Public Health – Seattle & King County (PHSKC) is the public health department in King County, Washington, United States. It is jointly managed by the City of Seattle and King County governments, serving approximately 2 million residents. Some of its services include King County Medic One, trans fat and menu-labeling regulation, online restaurant inspections, emergency preparedness, family planning and reproductive health services.
IntroductionResearch with Expert Advisors on Drug Use (READU) is a community-engaged research collaborative of people with lived and living experience, clinicians, and academic researchers. We sought to evaluate the challenges and rewards of the partnership model.Materials and methodsUsing the Peer Engagement Process Evaluation framework, the READU team collaborated on generating a list of focus group topics. All (n = 8) active team members participated in a focus group. Thematic analysis was used to identify key ideas.ResultsFive main themes were identified. “Collaborative Research Model” relates to the importance of a shared set of values, power dynamics, and the importance of centering community in research. “Group Dynamics” describes occasionally getting side-tracked in the work, as well as closeness among team members. “Individual Growth and Skill Development” concerns personal and intellectual development, as well as the benefits and opportunities for bi-directional training. “Institutional Structure,” encompasses the logistics of a hybrid working model and compensation issues. “Moving Forward and Future Work” involves the process of ending a research project in a positive way and envisioning future opportunities.DiscussionREADU’s partnership model is generally positive and mutually beneficial for all team members. All partners feel a sense of satisfaction and closeness, and that the relevance and impact of research is enhanced. Although some challenges have been identified, particularly related to compensation and the physical workplace, these are not intractable. The evaluation of this partnership should motivate researchers considering partnership with peer researchers and highlight practical considerations.
People who use drugs are disproportionately impacted by incarceration and face elevated overdose risk following release. Despite this heightened risk, access to evidence-based substance use disorder (SUD) treatment—particularly medications for opioid use disorder (MOUD)—remains limited. This study examined the association between past-year incarceration and SUD treatment utilization and unmet treatment demand among Washington State syringe services program (SSP) participants. Participants were surveyed across SSPs in 25 counties between October 2023 and January 2024 (N=1,661). Bivariate comparisons between respondents with and without past-year incarceration were conducted using Pearson χ2 tests. Three multivariable logistic regression models examined associations between past-year incarceration and: (1) receipt of any past-year SUD treatment, (2) receipt of MOUD, and (3) unmet SUD treatment demand (defined as inability to access requested help). Models adjusted for demographics, overdose history, housing, insurance, and past-week substance use, using cluster-robust standard errors at the SSP site level. Adjusted odds ratios and average marginal effects (AMEs) were calculated. Thirty percent (n=502) of respondents reported past-year incarceration. Compared with those without incarceration, recently incarcerated participants were younger, more likely to identify as men, and more likely to report homelessness (all p < 0.001). They also reported higher prevalence of past 3-month overdose (32
BACKGROUND:Doxycycline post-exposure prophylaxis (doxy-PEP) is a promising intervention to reduce bacterial sexually transmitted infections (STIs). We evaluated the effect of doxy-PEP on STI incidence and antimicrobial resistance in men who have sex with men and transgender women for up to 12 months of follow-up, inlcuding an open-label extension. METHODS:DoxyPEP, an open-label trial in Seattle (WA, USA) and San Francisco (CA, USA) among men who have sex with men and transgender women with at least one bacterial STI in the past year, randomly assigned participants by clinic (with computer-generated variable block sizes) 2:1 to doxy-PEP (200 mg doxycycline delayed-release tablets 24-72 h after condomless sex) or standard care. The independent endpoint adjudication committee was masked to group assignment. The primary outcome was presence of one or more bacterial STIs (Neisseria gonorrhoeae, Chlamydia trachomatis, or early syphilis) each quarter. This outcome was assessed in the modified intention-to-treat cohort, which included participants with at least one follow-up quarter (ie, ∼3 months) in their as-randomised assignment. After early termination of the randomised phase for efficacy, all participants still enrolled were offered doxy-PEP in an open-label extension (OLE). We report quarterly incidence of bacterial STIs for the as-randomised and OLE periods. Safety was assessed in all participants with any follow-up data. The trial was registered with ClinicalTrials.gov (NCT03980223) and is completed. FINDINGS:From Aug 19, 2020, to May 13, 2022, we enrolled 637 participants; 592 participants completed at least one follow-up quarter in the randomised phase (411 in the doxy-PEP group and 181 in the standard-care group) and 282 in the OLE phase (207 in the doxy-PEP group and 82 in the standard-care group). STIs were present in 129 (12·0%) of 1077 quarters in the doxy-PEP group versus 139 (30·5%) of 455 quarters in the standard-care group during the as-randomised period, showing an absolute difference of 19 percentage points and a relative risk of 0·39 (95% CI 0·31-0·49, p<0·0001). During the OLE, STIs were diagnosed in 51 (13%) of 388 quarters among those continuing doxy-PEP and 25 (17%) of 145 quarters among standard-care participants who initiated doxy-PEP. Throughout all quarters for participants on doxy-PEP, there was one grade 2 laboratory abnormality and five grade 3 adverse events that were possibly or probably related to doxy-PEP. No serious adverse events were attributed by site investigators to doxycycline. Of participants with positive gonorrhoea cultures during the study, eight (27%) of 29 taking doxy-PEP versus five (24%) of 21 not taking doxy-PEP had tetracycline resistance (minimum inhibitory concentration ≥2 μg/mL). INTERPRETATION:Doxy-PEP was effective in reducing bacterial STIs in this population of men who have sex with men and transgender women, including during an open-label extension when doxy-PEP efficacy was known. Doxy-PEP was well tolerated, highly acceptable, and with no new safety signals. FUNDING:US National Institutes of Health.
This review aims to describe the neurologic post-COVID-19 conditions (PCC, also known as “long COVID”), a complex array of diagnoses that can occur following recovery from acute COVID-19. The review also includes clinical considerations for the recognition, diagnosis and management of neurologic manifestations of PCC. Cognitive impairment (“Brain Fog”), headaches, and neuropathies are specifically reviewed.
