African American Clergy Recommendations to Enhance the Federal Plan to End the HIV Epidemic: A Qualitative Study.

African Americans in the southern United States continue to be disproportionately affected by HIV. Although faith-based organizations (FBOs) play important roles in the social fabric of African American communities, few HIV screening, care, and PrEP promotion efforts harness the power of FBOs. We conducted 11 focus groups among 57 prominent African American clergy from Arkansas, Mississippi, and Alabama. We explored clergy knowledge about the Ending the HIV Epidemic: A Plan for America (EHE); normative recommendations for how clergy can contribute to EHE; and how clergy can enhance the HIV care continua and PrEP. We explored how clergy have responded to the COVID-19 crisis, and lessons learned from pandemic experiences that are relevant for HIV programs. Clergy reported a moral obligation to participate in the response to the HIV epidemic and were willing to support efforts to expand HIV screening, treatment, PrEP and HIV care. Few clergy were familiar with EHE, U = U and TasP. Many suggested developing culturally tailored messages and were willing to lend their voices to social marketing efforts to destigmatize HIV and promote uptake of biomedical interventions. Nearly all clergy believed technical assistance with biomedical HIV prevention and care interventions would enhance their ability to create partnerships with local community health centers. Partnering with FBOs presents important and unique opportunities to reduce HIV disparities. Clergy want to participate in the EHE movement and need federal resources and technical assistance to support their efforts to bridge community activities with biomedical prevention and care programs related to HIV. The COVID-19 pandemic presents opportunities to build important infrastructure related to these goals.

Factors Associated with Colorectal Cancer Screening among Mississippi Adults: Findings from the Behavioral Risk Factor Surveillance System.

OBJECTIVES: Mississippi has one of the highest mortality rates in colorectal cancer (CRC) and one of the lowest rates of CRC screening in the United States. The purpose of the study was to assess the characteristics of Mississippians who met the US Preventive Services Task Force (USPSTF) recommendation on CRC screening and type of the test they used. METHODS: We analyzed the data from the 2018 Mississippi Behavioral Risk Factor Surveillance System (N = 5843), which included a CRC screening module for participants who were 50 years old or older. Respondents in this module were asked when, if ever, they had last undergone a colonoscopy, sigmoidoscopy, or stool occult test. Their responses were then categorized according to their compliance with the USPSTF recommendations on CRC screening. We compared the compliance with responders' sociodemographic and risk factors. Data analysis accounted for the complex sampling design. RESULTS: The majority of the CRC screening tests are colonoscopies: 60.1% of Mississippians aged 50 to 75 years had received one within 10 years. In addition, 7.8% had taken a stool test within the last year, and 1.9% had undergone sigmoidoscopy within 5 years. The prevalence of individuals aged 50 to 75 in Mississippi who met the USPSTF recommendation for CRC screening in 2018 was 62.6%. Women (65.5%), married (67.5%), those with health insurance (66.5%) or annual household income of ≥$75,000 (71.6%), those with a regular healthcare provider (68.0%), or those who quit smoking (70.4%) had higher compliance than their counterparts. After controlling for the covariates, the adults aged 50 to 75 who had health insurance or had a personal healthcare provider were 2.52 and 2.95 times more likely to be compliant, respectively (P < 0.001). Those who had quit smoking were 2.27 times more likely to be compliant with the USPSTF than current smokers (P < 0.001). Weight status, binge drinking, or physical inactivity was not associated with the CRC screening rates. CONCLUSIONS: Mississippi adults aged 50 to 75 were more likely to be compliant with the CRC screening standards if they had insurance coverage or access to care. To further increase the overall CRC screening rate and for the benefit of the 70 × 2020 state initiative, certain screenings such as stool test need to be promoted and recommended by family practitioners, and certain subgroups of the population such as smokers need to be targeted and educated.

Emerging Regional and Racial Disparities in the Lifetime Risk of Human Immunodeficiency Virus Infection Among Men who Have Sex With Men: A Comparative Life Table Analysis in King County, WA and Mississippi.

BACKGROUND: Little is known about the lifetime risk of human immunodeficiency virus (HIV) diagnosis among US men who have sex with men (MSM), trends in risk and how risk varies between populations. METHODS: We used census and HIV surveillance data to construct life tables to estimate the cumulative risk of HIV diagnosis among cohorts of MSM born 1940 to 1994 in King County, Washington (KC) and Mississippi (MS). RESULTS: The cumulative risk of HIV diagnosis progressed in 3 phases. In phase 1, risk increased among MSM in successive cohorts born 1940 to 1964. Among men born 1955 to 1965 (the peak risk cohort), by age 55 years, 45% of white KC MSM, 65% of black KC MSM, 22% of white MS MSM, and 51% of black MS MSM had been diagnosed with HIV. In phase 2, men born 1965 to 1984, risk of diagnosis among KC MSM declined almost 60% relative to the peak risk cohort. A similar pattern of decline occurred in white MS MSM, with a somewhat smaller decline observed in black MS MSM. In phase 3, men born 1985 to 1994, the pattern of risk diverged. Among white KC MSM, black KC MSM, and white MS MSM, HIV risk increased slightly compared with men born 1975 to 1984, with 6%, 14%, and 2% diagnosed by age 27 years, respectively. Among black MS MSM born 1985 to 1994, HIV risk rose dramatically, with 35% HIV diagnosed by age 27 years. CONCLUSIONS: The lifetime risk of HIV diagnosis has substantially declined among MSM in KC and among white MSM in MS, but is rising dramatically among black MSM in MS.

A regionally tailored epidemiological forecast and monitoring program to guide a healthcare system in the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, analytics and predictive models built on regional data provided timely, accurate monitoring of epidemiological behavior, informing critical planning and decision-making for health system leaders. At Atrium Health, a large, integrated healthcare system in the southeastern United States, a team of statisticians and physicians created a comprehensive forecast and monitoring program that leveraged an array of statistical methods. METHODS: The program utilized the following methodological approaches: (i) exploratory graphics, including time plots of epidemiological metrics with smoothers; (ii) infection prevalence forecasting using a Bayesian epidemiological model with time-varying infection rate; (iii) doubling and halving times computed using changepoints in local linear trend; (iv) death monitoring using combination forecasting with an ensemble of models; (v) effective reproduction number estimation with a Bayesian approach; (vi) COVID-19 patients hospital census monitored via time series models; and (vii) quantified forecast performance. RESULTS: A consolidated forecast and monitoring report was produced weekly and proved to be an effective, vital source of information and guidance as the healthcare system navigated the inherent uncertainty of the pandemic. Forecasts provided accurate and precise information that informed critical decisions on resource planning, bed capacity and staffing management, and infection prevention strategies. CONCLUSIONS: In this paper, we have presented the framework used in our epidemiological forecast and monitoring program at Atrium Health, as well as provided recommendations for implementation by other healthcare systems and institutions to facilitate use in future pandemics.

COVID-19 Inpatient Mortality Disparities Among American Indian Adults in Mississippi's Safety Net Hospital.

BACKGROUND: Long-standing health disparities experienced by American Indians (AIs) are associated with increased all-cause mortality rates and shortened life expectancies when compared to other races and ethnicities. Nationally, these disparities have persisted with the COVID-19 pandemic as AIs are more likely than all other races to be infected, hospitalized, or die from SARS-CoV-2. The Mississippi Band of Choctaw Indians, the only federally recognized American Indian tribe in the state, has been one of the hardest hit in the nation. METHODS: Using de-identified data from the University of Mississippi Medical Center's COVID-19 Research Registry, a retrospective cohort study was conducted to assess COVID-19 inpatient mortality outcomes among adults (≥ age 18) admitted at the state's safety net hospital in 2020. RESULTS: Exactly 41% (n = 25) of American Indian adults admitted with a deemed diagnosis of COVID-19 died while in hospital, in comparison to 19% (n = 153) of blacks and 23% (n = 65) of whites. Racial disparities persisted even when controlling for those risk factors the CDC reported put adults at greatest risk of severe outcomes from the disease. The adjusted probability of inpatient mortality among American Indians was 46% (p < 0.00) in comparison to 19% among blacks and 20% among whites. CONCLUSION: Although comorbidities were commonly observed among COVID-19 + American Indian inpatients, only one was associated with inpatient mortality. This challenges commonly cited theories attributing disparate COVID-19 mortality experiences among indigenous populations to disparate comorbidity experiences. Expanded studies are needed to further investigate these associations.

In-Hospital Mortality Disparities Among American Indian and Alaska Native, Black, and White Patients With COVID-19.

Importance: American Indian and Alaska Native populations have some of the highest COVID-19 hospitalization and mortality rates in the US, with those in Mississippi being disparately affected. Higher COVID-19 mortality rates among Indigenous populations are often attributed to a higher comorbidity burden, although examinations of these associations are scarce, and none were believed to have included individuals hospitalized in Mississippi. Objective: To evaluate whether racial mortality differences among adults hospitalized with COVID-19 are associated with differential comorbidity experiences. Design, Setting, and Participants: The described cross-sectional study used retrospective hospital discharge data from the Mississippi Inpatient Outpatient Data System. All adult (aged ≥18 years) Mississippians of a known racial identity and who had been hospitalized with COVID-19 from March 1 to December 31, 2020, in any of the state's 103 nonfederal hospitals were included. Data were abstracted on June 17, 2021. Exposure: Racial identity. Main Outcomes and Measures: In-hospital mortality as indicated by discharge status. Results: A total of 18 731 adults hospitalized with a COVID-19 diagnosis and known racial identity were included (median age, 66 [IQR, 53-76] years; 10 109 [54.0%] female; 225 [1.2%] American Indian and Alaska Native; 9191 [49.1%] Black; and 9121 [48.7%] White). Pooling across comorbidity risk groups, odds of in-hospital mortality among Black patients were 75% lower than among American Indian and Alaska Native patients (odds ratio [OR], 0.25 [95% CI, 0.18-0.34]); odds of in-hospital death among White patients were 77% lower (OR, 0.23 [95% CI, 0.16-0.31]). Within comorbidity risk group analyses, Indigenous patients with the lowest risk (Elixhauser Comorbidity Index score ≤0) had an adjusted probability of in-hospital death of 0.10 compared with 0.03 for Black patients (OR, 0.29 [95% CI, 0.10-0.82]) and 0.04 for White patients (OR, 0.37 [95% CI, 0.13-1.07]). Probability of in-hospital death at the highest comorbidity risk levels (Elixhauser Comorbidity Index score ≥16) was 0.69 for American Indian and Alaska Native patients compared with 0.28 for Black patients (OR, 0.16 [95% CI, 0.08-0.32]) and 0.25 for White patients (OR, 0.14 [95% CI, 0.07-0.27]). Conclusions and Relevance: This cross-sectional study of US adults hospitalized with COVID-19 found that American Indian and Alaska Native patients had lower comorbidity risk scores than those observed among Black or White patients. Despite empirical associations between reduced comorbidity risk scores and reduced odds of inpatient mortality, American Indian and Alaska Native patients were significantly more likely to die in the hospital of COVID-19 than Black or White patients at every level of comorbidity risk. Alternative factors that may contribute to high mortality rates among Indigenous populations must be investigated.

Subgroup comparison of COVID-19 case and mortality with associated factors in Mississippi: findings from analysis of the first four months of public data.

We compared subgroup differences in COVID-19 case and mortality and investigated factors associated with case and mortality rate (MR) measured at the county level in Mississippi. Findings were based on data published by the Mississippi State Department of Health between March 11 and July 16, 2020. The COVID-19 case rate and case fatality rate (CFR) differed by gender and race, while MR only differed by race. Residents aged 80 years or older and those who live in a non-metro area had a higher case rate, CFR, and MR. After controlling for selected factors, researchers found that the percent of residents who are obese, low income, or with certain chronic conditions were associated with the county COVID-19 case rate, CFR, and/or MR, though some were negatively related. The findings may help the state to identify counties with higher COVID-19 case rate, CFR, and MR based on county demographics and the degree of its chronic conditions.

Chemotherapy of Tuberculosis.

The management of tuberculosis (TB) can be a challenging process that has implications both for the affected patient and public health. Effective anti-TB chemotherapy both cures and renders the patient noncontagious. Biological factors specific to M. tuberculosis necessitate the use of multiple drugs for prolonged durations to adequately eradicate infection. Recommended regimens address the complexities of eliminating organisms from diverse reservoirs while preventing the emergence of drug resistance. First-line anti-TB therapy for drug susceptible disease effectively cures almost all patients within 6-9 months. The loss of first-line agents, due to resistance or intolerance, necessitates lengthy treatment courses, frequently 12-18 months or longer. Due to the long treatment times and the implications of missed doses, directly-observed therapy (DOT) is considered the standard of care. Drugs used for the treatment of TB have serious potential toxicities that require close monitoring and prompt response. A strong public health infrastructure and robust social supports are important elements to assure successful treatment. These numerous factors compel public health entities to take a lead role in the management of TB, either through the direct management of TB treatment or by assuring the activities of partner organizations.

Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center.

BACKGROUND: Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center. METHODS: Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing. RESULTS: Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%). CONCLUSIONS: Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.

Two cases of pott disease associated with bilateral psoas abscesses: case report.

STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to Mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. METHODS: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.

Nosocomial spread of Enterococcus faecium resistant to vancomycin and linezolid in a tertiary care medical center.

In May 2004 our institution encountered its first clinical isolate of linezolid-resistant, vancomycin-resistant Enterococcus faecium (LRVRE). Between October 2004 and July 2005, 40 patients from whom LRVRE organisms were recovered in clinical specimens were characterized. Epidemiologic investigation and pulsed-field gel electrophoresis patterns indicated a clonal outbreak related to nosocomial spread.