Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study

Background

Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs.

Methods

Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January 2023.

Findings

Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p = 0.023), male (70.2% vs. 55.2%, p = 0.009), White (78.5% vs. 60.2%, p < 0.0001), without personal vehicle (58.5% vs. 43.5%, p = 0.028), IDU (83.7% vs. 21.0%, p < 0.0001), and uninsured (61.2% vs. 48.8%, p = 0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p = 0.004).

Interpretation

The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations.

Funding

Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.

Covariates of Identified Stress and Depression among Seasonal Farmworkers

Many noted difficulties of farmworker life result in increased risk for stress and depression. To date, limited research has focused primarily on seasonal farmworkers; much of the prior research examines migrant farmworkers or both groups collectively. This study aims to: (1) describe levels of stress and depression among a sample of seasonal farmworkers; and (2) identify if covariates (age, gender, marital status, education level, years of residency, problems obtaining healthcare due to documentation, language barriers, transportation, costs, medical insurance, and stress level) are significant predictors of depressive symptoms. Survey data were collected from 150 Latino seasonal farmworkers. A hierarchical binary logistic regression was conducted to identify significant covariates. The results indicated that the only statistically significant covariates were health insurance coverage (p = 0.025) and stress (p = 0.008). Those farmworkers without health insurance were 1.8 times more likely than those with health insurance to possess depressive symptoms, while those demonstrating higher stress levels were over 7 times more likely to demonstrate symptoms of depression. The implications of the results are discussed in the manuscript.

Indian Migrant Workers in Lebanon and Their Access to Health Care

This paper examines Indian migrant workers' access to health care in Lebanon. The findings are based on quantitative and qualitative data collected in 1998 from a sample of 402 semi-skilled and unskilled migrant workers from India. The study tries to shed light on the plight of migrant workers, especially that of unauthorized ones, whose situation is compounded by meager income and the absence of a health insurance policy. High medical costs in Lebanon restrict migrants' access to health care, leaving many migrants to suffer from various diseases. The paper concludes with policy recommendations for sending and receiving countries, the implementation of which would contribute to the welfare and betterment of the health conditions of migrant workers.

Health care access and health care workforce for immigrant workers in the agriculture, forestry, and fisheries sector in the southeastern US

BACKGROUND

The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities.

METHODS

This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.

CONTENTS

Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

A nurse-led wellness program for migrant backstretch workers

PROBLEM

Migrant workers working at the back stretch of Philadelphia Park Racetrack are faced with healthcare challenges. This vulnerable population experiences health disparities as a result of lack of resources and increased exposure to risk.

METHOD

A needs assessment of backstretch workers was conducted to identify the healthcare needs of this unique population.

FINDINGS

The analysis revealed several areas of need for this vulnerable population primarily, effective bilingual communication, increasing access to healthcare services, implementing measures to address women's health issues, and improving nutritional status of workers.

CONCLUSION

Through multi-agency collaboration, continued development, and revision of strategies, health enhancement and disease prevention are accessible to vulnerable migrant workers. Faculty, students, and staff work with clients to provide quality health education programs, screenings, and referrals to improve their health.

Health care utilization among migrant Latino farmworkers: the case of skin disease

CONTEXT

Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources.

PURPOSE

Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers.

METHODS

Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms.

FINDINGS

Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year.

CONCLUSIONS

The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.

Delivery of health services to migrant and seasonal farmworkers

Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.

Farming and mental health problems and mental illness

BACKGROUND

Farmers experience one of the highest rates of suicide of any industry and there is growing evidence that those involved in farming are at higher risk of developing mental health problems. This article provides an overview of the literature examining mental health issues experienced by farming populations in the United Kingdom, Europe, Australia, Canada and the United States and identifies areas for further research.

METHOD

A literature review (Medline, Science Direct, Ingenta, Proquest and PsychINFO) was carried out using the words 'farmers', 'agriculture', 'depression', 'mental health', 'mental illness', 'stress', and 'suicide', as well as a review of relevant papers and publications known to the authors. (Papers not written in English and those published prior to 1985 were excluded.)

RESULTS

Fifty-two papers were identified with the majority focusing on stress and coping styles in farmers (24). A number of studies also focused on neuropsychological functioning and agricultural chemical use (7), depression (7), suicide (9), general mental health (4) and injury and mental health (1). This body of research studied male farmers, female farmers, farm workers, farming families, and young people living on farms. Research to date indicates that farmers, farm workers and their respective families face an array of stressors related to the physical environment, structure of farming families and the economic difficulties and uncertainties associated with farming which may be detrimental to their mental health.

CONCLUSION

Whilst suicide rates in some groups of farmers are higher than the general population, conclusive data do not exist to indicate whether farmers and farming families experience higher rates of mental health problems compared with the non-farming community. It is clear, however, that farming is associated with a unique set of characteristics that is potentially hazardous to mental health and requires further research.

Stress Among Migrant and Seasonal Farmworkers in Rural Southeast North Carolina

CONTEXT

Although funding to enhance the delivery of health care among migrant farmworkers has primarily focused on urgent care issues within this population, the etiology of mental health risks and perceived stress is poorly understood.

PURPOSE

To identify the type and severity of stress perceived by migrant and seasonal farmworkers in rural southeast North Carolina.

METHODS

During the pre-agricultural season in 2002, 151 migrant and seasonal farmworkers completed the 39-item Migrant Farmworker Stress Inventory (MFWSI) in either English or Spanish.

FINDINGS

Fifty-one percent (n = 77) of the respondents perceived themselves at a high level of stress (mean score above 80 of "caseness") that may subsequently put them at greater risk for experiencing psychological difficulties. The stressors highly ranked (mean>2.5 in a maximum of 4, with "extremely stressful" in a 5-point Likert scale 0 to 4) were related to their mobile lifestyle, language barriers, insecure job and legal status, financial restraint, and long working hours. Also, drug and alcohol use in the migrant community was found to be one of the significant sources of stressors. Variables influencing high levels of stress include education, social support, religion, marital status, and age. Despite a relatively high level of perceived stress, the majority of respondents (71.5%) viewed their physical health as either "good" or "excellent."

CONCLUSIONS

Findings from the study suggest the availability of social support systems may provide significant insight into developing appropriate health services for migrant and seasonal farmworkers and their families.