Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study.

In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16-3.89; p = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI.

Need for open data on COVID-19 vaccine uptake among pregnant people in the Caribbean: a call to action.

Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low- and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.

Las embarazadas con la enfermedad por coronavirus del 2019 (COVID-19) tienen un mayor riesgo de resultados maternos y fetales adversos que aquellas libres de la enfermedad. En el 2021, en Jamaica se notificó un gran aumento de la mortalidad materna, del cual casi la mitad fue atribuible a la COVID-19. Se ha demostrado que la vacunación contra la COVID-19 reduce tales riesgos, pero los países de ingresos bajos y medianos carecen de datos gratuitos y de carácter público, conocidos como datos abiertos, sobre la aceptación de la vacuna contra la COVID-19 por parte de las mujeres durante el embarazo. Los objetivos del presente artículo consistieron en examinar cómo los países de ingresos altos utilizan los datos abiertos para detectar las tendencias de aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo y formular estrategias de distribución de las vacunas; señalar los obstáculos que dificultan la disponibilidad de los datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe; y proponer una estrategia múltiple que permita aumentar la disponibilidad de datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe. Una estrategia múltiple para llenar este vacío de información implicaría: a) utilizar las entidades de recopilación de datos sobre inmunización materna ya existentes en el Caribe; b) adaptar las herramientas informáticas digitales para crear registros electrónicos de vacunación materna; y c) colaborar con asociados locales especializados en el análisis de datos. Facilitar el acceso a los datos abiertos sobre la aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo en el Caribe podría ofrecer beneficios considerables, tales como el establecimiento de objetivos cuantificables en materia de vacunación materna contra la COVID-19, y propiciar las deliberaciones sobre la toma de decisiones en materia de vacunación entre los prestadores de atención de salud y las embarazadas.

Gestantes com a doença pelo coronavírus 2019 (COVID-19) têm maior risco de desfechos maternos e fetais adversos em comparação com gestantes sem COVID-19. Em 2021, foi registrado um aumento acentuado da mortalidade materna na Jamaica, e quase metade era atribuível à COVID-19. Foi demonstrado que a vacinação contra a COVID-19 reduz esses riscos, mas os países de baixa e média renda não dispõem de dados gratuitos e publicamente disponíveis (os chamados dados abertos) sobre a adesão à vacina contra a COVID-19 entre gestantes. Os objetivos deste estudo foram: analisar como os países de alta renda usam dados abertos para detectar tendências na adesão à vacina contra a COVID-19 entre gestantes e desenvolver estratégias de distribuição da vacina; descrever os obstáculos para disponibilizar dados abertos sobre a vacinação materna contra a COVID-19 no Caribe; e propor uma estratégia multifacetada que aumente a disponibilidade de dados abertos sobre a vacinação materna contra a COVID-19 no Caribe. Uma estratégia multifacetada para obter dados a fim de preencher essa lacuna envolveria: (i) utilização das entidades existentes que coletam dados de imunização materna no Caribe; (ii) adaptação de ferramentas de software para estabelecer registros eletrônicos de imunização materna; e (iii) colaboração com parceiros locais especializados em análise de dados. A disponibilização de dados abertos sobre a adesão de gestantes à vacinação contra a COVID-19 no Caribe poderia oferecer benefícios substanciais, incluindo o desenvolvimento de metas mensuráveis de vacinação materna contra a COVID-19, e facilitar discussões entre profissionais de saúde e gestantes para a tomada de decisões sobre vacinas.

Need for open data on COVID-19 vaccine uptake among pregnant people in the Caribbean: a call to action / Necesidad de datos abiertos sobre la aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo en el Caribe: un llamado a la acción

[ABSTRACT]. Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.

[RESUMEN]. Las embarazadas con la enfermedad por coronavirus del 2019 (COVID-19) tienen un mayor riesgo de resultados maternos y fetales adversos que aquellas libres de la enfermedad. En el 2021, en Jamaica se notificó un gran aumento de la mortalidad materna, del cual casi la mitad fue atribuible a la COVID-19. Se ha demostrado que la vacunación contra la COVID-19 reduce tales riesgos, pero los países de ingresos bajos y medianos carecen de datos gratuitos y de carácter público, conocidos como datos abiertos, sobre la aceptación de la vacuna contra la COVID-19 por parte de las mujeres durante el embarazo. Los objetivos del presente artículo consistieron en examinar cómo los países de ingresos altos utilizan los datos abiertos para detectar las tendencias de aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo y formular estrategias de distribución de las vacunas; señalar los obstáculos que dificultan la disponibilidad de los datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe; y proponer una estrategia múltiple que permita aumentar la disponibilidad de datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe. Una estrategia múltiple para llenar este vacío de información implicaría: a) utilizar las entidades de recopilación de datos sobre inmunización materna ya existentes en el Caribe; b) adaptar las herramientas informáticas digitales para crear registros electrónicos de vacunación materna; y c) colaborar con asociados locales especializados en el análisis de datos. Facilitar el acceso a los datos abiertos sobre la aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo en el Caribe podría ofrecer beneficios considerables, tales como el establecimiento de objetivos cuantificables en materia de vacunación materna contra la COVID-19, y propiciar las deliberaciones sobre la toma de decisiones en materia de vacunación entre los prestadores de atención de salud y las embarazadas.

[RESUMO]. Gestantes com a doença pelo coronavírus 2019 (COVID-19) têm maior risco de desfechos maternos e fetais adversos em comparação com gestantes sem COVID-19. Em 2021, foi registrado um aumento acentuado da mortalidade materna na Jamaica, e quase metade era atribuível à COVID-19. Foi demonstrado que a vacinação contra a COVID-19 reduz esses riscos, mas os países de baixa e média renda não dispõem de dados gratuitos e publicamente disponíveis (os chamados dados abertos) sobre a adesão à vacina contra a COVID-19 entre gestantes. Os objetivos deste estudo foram: analisar como os países de alta renda usam dados abertos para detectar tendências na adesão à vacina contra a COVID-19 entre gestantes e desenvolver estratégias de distribuição da vacina; descrever os obstáculos para disponibilizar dados abertos sobre a vacinação materna contra a COVID-19 no Caribe; e propor uma estratégia multifacetada que aumente a disponibilidade de dados abertos sobre a vacinação materna contra a COVID-19 no Caribe. Uma estratégia multifacetada para obter dados a fim de preencher essa lacuna envolveria: (i) utilização das entidades exis- tentes que coletam dados de imunização materna no Caribe; (ii) adaptação de ferramentas de software para estabelecer registros eletrônicos de imunização materna; e (iii) colaboração com parceiros locais especial- izados em análise de dados. A disponibilização de dados abertos sobre a adesão de gestantes à vacinação contra a COVID-19 no Caribe poderia oferecer benefícios substanciais, incluindo o desenvolvimento de metas mensuráveis de vacinação materna contra a COVID-19, e facilitar discussões entre profissionais de saúde e gestantes para a tomada de decisões sobre vacinas.

Understanding Stakeholders' Perspectives to Increase COVID-19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions.

OBJECTIVE: Disparities in COVID-19 vaccine and booster uptake persist. This study aimed to obtain perspectives from community and physician stakeholders on COVID-19 vaccine and booster hesitancy and strategies to promote vaccine uptake among Black individuals with rheumatic and musculoskeletal conditions. METHODS: We invited community leaders and physicians in greater Boston and Chicago to participate in semi-structured interviews using a moderator guide developed a priori. Participants were queried about how to best address vaccine hesitancy, strategies to target high-risk populations, and factors to identify future community leaders. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using Dedoose. RESULTS: A total of 8 physicians and 12 community leaders participated in this study between November 2021 and October 2022. Qualitative analyses revealed misinformation/mixed messaging and mistrust, with subthemes including conspiracy theories, concerns regarding vaccine development and function, racism and historical injustices, and general mistrust of health care systems as the top cited reasons for COVID-19 vaccine hesitancy. Participants also shared demographic-specific differences, such as race, ethnicity, age, and gender that influenced the identified themes, with emphasis on COVID-19 vaccine access and apathy. Strategies for community-based vaccine-related information dissemination included personal storytelling with an iterative and empathetic approach, while recognizing the importance of protecting community leader well-being. CONCLUSION: To increase vaccine uptake among Black individuals with rheumatic conditions, strategies should acknowledge and respond to racial/ethnic and socioeconomic injustices that engender vaccine hesitancy. Messaging should be compassionate, individually tailored, and recognize heterogeneity in experiences and opinions. Results from these analyses will inform a planned community-based intervention in Boston and Chicago.

Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica.

Background: Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. Methods: We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Results: Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Conclusions: Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study.

BACKGROUND: Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. METHODS AND FINDINGS: We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015-2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state's population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in "percent college educated" was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher "percent Black/Latino/Indigenous" and higher "percent essential workers" had lower vaccine coverage (-0.8, 95% CI -1.3 to -0.3, p < 0.01; -5.5, 95% CI -7.3 to -3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between "median household income" and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. CONCLUSIONS: Eighteen months into MA's general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

Correlates of Homonegativity Towards Men Who Have Sex With Men Among Black Individuals in the United States.

This study aims to identify the factors that are associated with homonegativity toward men who have sex with men (MSM) within Black communities since the expansion of LGBTQ rights. A survey was completed in 2016 by a nationally representative sample of 868 Black respondents, 18-50 years old, via e-mail. Demographics, perception of same-gender sexual behaviors, religiosity, experienced racism, and contact with the carceral system (CS) were assessed. 61.6% of respondents endorsed at least one homonegative belief. Being male, residing in the South, attending religious services, receiving homonegative faith messaging, and having contact with the CS were significantly associated with homonegativity toward MSM while experiencing racism, older age, and residing in a non-metropolitan area were not. Education efforts on LGBTQ identities in Black communities should engage faith communities, extend to metropolitan and non-metropolitan areas of the South, and include younger and older adults. Programs that decrease the arrest of Black individuals may also help reduce homonegativity toward MSM.

Need for open data on COVID-19 vaccine uptake among pregnant people in the Caribbean: a call to action / Necesidad de datos abiertos sobre la aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo en el Caribe: un llamado a la acción / Necessidade de dados abertos sobre a adesão de gestantes à vacinação contra a COVID-19 no Caribe: um chamado à ação

ABSTRACT Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low- and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.

RESUMEN Las embarazadas con la enfermedad por coronavirus del 2019 (COVID-19) tienen un mayor riesgo de resultados maternos y fetales adversos que aquellas libres de la enfermedad. En el 2021, en Jamaica se notificó un gran aumento de la mortalidad materna, del cual casi la mitad fue atribuible a la COVID-19. Se ha demostrado que la vacunación contra la COVID-19 reduce tales riesgos, pero los países de ingresos bajos y medianos carecen de datos gratuitos y de carácter público, conocidos como datos abiertos, sobre la aceptación de la vacuna contra la COVID-19 por parte de las mujeres durante el embarazo. Los objetivos del presente artículo consistieron en examinar cómo los países de ingresos altos utilizan los datos abiertos para detectar las tendencias de aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo y formular estrategias de distribución de las vacunas; señalar los obstáculos que dificultan la disponibilidad de los datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe; y proponer una estrategia múltiple que permita aumentar la disponibilidad de datos abiertos sobre la vacunación materna contra la COVID-19 en el Caribe. Una estrategia múltiple para llenar este vacío de información implicaría: a) utilizar las entidades de recopilación de datos sobre inmunización materna ya existentes en el Caribe; b) adaptar las herramientas informáticas digitales para crear registros electrónicos de vacunación materna; y c) colaborar con asociados locales especializados en el análisis de datos. Facilitar el acceso a los datos abiertos sobre la aceptación de la vacuna contra la COVID-19 entre las mujeres durante el embarazo en el Caribe podría ofrecer beneficios considerables, tales como el establecimiento de objetivos cuantificables en materia de vacunación materna contra la COVID-19, y propiciar las deliberaciones sobre la toma de decisiones en materia de vacunación entre los prestadores de atención de salud y las embarazadas.

RESUMO Gestantes com a doença pelo coronavírus 2019 (COVID-19) têm maior risco de desfechos maternos e fetais adversos em comparação com gestantes sem COVID-19. Em 2021, foi registrado um aumento acentuado da mortalidade materna na Jamaica, e quase metade era atribuível à COVID-19. Foi demonstrado que a vacinação contra a COVID-19 reduz esses riscos, mas os países de baixa e média renda não dispõem de dados gratuitos e publicamente disponíveis (os chamados dados abertos) sobre a adesão à vacina contra a COVID-19 entre gestantes. Os objetivos deste estudo foram: analisar como os países de alta renda usam dados abertos para detectar tendências na adesão à vacina contra a COVID-19 entre gestantes e desenvolver estratégias de distribuição da vacina; descrever os obstáculos para disponibilizar dados abertos sobre a vacinação materna contra a COVID-19 no Caribe; e propor uma estratégia multifacetada que aumente a disponibilidade de dados abertos sobre a vacinação materna contra a COVID-19 no Caribe. Uma estratégia multifacetada para obter dados a fim de preencher essa lacuna envolveria: (i) utilização das entidades existentes que coletam dados de imunização materna no Caribe; (ii) adaptação de ferramentas de software para estabelecer registros eletrônicos de imunização materna; e (iii) colaboração com parceiros locais especializados em análise de dados. A disponibilização de dados abertos sobre a adesão de gestantes à vacinação contra a COVID-19 no Caribe poderia oferecer benefícios substanciais, incluindo o desenvolvimento de metas mensuráveis de vacinação materna contra a COVID-19, e facilitar discussões entre profissionais de saúde e gestantes para a tomada de decisões sobre vacinas.

Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

Association of culturally competent care with influenza vaccination coverage in the United States.

BACKGROUND: Cultural minority groups in the United States have lower vaccination rates or worse influenza-related outcomes. Culturally competent care, which aims to engage the social, cultural, and linguistic needs of all patients, may address some of these disparities. OBJECTIVE: We investigate how self-reported measures of culturally competent care is associated with influenza vaccination rates in the United States. METHODS: The National Health Interview Survey (NHIS) 2017 was queried for respondents asked a set of questions which assessed respondents' access to culturally competent care in the past year. The outcome of interest was self-reported receipt of the annual influenza vaccine. Sample-weighted multivariable logistic regressions estimated the adjusted odds ratios and 95 % confidence intervals (95 %CI) of influenza vaccination with response to the cultural competency survey questions as the dependent variable of interest. Subsequent marginal modeling predicted the adjusted vaccination rates among cultural minorities (racial/ethnic minorities, LGBTQ + adults, foreign-born individuals, and non-English speakers) and respondents with high-risk comorbidities for worse influenza outcomes. Models were adjusted for other known determinants of vaccination coverage. RESULTS: 20,303 sample adults were included in the analyses. There were significantly higher odds of influenza vaccination among respondents who were "always" or "most of the time" treated with respect by their providers (aOR 1.53, 95 %CI [1.23-1.90], P < 0.001), given easy-to-understand information (aOR 1.37, 95 %CI [1.19-1.58], P < 0.001), asked about their opinions or beliefs about their care (aOR 1.29, 95 %CI [1.19-1.39], P < 0.001), and seen by providers who shared or understood their culture (aOR 1.15 95 %CI [1.01-1.30], P = 0.03), compared to their counterparts who responded with "some" or "none of the time" to the same survey questions. Higher adjusted influenza vaccination rates were seen among multiple racial/ethnic groups, LGBTQ + adults, foreign-born individuals, non-English speakers, and individuals with high-risk comorbidities who reported positive responses to the cultural competency survey questions. CONCLUSIONS: We demonstrate a positive association between self-reported frequency of access to culturally competent care and receipt of the annual influenza vaccine. These findings support future efforts to evaluate vaccination outcomes among patients who receive components of culturally competent care, such as linguistically appropriate services, race-concordant healthcare workforce, and community engagement.

Acceptability of COVID-19 vaccines among Black immigrants living in the United States.

Background: Coronavirus disease 2019 (COVID-19) has disproportionately affected the Black community in the United States (U.S.). The emergency authorization of three COVID-19 vaccines in the U.S.-issued between December 2020 and February 2021-will significantly reduce hospitalizations and deaths due to COVID-19. To date, no published study on COVID-19 vaccine acceptability among Black individuals in the U.S. has examined the unique experiences of Black immigrants. Methods: Between January and February 2021, we conducted an online quantitative survey of first and second generation Black immigrants across the U.S. (n = 388). We fit bivariate and multivariable multinomial logistic regression models to examine acceptability of the COVID-19 vaccines. Results: Overall, 57% of participants reported that they would get the COVID-19 vaccine immediately if it was available to them or had already received at least one dose of the vaccine, 37% would delay getting the vaccine, and 6% indicated that they would never get the vaccine. Compared to participants who reported that they would get the COVID-19 vaccine immediately/had already received at least one dose, participants who indicated that they would never get the vaccine were more likely to have an associate's degree or lower [adjusted odds ratio (aOR) 9.25; 95% confidence interval (CI): 2.34 to 36.6] and a bachelor's degree (aOR 3.79; 95% CI: 1.14 to 12.6) compared to having a master's degree or higher. Additionally, compared to participants who reported that they would get the COVID-19 vaccine immediately/had already received at least one dose, participants who indicated that they would delay getting the COVID-19 vaccine were more likely to: identify as female (aOR 2.62; 95% CI: 1.45 to 4.72), identify as heterosexual (aOR 4.33; 95% CI: 1.46 to 12.9), report having been employed in healthcare operations and care delivery in the previous 6 months (aOR 2.08; 95% CI: 1.02 to 4.25), and history of a laboratory-confirmed COVID-19 diagnosis (aOR 2.44; 95% CI: 1.15 to 5.19). Conclusion: Our results suggest that COVID-19 vaccine hesitancy may be high among Black immigrants in the U.S. We found that lower educational attainment, being female, and employment in healthcare setting were associated with vaccine refusal and delay. Culturally-relevant interventions are needed to ensure optimal vaccination rates among this vulnerable population.

A qualitative study of COVID-19 vaccine intentions and mistrust in Black Americans: Recommendations for vaccine dissemination and uptake.

BACKGROUND: COVID-19 vaccination rates among Black Americans have been lower than White Americans and are disproportionate to their population size and COVID-19 impact. This study examined reasons for low vaccination intentions and preferred strategies to promote COVID-19 vaccination. METHODS: Between November 2020 and March 2021, we conducted semi-structured interviews with 24 participants who expressed low vaccination intentions in a RAND American Life Panel survey; we also interviewed five stakeholders who represent organizations or subgroups in Black communities that have been highly affected by COVID-19. RESULTS: Many interviewees discussed the "wait-and-see" approach, citing that more time and evidence for vaccine side effects and efficacy are needed. Perceived barriers to COVID-19 vaccination included structural barriers to access (e.g., transportation, technology) and medical mistrust (e.g., towards the vaccines themselves, the government, healthcare providers and healthcare systems, and pharmaceutical companies) stemming from historical and contemporary systematic racism against Black communities. Interviewees also discussed strategies to promote COVID-19 vaccines, including acknowledging systemic racism as the root cause for mistrust, preferred messaging content (e.g., transparent messages about side effects), modes, and access points (e.g., a variety of medical and non-medical sites), and trusted information sources (e.g., trusted leaders, Black doctors and researchers). CONCLUSIONS: These insights can inform ways to improve initial and booster vaccination uptake as the COVID-19 pandemic progresses.

COVID-19 Vaccine Intentions and Mistrust in a National Sample of Black Americans.

BACKGROUND: National data indicate low intentions for COVID-19 vaccination among a substantial minority of Black Americans, and disproportionately lower vaccination rates among Black Americans than White Americans. METHODS: A total of 207 of the 318 Black participants (65%) in the RAND American Life Panel, a nationally representative internet panel, were surveyed about COVID-19 vaccine intentions in November-December 2020. Participants' census tracts were geocoded using the Centers for Disease Control and Prevention's Social Vulnerability Index. RESULTS: Overall, 35% agreed or strongly agreed that they would not get a COVID-19 vaccine, 40% agreed or strongly agreed that they would get vaccinated, and 25% reported "don't know." Significant multivariable predictors of not wanting to get vaccinated included high mistrust of the vaccine itself (e.g., concerns about harm and side effects), OR (95% CI) = 2.2 (1.2-3.9), p = .007, and weak subjective norms for vaccination in one's close social network, OR (95% CI) = 0.6 (0.4-0.7), p < .001. Residence in an area of higher socioeconomic vulnerability was a marginally significant predictor, OR (95% CI) = 3.1 (0.9-11.0), p = .08. CONCLUSIONS: High mistrust around COVID-19 vaccines may lower vaccine confidence. Social network members' attitudes can be influential in encouraging vaccination. Public health communications could use transparent and clear messaging on safety and efficacy, and acknowledge historical and ongoing discrimination and racism as understandable reasons for low confidence in COVID-19 vaccines. Future research is needed to consider vaccine access challenges in tandem with mistrust as contributing to low vaccination rates across health conditions.

HIV Risk-Related Behaviors and Willingness to Use Pre-Exposure Prophylaxis Among Black Americans with an Arrest History.

OBJECTIVE: Black individuals in the USA are arrested and incarcerated at a significantly higher rate than White individuals, and incarceration is associated with increased HIV vulnerability. Pre-exposure prophylaxis (PrEP) reduces the risk for HIV transmission, but little is known about the relationship between HIV risk behavior and willingness to use PrEP among Black individuals with an arrest history. METHOD: A total of 868 individuals completed a nationally representative survey and provided baseline data on sexual risk. Participants were grouped as those with a history of arrest (N = 226) and those with no history of arrest (N=619) based on self-reported arrest history. Our study examined HIV risk behaviors associated with willingness to use PrEP between those with arrest history and those without arrest history. RESULTS: Participants with an arrest history were more likely to have a lifetime history of anal sex (p<0.0001) and sexually transmitted diseases (p=0.0007). A history of multiple sexual partners in the past 3 months was associated with PrEP willingness in individuals with an arrest history [aPR 2.61 (1.77, 3.85), p<0.0001], adjusting for other covariates in the model. CONCLUSIONS: Differences in risk behavior and willingness to use PrEP exist by arrest history. Understanding these risk behaviors are necessary to increase access to PrEP. PrEP uptake and adherence interventions, when recommended and made available for individuals at substantive risk of HIV infection at the time of arrest and during incarceration, are essential to reducing the spread of HIV in correctional facilities and in communities to which they return.

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural- and policy-level options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.

Association Between HIV Testing and HIV-Related Risk Behaviors Among US and Non-US Born Black Individuals Living in the US: Results From the National Survey on HIV in the Black Community (NSHBC).

Despite improvements in HIV prevention and treatment, Black individuals continue to be disproportionately affected by the HIV epidemic in the US. Using data from the National Survey on HIV in the Black Community, we examined the differences in demographic characteristics, risk behaviors, and HIV testing between US and non-US born Black adults. 868 individuals completed the survey and provided baseline data on sexual risk. Participants were grouped as US-born (N = 763) and non-US born (N = 101) based on self-reported place of birth. Amongst US-born participants, males were less likely to test for HIV, whereas those who reported a lifetime history of anal sex and sexually transmitted infections (STIs) were more likely to test for HIV. Non-US born participants who reported a single marital status were less likely to test for HIV, whereas those who reported a lifetime history of STIs were more likely to test for HIV. Some differences in predictors of HIV testing exist by place of birth. Understanding these differences is needed to develop HIV/AIDS prevention and treatment programs for US and non-US born Black individuals.

The transient effect of a peer support intervention to improve adherence among adolescents and young adults failing antiretroviral therapy in Harare, Zimbabwe: a randomized control trial.

BACKGROUND: Adolescents and young adults living with HIV in sub Saharan Africa are at high risk of poor adherence to antiretroviral therapy (ART) and virologic failure (VF). METHODS: We conducted a randomized control trial among adolescents and young adults on ART with VF to assess the effectiveness of a community-based peer support intervention aimed at improving VF. Viral load (VL) levels were obtained at 12, 24 and 36 weeks. A subset of the participants had baseline HIV drug resistance (HIVDR) genotyped using Sanger sequencing. RESULTS: The participants' median (interquartile range (IQR)) age was 18.1 (IQR: 15.1-20.0) years and half (50.5%, n = 107) were male. At week 24, the proportion of subjects with a detectable viremia was significantly lower in the intervention arm than in the standard of care (SOC) arm (76.0% (n = 79) vs. 89.0% (n = 96), p = 0.013). At Week 36, there remained a difference in the proportion of subjects with a detectable VL between the intervention arm (68.3%, n = 71) and SOC arm (79.6%, n = 86), which was trending towards statistical significance (p = 0.059). There was no difference in the probability of having a detectable VL over time between the intervention and SOC groups (adjusted odds ratio: 1.14, p = 0.439). Baseline HIVDR was observed in 44.0% of the participants in the intervention and 56.0% in the SOC group (p = 0.146). CONCLUSION: A transient effect of the peer support intervention in improving VF was observed among adolescents and young people failing ART. TRIAL REGISTRATION: This study is registered with www.clinicaltrials.gov under the reference number: NCT02833441.

Neighborhood Social Cohesion and Inequalities in COVID-19 Diagnosis Rates by Area-Level Black/African American Racial Composition.

Geographic inequalities in COVID-19 diagnosis are now well documented. However, we do not sufficiently know whether inequalities are related to social characteristics of communities, such as collective engagement. We tested whether neighborhood social cohesion is associated with inequalities in COVID-19 diagnosis rate and the extent the association varies across neighborhood racial composition. We calculated COVID-19 diagnosis rates in Philadelphia, PA, per 10,000 general population across 46 ZIP codes, as of April 2020. Social cohesion measures were from the Southeastern Pennsylvania Household Health Survey, 2018. We estimated Poisson regressions to quantify associations between social cohesion and COVID-19 diagnosis rate, testing a multiplicative interaction with Black racial composition in the neighborhood, which we operationalize via a binary indicator of ZIP codes above vs. below the city-wide average (41%) Black population. Two social cohesion indicators were significantly associated with COVID-19 diagnosis. Associations varied across Black neighborhood racial composition (p <0.05 for the interaction test). In ZIP codes with ≥41% of Black people, higher collective engagement was associated with an 18% higher COVID-19 diagnosis rate (IRR=1.18, 95%CI=1.11, 1.26). In contrast, areas with <41% of Black people, higher engagement was associated with a 26% lower diagnosis rate (IRR=0.74, 95%CI=0.67, 0.82). Neighborhood social cohesion is associated with both higher and lower COVID-19 diagnosis rates, and the extent of associations varies across Black neighborhood racial composition. We recommend some strategies for reducing inequalities based on the segmentation model within the social cohesion and public health intervention framework.