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2.
Aust N Z J Public Health ; 48(1): 100130, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38354624

ABSTRACT

OBJECTIVE: The objective of this study was to investigate the geospatial distribution of COVID-19 vaccination rates for Aboriginal and Torres Strait Islander Peoples across Local Government Areas in Australia. METHODS: We described the patterns of COVID-19 vaccination across jurisdictions, identified clusters with different levels of vaccination uptake, and assessed the relationship between contextual factors and vaccination (spatial error model, spatial lag model, and geographic weighted regression). RESULTS: The proportion of the Aboriginal and Torres Strait Islander population that received at least two doses of a COVID-19 vaccine by the last week of June 2022 ranged from 62.9% to 97.5% across Local Government Areas. The proportion of the overall population who is Aboriginal or Torres Strait Islander (ß = 0.280, standard deviation [SD] = 1.92), proportion of the total labour force employed (ß =0.286, SD = 0.98), and proportion of individuals who speak an Aboriginal or Torres Strait Islander language (ß =0.215, SD = 0.15) had, on average, the strongest effects on COVID-19 vaccination rates. CONCLUSION: Findings underscore the extent to which area-level demographic influence the COVID-19 vaccination for Aboriginal and Torres Strait Islander Australians. IMPLICATIONS FOR PUBLIC HEALTH: Findings can inform vaccination strategies that prioritise geographic areas with higher vulnerability to promote equity for Aboriginal and Torres Strait Islander Peoples.


Subject(s)
COVID-19 Vaccines , COVID-19 , Health Services, Indigenous , Vaccination , Humans , Australia/epidemiology , Australian Aboriginal and Torres Strait Islander Peoples , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Vaccination/statistics & numerical data , Geography, Medical
3.
Parasit Vectors ; 17(1): 41, 2024 Jan 29.
Article in English | MEDLINE | ID: mdl-38287434

ABSTRACT

BACKGROUND: Chagas disease is a neglected tropical disease (NTD). Cost-effective strategies for large-scale implementation of diagnosis and etiological treatment are urgently needed to comply with NTD control goals. We determined the seroprevalence of Trypanosoma cruzi infection and associated risk factors in a well-defined rural population of Pampa del Indio municipality including creole and indigenous (Qom) households and developed two indices to identify houses harboring infected children. METHODS: We serodiagnosed and administered a questionnaire to 1337 residents (48.2% of the listed population) in two sections of the municipality (named Areas II and IV) 6-9 years after deploying sustained vector control interventions. Multiple logistic regression models were used to evaluate the relationship between human infection and a priori selected predictors. Two risk indices were constructed based on environmental and serostatus variables, and we used spatial analysis to test whether households harboring T. cruzi-seropositive children were randomly distributed. RESULTS: The global seroprevalence of T. cruzi infection was 24.8%. Human infection was positively and significantly associated with exposure time to triatomines, the household number of seropositive co-inhabitants, maternal seropositivity for T. cruzi, recent residence at the current house and the presence of suitable walls for triatomine colonization in the domicile. The pre-intervention mean annual force of infection (FOI) was 1.23 per 100 person-years. Creoles from Area IV exhibited the highest seroprevalence and FOI; Qom people from both areas displayed intermediate ones and creoles from Area II the lowest. Three hotspots of infected children were spatially associated with hotspots of triatomine abundance at baseline and persistent house infestation. No child born after vector control interventions was T. cruzi seropositive except for one putative transplacental case. Two simple risk indices (based on self-reported inhabiting an infested house and suitable walls for triatomines or maternal serostatus) identified 97.3-98.6% of the households with at least one T. cruzi-seropositive child. CONCLUSIONS: We showed strong heterogeneity in the seroprevalence of T. cruzi infection within and between ethnic groups inhabiting neighboring rural areas. Developed indices can be used for household risk stratification and to improve access of rural residents to serodiagnosis and treatment and may be easily transferred to primary healthcare personnel.


Subject(s)
Chagas Disease , Trypanosoma cruzi , Animals , Child , Humans , Chagas Disease/epidemiology , Risk Factors , Seroepidemiologic Studies , Triatoma , Indigenous Peoples , Argentina
4.
Aust J Prim Health ; 30(1): NULL, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38104344

ABSTRACT

BACKGROUND: A COVID-19 vaccination training program was designed for Aboriginal and Torres Strait Islander (First Nations) health workers and practitioners in Queensland to expand their scope of practice to include COVID-19 immunisation. In the setting of a global pandemic, the project aimed to improve vaccination levels and show how First Nations staff are central to community-led responses to effectively address their community's health needs. METHODS: The program, consisting of an online module and face to face workshop, is described and then evaluated with the RE-AIM framework via mixed methods of participant training surveys and qualitative feedback. RESULTS: The program reached 738 online and 329 workshop participants with the majority identifying as First Nations. The 52 workshops were attended by participants from 12 different hospital and health services in Queensland and 13 Aboriginal Community Controlled Health Organisations (ACCHOs). Feedback was positive, with participants rating the training highly. Of the First Nations Health Workers and Practitioners who responded to the workshop follow up survey, the majority (34/40) implemented their new skills in practice helping minimise the impact of COVID-19 outbreaks in their community. Most respondents (38/40) considered vaccination should be permanently in their scope of practice. CONCLUSIONS: The successful implementation of the vaccination training project was an example of First Nations led health care. Improving scope of practice for First Nations health staff can improve not just career retention and progression but also the delivery of primary care to a community that continues to bear the inequity of poorer health outcomes.


Subject(s)
COVID-19 , Health Services, Indigenous , Humans , Australian Aboriginal and Torres Strait Islander Peoples , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Power, Psychological , Vaccination , Health Workforce
5.
Med J Malaysia ; 78(7): 883-889, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38159922

ABSTRACT

INTRODUCTION: Despite substantial progress in reducing hepatitis B prevalence in the general population, the indigenous population in Malaysia continues to face a significant burden of infection, with high seroprevalence rates. It is hypothesised that transmission patterns differ between the indigenous and non-indigenous populations. This study aimed to compare key risk factors for hepatitis B transmission in indigenous and non-indigenous cases. MATERIALS AND METHODS: This is a comparative crosssectional study using secondary data from the eNotifikasi system and hepatitis B case investigation forms between 2018 and 2022 from four district health offices in Pahang, Malaysia. Demographic data, hepatitis B vaccination status and risk factors were assessed. Data analysis employed were independent chi-squared tests, t-tests and binary logistic regression. RESULTS: The study included 285 cases (141 indigenous and 145 non-indigenous). Among the indigenous cases, 72.3% were unvaccinated and 59.6% reported a history of infected mother, followed by percutaneous exposure, multiple sexual partners, and sharing syringe. The odds for those with a history of an infected mother being indigenous group is 2.5 times (95% CI: 1.4-4.4) compared to those with a history of an infected mother being non-indigenous group. CONCLUSION: Significant difference exists in hepatitis B risk factors between indigenous and non-indigenous populations. The main risk factor for indigenous community is history of infected mother. Thus, the necessity of incorporating hepatitis B screening into the current practice of antenatal HIV screening, specifically targeting the indigenous community, should be given consideration.


Subject(s)
Hepatitis B Surface Antigens , Hepatitis B , Humans , Female , Pregnancy , Seroepidemiologic Studies , Hepatitis B/epidemiology , Hepatitis B/diagnosis , Risk Factors , Prevalence , Indigenous Peoples , Hepatitis B virus
6.
Harm Reduct J ; 20(1): 154, 2023 10 20.
Article in English | MEDLINE | ID: mdl-37864220

ABSTRACT

BACKGROUND: The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance. METHODS: Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program. RESULTS: Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available. CONCLUSIONS: The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.


Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Communicable Diseases , Health Promotion , Health Services Accessibility , Health Services, Indigenous , Humans , Australia , Liver , New South Wales , Peer Group , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Blood-Borne Infections/diagnosis , Blood-Borne Infections/therapy , Blood-Borne Infections/virology , Communicable Diseases/diagnosis , Communicable Diseases/therapy
7.
Harm Reduct J ; 20(1): 153, 2023 10 20.
Article in English | MEDLINE | ID: mdl-37864234

ABSTRACT

The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses (BBVs) and sexually transmitted infections (STIs). The goal of the program is to increase access to BBV and STI education, screening, treatment, and vaccination in recognition and response to the systemic barriers that Aboriginal and Torres Strait Islander peoples face in accessing health care. This commentary introduces a series of papers that report on various aspects of the evaluation of the Deadly Liver Mob (DLM) program. In this paper, we explain what DLM is and how we constructed an evaluation framework for this complex health promotion intervention.


Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Communicable Diseases , Health Promotion , Hepatitis C , Humans , Australia , Health Services, Indigenous , Hepacivirus , Hepatitis C/ethnology , Hepatitis C/prevention & control , New South Wales , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Peer Group , Communicable Diseases/diagnosis , Communicable Diseases/therapy , Blood-Borne Infections/diagnosis , Blood-Borne Infections/therapy
8.
Drug Alcohol Rev ; 42(7): 1633-1638, 2023 11.
Article in English | MEDLINE | ID: mdl-37867367

ABSTRACT

INTRODUCTION: Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020. METHODS: Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs. RESULTS: AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]). DISCUSSION AND CONCLUSIONS: The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.


Subject(s)
Alcoholism , COVID-19 , Health Services, Indigenous , Humans , Alcoholism/diagnosis , Retrospective Studies , Australian Aboriginal and Torres Strait Islander Peoples , Communicable Disease Control , COVID-19/prevention & control , Victoria , Health Services , Community Health Services
9.
Front Public Health ; 11: 1175835, 2023.
Article in English | MEDLINE | ID: mdl-37900024

ABSTRACT

Introduction: Zoonoses are a health concern for Aboriginal and Torres Strait Islander peoples in Australia that face elevated risk of disease related to the environment and animals. Internationally, One Health is encouraged to effectively manage zoonoses by taking integrated approaches involving animal, human, and environmental health sectors to improve health outcomes. However, Australia's health systems manage zoonotic diseases in animals and people separately which does not support a One Health approach. For the effective management of zoonoses, a strong evidence base and database regarding the epidemiology of zoonotic pathogens is needed. However, we currently lack this evidence limiting our understanding of the impact of zoonoses on Aboriginal and Torres Strait Islander populations. Methods: As a first step towards building the evidence base, we undertook a descriptive analysis of Aboriginal and Torres Strait Islander zoonotic notifications in Australia from 1996 to 2021. We presented notifications as annual notification rates per 100,000 population, and percentages of notifications by state, remoteness, sex, and age group. Results: Salmonellosis and campylobacteriosis were the most notified zoonoses with the highest annual notification rates of 99.75 and 87.46 per 100,000 population, respectively. The north of Australia (Queensland, Northern Territory and Western Australia), remote and outer regional areas, and young children (0-4 years of age) had the highest percentages of notifications. Discussion: To our knowledge, these findings are the first national presentation of the epidemiology of zoonoses within Aboriginal and Torres Strait Islander populations. A greater understanding of transmission, prevalence and impact of zoonoses on Aboriginal and Torres Strait Islander peoples (including animal and environmental health factors) is required to inform their effective management through a One Health approach.


Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Disease Notification , One Health , Zoonoses , Animals , Child , Child, Preschool , Humans , Australia/epidemiology , Australian Aboriginal and Torres Strait Islander Peoples/statistics & numerical data , Data Analysis , One Health/statistics & numerical data , Zoonoses/epidemiology , Zoonoses/transmission , Health Services, Indigenous/statistics & numerical data , Disease Notification/statistics & numerical data
10.
Nutrients ; 15(19)2023 Oct 07.
Article in English | MEDLINE | ID: mdl-37836563

ABSTRACT

The COVID-19 pandemic has notably impacted food security, especially among urban Indigenous communities. This study aimed to examine the impact of the pandemic and related lockdown measures on the food security of urban Indigenous peoples in Saskatchewan, Canada. In partnership with Indigenous co-researchers, we designed an online survey disseminated via SurveyMonkey® (San Mateo, CA, USA) from August 2021 to August 2022. This survey detailed background information, the Household Food Security Survey Module (HFSSM), state of food access, and traditional food consumption habits. Of the 130 Indigenous respondents, 75.8% were female, 21.9% male, and 2.3% non-binary, with an average age of 36.2 years. A significant 68.4% experienced food insecurity during the pandemic's first four months. Increased food prices (47.1%) and reduced market availability (41.4%) were the dominant causes. Additionally, 41.8% highlighted challenges in accessing traditional foods. Relying on community resources and government food distribution programs (40.7%) was the most reported coping strategy for those experiencing food insecurity. Notably, 43.6% reported receiving no government financial support during the crisis. This study emphasizes the severe food insecurity among urban Indigenous communities in Saskatchewan during the pandemic. The findings highlight the immediate need for interventions and policies that ensure access to culturally relevant food, especially for future crises.


Subject(s)
COVID-19 , Pandemics , Humans , Male , Female , Adult , Saskatchewan/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Food Supply , Communicable Disease Control , Canada , Adaptation, Psychological , Food Security , Indigenous Peoples
11.
Australas Psychiatry ; 31(6): 786-790, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37772406

ABSTRACT

OBJECTIVE: Use of seclusion within mental health inpatient facilities is harmful for consumers and staff, but it is still used in many Aotearoa New Zealand and Australian facilities, at higher, inequitable rates for the indigenous populations of both countries. We report early results from a national programme to eliminate seclusion in mental health services in Aotearoa New Zealand, using a bicultural approach to reduce inequity for Maori. METHOD: The 'Zero Seclusion: Safety and dignity for all' programme, with programme teams nationwide, developed a co-designed bicultural change package combining Maori cultural and Western clinical interventions, incorporating quality improvement methodologies. Outcome measures included seclusion rates, duration, and average number of episodes per person admitted, by ethnicity, with a focus on equity. RESULTS: Nationally, rates of seclusion for Maori reduced from the 12-month (to August 2019) baseline mean monthly rate of 7.5% to 6.8%, sustained from late 2020 to September 2022. The duration of seclusion for Maori reduced by 33% (4.5 h at baseline to 3.0). CONCLUSION: A focus on inequity for Maori in use of seclusion, and a bicultural approach with cultural and clinical interventions, has been associated with a national reduction in rates and duration of seclusion for Maori.


Subject(s)
Healthcare Disparities , Hospitals, Psychiatric , Maori People , Patient Isolation , Quality Improvement , Humans , Australia , Hospitalization , Indigenous Peoples , New Zealand
12.
J Acquir Immune Defic Syndr ; 94(2S): S73-S79, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37707852

ABSTRACT

BACKGROUND: There is an urgent need to conduct innovative research on the health needs of populations whose intersecting identities, such as being Black, Indigenous, and other People of Color (BIPOC) and sexual and gender identity (SGM) persons, put them at greater risk of HIV infection. More so, as important as it is to train on the best practices, it is as important to train aspiring BIPOC SGM scholars in intersectional HIV science so that they can address the HIV-related issues of BIPOC SGM populations. METHODS: In line with guidelines to increase diversity in the HIV workforce, we sought to (1) solidify the interest of BIPOC SGM trainees engaging in intersectional HIV science by piloting a 2-week Summer Intensive Program, (2) leverage the relationships and resources of our community partner to enhance our recruitment from HBCUs and MSIs, and (3) identify opportunities for postprogram training and mentoring activities. RESULTS: Our data suggest that participants gained a great deal from the instructional sessions. Participants commented on the quality of the sessions, effectiveness of the instructional faculty, and a confirmed interest in HIV science. CONCLUSIONS: We succeeded in promoting interest in and commitment to HIV science among early career BIPOC SGM scholars. An instructional program of this intensity is best suited to those with some experience in graduate school and existing interest in HIV science. As a program serving multiply minoritized populations, clarification of host institution policies and procedures, as well as administrative support, are essential for ensuring a smooth experience for scholars visiting from outside institutions.


Subject(s)
Gender Identity , HIV Infections , Female , Humans , Male , HIV Infections/prevention & control , Sexual Behavior , Black or African American , Minority Groups , Indigenous Peoples , Biomedical Research
13.
Lancet HIV ; 10(8): e543-e551, 2023 08.
Article in English | MEDLINE | ID: mdl-37482067

ABSTRACT

Since its introduction in 2007, the UN Declaration on the Rights of Indigenous Peoples (UNDRIP) has been adopted by 144 countries worldwide. In a ten-point statement released in 2017, Indigenous leaders in the HIV and AIDS community established a list of truths and actions to be used for advocacy to end AIDS among Indigenous Peoples through self-determination, justice, and human rights. 15 years after the UNDRIP and 5 years after the 10-point statement, this Review asks where we are in terms of upholding the UNDRIP and the International Indigenous HIV and AIDS Community statement in relation to HIV and AIDS, and what is needed to better uphold and respond to these directives. HIV in Indigenous populations continues to intersect with multiple forms of oppression, racism, and discrimination, which are yet to be eliminated from laws, policies, and practices. Eradicating white supremacy and Indigenous-specific racism across all health systems is a bare minimum requirement to uphold Indigenous rights within health care, and must be accompanied by support for Indigenous, self-determined, culturally tailored, and community-specific health and wellness services.


Subject(s)
HIV Infections , Humans , HIV Infections/epidemiology , HIV Infections/prevention & control , Indigenous Peoples , Delivery of Health Care , Human Rights , United Nations
16.
Lancet Infect Dis ; 23(10): e431-e444, 2023 10.
Article in English | MEDLINE | ID: mdl-37148904

ABSTRACT

The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.


Subject(s)
COVID-19 , Communicable Diseases , Humans , Pandemics/prevention & control , COVID-19/epidemiology , North America/epidemiology , Canada/epidemiology , Indigenous Peoples , Communicable Diseases/epidemiology
17.
Int J Equity Health ; 22(1): 84, 2023 05 09.
Article in English | MEDLINE | ID: mdl-37161482

ABSTRACT

BACKGROUND: Syphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn`s health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide. METHODS: We conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO. RESULTS: The strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples' health. CONCLUSIONS: Maternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis.


Subject(s)
Syphilis, Congenital , Syphilis , Female , Humans , Infant, Newborn , Pregnancy , Brazil , Family , Indigenous Peoples , Syphilis/epidemiology
18.
Trials ; 24(1): 248, 2023 Apr 01.
Article in English | MEDLINE | ID: mdl-37004106

ABSTRACT

BACKGROUND: Nen UnkUmbi/EdaHiYedo ("We Are Here Now," or NE) is an intervention to prevent STIs, HIV, HCV, and teen pregnancy among Assiniboine and Sioux youth of the Fort Peck Reservation in the state of Montana in the USA. A cluster-randomized stepped-wedge design (SWD) trial is used to evaluate NE, where clusters are schools. The purpose of this study is to evaluate whether there is evidence of a secular trend associated with the COVID-19 pandemic. METHODS: The original study design is a cluster-randomized stepped-wedge design (SWD), in which five schools that youth from Fort Peck attend are the clusters to be randomized into the intervention one at a time, with all schools eventually being randomized to the intervention across three steps. N/E is a 5-year study involving 456 15- to 18-year-old youth. For this study, we use a mixed quantitative and qualitative methods approach to understand how the COVID-19 pandemic may have been associated with the study's primary outcome variables. Data were drawn from the first cluster exposed to the intervention and one control cluster that did not yet receive the intervention during the period in which COVID-19 mitigation efforts were being implemented. A pre-post COVID questionnaire was added to core measures administered, and semistructured qualitative interviews were conducted with youths regarding their perceptions of how the pandemic altered their sexual behaviors. RESULTS: One hundred eighteen youth responded to the questionnaire and 31 youth participated in semistructured qualitative interviews. Youth reporting having sex with less people due to COVID-19 reported more sex acts (incident rate ratio (IRR)=3.6, 95% CI 1.6-8.1) in comparison to those who did not report having sex with less people, and youth who reported having sex with the same amount of people due to COVID-19 reported less sex acts (IRR=0.31, 95% CI 0.14-0.7) in comparison to those who did not report having sex with the same amount of people. Youth reporting having sex less times due to COVID-19 experienced a greater number of sex acts in comparison to those who did not report having sex less times (IRR=2.7, 1.2-6.4). Results suggest that more sexually active individuals reported perceiving having sex with less people and less frequent engagement in sex during the pandemic. It is possible that the COVID-19 pandemic period was associated with a truncation in the distribution of sexual activity that would bias an estimate of the intervention's effect. CONCLUSION: Findings suggest evidence of a secular trend. This trend must be accounted for at trial end, and sensitivity analyses are recommended. Documenting and reporting on these findings encourages transparent reporting during the implementation of a SWD trial during a global pandemic, and informs endline analyses. TRIAL REGISTRATION: This trial is registered with the Clinical trials registry of the US National Library of Medicine at the National Institutes of Health (NIH). It was registered on October 1, 2018. The study presented in this manuscript is funded by NIH National Institute on Minority Health and Health Disparities (NIMHD), Award # R01MD012761-01, Elizabeth Rink (Principal Investigator). The study's ClinicalTrials.gov number is NCT03694418.


Subject(s)
COVID-19 , Sexually Transmitted Diseases , Pregnancy , Female , Humans , Adolescent , Pandemics , Reproductive Health , Sexual Behavior , Sexually Transmitted Diseases/prevention & control
19.
Clin Chest Med ; 44(2): 425-434, 2023 06.
Article in English | MEDLINE | ID: mdl-37085230

ABSTRACT

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.


Subject(s)
COVID-19 , Health Inequities , Health Services Accessibility , Social Determinants of Health , Social Discrimination , Vulnerable Populations , Humans , Black or African American , COVID-19/epidemiology , COVID-19/ethnology , COVID-19/prevention & control , COVID-19/psychology , Emigrants and Immigrants/psychology , Emigrants and Immigrants/statistics & numerical data , Ethnicity/statistics & numerical data , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Hispanic or Latino/psychology , Hispanic or Latino/statistics & numerical data , Indigenous Peoples/psychology , Indigenous Peoples/statistics & numerical data , Poverty/ethnology , Poverty/psychology , Poverty/statistics & numerical data , Social Determinants of Health/economics , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Social Discrimination/economics , Social Discrimination/ethnology , Social Discrimination/psychology , Social Discrimination/statistics & numerical data , Social Marginalization/psychology , Trust/psychology , United States/epidemiology , Vaccination/economics , Vaccination/psychology , Vaccination/statistics & numerical data , Vulnerable Populations/psychology , Vulnerable Populations/statistics & numerical data , White/psychology , White/statistics & numerical data
20.
Article in English | MEDLINE | ID: mdl-36901423

ABSTRACT

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.


Subject(s)
Health Services, Indigenous , Hepatitis C, Chronic , Humans , Antiviral Agents , Australian Aboriginal and Torres Strait Islander Peoples , Hepacivirus , South Australia , Culture
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