Expanding Hepatitis C Virus Treatment in the New Mexico State Prison System: Using the ECHO Model for Provider and Prison Peer Education.

It is critical to address hepatitis C virus (HCV) in carceral settings to achieve worldwide elimination of the virus. We describe New Mexico's (NM) experience expanding HCV treatment in state prisons, supplemented with Project ECHO (ECHO; virtual mentorship through guided practice) and the NM Peer Education Program (NMPEP). We describe how using these programs may be a model for expanding treatment in prisons globally. ECHO, NM Corrections Department (NMCD) and Wexford Health Services (WHS) collaborate to treat HCV in state prisons and increase HCV knowledge among incarcerated persons using NMPEP. Each person arriving in prison is tested for HCV and those with active infection receive baseline labs, which are reviewed. Patients not meeting criteria for simplified treatment are presented to ECHO for expert guidance. Otherwise, patients are treated by WHS without consultation. NMPEP provides patient-to-patient education in prisons, addressing HCV myths and exploring treatment refusals. From December 2020 to June 2023, 3603 people had HCV viremia. In this study, 1685 people started treatment: 1280 were treated using the simplified algorithm and 405 were presented to ECHO. Of the 988 people who completed treatment and had sustained virologic response (SVR) labs drawn, 89.2% achieved SVR (i.e., cure). Most of the 107 people who did not achieve SVR had presumed reinfection. NMPEP trained 148 peer educators who educated 3832 peers about HCV prevention and treatment. HCV treatment in prisons can be expanded by implementing simplified treatment algorithms, use of the ECHO model for patients with advanced disease and peer education.

Childhood dietary quality predicts adult facial fluctuating asymmetry in contemporary New Mexicans.

Fluctuating asymmetry (FA) in adults is thought to reflect specific types of developmental stress. If true, adult FA may be a proxy for developmental stress in past as well as current populations. To date, studies of the link between development and adult FA have produced ambiguous results due to insufficient measurement data for childhood environments. This study seeks to overcome this limitation using a structural equation modeling approach to evaluate the relationship between 29 measures of developmental environments and precise measures of adult FA. Sociodemographic information and 3D facial photographs were collected from 80 adult New Mexicans. Facial FA was measured from the photographs using geometric morphometric analysis of 12 facial landmarks. Each participant responded to a questionnaire addressing the developmental environment, including childhood home environment, family SES, health, and dietary quality. We used structural equation models to examine predictive relationships between latent variables constructed from questionnaire responses and adult facial FA. Childhood dietary quality was negatively associated with adult FA scores, meaning that poorer diets predict higher FA (standardized path coefficient -0.174, p = 0.039). Factors that loaded positively on the dietary quality construct were a diet quality index, the frequency of homemade meals, and the frequency of homemade breakfast, while the frequency of fast-food meals loaded negatively. No other latent variable predicted adult facial FA. We posit that the negative relationship between dietary quality and FA reflects a negative energy balance experienced during development. Insufficient nutrition results in a reduced capacity to buffer against environmental perturbations, with increased FA as evidence. Given previously established links between FA and adult health outcomes in humans, this finding also underscores the importance of dietary quality during development for ensuring health and wellbeing later in life. These results indicate that FA in facial shape may signal the relative quality of dietary conditions during development.

First Responder Resiliency ECHO: Innovative Telementoring during the COVID-19 Pandemic.

The First Responder ECHO (Extension for Community Outcomes) program was established in 2019 to provide education for first responders on self-care techniques and resiliency while establishing a community of practice to alleviate the enormous stress due to trauma and substance misuse in the community. When the SARS-CoV-2 (COVID-19) pandemic hit the United States (US) in March 2020, a tremendous strain was placed on first responders and healthcare workers, resulting in a program expansion to include stress mitigation strategies. From 31 March 2020, through 31 December 2020, 1530 unique first responders and frontline clinicians participated in the newly expanded First Responder Resiliency (FRR) ECHO. The robust curriculum included: psychological first aid, critical incident debriefing, moral distress, crisis management strategies, and self-care skills. Survey and focus group results demonstrated that, while overall stress levels did not decline, participants felt more confident using psychological first aid, managing and recognizing colleagues who needed mental health assistance, and taking time for self-care. Although first responders still face a higher level of stress as a result of their occupation, this FRR ECHO program improves stress management skills while providing weekly learning-listening sessions, social support, and a community of practice for all first responders.

The project ECHO first responder resiliency program: curriculum development, listening groups and lessons learned to support providers virtually during a pandemic.

The First Responder (FR) Resilience ECHO Program continues as a virtual telementoring platform supporting FRs both within New Mexico and internationally. The program began initially to support FRs through the opioid epidemic, and as the COVID-19 pandemic grew, the curriculum and audience broadened to include self-care and resilience skills to participants around the world. The notion of a FR was changed as providers everywhere were facing new challenges in their front-facing experience, whether this be a sense of overwhelm, an experience of detachment or of overload. The curriculum was altered with ongoing input from participants to address the needs of those working to help others during the COVID-19 pandemic, and included didactics in psychological first aid, self-care and resilience, peak performance skills, communication methods, diagnostic and systems descriptions, as well as the development of effective peer support programs around the nation. Perhaps the most important innovation was the development of listening groups, where participants could connect with one another in breakout rooms (15-20 min) to witness one another's account of their current situation. Project ECHO is a well-established and renowned telementoring program that assists clinicians in the treatment of disease through the demonopolization of knowledge. The FR Resiliency ECHO Program grew out of the core ECHO model to assist FRs in developing skills to work with various crises that our society currently faces, in particular, the opioid epidemic and later, the COVID-19 pandemic. The project created a unique online experience and curriculum to facilitate both skill development and a sense of ongoing connection to a community of peers. This article describes the curriculum, the development of the listening group experience, and the feedback received from participants through focus groups.

Innovative COVID-19 Programs to Rapidly Serve New Mexico : Project ECHO.

Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico is a telementoring program that uses videoconferencing technology to connect health care providers in underserved communities with subject matter experts. In March 2020, Project ECHO created 10 coronavirus disease 2019 (COVID-19) telementoring programs to meet the public health needs of clinicians and teachers living in underserved rural and urban regions of New Mexico. The newly created COVID-19 programs include 7 weekly sessions (Community Health Worker [in English and Spanish], Critical Care, Education, First-Responder Resiliency, Infectious Disease Office Hours, and Multi-specialty) and 3 one-day special sessions. We calculated the total number of attendees, along with the range and standard deviation, per session by program. Certain programs (Critical Care, Infectious Disease Office Hours, Multi-specialty) recorded the profession of attendees when available. The Project ECHO research team collected COVID-19 infection data by county from March 11 through May 31, 2020. During that same period, 9765 health care and general education professionals participated in the COVID-19 programs, and participants from 31 of 35 (89%) counties in New Mexico attended the sessions. Our initial evaluation of these programs demonstrates that an interprofessional clinician group and teachers used the Project ECHO network to build a community of practice and social network while meeting their educational and professional needs. Because of Project ECHO's large reach, the results of the New Mexico COVID-19 response suggest that the rapid use of ECHO telementoring could be used for other urgent national public health problems.