To assess knowledge and attitudes regarding cancer genetic testing among Black women with and without breast cancer and to identify individual-level predictors of these outcomes. Participants were 927 women who completed a questionnaire about personal and family history of cancer; prior hereditary cancer genetic testing; and cancer genetics knowledge, attitudes, and self-efficacy. Linear regression was used to examine predictors of cancer genetics knowledge, attitudes, and self-efficacy. Knowledge scores did not differ between women who had a history of breast cancer (mean, 12.5/16; SD 2.4) and those who did not (mean, 12.3; SD, 2.4). The majority of women answered most questions correctly; however, incorrect responses were common for questions about inherited cancer etiology (34

Smokers have a high prevalence of oral health issues, placing them at greater risk for dental fear and anxiety and appointment non-attendance. To our knowledge, no studies examine patient’s characteristics associated with dental fear and anxiety in smokers. We investigated the association between a constellation of factors and dental fear and anxiety in cigarette smokers to guide future intervention development. This is a secondary analysis of baseline data collected between 12/15/20 and 7/28/24 from adult dental patients who were scheduled for an appointment at one of two urban university-affiliated dental school clinics and enrolled in a trial on motivating smoking cessation (n = 424, 48.2

BACKGROUND/OBJECTIVES Little is known about the timing and risk factors for developing depression among autistic youth. We tested the hypotheses that depression incidence occurs at higher rates and younger ages in autistic vs nonautistic youth and that known depression risk factors in the general population would predict current depression among autistic youth. METHODS We used nationally representative survey data from a cross-section of United States households with children aged 0 to 17 years. We built a logistic regression model estimating the interaction between age and having autism when predicting depression. With the autistic subpopulation, we built a best-fit model of predictors for depression. RESULTS In the logistic regression model predicting depression incidence, autism, age, and other relevant covariates significantly predicted current depression; autism and age significantly interacted such that the increased rate of depression for autistic vs nonautistic youth widens as age of the children increases. We found statistically significant predictors of depression within autistic youth: female sex (adjusted odds ratio [aOR] for male relative to female youths, 0.31), multiple adverse childhood experiences (aOR, 2.94), higher frequency of being bullied (aOR, 7.94), higher intellectual ability (aOR for moderate/severe intellectual disability [ID] relative to no ID, 0.46), higher severity of anxiety symptoms (aOR, 20.24), and older age (aOR, 1.26). CONCLUSIONS Overall, autistic children displayed depression at an earlier age than nonautistic children, with a steady increase through adolescence. Depression prevention efforts are likely to be most impactful if geared toward those whose identities, life experiences, symptoms, and environments put them at higher risk depression.

INTRODUCTION:Text messaging programs are effective for smoking cessation. Unprompted, participant-initiated text messages that are unrecognized by rules-based programs (UNRs) provide real-time reactions and feedback regarding program experiences. This mixed methods study characterizes UNRs and examines their prospective relationship with treatment outcome. METHODS:This is a secondary analysis of a randomized controlled cessation induction trial with adult smokers in a 4-week text message program. UNRs were defined as participant-initiated text messages not matching pre-defined expected responses or not in answer to pre-programmed queries. UNRs were qualitatively coded (if not related to a study payment issue or question) and analyzed for associations with participant and program characteristics as well as outcomes (use of evidence-based treatments [EBTs] for cessation and 7-day point prevalence abstinence from smoking). RESULTS:Participants (n=440; mean age = 47.5, 47.4% female, 16.9% motivated to quit) sent 2,264 UNRs (1,785 met criteria for coding) and 59.8% sent > 1 UNR. Sending any UNR or any codable UNR predicted greater odds of EBT use during the 7-month study period (self-reported and objectively verified, all ORs > 1.50). Sending any codable UNR (OR = 1.91 [1.09-3.33]) or a UNR acknowledging a program-initiated text (OR = 2.00 [1.18-3.37]) predicted greater odds of self-reported smoking abstinence during the follow-up. Sending a UNR conveying updates on target behaviors predicted greater odds of biochemically verified abstinence during follow-up (OR = 3.05 [1.24-7.46]). CONCLUSIONS:UNRs may serve as markers of meaningful engagement and early indicators of subsequent behavioral outcomes in text messaging programs.

Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital. Methods: An electronic query was performed using the International Classification of Diseases, 9th Revision (ICD-9) coding to identify 740 outpatients with IBS between 1 January 2005 and 30 September 2007. Demographic data and ICD-9 coded comorbidities were extracted from electronic records. Data analysis used descriptive statistics and multiple logistic regression analyses. Results: Comorbid anxiety and depression were significantly more prevalent in female patients (A:24%, p = 0.03; D:29%, p = 0.008) compared with male patients. White female IBS patients had a higher risk for anxiety but not depression compared with non-White patients (p = 0.02). Female sex (p = 0.02), obesity (p = 0.007), and age above fifty (p = 0.02) but not race/ethnicity were significant risk factors for depression. IBS with constipation was more prevalent in female patients (p = 0.005) and in Hispanic compared with non-Hispanic patients (p = 0.03). Conclusions: Significant sex-based and racial/ethnic differences were identified related to body mass index (BMI), age, and IBS subtypes in this study. Comorbid mood disorders occurred significantly more frequently in female patients, and risk factors for comorbid depression included female sex, older age, and obesity but not race/ethnicity.

BackgroundPatient navigation is an evidence-based intervention for reducing delays in cancer care for underserved populations. There are limited economic evaluations of patient navigation in the US health care system and few have considered costs at various phases along the implementation spectrum. Having economic data, including costs and cost savings, can support sustainability of patient navigation programs. This study presents findings from a cost and activity analysis of a citywide hospital-based patient navigation program to engage women in timely breast cancer treatment post-diagnosis.MethodsThis study was conducted as part of Translating Research Into Practice (TRIP), a citywide patient navigation hybrid effectiveness-implementation research study conducted at five cancer care hospitals in Boston, Massachusetts. The authors surveyed participating patient navigators and supervisors about their tasks and level of effort over consecutive 10-day periods from 2019 to 2021. Patient navigators documented the time spent on activities in accordance with an 11-step protocol across five sites. Cost data were collected from annual fiscal year end expenditure hospital administrative databases at concurrent time frames. Descriptive analyses were used to calculate average time on tasks, cost per activity and cost per outcome. Cost savings were estimated by calculating the additional persons engaged in timely entry to treatment compared to a matched control group with respect to hospitalization and emergency room costs averted.ResultsAverage time spent per day on TRIP-specific navigation activities was approximately 3 hours (range, 0-8 hours) and the average time per patient per day was 25 minutes (n = 7 navigators). Total costs for clinical site interventions were $218,394 for startup and $392,407 for maintenance costs over the study period. A total of 223 patients were served during the intervention period with an average cost per patient of $979 for startup and $1759 for maintenance. Potential costs savings with the TRIP navigation program from averted hospitalization and emergency room visits for 63 additional patients who received timely treatment is estimated at $21,798-$30,429 and $2536-$5692 per patient, respectively, compared to treatment as usual.ConclusionsThe economic evaluation in this study provides insight into startup and implementation costs for uptake and scalability of navigation programs across a citywide system. The information may be useful for payors in reimbursing navigation activities and health systems in planning for high quality navigation programs to ensure patient-centered and timely treatment for women diagnosed with breast cancer.

BACKGROUND:Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho. METHODS:A mixed-methods study employing a single-group pre-test post-test design was conducted, guided by the RE-AIM theory. Training occurred from November 2021 to June 2022. Nurses completed the Problem-Solving Inventory (PSI) before and 3-6 months after training to measure changes in problem-solving efficacy. Quality scores were assigned to nurses' planned quality improvement projects; project implementation was assessed 3-6 months after training. In-depth interviews (IDIs) explored changes in knowledge, problem-solving efficacy, and skills. Statistical analyses utilized paired T-tests and logistic regressions using STATA 17; content analysis was conducted on IDIs using NVivo12. RESULTS:Of 300 nurses, 89 were trained (30%) in the first year. Mainly medium or high-quality scores were achieved for the project designed. However, among 79 participants, only 49.4% reported initiating their projects. Overall problem-solving efficacy improved 3-6 months after training, but the increase was not statistically significant. Nurses reported improved knowledge, confidence and communication skills, enhanced problem-solving approaches, and increased emotional maturity in solving problems. A one-unit increase in project quality score correlated with a 35.0% increase in the odds of project initiation. CONCLUSION:PSBHN demonstrated improved knowledge and minimal improvement in problem-solving efficacy among nurses 3-6 months post-training. However, application of skills gained in implementing their projects was insufficient. Still, PSBHN shows promise in addressing healthcare challenges in resource-limited settings. Some participants were able to start their projects but the inconsistency in follow-through suggests a need for more research into the factors that can improve completion of implementation for better health outcomes.

Importance:Best practices for improving access to assessment of hereditary cancer risk in primary care are lacking. Objective:To compare 2 population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offering eligible individuals genetic testing for cancer susceptibility. Design, Setting, and Participants:The EDGE (Early Detection of Genetic Risk) clinical trial cluster-randomized 12 clinics from 2 health care systems in Montana, Wyoming, and Washington state to 1 of 2 engagement approaches for assessment of hereditary cancer risk in primary care. The study population included 95 623 English-speaking patients at least 25 years old with a primary care visit during the recruitment window between April 1, 2021, and March 31, 2022. Intervention:The intervention comprised 2 risk assessment engagement approaches: (1) point of care (POC), conducted by staff immediately preceding clinical appointments, and (2) direct patient engagement (DPE), where letter and email outreach facilitated at-home completion. Patients who completed risk assessment and met prespecified criteria were offered genetic testing via a home-delivered saliva testing kit at no cost. Main Outcomes and Measures:Primary outcomes were the proportion of patients with a visit who (1) completed the risk assessment and (2) completed genetic testing. Logistic regression models were used to compare the POC and DPE approaches, allowing for overdispersion and including clinic as a design factor. An intention-to-treat analysis was used to evaluate primary outcomes. Results:Over a 12-month window, 95 623 patients had a primary care visit across the 12 clinics. Those who completed the risk assessment (n = 13 705) were predominately female (64.7%) and aged between 65 and 84 years (39.6%). The POC approach resulted in a higher proportion of patients completing risk assessment than the DPE approach (19.1% vs 8.7%; adjusted odds ratio [AOR], 2.68; 95% CI, 1.72-4.17; P < .001) but a similar proportion completing testing (1.5% vs 1.6%; AOR, 0.96; 95% CI, 0.64-1.46; P = .86). Among those eligible for testing, POC test completion was approximately half of that for the DPE approach (24.7% vs 44.7%; AOR, 0.49; 95% CI, 0.37-0.64; P < .001). The proportion of tested patients identified with an actionable pathogenic variant was significantly lower for the POC approach than the DPE approach (3.8% vs 6.6%; AOR, 0.61; 95% CI, 0.44-0.85; P = .003). Conclusions and Relevance:In this cluster randomized clinical trial of risk assessment delivery, POC engagement resulted in a higher rate of assessment of hereditary cancer risk than the DPE approach but a similar rate of genetic testing completion. Using a combination of engagement strategies may be the optimal approach for greater reach and impact. Trial Registration:ClinicalTrials.gov Identifier: NCT04746794.

Best practices for improving access to assessment of hereditary cancer risk in primary care are lacking. To compare 2 population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offering eligible individuals genetic testing for cancer susceptibility. The EDGE (Early Detection of Genetic Risk) clinical trial cluster-randomized 12 clinics from 2 health care systems in Montana, Wyoming, and Washington state to 1 of 2 engagement approaches for assessment of hereditary cancer risk in primary care. The study population included 95 623 English-speaking patients at least 25 years old with a primary care visit during the recruitment window between April 1, 2021, and March 31, 2022. The intervention comprised 2 risk assessment engagement approaches: (1) point of care (POC), conducted by staff immediately preceding clinical appointments, and (2) direct patient engagement (DPE), where letter and email outreach facilitated at-home completion. Patients who completed risk assessment and met prespecified criteria were offered genetic testing via a home-delivered saliva testing kit at no cost. Primary outcomes were the proportion of patients with a visit who (1) completed the risk assessment and (2) completed genetic testing. Logistic regression models were used to compare the POC and DPE approaches, allowing for overdispersion and including clinic as a design factor. An intention-to-treat analysis was used to evaluate primary outcomes. Over a 12-month window, 95 623 patients had a primary care visit across the 12 clinics. Those who completed the risk assessment (n = 13 705) were predominately female (64.7%) and aged between 65 and 84 years (39.6%). The POC approach resulted in a higher proportion of patients completing risk assessment than the DPE approach (19.1% vs 8.7%; adjusted odds ratio [AOR], 2.68; 95% CI, 1.72-4.17; P < .001) but a similar proportion completing testing (1.5% vs 1.6%; AOR, 0.96; 95% CI, 0.64-1.46; P = .86). Among those eligible for testing, POC test completion was approximately half of that for the DPE approach (24.7% vs 44.7%; AOR, 0.49; 95% CI, 0.37-0.64; P < .001). The proportion of tested patients identified with an actionable pathogenic variant was significantly lower for the POC approach than the DPE approach (3.8% vs 6.6%; AOR, 0.61; 95% CI, 0.44-0.85; P = .003). In this cluster randomized clinical trial of risk assessment delivery, POC engagement resulted in a higher rate of assessment of hereditary cancer risk than the DPE approach but a similar rate of genetic testing completion. Using a combination of engagement strategies may be the optimal approach for greater reach and impact. ClinicalTrials.gov Identifier: NCT04746794.

Key PointsCardiovascular-kidney-metabolic (CKM) is a global public health problem; however, its mediators remain poorly known, in part due to the lack of a reliable animal model.A combination of high fat and adenine diet recapitulate some of the CKD and metabolic phenotypes of CKM.This model also demonstrates myocardial fibrosis and peripheral artery disease with sex-based differences and can be leveraged to probe mechanisms of CKM.BackgroundCardiovascular-kidney-metabolic (CKM) syndrome is a public health problem in the United States and results in premature cardiovascular disease at a relatively preserved GFR. The molecular mediators of CKM are poorly understood, partly due to the lack of a reliable animal model. We set out to generate an animal model with renal and metabolic dysfunctions, using peripheral artery disease (PAD) as a CKM manifestation.MethodsC57BL/6 male and female mice were randomized into four groups: a normal diet (controls), a 0.2% adenine diet (AD, a CKD model), a high-fat diet (HFD, a metabolic model), and a combination of HFD+AD (a potential CKM model). The mice underwent a hind limb ischemia, followed by an array of structural, endurance, and postexercise hyperemia assays.ResultsCompared with control mice, HFD+AD male mice had 23%-50% higher weight and GFR than the AD group (P = 0.003). The kidneys of HFD+AD showed tubular atrophy, tubulointerstitial fibrosis, immune infiltration, glomerulomegaly, consistent with glomerular hyperperfusion, hypercholesterolemia, impaired glucose tolerance, and adipophilin in the liver, an early marker of hepatic steatosis, and myocardial fibrosis. The HFD+AD mice showed reductions in the hind limb perfusion ratios, microcapillary density, type 2 muscle fibers, and increased muscle fibrosis, immune infiltration, and lowest cross-sectional muscle area. Female CKM mice revealed distinct differences from male mice. Compared with AD and HFD alone, female CKM mice exposed to HFD+AD demonstrated additive phenotypes in endurance assays (distance traveled, exhaustion time, and grip strength) without a similar effect in postischemia perfusion, suggesting skeletal muscle, and microcapillary dysfunction.ConclusionsA combination of HFD+AD in mice displays features of CKD, metabolic disorders, and cardiovascular disease at a higher GFR, consistent with human CKM. This model can be explored to probe the mechanisms and heterogeneity and sex-specific differences in CKM.

Breastfeeding provides numerous benefits for mothers and infants, but there are disparities in breastfeeding rates by race and ethnicity in the United States. Our study aimed to identify the extent to which Baby Friendly Hospital Initiative (BFHI) key clinical practices during the birth hospitalization influenced breastfeeding success by race and ethnicity. This study was a secondary analysis of the 2016 to 2019 National Pregnancy Risk Assessment Measurement System (PRAMS), a cross-sectional survey. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We examined the odds of breastfeeding to ≥ 10 weeks by percent of key clinical practices received and racial and ethnic group. Absolute racial differences were calculated to reflect the difference in breastfeeding rates by race and ethnicity overall, and stratified by percent of BFHI key clinical practices received. BFHI key clinical practices were a significant predictor of breastfeeding at ≥ 10 weeks; receipt of progressively more key clinical practices resulted in higher odds of breastfeeding. Over 75% of mothers who received 100% of key clinical practices breastfed for at least 10 weeks across all racial and ethnic groups. Among mothers who received ideal breastfeeding care, disparities were eliminated; there were no statistically significant differences in rates of breastfeeding ≥ 10 weeks for Black non-Hispanic (adjusted absolute racial difference [aARD] -4.5, 95% CI [-9.5, 0.4]), Hispanic English-speaking (aARD -2.6, 95% CI [-6.6, 1.4]), or Hispanic Spanish-speaking (aARD 1.7, 95% CI [-5.2, 8.6]) mothers compared to White non-Hispanic mothers. There is a need to renew the push for universal adoption of BFHI by U.S. hospitals to address racial and ethnic disparities in breastfeeding outcomes.

OBJECTIVE:To estimate the association between pregnancy-associated death or severe maternal morbidity and infant outcomes. METHODS:We conducted a retrospective cohort study using Massachusetts statewide data from 1999 to 2021. The dataset included hospital records longitudinally linked to births and maternal and infant death records. The primary exposures were pregnancy-associated death (deaths during pregnancy or in the year postpartum), severe maternal morbidity, and pregnancy-associated death after severe maternal morbidity. The main outcomes were infant death in the first year and, for those infants who survived, hospitalization in the first year of life. Bivariate and robust Poisson regression analyses through generalized estimating equations regression were used to estimate the association between the exposures and outcomes. RESULTS:Of 1,617,054 live births in Massachusetts between 1999 and 2020, there were 474 pregnancy-associated deaths. Pregnancy-associated death ratios were highest among individuals who were aged 40 years or older (49.3/100,000), who were non-Hispanic Black (43.0/100,000), who had public insurance (51.1/100,000), or who had a parity of four or more (80.6/100,000). Among individuals experiencing severe maternal morbidity (745.3/100,000), those who had a hospital encounter associated with opioid use (721.2/100,000) or a documented prepregnancy comorbidity (200.7/100,000) had the highest pregnancy-associated death ratios. In cases of pregnancy-associated death, the infant mortality rate per 1,000 live births was 55.0 (95% CI, 34.9-75.2) compared with 4.0 (95% CI, 3.9-4.1) when the mother survived. When the pregnancy-associated death followed severe maternal morbidity, the infant mortality rate was 87.9 per 1,000 live births (95% CI, 29.7-146.1). After a pregnancy-associated death, when a full-term infant survived to 1 year of age, there was a 35% greater likelihood of rehospitalization in the first year of life (adjusted risk ratio 1.35, 95% CI, 1.01-1.82) than when the mother did not die. CONCLUSION:Pregnancy-associated death was associated with infant death and worse health of surviving children in the first year of life, further demonstrating the far-reaching consequences of maternal deaths and the clear link between maternal and infant health.

The thalamus is critical for the relay and modulation of visual information. As such, injury to the developing thalamus may result in cerebral visual impairment (CVI). This study investigated quantitative volume reductions of the thalamus in cerebral visual impairment compared to controls and probed the association between thalamic volume and the severity of cerebral visual impairment-related visual dysfunctions. Thalamic volumes were quantified using T1-weighted magnetic resonance imaging (MRI) data from 23 participants with cerebral visual impairment and 42 controls. Nineteen participants with cerebral visual impairment also completed the CVI Questionnaire. Cerebral visual impairment was associated with significant volume reductions of the global thalami, anterior, lateral, and ventral thalamic regions, as well as several nuclei, particularly in those with cerebral visual impairment due to periventricular leukomalacia. Within the cerebral visual impairment group, smaller volumes of the right thalamus and lateral pulvinar were significantly associated with more reported difficulties moving through space. Together, these results provide empirical evidence supporting aberrant thalamic development as a potential mechanism underlying cerebral visual impairment.

BACKGROUND:Black-White inequities in severe maternal morbidity in the United States are extreme and growing. Maternal safety bundles (MSBs) have been associated with closing racial equity gaps in maternal health in some states. The objective of this study was to explore clinician perspective and experiences of implementing an Equity maternal safety bundle across five hospitals in Massachusetts to address inequities in perinatal care and birth outcomes. METHODS:Focus group discussions and interviews were conducted in Fall 2022 and Fall 2023 (before and after Equity MSB implementation) among obstetric nurses, resident physicians, and attending physicians. Discussions were facilitated using a semi-structured guide developed using the Consolidated Framework for Implementation Research (CFIR). Transcripts were independently coded by two analysts using NVivo 14. A codebook was developed using CFIR for deductive coding. We added inductive codes as appropriate. We calculated Cohen's kappa coefficients to assess interrater reliability. Themes were generated through an iterative process and compared across study time points. RESULTS:Fifteen clinicians participated at each time point with similar distributions across race, ethnicity, gender, and profession. Seven themes emerged from these interviews: 1) the importance of leadership support to prioritize equity, 2) a culture of equity as a facilitator for implementation, 3) the need for improved processes for self-reported race, ethnicity, and language data collection, stratification, and dissemination, 4) staff, time, and funding as necessary resources, 5) the need for an early focus on staff education, 6) existing siloes between physicians and nurses and exclusion of trainees as barriers to implementation, and 7) differences between an Equity-MSB and other MSBs. CONCLUSIONS:Leadership prioritization of equity and a culture of equity emerged as facilitators to successful implementation of elements of the Equity MSB. Challenges identified included resistance to change among colleagues, limited resources, and clinician siloes. When compared to previously implemented MSBs, participants found that leadership made this work a priority. As future hospital teams embark on implementing equity-focused action, these known facilitators and barriers should be considered and addressed during the pre- and early-implementation phases.

This study examines changes in Baby Friendly Hospital Initiative (BFHI) key clinical practices in US hospitals during the early coronavirus disease 2019 (COVID-19) pandemic (April– December 2020) compared to before the pandemic. Using data from PRAMS (Pregnancy Risk Assessment Monitoring System) between 2016 and 2020, we conducted linear regression analyses to calculate the percentage-point change in BFHI key clinical practices overall and by race and ethnicity. A total of 73,380 new mothers were included in our analyses. Overall, receipt of ideal breastfeeding care declined during the pandemic [(pp -1.6, 95

OBJECTIVES:This study examines the associations between race and ethnicity and receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals. METHODS:National data from 2016 to 2019 CDC PRAMS were analyzed. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We conducted adjusted regression analyses to compare the odds of receiving individual key clinical practices that support breastfeeding, as well as the percent of key clinical practices received. RESULTS:While some key clinical practices were received at high rates, less than 25% of mothers received 100% of recommended key clinical practices. Compared to White non-Hispanic mothers, mothers from various racial and ethnic groups were at lower odds of receiving 100% of key clinical practices: Black non-Hispanic [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) (0.47-0.65)], English-Speaking Hispanic [AOR 0.79, 95% CI (0.71-0.88)], Spanish-speaking Hispanic [AOR 0.63, 95% CI (0.53-0.73)], and Asian/Pacific Islander non-Hispanic [AOR 0.54, 95% CI (0.47-0.63)]. CONCLUSIONS FOR PRACTICE:Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group.

Objectives. To characterize differences in outcomes of 733 Black women aged 50 years and older compared with younger women with HIV engaged in bundled interventions across 12 US sites from 2021 to 2023. Methods. We examined age differences in physical component score (PCS) and mental component score (MCS) for health-related quality of life, stigma, and viral suppression over 12 months. We examined outcome effects by age and intervention. We collected comorbidities and preventive health screenings. Results. Lower PCS was associated with each year with HIV for older women (b = −0.13; 95% confidence interval [CI] = −0.25, −0.02) and for younger women in the stigma reduction intervention (b = −3.36; 95% CI = −5.88, −0.84). Younger women in the intimate partner violence intervention demonstrated a decrease in MCS quality of life (b = −3.07; 95% CI = −5.16, −0.98). Stigma scores were increased for younger women in the Red Carpet Experience (b = 2.70; 95% CI = 0.07, 5.33) but lower for older women in the self-efficacy intervention (b = −1.41; 95% CI = −2.24, −0.57). Viral load suppression was associated with peer−patient navigation for older women (adjusted odds ratio [AOR] = 4.73; 95% CI = 1.51, 14.81) and the intimate partner violence intervention for younger women (AOR = 3.83; 95% CI = 2.15, 6.82). Health screenings were low. Conclusions. Interventions that center Black women beyond traditional HIV treatment are needed with a focus on health screenings to improve the quality of life of older women. ( Am J Public Health. 2025;115(S1):S57–S67. https://doi.org/10.2105/AJPH.2025.308021 )