2
|
Taggart T, Jonathon Rendina H, Boone CA, Burns P, Carter J, English D, Hull S, Massie JS, Mbaba M, Mena L, Río-González AMD, Shalhav O, Talan AJ, Wolfer C, Bowleg L. Stigmatizing Spaces and Places as Axes of Intersectional Stigma Among Sexual Minority Men in HIV Prevention Research. Am J Public Health 2022; 112:S371-S373. [PMID: 35763746 PMCID: PMC9241459 DOI: 10.2105/ajph.2021.306676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Tamara Taggart
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - H Jonathon Rendina
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Cheriko A Boone
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Paul Burns
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Joseph Carter
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Devin English
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Shawnika Hull
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Jenné S Massie
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Mary Mbaba
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Leandro Mena
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Ana María Del Río-González
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Ore Shalhav
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Ali J Talan
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Carly Wolfer
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| | - Lisa Bowleg
- Tamara Taggart and H. Jonathon Rendina are with the School of Public Health, George Washington University, Washington, DC. Cheriko A. Boone, Jenné S. Massie, Mary Mbaba, Ana María del Río-González, and Lisa Bowleg are with the College of Arts and Sciences, George Washington University. Paul Burns is with the School of Public Health, University of Mississippi Medical Center, Jackson. Joseph Carter, Ore Shalhav, and Carly Wolfer are with the School of Arts and Sciences, Hunter College, New York, NY. Devin English is with the School of Public Health, Rutgers University, New Brunswick, NJ. Shawnika Hull is with the School of Communication and Information, Rutgers University. Leandro Mena is with the School of Population Health, University of Mississippi Medical Center. Ali J. Talan is with Whitman-Walker Institute, Inc., Washington, DC
| |
Collapse
|
3
|
Quan AML, Mah C, Krebs E, Zang X, Chen S, Althoff K, Armstrong W, Behrends CN, Dombrowski JC, Enns E, Feaster DJ, Gebo KA, Goedel WC, Golden M, Marshall BDL, Mehta SH, Pandya A, Schackman BR, Strathdee SA, Sullivan P, Tookes H, Nosyk B. Improving health equity and ending the HIV epidemic in the USA: a distributional cost-effectiveness analysis in six cities. Lancet HIV 2021; 8:e581-e590. [PMID: 34370977 PMCID: PMC8423356 DOI: 10.1016/s2352-3018(21)00147-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the USA, Black and Hispanic or Latinx individuals continue to be disproportionately affected by HIV. Applying a distributional cost-effectiveness framework, we estimated the cost-effectiveness and epidemiological impact of two combination implementation approaches to identify the approach that best meets the dual objectives of improving population health and reducing racial or ethnic health disparities. METHODS We adapted a dynamic, compartmental HIV transmission model to characterise HIV micro-epidemics in six US cities: Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle. We considered combinations of 16 evidence-based interventions to diagnose, treat, and prevent HIV transmission according to previously documented levels of scale-up. We then identified optimal combination strategies for each city, with the distribution of each intervention implemented according to existing service levels (proportional services approach) and the racial or ethnic distribution of new diagnoses (between Black, Hispanic or Latinx, and White or other ethnicity individuals; equity approach). We estimated total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios of strategies implemented from 2020 to 2030 (health-care perspective; 20-year time horizon; 3% annual discount rate). We estimated three measures of health inequality (between-group variance, index of disparity, Theil index), incidence rate ratios, and rate differences for the selected strategies under each approach. FINDINGS In all cities, optimal combination strategies under the equity approach generated more QALYs than those with proportional services, ranging from a 3·1% increase (95% credible interval [CrI] 1·4-5·3) in New York to more than double (101·9% [75·4-134·6]) in Atlanta. Compared with proportional services, the equity approach delivered lower costs over 20 years in all cities except Los Angeles; cost reductions ranged from $22·9 million (95% CrI 5·3-55·7 million) in Seattle to $579·8 million (255·4-940·5 million) in Atlanta. The equity approach also reduced incidence disparities and health inequality measures in all cities except Los Angeles. INTERPRETATION Equity-focused HIV combination implementation strategies that reduce disparities for Black and Hispanic or Latinx individuals can significantly improve population health, reduce costs, and drive progress towards Ending the HIV Epidemic goals in the USA. FUNDING National Institute on Drug Abuse.
Collapse
Affiliation(s)
- Amanda My Linh Quan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Xiao Zang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Siyuan Chen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Czarina Navos Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kelly A Gebo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Matthew Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Shruti H Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ankur Pandya
- T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | | | | | - Hansel Tookes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
| |
Collapse
|