Implementation of a peer-delivered opioid overdose response initiative in New York City emergency departments: Insight from multi-stakeholder qualitative interviews.

BACKGROUND: Emergency departments (EDs) are critical touchpoints for overdose prevention efforts. In New York City (NYC), the Health Department's Relay initiative dispatches trained peer "Wellness Advocates" (WAs) to engage with patients in EDs after an overdose and for up to 90 days subsequently. Interest in peer-delivered interventions for patients at risk for overdose has grown nationally, but few studies have explored challenges and opportunities related to implementing such interventions in EDs. METHODS: We conducted in-depth interviews with Relay WAs, ED patients, and ED providers across 4 diverse NYC EDs. Sampling was purposeful and continued until theoretical saturation was reached. Interviews followed a semi-structured interview guide based on key domains from the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by telephone or web conferencing; audio recordings were professionally transcribed. The study utilized rapid qualitative analysis using template summaries and summary matrices followed by line-by-line coding conducted independently by 3 researchers, then discussed and harmonized at group coding meetings. Coding was both inductive (using an a priori code list based on CFIR domains and study goals) and deductive (new codes allowed to emerge from transcripts). Dedoose software was used for data organization. RESULTS: We conducted 32 in-depth interviews (10 WAs, 12 patients, 10 ED providers). Four overarching themes emerged: 1) EDs are characterized by multiple competing demands (e.g., related to provider time and physical space), underscoring the utility of Relay and leading to some practical challenges for its delivery; 2) There is a strong role distinction of WAs as peers with lived experience; 3) ED providers value Relay, even though they have a limited understanding of its full scope and outcomes; 4) While the role of structural factors (e.g., homelessness and unstable housing) is recognized, responsibility is often placed on patients for controlling their own success. CONCLUSIONS: We identified four themes that shed new light on the implementation of peer-based overdose prevention programs in EDs. Our findings highlight unique ED inner and outer setting factors that may impact program implementation and effectiveness. The findings provide actionable information to inform implementation of similar programs nationally.

Behavioural responses of a trans-hemispheric migrant to climate oscillation.

Large-scale climatic fluctuations, such as the El Niño-Southern Oscillation, can have dramatic effects on ocean ecosystem productivity. Many mobile species breeding in temperate or higher latitudes escape the extremes of seasonal climate variation through long-distance, even trans-global migration, but how they deal with, or are affected by, such longer phased climate fluctuations is less understood. To investigate how a long-lived migratory species might respond to such periodic environmental change we collected and analysed a 13 year biologging dataset for a trans-equatorial migrant, the Manx shearwater (Puffinus puffinus). Our primary finding was that in El Niño years, non-breeding birds were at more northerly (lower) latitudes than in La Niña years, a response attributable to individual flexibility in migratory destinations. Daily time spent foraging varied in concert with this latitudinal shift, with birds foraging less in El Niño years. Secondarily, we found that in subsequent breeding, a hemisphere away, El Niño years saw a reduction in foraging time and chick provisioning rates: effects that could not be attributed to conditions at their breeding grounds in the North Atlantic. Thus, in a highly migratory animal, individuals may adjust to fluctuating non-breeding conditions but still experience cascading carry over effects on subsequent behaviour.

Productivity declines threaten East African soda lakes and the iconic Lesser Flamingo.

Soda lakes are some of the most productive aquatic ecosystems.1 Their alkaline-saline waters sustain unique phytoplankton communities2,3 and provide vital habitats for highly specialized biodiversity including invertebrates, endemic fish species, and Lesser Flamingos (Phoeniconaias minor).1,4 More than three-quarters of Lesser Flamingos inhabit the soda lakes of East Africa5; however, populations are in decline.6 Declines could be attributed to their highly specialized diet of cyanobacteria7 and dependence on a network of soda lake feeding habitats that are highly sensitive to climate fluctuations and catchment degradation.8,9,10,11,12 However, changing habitat availability has not been assessed due to a lack of in situ water quality and hydrology data and the irregular monitoring of these waterbodies.13 Here, we combine satellite Earth observations and Lesser Flamingo abundance observations to quantify spatial and temporal trends in productivity and ecosystem health over multiple decades at 22 soda lakes across East Africa. We found that Lesser Flamingo distributions are best explained by phytoplankton biomass, an indicator of food availability. However, timeseries analyses revealed significant declines in phytoplankton biomass from 1999 to 2022, most likely driven by substantial rises in lake water levels. Declining productivity has reduced the availability of healthy soda lake ecosystems, most notably in equatorial Kenya and northern Tanzania. Our results highlight the increasing vulnerability of Lesser Flamingos and other soda lake biodiversity in East Africa, particularly with increased rainfall predicted under climate change.14,15,16 Without improved lake monitoring and catchment management practices, soda lake ecosystems could be pushed beyond their environmental tolerances. VIDEO ABSTRACT.

Tracking seabird migration in the tropical Indian Ocean reveals basin-scale conservation need.

Understanding marine predator distributions is an essential component of arresting their catastrophic declines.1,2,3,4 In temperate, polar, and upwelling seas, predictable oceanographic features can aggregate migratory predators, which benefit from site-based protection.5,6,7,8 In more oligotrophic tropical waters, however, it is unclear whether environmental conditions create similar multi-species hotspots. We track the non-breeding movements and habitat preferences of a tropical seabird assemblage (n = 348 individuals, 9 species, and 10 colonies in the western Indian Ocean), which supports globally important biodiversity.9,10,11,12 We mapped species richness from tracked populations and then predicted the same diversity measure for all known Indian Ocean colonies. Most species had large non-breeding ranges, low or variable residency patterns, and specific habitat preferences. This in turn revealed that maximum species richness covered >3.9 million km2, with no focused aggregations, in stark contrast to large-scale tracking studies in all other ocean basins.5,6,7,13,14 High species richness was captured by existing marine protected areas (MPAs) in the region; however, most occurred in the unprotected high seas beyond national jurisdictions. Seabirds experience cumulative anthropogenic impacts13 and high mortality15,16 during non-breeding. Therefore, our results suggest that seabird conservation in the tropical Indian Ocean requires an ocean-wide perspective, including high seas legislation.17 As restoration actions improve the outlook for tropical seabirds on land18,19,20,21,22 and environmental change reshapes the habitats that support them at sea,15,16 appropriate marine conservation will be crucial for their long-term recovery and whole ecosystem restoration.

A user-friendly guide to using distance measures to compare time series in ecology.

Time series are a critical component of ecological analysis, used to track changes in biotic and abiotic variables. Information can be extracted from the properties of time series for tasks such as classification (e.g., assigning species to individual bird calls); clustering (e.g., clustering similar responses in population dynamics to abrupt changes in the environment or management interventions); prediction (e.g., accuracy of model predictions to original time series data); and anomaly detection (e.g., detecting possible catastrophic events from population time series). These common tasks in ecological research all rely on the notion of (dis-) similarity, which can be determined using distance measures. A plethora of distance measures have been described, predominantly in the computer and information sciences, but many have not been introduced to ecologists. Furthermore, little is known about how to select appropriate distance measures for time-series-related tasks. Therefore, many potential applications remain unexplored. Here, we describe 16 properties of distance measures that are likely to be of importance to a variety of ecological questions involving time series. We then test 42 distance measures for each property and use the results to develop an objective method to select appropriate distance measures for any task and ecological dataset. We demonstrate our selection method by applying it to a set of real-world data on breeding bird populations in the UK and discuss other potential applications for distance measures, along with associated technical issues common in ecology. Our real-world population trends exhibit a common challenge for time series comparisons: a high level of stochasticity. We demonstrate two different ways of overcoming this challenge, first by selecting distance measures with properties that make them well suited to comparing noisy time series and second by applying a smoothing algorithm before selecting appropriate distance measures. In both cases, the distance measures chosen through our selection method are not only fit-for-purpose but are consistent in their rankings of the population trends. The results of our study should lead to an improved understanding of, and greater scope for, the use of distance measures for comparing ecological time series and help us answer new ecological questions.

Protected areas slow declines unevenly across the tetrapod tree of life.

Protected areas (PAs) are the primary strategy for slowing terrestrial biodiversity loss. Although expansion of PA coverage is prioritized under the Convention on Biological Diversity, it remains unknown whether PAs mitigate declines across the tetrapod tree of life and to what extent land cover and climate change modify PA effectiveness1,2. Here we analysed rates of change in abundance of 2,239 terrestrial vertebrate populations across the globe. On average, vertebrate populations declined five times more slowly within PAs (-0.4% per year) than at similar sites lacking protection (-1.8% per year). The mitigating effects of PAs varied both within and across vertebrate classes, with amphibians and birds experiencing the greatest benefits. The benefits of PAs were lower for amphibians in areas with converted land cover and lower for reptiles in areas with rapid climate warming. By contrast, the mitigating impacts of PAs were consistently augmented by effective national governance. This study provides evidence for the effectiveness of PAs as a strategy for slowing tetrapod declines. However, optimizing the growing PA network requires targeted protection of sensitive clades and mitigation of threats beyond PA boundaries. Provided the conditions of targeted protection, adequate governance and well-managed landscapes are met, PAs can serve a critical role in safeguarding tetrapod biodiversity.

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV.

BACKGROUND: Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. METHODS: Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. RESULTS: Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. CONCLUSIONS: To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.

Quantifying reliability and data deficiency in global vertebrate population trends using the Living Planet Index.

Global biodiversity is facing a crisis, which must be solved through effective policies and on-the-ground conservation. But governments, NGOs, and scientists need reliable indicators to guide research, conservation actions, and policy decisions. Developing reliable indicators is challenging because the data underlying those tools is incomplete and biased. For example, the Living Planet Index tracks the changing status of global vertebrate biodiversity, but taxonomic, geographic and temporal gaps and biases are present in the aggregated data used to calculate trends. However, without a basis for real-world comparison, there is no way to directly assess an indicator's accuracy or reliability. Instead, a modelling approach can be used. We developed a model of trend reliability, using simulated datasets as stand-ins for the "real world", degraded samples as stand-ins for indicator datasets (e.g., the Living Planet Database), and a distance measure to quantify reliability by comparing partially sampled to fully sampled trends. The model revealed that the proportion of species represented in the database is not always indicative of trend reliability. Important factors are the number and length of time series, as well as their mean growth rates and variance in their growth rates, both within and between time series. We found that many trends in the Living Planet Index need more data to be considered reliable, particularly trends across the global south. In general, bird trends are the most reliable, while reptile and amphibian trends are most in need of additional data. We simulated three different solutions for reducing data deficiency, and found that collating existing data (where available) is the most efficient way to improve trend reliability, whereas revisiting previously studied populations is a quick and efficient way to improve trend reliability until new long-term studies can be completed and made available.

A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics.

Introduction: Virtual and low-touch behavioral interventions are needed for African American/Black and Latino persons living with HIV (PLWH) with barriers to HIV viral suppression, particularly during COVID-19. Guided by the multiphase optimization strategy, we explored three components for PLWH without viral suppression, grounded in motivational interviewing and behavioral economics: (1) motivational interviewing counseling, (2) 21-weeks of automated text messages and quiz questions about HIV management, and (3) financial rewards for viral suppression (lottery prize vs. fixed compensation). Methods: This pilot optimization trial used sequential explanatory mixed methods to explore the components' feasibility, acceptability, and preliminary evidence of effects using an efficient factorial design. The primary outcome was viral suppression. Participants engaged in baseline and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. A subset engaged in qualitative interviews. We carried out descriptive quantitative analyses. Then, qualitative data were analyzed using directed content analysis. Data integration used the joint display method. Results: Participants (N = 80) were 49 years old, on average (SD = 9), and 75% were assigned male sex at birth. Most (79%) were African American/Black, and the remainder were Latino. Participants were diagnosed with HIV 20 years previously on average (SD = 9). Overall, components were feasible (>80% attended) and acceptability was satisfactory. A total of 39% (26/66) who provided laboratory reports at follow-up evidenced viral suppression. Findings suggested no components were entirely unsuccessful. The lottery prize compared to fixed compensation was the most promising component level. In qualitative analyses, all components were seen as beneficial to individual wellbeing. The lottery prize appeared more interesting and engaging than fixed compensation. However, structural barriers including financial hardship interfered with abilities to reach viral suppression. The integrated analyses yielded areas of convergence and discrepancy and qualitative findings added depth and context to the quantitative results. Conclusions: The virtual and/or low-touch behavioral intervention components tested are acceptable and feasible and show enough potential to warrant refinement and testing in future research, particularly the lottery prize. Results must be interpreted in the context of the COVID-19 pandemic. Trial registration: NCT04518241 (https://clinicaltrials.gov/ct2/show/NCT04518241).

Anthropogenic predictors of varying Holocene occurrence for Europe's large mammal fauna.

Understanding how species respond to different anthropogenic pressures is essential for conservation planning. The archaeological record has great potential to inform extinction risk assessment by providing evidence on past human-caused biodiversity loss, but identifying specific drivers of past declines from environmental archives has proved challenging. We used 17 684 Holocene zooarchaeological records for 15 European large mammal species together with data on past environmental conditions and anthropogenic activities across Europe, to assess the ability of environmental archives to determine the relative importance of different human pressures in shaping faunal distributions through time. Site occupancy probability showed differing significant relationships with environmental covariates for all species, and nine species also showed significant relationships with anthropogenic covariates (human population density, % cropland, % grazing land). Across-species differences in negative relationships with covariates provide ecological insights for understanding extinction dynamics: some mammals (red deer, aurochs, wolf, wildcat, lynx, pine marten and beech marten) were more vulnerable to past human-environmental interactions, and differing single and synergistic anthropogenic factors influenced likelihood of past occurrence across species. Our results provide new evidence for pre-industrial population fragmentation and depletion in European mammals, and demonstrate the usefulness of historical baselines for understanding species' varying long-term sensitivity to multiple threats.

Ongoing over-exploitation and delayed responses to environmental change highlight the urgency for action to promote vertebrate recoveries by 2030.

To safeguard nature, we must understand the drivers of biodiversity loss. Time-delayed biodiversity responses to environmental changes (ecological lags) are often absent from models of biodiversity change, despite their well-documented existence. We quantify how lagged responses to climate and land-use change have influenced mammal and bird populations around the world, while incorporating effects of direct exploitation and conservation interventions. Ecological lag duration varies between drivers, vertebrate classes and body size groupings-e.g. lags linked to climate-change impacts are 13 years for small birds, rising to 40 years for larger species. Past warming and land conversion generally combine to predict population declines; however, such conditions are associated with population increases for small mammals. Positive effects of management (>+4% annually for large mammals) and protected areas (>+6% annually for large birds) on population trends contrast with the negative impact of exploitation (<-7% annually for birds), highlighting the need to promote sustainable use. Model projections suggest a future with winners (e.g. large birds) and losers (e.g. medium-sized birds), with current/recent environmental change substantially influencing abundance trends to 2050. Without urgent action, including effective conservation interventions and promoting sustainable use, ambitious targets to stop declines by 2030 may already be slipping out of reach.

Achieving a real-time online monitoring system for conservation culturomics.

Environmental monitoring is increasingly shifting toward a set of systems that describe changes in real time. In ecology specifically, a series of challenges have prevented the rollout of real-time monitoring for features such as biodiversity change or ecosystem service provision. Conservation culturomics, a field concerned with interactions between people and nature, is well placed to demonstrate how monitoring might move toward a network of real-time platforms, given its existence exclusively in the digital realm. We examined a set of considerations associated with the development of real-time monitoring platforms for conservation culturomics and introduce a near real-time platform for the Species Awareness Index, a global index of changing biodiversity awareness derived from the rate of change in page views for species on Wikipedia. This platform will update automatically each month, operating in near real time (https://joemillard.shinyapps.io/Real_time_SAI/). There are plans to make the underlying data queryable via an application programing interface independent of the platform. The real-time Species Awareness Index will represent the first real-time and entirely automated conservation culturomic platform and one of the first real-time platforms in the discipline of ecology. Real-time monitoring for culturomics can provide insight into human-nature interactions as they play out in the physical realm and provide a framework for the development of real-time monitoring in ecology. Real-time monitoring metrics can be processed on private virtual machines and hosted on publicly available cloud services. Conservation now needs an online, real-time observatory that can evolve with the structure of the web.

Obtención de un sistema virtual de monitoreo en tiempo real para la culturomía de la conservación Resumen El monitoreo ambiental se enfoca cada vez más en un conjunto de sistemas que describen los cambios en tiempo real. En cuanto a la ecología, una serie de obstáculos ha impedido el despliegue del monitoreo en tiempo real para funciones como el cambio en la biodiversidad o el suministro de servicios ambientales. La culturomía de la conservación, un campo enfocado en las interacciones entre las personas y la naturaleza, es una buena opción para demostrar cómo el monitoreo podría transformarse en una red de plataformas en tiempo real, dado que sólo existe en el ámbito digital. Analizamos una serie de consideraciones asociadas con el desarrollo de plataformas de monitoreo en tiempo real para la culturomía de la conservación e introdujimos una plataforma casi en tiempo real para el Índice de Conciencia de Especies, un índice mundial del cambio en la conciencia sobre la biodiversidad derivado de la tasa de cambio en las visitas a las páginas de Wikipedia de diferentes especies. Esta plataforma se actualizará automáticamente cada mes, por lo que opera casi en tiempo real (https://joemillard.shinyapps.io/Real_time_SAI/). Existen planes para hacer que los datos subyacentes sean consultables por medio de una interfaz de programación de aplicaciones independiente de la plataforma. El Índice de Conciencia de Especies en tiempo real será la primera plataforma de culturomía de la conservación automatizada por completo y en tiempo real, así como una de las primeras plataformas de este tipo para la disciplina de la ecología. El monitoreo en tiempo real de la culturomía puede proporcionar información sobre las interacciones humano-naturaleza conforme se desarrollan en el ámbito físico y también un marco de trabajo para el desarrollo del monitoreo en tiempo real para la ecología. Las medidas del monitoreo en tiempo real pueden procesarse en máquinas virtuales privadas y albergarse en servicios públicos de nubes de almacenamiento. Hoy en día, la conservación necesita un observatorio en línea y en tiempo real que pueda evolucionar con la estructura de la web.

Exploring behavioral intervention components for African American/Black and Latino persons living with HIV with non-suppressed HIV viral load in the United States: a qualitative study.

BACKGROUND: The persistence of racial/ethnic inequities in rates of engagement along the HIV care continuum signals the need for novel approaches. We developed six behavioral intervention components for use in an optimization trial, grounded in a model that integrates critical race theory, harm reduction, and self-determination theory, designed to address various barriers that African American/Black and Latino persons living with HIV (PLWH) experience to the HIV care continuum. The components were: health education, motivational interviewing sessions, pre-adherence skill building, peer mentorship, focused support groups, and navigation. The present qualitative exploratory study describes participants' perspectives on the components' acceptability, feasibility, and impact. METHODS: Participants were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City. From a larger trial, we randomly selected 46 participants for in-depth semi-structured interviews. Interviews were audio-recorded and transcribed verbatim, and data were analyzed using directed content analysis. Quantitative data on sociodemographic and background characteristics and components' acceptability and feasibility were also collected. RESULTS: On average, participants were 49 years old and had lived with HIV for 19 years. Most were cisgender-male and African American/Black. Participants reported a constellation of serious social and structural challenges to HIV management including chronic poverty, unstable housing, and stigma. Across components, a non-judgmental and pressure-free approach and attention to structural and cultural factors were seen as vital to high levels of engagement, but lacking in most medical/social service settings. Prominent aspects of individual components included establishing trust (health education); developing intrinsic motivation, goals, and self-reflection (motivational interviewing sessions); learning/practicing adherence strategies and habits (pre-adherence skill building); reducing social isolation via peer role models (peer mentorship); reflecting on salient goals and common challenges with peers without stigma (focused support groups); and circumventing structural barriers to HIV management with support (navigation). Components were found acceptable and feasible. Findings suggested ways components could be improved. CONCLUSIONS: The present study advances research on interventions for African American/Black and Latino PLWH, who experience complex barriers to engagement along the HIV care continuum. Future study of the components is warranted to address racial/ethnic health inequities in HIV.

Past, present, and future of the Living Planet Index.

As we enter the next phase of international policy commitments to halt biodiversity loss (e.g., Kunming-Montreal Global Biodiversity Framework), biodiversity indicators will play an important role in forming the robust basis upon which targeted, and time sensitive conservation actions are developed. Population trend indicators are one of the most powerful tools in biodiversity monitoring due to their responsiveness to changes over short timescales and their ability to aggregate species trends from global down to sub-national or even local scale. We consider how the project behind one of the foremost population level indicators - the Living Planet Index - has evolved over the last 25 years, its value to the field of biodiversity monitoring, and how its components have portrayed a compelling account of the changing status of global biodiversity through its application at policy, research and practice levels. We explore ways the project can develop to enhance our understanding of the state of biodiversity and share lessons learned to inform indicator development and mobilise action.

A new biologging approach reveals unique flightless molt strategies of Atlantic puffins.

Animal-borne telemetry devices provide essential insights into the life-history strategies of far-ranging species and allow us to understand how they interact with their environment. Many species in the seabird family Alcidae undergo a synchronous molt of all primary flight feathers during the non-breeding season, making them flightless and more susceptible to environmental stressors, including severe storms and prey shortages. However, the timing and location of molt remain largely unknown, with most information coming from studies on birds killed by storms or shot by hunters for food. Using light-level geolocators with saltwater immersion loggers, we develop a method for determining flightless periods in the context of the annual cycle. Four Atlantic puffins (Fratercula arctica) were equipped with geolocator/immersion loggers on each leg to attempt to overcome issues of leg tucking in plumage while sitting on the water, which confounds the interpretation of logger data. Light-level and saltwater immersion time-series data were combined to correct for this issue. This approach was adapted and applied to 40 puffins equipped with the standard practice deployments of geolocators on one leg only. Flightless periods consistent with molt were identified in the dual-equipped birds, whereas molt identification in single-equipped birds was less effective and definitive and should be treated with caution. Within the dual-equipped sample, we present evidence for two flightless molt periods per non-breeding season in two puffins that undertook more extensive migrations (>2000 km) and were flightless for up to 77 days in a single non-breeding season. A biannual flight feather molt is highly unusual among non-passerine birds and may be unique to birds that undergo catastrophic molt, i.e., become flightless when molting. Although our conclusions are based on a small sample, we have established a freely available methodological framework for future investigation of the molt patterns of this and other seabird species.

Behavioral intervention grounded in motivational interviewing and behavioral economics shows promise with Black and English-speaking Latino persons living with HIV with unsuppressed HIV viral load in New York City: A mixed methods pilot study.

Introduction: Sustained HIV viral suppression is the ultimate goal of HIV treatment. African American/Black and Latino persons with HIV (PWH) in the United States are less likely than their White peers to achieve and sustain viral suppression. To address these disparities, we developed a "low-touch" behavioral intervention drawing on motivational interviewing and behavioral economics. The intervention had three main components: (1) a motivational interviewing counseling session, (2) 16 weeks of automated text messages and quiz questions about HIV management, where participants earned points by answering quiz questions, and 3) a lottery prize, based on viral suppression status, number of points earned, and chance (max. $275). Materials and methods: The intervention was tested in a pre-test/post-test design. The present pilot study used mixed methods to explore the intervention's feasibility, acceptability, impact, and ways it could be improved. Participants engaged in a baseline assessment, qualitative interview, and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. We carried out descriptive quantitative analyses. Qualitative data were analyzed using a directed content analysis approach. Data integration was carried out using the joint display method. Findings: Participants (N = 40) were 50 years old, on average (SD = 11), and approximately half (58%) were male. Close to two-thirds (68%) were African American/Black and 32% were Latino. Participants were diagnosed with HIV 22 years ago on average (SD = 8). The intervention was feasible (e.g., mean number of quiz questions answered = 13/16) and highly acceptable. While not powered to assess efficacy, the proportion with suppressed HIV viral load increased from baseline to follow-up (46% participants at the first, 52% participants at the second follow-up evidenced HIV viral suppression). In qualitative analyses, perspectives included that overall, the intervention was acceptable and useful, it was distinct from other programs, lottery prizes were interesting and appreciated but not sufficient to motivate behavior change, and the structure of lottery prizes was not sufficiently clear. Regarding data integration, qualitative data shed light on and extended quantitative results, and added richness and context. Conclusion: This low-touch intervention approach is sufficiently promising to warrant refinement and study in future research.

Global patterns of resilience decline in vertebrate populations.

Maintaining the resilience of natural populations, their ability to resist and recover from disturbance, is crucial to prevent biodiversity loss. However, the lack of appropriate data and quantitative tools has hampered our understanding of the factors determining resilience on a global scale. Here, we quantified the temporal trends of two key components of resilience-resistance and recovery-in >2000 population time-series of >1000 vertebrate species globally. We show that the number of threats to which a population is exposed is the main driver of resilience decline in vertebrate populations. Such declines are driven by a non-uniform loss of different components of resilience (i.e. resistance and recovery). Increased anthropogenic threats accelerating resilience loss through a decline in the recovery ability-but not resistance-of vertebrate populations. These findings suggest we may be underestimating the impacts of global change, highlighting the need to account for the multiple components of resilience in global biodiversity assessments.