An outbreak of HIV infection among people who inject drugs in northeastern Massachusetts: findings and lessons learned from a medical record review.

BACKGROUND: We conducted a medical record review for healthcare utilization, risk factors, and clinical data among people who inject drugs (PWID) in Massachusetts to aid HIV outbreak response decision-making and strengthen public health practice. SETTING: Two large community health centers (CHCs) that provide HIV and related services in northeastern Massachusetts. METHODS: Between May and July 2018, we reviewed medical records for 88 people with HIV (PWH) connected to the outbreak. The review period included care received from May 1, 2016, through the date of review. Surveillance data were used to establish date of HIV diagnosis and assess viral suppression. RESULTS: Sixty-nine (78%) people had HIV infection diagnosed during the review period, including 10 acute infections. Persons had a median of 3 primary care visits after HIV diagnosis and zero before diagnosis. During the review period, 72% reported active drug or alcohol use, 62% were prescribed medication assisted treatment, and 41% were prescribed antidepressants. The majority (68, 77%) had a documented ART prescription. HIV viral suppression at < 200 copies/mL was more frequent (73%) than the overall across the State (65%); it did not correlate with any of the sociodemographic characteristics studied in our population. Over half (57%) had been hospitalized at least once during the review period, and 36% had a bacterial infection at hospitalization. CONCLUSIONS: Medical record review with a field investigation of an outbreak provided data about patterns of health care utilization and comorbidities not available from routine HIV surveillance or case interviews. Integration of HIV screening with treatment for HIV and SUD can strengthen prevention and care services for PWID in northeastern Massachusetts.

Verbal ability and executive functioning development in preschoolers at head start.

Research suggests that executive functioning skills may enhance the school readiness of children from disadvantaged homes. Questions remain, however, concerning both the structure and the stability of executive functioning among preschoolers. In addition, there is a lack of research addressing potential predictors of longitudinal change in executive functioning during early childhood. This study examined the structure of executive functioning from fall to spring of the preschool year using a multimethod battery of measures. Confirmatory factor analyses revealed a unidimensional model fit the data well at both time points, and tests of measurement invariance across time points indicated that children's mean latent executive functioning scores significantly improved over time. Verbal ability was a significant predictor of longitudinal change in executive functioning. Theoretical implications and directions for future research are discussed.