Engagement in HIV Care Among New York City Transgender Women of Color: Findings from the Peer-Led, TWEET Intervention, a SPNS Trans Women of Color Initiative.

Transgender women (TW) have higher HIV prevalence rates than cisgender (i.e., non-transgender) women. However, utilization of healthcare for transgender people in the U.S. is low. As part of a multisite initiative to facilitate entry and retention in HIV care for TW of color, we compared health outcomes between participants who became Peer Leaders and those who did not. From 2013 to 2016, 163 New York City, mostly Latina, TW enrolled in the Transgender Women Engagement and Entry to Care Project (TWEET). The TWEET intervention included peer-led, group-based educational sessions called Transgender Leader-Teach Back; 39% completed Peer Leadership requirements. Comparing pre-post change by Peer Leader status, Peer Leaders had a significant decrease in viral load and significant increase in CD4 at the last HIV care visit compared to the first. In multivariable logistic regression, predictors associated with Peer Leadership included having at least some college education, being in a relationship, stable housing, receiving legal assistance for political asylum, and having two or more HIV care visits during the intervention. Findings suggest that, for trans women who have completed at least secondary school education, participating in a peer-led intervention can lead to improved HIV care engagement. Understanding which program components lead to becoming a Peer Leader, and how to better engage non-Peer Leaders, are important next steps.

First Accurate Normalization of the ß-delayed α Decay of

The ^{12}C(α,γ)^{16}O reaction plays a central role in astrophysics, but its cross section at energies relevant for astrophysical applications is only poorly constrained by laboratory data. The reduced α width, γ_{11}, of the bound 1^{-} level in ^{16}O is particularly important to determine the cross section. The magnitude of γ_{11} is determined via sub-Coulomb α-transfer reactions or the ß-delayed α decay of ^{16}N, but the latter approach is presently hampered by the lack of sufficiently precise data on the ß-decay branching ratios. Here we report improved branching ratios for the bound 1^{-} level [b_{ß,11}=(5.02±0.10)×10^{-2}] and for ß-delayed α emission [b_{ßα}=(1.59±0.06)×10^{-5}]. Our value for b_{ßα} is 33% larger than previously held, leading to a substantial increase in γ_{11}. Our revised value for γ_{11} is in good agreement with the value obtained in α-transfer studies and the weighted average of the two gives a robust and precise determination of γ_{11}, which provides significantly improved constraints on the ^{12}C(α,γ) cross section in the energy range relevant to hydrostatic He burning.

Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism.

BACKGROUND: Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders. METHOD: Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone. RESULTS: Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P<.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 1.9-24.7). CONCLUSIONS: Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.

Psychiatric illness and comorbidity among adult male jail detainees in drug treatment.

The prevalence of psychiatric disorders was examined in a sample of 204 pretrial jail detainees receiving standard drug treatment. More than half of the sample had at least one lifetime DSM-III-R axis I diagnosis, and the lifetime rates of serious mental illness were higher than reported prevalence rates for arrestees in general jail populations. Detainees with comorbid disorders were more likely than others to have more than one co-occurring psychiatric disorder, to have been arrested for property crimes, and to be dependent on alcohol, marijuana, or PCP. The findings argue for the expansion of integrated treatment services within criminal justice drug treatment settings.

Final thoughts on IMPACT: a federally funded, jail-based, drug-user-treatment program.

A federal demonstration project in the Cook County Jail, called IMPACT (Intensive Multi-phased Program of Assessment and Comprehensive Treatment), provided residential drug-user treatment to more than 3,000 inmates during its 5 years of operation between January 1991 and October 1995. In that time, much was learned about initiating and conducting a complex, intensive, longer-term drug-user-treatment program in a jail setting. This article describes IMPACT and summarizes the results of a process and an outcome evaluation of the program and a series of focus groups. Based on these studies, we recommend ways to improve the design and implementation of drug-user treatment programs in jails.

Comparison of two systems to measure the severity of illness.

Using two systems of rating inpatient severity of illness, teaching hospital patients were classified into 15 common medical DRGs. The two systems were then analyzed and compared regarding conceptual differences, ability to predict costs within DRGs, and potential future resource usage with case-mix classifications.

Isolating the impact of psychiatric consultations in the general hospital: psychiatric comorbidities and nursing intensity.

The amount of nursing services represents a substantial portion of the total cost of hospital treatment of medical/surgical patients. Patients receiving psychiatric consultations were compared to matched patients (DRG and LOS) who did not receive psychiatric services on the intensity of their nursing service needs. These two groups were then compared on the measure of nursing intensity before and after the timing of the consultation. Those who received a consultation had significantly lower intensity scores prior to seeing the psychiatrist. Although patients receiving psychiatric consultations did not show a significantly greater reduction in nursing acuity relative to their baseline levels than did the matched control patients, the amount of time the psychiatrist spent with consultation patients was positively related with the change in nursing intensity post-consultation.