Using Rapid-Cycle Change to Improve COVID-19 Vaccination Strategy in Primary Care.

During the COVID-19 pandemic, misinformation and distrust exacerbated disparities in vaccination rates by race and ethnicity throughout the United States. Primary care, public health systems, and community health centers have shifted their vaccination outreach strategies toward these disparate, unvaccinated populations. To support primary care, we developed the SAVE Sprint model for implementing rapid-cycle change to improve vaccination rates by overcoming community outreach barriers and workforce limitations. Participants were recruited for the 10-week SAVE Sprint program through partnerships with the National Association of Community Health Centers (NACHC) and the Resilient American Communities (RAC) Initiative. The majority of the participants were from community health centers. Data were evaluated during the program through progress reports and surveys, and interviews conducted three months post-intervention were recorded, coded, and analyzed. The SAVE Sprint model of rapid-cycle change exceeded participants' expectations and led to improvements in patient education and vaccination among their vulnerable populations. Participants reported building new skills and identifying strategies for targeting specific populations during a public health emergency. However, participants reported that planning for rapid-pace change and trust-building with community partners prior to a health care crisis is preferable and would make navigating an emergency easier.

Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study.

BACKGROUND: Stigma affects persons living with HIV in myriad ways, including mental health, adherence to antiretroviral therapy, and retention in care, and may manifest at inter- and intra-personal levels. Youth are particularly vulnerable; those in vulnerable groups may experience multiple stigmas. In Vietnam, new HIV infections are rising among men in young age groups. To better understand the facets of stigma experienced by young men living with HIV in Vietnam, we conducted a qualitative study with youth and clinicians. METHODS: We conducted in-depth interviews with ten youth and two clinicians in Hanoi, querying experiences of inter- and intra-personal stigma, coping strategies, and disclosure. As a framework for further research, we developed a conceptual model based on our findings and the published evidence base which portrays interactions among HIV-related stigma, coping strategies, and ART adherence, care engagement, and health outcomes. RESULTS: Common themes that emerged from interviews with youth included extensive internalized/self-stigma and perceived stigma, yet limited experienced interpersonal stigma due to non-disclosure and avoidant coping strategies. Within different types of relationships or contexts, youth used different strategies. Non-disclosure with family, friends, and workplaces/school, and avoidance of romantic relationships and health care were common. Mental health and social support appeared to be mediating factors between coping strategies and health outcomes. CONCLUSIONS: Validation of this model of mechanisms of the impact of stigma for youth will require further research with larger samples. In the meantime, public campaigns to increase public awareness related to HIV should be implemented in Vietnam. Critical support for youth and their mental health should involve approaches tailored to the individual, taking into account context and personal capacity, including adequate time to prepare psychologically for disclosure. Some strategies for safe and effective disclosure are suggested.