Health Insurance and Initiation of Direct-Acting Antivirals for Hepatitis C in US Women With Human Immunodeficiency Virus.

BACKGROUND: Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is well tolerated, cost-effective, and yields high sustained virologic response rates, yet it has remained financially inaccessible to many patients. METHODS: Participants of the Women's Interagency HIV Study (an observational US cohort) with human immunodeficiency virus (HIV) and HCV (RNA+) reporting no prior hepatitis C treatment were followed for DAA initiation (2015-2019). We estimated risk ratios (RRs) of the relationship between time-varying health insurance status and DAA initiation, adjusting for confounders with stabilized inverse probability weights. We also estimated weighted cumulative incidences of DAA initiation by health insurance status. RESULTS: A total of 139 women (74% Black) were included; at baseline, the median age was 55 years and 86% were insured. Most had annual household incomes ≤$18 000 (85%); advanced liver fibrosis (21%), alcohol use (45%), and recreational drug use (35%) were common. Across 439 subsequent semiannual visits, 88 women (63%) reported DAA initiation. Compared with no health insurance, health insurance increased the likelihood of reporting DAA initiation at a given visit (RR, 4.94; 95% confidence limit [CL], 1.92 to 12.8). At 2 years, the weighted cumulative incidence of DAA initiation was higher among the insured (51.2%; 95% CL, 43.3% to 60.6%) than the uninsured (3.5%; 95% CL, 0.8% to 14.6%). CONCLUSIONS: Accounting for clinical, behavioral, and sociodemographic factors over time, health insurance had a substantial positive effect on DAA initiation. Interventions to increase insurance coverage should be prioritized to increase HCV curative therapy uptake for persons with HIV.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study.

BACKGROUND: Influenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica. METHODS: We conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information-separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP. RESULTS: We surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89-6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06-5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08-4.68); and secondary/university education (aOR: 0.15-0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms. CONCLUSION: Vaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

A new smoking cessation 'cascade' among women with or at risk for HIV infection.

OBJECTIVES: The aim of this study was to define a smoking cessation 'cascade' among USA women with and without HIV and examine differences by sociodemographic characteristics. DESIGN: An observational cohort study using data from smokers participating in the Women's Interagency HIV Study between 2014 and 2019. METHODS: We followed 1165 women smokers with and without HIV from their first study visit in 2014 or 2015 until an attempt to quit smoking within approximately 3 years of follow-up, initial cessation (i.e. no restarting smoking within approximately 6 months of a quit attempt), and sustained cessation (i.e. no restarting smoking within approximately 12 months of a quit attempt). Using the Aalen-Johansen estimator, we estimated the cumulative probability of achieving each step, accounting for the competing risk of death. RESULTS: Forty-five percent of smokers attempted to quit, 27% achieved initial cessation, and 14% achieved sustained cessation with no differences by HIV status. Women with some post-high school education were more likely to achieve each step than those with less education. Outcomes did not differ by race. Thirty-six percent [95% confidence interval (95% CI): 31-42] of uninsured women attempted to quit compared with 47% (95% CI: 44-50) with Medicaid and 49% (95% CI: 41-59) with private insurance. CONCLUSION: To decrease smoking among USA women with and without HIV, targeted, multistage interventions, and increased insurance coverage are needed to address shortfalls along this cascade.

HIV and women in the USA: what we know and where to go from here.

New diagnoses of HIV infection have decreased among women in the USA overall, but marked racial and geographical disparities persist. The federal government has announced an initiative that aims to decrease the number of new infections in the nation by 90% within the next 10 years. With this in mind, we highlight important recent developments concerning HIV epidemiology, comorbidities, treatment, and prevention among women in the USA. We conclude that, to end the US HIV epidemic, substantially greater inclusion of US women in clinical research will be required, as will better prevention and treatment efforts, with universal access to health care and other supportive services that enable women to exercise agency in their own HIV prevention and care. Ending the epidemic will also require eliminating the race, class, and gender inequities, as well as the discrimination and structural violence, that have promoted and maintained the distribution of HIV in the USA, and that will, if unchecked, continue to fuel the epidemic in the future.

Telemedicina en procesos de rehabilitación en pacientes con paraplejia bajo el contexto de Atención Primaria de Salud / Telemedicine in rehabilitation processes in patients with paraplegia under the context of Primary Health Care

Encontrar estrategias costo-efectivas para la rehabilitación y la educación del paciente con paraplejia, basado en sus necesidades, es menester para su abordaje integral, así como para la disminución de costos directos e indirectos. La telemedicina podría ser una herramienta adecuada. Este trabajo se propuso realizar una revisión crítica de la literatura sobre la utilidad de la telemedicina para la rehabilitación y el manejo del paciente con paraplejia, en el contexto de la Atención Primaria de Salud. Se realizó una búsqueda en las bases de datos PubMed, Medline y EMBASE, con descriptores tipo MeSH y DeCS. No se aplicó ningún filtro de temporalidad, idioma o grupo etario. Se reunieron 134 artículos. El criterio de búsqueda y de selección se basó en los elementos PICO. Luego del análisis de contenido de cada uno, se escogieron 29 artículos. El análisis crítico de la literatura se realizó por medio de los elementos PRISMA. La telemedicina y la telerrehabilitación son herramientas que pudieran ser útiles para pacientes parapléjicos o cuadripléjicos; sin embargo, no existe literatura ni evidencia sobre este tipo de intervenciones en esta población. Intervenciones en pacientes con enfermedades neurológicas diferentes a la paraplejia muestran que potencialmente la telemedicina podría tener beneficios y reducir costos en la rehabilitación. Las herramientas tecnológicas y de telemedicina en pacientes parapléjicos podrían favorecer potencialmente su rehabilitación y el uso eficiente de los recursos; no obstante, es necesaria la realización de estudios en el área, para determinar el beneficio real de la telemedicina como estrategia de Atención Primaria de Salud en el paciente con paraplejia y cuadriplejia(AU)

Finding cost-effective strategies for the rehabilitation and education of patients with paraplegia, based on their needs, is necessary for their comprehensive approach, as well as for the reduction of direct and indirect costs. The objective of this work was to perform a critical review of the literature on the usefulness of telemedicine for the rehabilitation and management of patients with paraplegia, in the context of Primary Health Care. A review of the literature in the PubMed, Medline and EMBASE databases was performed with MeSH and DeCS type descriptors. No filter of temporality, language or age group was applied. 134 articles were collected. The searching and selection criteria were based on the PICO elements; after the content analysis of each one, 29 articles were chosen. The critical analysis of the literature was carried out through the PRISMA elements. Telemedicine and telerehabilitation are tools that could be useful for paraplegic or quadriplegic patients; however, there is no literature or evidence on this type of interventions in this population. Interventions in patients with neurological diseases other than paraplegia show that telemedicine could potentially have benefits and reduce rehabilitation costs. The technological and telemedicine tools in paraplegic patients could potentially favor their rehabilitation and efficient use of resources; however, studies in the area are necessary to determine the real benefit of telemedicine as a care strategy primary health in the patient with paraplegia and quadriplegia(AU)

Preventing HIV infection in women.

Although the number of new infections has declined recently, women still constitute almost half of the world's 34 million people with HIV infection, and HIV remains the leading cause of death among women of reproductive age. Prevention research has made considerable progress during the past few years in addressing the biological, behavioral, and social factors that influence women's vulnerability to HIV infection. Nevertheless, substantial work still must be performed to implement scientific advancements and to resolve many questions that remain. This article highlights some of the recent advances and persistent gaps in HIV prevention research for women and outlines key research and policy priorities.

Utilidad del análisis de la variabilidad de la frecuencia cardíaca en la valoración de neuropatía autonómica diabética / Utility of analysis of the variability of the cardiac frequency in the valoration of diabetic autonomic neuropathy

Una complicación de la diabetes mellitus es la neuropatía autonómica...