For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study (n = 251). Participants completed interviews evaluating IPV and covariates. CD4 count < 200 (CD4 < 200), detectable HIV viral load (VL), and engagement in care (''no show rate'' [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p < 0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% selfidentified as ''men who have sex with men.'' IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4 < 200 ( p = 0.005) and a detectable VL ( p = 0.04) but trended toward significance with a high NSR ( p = 0.077). Being threatened by a partner was associated with a CD4 < 200 ( p = 0.005), a detectable VL ( p = 0.011), and high NSR ( p = 0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4 < 200 ( p = 0.005) and detectable VL ( p = 0.035). Being threatened by a partner predicted having a CD4 < 200 ( p = 0.020), a detectable VL ( p = 0.007), and a high NSR ( p = 0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses.

Objective With adolescent mass casualty incidents (MCI) on the rise, out‐of‐hospital readiness is critical to optimize disaster response. We sought to test the feasibility and acceptability of a 360 Virtual Reality (360 VR) platform for disaster event decisionmaking. Methods This was a cross‐sectional observational assessment of a subject's ability to triage and perform out‐of‐hospital interventions using a 360 VR MCI module. A convenience sample of attendees was recruited over 1.5 days from the American College of Emergency Physicians (ACEP) national conference in San Diego, CA. Results Two hundred and seven (207) subjects were enrolled. Ninety‐six (46%) subjects identified as attendings, 66 (32%) as residents, 13 (6%) as medical students, 4 (2%) as emergency medical technicians and 28 (14%) as other. When comparing mean scores between groups, physicians who were <40 years old had mean scores higher than physicians who were >40 years old (8.7 vs 6.5, P < 0.001). Residents achieved higher scores than attendings (8.6 vs 7.5, P = 0.005). Based on a 5‐point Likert scale, participants felt the 360 VR experience was engaging (median = 5) and enjoyable (median = 5). Most felt that 360 VR was more immersive than mannequin‐based simulation training (median = 5). Conclusion We conclude that 360 VR is a feasible platform for assessing triage and intervention decisionmaking for adolescent MCIs. It is well received by subjects and may have a role as a training and education tool for disaster readiness. In this era of distanced learning, 360 VR is an attractive option for future immersive educational experiences.

Introduction The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient. Methods This was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31–April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials . Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences. Results All participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9–75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7–29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%. Conclusion A mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.

This pilot study demonstrates the feasibility and acceptability of using mobile media technology to deliver peer health messages. Future research should explore how to best use mobile media to improve engagement in care and reduce perceptions of stigma.

Background: Acetazolamide is the most common medication used for prevention of acute mountain sickness (AMS), usually administered the day or night before ascent. The objective of this study was to evaluate the efficacy of day of ascent dosing of acetazolamide for AMS prevention. Methods: Double-blind, randomized, controlled noninferiority trial of acetazolamide 125 mg twice daily beginning either the night before or the morning of ascent. Healthy low altitude adults ascended from 1240 m (4100 ft) to 3810 m (12,570 ft) during summer 2018 on White Mountain, California. Primary outcome was incidence of AMS with the two different dosing patterns, assessed by the 1993 Lake Louise Questionnaire (LLQ) of ‡3 with headache and a minimum of 1 for other symptom. Results: One hundred four participants completed the study, with 54 (52%) randomized to night before acetazolamide and 50 (48%) to day of ascent dosing, without differences in baseline characteristics. There was 9% greater incidence of AMS in the day of ascent acetazolamide group (48.0% vs. 39%, 95% confidence interval [CI]-11.8 to 30, p = 0.46, number needed to treat [NNT] = 5.6 vs. 3.7), with the CI just surpassing the predetermined 26% noninferiority margin. There was a lower incidence of severe AMS (1993 LLQ >5) in the day of ascent group (n = 5, 10%, NNT = 2.3) compared with night before dosing (n = 12, 22%, NNT = 3.1) (95% CI-28 to 3.6), and lower average symptom severity in the day of ascent group (3 vs. 3.5, 95% CI-0.5 to 1.4). Conclusions: Day of ascent acetazolamide demonstrated higher rates of AMS compared with traditional dosing by a small margin. With similar rates of severe AMS and overall symptom severity, the potential for improved convenience and compliance may support day of ascent use.

Many AIDS drug assistance programs (ADAPs) purchased Affordable Care Act (ACA) qualified health plans (QHPs) for low-income people living with HIV. To date, little has been written about this from the client perspective. The study's objective was to gain information about the experience of Virginia ADAP-funded QHP enrollment and the impact of this change. English-speaking clients who were eligible for ADAP-funded QHPs were recruited at three HIV clinics in Virginia. The goal was to enroll ‡5% of those who were eligible for ADAP-funded QHPs in two Virginia Department of Health planning districts. Participants were surveyed about demographic characteristics, and semi-structured interviews were performed. Descriptive analyses were performed for cohort characteristics. Using an open coding strategy, codebooks were generated for the interviews and themes were identified. The cohort (n = 53) met our recruitment goal. Two-thirds gained their ACA knowledge at HIV clinics from case managers and social workers. Many barriers to enrollment were identified, including internet access/literacy. Almost 9 out of 10 participants had concerns about privacy, which centered on QHP's mandated use of mail-order pharmacies. Except for medication concerns, most participants had positive perceptions of the impact of QHP enrollment on their health care. HIV clinic case managers and social workers are often the primary source of knowledge for patients about insurance options and their assistance is crucial for QHP enrollment. Our findings indicate that reducing identified barriers and addressing privacy concerns by allowing people to opt out of mail order pharmacies may encourage QHP enrollment.

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