Peripartum mobility and maternal/child separation among women living with HIV in South Africa.

This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.

Characterizing residential mobility among people with HIV in Tennessee and its impact on HIV care outcomes.

OBJECTIVE: Our objective was to assess the prevalence and patterns of mobility among people with HIV (PWH) in Tennessee and its impact on HIV care outcomes. DESIGN: Retrospective cohort study. METHODS: We combined residential address and HIV surveillance data from PWH in Tennessee from 2016 to 2018. Using Poisson regression, we estimated associations between in-state mobility (change in address or total miles moved) in 1 year and outcomes in the subsequent year; retention: having two CD4 + /HIV RNA values (labs) in a calendar year at least 3 months apart, loss to follow-up (LTFU): having labs at baseline but not the subsequent year, and viral suppression: HIV RNA less than 200 copies/ml. We applied a kernel density estimator to origin-destination address lines to visualize mobility patterns across demographic subgroups. RESULTS: Among 17 428 PWH [median age 45 years (interquartile range; IQR 34-53)], 6564 (38%) had at least one move. Median miles moved was 8.9 (IQR 2.6-143.4)). We observed in-state movement between major cities (Chattanooga, Knoxville, Memphis and Nashville) and out-of-state movement to and from Georgia and Florida. Having at least one in-state move was associated with a decreased likelihood of retention [adjusted relative risk (aRR) = 0.91; 95% confidence interval (CI) 0.88-0.95], and an increased risk of LTFU (aRR = 1.17; 95% CI 1.04-1.31, two to three moves vs. none). Greater distance moved in-state was associated with decreased retention and increased LTFU (aRR = 0.53; 95% CI 0.49-0.58, aRR = 2.52; 95% CI 2.25-2.83, respectively for 1000 vs. 0 miles). There was no association between mobility and viral suppression. CONCLUSION: Mobility is common among PWH in Tennessee and is associated with initial poor engagement in HIV care.

Emotional Freedom Techniques for Postpartum Depression, Perceived Stress, and Anxiety.

OBJECTIVE: To examine the effect of an Emotional Freedom Techniques (EFT) group intervention on perceived stress, depression, and anxiety symptoms in women in the postpartum period. DESIGN: A one-group pre- and posttest quasi-experimental design. SETTING/LOCAL PROBLEM: Postpartum depression (PPD) and anxiety affect nearly one in five women in the first 12 months after childbirth. The COVID-19 pandemic was associated with a significant worsening of symptoms of PPD, stress, and anxiety in this population. Mental health screening is the standard of care in perinatal settings. This practice has led to an increased rate of PPD and anxiety diagnoses and the need for evidence-based nonpharmacologic interventions to support mothers with PPD and anxiety. PARTICIPANTS: Eleven mothers seeking care for lactation concerns who screened positive for PPD and anxiety symptoms. INTERVENTION/MEASUREMENTS: A total of eight 1-hour group EFT sessions were offered to participants over a period of 4 weeks. During the group sessions, participants were taught how to perform the steps of EFT and apply it in a supportive group format. Measurement tools included the Subjective Unit of Distress Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. The preintervention and postintervention scores of these tools were compared using a paired-samples t test. RESULTS: After implementing EFT as a group intervention, we observed a reduction in mental health burden experienced by women in the postpartum period. There was a statistically significant decrease in depression (p = .003), anxiety (p <.001), and perceived stress (p <.001) scores 1 month after the EFT intervention. CONCLUSION: These findings suggest that EFT may be a viable adjunctive intervention for managing depression, anxiety, and stress in the postpartum period. Further research with larger and more diverse samples is needed to confirm these findings.

Geographic Variation in Access to Cardiac Rehabilitation.

BACKGROUND: There is marked geographic variation in cardiac rehabilitation (CR) initiation, ranging from 10% to 40% of eligible patients at the state level. The potential causes of this variation, such as patient access to CR centers, are not well studied. OBJECTIVES: The authors sought to determine how access to CR centers affects CR initiation in Medicare beneficiaries. METHODS: The authors used Medicare files to identify CR-eligible Medicare beneficiaries and calculate CR initiation rates at the hospital referral region (HRR) level. We used linear regression to evaluate the percent variation in CR initiation accounted for by CR access across HRRs. We then employed geospatial hotspot analysis to identify CR deserts, or counties in which patient load per CR center is disproportionately high. RESULTS: A total of 1,133,657 Medicare beneficiaries were eligible for CR from 2014 to 2017, of whom 263,310 (23%) initiated CR. The West North Central Census Division had the highest adjusted CR initiation rate (35.4%) and the highest density of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). Density of CR programs accounted for 21.2% of geographic variation in CR initiation at the HRR level. A total of 40 largely urban counties comprising 14% of the United States population age ≥65 years had disproportionately low CR access and were identified as CR deserts. CONCLUSIONS: A substantial proportion of geographic variation in CR initiation was related to access to CR programs, with a significant amount of the U.S. population living in CR deserts. These data invite further study on interventions to increase CR access.