Evaluation of a collaborative model between managed care and affordable housing on acute care costs.

OBJECTIVES: This study evaluated a collaborative service model between the largest Medicaid managed care organization (MCO) in Texas, Superior HealthPlan, and the affordable housing provider Prospera Housing Community Services. STUDY DESIGN: Using a quasi-experimental 2-groups research design, we compared health care outcomes and costs between a sample of 104 participants served by the Prospera+Superior collaborative model and a group of 104 participants who had health care coverage through the Superior HealthPlan Medicaid MCO but did not live at Prospera properties (ie, Superior-only group). METHODS: Data from medical claims were analyzed to examine change in outcomes 12 months before and after implementation of the Prospera+Superior collaborative model in 2019. RESULTS: The Prospera+Superior group had a 56% lower rate of emergency department/urgent care visits and spent $2061 less in prescription costs than the Superior-only group after implementation. CONCLUSIONS: These findings provide needed evidence of the clinical and economic value of forming multisector collaborative models between MCOs and other community providers.

Acceptability of Anal Human Papillomavirus Home Self-Sampling and Clinician Sampling Among Sexual and Gender Minority Individuals in Milwaukee, Wisconsin: The Prevent Anal Cancer Self-Swab Study.

Purpose: Anal cancer has disproportionately high incidence among sexual minority men. We compared acceptability of home versus clinic human papillomavirus (HPV) anal swabbing. Methods: The Prevent Anal Cancer Self-Swab Study recruited sexual and gender minority individuals in Milwaukee, Wisconsin. Eligible participants were randomized to a home or clinic arm. Home participants received a mailed anal HPV self-sampling kit. Clinic participants attended a clinic appointment where a clinician collected an anal HPV swab. We examined acceptability (overall thoughts, comfort with method, pain, and future willingness to swab) of home versus clinic swabbing using postswab survey responses. Results: A total of 191 individuals completed swabbing and a postswab survey (home = 53.4%, clinic = 46.6%). Mean age was 47 years (range = 25-78). Reported overall thoughts about home (71.6%) and clinic (69.7%) swabbing were mostly positive (p = 0.83). Overall thoughts about the home kit did not differ by participant characteristics, but overall thoughts about clinician swabbing differed by race (p = 0.04) and HIV status (p = 0.002). Nearly all participants (98.4%) reported they were comfortable receiving the kit or getting the swabbing in the clinic, reported little or no pain (98.4%), and reported willingness to undergo swabbing in the future (97.9%). After swabbing, clinic participants reported greater trust that swabbing can give accurate information about anal cancer risk (89.9%) than home participants (69.6%) (p < 0.001), and that swabbing will help them avoid anal cancer (clinic = 79.8%, home = 59.8%) (p = 0.01). Conclusion: Anal swabbing acceptability was high and did not differ between home and clinic. Participants reported high confidence and knowledge using the mailed anal self-sampling kit. Clinical Trial Registration number is NCT03489707.

The impact of body mass index and physical disability on home-based anal self-sampling.

PURPOSE: Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. METHODS: We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n = 120) or clinic (n = 120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilized data from participants who used the at-home kit and completed a baseline clinic visit and post-swab survey (n = 82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. RESULTS: Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR = 1.10, 95% CI 1.003-1.20, p = 0.04) and swab positioning (aOR = 1.11, 95% CI 1.02-1.20, p = 0.01). Although not significant, participants who said body positioning was difficult had 2.79 higher odds of having a physical disability. Specimen adequacy did not differ by BMI category (p = 0.76) or physical disability (p = 0.88). CONCLUSION: Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.

Concordance of Human Papillomavirus Genotypes in Mailed Home-Based Self-Collected Versus Clinician-Collected Anal Swabs Among Sexual and Gender Minority Individuals.

BACKGROUND: Home-based self-sampling may be a viable option for anal cancer screening among sexual minority men (SMM). Yet limited research has compared home-based self-collected with clinician-collected anal swabs for human papillomavirus (HPV) genotyping. METHODS: The Prevent Anal Cancer Self-Swab Study recruited SMM and transgender persons 25 years and over in Milwaukee, WI to participate in an anal cancer screening study. Participants were randomized to a home or clinic arm. Home-based participants were mailed an anal self-sampling kit to complete and return via postal mail. They were also asked to attend a clinic appointment where a clinician collected an anal swab. Swabs were HPV-genotyped using the SPF 10 -LiPA 25 assay. We analyzed 79 paired self and clinician swabs to determine HPV prevalence, percent agreement, and sensitivity and specificity of the mailed home-based anal self-swab to detect HPV genotypes using the clinician-collected swab as the reference. RESULTS: The median number of days between the home and clinic swab was 19 days (range = 2 to 70). Human papillomavirus was detected in 73.3% of self and 75.0% of clinician anal swabs ( P = 0.99). Prevalence of any HPV, any high-risk HPV, any low-risk HPV, and individual HPV types did not significantly differ between self and clinician anal swabs. Agreement between self and clinician swabs was over 90% for 21 of the 25 HPV genotypes. Mailed home-based self-collected swabs had a sensitivity of 94.1% (95% confidence interval, 82.9-99.0) for detection of high-risk HPV versus clinician-collected sampling. CONCLUSIONS: Mailed home-based self-collected and clinician-collected anal swabs demonstrated high concordance for HPV genotyping.

Health-related quality of life and recovery capital among recovery residents taking medication for opioid use disorder in Texas.

Background: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL. Methods: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted using T-, Chi-squared, and Fisher's exact tests. Results: Most participants were 35 years/older (50.7%), male (58.9%), non-Hispanic White (68.4%), heterosexual (82.8%), and reported HRQOL problems, mainly anxiety/depression (78.4%) and pain/discomfort (55.7%). Participants who were 35 years/older [mean (SD) = 42.6 (7.3)] were more likely to report mobility and pain/discomfort problems than younger participants. Female participants were more likely to report pain/discomfort problems than male participants. Sexual minorities were more likely to report anxiety/depression problems than heterosexual participants. Married participants and those in committed relationships were more likely to report problems conducting self-care than single/never-married participants. Comorbid conditions were associated with mobility, pain/discomfort, and usual activities problems. Most participants reported high social (65.4%), personal (69.0%), and total (65.6%) RC. Low personal RC was associated with mobility (aOR = 0.43, CI = 0.24-0.76), self-care (aOR = 0.13, CI = 0.04-0.41), usual activities (aOR = 0.25, CI = 0.11-0.57), pain/discomfort (aOR = 0.37, CI = 0.20-0.68), and anxiety/depression (aOR = 0.33, CI = 0.15-0.73) problems. Low total RC was associated with problems conducting self-care (aOR = 0.20, CI = 0.07-0.60), usual activities (aOR = 0.43, CI = 0.22-0.83), pain/discomfort problems (aOR = 0.55, CI = 0.34-0.90), and anxiety/depression (aOR = 0.20, CI = 0.10-0.41) problems. Social RC was not associated with HRQOL. Conclusion: Personal and total RC and comorbid conditions predict HRQOL. Although the opioid crisis and the increasing prevalence of comorbidities have been described as epidemics, they are currently being addressed as separate public health issues. Our findings underscore the importance of ensuring residents are provided with interprofessional care to reduce the burden of comorbidities, which can negatively impact their OUD recovery. Their RC should be routinely assessed and enhanced to support their recovery and improve HRQOL.

Sleep disturbance as a precursor to anxiety, depression, and PTSD among rural Kenyans: A cross-lagged panel analysis from a rural Kenyan interventional cohort.

Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well-being within low- or middle-income countries. This study utilised longitudinal cohort data from a community-based empowerment programme in Meru County, Kenya to assess cross-lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18-86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within-time correlations across measures, within-measure correlations across time, and sociodemographic background characteristics. The findings are consistent with research across high-income countries, underscoring the need for more contextualised research into sleep behaviours across low- and middle-income countries. The findings may inform interventions to increase mental and social well-being within Kenya.

Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas.

OBJECTIVES: Situational confidence, that is, confidence to resist substance use in high-risk situations, and recovery capital (RC) are resources that individuals can draw upon to initiate and sustain their recovery from opioid use disorder. We assessed the associations between total, social, and personal RC and situational confidence among recovery residents taking medications for opioid use disorder. METHODS: Cross-sectional associations between the Brief Situational Confidence Questionnaire and Assessment of Recovery Capital scores were assessed among participants (N = 267) enrolled in a longitudinal study in 13 recovery homes for persons taking medications for opioid use disorder in Texas using χ 2 tests and multivariable logistic regression. RESULTS: Most participants were 35 years or older (51.7%), male (59.4%), non-Hispanic White (71.5%), and unemployed (66.0%); used more than one substance (77.9%); and had higher educational levels (53.8%). The majority had high situational confidence (66.7%), social (63.7%), physical (67.0%), and total (64.8%) RC. Education (model 1: adjusted odds ratio [aOR], 1.96; confidence interval [CI], 1.13-3.40; model 2: aOR, 2.03; CI, 1.17-3.51) and social (aOR, 2.08; CI, 1.11-3.92), personal (aOR, 2.06; CI, 1.08-3.93), and total (aOR, 2.98; CI, 1.71-5.20) RC were associated with situational confidence. CONCLUSIONS: Our findings highlight the need for recovery housing operators to be trained on the relevance of RC and situational confidence to practice to improve recovery outcomes among residents with opioid use disorder. Health planners, recovery housing administrators, and policymakers should strengthen recovery residence-based services and systems to improve individual RC and situational confidence.

Determining call-to-entry rate and recruitment barriers in clinical studies for community clinics serving low-income populations: a cohort study.

BACKGROUND: Recruitment for clinical studies is challenging. To overcome barriers, investigators have previously established call-to-entry rates to assist in planning. However, rates specific to low-income minority populations are needed to account for additional barriers to enrolment these individuals face. OBJECTIVE: To obtain a call-to-entry rate in a low-income uninsured Hispanic population with chronic disease. METHODS: We used data from four of our randomised clinical studies to determine the call-to-entry rate for individuals (n=1075) with or at risk for type 2 diabetes: participants needed/potential participants contacted=recruitment rate (yield). Research staff contacted potential participants to enrol in a study that evaluated 6 month diabetes programmes at community clinics from 2015 to 2020. We recorded call-to-entry rates, reasons for declining the study, show rates, and attrition. RESULTS: The call-to-entry rate was 14.5%. Forty per cent of potential participants could not be contacted, and 30.6%, 19.1%, and 5.4% responded yes, no, and maybe, respectively. No show percentages were 54% for yes and 91.4% for maybe responders. The majority (61.6%) declined due to inability to attend; reasons to decline included work (43%), eligibility (18%), transportation (10%), out of town (9%), did not think they needed the programme (7%) and other/unknown (14%). Being a physician predicted inability to reach participants (adjusted OR 2.91, 95% CI 1.73 to 4.90). Attrition was 6.8%. CONCLUSIONS: We described a call-to-entry rate and detailed recruitment data, including reasons to decline the study. This valuable information can assist investigators in study planning and overcoming enrolment barriers in low-income populations. Telehealth-based or strategies that limit transportation needs may increase participant involvement. TRIAL REGISTRATION NUMBER: NCT03394456.

Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic.

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

Addressing Training Gaps: A Competency-Based, Telehealth Training Initiative for Community Health Workers.

Background: To overcome vast variations in Community Health Worker (CHW) training, investigators for the CHW Core Consensus Project (CCCP) derived three types of CHW (Category 1, 2, 3) and established competencies for each category. However, studies are needed that implement these competencies in real-world settings. Objective: Using the six competency domains of the CCCP as a theoretical backbone, we developed and evaluated a training for Category 1 CHWs, individuals whose focus is on community outreach and advocacy. Methods: We developed five telehealth-based, bilingual (Spanish/English) training sessions and implemented them among Category 1 Latino(a) CHWs. We measured the number of CHWs who achieved ≥70% correct on a domain-based posttest, attendance, and qualitative feedback. Results: All (18/18) CHWs achieved at least 70% on the posttest (mean: 93.7%; range 73.3-100%). Training attendance was 98.9%. Using a six-point scale, CHWs reported high levels of satisfaction overall (5.72 ± 0.57/6.0), with telehealth (5.72 ± 0.58/6.0), effectiveness of teaching strategies/methods (5.89 ± 0.32/6.0), achieving training objectives (5.96 ± 0.15/6.0), knowledge improvement (5.72 ± 0.57/6.0), and interest (5.78 ± 0.43/6.0). Conclusion: We successfully developed and evaluated a bilingual training program for Category 1 CHWs to address core competency gaps. High CHW attendance reinforces the value of telehealth modalities and their potential to increase the reach for CHW training. To overcome gaps in chronic disease training, investigations are needed to address additional CHW trainings. Trial Registration: NCT04835493.

Home-based self-sampling vs clinician sampling for anal precancer screening: The Prevent Anal Cancer Self-Swab Study.

Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self-collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home-based self-collection swabbing kit or attend a clinic-based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home-arm and clinic-arm individuals returned the swab, respectively (P = .003), difference between groups, 15.0% (95% CI 5.4%-24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P = .006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P < .001). Self-collected swabs and clinician-collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self-collect swabs at home rather than attend a clinic.

The Impact of Body Mass Index and Medical Conditions on Home-based Anal Self-Sampling.

Purpose. Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. Methods. We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n=120) or clinic (n=120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilizes data from participants who used the kit and completed a baseline clinic visit and post-swab survey (n=82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. Results. Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR=1.10, 95% CI 1.003-1.20, p =.04) and swab positioning (aOR=1.11, 95% CI 1.02-1.20, p =.01). Physical disability was not significantly associated with body or swab positioning difficulty. Specimen adequacy did not differ by BMI category ( p =.76) or physical disability ( p =.88). Conclusion. Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.

The CTSA Diversity, Equity, Inclusion, and Accessibility (DEIA) Task Force's recommendations for the CTSA program consortium.

The Clinical and Translational Science Award (CTSA) Program recognizes that advancing diversity, equity, inclusion, and accessibility (DEIA) requires moving beyond statements of commitment to transformative actions. In 2021, the CTSA Program created a Task Force (TF) to initiate work in support of structural and transformational initiatives that advance DEIA for the consortium and its individual hubs. We describe the process of forming the expertise-driven (DEIA) TF and our activities to date. We 1) developed and adopted the DEIA Learning Systems Framework to guide our approach; 2) defined a set of recommendations across four focus areas (Institutional; Programmatic; Community-Centered; and Social, Cultural, Environmental); and 3) designed and disseminated a survey to capture the CTSA Program's baseline demographic, community, infrastructural, and leadership diversity. The CTSA Consortium also elevated the TF to a standing Committee to extend our understanding, development, and implementation of DEIA approaches to translational and clinical science. These initial steps provide a foundation for collectively fostering environment that support DEIA across the research continuum.

Medical Care Needs of Laundromat Users in San Antonio, Texas: A Potentially Unique Setting for Health Interventions.

Innovative community-based public-private partnerships are forming to address health needs of underserved communities. This study partnered with laundromats in San Antonio, Texas to understand the health and healthcare needs of laundromat users as a possible underserved population. A total of 193 laundromat users across eight laundromats participated in a survey based on the Texas Behavioral Risk Factor Surveillance System (BRFSS) that asked about health status, access to care, vaccinations, and use of preventive healthcare services. Responses were compared to population estimates from Bexar County and the state of Texas. Results showed that over half of the sample of laundromat users were female, racial/ethnic minorities, living at poverty level, and did not have health insurance coverage. Compared to county and state population estimates, laundromat users were significantly more likely to report poor health and physical impairment; and were less likely to have a primary care provider, to have received a routine medical checkup in the past year, and to have been tested for HIV. Laundromat users were also less likely to receive some gender-specific preventive healthcare screenings such as pap smears and mammograms for women, and prostate exams for men than county or state population estimates. In the laundromat sample, 78% expressed interest in receiving healthcare services on-site at laundromats. Together, these findings suggest laundromats may be a unique setting for healthcare intervention to reach undeserved, racial/ethnic minority communities. Pilot programs that target this setting are needed to explore this opportunity to deliver community-based public health practice.

The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study.

Background: Anal cancer disproportionately affects men who have sex with men (MSM) living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Method: MSM and trans persons 25 years and older were randomized to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA one year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results: 62.8% of 196 participants who engaged in screening attended HRA. Although not significant ( p =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.44, 95% CI 1.11 - 1.87) and lower among participants preferring versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53 - 0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) ( p =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), ( p =0.04); however, no differences in attendance by race or HIV status were observed in the home arm. Conclusions: HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.

Characteristics of Tenants Who Delayed Rent Payments during Eviction Moratoria in 2020.

This study examined the characteristics of US tenants who reported delaying rent payments during the eviction moratoria in 2020 in respond to the coronavirus disease 2019 (COVID-19) pandemic. A nationally representative sample of 3393 US tenants was assessed from May to June 2020 during a period that eviction moratoria were issued across the country. In the total sample, 22.9% of US tenants reported they delayed paying rent because of the eviction moratoria. Tenants who delayed paying rent were nearly 7 times as likely to be at risk of eviction, more than 3 times as likely to endorse recent suicidal ideation, and 1.6 times as likely to report recent illicit drug use compared to tenants who did not delay paying rent. These findings highlight the health and social needs of tenants in the aftermath of the COVID-19 pandemic.

Effect of the environment on home-based self-sampling kits for anal cancer screening.

BACKGROUND: Anal cancer incidence has increased in Western countries in recent decades and currently there are no consensus screening guidelines. Home-based self-sampling kits might facilitate screening for anal precancer/cancer but could require travel through postal mail where they may experience extreme temperatures or long transport times. OBJECTIVE: To determine the effect of the environment on specimen adequacy for HPV genotyping of a mailed home-based self-sampling anal cancer screening kit. STUDY DESIGN: The Prevent Anal Cancer (PAC) Study in Milwaukee, Wisconsin recruited men who have sex with men (MSM) and transgender persons 25 years of age and older. Participants were randomized to receive a mailed self-sampling kit or attend a clinic for screening. Kits were insulated with foam and included a device to record temperature every twenty minutes. Samples were returned via mail and underwent HPV genotyping using the SPF10-LiPA25 assay which also detected human RNase P to determine specimen adequacy by qPCR. For the first 93 kits, logistic regression assessed associations between specimen inadequacy and temperature, freeze-thaw cycle, presence of fecal matter, and number of days in an uncontrolled environment. RESULTS: Most specimens (92.5%) were adequate for HPV genotyping. Specimen inadequacy was not associated with temperature, freeze-thaw cycle, or transit time. Fecal matter was present more often in inadequate (71.4%) compared to adequate specimens (16.3%) (p = .004). CONCLUSIONS: These real-world data from mailed home-based anal self-sampling kits found that environmental conditions did not affect specimen adequacy. While over 90% of specimens were adequate, presence of fecal matter predicted specimen inadequacy.

A qualitative investigation of organizational challenges and facilitators to screening individuals experiencing homelessness for hepatitis C virus (HCV) in Houston, Texas.

BACKGROUND: Individuals experiencing homelessness may be at a disproportionately high risk for hepatitis C (HCV) because they may be more likely to engage in HCV risk behaviors. Community organizations that provide services to these vulnerable individuals can effectively screen, diagnose, and navigate them into HCV care. However, screening people experiencing homelessness for HCV at such organizations is limited by various challenges that remain understudied, including budgetary considerations and strategies to improve teamwork and communication. Accordingly, this study investigated the organizational challenges and facilitators to HCV screening of individuals experiencing homelessness as reported by homeless services providers. METHODS: Staff (N = 21) at two community organizations in Houston, Texas, completed an interviewer-administered survey and a semi-structured interview in August 2020 to assess the challenges and facilitators to screening people experiencing homelessness for HCV. Interviews were coded, and a thematic analysis was conducted to identify challenges as well as facilitators to HCV screening among individuals experiencing homelessness. RESULTS: Almost half of participants were employed in social services (42.86%; n = 9), while the remainder were employed in management/administration and health services. Barriers to HCV screening included funding, logistics, and resource-related challenges; and limited communication and collaboration around HCV screening. Facilitators to HCV screening included providing HCV education and training for all staff; and incentivizing, formalizing, and funding HCV screening. CONCLUSIONS: Community organizations can help minimize barriers to HCV screening among individuals experiencing homelessness by providing staff with training specific to HCV, client education around HCV and the screening process, and providing clients with incentives for participation, as well as by maximizing community and clinic partnerships to provide linkage to care and services to this high-risk population.

Assessing the Health Status and Needs of Informal Workers at Texas Truck Stops.

BACKGROUND: The experiences of informal workers are often characterized by homelessness, social isolation, lack of access to health care, mental illness, and substance use. The aim of this study is to conduct an assessment of the health status and needs of informal workers at truck stops. METHODS: This study took place at multiple Texas truck stops in 2017, where 25 informal male workers participated in a semi-structured interview and demographic survey. Recorded interviews were transcribed and coded, and a thematic analysis was conducted. RESULTS: The primary themes were the following: (1) substance use; (2) mental illness; (3) criminal justice involvement; (4) lack of access to health care; and (5) lack of access to transportation. CONCLUSIONS: These findings support the need for health promotion programming at truck stops. Interventions at truck stops would need to be multifaceted to address the multiple layers of disenfranchisement and marginalization.

Mental Healthcare: Experiences of Rural Women With Disabilities Following Interpersonal Violence.

Women with disabilities are at increased risk of interpersonal violence compared to women without disabilities. Little is known, however, about women with disabilities' experience accessing and participating in counseling and other mental health services during and following their victimization, particularly when living in a rural setting. This study involved qualitative interviews with 33 women with diverse disabilities who experienced interpersonal violence in rural communities. Researchers used thematic content analysis to identify three key themes from the findings: (a) experiences learning about mental health service options, (b) challenges to finding an appropriate "fit" and therapy approach, and (c) access barriers to mental health services. Participants emphasized the need for provider training specific to disability, the inclusion of people with disabilities more prominently in the mental health workforce, and the importance of advancements in accessible telemental health. We discuss implications for improving mental health services.