RESUMO
Over the course of the past two decades, attrition within the US governmental public health workforce has passed concerning and become dire. The practice sector has struggled to recruit and retain new talent, despite the infusion of considerable federal investment in workforce expansion initiatives. In 2020, Emory University's Rollins School of Public Health partnered with the Georgia Department of Public Health to establish the Rollins Epidemiology Fellowship Program. Initially created to recruit and place early-career master of public health-level epidemiologists into Georgia's public health system for COVID-19 pandemic response, the two-year service-learning program has evolved into an effective and replicable model of direct academic involvement in strengthening the governmental public health workforce. Here we describe the program's structure and early results, spotlighting it for consideration by the federal government and other jurisdictions interested in directly engaging academia in efforts to revitalize the public health workforce.
Assuntos
COVID-19 , Bolsas de Estudo , Humanos , Georgia , COVID-19/epidemiologia , Epidemiologia/educação , Saúde Pública , Mão de Obra em Saúde , Recursos HumanosRESUMO
June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight. Other major epidemics over the past decade have included Ebola, arbovirus infections, and coronavirus disease (COVID-19). A benchmark against which to compare other global interventions is the HIV/AIDS response in terms of funding, coordination, and solidarity. Lessons from Ebola and HIV/AIDS are pertinent to the COVID-19 response. The fifth decade of AIDS will have to position HIV/AIDS in the context of enhanced preparedness and capacity to respond to other potential pandemics and transnational health threats.
Assuntos
Síndrome da Imunodeficiência Adquirida , COVID-19 , Infecções por HIV , Doença pelo Vírus Ebola , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Infecções por HIV/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Pandemias , SARS-CoV-2Assuntos
Atitude , COVID-19 , Saúde Pública , Ciência , Confiança , Governo Federal , Humanos , Política , Administração em Saúde Pública , Estados UnidosRESUMO
Substantial progress has been made towards the goal of ending the HIV/AIDS epidemic due to advancements in both prevention and treatment of HIV. However, major challenges still remain. We describe basic principles of epidemic control in the context of HIV and identify a number of attainable goals in terms of control and elimination of HIV in specific populations and risk groups, given currently available HIV prevention and treatment methods. Currently available HIV prevention methods make it a feasible goal to eliminate HIV transmission attributable to mother-to-child transmission and blood transfusions. Reductions in transmission attributable to sexual behavior and injection drug use are feasible, but elimination of these modes of transmission will require further advancements in behavioral and biomedical HIV prevention. With regard to HIV-related mortality, we argue that elimination of death due to HIV-related causes is a feasible goal. HIV-related deaths should be treated as sentinel events triggering epidemiological investigation into the breakdowns in the HIV care continuum that led to them. We briefly discuss additional considerations that will affect the success of HIV prevention programs.
Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Objetivos , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Incidência , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , PrevalênciaRESUMO
The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public health in humanitarian response. These modest efforts are just the beginning in terms of addressing the global shortage of skilled public health professionals that can coordinate humanitarian response. Evaluating existing programs will allow for refinement of current programs. Ultimately, these programs may influence the development of new programs and inform others interested in this area. Evans DP , Anderson M , Shahpar C , del Rio C , Curran JW . Innovation in graduate education for health professionals in humanitarian emergencies. Prehosp Disaster Med. 2016;31(5):532-538.
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Altruísmo , Planejamento em Desastres , Educação de Pós-Graduação , Pessoal de Saúde/educação , Educação Baseada em Competências , Georgia , Humanos , Estudos de Casos OrganizacionaisRESUMO
BACKGROUND: Black/white disparities in HIV incidence and prevalence among men who have sex with men (MSM) in the United States remain largely unexplained. We examined the impact on HIV prevalence and incidence of interventions that decrease disparities in HIV care. Deciding which interventions have most impact on reducing disparities is critical. METHODS: Using available US Centers for Disease Control and Prevention (CDC) estimates, we constructed HIV care continua for black and white MSM for 2009-2010. These estimates were used as parameters in a deterministic model to yield estimated race-specific transmissions, transmission rates, incidence rates, and rate-ratios (RR). We examined the impact of changes in the care continuum for black MSM on transmission and incidence rates. FINDINGS: Marked disparities were found throughout the care continuum: ultimately, 16% of black and 34% of white MSM achieved viral suppression. Based on these care continua, 9,833 and 9,710 new HIV transmissions were estimated annually respectively from HIV-positive black and white MSM (transmission RR=1·36 and incidence RR=7·92). In a model where black and white MSM have identical care outcomes, transmission RR=1·00 and incidence RR=5·80. Scenarios of 95% diagnosis, 95% retention, and concurrent 95% diagnosis and 95% retention respectively yield transmission RR=1·00, 1·02, 0·56, and incidence RR=5·81, 5·93, 3·28. INTERPRETATION: Disparities in HIV transmission rates may be reduced by improving the HIV care continuum outcomes, but existing racial disparities in HIV prevalence will likely continue to drive higher incidence among black MSM for decades to come.
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Planejamento em Desastres/organização & administração , Saúde Pública/educação , Pesquisa , Faculdades de Saúde Pública/organização & administração , Centers for Disease Control and Prevention, U.S. , Defesa Civil/organização & administração , Prática Clínica Baseada em Evidências , Humanos , Estados UnidosAssuntos
Educação Baseada em Competências/normas , Educação Profissional em Saúde Pública/normas , Saúde Global/educação , Aprendizagem Baseada em Problemas/normas , Educação Baseada em Competências/métodos , Educação Baseada em Competências/tendências , Currículo/normas , Currículo/tendências , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Educação Profissional em Saúde Pública/organização & administração , Educação Profissional em Saúde Pública/tendências , Avaliação Educacional/métodos , Georgia , Humanos , Estudos Interdisciplinares/normas , Estudos Interdisciplinares/tendências , Aprendizagem Baseada em Problemas/métodos , Aprendizagem Baseada em Problemas/tendências , Faculdades de Saúde PúblicaRESUMO
Integration of innovative social and behavioral science with public health approaches for HIV prevention and treatment is of critical importance for slowing the global HIV epidemic. Strengthening and focusing social and behavioral research linking testing and treatment strategies to populations at greatest risk for HIV is crucial. The Social and Behavioral Science Research Network(SBSRN), originated in 2006, involves twenty NIH-funded CFAR Centers and is responding to this challenge.
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Síndrome da Imunodeficiência Adquirida/prevenção & controle , Ciências do Comportamento , HIV , Ciências Sociais , Síndrome da Imunodeficiência Adquirida/etiologia , Humanos , Pesquisa Translacional BiomédicaAssuntos
Fármacos Anti-HIV/administração & dosagem , Desoxicitidina/análogos & derivados , Infecções por HIV/prevenção & controle , Implementação de Plano de Saúde , Compostos Organofosforados/administração & dosagem , Desoxicitidina/administração & dosagem , Combinação de Medicamentos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila , Humanos , Prevenção PrimáriaRESUMO
The President's Emergency Plan for AIDS Relief (PEPFAR) has made a major contribution to the reduction of the global HIV/AIDS burden. The program initially focused on rapidly scaling up treatment and prevention services in fifteen low-income countries, then transitioned to an approach that emphasizes sustainability, defined as the capacity to maintain program services after financial, managerial, and technical assistance from the United States and other external donors essentially ceases. Today, PEPFAR continues to expand its HIV prevention, treatment, and care activities while also supporting capacity-building initiatives, coordination efforts, and implementation science. The latter is research focused on improving service delivery, maximizing cost-effectiveness, and achieving public health impact. Recent advances in both scientific knowledge and the provision of prevention, treatment, and care services have bred cautious optimism about greatly reducing the spread of HIV. However, success will require a substantial increase in resources, strengthened health systems, renewed commitment to HIV prevention, and well-financed efforts to develop an effective HIV vaccine.
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Síndrome da Imunodeficiência Adquirida/terapia , Cooperação Internacional , Síndrome da Imunodeficiência Adquirida/prevenção & controle , África Subsaariana , Emergências , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Humanos , Objetivos Organizacionais , Avaliação de Programas e Projetos de Saúde , Estados UnidosRESUMO
Following its recognition in 1981, the HIV/AIDS epidemic has evolved to become the greatest challenge in global health, with some 34 million persons living with HIV worldwide. Early epidemiologic studies identified the major transmission routes of the virus before it was discovered, and enabled the implementation of prevention strategies. Although the first identified cases were in MSM in the United States and western Europe, the greatest impact of the epidemic has been in sub-Saharan Africa, where most of the transmission occurs between heterosexuals. Nine countries in southern Africa account for less than 2% of the world's population but now they represent about one third of global HIV infections. Where broadly implemented, HIV screening of donated blood and antiretroviral treatment (ART) of pregnant women have been highly effective in preventing transfusion-associated and perinatally acquired HIV, respectively. Access to sterile equipment has also been a successful intervention for injection drug users. Prevention of sexual transmission has been more difficult. Perhaps the greatest challenge in terms of prevention has been in the global community of MSM in which HIV remains endemic at high prevalence. The most promising interventions are male circumcision for prevention of female-to-male transmission and use of ART to reduce infectiousness, but the extent to which these interventions can be brought to scale will determine their population-level impact.