoa

Objectives: The Ear, Nose, and Throat Department of Samoa is developing a school outreach service, and the aim of this study is to determine the pattern of ear disease among students attending a school for people with disabilities in Samoa. Methods: The study design is a prospective study of a 2-day outreach visit to a school for people with disabilities by the Samoan Ear, Nose, and Throat team who recorded their clinical findings (N = 28). Two Ear, Nose, and Throat Specialists performed ear examinations for each student and recorded their diagnosis and recommendations as per routine Ear, Nose, and Throat Clinic protocols on a purposefully designed form based on the World Health Organization Ear and Hearing Survey. This information was entered into an Excel spreadsheet for descriptive statistical analysis. Results: Results showed that 39% (n = 11) of students passed their initial ear examination, while 61% (n = 17) of students presented with at least one ear condition requiring Ear, Nose, and Throat intervention. The most common pathology was impacted wax (n = 15 ears). Following the Ear, Nose, and Throat Clinic outreach visit, 21 students (75%) no longer required Ear, Nose, and Throat or medical services, five students (18%) required a medical prescription for the treatment of ear disease, and two students (7%) were referred to the Ear, Nose, and Throat Department for further review. Conclusion: Students attending schools for people with disabilities are a priority population for the Ear, Nose, and Throat Clinical service outreach programme.