Call to action: how can the US Ending the HIV Epidemic initiative succeed?

The Lancet Series on HIV in the USA describes the current state of the nation's HIV epidemic, including ongoing inequities and challenges for key populations and comorbidities. [1][2][3][4][5][6] Black Americans have consistently shouldered many of these HIV inequities, a pattern also seen in the COVID-19 pandemic. The overlapping racial disparities related to COVID-19 and HIV 7,8 highlight lessons that policy makers, public health practitioners, providers, and communities can leverage in their strategies to eliminate the Same script, different viruses: HIV and COVID-19 in US Black communities in subgroups of patients including SMuRF-less patients and women is mandatory.However, the success of risk stratification and treatment depends on accurate diagnosis and identification of the underlying disease mechanisms. Several different disease mechanisms have been identified in STEMI. Atherosclerotic coronary artery occlusion is the most common finding in patients with STEMI. 1 However, in myocardial infarction with non-obstructive coronary arteries, which is particularly common in women, several other disease mechanisms have been identified. These include non-obstructive coronary artery atherosclerosis and plaque rupture, coronary artery embo lism, vasospasm, and spontaneous coronary artery dissection (SCAD). 11,12 In female patients with SCAD, Figtree and colleagues observed a lower 30-day mortality rate than for female patients without SCAD; however, SCAD is particularly common among young and middle-aged women (≤50 years) and associated with underlying systemic arteriopathy with a recurrence rate of 10-30% and a reduction in quality of life. 12 A further consideration is that Takotsubo cardiomyopathy or stress cardiomyopathy might mimic STEMI. 13 Therefore, a detailed assessment is indicated in select patients with STEMI, supplementing invasive coronary angiography with cardiac MRI, to exclude myocarditis and detect myocardial necrosis, and an intravascular assessment of coronary flow and structure, possibly also including functional testing. Such a comprehensive assessment would secure correct diagnosis, risk assessment, and treatment, particularly in women with STEMI and nonobstructive coronary arteries.Without consideration of risk, there cannot be gain, and thus new sex-specific risk factors and risk markers should be implemented in clinical risk models that can identify high-risk individuals among SMuRF-less patients with STEMI. Improvement in risk stratification and accurate diagnosis would help to tailor treatment in SMuRF-less patients, reducing the excess mortality and avoiding undertreatment in this subgroup.I declare no competing interests.

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confidence: 96%

Same script, different viruses: HIV and COVID-19 in US Black communities

2021

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“…Finally, this population experiences many challenges in being linked to care while also experiencing extremely high risk for HIV acquisition [ 10 , 17 , 58 , 59 ]. Successful implementation of PrEP care within the criminal justice system and linking criminal justice–involved individuals to PrEP care in the community has the potential to significantly reduce the spread of HIV both within the criminal justice setting and the broader community, and is an important step to ending the HIV epidemic in the United States [ 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study

Murphy¹,

Sosnowy²,

Rogers³

et al. 2022

JMIR Res Protoc

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Background HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. Objective The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. Methods This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. Results The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. Conclusions Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. International Registered Report Identifier (IRRID) DERR1-10.2196/31928

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“… 5 , 6 For instance, stigma toward HIV persists and presents barriers to HIV testing, prevention, and treatment engagement across low- and middle-income contexts 7 as well as high-income contexts. 8 There is also stigma toward sexually transmitted infections (STI) that presents related barriers to testing and treatment. 9 Self-care interventions such as HIV self-testing and STI self-sampling offer confidential and convenient alternatives to healthcare provider testing.…”

Section: Introductionmentioning

confidence: 99%

Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey

Logie

Berry

Ferguson

et al. 2022

Sexual and Reproductive Health Matters

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Self-care interventions hold the potential to improve sexual and reproductive health (SRH) and well-being. Yet key knowledge gaps remain regarding how knowledge and uptake vary across different types of self-care interventions. There is also limited understanding of health workers’ confidence in promoting SRH self-care interventions, and how this may differ based on personal uptake experiences. To address these knowledge gaps, we conducted a web-based cross-sectional survey among health workers and laypersons from July to November 2018. We investigated the following information about SRH self-care interventions: knowledge and uptake; decisions for use; and associations between health workers’ uptake and providing prescriptions, referrals, and/or information for these interventions. Participants ( n = 837) included laypersons ( n = 477) and health workers ( n = 360) from 112 countries, with most representation from the WHO European Region (29.2%), followed by the Americas (28.4%) and African (23.2%) Regions. We found great heterogeneity in knowledge and uptake by type of SRH self-care intervention. Some interventions, such as oral contraception, were widely known in comparison with interventions such as STI self-sampling. Across interventions, participants perceived benefits of privacy, convenience, and accessibility. While pharmacies and doctors were preferred access points, this varied by type of self-care intervention. Health workers with knowledge of the self-care intervention, and who had themselves used the self-care intervention, were significantly more likely to feel confident in, and to have provided information or referrals to, the same intervention. This finding signals that health workers can be better engaged in learning about self-care SRH interventions and thereby become resources for expanding access.

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Call to action: how can the US Ending the HIV Epidemic initiative succeed?

Cited by 35 publications

References 33 publications

Same script, different viruses: HIV and COVID-19 in US Black communities

Same script, different viruses: HIV and COVID-19 in US Black communities

Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study

Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey

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