A Pilot Sexual and Gender Minority Health Curriculum for the Largest Public Health Care System in the United States.

PROBLEM: Sexual and gender minority (SGM) people face multiple health disparities. Clinicians often lack adequate training to address health needs of SGM people. In this setting, some health care organizations have sought to develop system-wide curricula to build clinician knowledge and capacity around SGM health. APPROACH: NYC Health + Hospitals partnered with the National LGBTQIA+ [lesbian, gay, bisexual, transgender, queer, intersex, asexual] Health Education Center at The Fenway Institute to design and implement a novel SGM health care curriculum, offered from 2017 to 2020. The pilot program featured a 90-minute live introductory session, a pretest, a post-test, and six 45-minute online modules focusing on a range of topics in SGM health care. OUTCOMES: Of approximately 35,000 employees from a range of settings and professional roles across NYC Health + Hospitals, 792 participated in the pilot program; most were clinicians at acute care hospitals, with the single largest group being attending clinicians. The proportion of eligible employees completing each component of the curriculum varied: 544 of 792 (68.7%) completed the online pretest, while 373 of 792 (47.1%) completed the module on behavioral health. Of 373 participants who completed both the pre- and post-tests, mean scores rose significantly from 60.9 on the pretest to 81.9 on the post-test ( P < .001). NEXT STEPS: Future efforts should focus on increasing staff participation in the curriculum through scale-up efforts across the health care system, as well as measuring patient outcomes to assess the clinical impact of the initiative.

Coping With Trauma, Celebrating Life: Reinventing Patient And Staff Support During The COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the New York City Health + Hospitals system. In addition to ramping up capacity and adapting operations quickly to handle the patient surge, NYC Health + Hospitals had to find new ways to provide emotional and psychological support for patients, families, and staff. To help families keep in touch, dedicated staff members provided daily updates by telephone and used tablets for virtual visits. An expanded palliative care team held virtual consultations with families to discuss advance care planning and end-of-life decisions. Bereavement hotlines were set up for families who lost loved ones. Enhanced staff support included one-on-one and group sessions with behavioral health specialists, a behavioral health hotline, a webinar series, and respite rooms, as well as complimentary lodging and child care. NYC Health + Hospitals created new rituals to celebrate recoveries and mourn losses. As regular operations resume, NYC Health + Hospitals plans to sustain and build on emotional and psychological support initiatives developed during the surge.

High levels of pretreatment and acquired HIV drug resistance in Nicaragua: results from the first nationally representative survey, 2016.

INTRODUCTION: A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48). METHODS: A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from March to November 2016. Nineteen of 45 total ART clinics representing >90% of the national cohort of adults on ART were included. ART initiators were defined as PLHIV initiating or reinitiating first-line ART. HIVDR was assessed for protease, reverse transcriptase and integrase Sanger sequences using the Stanford HIVdb algorithm. Viral load (VL) suppression was defined as <1000 copies/mL. Results were weighted according to the survey design. RESULTS AND DISCUSSION: A total of 638 participants were enrolled (PDR: 171; ADR12: 114; ADR48: 353). The proportion of ART initiators with prior exposure to antiretrovirals (ARVs) was 12.3% (95% CI: 5.8% to 24.3%). PDR prevalence to any drug was 23.4% (95% CI: 14.4% to 35.6%), and 19.3% (95% CI: 12.2% to 29.1%) to non-nucleoside reverse transcriptase inhibitors (NNRTI). NNRTI PDR was higher in ART initiators with previous ARV exposure compared with those with no exposure (76.2% vs. 11.0%, p < 0.001). Protease inhibitors (PI) and integrase strand transfer inhibitors PDR was not observed. VL suppression rate was 77.8% (95% CI: 67.1% to 85.8%) in ADR12 and 70.3% (95% CI: 66.7% to 73.8%) in ADR48. ADR12 prevalence to any drug among PLHIV without VL suppression was 85.1% (95% CI: 66.1% to 94.4%), 82.4% to NNRTI and 70.2% to nucleoside reverse transcriptase inhibitors (NRTI). ADR48 prevalence to any drug among PLHIV without VL suppression was 75.5% (95% CI: 63.5% to 84.5 %), 70.7% to NNRTI, 59.4% to NRTI and 4.6% to PI. CONCLUSIONS: Despite implementation challenges yielding low-precision HIVDR estimates, high rates of NNRTI PDR were observed in Nicaragua, suggesting consideration of non-NNRTI-based first-line regimens for ART initiators. Strengthened HIVDR monitoring, systematic VL testing, and improved ART adherence support are also warranted.

Estudio Multicéntrico Centroamericano de Prevalencia de VIH/ITS y Comportamientos de Hombres que tiene Sexo con otros Hombres en Nicaragua (EMC) / I study Central American Multicéntrico of Prevalencia of VIH/ITS and Behaviors of Men that he/she has Gender with other Men in Nicaragua (EMC)

Aborda el Estudio Multicentrico Centroamericano de Prevalencia de VIH/ITS y Comportamiento (EMC) en Hombres que tienen sexo con otros Hombres(HSH). Se realizó en Nicaragua entre marzo y julio del 2002, con el objetivo de determinar la prevalencia de VIH e ITS, identificar características sociodemográficas determinar el nivel de conocimiento sobre el IVH e ITS, determinar patrones de comportamiento de riesgo y explorar la relación entre la prevalencia de VIH e ITS y variables sociodemográficas y de comportamiento en esta población. Se llevo a cabo en 199 hombres residentes de Managua. El 45.6 porciento participante se auto-identifica como gay/homosexual y el 33.3 porciento como bisexual; los auto/identificados como heterosexuales y los travestís representan porcentajes menores con el 11.1 porciento y el 9.4 porciento respectivamente. Mas de la mitad (57 porciento) dice haber iniciado su actividad sexual a los 14 años o antes, el promedio de edad de la primera relación sexual es de 14.5 años. Se espera que los hallazgo del estudio sean muy utiles para los gerentes y planificadores tanto del sector gubernamental como no gubernamental, que forman parte de la respuesta nacional a la epidemia del VIH y otras ITS, a fin de orientar mejor las estrategias de promoción y prevención, en fomra específica aquellas dirigidas hacia la población de HSH.