Background Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal. Methods A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g. Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population. Results The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse (“chemsex”) (AOR: 3.37; 95% CI: 1.44–7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13–3.85), HIV testing in the previous 6 months (AOR: 3.23; 95% CI: 1.74–5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02–3.34) were associated with having taken PrEP in the past. Conclusions This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.

Background Preventing HIV transmission among people who inject drugs (PWID) is a key element of the US Ending the HIV Epidemic strategy and includes both pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD). While both lead to decreases in HIV transmission, MOUD has other social and health benefits; meanwhile, PrEP has additional HIV prevention advantages from sexual risk and the injection of stimulants. However, these medications are often prescribed in different settings and require multiple visits before initiation. Strategies to integrate these services (i.e., co-prescription) and offer same-day prescriptions may reduce demands on patients who could benefit from them. Methods Nominal group technique, a consensus method that rapidly generates and ranks responses, was used to ascertain barriers and solutions for same-day delivery of PrEP and MOUD as an integrated approach among PWID (n = 14) and clinical (n = 9) stakeholders. The qualitative portion of the discussion generated themes for analysis, and the ranks of the proposed barriers and solutions to the program are presented. Results The top three barriers among PWID to getting a same-day prescription for both PrEP and MOUD were (1) instability of insurance (e.g., insurance lapses); (2) access to a local prescriber; and (3) client-level implementation factors, such as lack of personal motivation. Among clinical stakeholders, the three greatest challenges were (1) time constraints on providers; (2) logistics (e.g., coordination between providers and labs); and (3) availability of providers who can prescribe both medications. Potential solutions identified by both stakeholders included pharmacy delivery of the medications, coordinated care between providers and health care systems (e.g., case management), and efficiencies in clinical care (e.g., clinical checklists), among others. Conclusions Implementing and sustaining a combined PrEP and MOUD strategy will require co-training providers on both medications while creating efficiencies in systems of care and innovations that encourage and retain PWID in care. Pilot testing the co-prescribing of PrEP and MOUD with quality performance improvement is a step toward new practice models.

Background: The number of deaths from drug overdose in the United States has more than doubled in the past decade. In particular, drug overdose deaths involving fentanyl have doubled every year since 2013. Rapid fentanyl test strips (FTS) are a useful strategy for detecting traces of fentanyl in substances and have received overwhelming support from individuals with opioid-dependence. Methods: We investigated fentanyl use, knowledge of FTS, willingness to use FTS, and overdose history among a sample of 105 individuals currently on medication for opioid use disorder (MOUD). Results: Results showed that the majority (63%) of the sample had experienced a non-fatal overdose and that 85% of participants were willing to use FTS. The majority of participants reported concern about fentanyl in their drug supply (70%) and 77% reported likelihood of past unintentional fentanyl use. Of note, only about half (47%) of participants knew of FTS prior to being surveyed, and only 17% reported ever using FTS. Conclusion: These results expand on previous literature that documents high levels of willingness, yet low uptake of FTS among individuals on MOUD. Widespread education about FTS, in addition to the implementation of the use of FTS, is a highly promising and critical primary prevention alternative to overdose treatment and/or death due to fentanyl.

The authors discuss how Boston Public Schools (BPS) and a team from Massachusetts Institute of Technology addressed the BPS bus routing problem. They developed an algorithm that decomposes and separately solves subproblems of assigning students to bus stops, assigning stops to bus trips, and connecting trips into an itinerary for each bus.

Purpose: Employing a social determinants of health (SDOH) framework including race/ethnicity, socioeconomic status (SES) (education, income) and barriers related to housing stability, food security, ability to pay utilities, transportation, and personal safety, we: 1) Describe the impact of COVID-19 on high risk, mostly minority communities (Black/African American and Hispanic/Latino) in New Haven, CT; and 2) Determine how SDOH barriers (numbers and types) impact needs, knowledge and beliefs, and adherence to pandemic control measures, as well as cancer prevention behavior and intentions. Background: As is well recognized from previous pandemics and epidemics, the burden of disease falls disproportionately on those individuals with fewest resources. It is now clear that the COVID-19 associated death and disease burden in minority and low socioeconomic communities is disproportionate to their numbers in the general population. In addition to the disproportionate acute impact of the COVID-19 on vulnerable communities, the long-term impact may be lost ground with respect to cancer prevention due to disruption, distrust and misinformation. Additionally, the recent news events and public discussion around police violence and systemic racism likely potentiates the disparities that were due to COVID-19 alone. Methods: We conducted a Qualtrics survey assessing all aspects of COVID-19 impact, with extensive SDOH measures, including everyday racism, medical mistrust, cancer prevention and screening, access to health care, and intentions regarding future vaccination uptake, adherence to COVID-19 preventive practices, lifestyle behaviors associated with cancer prevention, and cancer screening. Participants (n=300) are from New Haven, are primarily African American/Black and Hispanic/Latinx, and include a subset of cancer survivors. With 26% of the population living below the federal poverty level, we are able to identify long-term impact of Covid-19 on cancer prevention and screening in a high-risk population. Analysis includes descriptive and multivariate adjusted logistic regression findings predicting maintenance of healthy lifestyle (primary cancer prevention) and cancer screening. Results: Descriptive data demonstrate high levels of SDOH and the impact of COVID-19 on many aspects of life for this study population. We present predictors of healthy lifestyle behaviors and intention to adhere to cancer screening guidelines going forward as well as intent to vaccinate against COVID-19 when vaccine becomes available. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx (HL) and/or low socioeconomic status (SES) individuals stem from the disproportionate burden of SDOH and will impact cancer prevention behavior. Findings will inform community level interventions in the event of continued COVID-19 (or similar) public health challenges, while identifying opportunities to advance cancer prevention long-term. Citation Format: Beth A. Jones, Sakinah Suttiratana, Roy Herbst, William Eger, Eiman Ibrahim, Hannah Behringer, Eduardo Reyes, Nailah Hutchinson, Shua Kim, Jonathan Colon, Jose DeJesus, Sarah Alsup, Rachel A. Clare, Monique Killins. COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in vulnerable populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-263.

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Purpose: Determine the role of social determinants of health (SDOH), including socioeconomic status (SES) (education, income in predicting intent to vaccinate for COVID-19 among a diverse community-based population, oversampled for cancer survivors in Connecticut (CT). Background: Race, ethnicity, and the SDOH (e.g., food insecurity, housing instability, trouble paying utilities bills) have a known impact on COVID-19 incidence, morbidity, and mortality. Although the impact on cancer survivors is not as well understood, this population may also face disproportionately severe outcomes. To our knowledge, there are no published studies that address intention to vaccinate in community based populations that are predominantly African American/Black (AA) or Hispanic/Latinx (H/L), nor in the cancer survivors who live in these communities. Prior studies have suggested that some vulnerable populations have lowered willingness to vaccinate (e.g., for influenza) than other groups. This study will explore the role of the high burden of SDOH barriers and selected socio-cultural factors such as perceived risk, medical mistrust, and source of health information. Methods: Data for this study are from 252 CT residents, collected from August - December, 2020 using Qualtrics, an online survey platform. Using an extensive network of community partners, we recruited through list serves and social media, targeting communities known to be most impacted by the pandemic. The intent was to enroll a population that was similar to the racial/ethnic sociodemographic profile of the city of New Haven, while oversampling cancer survivors. Using SAS 9.4, we conducted descriptive and multivariate analyses to identify the role of SDOH in willingness to vaccinate. Results: The study population was disproportionately African American/Black (23.5%) and Hispanic/Latinx (17.5%) and included 83 (32.9%) cancer survivors. In this high-risk population, 38.9% of the sample were unwilling or uncertain whether they would vaccinate against Covid-19 in the future. In multivariate adjusted model, individuals reporting at least one SDOH barrier (food insecurity, trouble paying utilities bills, or housing instability) were significantly less likely to vaccinate (odds ratio=2.26;95% Confidence Interval 1.17-4.36). Other significant predicators included low perceived risk and lacking confidence in information provided through the health care system. Conclusion: Social determinants of health play a critical role in predicting intent to vaccinate for COVID-19. Special efforts are needed to ensure that vulnerable populations understand their individual risk, the benefits and risks of getting the COVID-19 vaccine, with interventions aimed at enlisting trusted entities that may not be recognized as traditional sources of health information. Citation Format: Beth A. Jones, William Eger, Sakinah Suttiratana, Roy Herbst, Eiman Ibrahim, Hannah Behringer, Rachel A. Clare. Social Determinants of Health (SDOH) barriers as predictors of intent to vaccinate for COVID-19 in a vulnerable population [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-06.

Purpose: Employing a social determinants of health (SDOH) framework including race/ethnicity, socioeconomic status (SES) (education, income) and other barriers we: 1) Describe the impact of COVID-19 on young adults (GENZ) who live in CT; 2) Determine if COVID-19 vaccine hesitancy is related to other vaccine utilization (HPV and Flu) and other cancer prevention behaviors Background: As is well recognized from previous pandemics and epidemics, the burden of disease falls disproportionately on those individuals with fewest resources. It is now clear that the COVID-19 associated death and disease burden in minority and low socioeconomic communities is disproportionate to their numbers in the general population. In addition to the disproportionate acute impact of the COVID-19 on vulnerable communities, the long-term impact may be lost ground with respect to cancer prevention due to disruption, distrust and misinformation. Little is known about how the pandemic has impacted young adults and whether this has influenced behaviors that are key to cancer prevention. Methods: In May, 2021, we conducted a Qualtrics survey assessing all aspects of COVID-19 impact, with extensive SDOH measures, including everyday racism and medical mistrust, cancer prevention and screening, access to health care, and intentions regarding future vaccination uptake, adherence to COVID-19 preventive practices, lifestyle behaviors associated with cancer prevention, and cancer screening. Participants (n=232) are 18-25 year olds with a permanent address in Connecticut. We used social networks and social media to recruit participants. Analysis includes descriptive and multivariate adjusted logistic regression findings predicting maintenance of healthy lifestyle (primary cancer prevention) and cancer screening and associations with COVID-19 vaccine hesitancy. Results: In this sample of young adults, the average age was 21.2 (range 18-25), with 52% reporting their race/ethnicity as Hispanic/Latinx (33%) or African American/Black (19%); 53.3% were female, 46.2% were male, and .4% reported other. Descriptive data demonstrate high levels of SDOH and the impact of COVID-19 on many aspects of life for this study population. COVID-19 vaccine hesitancy was relatively low at 12.2%, with 57% of GENZ participants reporting that they had already vaccinated. We present predictors of healthy lifestyle behaviors and intention to adhere to cancer screening guidelines going forward and the relationship to history of and intent to vaccinate against COVID-19. Conclusion: The unique challenges of young adults during COVID-19 are not well documented. Findings will inform community level interventions in the event of continued COVID-19 (or similar) public health challenges, while identifying opportunities to advance cancer prevention long-term for these young adults. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Shua Kim, William Eger. COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in GENZ population (Ages 18-25) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-075.