Patient and Provider Perceptions of Barriers and Facilitators to Pre-exposure Prophylaxis Access and Adherence in Black and Latinx Young Men Who Have Sex with Men.

In the United States, the use of pre-exposure prophylaxis (PrEP) has led to a substantial decrease in HIV prevalence and incidence. However, some populations, including young men who have sex with men (YMSM) of color, continue to be disproportionately impacted, highlighting the need for tailored interventions addressing barriers to adequate PrEP access. In collaboration with partner clinics, we recruited 19 PrEP clients and 19 PrEP providers (n = 35) to participate in hour-long in-depth interviews. Although client interviews explored personal experiences with stigma, barriers, and motivators to PrEP and information preferences, provider interviews explored providers' perceived stigma in their clinic, perceived barriers and motivators to meeting clients' PrEP needs, and rapport building with clients. Most participants were affiliated with one of the southern partner clinics. Clients and providers noted similar determinants to PrEP access, uptake, and adherence. Both recognized the impact of personal barriers such as routine adjustments and perception of need, as well as institutional barriers such as transportation and financial difficulties. Clients emphasized the role of the client-provider relationship as part of contributing to willingness to disclose information such as HIV status and sexual practices. Providers noted the importance of sexual health and LGBTQ+ topics in their training. Despite limited geographical scope and the sensitive nature of HIV-related topics, this study has several implications. PrEP clinics may benefit from hiring providers who share identities and experiences with YMSM clients of color and operating with a flexible schedule. Medical provider training should include comprehensive sexual health and LGBTQ+ competencies to reduce bias in care.

Long-term functional outcomes after traumatic popliteal artery injury: A 20-year experience.

BACKGROUND: Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome. METHODS: Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI. RESULTS: A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7-15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA. CONCLUSION: Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI. LEVEL OF EVIDENCE: Prognostic, level III.

Cardiovascular autonomic function in healthy adolescents.

OBJECTIVE: The purpose of this study was to determine effects of age, sex, race, body mass index, and Tanner's stage on short-term evoked cardiovascular autonomic tests (ie, Valsalva ratio and change in heart rate with deep breathing) and 24-hour heart rate variability (HRV) in a sample of healthy adolescents, as well as to identify normative indices of both short-term evoked and 24-hour HRV in this age group. DESIGN: A descriptive, correlational design was used. SETTING: Study took place in a university hospital in a health science center located in the mid-South. SUBJECTS: Participants included 75 healthy adolescents: mean age was 15.0 +/- 1.6 years, 14 were African American, 61 were white, 49 were girls, and 26 were boys. OUTCOME MEASURES: Study measures included the Valsalva ratio, change in heart rate with deep breathing, and 24-hour HRV with power spectral analysis with Holter monitoring. RESULTS: Major significant findings included lower values of 24-hour HRV measures for girls and African American adolescents (P <.05). Indices for normal ranges of both the short-term evoked and 24-hour HRV measures were computed with 95% confidence intervals. CONCLUSIONS: Few published studies address cardiac autonomic function, including 24-hour HRV, in adolescents. Most studies reporting actual normative control values of HRV for youth typically have not addressed sex or racial differences. Our study included the largest number of adolescents to date in the reported literature and demonstrated the importance of considering sex and race variation in interpreting test results. The availability of state-of-the-art technology for obtaining HRV data allows for the early identification of subclinical cardiac autonomic changes in youth who have predispositions for cardiac complications, such as those with diabetes, congenital heart disease, or obesity.