Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC).

Older persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009-2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86-11.59), and the mean multimorbidity was 4.75 (SE = 0.32). After adjusting, health literacy (OR 0.87, 95% CI 0.77-0.99) was found to be significantly associated with durable viral suppression. Adequate health literacy can help with achieving durable viral suppression. For these persons, addressing health literacy might increase their ability to access and navigate the healthcare system, thereby helping them stay engaged and maintain adherence to HIV care.

A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act.

The impact of the Affordable Care Act (ACA) on HIV care patients, aged 18-64, was evaluated in three jurisdictions with Medicaid expansion (Chicago, New York State, and Washington) and three jurisdictions without Medicaid expansion (Georgia, Texas, and Virginia) using data from the Medical Monitoring Project. Multivariate regression models were used to evaluate insurance status that was reported pre- and post-ACA; self-reported impact of ACA on HIV care was explored with descriptive statistics. The likelihood of having insurance was significantly greater post-ACA compared to pre-ACA in Chicago (aRR = 1.33, 95%CI = 1.20, 1.47), Washington (aRR = 1.15, 95%CI = 1.08, 1.22), and Virginia (aRR = 1.14, 95%CI = 1.00, 1.29). In Washington and Chicago, the likelihood of being Medicaid-insured was greater post-ACA compared to pre-ACA implementation (Chicago: aRR = 1.25, 95%CI = 1.03,1.53; Washington: aRR = 1.66 95% CI = 1.30, 2.13). No other significant differences were observed. Only a subset of HIV care patients (range: 15-35%) reported a change in insurance that would have coincided with the implementation of ACA; and within this subset, a change in medical care costs was the most commonly noted issue. In conclusion, the influence of ACA on insurance coverage and other factors affecting HIV care likely varies by jurisdiction.

Molecular detection of viral causes of encephalitis and meningitis in New York State.

The etiology of encephalitis and meningitis, serious diseases of the central nervous system (CNS), in most cases remains unknown. The importance of establishing a diagnosis however, becomes even more important as advances are made in effective therapy. Molecular methods of detection, in particular, PCR, are being used routinely and have established a place in the arsenal of tools for diagnosis of CNS infections. In this study a viral etiological agent was detected by PCR in 340 of the total 2,357 specimens from patients who exhibited symptoms of encephalitis or meningitis. The detection rate increased from 8.9% during the first year of the study to 14.8% during the second year of the study with improved methodology and an expanded panel of viral agents. Methods were enhanced by developing real-time PCR assays (some multiplexed), using increased automation, superior nucleic acid extraction, and reverse transcription (RT) methods, and incorporation of an internal extraction control. Additionally, adenovirus and human herpes virus 6 (HHV-6) were added to the original panel of 10 viruses that included enteroviruses, herpesviruses, and arboviruses. The most common viruses detected were enteroviruses (129; 5.5%), Epstein-Barr virus (EBV) (85; 3.6%), herpes simplex viruses (HSVs) 1 and 2 (67; 2.8%), and varicella zoster virus (VZV) (44; 1.9%).