Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS.

BACKGROUND: Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. METHODS: We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. RESULTS: Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. CONCLUSION: Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective.

As the country responds to coronavirus disease 2019 (COVID-19), the role of public health in ensuring the delivery of equitable health care in rural communities has not been fully appreciated. The impact of such crises is exacerbated in rural racial/ethnic minority communities. Various elements contribute to the problems identified in rural areas, including a declining population; economic stagnation; shortages of physicians and other health care providers; a disproportionate number of older, poor, and underinsured residents; and high rates of chronic illness. This commentary describes the challenges faced by rural communities in addressing COVID-19, with a focus on the issues faced by southeastern US states. The commentary will also address how the COVID-19 Community Vulnerability Index may be used as a tool to identify communities at heightened risk for COVID-19 on the basis of 6 clearly defined indicators.

Risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission clinics in Northwest Nigeria.

Despite the effectiveness of antiretroviral therapy (ART) in the prevention of mother-to-child transmission of HIV (PMTCT), some HIV-infected women in PMTCT care are at risk of transmitting HIV to their babies. Using a 1:1 unmatched case-control study design, we assessed the risk factors for perinatal transmission among women who received ART for PMTCT in Sokoto State, Nigeria. Data were abstracted from medical records of cases (94 HIV-infected babies) and controls (94 HIV-uninfected babies) and their mothers who accessed PMTCT services in three purposefully selected secondary health facilities. We conducted univariate and multivariate logistic regressions to determine if sociodemographic characteristics, time of enrolment, type of maternal ART, receipt of infant antiretroviral (ARV) prophylaxis, place of delivery, or feeding practice were associated with HIV infection among HIV-exposed babies. Sixteen percent of the mothers of babies in the case group had early enrolment while 90% of those in the control group enrolled early. Infant prophylaxis was received in 54% of cases and 95% of controls. In both groups, 99% of the mothers practiced mixed feeding. In the univariate analysis, factors that were significantly associated with HIV infection were religion (islam), rural residence, late⁠ enrolment, and non-receipt of infant ARV prophylaxis. In the multivariate analysis, rural residence (Adjusted odds ratio (aOR) = 8.01, 95% CI = 1.79-35.78), late enrolment (aOR = 41.72, 95% CI = 15.16-114.79), and non-receipt of infant ARV prophylaxis (aOR = 4.1, 95% CI = 1.18-14.33) remained statistically significant. Findings from this study indicate that eliminating MTCT in Nigeria requires interventions that will enhance timely access of ART by mother-baby dyads.

The Open Arms Healthcare Center's Integrated HIV Care Services Model.

INTRODUCTION: Mississippi has the seventh highest rate of people newly diagnosed with HIV infection, and the city of Jackson - the capital and largest metropolitan area of Mississippi - has the third highest rate of AIDS diagnoses among all metropolitan areas in the nation. Linking patients to care and proper adherence to antiretroviral therapy is important for achieving viral load suppression and reducing transmission of the virus. However, many HIV-infected patients have social and clinical barriers to achieving viral suppression. To overcome these barriers the Open Arms Healthcare Center has implemented an integrated HIV care services model. PURPOSE AND OBJECTIVES: The purpose of this study was to determine whether an integrated model of HIV care influenced linkage to health care, adherence to antiretroviral therapy, and viral load suppression. INTERVENTION APPROACH: The integrated HIV care services model consisted of 5 care coordination components: 1) case management, 2) HIV health care (primary health care), 3) behavioral health care (mental and substance abuse screening and treatment), 4) adherence counseling (a pharmacist-led intervention), and 5) social support services (transportation, emergency food assistance, housing, and legal assistance). EVALUATION METHODS: We used a cross-sectional research design to examine Open Arms electronic health record data collected from 231 patients from January 2015 through December 2017 to determine if an integrated model of HIV care resulted in increased linkage to health care, higher adherence rates, and improved viral load suppression. RESULTS: Findings showed a 38.0% increase in the viral load suppression rate, a 12.8% increase in antiretroviral therapy adherence rate, and an 11.0% increase in retention rates among Open Arms patients receiving integrated HIV care. IMPLICATIONS FOR PUBLIC HEALTH: A comprehensive, holistic approach helps to effectively identify and connect HIV-positive patients to care and relink patients who may have fallen out of care.

Adaptation of a bidirectional crisis and emergency risk communication framework by community-engaged research partnerships in rural Mississippi during the COVID-19 pandemic.

Community engagement is important for reaching populations at risk for health inequities in the coronavirus disease 2019 (COVID-19) pandemic. A community-engaged risk communication intervention implemented by a community-engaged research partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts has demonstrated high acceptability, feasibility, perceived efficacy, and sustainability. In this study, we describe the adaptation of the intervention by a community-academic partnership with rural African American populations in three Mississippi counties with high COVID-19 disparities. Intervention reach was assessed by the number of messages delivered by Communication Leaders to members of their social networks. Perceived scalability of the intervention was assessed by the Intervention Scalability Assessment Tool. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, meet resource needs, and advise statewide decision-makers. In the first 3 months, more than 8482 individuals were reached in the three counties. The intervention was deemed to be highly scalable by partnership members. Adaptation of a community-engaged pandemic CERC intervention is feasible and scalable, and it has the potential to reduce COVID-19 inequities across heterogeneous populations. This approach may be incorporated into current and future pandemic preparedness policies for community engagement.

The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study.

Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.