Association Between Institution ZIP Code Characteristics and NIH Funding.

Introduction. While racial NIH funding disparities have been identified, little is known about the link between community demographics of institutions and NIH funding. We sought to evaluate the association between institution zip code characteristics and NIH funding. Methods. We linked the 2011-2021 NIH RePORTER database to Census data. We calculated the funding to each institution and stratified institutions into funding quartiles. We defined out independent variables as institution ZIP code level race/ethnicity (White, Black, and Hispanic), and socioeconomic status (household income, high school graduation rate, and unemployment rate). We used ordinal regression models to evaluate the association between institution ZIP code characteristics and grant funding quartile. Results. We included 731,548 grants (US$271,495,839,744) from 3,971 ZIP codes. The funding amounts in millions of U.S. dollars for the funding quartiles were fourth - 0.25, third - 1.1, second - 3.8, first - 43.5. Using ordinal regression, we found an association between increasing unemployment rate (OR = 1.03 [1.02, 1.05]), increasing high school graduation rate (OR = 3.6 [1.6, 8.4]), decreasing proportion of White people (OR = 0.4 [0.3, 0.5]), increasing proportion of Black people (OR = 1.3 [0.9, 1.8]), and increasing proportion of Hispanic/Latine people (OR = 2.5 [1.7, 3.5]) and higher grant funding quartiles. We found no association between household income and grant funding quartile. Conclusion. We found ZIP code demographics to be inadequate for evaluating NIH funding disparities, and the association between institution ZIP code demographics and investigator demographics is unclear. To evaluate and improve grant funding disparities, better grant recipient data accessibility and transparency are needed.

National community disparities in prehospital penetrating trauma adjusted for income, 2020-2021.

INTRODUCTION: While Black individuals experienced disproportionately increased firearm violence and deaths during the COVID-19 pandemic, less is known about community level disparities. We sought to evaluate national community race and ethnicity differences in 2020 and 2021 rates of penetrating trauma. METHODS: We linked the 2018-2021 National Emergency Medical Services Information System databases to ZIP Code demographics. We stratified encounters into majority race/ethnicity communities (>50% White, Black, or Hispanic/Latino). We used logistic regression to compare penetrating trauma for each community in 2020 and 2021 to a combined 2018-2019 historical baseline. Majority Black and majority Hispanic/Latino communities were compared to majority White communities for each year. Analyses were adjusted for household income. RESULTS: We included 87,504,097 encounters (259,449 penetrating traumas). All communities had increased odds of trauma in 2020 when compared to 2018-2019, but this increase was largest for Black communities (aOR 1.4, [1.3-1.4]; White communities - aOR 1.2, [1.2-1.3]; Hispanic/Latino communities - aOR 1.1. [1.1-1.2]). There was a similar trend of increased penetrating trauma in 2021 for Black (aOR 1.2, [1.2-1.3]); White (aOR 1.2, [1.1-1.2]); Hispanic/Latino (aOR 1.1, [1.1-1.1]). Comparing penetrating trauma in each year to White communities, Black communities had higher odds of trauma in all years (2018/2019 - aOR 3.0, [3.0-3.1]; 2020 - aOR 3.3, [3.3-3.4]; 2021 - aOR 3.3, [3.2-3.2]). Hispanic/Latino also had more trauma each year but to a lesser degree (2018/2019 - aOR 2.0, [2.0-2.0]; 2020 - aOR 1.8, [1.8-1.9]; 2021 - aOR 1.9, [1.8-1.9]). CONCLUSION: Black communities were most impacted by increased penetrating trauma rates in 2020 and 2021 even after adjusting for income.

Hard-to-Reach or Hardly Reached? The "Difficulty" of Engaging Cisgender Black Females in Sexual Health Research.

Rather than placing the onus on stigmatized and disenfranchised communities as hard-to-reach in sexual health research, we challenge researchers to recognize and provide outreach to populations who are hardly reached, such as cisgender Black women. We posit that the disparate human immunodeficiency virus (HIV) and sexually transmitted infection (STI) rates experienced by Black women in the USA are due in part to social and structural inequities and lack of researcher outreach within these communities. Social inequities give rise to racial and gender discrimination, which often results in structural barriers that researchers may not acknowledge. Structural barriers include medical mistrust and lack of access to preventative sexual health services, health care, education, and other resources. To achieve health equity, researchers must engage with Black women to understand the unique struggles they face and intervene with non-stigmatizing, culturally appropriate interventions. Interventions must utilize gatekeepers, influencers, community organizations, community advisory boards, and peer support. It is critical that sexual health researchers reach out to those who do not fall under the traditional hard-to-reach category but are hardly reached to counteract the current projection that 1 in 32 Black women will be diagnosed with HIV in their lifetime.

Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults - United States, December 2020-March 2023.

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline and the 3-month follow-up, from 98.4% to 48.2% for persons who received a positive SARS-CoV-2 test results (COVID test-positive participants) and from 88.2% to 36.6% for persons who received negative SARS-CoV-2 test results (COVID test-negative participants). Persistent symptoms decreased through 12 months; no difference between the groups was observed at 12 months (prevalence among COVID test-positive and COVID test-negative participants = 18.3% and 16.1%, respectively; p>0.05). Both groups reported symptoms that emerged or reemerged at 6, 9, and 12 months. Thus, these symptoms are not unique to COVID-19 or to post-COVID conditions. Awareness that symptoms might persist for up to 12 months, and that many symptoms might emerge or reemerge in the year after COVID-like illness, can assist health care providers in understanding the clinical signs and symptoms associated with post-COVID-like conditions.

Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073.

Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation (SD) = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.

A survey with interventional components delivered on tablet devices versus usual care to increase pre-exposure prophylaxis uptake among cisgender Black women: a pilot randomized controlled trial.

BACKGROUND: Cisgender (cis) Black women in the USA are more likely to become HIV positive during their lifetime than other women. We developed and implemented a behavioral intervention, Increasing PrEP (iPrEP), the first pilot randomized controlled trial (RCT) aimed at motivating cis Black women to be willing to use PrEP for HIV prevention and attend an initial PrEP clinic visit following an emergency department visit. METHODS: Eligible participants were Black cisgender women ages 18-55 years who acknowledged recent condomless sex and substance use. Participants were randomized to iPrEP or usual care (UC). iPrEP is a survey-based intervention designed to raise awareness and knowledge about PrEP. Participants completed an assessment of knowledge of and willingness to use PrEP before and after the intervention, then received a warm-hand off with referral to a local PrEP clinic. Enrolled participants were followed for 6 months. RESULTS: Forty enrolled participants were ages 18-54 years. Education levels varied evenly between some high school education and graduate education. Most participants were single (n = 25) or married (n = 7). Twenty-two participants were employed full-time. Pre-test results indicated that 21 of 40 participants had heard of PrEP. All participants identified PrEP as a daily HIV prevention medication. For those randomized to iPrEP, the odds of knowing about PrEP at post-test, when controlling for baseline, were higher relative to UC (OR = 5.22, 95%CrI = 0.50, 94.1]. iPrEP did not have any effect on willingness relative to UC. The estimate for iPrEP on willingness is marginally higher (4.16 vs. 4.04; i.e., 0.12 points higher); however, the posterior probability of 67.9% does not suggest a strong degree of evidence in favor of an effect. During the post-test, those receiving iPrEP were less ready to take PrEP than those receiving UC. CONCLUSIONS: Findings suggest that iPrEP increased knowledge about the PrEP medication but had a negative impact on readiness to take PrEP relative to UC. It is imperative that future research among cisgender Black women carefully considers the content provided in interventions designed to increase PrEP use, balancing the benefits of PrEP with the side effects and daily pill burden. TRIAL REGISTRATION: clinicaltrial.gov Identifier: NCT03930654, 29/04/2019.

Three-Month Symptom Profiles Among Symptomatic Adults With Positive and Negative Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Prospective Cohort Study From the INSPIRE Group.

BACKGROUND: Long-term symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are a major concern, yet their prevalence is poorly understood. METHODS: We conducted a prospective cohort study comparing adults with SARS-CoV-2 infection (coronavirus disease-positive [COVID+]) with adults who tested negative (COVID-), enrolled within 28 days of a Food and Drug Administration (FDA)-approved SARS-CoV-2 test result for active symptoms. Sociodemographic characteristics, symptoms of SARS-CoV-2 infection (assessed with the Centers for Disease Control and Prevention [CDC] Person Under Investigation Symptom List), and symptoms of post-infectious syndromes (ie, fatigue, sleep quality, muscle/joint pains, unrefreshing sleep, and dizziness/fainting, assessed with CDC Short Symptom Screener for myalgic encephalomyelitis/chronic fatigue syndrome) were assessed at baseline and 3 months via electronic surveys sent via text or email. RESULTS: Among the first 1000 participants, 722 were COVID+ and 278 were COVID-. Mean age was 41.5 (SD 15.2); 66.3% were female, 13.4% were Black, and 15.3% were Hispanic. At baseline, SARS-CoV-2 symptoms were more common in the COVID+ group than the COVID- group. At 3 months, SARS-CoV-2 symptoms declined in both groups, although were more prevalent in the COVID+ group: upper respiratory symptoms/head/eyes/ears/nose/throat (HEENT; 37.3% vs 20.9%), constitutional (28.8% vs 19.4%), musculoskeletal (19.5% vs 14.7%), pulmonary (17.6% vs 12.2%), cardiovascular (10.0% vs 7.2%), and gastrointestinal (8.7% vs 8.3%); only 50.2% and 73.3% reported no symptoms at all. Symptoms of post-infectious syndromes were similarly prevalent among the COVID+ and COVID- groups at 3 months. CONCLUSIONS: Approximately half of COVID+ participants, as compared with one-quarter of COVID- participants, had at least 1 SARS-CoV-2 symptom at 3 months, highlighting the need for future work to distinguish long COVID. CLINICAL TRIALS REGISTRATION: NCT04610515.

Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection.

Introduction: Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. Methods: Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. Results: Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). Discussion: Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.

Association of Initial SARS-CoV-2 Test Positivity With Patient-Reported Well-being 3 Months After a Symptomatic Illness.

Importance: Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use. Objective: To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection. Design, Setting, and Participants: This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]). Participants were enrolled from December 11, 2020, to September 10, 2021, and comprised adults (aged ≥18 years) with acute symptoms suggestive of SARS-CoV-2 infection at the time of receipt of a SARS-CoV-2 test approved by the US Food and Drug Administration. The analysis included the first 1000 participants who completed baseline and 3-month follow-up surveys consisting of questions from the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29; 7 subscales, including physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and the PROMIS Short Form-Cognitive Function 8a scale, for which population-normed T scores were reported. Exposures: SARS-CoV-2 status (positive or negative test result) at enrollment. Main Outcomes and Measures: Mean PROMIS scores for participants with positive COVID-19 tests vs negative COVID-19 tests were compared descriptively and using multivariable regression analysis. Results: Among 1000 participants, 722 (72.2%) received a positive COVID-19 result and 278 (27.8%) received a negative result; 406 of 998 participants (40.7%) were aged 18 to 34 years, 644 of 972 (66.3%) were female, 833 of 984 (84.7%) were non-Hispanic, and 685 of 974 (70.3%) were White. A total of 282 of 712 participants (39.6%) in the COVID-19-positive group and 147 of 275 participants (53.5%) in the COVID-19-negative group reported persistently poor physical, mental, or social well-being at 3-month follow-up. After adjustment, improvements in well-being were statistically and clinically greater for participants in the COVID-19-positive group vs the COVID-19-negative group only for social participation (ß = 3.32; 95% CI, 1.84-4.80; P < .001); changes in other well-being domains were not clinically different between groups. Improvements in well-being in the COVID-19-positive group were concentrated among participants aged 18 to 34 years (eg, social participation: ß = 3.90; 95% CI, 1.75-6.05; P < .001) and those who presented for COVID-19 testing in an ambulatory setting (eg, social participation: ß = 4.16; 95% CI, 2.12-6.20; P < .001). Conclusions and Relevance: In this study, participants in both the COVID-19-positive and COVID-19-negative groups reported persistently poor physical, mental, or social well-being at 3-month follow-up. Although some individuals had clinically meaningful improvements over time, many reported moderate to severe impairments in well-being 3 months later. These results highlight the importance of including a control group of participants with negative COVID-19 results for comparison when examining the sequelae of COVID-19.

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities-HPTN 073.

Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.

The Influence of Family Bonding, Support, Engagement in Healthcare, on PrEP Stigma among Young Black and Latino Men Who Have Sex with Men: A Path Analysis.

This study employs the ecodevelopmental theory to examine the influence of mother and father bonding, family engagement in healthcare, and family support on PrEP stigma among BLMSM. We used a cross-sectional sample from wave five of the Healthy Young Men (HYM) study, with a survey sample of 399 participants aged 16−24 years. We conducted two-path analyses to test multiple hypotheses: (1) mother/father bonding is associated with an increase in family engagement in healthcare; (2) family engagement in healthcare is associated with family social support; and (3) family social support is associated with PrEP stigma. Family social support was negatively correlated with PrEP stigma (r = −0.15; p < 0.001). The findings show that families either led by a Black/Latino father or mother have a significant impact on the sexual health-seeking behavior of BLMSM and their perception of HIV and PrEP.

Novel Use of Video Logs to Deliver Educational Interventions to Black Women for Disease Prevention.

INTRODUCTION: Cisgender Black women comprise 67% of new human immunodeficiency virus (HIV) diagnoses among women in the South and are 11 times more likely to become HIV positive than White women in Texas. Optimal progress toward ending the HIV epidemic requires strategies that will interrupt transmission pathways in hotspot locations like Harris County, TX. Researchers are calling for public health interventions that can prevent HIV and sexually transmitted infections (STI) transmission; thus, we launched the first video log (vlog)-based, pilot HIV prevention intervention. METHODS: In a prospective. randomized controlled trial of two educational intervention strategies delivered as vlogs eligible participants were randomized to either 1) an interactive gaming, education-based strategy, or 2) a storytelling, education-based strategy. Eligible participants were cisgender Black women being seen in the emergency department (ED) for a non-emergent condition who reported recent condomless heterosexual sex, were ages 18-45, and had social media access. Enrolled women completed a screening assessment, informed consent, randomization, and 10-item pre-and-post assessments with true/false statements before and after viewing a brief vlog on a tablet device to identify changes in knowledge before and after being educated on HIV/STI transmission. RESULTS: Twenty-six women were randomized to the Taboo group, an interactive gaming, education-based strategy, (14 [53.8%]), or to storytelling, an education-based strategy using non-fictional and fictional case scenarios (12 [46.2%]). Taboo participants self-identified as African-American (12 [85.7%]), Black (1 [7.1%]) or "other" (1 [7.1%]), were younger (28.6% were ≥ 30 years), single (57.1%), reported a previous STI (8 [57.1%]), and were likely employed (57.2%). Storytelling participants self-identified as African-American (7 [58.3%]) or Black (5 [41.7%]), were older (49.9% were ≥ 30 years), in a relationship but not married (50%), and half were unemployed. Highest level of education and monthly income varied. The storytelling strategy increased knowledge in two areas and the Taboo strategy increased knowledge in one. No intervention effect was identified in three areas, and a significant decrease in knowledge (P < .0001) was discerned in eight areas for Taboo and six areas for storytelling. CONCLUSION: Further research is necessary to confirm whether delivery of HIV prevention interventions with vlogs is a useful approach for HIV-vulnerable populations. Findings suggest that vlogs are a feasible approach to brief behavioral interventions during an ED visit.

Prevalence of Prenatal HIV Screening in Massachusetts: Examining Patterns in Prenatal HIV Screening Using the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2016.

Prenatal HIV screening is critical to eliminate mother-to-child (MTC) HIV transmission. Although Massachusetts (MA) has near-zero MTC transmission rates, recent trends in statewide prenatal HIV testing are unknown. This study examined variations in prenatal HIV screening across race/ethnicity, socioeconomic status, and prenatal care settings in MA, in the period following national and state-level changes in guidance encouraging routine prenatal HIV testing.According to the MA Pregnancy Risk Assessment Monitoring System (PRAMS) data, 68.3% of pregnant women in MA were screened for HIV between 2007 and 2016. There were significant differences in prenatal screening rates across race/ethnicity, with 83.38% of Black non-Hispanic (NH), 85.5% of Hispanic women, and 62.4% of White NH women reporting being tested for HIV at some point during their pregnancy (P <.0001). Multivariate regression found that differences in screening were explained by race/ethnicity, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) status, prenatal care site, type of insurance, nativity, and marital status. Annual rates of prenatal HIV screening did not change significantly in MA from 2007 to 2016 (P = .27).The results of the analysis revealed that prenatal HIV screening rates differ based on race/ethnicity, with higher rates in Black NH and Hispanic women when compared to White NH women. The racial disparities in prenatal HIV screening and lack of universal screening in MA raises questions about the effectiveness of the state's approach.

Predictors of Anticipated PrEP Stigma among Women with Self-Reported Problematic Substance Use: Implications for Engaging Women in the PrEP Care Continuum.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but it has been underutilized by women. Anticipated stigma regarding use of PrEP is a contributing factor in the underutilization of this prevention strategy. The current study explored the relationships among PrEP stigma, sex risk (i.e., inconsistent condom use, condomless sex with persons of unknown serostatus, or sex in exchange for money or drugs), substance use, attitudes toward HIV testing, and medical mistrust. Participants were 106 primarily ethnic-minority women who reported recent substance use and agreed to participate in a study exploring HIV prevention attitudes. Within this sample, the majority of participants had one or more CDC-defined PrEP indications. Findings indicate that medical mistrust was associated with perceived PrEP stereotypes and HIV testing attitudes. These results provide some insight into reasons for low PrEP uptake among women at risk for HIV. Implications for HIV prevention with women are discussed.

An Assessment of Emergency Nurses' Perspectives on Nurse-Driven Human Immunodeficiency Virus Testing in the Emergency Department.

INTRODUCTION: Engaging emergency clinicians in universal human immunodeficiency virus screening is paramount to achieving goals of reengaging human immunodeficiency virus-positive persons into care, identifying new human immunodeficiency virus cases, and linking them to care. The study aim was to identify beliefs and barriers towards opt-out human immunodeficiency virus testing among emergency nurses. METHODS: A cross-sectional study used Qualtrics software to deliver a survey on a tablet device to emergency nurses in a private Level 1 trauma hospital in Houston, Texas during downtimes of their clinical shifts. The survey evaluated perspectives on human immunodeficiency virus screening and knowledge relative to rapid screening and human immunodeficiency virus prevalence rates locally and nationally. RESULTS: Fifty emergency nurses were enrolled. Few nurses accurately identified human immunodeficiency virus prevalence rates at the local hospital and city level (10% and 42%, respectively). Most (54%) of nurses correctly estimated human immunodeficiency virus prevalence rates nationally. Nearly half of the nurses (42.0%) correctly predicted the cost of a rapid human immunodeficiency virus test with accuracy and most were willing to offer rapid human immunodeficiency virus testing all the time (60.0%). Eighty-eight percent of nurses were supportive of facilitating universal human immunodeficiency virus screening. However, 92.0% strongly supported human immunodeficiency virus testing for high risk patients only when compared to 80.0% support of testing for all eligible patients. Qualitative data revealed time constraints and follow-up concerns as barriers. DISCUSSION: Emergency nurses reported barriers that sometimes prevented application of Centers for Disease Control and Prevention recommendations to human immunodeficiency virus screening. Strategies to overcome these barriers are instrumental to programmatic success. Solutions can corroborate the importance of emergency nurses to the nation's Ending the HIV Epidemic plan.

Racial and sex disparities in HIV screening outcomes within emergency departments of Harris County, Texas.

OBJECTIVES: The emergency department provides opportunities for identifying undiagnosed HIV cases. We sought to describe the racial and sex epidemiology of HIV through ED screening in Harris County, Texas, one of the most diverse and populous metropolitan cities in the Southern United States. METHODS: We used a descriptive secondary analysis of a universal HIV screening program (2010-2017) to quantify demographic differences in HIV incidence. We applied a validated codebook to a dataset by the local health department containing 894,387 records of ED visits with 62 variables to assess race/ethnicity and sex differences. RESULTS: Of 885,199 (98.9%) patients screened for HIV during an ED visit, 1795 tested positive (incidence rate = 0.2%). Of those tested for HIV, most were White (66.3%), followed by racial minorities (African Americans (29.9%), Asians (3.6%), and American Indian, Alaska Native, Native Hawaiian or Pacific Islanders (natives) (0.1%). Half of those tested were Hispanic. Conversely, of patients testing positive (n = 1782, 99.3% of positive cases), most were African American (52.6%) followed by Whites (46.6%), Asians (0.7%), and natives (0.1%). Less than half (35.5%) of positives were Hispanic. A racial disparity in HIV incidence was discovered among African American females. This group represented 16.8% of the tested population; yet accounted for 65.8% of females who tested positive for HIV and 20.3% of all HIV-positive test results. CONCLUSION: Descriptive findings of the racial and sex epidemiology of HIV revealed that African American females had the largest disparity between the population tested and those who tested positive for HIV.

Point-of-Care Ultrasound in Sternal Notch Confirms Depth of Endotracheal Tube in Children.

OBJECTIVES: To determine if a saline-filled cuff seen at the suprasternal notch on ultrasound corresponds to correct endotracheal tube depth on a chest radiograph (tip at/below clavicle AND ≥ 1 cm above carina). DESIGN: Prospective observational study. SETTING: Tertiary Care Pediatric hospital. PATIENTS: Patients between the ages of 0-18 years requiring nonemergent cardiac catheterizations and endotracheal intubation with a cuffed endotracheal tube were included in the study. Children with anticipated or known difficult airways were excluded. INTERVENTIONS: Ultrasound evaluation of the neck following saline inflation of the endotracheal tube cuff. MEASUREMENTS AND MAIN RESULTS: Ultrasonography of the patient's neck was performed following intubation by a pediatric anesthesiologist. A linear probe was used in transverse axis to identify the saline-filled cuff starting at the suprasternal notch and moving cephalad. A cine-fluoroscopic image, similar to a chest radiograph, was obtained to ascertain the endotracheal tube depth after the cuff was identified sonographically. Endotracheal tube cuffs seen on ultrasound at the suprasternal notch were compared with the endotracheal tube depth on the cine-fluoroscopic image. A total of 75 children were enrolled in the study. The endotracheal tube was seen sonographically at the suprasternal notch in 70 patients of which 60 had complete data (an adequate chest radiograph available for review). Patient ages ranged from 2 months to 18 years with a median age of 4 years. The median endotracheal tube tip to carina distance was 2.4 cm (interquartile range, 1.75-3.3 cm.) The endotracheal tube tip to carina distance was greater than or equal to 1 cm in 57 out of the 60 patients. Endotracheal tube cuff at the suprasternal notch on ultrasound corresponded with correct endotracheal tube depth on chest radiograph with an accuracy of 95% (CI, 86-98%). CONCLUSIONS: Visualization of the cuff at the suprasternal notch by ultrasound demonstrates potential as a means of confirming correct depth of the endotracheal tube following endotracheal intubation.

Utilizing emergency departments for pre-exposure prophylaxis (PrEP).

HIV incidence and prevalence rates in emergency departments (EDs) around the nation warrant strategies to protect and sustain the HIV negative status of persons who are at risk for HIV. The ED provides a rare opportunity to serve as a vehicle for connecting pre-exposure prophylaxis (PrEP)-eligible patients with clinical settings such as an ED that are knowledgeable and well informed about PrEP. PrEP has established efficacy at preventing HIV acquisition. The greatest challenge is access to PrEP and uptake thereof among vulnerable populations. We propose recommendations to improve the functionality of EDs as access points for PrEP referrals as an HIV prevention strategy to increase PrEP availability and uptake.