Missed Opportunities for HIV Testing and PrEP Education in a High-risk Population at a Safety-net Health Care System.

The U.S. Ending the HIV Epidemic initiative was launched in 2019 with the goal of reducing new HIV infections by 90% by 2030. In this retrospective chart review in 2019, we determined the incidence of HIV testing and PrEP counseling among patients without known HIV who were diagnosed with gonorrhea or chlamydia in a safety-net health care system. Our results showed that 58% of positive gonorrhea and chlamydia tests had a follow-up HIV test within 90 days and 19% of individuals testing positive for gonorrhea received PrEP education within 180 days. Initial care in an emergency department and female gender were associated with a lower likelihood of follow-up HIV testing and PrEP counseling. There are missed opportunities to offer HIV testing and PrEP education to those at risk of HIV acquisition.

Tooth loss and dental caries in community-dwelling older adults in northern Manhattan.

OBJECTIVE: To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan. BACKGROUND: The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City. MATERIALS AND METHODS: Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%). RESULTS: The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism. CONCLUSION: Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.

The problem of late ART initiation in Sub-Saharan Africa: a transient aspect of scale-up or a long-term phenomenon?

Efforts to scale-up HIV care and treatment have been successful at initiating large numbers of patients onto antiretroviral therapy (ART), although persistent challenges remain to optimizing scale-up effectiveness in both resource-rich and resource-limited settings. Among the most important are very high rates of ART initiation in the advanced stages of HIV disease, which in turn drive morbidity, mortality, and onward transmission of HIV. With a focus on sub-Saharan Africa, this review article presents a conceptual framework for a broader discussion of the persistent problem of late ART initiation, including a need for more focus on the upstream precursors (late HIV diagnosis and late enrollment into HIV care) and their determinants. Without additional research and identification of multilevel interventions that successfully promote earlier initiation of ART, the problem of late ART initiation will persist, significantly undermining the long-term impact of HIV care scale-up on reducing mortality and controlling the HIV epidemic.