Incarceration, Inequality, and Hepatitis C Treatment: The Story of Two Southern States.

Hepatitis C virus (HCV) infection causes liver-related morbidity/mortality and disproportionately affects people who are incarcerated and non-Hispanic Black populations, largely due to social and policy issues that contribute to poor health. With the advent of highly efficacious treatment, HCV is now curable. However, most states' departments of corrections do not offer universal HCV testing or treatment. Two southern states-Tennessee and Louisiana-provide examples of divergent approaches to addressing HCV infection. While Tennessee has offered treatment on a limited basis, resulting in a class action lawsuit, the state of Louisiana recently adopted a new approach. In establishing the 2019 Hepatitis Elimination Plan, the state created a standard of care for HCV infection that included robust testing and treatment in state prison facilities while capping costs. Louisiana has demonstrated the feasibility of HCV testing and treatment programs within state prisons, an important step towards achieving health equity.

Evaluating for health equity among a cluster of health departments implementing PrEP services.

African American/Black and Hispanic/Latino sexual and gender minority populations are disproportionately affected by HIV in the United States and continue to experience HIV-related disparities. CDC funded project PrIDE to support 12 health departments (HD) with implementing pre-exposure prophylaxis (PrEP) strategies for men who have sex with men (MSM) and transgender persons, with a health-equity focus established by HDs. Each HD conducted mixed-methods evaluation of at least one local strategy. CDC employed a cluster evaluation approach to maximize cross validation. As a result, this cluster evaluation focused on three HDs that evaluated health equity-focused PrEP implementation strategies. Findings suggest that integrating health equity strategies such as storytelling and healthcare worker (HCW) trainings can help reduce HIV-related disparities. Storytelling improved HCW's understanding of clients' experiences of stigma due to racial, gender, and sexual identities. Provider training increased competencies on culturally appropriate care and the use of clinic services by Black and Hispanic MSM and transgender persons. Good practices included community engagement, seeking leadership buy-in, and integration of programmatic staff in health equity and evaluation activities. Evaluating strategies and training policies addressing social determinants of health that adversely affect HIV outcomes may help mitigate barriers Black and Hispanic MSM and transgender populations encounter in their HIV prevention seeking efforts.

A psychometric assessment of a network social capital scale among sexual minority men and gender minority individuals.

BACKGROUND: Social capital, the potential for individuals to access resources through group memberships, is linked to a constellation of health outcomes. We modified a previously evaluated Constructed Family Social Capital Scale for gay, bisexual and other men who have sex with men who belong to constructed families to create a new measure of social capital within sexual minority men and gender minority individuals' social networks. METHODS: Participants were recruited from a Pride festival in Milwaukee, Wisconsin in 2018 to complete a cross-sectional survey. This analysis is restricted to 383 participants who identified as sexual minority men or gender minority individuals and completed nine items measuring social capital within their social networks. We conducted exploratory and confirmatory factor analyses to assess factor structure. Internal consistency was measured using Cronbach's alpha. RESULTS: Reliability was high, indicating the scale's utility to assess Network Social Capital among sexual minority men and gender minority individuals. A single-factor solution with high factor loadings was found for the nine-item scale. CONCLUSIONS: This study extended the psychometric properties of a preliminary social capital instrument modified from a prior study in a different population and context. The modified measure has implications for use among sexual minority men and gender minority individuals to measure social capital within social networks. Previous studies suggest that interventions to enhance social capital among sexual minority men and gender minority individuals may be beneficial for HIV prevention interventions. This tool may be relevant for the evaluation of social capital interventions within networks of sexual minority men and gender minority individuals.

Louisiana Medicaid access for treatment and care for hepatitis C virus (LA-MATCH) project: A cross-sectional study protocol.

INTRODUCTION: This article presents the Louisiana Hepatitis C Elimination Program's evaluation protocol underway at the Louisiana State University Health Sciences Center-New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years. MATERIALS AND METHODS: A cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid. DISCUSSION: The evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs.

Asthma status moderates the relationship between neighbourhood disadvantage and obesity in African American adolescent females.

INTRODUCTION: Significant health disparities exist in asthma and obesity for African American youths. Successful interventions present an opportunity to address these disparities but require detailed study in order to ensure generalizability. This study investigated the intersection of obesity, neighbourhood disadvantage, and asthma. METHODS: Data were extracted from 129 African American females ages 13 to 19 years (mean = 15.6 years [SD = 1.9]). Obesity was measured via body mass index (BMI). Asthma status was based on clinical diagnosis and/or results of the International Study of Asthma and Allergies during Childhood (ISAAC) questionnaire. The concentrated disadvantage index (CDI) assessed neighbourhood disadvantage. RESULTS: Findings showed that 21.5% (n = 28) of participants were clinically defined as having asthma, 76.2% (n = 99) had obesity, and 24.9% (n = 31) were classified without obesity. The mean BMI was 35.1 (SD = 9.1) and the mean CDI was 1.0 (SD = 0.9). CDI and obesity were significantly associated in participants without asthma, but not in those with asthma. Multivariable linear regression results showed a significant interaction between CDI and asthma (t value = 2.2, P = .03). CONCLUSION: In sum, results from this study found that asthma moderated the relationship between neighbourhood disadvantage and obesity.

Blood donation history and eligibility assessment in a community-based sample of men who have sex with men.

BACKGROUND: In 2016, the US Food and Drug Administration changed the regulation from a permanent deferral from donation for men who have sex with men (MSM) to a 1-year deferral since last sexual contact. It is unknown what proportions of MSM try to donate and if they would be willing to answer individual risk-based questions to assess their current eligibility. STUDY DESIGN AND METHODS: The National HIV Behavioral Surveillance surveys periodically measure human immunodeficiency virus (HIV) prevalence and risk behaviors among MSM using a venue-based, time-location sampling method. In the 2014 cycle, that is, before the policy change, investigators in San Francisco and New Orleans added questions about blood donation. Questions inquired into three domains: donation history, policy awareness, and knowledge about HIV testing of donations. RESULTS: There were 404 and 557 respondents in San Francisco and New Orleans, respectively. Nearly one in three MSM in San Francisco (27.4%) and New Orleans (31.4%) tried to donate after their first MSM contact. A majority (63.1% in San Francisco, 58.8% in New Orleans) somewhat or strongly agreed that they would be willing to be asked detailed questions for donation eligibility assessment. CONCLUSIONS: The proportion of MSM who reported trying to donate was similar in the two cities. However, a substantial proportion did not agree to be asked more detailed risk behavior questions to assess eligibility. In these two geographic locations, prominent regional differences were not evident.

Untangling the disaster-depression knot: The role of social ties after Deepwater Horizon.

The mental health consequences of disasters, including oil spills, are well known. The goal of this study is to examine whether social capital and social support mediate the effects of exposure to the Deepwater Horizon oil spill on depression among women. Data for the analysis come from the first wave of data collection for the Women and Their Children's Health Study, a longitudinal study of the health effects of women exposed to the oil spill in southern Louisiana, USA. Women were interviewed about their exposure to the oil spill, depression symptoms, structural social capital (neighborhood organization participation), cognitive social capital (sense of community and informal social control), and social support. Structural equation models indicated that structural social capital was associated with increased levels of cognitive social capital, which were associated with higher levels of social support, which in turn were associated with lower levels of depression. Physical exposure to the oil spill was associated with greater economic exposure, which in turn was associated with higher levels of depression. When all variables were taken into account, economic exposure was no longer associated with depression, and social support and cognitive social capital mediated the effect of economic exposure on depression, explaining 67% of the effect. Findings support an extension of the deterioration model of social support to include the additional coping resource of social capital. Social capital and social support were found to be beneficial for depression post-oil spill; however, they were themselves negatively impacted by the oil spill, explaining the overall negative effect of the oil spill on depression. A better understanding of the pathways between the social context and depression could lead to interventions for improved mental health in the aftermath of a disaster.

Smoking and experiences with tobacco cessation among men who have sex with men: New Orleans, 2011.

Smoking continues to be a problem in the United States, particularly among men who have sex with men (MSM). The current study assesses the prevalence of current and lifetime smoking as well as cessation experiences in a sample of MSM. Two-thirds of the sample had ever smoked tobacco and 50 % of MSM were current smokers. Prevalence of current smoking in this sample was higher than comparative data obtained from HIV positive patients at a local clinical population. Smoking was found to be associated with HIV status, race, age, education, income and alcohol use. A high proportion of MSMs social networks were smokers especially among current smokers. Continued efforts targeting or linking MSM into tobacco cessation efforts are recommended.

The European and American use of exploratory approaches for first-in-human studies.

Exploratory approaches for first-in-human clinical studies have evolved over the last few years and have stimulated the issuance of national regulatory guidances in some European countries as well as the United States. With the increasing implementation of these approaches and the recent preparation of a multiregional regulatory guidance (ICH M3 rev2), an exchange of experiences on the opportunities and challenges of exploratory clinical trials was desirable; thus, a workshop focusing on the use of this clinical approach was planned and conducted in Lisbon, Portugal, March 18-19, 2009 sponsored by the Portuguese Health Authority (INFARMED) and DIA. The structure of the workshop focused in three main areas. Regulatory representatives from Portugal, Belgium, Germany, the United Kingdom and the United States formally reviewed their experiences. This was followed by a discussion on issues from an ethics review perspective as well as an insight to the opportunities in the area of biologics. The industry perspective was presented by representatives from Merck, Pfizer, J&J, Novartis, Speedel, AstraZeneca, GSK, and Roche. Finally, through break out sessions, issues were identified to be addressed moving forward. It is the purpose of this paper to report on the outcome of this workshop.