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Hong C, Hoskin J, Berteau LK, Schamel JT, Wu ESC, King AR, Randall LA, Holloway IW, Frew PM. Violence Victimization, Homelessness, and Severe Mental Illness Among People Who Use Opioids in Three U.S. Cities. J Interpers Violence 2023; 38:11165-11185. [PMID: 37462229 PMCID: PMC10466992 DOI: 10.1177/08862605231179720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
This study examined the associations between violence victimization, homelessness, and severe mental illness (SMI) among people who use opioids (PWUOs) in three U.S. cities. We analyzed data from a cross-sectional survey conducted from May 2019 to February 2020 across three study sites: Los Angeles, CA; Las Vegas, NV; and Atlanta, GA. We used multivariable regressions to examine how multiple victimizations and housing situation are associated with SMI. Based on K-6 scale, nearly half (44.2%) were screened positive for SMI. Meanwhile, 69.7% of the participants reported experiencing some kind of violence in their lifetime, and more than half (51.9%) reported experiencing recent violence (in the past 6 months). The most common form of lifetime violence was emotional (59.5%), followed by physical and intimate partner violence (IPV) (56.1 and 34.9%, respectively), and 34.9% of all participants reported experiencing multiple forms of victimization in the past 6 months. Participants who reported homelessness were more likely to report having experienced recent violence victimization (p < .001). In multivariable models, experiencing recent victimization was significantly associated with SMI (adjusted odds ratio (AOR) = 1.85, 95% confidence interval [CI] [1.46, 2.38]), as was homelessness (AOR = 1.57, 95% CI [1.15, 2.14]), after adjusting for study covariates. Among those with moderate and SMI (n = 927), only 22% were currently receiving mental health services, and those who reported having experienced any forms of violence in the past 6 months were more likely to utilize mental health services than those who had not experienced any recent violence victimization (25 vs. 17.9%, p < .05). To improve mental health and wellness among this high priority population, mental health facilities and syringe service programs may consider screening for experiences of violence and using trauma-informed mental health approaches. Harm reduction interventions must be responsive to the diverse individual and structural-level needs of PWUOs, especially those experiencing homelessness and housing insecurity. Holistic strategies and services are needed to meet the social and structural needs of this population.
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Affiliation(s)
- Chenglin Hong
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jordan Hoskin
- State of California Department of Rehabilitation, Los Angeles, USA
| | | | - Jay T Schamel
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | - Adrian R King
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
| | - Laura A Randall
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
| | - Ian W Holloway
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Paula M Frew
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
- Merck & Co., Inc., Kenilworth, NJ, USA
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2
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Carey JW, Roland KB, Bessler PA, Tesfaye C, Randall LA, Frew PM. Overcoming Challenges to HIV Medical Care-seeking and Treatment Among Data-to-Care Program Clients in Baton Rouge and New Orleans, Louisiana. J Assoc Nurses AIDS Care 2023; 34:71-82. [PMID: 36524875 PMCID: PMC10988392 DOI: 10.1097/jnc.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Data to Care (D2C) uses US public health surveillance data to identify persons with diagnosed HIV who are not receiving adequate medical care. These persons are linked to care and ancillary social services through personalized outreach. We conducted semistructured interviews with 36 adults with HIV in Louisiana who were engaged for the first time or reengaged back into HIV care through D2C efforts. Before D2C program staff contact, nearly 40% were not contemplating HIV care. Program clients cited barriers to HIV care, including difficulties with appointment scheduling and transportation, health care service and drug costs, low motivation, and competing non-HIV health needs. Thirty-four of the 36 clients said that D2C staff helped them overcome these barriers. Clients also described psychosocial support from D2C staff. After receiving D2C program assistance, more than 90% of clients reported consistently receiving HIV medical care and taking medications. Our findings suggest that D2C staff successfully identified client needs and provided tailored assistance.
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Affiliation(s)
- James W. Carey
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention
| | | | | | - Casey Tesfaye
- Research Support Services, Incorporated, Evanston, Illinois
| | - Laura A. Randall
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
| | - Paula M. Frew
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
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3
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Frew PM, Schamel JT, Randall LA, King AR, Spaulding AC, Wu E, Holloway IW. Vaccine confidence among people who use drugs: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2123201. [PMID: 36170655 DOI: 10.1080/21645515.2022.2123201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18-69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0-12), 35% medium (EVCI 13-20) and 10% high (EVCI 21-24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.
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Affiliation(s)
- Paula M Frew
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Jay T Schamel
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Laura A Randall
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Adrian R King
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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4
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King AR, Shah S, Randall LA, Frew PM, Spaulding A, Holloway IW. Acceptability of injectable pre-exposure prophylaxis among people who inject drugs in three urban U.S. settings. BMC Infect Dis 2022; 22:737. [PMID: 36104676 PMCID: PMC9473463 DOI: 10.1186/s12879-022-07572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Outbreaks of new HIV transmission among people who inject drugs (PWID) are a major public health concern. Oral daily PrEP, has been identified as a critical addition to the biomedical toolkit for this population. However, limited research on the acceptability of long-acting injectable PrEP has been conducted with this population. Methods We conducted a cross sectional multi-site survey with 1127 participants from May 2019–February 2020 to assess the acceptability of novel PrEP regimens. We computed bivariate and multivariable logistic regressions to evaluate correlates of the outcome variable: acceptability of 3-month injectable-PrEP. SAS v.9.4 was used to conduct statistical analysis. Results Limited knowledge of or use of PrEP, past or present, was evident within the sample. Injection drug use in the past six months was significantly associated with LA injectable PrEP acceptability, with the odds of acceptability being 1.885 (CI: 1.376, 2.582) times greater than those who did not inject drugs. After adjusting for confounders, injection drug use was significantly associated with the outcome, such that the odds of acceptability of LA injectable PrEP were 1.705 (CI: 1.198, 2.427) times greater among PWID compared to those who did not inject drugs (p < 0.03). The results demonstrate acceptability (38.2%) in a durable (3-month) injectable PrEP modality among participants who also identified as PWID. Conclusions PrEP promotion efforts among PWID to increase access to long-acting injectable PrEP are necessary. Through efforts to increase acceptance and regular use of long-acting injectable PrEP, public health strategies may be able to effectively lessen chances of future HIV outbreaks among PWID.
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Roland KB, Carey JW, Bessler PA, Langer Tesfaye C, Randall LA, Betley V, Schoua-Glusberg A, Frew PM. "Take care of their hierarchy of needs first": strategies used by data-to-care staff to address barriers to HIV care engagement. AIDS Care 2022; 35:764-771. [PMID: 35611755 DOI: 10.1080/09540121.2022.2077296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Data-to-Care (D2C) is a public health strategy designed to engage out-of-care (OOC) persons with HIV (PWH) in HIV care. OOC PWH are identified through review of state and local HIV data and engaged in care through individualized efforts that address barriers to HIV care. Perspectives of D2C program staff can contribute to D2C program development and sustainability. We conducted semi-structured interviews in 2017 with 20 D2C program staff from Louisiana (n = 10) and Virginia (n = 10), states with distinct D2C programs. We used content and thematic analysis to analyze interview transcripts. In both states, common barriers to care for OOC PWH include limited transportation, stigma, substance use, poverty, homelessness, and mental illness. To address these barriers and engage OOC clients in HIV care, staff and programs provided transportation vouchers and housing assistance, integrated substance use and mental health services into care engagement processes, provided empathy and compassion, and assessed and addressed basic unmet needs. Identifying and addressing social and structural barriers to HIV care is a critical and often a necessary first step in engaging OOC clients in HIV care. These findings can be used for D2C program design and implementation, facilitating engagement in HIV care for OOC PWH.
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Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | - James W Carey
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | - Patricia A Bessler
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | | | - Laura A Randall
- School of Medicine & Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Paula M Frew
- School of Medicine & Rollins School of Public Health, Emory University, Atlanta, GA, USA
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6
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Carey JW, Courtenay-Quirk C, Carnes N, Wilkes AL, Schoua-Glusberg A, Tesfaye C, Betley V, Pedersen S, Randall LA, Frew PM. HIV Testing Program Activities and Challenges in Four U.S. Urban Areas. AIDS Educ Prev 2022; 34:99-115. [PMID: 35438537 PMCID: PMC10953676 DOI: 10.1521/aeap.2022.34.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.
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Affiliation(s)
- James W Carey
- Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari Courtenay-Quirk
- HIV Research Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neal Carnes
- HIV Prevention Capacity Development Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aisha L Wilkes
- Prevention Research Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia; currently she is with the National Center for Injury Prevention and Control at CDC
| | | | - Casey Tesfaye
- Research Support Services Inc. in Evanston, Illinois
| | | | | | | | - Paula M Frew
- UNLV Population Health & Health Equity Initiative, Las Vegas, Nevada at the time of the study; currently she is with Merck & Co., Inc., Kenilworth, New Jersey
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7
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Frew PM, Randall LA, King AR, Schamel JT, Spaulding AC, Holloway IW. Health Behavior Survey Among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Surveillance in Community Settings. JMIR Res Protoc 2021; 10:e25575. [PMID: 34505834 PMCID: PMC8463945 DOI: 10.2196/25575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Background In 2018, 2 million Americans met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for an opioid use disorder, and 9.9 million Americans had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data are limited on the behavioral and contextual risks as well as the protective factors fueling the opioid epidemic in some hard hit US cities—Atlanta, Los Angeles, and Las Vegas. Opioid use also contributes to the risk of other health problems such as HIV and hepatitis C virus infections or mental health disorders and is linked to behavioral and environmental risks (eg, homelessness, experiences of violence, involvement in the justice system). Knowledge of the relationships between these linked vulnerabilities and how they influence service utilization is critical to effective policy and interventions. Objective This survey explores the relationships between demographic and economic characteristics, behavioral and environmental risk factors, and service utilization of people who use opioids to inform public health practice, policy, and future efforts to mitigate the risks faced by this population experiencing multiple health, social, and economic vulnerabilities. The results of this survey will be used to identify needs and intervention points for people who use drugs currently served by public health organizations. Methods We implemented a community-engaged strategy that involved development and execution of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings) and recruitment and enrollment of participants aged 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019 to 2020. The recruited participants completed a survey, including a variety of measures to assess health (physical and mental) and health behaviors such as sexual behavior, vaccine receipt, and HIV/ hepatitis C virus infection testing. Additional items assessed drug use and misuse, syringe exchange and health service utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. Results This protocol was successfully implemented despite challenges such as real-time technology issues and rapidly finding and surveying a difficult-to-reach population. We sampled 1127 unique participants (248 in Atlanta, 465 in Los Angeles, and 414 in Las Vegas). Conclusions The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult-to-reach population. Local efforts such as these are needed to develop policies and practices that promote harm reduction among people who use opioids. International Registered Report Identifier (IRRID) RR1-10.2196/25575
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Affiliation(s)
- Paula M Frew
- University of Nevada Las Vegas School of Public Health, Las Vegas, NV, United States.,UNLV Population Health & Health Equity Initiative, Las Vegas, NV, United States
| | - Laura A Randall
- University of Nevada Las Vegas School of Public Health, Las Vegas, NV, United States.,UNLV Population Health & Health Equity Initiative, Las Vegas, NV, United States
| | - Adrian R King
- University of Nevada Las Vegas School of Public Health, Las Vegas, NV, United States.,UNLV Population Health & Health Equity Initiative, Las Vegas, NV, United States
| | - Jay T Schamel
- University of Nevada Las Vegas School of Public Health, Las Vegas, NV, United States.,UNLV Population Health & Health Equity Initiative, Las Vegas, NV, United States
| | - Anne C Spaulding
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA, United States
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- University of Nevada Las Vegas School of Public Health, Las Vegas, NV, United States.,UNLV Population Health & Health Equity Initiative, Las Vegas, NV, United States.,Department of Epidemiology, Emory University School of Public Health, Atlanta, GA, United States.,Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Denson DJ, Gelaude D, Saul H, Schoua-Glusberg A, Randall LA, Kenward K, Gall E, Hickson D, Schamel J, Frew PM. "To Me, Everybody Is infected": Understanding Narratives about HIV Risk among HIV-negative Black Men Who Have Sex with Men in the Deep South. J Homosex 2021; 68:973-992. [PMID: 31794351 PMCID: PMC7266721 DOI: 10.1080/00918369.2019.1694338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
For black MSM living in the Deep South, the intersection of sexuality, race, and geography impacts HIV risk substantially. Between July and September 2016, we conducted a qualitative study among HIV-negative black MSM in five southern cities in the US with elevated HIV prevalence. Analysis included assessment of interrater reliability, cluster analysis, and descriptive statistics. We enrolled 99 black MSM (mean age: 33.6; SD = 12.8; range: 17-68 years). Four overarching themes emerged: harboring fear of HIV and the internalization of HIV stigma; scrutinizing potential partners to assess riskiness and HIV status; embracing distance and isolation from those perceived as a threat to HIV status; and exhibiting self-efficacy toward HIV prevention and utilizing risk reduction strategies. Future HIV prevention efforts may benefit by balancing risk and deficit based strategies with those that emphasize resilience, address disenfranchisement via structural interventions, and assess and treat inherent trauma(s).
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Affiliation(s)
- Damian J. Denson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Deborah Gelaude
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Heather Saul
- Department of Health, Science, and Human Services, ICF International, Incorporated, Atlanta, Georgia, USA
| | | | - Laura A. Randall
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Elizabeth Gall
- Division of Health, IMPAQ International, LLC, Columbia, Maryland, USA
| | | | - Jay Schamel
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paula M. Frew
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
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9
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Frew PM, Schamel JT, Randall LA, King AR, Holloway IW, Burris K, Spaulding AC. Identifying Missed Opportunities for Routine Vaccination among People Who Use Drugs. Int J Environ Res Public Health 2021; 18:1447. [PMID: 33557231 PMCID: PMC7913920 DOI: 10.3390/ijerph18041447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 01/08/2023]
Abstract
In the US, adult immunization coverage remains low, especially among vulnerable populations, as recent hepatitis A outbreaks have demonstrated. We studied the vaccination history variation among the US adults who use drugs by implementing a community-engaged research survey to identify reported immunization coverage, missed opportunities (MO), and places where immunizations might be delivered. Our analysis of a sample of 1127 participants recruited at community syringe exchanges in three cities identified higher overall vaccination receipt in Los Angeles compared to Atlanta or Las Vegas (e.g., HAV receipt 52.2% LA, 42.1% LV, 41.4% Atlanta). Overall, fewer participants reported having received HAV (45.9%), HBV (47.5%), or influenza (47.6%) vaccines than MMR (57.1%) or Td/Tdap (61.1%). Across sites, HAV receipt was higher for participants incarcerated ≥ 5 years (54.2% vs. 43.6% for those incarcerated < 5 years, 49.4% no incarceration history, p = 0.02). HBV receipt was higher among participants who were not intravenous drug users (56.1% vs. 46.0%, p = 0.03). Additionally, income >$20k predicted higher rates of MMR receipt (67.0% vs. 56.5%, p = 0.009), as did stable housing (62.8% vs. 54.3%, p = 0.01). To address the need to expand vaccine coverage among vulnerable adults, delivering vaccine at sites where persons who use drugs access services, or in correctional facilities, may be warranted.
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Affiliation(s)
- Paula M. Frew
- UNLV School of Public Health, UNLV School of Medicine, and UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV 89154, USA; (P.M.F.); (J.T.S.); (L.A.R.); (A.R.K.); (K.B.)
| | - Jay T. Schamel
- UNLV School of Public Health, UNLV School of Medicine, and UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV 89154, USA; (P.M.F.); (J.T.S.); (L.A.R.); (A.R.K.); (K.B.)
| | - Laura A. Randall
- UNLV School of Public Health, UNLV School of Medicine, and UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV 89154, USA; (P.M.F.); (J.T.S.); (L.A.R.); (A.R.K.); (K.B.)
| | - Adrian R. King
- UNLV School of Public Health, UNLV School of Medicine, and UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV 89154, USA; (P.M.F.); (J.T.S.); (L.A.R.); (A.R.K.); (K.B.)
| | - Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA;
| | - Katherine Burris
- UNLV School of Public Health, UNLV School of Medicine, and UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV 89154, USA; (P.M.F.); (J.T.S.); (L.A.R.); (A.R.K.); (K.B.)
| | - Anne C. Spaulding
- Department of Epidemiology, Emory University, Atlanta, GA 30322, USA
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Holloway IW, C Spaulding A, Miyashita Ochoa A, A Randall L, R King A, Frew PM. COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies. J Int AIDS Soc 2020; 23:e25551. [PMID: 32640098 PMCID: PMC7300636 DOI: 10.1002/jia2.25551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ian W Holloway
- Department of Social WelfareUCLA Luskin School of Public AffairsLos AngelesCAUSA
| | | | | | - Laura A Randall
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - Adrian R King
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - The HBOU Study Team
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - Paula M Frew
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
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Limaye RJ, Malik F, Frew PM, Randall LA, Ellingson MK, O'Leary ST, Bednarczyk RA, Oloko O, Salmon DA, Omer SB. Patient Decision Making Related to Maternal and Childhood Vaccines: Exploring the Role of Trust in Providers Through a Relational Theory of Power Approach. Health Educ Behav 2020; 47:449-456. [PMID: 32306760 DOI: 10.1177/1090198120915432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immunization is one of the most effective ways to prevent infectious diseases. However, vaccination rates are suboptimal in the United States. Obstetric providers are critical in influencing vaccine decision making among pregnant women, as trust between a patient and provider may facilitate willingness to accept vaccination. Little is known about how power between a patient and provider affects vaccine acceptance. This study explored pregnant women's trust in obstetric providers within the context of vaccines. Using concepts from the relational theory of power, we conducted 40 in-depth interviews with a purposive sample of pregnant women from four Ob-Gyn practices each in Georgia and Colorado. Results suggest that to enhance trust, providers could gain distributive power by conveying empathy. Designated power through medical experience was associated with both trust and distrust, as some women trusted their providers because of their authority and medical credentials, while others viewed authority and experience as reasons to distrust their provider. To increase acceptance, providers should acknowledge the underlying power dynamics within these interpersonal relationships and strengthen rapport with patients through empathy and dialogue.
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Hargreaves AL, Nowak G, Frew P, Hinman AR, Orenstein WA, Mendel J, Aikin A, Nadeau JA, McNutt LA, Chamberlain AT, Omer SB, Randall LA, Bednarczyk RA. Adherence to Timely Vaccinations in the United States. Pediatrics 2020; 145:peds.2019-0783. [PMID: 32086389 DOI: 10.1542/peds.2019-0783] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate (1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and (2) associations between schedule adherence, sociodemographic characteristics, and up-to-date immunization status by 19 to 35 months of age. METHODS We used 2014 National Immunization Survey provider-verified vaccination data to classify vaccination patterns as "recommended" (ie, in line with ACIP dose- and age-specific recommendations), "alternate" (ie, in line with either limiting the number of shots per visit or skipping at least 1 vaccine series), or "unknown or unclassifiable" (ie, not in line with ACIP recommendations or clearly limiting shots per visit or vaccine series). We evaluated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. RESULTS The majority of children's patterns were classified as "recommended" (63%), with 23% and 14% following alternate or unknown or unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19 to 35 months. Not being up-to-date was associated with alternate (prevalence ratio = 4.2, 95% confidence interval: 3.9-4.5) and unknown or unclassifiable (prevalence ratio = 2.4, 95% confidence interval: 2.2-2.7) patterns. CONCLUSIONS High vaccine coverage by 19 to 35 months of age may miss nonadherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.
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Affiliation(s)
- Allison L Hargreaves
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Glen Nowak
- Grady College of Journalism and Mass Communication, University of Georgia, Athens, Georgia
| | - Paula Frew
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | | | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, and.,Emory Vaccine Center, Emory University, Atlanta, Georgia
| | - Judith Mendel
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Ann Aikin
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Jessica A Nadeau
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | - Louise-Anne McNutt
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | | | - Saad B Omer
- Hubert Department of Global Health and.,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
| | - Laura A Randall
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Robert A Bednarczyk
- Hubert Department of Global Health and .,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
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13
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Carey JW, Carnes N, Schoua-Glusberg A, Kenward K, Gelaude D, Denson DJ, Gall E, Randall LA, Frew PM. Barriers and Facilitators for Antiretroviral Treatment Adherence Among HIV-Positive African American and Latino Men Who Have Sex With Men. AIDS Educ Prev 2019; 31:306-324. [PMID: 31361514 PMCID: PMC10985706 DOI: 10.1521/aeap.2019.31.4.306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Some Black/African American and Hispanic/Latino men who have sex with men (MSM) living with HIV do not take antiretroviral therapy (ART). We conducted semistructured interviews with 84 adult, Black/African American and Hispanic/Latino MSM with HIV to understand ART barriers and facilitators. We used chi-square statistics to identify factors associated with ART use (p ≤ .05), and selected illustrative quotes. Over half (51.2%) said they followed their doctor's instructions; however, only 27.4% reported consistently taking ART. Some men delayed ART until overcoming diagnosis denial or becoming very sick. ART use was facilitated by encouragement from others, treatment plans, side effect management, lab test improvements, pill-taking reminders, and convenient care facilities that provide "one-stop shop" services. Men were more likely to take ART when having providers who communicated effectively and were perceived to treat them with respect. Healthcare personnel can use our findings to strengthen services for MSM of color.
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Affiliation(s)
- James W Carey
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Neal Carnes
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | | | - Deborah Gelaude
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Damian J Denson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Laura A Randall
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, and the University of Nevada School of Public Health and UNLV Health for Nevada: Health Disparities Initiative, Las Vegas, Nevada
| | - Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, and the University of Nevada School of Public Health and UNLV Health for Nevada: Health Disparities Initiative, Las Vegas, Nevada
- Emory Rollins School of Public Health, Hubert Department of Global Health and the Department of Behavioral Sciences and Health Education, Atlanta, Georgia
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Frew PM, Murden R, Mehta CC, Chamberlain AT, Hinman AR, Nowak G, Mendel J, Aikin A, Randall LA, Hargreaves AL, Omer SB, Orenstein WA, Bednarczyk RA. Development of a US trust measure to assess and monitor parental confidence in the vaccine system. Vaccine 2018; 37:325-332. [PMID: 30503657 DOI: 10.1016/j.vaccine.2018.09.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. METHODS We used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., "Information Environment", "Trust", "Healthcare Provider", "Attitudes and Beliefs", and "Social Norms"). Reliability for EVCI was assessed using Cronbach's alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. RESULTS Respondents' EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. CONCLUSIONS We developed EVCI to reliably measure parental vaccine confidence, with individuals' scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.
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Affiliation(s)
- Paula M Frew
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Raphiel Murden
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - C Christina Mehta
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison T Chamberlain
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Alan R Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, United States
| | - Glen Nowak
- University of Georgia Grady College of Journalism and Mass Communication, 120 Hooper St, Athens, GA 30602, United States
| | - Judith Mendel
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Ann Aikin
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Laura A Randall
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison L Hargreaves
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Saad B Omer
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Walter A Orenstein
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States
| | - Robert A Bednarczyk
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
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15
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Frew PM, Holloway IW, Goldbeck C, Tan D, Wu E, Jauregui J, Fenimore VL, Randall LA, Lutz CS, Mendel J, Aikin AL, Nowak GJ, Bednarczyk RA. Development of a measure to assess vaccine confidence among men who have sex with men. Expert Rev Vaccines 2018; 17:1053-1061. [PMID: 30433837 PMCID: PMC9993617 DOI: 10.1080/14760584.2018.1541405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent serogroup C meningococcal disease outbreaks led to meningococcal vaccine recommendations for Southern California men who have sex with men (MSM). Assessment of vaccine confidence is critical to improving vaccine coverage in the context of disease outbreaks wherein immunization(s) are recommended. METHODS We surveyed MSM using venue-based sampling and began development of the vaccine confidence index (VCI) with 30 survey items corresponding to trust- and safety-related perceptions. We performed exploratory factor analyses and computed the Cronbach's alpha coefficient to assess internal consistency of the VCI. We created a categorical confidence variable (low, medium, and high confidence) and conducted bivariate and multivariate analyses to evaluate associations with reported confidence and immunization uptake. RESULTS Ten survey items were included in the final VCI and formed the confidence measure. Participants with low confidence had the lowest levels of reported uptake for both meningococcal vaccines. Confidence differed significantly (p ≤ 0.05) between MSM who indicated they received vaccines recommended within the context of the outbreak and those who did not. CONCLUSIONS Our VCI is sensitive to a number of issues that may influence vaccine confidence. It is useful for assessing MSM trust and acceptance of recommended immunizations and may be used to inform intervention development.
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Affiliation(s)
- Paula M Frew
- a Department of Medicine, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA.,b Rollins School of Public Health, Hubert Department of Global Health , Emory University , Atlanta , GA , USA.,c Emory Center for AIDS Research , Atlanta , GA , USA
| | - Ian W Holloway
- d Department of Social Welfare , UCLA Luskin School of Public Affairs , Los Angeles , CA , USA.,e UCLA Center for AIDS Research , Los Angeles , CA , USA.,f California HIV/AIDS Policy Research Center , Los Angeles , CA , USA
| | - Cameron Goldbeck
- d Department of Social Welfare , UCLA Luskin School of Public Affairs , Los Angeles , CA , USA.,f California HIV/AIDS Policy Research Center , Los Angeles , CA , USA
| | - Diane Tan
- d Department of Social Welfare , UCLA Luskin School of Public Affairs , Los Angeles , CA , USA
| | - Elizabeth Wu
- d Department of Social Welfare , UCLA Luskin School of Public Affairs , Los Angeles , CA , USA
| | - Juan Jauregui
- d Department of Social Welfare , UCLA Luskin School of Public Affairs , Los Angeles , CA , USA
| | - Vincent L Fenimore
- b Rollins School of Public Health, Hubert Department of Global Health , Emory University , Atlanta , GA , USA
| | - Laura A Randall
- a Department of Medicine, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA
| | - Chelsea S Lutz
- a Department of Medicine, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA
| | - Judith Mendel
- g Health and Human Services , National Vaccine Program Office , Washington , DC , USA
| | - Ann L Aikin
- g Health and Human Services , National Vaccine Program Office , Washington , DC , USA
| | - Glen J Nowak
- h University of Georgia Grady College of Journalism and Mass Communication , Athens , GA , USA
| | - Robert A Bednarczyk
- b Rollins School of Public Health, Hubert Department of Global Health , Emory University , Atlanta , GA , USA.,i Emory Vaccine Center , Atlanta , GA , USA
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Mehrotra A, Fisher AK, Mullen J, Rodriguez L, Jiles AJ, Albert AP, Randall LA, Frew PM. Provider insight on surmounting specialty practice challenges to improve Tdap immunization rates among pregnant women. Heliyon 2018; 4:e00636. [PMID: 29872768 PMCID: PMC5986541 DOI: 10.1016/j.heliyon.2018.e00636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/11/2017] [Accepted: 05/23/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pertussis, or "whooping cough," is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27-36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16-61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women. METHODS Our aim was to inform new strategies to increase uptake of the Tdap vaccine among pregnant women and, ultimately, reduce pertussis-related morbidity and mortality in infants. We conducted interviews with a sample of 24 ob-gyns. We subsequently performed grounded theory analyses of transcripts using deductive and inductive coding strategies followed by intercoder reliability assessment. RESULTS All physicians interviewed were familiar with the most recent recommendation of giving the Tdap vaccine during the third trimester of every pregnancy, and the majority of physicians stated that they felt that the vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus. Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice. Implementation challenges for physicians included insurance reimbursement and other challenges (i.e., patient refusal). Tdap vaccination during pregnancy was a lower clinical priority for some physicians. Physicians recognized the benefits associated with Tdap vaccination during pregnancy. CONCLUSIONS Findings indicate while most ob-gyns recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial concerns for the practice can outweigh the perceived benefits. This resulted in some ob-gyns reporting choosing not to stock and administer the vaccine in their practice. Recommendations to address these concerns include 1) structural support for Tdap vaccine administration in ob-gyns practices; 2) Continuing medical education-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in communicating the importance of Tdap vaccination during pregnancy.
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Affiliation(s)
- Arpita Mehrotra
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, USA
| | - Allison Kennedy Fisher
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
| | - Jennifer Mullen
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
| | - Leslie Rodriguez
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
| | - Angela J. Jiles
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
| | - Alison P. Albert
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
| | - Laura A. Randall
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, USA
| | - Paula M. Frew
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, USA
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, USA
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, USA
- Emory University Rollins School of Public Health, Hubert Department of Global Health, USA
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Carey JW, Carnes N, Schoua-Glusberg A, Kenward K, Gelaude D, Denson D, Gall E, Randall LA, Frew PM. Barriers and Facilitators for Clinical Care Engagement Among HIV-Positive African American and Latino Men Who Have Sex with Men. AIDS Patient Care STDS 2018; 32:191-201. [PMID: 29668307 PMCID: PMC11002881 DOI: 10.1089/apc.2018.0018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Achieving optimal health among people living with HIV (PLWH) requires linkage to clinical care upon diagnosis, followed by ongoing engagement in HIV clinical care. A disproportionate number of black/African American and Hispanic/Latino men who have sex with men (MSM) living with HIV do not, however, achieve ongoing care. We conducted semistructured interviews in 2014 with 84 urban black/African American and Hispanic/Latino MSM living with HIV to understand their barriers and facilitators to engagement. We classified men as care-engaged or not at the time of the interview, and conducted content analysis of the interview transcripts to identify barriers and facilitators to engagement. Respondent mean age was 42.4 years (range, 20-59). Over half (59.5%, n = 50) were black/African American. Slightly more than a third (38.1%, n = 32) reported not being continuously care-engaged since diagnosis, and 17.9% (n = 15) delayed entry, although they have subsequently entered and remained in care. Sustained engagement began with overcoming denial after diagnosis and having treatment plans, as well as having conveniently located care facilities. Engagement also was facilitated by services tailored to meet multiple patient needs, effective patient-provider communication, and providers who show empathy and respect for their patients. Respondents were less likely to be care-engaged when these factors were absent. It can be difficult for racial and ethnic minority MSM living with HIV to begin and sustain care engagement. To optimize care engagement, our findings underscore the value of (1) convenient multipurpose HIV care facilities that meet patient needs; (2) excellent provider-patient communication that reinforces respect, trust, and HIV treatment literacy; and (3) assisting PLWH to create personalized treatment plans and overcome possible challenges such as diagnosis denial.
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Affiliation(s)
- James W. Carey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neal Carnes
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Deborah Gelaude
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Damian Denson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Laura A. Randall
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paula M. Frew
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, Atlanta, Georgia
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Frew PM, Randall LA, Malik F, Limaye RJ, Wilson A, O'Leary ST, Salmon D, Donnelly M, Ault K, Dudley MZ, Fenimore VL, Omer SB. Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings. Hum Vaccin Immunother 2018; 14:1548-1557. [PMID: 29313458 DOI: 10.1080/21645515.2018.1425116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pregnancy is an ideal time to communicate with women about vaccines for themselves and their infants, yet maternal immunization rates remain suboptimal. This study aimed to identify clinic, provider, and staff-related attributes and facilitators to be utilized for a comprehensive vaccine intervention in ob-gyn clinical settings. We conducted in-depth interviews with 24 providers, both healthcare providers (e.g., physicians, nurse practitioners, midwives) and practice managers, from urban and suburban ob-gyn practices in Georgia and Colorado about their immunization attitudes, practices, and patient experiences. Qualitative analyses included Pearson correlation tests to evaluate patterns and relationships within the data to determine themes. Six major themes emerged: 1) strong provider "buy in" for maternal immunization; 2) the supporting role of clinical/interpersonal cues for vaccine promotion; 3) varying provider-patient communication approaches and its influence on maternal and pediatric uptake; 4) an urgent need for a designated office immunization champion; 5) reimbursement and practice implementation challenges; and 6) region differences in attitudes and values toward maternal immunization. Although providers expressed strong support for maternal immunization practices and offered environmental cues for vaccine promotion, practices often lacked a designated, structured role for an immunization champion equipped to manage delicate conversations with patients. The findings reflect needs for immunization champion identification, training, and support, along with best practices guidelines to improve coordination of vaccine promotion and delivery efforts in ob-gyn provider offices. Additionally, provider training on communication approaches to enhance acceptance and uptake of maternal vaccines is warranted.
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Affiliation(s)
- Paula M Frew
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA.,b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Laura A Randall
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Fauzia Malik
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Rupali J Limaye
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Andrew Wilson
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Sean T O'Leary
- d University of Colorado Denver , Department of Pediatrics, Division of Infectious Diseases , Denver , CO , USA
| | - Daniel Salmon
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Meghan Donnelly
- e University of Colorado School of Medicine , Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Denver , CO , USA
| | - Kevin Ault
- f University of Kansas Medical Center , Department of Obstetrics and Gynecology , Kansas City , KS , USA
| | - Matthew Z Dudley
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Vincent L Fenimore
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Saad B Omer
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.,g Emory University Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.,h Emory University School of Medicine , Department of Medicine, Division of Pediatrics , Atlanta , GA , USA
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Shapiro ET, Schamel JT, Parker KA, Randall LA, Frew PM. The role of functional, social, and mobility dynamics in facilitating older African Americans participation in clinical research. Open Access J Clin Trials 2017; 9:21-30. [PMID: 28804246 PMCID: PMC5552064 DOI: 10.2147/oajct.s122422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Older African Americans experience disproportionately higher incidence of morbidity and mortality related to chronic and infectious diseases, yet are significantly underrepresented in clinical research compared to other racial and ethnic groups. This study aimed to understand the extent to which social support, transportation access, and physical impediments function as barriers or facilitators to clinical trial recruitment of older African Americans. METHODS Participants (N=221) were recruited from six African American churches in Atlanta and surveyed on various influences on clinical trial participation. RESULTS Logistic regression models demonstrated that greater transportation mobility (odds ratio [OR]=2.10; p=0.007) and social ability (OR=1.77; p=0.02) were associated with increased intentions of joining a clinical trial, as was greater basic daily living ability (OR=3.25; p=0.03), though only among single participants. Among adults age ≥65 years, those with lower levels of support during personal crises were more likely to join clinical trials (OR=0.57; p=0.04). CONCLUSION To facilitate clinical trial entry, recruitment efforts need to consider the physical limitations of their potential participants, particularly basic physical abilities and disabilities. Crisis support measures may be acting as a proxy for personal health issues among those aged >65 years, who would then be more likely to seek clinical trials for the personal health benefits. Outreach to assisted living homes, hospitals, and other communities is a promising avenue for improved clinical trial recruitment of older African Americans.
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Affiliation(s)
- Eve T Shapiro
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Jay T Schamel
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Laura A Randall
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Paula M Frew
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Flannigan L, Orenstein WA, Bednarczyk R, Nowak G, Mendel J, Aikin A, Chamberlain A, Hinman AR, Omer S, Randall LA, Frew P. Personal Values as Mediators of Receipt of Non-influenza Childhood Vaccines. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Frew P, Murden R, Mehta CC, Chamberlain A, Hinman AR, Nowak G, Mendel J, Aikin A, Randall LA, Hargreaves AL, Omer S, Orenstein WA, Flannigan L, Bednarczyk RA. Development of a Vaccine Confidence Index for Monitoring and Assessing Parental Confidence in Childhood Vaccination. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Frew PM, Parker K, Vo L, Haley D, O'Leary A, Diallo DD, Golin CE, Kuo I, Soto-Torres L, Wang J, Adimora AA, Randall LA, Del Rio C, Hodder S. Socioecological factors influencing women's HIV risk in the United States: qualitative findings from the women's HIV SeroIncidence study (HPTN 064). BMC Public Health 2016; 16:803. [PMID: 27530401 PMCID: PMC4988035 DOI: 10.1186/s12889-016-3364-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. Methods We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18–44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices. Results The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Conclusions Multilevel syndemic factors contribute to women’s vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk. Trial registration Clinicaltrials.gov, NCT00995176
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Affiliation(s)
- Paula M Frew
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA. .,Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA. .,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA. .,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA.
| | - Kimberly Parker
- Department of Health Studies, Texas Woman's University, CFO Bldg - 1007, PO Box 425499, Denton, TX, 76204, USA
| | - Linda Vo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Danielle Haley
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA
| | - Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | | | - Carol E Golin
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Washington, DC, USA
| | - Jing Wang
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Laura A Randall
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA.,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA
| | - Sally Hodder
- West Virginia University School of Medicine, One Medical Center Drive, HSC-South 2244, Morgantown, WV, 26506, USA
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Walton WE, Workman PD, Randall LA, Jiannino JA, Offill YA. Effectiveness of control measures against mosquitoes at a constructed wetland in southern California. J Vector Ecol 1998; 23:149-160. [PMID: 9879071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effectiveness of larvicide and adulticide treatments against mosquitoes at a constructed wetland in San Jacinto, California was assessed with larval surveys, trapping of emerging adults, and collections of host-seeking females by carbon dioxide-baited traps. Bacillus thuringiensis var. israelensis (Bti, Bactimos pellets) applied at a rate of 19 kg/ha did not demonstrably affect Culex larval and emergent adult populations. Larval populations in the seven marshes of the wetland decreased from approximately one third-fourth instar larva/dip to undetectable levels following two applications of Bacillus sphaericus (Vectolex CG) at a rate of either 19 or 23.6 kg/ha. The largest decline in the number of adult mosquitoes emerging per day from vegetated regions of the wetland occurred after B. sphaericus treatments. The Culex erythrothorax host-seeking population declined about 80-fold during September beginning three weeks after the first treatment with B. sphaericus; however, the Culex tarsalis host-seeking population did not decline abruptly until mid-October 1997. This result suggests that immigration of females from other developmental sites might be an important factor influencing the Cx. tarsalis host-seeking population at the wetlands. Safety concerns required that insecticide applications were carried out during daylight hours, and two daytime applications of adulticide (Pyrenone) in early August were ineffective against mosquitoes resting in the thick vegetation.
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Affiliation(s)
- W E Walton
- Department of Entomology, University of California, Riverside 92521, USA
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Abstract
We have developed a simple, sensitive bioassay for transforming growth factors beta 1 and beta 2 (TGF-beta 1 and TGF-beta 2) based on the ability of these cytokines to inhibit the interleukin-5 induced proliferation of the erythroleukaemia cell line, TF-1. This assay is rapid, reproducible and sensitive to less than 500 fg/ml of TGF-beta 1, and 5-10 pg/ml TGF-beta 2. The assay is 100-1000-fold less sensitive to other inhibitory molecules such as interferon-beta, interferon-gamma and TNF-alpha. The assay can be made specific for TGF-beta 1 or TGF-beta 2 by including specific neutralising antibodies for TGF-beta 1 or TGF-beta 2. The assay can recognise all the readily available recombinant molecular species of these molecules as well as the natural proteins produced from human and bovine platelets and detects TGF-beta in serum samples.
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Affiliation(s)
- L A Randall
- Division of Immunobiology, National Institute for Biological Standards and Control, Potters Bar, Herts, UK
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Snipe RM, Bullock SC, Randall LA. Service and teaching issues in an inner-city university-based psychiatry clinic. J Natl Med Assoc 1978; 70:263-6. [PMID: 702560 PMCID: PMC2609636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The provision of quality out-patient psychiatric care to a predominately black inner-city population, in a University setting such as ours, is a complex and challenging task. This paper addresses service and teaching issues related to the provision of that care in the Adult Unit of the Howard University Hospital Mental Health Clinic. In this setting there is a mandate for clinical teaching and research as well, two vital components in the delivery of quality psychiatric service by knowledgeable and skilled health care providers.
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