Women of transgender experience and transfeminine people (WTE/TFP) are disproportionately impacted by HIV. Between July 2023 and May 2024, a total of 2059 eligible WTE/TFP across nine project areas participated in the National HIV Behavioral Surveillance (NHBS-Trans) project. Among the 1993 participants with valid HIV test results, 35.7
IntroductionIn Philadelphia there are racial disparities in health outcomes during the perinatal period, such that Black infants and their parents experience a disproportionately higher burden of poor outcomes compared to their White counterparts. These excess risks are driven at least in part by high rates of poverty and other manifestations of structural racism. The provision of guaranteed income (GI) or unconditional cash payments during and after pregnancy, is a bold and evidence-based approach to advancing equity in financial security and health. The objective of this protocol paper is to describe the community-centered approach to the design of (a) the Philly Joy Bank (PJB), a perinatal GI program in Philadelphia, and (b) the evaluation of PJB’s impact.MethodsPJB was conceived by an established coalition of community partners through a collective impact model. Decisions related to the design and implementation of PJB are made through a consensus building process that centers the voices of Lived Experience Experts (i.e., Black birthing people in Philadelphia). Congruent with the community-driven design of PJB, the evaluation of the impact of PJB is grounded in the principles of community-based participatory research and is co-designed by the community.ResultsThe study purpose is to assess the feasibility and acceptability of PJB (Aim 1); to examine whether and how GI affects ability to meet basic needs and parental stress (Aim 2); and to explore the impact of PJB on parental mental health and the preliminary impact on infant prematurity (low birthweight and preterm birth) (Aim 3). Descriptive statistics, mixed effects regression analyses, and participatory qualitative analysis approaches will be used to achieve study aims.DiscussionGI is a promising upstream structural intervention to address persistent health inequities during the perinatal period: a critical period of the life course. Understanding if and how GI improves health for birthing people and their infants can inform implementation and policy to advance health equity.
Background: Antibiotics are among the most frequently prescribed medications in skilled nursing facilities (SNFs), yet an estimated 40-75% of these prescriptions may be inappropriate or unnecessary. Vulnerability of SNF residents to antibiotic resistance, C. difficile, and adverse drug events make antibiotic stewardship programs (ASPs) crucial in these settings. Pharmacists are central to the success of ASPs, yet the scope of their responsibilities within Philadelphia SNFs is not known. Our team designed a survey to evaluate how consultant pharmacists are embedded in SNF ASPs, barriers to providing AS services, and interest in receiving further education. Methods: We designed a REDCap survey using the CDC Core Elements for AS in Nursing Homes and the Centers for Medicare & Medicaid Services’ Revised Long-Term Care Surveyor Guidance, which included facility-specific questions for each SNF served, as well as general questions. The survey was disseminated through a multi-modal approach to consultant pharmacists (n=26) identified through previous program activities and all Philadelphia SNFs (n=46) via email, phone, and collaborative meetings. Responses were summarized using descriptive statistics. Results: Fourteen pharmacists completed the survey, covering 23/46 (50%) Philadelphia SNFs. Eight pharmacists (57%) reported providing consulting services to <1 SNF in Philadelphia. Six pharmacists (43%) reported having formal training in AS or infectious diseases, and five (36%) served as the lead or co-lead of ASPs, covering 9/23 SNFs (39%). In 83% of SNFs, pharmacists were contracted to provide AS services for <5 hours per week. Limited contracted hours to perform AS activities was the most common consultant-related barrier to providing AS services, reported by 50% of pharmacists. The most commonly reported facility-related barriers were high rate of staff turnover (36%) and staff time constraints (29%). Pharmacists reported supporting a penicillin allergy delabeling program in 17% of SNFs and reported using antibiotic timeouts to assess antibiotic use in 13% of SNFs. Among the 79% of pharmacists interested in receiving further AS education, priority topics were building engagement and collaboration among staff, residents, and leadership (50%), clinical patient care (43%), and tracking, analyzing, and reporting AS metrics (30%). Conclusion: Health departments have an opportunity to enhance AS services delivered by SNF consultant pharmacists through educational outreach. Our survey identified penicillin allergy delabeling, initiating antibiotic timeouts, and AS metric reporting as priority topics. Systemic barriers, such as limited time for AS activities and staff turnover, were frequently reported. Addressing these barriers will be essential to enable sustained improvements in SNF ASPs.
Background:Hepatitis C virus (HCV) coinfection is associated with poor health outcomes for persons with human immunodeficiency virus (HIV). Although higher HIV viral suppression rates have been reported among people with HIV who participate in Ryan White services, studies have not assessed effects on HCV coinfection. Methods:We used Philadelphia's routine HIV and hepatitis surveillance data to identify new HIV diagnoses during November 2018-October 2021 in a retrospective cohort analysis. We plotted Kaplan-Meier curves and performed Cox regressions to understand effects of HCV coinfection and receipt of Ryan White support services on time to reach HIV viral suppression, adjusting for linkage to HIV care, retention in HIV care, race and ethnicity, gender, age at time of HIV diagnosis, and injection drug use history. Results:Kaplan-Meier plots revealed that median time to HIV viral suppression was shorter among persons with HIV monoinfection, compared with HIV and HCV coinfection (80 days vs 235 days; P < .001). When adjusted for covariates, persons with HCV coinfection remained less likely to reach HIV viral suppression than persons without HCV coinfection for each day of follow-up (hazard ratio, 0.53 [95% confidence interval {CI}, .39-.72]). Compared with persons who received no support services, persons who received ≥1 service weekly and persons who received ≥2 services weekly were 60% (95% CI, 27%-101%) and 117% (95% CI, 36%- 223%) more likely to achieve viral suppression, respectively, for each day of follow-up. Conclusions:Addressing social determinants of health through federally sponsored Ryan White services can improve health for persons with HIV monoinfection and HCV coinfection.
Stimulant use among men who have sex with men (MSM) can contribute to HIV risk and care challenges. Monitoring and responding to local trends are critical for Ending the HIV Epidemic (EHE) initiatives. We assessed stimulant use patterns in Baltimore, Philadelphia, and Washington, DC from 2008 to 2023 using National HIV Behavioral Surveillance data. We collected cross-sectional data in each city using venue-based sampling in 2008, 2011, 2014, 2017, and 2023. We estimated average predicted probabilities of methamphetamine, powder cocaine, and crack cocaine use, and evaluated differences in prevalence of stimulant use overall and by race/ethnicity. In DC, stimulant use was stable or declined. Methamphetamine use remained stable overall (8
