Uptake and Discontinuation of Pre-Exposure Prophylaxis Among Uninsured Transgender and Cisgender Women: A Public-Private Partnership Model in North Carolina.

HIV pre-exposure prophylaxis (PrEP) remains underutilized among cis and trans women. The PrEP Initiative Program (PIP) is a novel public-private partnership implemented at 12 local clinics in North Carolina. PIP provides HIV/sexually transmitted infection (STI) testing and clinical and laboratory monitoring for PrEP to uninsured/underinsured clients. We sought to understand service-related differences among both cis and trans women enrolled in PIP, including STIs diagnoses, clinic type, sources of referral, services needed, and reasons for PrEP discontinuation. The Kaplan-Meier curves display retention on PrEP over the duration of the program. Since 2018, 142 women (cis n = 113; trans n = 29) enrolled, and 136 started PrEP. The majority were ages 25-34 years (31.7%) or 18-24 years (29.6%), Black (57.8%) or Latinx (24.7%). Approximately 20.6% of recipients reported at least one STI while enrolled. Overall, trans women requested fewer services than cis women. After accounting for the amount of time each patient was taking PrEP, there were higher rates of trans women diagnosed with syphilis than cis women. Rates of persons with other STIs were not notably different between trans and cis women. Clinic access varied by gender: 69% of trans women were enrolled at only one site. Trans women were retained significantly longer: The Kaplan-Meier adjusted median time to discontinuation was 560 and 238 days for trans and cis women, respectively. PIP successfully reached historically marginalized and uninsured cis and trans women who may benefit from PrEP. Further investigations into factors contributing to recruitment and retention of women in HIV prevention programs are needed.

A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression.

BACKGROUND: Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE: The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING: Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS: We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS: Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS: Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.

The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement.

OBJECTIVE: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs. METHODS: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions. RESULTS: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event. DISCUSSION: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.

Chilean Health Care Providers' Perceived Comfort in Performing Oral Rapid Testing for HIV: A Cross-Sectional Study.

OBJECTIVES: To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing. DESIGN: One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results. RESULTS: Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort. CONCLUSIONS: Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.

Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle.

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven's (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners' work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

The Association Between Preconception Care Receipt and the Timeliness and Adequacy of Prenatal Care: An Examination of Multistate Data from Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011.

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.

Predictors of readiness for oral rapid HIV testing by Chilean health care providers / Factores predictivos de la disposición de los prestadores de atención de salud de Chile a realizar la prueba oral rápida de detección del VIH

Objective. This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence- based practice (EBP). Methods. Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results. Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion. The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.

Objetivo. En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos. Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados. El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones. Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.

Predictors of readiness for oral rapid HIV testing by Chilean health care providers / Factores predictivos de la disposición de los prestadores de atención de salud de Chile a realizar la prueba oral rápida de detección del VIH

ABSTRACT Objective This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence-based practice (EBP). Methods Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.

RESUMEN Objetivo En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.

Wage Inequity: Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses.

The labor market perspective focuses on supply and demand for registered nurses (RNs) as employees. This perspective contrasts with beliefs in the public health sector that RNs working in local health departments (LHD) as public health nurses (PHNs) accept lower wages because of factors other than market demand. This study sought to describe the extent to which hourly wages of RNs working in LHDs are competitive with hospital RN wages within the same county market. A repeated measures survey design was used in collecting 2010 and 2014 data. The unit of analysis was the county, as an RN labor market for LHDs and hospitals. Survey questions captured factors common in human resources benefits and wage packages, such as differential pay, hourly rate pay based on years of experience, components of benefit packages (eg, sick and vacation leave), and reimbursement for education. Within each county, the LHD and all hospitals constituted a "market," yielding a potential 12 markets in our study sample. Human resources representatives from each of the 12 LHDs and from all hospitals within those 12 counties were invited to participate. We conducted comparisons with survey data using t test of mean differences on mean RN wages across years of experience. On average, LHDs paid significantly less than hospitals in their markets, at all levels of RN experience, and this gap increased with RN experience in the sample markets. Salary compression was evident in 2010 and worsened for PHNs in 2014, when compared with hospital RNs. In 2014, 100% of the sample LHDs offered reimbursements for continuing education for PHNs compared with 89% of hospitals providing this benefit. This study contributes to our understanding of the human resources challenges faced by LHDs and provides evidence elucidating resources issues that need to be addressed in order to improve recruitment and retention of PHNs.