Rapid assessment of the HIV/AIDS crisis in racial and ethnic minority communities: an approach for timely community interventions

The motives and methods of methamphetamine and 'heroin' co-use in West Virginia

BACKGROUND

Opioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years.

METHODS

This study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews.

RESULTS

We found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: 'intrinsic use', encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; 'opioid assisting use' in which methamphetamine helped people manage their existing heroin/fentanyl use; and 'reluctant or indifferent use' for social participation, reflecting methamphetamine's low cost and easy availability.

CONCLUSIONS

Methamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. 'Reluctant' uptake attests to methamphetamine's social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.

Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA

BACKGROUND

Efforts to mitigate HIV transmission among gay and bisexual men have not been sufficient to level persistent racial inequities which now extend to the use of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. Community-involved ethnographic research is crucial to galvanizing collaboration between patients, researchers, and policymakers to identify the social determinants of emerging PrEP inequities. In partnership with community key informants, we conducted a Rapid Ethnographic Assessment (REA) of multilevel PrEP use determinants among young Black gay and bisexual (YBGBM) men in the metropolitan Atlanta area to inform the development and coordination of local HIV programs.

METHODS

In the assessment, we drew upon the perspectives of local clinicians, community-based organization leaders, health educators, and PrEP clients to identify barriers and facilitators to PrEP use among YBGBM through interviews (N = 23). Data were collected from September 2020 -to January 2021 and were analyzed through a staged deductive-inductive thematic analysis. The themes were later summarized and presented to community stakeholder participants to facilitate member-checking.

RESULTS

Our analyses revealed structural, cultural, relationship, and developmental factors which shaped PrEP use. The most prominent being "ease of access to PrEP" (structural level), "provider support" (interpersonal), and "life-stage traits" (individual). Our results also contribute novel information concerning the axes of intersectional stigma (spatial, racial, sexual identity, and HIV) among YBGBM in Atlanta and its divergent effects on PrEP use.

CONCLUSION

Increased PrEP use among YBGBM, particularly among those living in the south, is essential to ending the domestic HIV epidemic. Altogether, our results emphasize the need for PrEP program modifications, which increase flexibility in methods and modes of access and are culturally adapted to the needs of YBGBM. There is also a need for resources that holistically focus on mental health, trauma, and racism as critical components of support.

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

OBJECTIVE

The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries.

DATA EXTRACTION AND SYNTHESIS

Two reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation.

RESULTS

We identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation.

CONCLUSIONS

We found a lack of clarity about what 'rapid evaluation' means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.

Locating the Risk: Using Participatory Mapping to Contextualize Perceived HIV Risk across Geography and Social Networks among Men Who Have Sex with Men in the Deep South

HIV incidence among African American (AA) young men who have sex with men (YMSM) has remained stable even though they made up the largest number of new HIV diagnoses among men who have sex with men (MSM) in 2017. HIV spreads at increased rates in dense sexual networks. Identifying the location of risk behaviors "activity spaces" could inform geographically circumscribed HIV prevention interventions. Utilizing the modified social ecological model we completed five semi-structured focus groups incorporating a modified social mapping technique, based on Singer et al.'s approach. Participants included 27 AA YMSM. Focus groups explored how and where HIV transmission happens in Jackson, Mississippi. Result themes included: 1) location of sexual behaviors, 2) knowledge of geographic hotspots of HIV infection in Jackson, and 3) traveling to meet partners: at home and away. HIV transmission or "activity spaces" may be occurring outside identified HIV hot spots. Mixed geospatial and qualitative methods offered a comprehensive assessment of where HIV transmission occurs, and suggests that geographically circumscribed interventions may need to focus on where individuals living with HIV reside and in specific geographic locations where they engage in behaviors that raise their HIV acquisition risks.

Possibilities and constraints of rapid online ethnography: Lessons from a rapid assessment of COVID-19 policy for people who use drugs

During the COVID-19 Pandemic, health care provision changed rapidly and funding became available to assess pandemic-related policy change. Research activities, however, were limited to contactless, online delivery. It was clear early on that some elements of online rapid ethnography were feasible and effective, while others would not approach traditional ethnographic depth. We conducted an online Rapid Assessment, Response, and Evaluation (RARE) project from August 2020 to September 2021 to understand how COVID-19 policy impacted people who use drugs. Our interdisciplinary research team conducted online ethnographic interviews and focus groups with 45 providers and community stakeholders, and 19 clients from rural and urban areas throughout Arizona. In addition, 26 webinars, online trainings, and virtual conferences focused on opioid policy and medication for opioid use disorders (MOUD) were opportunities to observe conversations among providers and program representatives about how best to implement policy changes, how to reach people in recovery, and what aspects of the changes should carry forward into better all-around opioid services in the future. Our RARE project was successful in collecting a range of providers' perspectives on both rural and urban implementation of take-home MOUDs as well as a wide view of national conversations, but client perspectives were limited to those who were not impacted by the policies and continued to attend in-person daily clinic visits. We describe challenges to online rapid ethnography and how online research may have allowed for an in-depth, but incomplete picture of how policy changes during COVID-19 policy affected people with opioid use disorders.

Lessons Learned From a Qualitative COVID-19 Investigation Among Essential Workers With Limited English Proficiency in Southwest Kansas

In this commentary, we briefly describe our methodology in conducting a remote qualitative investigation with essential workers from southwest Kansas, and then describe some key considerations, challenges, and lessons learned in recruiting and conducting interviews remotely. From August 4, 2020 through August 26, 2020, Centers for Disease Control and Prevention (CDC) staff conducted five phone interviews with culturally and linguistically diverse employees in southwest Kansas to understand COVID-19 knowledge, attitudes, and practices and communication preferences. Our experience details the potential challenges of the federal government in recruiting individuals from these communities and highlights the possibilities for more effectively engaging health department and community partners to support investigation efforts. Optimizing recruitment strategies with additional participation from community partners, developing culturally and linguistically appropriate data collection tools, and providing supportive resources and services may augment participation from refugee, immigrant, and migrant (RIM) communities in similar remote investigations.

Pacing Forward in the Face of Fragility: Lessons From African Institutions and Governments' Response to Public Health Emergencies

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of “unfortunate realties” ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013–2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.

Incorporating qualitative research methods into the monitoring and evaluation of neglected tropical disease programmes: a scoping literature review

This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.

A Dyadic Analysis of Criminal Justice Involvement and Sexual HIV Risk Behaviors Among Drug-Involved Men in Community Corrections and Their Intimate Partners in New York City: Implications for Prevention, Treatment and Policies

People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.

A rapid-cycle assessment strategy for understanding the opioid overdose epidemic in local communities

BACKGROUND

Certain communities in the United States experience greater opioid-involved overdose mortality than others. Interventions to stem overdose benefit from contextual understandings of communities' needs and strengths in addressing the opioid crisis. This project aims to understand multiple stakeholder perspectives on the opioid epidemic in communities disproportionately affected by opioid-involved overdose mortality. Methods: We performed a rapid-cycle qualitative assessment study utilizing in-depth interviews with community stakeholders and observations of community meetings in eight communities in Allegheny County, Pennsylvania, USA, disproportionately impacted by opioid-involved overdose mortality. Stakeholder categories included: current and past illicit users of opioids; medical and social service providers; emergency medical services; law enforcement; spouse or other family members of illicit users/former users of opioids; government officials; school officials; community members. Content analysis was utilized to identify themes and answer study questions. Regular feedback to stakeholders was provided to support targeted interventions. Results: We performed semi-structured, in-depth interviews with 130 community stakeholders and 29 community meeting observations in 2018-2019. Participants perceived similar economic and social determinants as origins of the opioid overdose epidemic including lack of economic resources, loss of jobs, transient populations and dilapidated housing. However, they differed in their awareness of and attention to the epidemic. Awareness was dependent on the visibility of opioid use (presence of paraphernalia litter, location of drug users, media coverage, and relationship to users). Overall, there was good knowledge of naloxone for opioid overdose reversal but less knowledge about local syringe services programs. Perceptions of harm reduction efforts were ambivalent. Conclusions: Members of communities impacted by the opioid epidemic perceived that economic downturn was a major factor in the opioid overdose epidemic. However, the varied beliefs within and between communities suggest that interventions need to be tailored according to the cultural norms of place.

Provision of STD Services in Community Settings After the Loss and Return of State Funding to Support Service Provision: Observations From Select Providers in Massachusetts, 2010 and 2013

CONTEXT

In 2008, the $1.2 M sexually transmitted disease (STD) services line item supporting STD clinical services by the Massachusetts Department of Public Health was eliminated, forcing the cessation of all state-supported STD service delivery.

OBJECTIVE

To determine the impact on community provision of STD services after the elimination of state funds supporting STD service provision.

DESIGN AND SETTING

Rapid ethnographic assessments were conducted in May 2010 and September 2013 to better understand the impact of budget cuts on STD services in Massachusetts. The rapid ethnographic assessment teams identified key informants through Massachusetts's STD and human immunodeficiency virus programs.

PARTICIPANTS

Fifty providers/clinic administrators in 19 sites (15 unique) participated in a semistructured interview (community health centers [n = 10; 53%], hospitals [n = 4; 21%], and other clinical settings [n = 5; 26%]).

RESULTS

Results clustered under 3 themes: financial stability of agencies/clinics, the role insurance played in the provision of STD care, and perceived clinic capacity to offer appropriate STD services. Clinics faced hard choices about whether to provide care to patients or refer elsewhere patients who were unable or unwilling to use insurance. Clinics that decided to see patients regardless of ability to pay often found themselves absorbing costs that were then passed along to their parent agency; the difficulty and financial strain incurred by a clinic's parent agency by providing STD services without support by state grant dollars emerged as a primary concern. Meeting patient demand with staff with appropriate training and expertise remained a concern.

CONCLUSIONS

Provision of public health by private health care providers may increase concern among some community provision sites about the sustainability of service provision absent external funds, either from the state or from the third-party billing. Resource constraints may be felt across clinic operations. Provision of public health in the for-profit health system involves close consideration of resources, including those: leveraged, used to provide uncompensated care, or available for collection through third-party billing.

"Cancer is in style": lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador

Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America.Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques.Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets.Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America.

An Investigation of Early Syphilis Among Men Who have Sex with Men: Alaska, 2018: Findings from a 2018 Rapid Ethnographic Assessment

The state of Alaska had a sharp increase in cases of primary and secondary syphilis among gay, bisexual, and other men who have sex with men (GBMSM) in 2018, centered in Anchorage. A rapid ethnographic assessment was conducted in October 2018 to examine contextual factors contributing to local increases in syphilis. The assessment team conducted qualitative interviews with 64 (N=49 interviews) key informants in Anchorage and Matanuska-Susitna Valley identified through the STD/HIV program at the Alaska Department of Health and Social Services, Division of Public Health (ADPH):  ADPH staff (n = 11; 22%) Medical Providers (n = 18; 37%), Community-Based Organizations/Partners (n = 9; 18%), and GBMSM Community Members (n = 11; 22%). This project was deemed exempt from IRB review. Primary factors affecting syphilis transmission, care, and treatment among GBMSM were: (1) Low awareness about the current syphilis outbreak and ambivalence about syphilis and other STIs; (2) Aspects of sexual partnering such as travel, tourism, and the use of online sites and apps to facilitate anonymous sex and multiple (both sequential/concurrent) partnering; (3) The synergistic effects of substance use, homelessness, and transactional sex; (4) Choosing condomless sex; and (5) Challenges accessing healthcare, including the ability to find appropriate and culturally competent care. Syphilis increases may have been influenced by factors which spanned multiple sectors of the Anchorage community, including individual behavior, community-level risk and protective factors, and use of and interactions with resources offered by ADPH, community-based organizations, and medical providers.

"They Dumped Me Like Trash": The Social and Psychological Toll of Victimization on Latino Day Laborers' Lives

Although recent rhetoric links undocumented immigrants to criminality, reports indicate undocumented immigrants commit less crime than their native-born counterparts and that this vulnerable group may be at increased risk for criminal victimization. Immigrants living in new immigrant settlement cities may be particularly at risk for exposure to criminal victimization due to the vulnerabilities associated with a lack of an established Latino community and limited availability of culturally appropriate social services to provide support. This ethnographic study examines the experiences of victimization and its social and psychological toll of a street-recruited sample of Latino day laborers (LDLs) (N = 25) living and working in Baltimore, a new immigrant settlement city. Findings elucidate and describe the specific types of victimization experienced by LDLs, including workplace victimization (wage theft, abandonment at the jobsite, poor working conditions, verbal abuse) and street-level victimization (assault and robbery), as well as reveal the social and psychological toll of victimization (sociocultural alienation, despair or desesperación, and problem drinking) on their lives. Findings have implications for community psychology, through research and practice, as they provide insights for prevention and intervention within the intersection of structural vulnerability (i.e., undocumented immigration status), violence, and mental health.

A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation

As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.

Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada

BACKGROUND AND AIMS

North America's overdose epidemic is increasingly driven by fentanyl and fentanyl-adulterated drugs. Supervised consumption sites, including low-threshold models (termed overdose prevention sites; OPS), are now being debated in the United States and implemented in Canada. Despite evidence that gendered and racialized violence shape access to harm reduction among women who use drugs (WWUD), this has not been examined in relation to OPS and amid the overdose epidemic. This study explores how overlapping epidemics of overdose and gendered and racialized violence in Vancouver's Downtown Eastside, one of North America's overdose epicenters, impacts how marginalized WWUD experience OPS.

DESIGN

Qualitative analysis using rapid ethnographic fieldwork. Data collection included 185 hours of naturalistic observation and in-depth interviews; data were analyzed thematically using NVivo.

SETTING

Vancouver, Canada.

PARTICIPANTS

Thirty-five WWUD recruited from three OPS.

MEASUREMENTS

Participants' experiences of OPS and the public health emergency.

FINDINGS

The rapid onset and severity of intoxication associated with the use of fentanyl-adulterated drugs in less regulated drug use settings not only amplified WWUD's vulnerability to overdose death but also violence. Participants characterized OPS as safer spaces to consume drugs in contrast to less regulated settings, and accommodation of assisted injections and injecting partnerships was critical to increasing OPS access among WWUD. Peer-administered injections disrupted gendered power relations to allow women increased control over their drug use; however, participants indicated that OPS were also gendered and racialized spaces that jeopardized some women's access.

CONCLUSION

Although women who use drugs in Vancouver, Canada appear to feel that overdose prevention sites address forms of everyday violence made worse by the overdose epidemic, these sites remain 'masculine spaces' that can jeopardize women's access.

Study Design and Use of Inquiry Frameworks in Qualitative Research Published in Health Education & Behavior

Qualitative methods help us understand context, explore new phenomena, identify new research questions, and uncover new models of change. To better understand how researchers in health education and health behavior use qualitative methods, we reviewed qualitative articles published in Health Education & Behavior from 2000 to 2015. We identified 48 articles that met our inclusion criteria and extracted information on the qualitative inquiry framework, use of theory, data collection methods, sampling strategy, general analysis approach, and reporting of results. Use of common qualitative inquiry frameworks was rare, with just one grounded theory study, five ethnographies, and one case study. No studies were framed using phenomenological or narrative inquiry approaches. Theory was used most commonly to select sensitizing constructs for analysis (41.7%) and to inform development of data collection instruments (27.1%). Interviews were the most common data collection method (66.7%), with focus groups next most common (39.6%). Sampling was typically purposive (87.5%), although often not labeled as such. Almost all (95.8%) the articles used quotes to illustrate themes and more than half (58.3%) used descriptors of magnitude (e.g., most, some) to report findings. The use of qualitative methods by health education and behavior researchers could be enriched with more intentional application of a broader range of inquiry frameworks. More deliberate application of a range of inquiry frameworks has the potential to broaden the types of research questions asked, application and generation of theory, study design, analytic strategies, and reporting of results.

Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery

BACKGROUND

The ability to capture the complexities of healthcare practices and the quick turnaround of findings make rapid ethnographies appealing to the healthcare sector, where changing organisational climates and priorities require actionable findings at strategic time points. Despite methodological advancement, there continue to be challenges in the implementation of rapid ethnographies concerning sampling, the interpretation of findings and management of field research. The purpose of this review was to explore the benefits and challenges of using rapid ethnographies to inform healthcare organisation and delivery and identify areas that require improvement.

METHODS

This was a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Mixed Methods Appraisal Tool to assess the quality of the articles. We developed the search strategy using the Population, Intervention, Comparison, Outcomes, Settingframework and searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, Web of Science and ProQuest Central. We included articles that reported findings from rapid ethnographies in healthcare contexts or addressing issues related to health service use.

RESULTS

26 articles were included in the review. We found an increase in the use of rapid ethnographies in the last 2‰years. We found variability in terminology and developed a typology to clarify conceptual differences. The studies generated findings that could be used to inform policy and practice. The main limitations of the studies were: the poor quality of reporting of study designs, mainly data analysis methods, and lack of reflexivity.

CONCLUSIONS

Rapid ethnographies have the potential to generate findings that can inform changes in healthcare practices in a timely manner, but greater attention needs to be paid to the reflexive interpretation of findings and the description of research methods.

TRIAL REGISTRATION NUMBER

CRD42017065874.

When "the Cure" Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico

BACKGROUND

Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR).

AIM

This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population.

METHOD

A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs.

RESULTS

Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services.

DISCUSSION

These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services.

CONCLUSION

New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.

Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'

BACKGROUND

The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use.

METHODS

A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.

RESULTS

(1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports.

CONCLUSION

Massachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations.

HIV prevalence in children and youth living on the street and subject to commercial sexual exploitation: a systematic review

The aim of this review was to describe HIV prevalence in children and youth living on the street and subject to commercial sexual exploitation, and the studies' characteristics in terms of place, time, population, and sample design. This was a systematic review, not a meta-analysis, based on an article search in 10 electronic databases: Science Direct, MEDLINE, OVID, LILACS, Wiley InterScience, MD Consult, Springer Link, Embase, Web of Science, and Ebsco. A complementary search was also performed in the libraries of schools of public health and webpages of U.N. agencies, besides the reference lists from the selected articles. We selected observational studies focused on children and youth living on the street and subject to commercial sexual exploitation, ranging in age from 10 to 20 years, with the results for HIV prevalence rates. A total of 9,829 references were retrieved, of which 15 met the inclusion criteria and comprise this descriptive summary. Of these 15 articles, 12 were conducted in children and youth living on the street and three in children subject to commercial sexual exploitation. All 15 were cross-sectional studies. HIV prevalence in children and youth living on the street ranged from 0% in Dallas, USA and Cochabamba, Bolivia to 37.4% in St. Petersburg, Russia. In children and youth living subject to commercial sexual exploitation, prevalence ranged from 2% in Toronto, Canada to 20% in Kolkata, India. In conclusion, HIV infection is present in children and youth living on the street and subject to commercial sexual exploitation. Measures are needed for prevention, diagnosis, and treatment as a public health priority and an ethical responsibility on the part of governments and society.

Assessment: A Core Function for Implementing Effective Interventions in Sexually Transmitted Disease Control Programs

Assessment is a core function in sexually transmitted disease (STD) prevention and control programs. Assessment is more than reviewing case report data; it includes taking into consideration an array of data of various sources and types to be able to respond to emerging disease threats, align human and financial resources, and plan for the future. In this article, we outline key assessment domains, data sources, activities, and methods for STD programs. We present an illustrative case study of how assessment can be used to identify effective interventions for STD control.

Rapid Assessment of Drug Abuse Prevention Needs for Youth in Small Spanish Municipalities: Coping with Resource Limitations

This study evaluates the drug abuse prevention needs for Spanish youth in municipalities with a population below 7,000 inhabitants in the province of Valencia, Spain. The primary goal of the project was to generate policy and to identify possible courses of drug prevention in these towns. The project utilized the basic RARE model. Grounded Theory was used to frame the qualitative analysis. Interviews with local cultural experts provided strong evidence that many specifically mandated prevention needs are not adequately covered in small municipalities. The data emphasizes the ways in which young people are critical of the prevention actions directed at them. The recommended programs emphasize (1) joint actions using youth networks, (2) educating parents to take an active role in the prevention chain, (3) extending the range and availability of leisure activities, and (4) making sure that the information campaigns are adapted to the interests of young people.

Implementing Qualitative Data Management Plans to Ensure Ethical Standards in Multi-Partner Centers

Thorough data management is crucial for the protection of people who participate in research and the ability for researchers to share results with the public. The impact of inadequate adherence to data management is particularly evident in small field sites and among vulnerable populations partoicipating in Community-Based Participatory Research (CBPR). CBPR presents exciting opportunities for multimedia and multi-sectoral dissemination of research results and policy change, especially concerning the impact of research on health equity for underrepresented populations. In this article, we discuss how we defined data boundaries and protections to adhere to ethical standards while also prioritizing data dissemination while using CBPR with American Indians in Arizona. Although complex partnerships can introduce additional risks to data oversight, data management practices can also increase opportunities for wide-reaching dissemination. We hope to contribute to the literature on data sharing in multi-partnership projects to bolster the impact of dissemination while also protecting participants and populations who chose to collaborate in research and policy practices.

Salmonella infections modelling in Mississippi using neural network and geographical information system (GIS)

OBJECTIVES

Mississippi (MS) is one of the southern states with high rates of foodborne infections. The objectives of this paper are to determine the extent of Salmonella and Escherichia coli infections in MS, and determine the Salmonella infections correlation with socioeconomic status using geographical information system (GIS) and neural network models.

METHODS

In this study, the relevant updated data of foodborne illness for southern states, from 2002 to 2011, were collected and used in the GIS and neural networks models. Data were collected from the Centers for Disease Control and Prevention (CDC), MS state Department of Health and the other states department of health. The correlation between low socioeconomic status and Salmonella infections were determined using models created by several software packages, including SAS, ArcGIS @RISK and NeuroShell.

RESULTS

Results of this study showed a significant increase in Salmonella outbreaks in MS during the study period, with highest rates in 2011 (47.84 ± 24.41 cases/100,000; p<0.001). MS had the highest rates of Salmonella outbreaks compared with other states (36 ± 6.29 cases/100,000; p<0.001). Regional and district variations in the rates were also observed. GIS maps of Salmonella outbreaks in MS in 2010 and 2011 showed the districts with higher rates of Salmonella. Regression analysis and neural network models showed a moderate correlation between cases of Salmonella infections and low socioeconomic factors. Poverty was shown to have a negative correlation with Salmonella outbreaks (R(2)=0.152, p<0.05).

CONCLUSIONS

Geographic location besides socioeconomic status may contribute to the high rates of Salmonella outbreaks in MS. Understanding the geographical and economic relationship with infectious diseases will help to determine effective methods to reduce outbreaks within low socioeconomic status communities.

Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa

BACKGROUND

Stigma is a known barrier to HIV testing and care. Because access to antiretroviral therapy reduces overt illness and mortality, some scholars theorized that HIV-related stigma would decrease as treatment availability increased. However, the association between ART accessibility and stigma has not been as straightforward as originally predicted.

METHODS

We conducted a "situational analysis"--a rapid, community-based qualitative assessment to inform a combination HIV prevention program in high prevalence communities. In the context of this community-based research, we conducted semi-structured interviews and focus groups with 684 individuals in four low-resource sub-districts in North West Province, South Africa. In addition to using this data to inform programming, we examined the impact of stigma on the uptake of services.

RESULTS

Findings suggested that anticipated stigma remains a barrier to care. Although participants reported less enacted stigma, or hostility toward people living with HIV, they also felt that HIV remains synonymous with promiscuity and infidelity. Participants described community members taking steps to avoid being identified as HIV-positive, including avoiding healthcare facilities entirely, using traditional healers, or paying for private doctors. Such behaviors led to delays in testing and accessing care, and problems adhering to medications, especially for men and youth with no other health condition that could plausibly account for their utilization of medical services.

CONCLUSIONS

We conclude that providing access to ART alone will not end HIV-related stigma. Instead, individuals will remain hesitant to seek care as long as they fear that doing so will lead to prejudice and discrimination. It is critical to combat this trend by increasing cultural acceptance of being seropositive, integrating HIV care into general primary care and normalizing men and youths' accessing health care.

A situational analysis methodology to inform comprehensive HIV prevention and treatment programming, applied in rural South Africa

Successful HIV prevention programming requires engaging communities in the planning process and responding to the social environmental factors that shape health and behaviour in a specific local context. We conducted two community-based situational analyses to inform a large, comprehensive HIV prevention programme in two rural districts of North West Province South Africa in 2012. The methodology includes: initial partnership building, goal setting and background research; 1 week of field work; in-field and subsequent data analysis; and community dissemination and programmatic incorporation of results. We describe the methodology and a case study of the approach in rural South Africa; assess if the methodology generated data with sufficient saturation, breadth and utility for programming purposes; and evaluate if this process successfully engaged the community. Between the two sites, 87 men and 105 women consented to in-depth interviews; 17 focus groups were conducted; and 13 health facilities and 7 NGOs were assessed. The methodology succeeded in quickly collecting high-quality data relevant to tailoring a comprehensive HIV programme and created a strong foundation for community engagement and integration with local health services. This methodology can be an accessible tool in guiding community engagement and tailoring future combination HIV prevention and care programmes.

Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS

OBJECTIVE

This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006.

METHODS

The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends.

RESULTS

Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits.

CONCLUSION

CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.

Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities

Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings.

Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users' experiences

INTRODUCTION

While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors.

METHODS

As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage.

RESULTS

Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence.

CONCLUSIONS

The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

Applying qualitative data derived from a Rapid Assessment and Response (RAR) approach to develop a community-based HIV prevention program for adolescents in Thailand

HIV education programs are needed to address risk-taking behavior for adolescents. The purpose of our study was to use the World Health Organization's Rapid Assessment and Response (RAR) method to design a community-based, cultural- and age-appropriate HIV prevention program for adolescents in Bangkok, Thailand. Adolescent single-gender-specific focus groups (n = 3; 28 participants) were used to gather reactions/ideas about program topics/approaches. An adult, mixed-gender group was held to review information identified by adolescents. Sessions were audiotaped and transcribed verbatim. Themes regarding HIV content and the process of implementation emerged from a qualitative content analysis of the data. Community representatives recommended incorporation of HIV information and risk-prevention skills. Information delivery suggestions included small group discussions, interactive games/role-playing, program materials/terminology, and HIV-infected program facilitators. Community members provided critical input toward an HIV prevention program tailored to meet adolescents' unique needs/interests. The RAR model provides opportunities to engage communities in developing health-related interventions.

Emerging patterns of crack use in Mexico City

BACKGROUND

Recent studies in Mexico have documented a significant increase in crack cocaine use, indicating the potential for an emerging drug epidemic.

METHODS

Ethnographic observations and interviews were used describe the profiles and patterns of use among street-recruited crack users in Mexico City. The data came from an international research collaboration funded by the National Institutes of Health.

RESULTS

A polythetic typology was developed based on five dimensions central to categorizing patterns of crack use behavior: frequency of use, duration of use, context, social networks, and social contracts. Four types of users were discovered applying these dimensions: dabblers, stable users, crack heads, and old heads. Although several similarities were documented between patterns of crack use in Mexico and those in the United States and Western Europe, several key aspects distinguished crack users in this population: (1) self-regulated use; (2) non-linear progression of crack; and (3) the influence of the dimensions pertaining to setting, social networks, and social contract as contributing to understanding of the previous two. Further, we provide a discussion of how specific contextual factors in Mexico may be giving rise to these emerging patterns.

CONCLUSION

Compared to the U.S. and Europe, this study finds that the majority of crack users were able to self-regulate their use without major disruption to daily social functioning. As crack use spreads in Mexico and other Latin American countries, we need to recognize the importance of social context in developing more tailored health and social responses that are specific to these developing countries.

[The racialization of public health in the United States : the possibility that the concept be allowed to die out]

Résumé

Aux États-Unis, une intensification de l’usage de la race en santé publique a récemment été notée ; une idée qui est pourtant controversée dans les sciences. La race a été vue dans ce contexte comme un objet de discours entre pouvoirs et savoirs, un objet qui se réfère au corps devenu au cours des derniers siècles un site discursif pour représenter la différence. Cet article s’appuie sur une analyse de documents de la santé publique parus aux États-Unis et issus de bureaux fédéraux et d’une importante revue spécialisée dans le domaine sanitaire, qui ont été publiés entre 2001 et 2009. Cette étude a analysé la manière dont la race est représentée, produite comme objet de connaissance et régulée par les pratiques discursives dans ces documents. Les résultats décrivent deux processus enchevêtrés, la racialisation et la sanitarisation, qui concourent à reformuler l’idée de race. Le premier est un ensemble d’opérations qui visent à identifier, à situer et à opposer les sujets et les groupes à partir de labels standardisés. La sanitarisation assure la traduction des groupes racialisés en termes de maladies, de comportements, de vie ou de mort. Ces pratiques aboutissent à la caractérisation et à la formation d’objets racialisés et sanitarisés et à des stéréotypes ; un ensemble d’opérations qui a tendance à naturaliser la différence. La racialisation apparaît également tiraillée entre un pouvoir sur la vie et un droit de laisser mourir. Enfin, cette étude propose aux acteurs de la santé publique de sortir des frontières imposées par le discours racialisant.

HIV risk perception and behavior among sex workers in three major urban centers of Mozambique

HIV risk perceptions and behaviors of 236 commercial sex workers from three major Mozambican urban centers were studied using the International Rapid Assessment, Response and Evaluation (I-RARE) methodology. All were offered HIV testing and, in Maputo, syphilis testing was offered as well. Sixty-three of the 236 opted for HIV testing, with 30 (48%) testing positive for HIV. In Maputo, all 30 receiving HIV tests also had syphilis testing, with 6 (20%) found to be positive. Results include interview excerpts and qualitative results using I-RARE methodology and AnSWR-assisted analyses of the interviews and focus group sessions.

Synthesizing evidence-based strategies and community-engaged research: a model to address social determinants of health

Addressing social determinants of health (SDH) requires multileveled intervention designs. Increasingly, organizations and coalitions face pressure to use evidence-based strategies when seeking to address SDH. Evidence-based strategies, however, must be locally relevant and integrated into existing systems to function efficiently. We propose the incorporation of an effective rapid assessment technique, Rapid Assessment, Response, and Evaluation (RARE), with evidence-based strategies, findings, and recommendations embedded in community-engaged research to increase the likelihood of success in addressing SDH. Our RARE project--a partnership among a community health center, a nonprofit funding agency, and academic faculty researchers--resulted in community- and policy-level interventions for the prevention of childhood obesity in a Southwestern U.S. city.

Potential use of school absenteeism record for disease surveillance in developing countries, case study in rural Cambodia

BACKGROUND

Disease surveillance allows prospective monitoring of patterns in disease incidence in the general community, specific institutions (e.g. hospitals, elderly care homes), and other important population subgroups. Surveillance activities are now routinely conducted in many developed countries and in certain easy-to-reach areas of the developing ones. However due to limited health resources, population in rural area that consisted of the most the vulnerable groups are not under surveillance. Cheaper alternative ways for disease surveillance were needed in resource-limited settings.

METHODS AND FINDINGS

In this study, a syndromic surveillance system using disease specific absenteeism rates was established in 47 pre-schools with 1,417 students 3-6 y of age in a rural area of Kampot province, Cambodia. School absenteeism data were collected via short message service. Data collected between 1st January and 31st December 2012 was used for system evaluation for future potential use in larger scale. The system appeared to be feasible and acceptable in the rural study setting. Moderate correlation was found between rates of school absenteeism due to illness and the reference data on rates of attendance at health centers in persons <16 y (maximum cross-correlation coefficient = 0.231 at lag = -1 week).

CONCLUSIONS

School absenteeism data is pre-existing, easily accessible and requires minimum time and resources after initial development, and our results suggest that this system may be able to provide complementary data for disease surveillance, especially in resource limited settings where there is very little information on illnesses in the community and traditional surveillance systems are difficult to implement. An important next step is to validate the syndromic data with other forms of surveillance including laboratory data.

Crime Victimization Among Immigrant Latino Day Laborers in Post-Katrina New Orleans

Reports indicate that the criminal victimization of Latino immigrants in the United States has been increasing yet is often underreported. This may be especially true in new immigrant settlement cities that lack an established Latino community to provide support and feelings of security. New Orleans is an important context to investigate criminal victimization as it has experienced a large demographic shift in Latino composition post–Hurricane Katrina. This ethnographic study elucidates the social processes and structural factors that contribute to the criminal victimization of Latino day laborers (LDLs) in New Orleans. Three emergent social processes associated to criminal victimization are discussed, including: (1) distinct settlement process; (2) chaos of the setting and lifestyle; and (3) high-risk exposure. LDLs’ experiences of crime victimization are also explored. Findings reveal distinct structural factors associated to new immigrant settlement cities that contribute to the heightened vulnerability of LDLs.

Is health a labour, citizenship or human right? Mexican seasonal agricultural workers in Leamington, Canada

Post-North American Free Trade Agreement (NAFTA) trade liberalisation combined with post-9/11 border securitisation means North America increasingly relies on pools of temporary foreign labour, particularly in the agricultural and service sectors. Despite being temporary, these workers often spend most of their years on foreign soil, living and working in isolated rural communities, far from their own families and communities. Migrants' mental and physical health suffers due to hazardous and stressful working conditions, sub-standard housing, lack of social support and limited access to health and social welfare services. Assuming access to health is a basic human right, who is responsible for the health of temporary foreign migrant workers? Is it the nation-state? or the Employers and/or unions? or Civil society? Research and practice show that a combined multisector approach is best; however, such initiatives are often uneven due to questions of sovereignty and citizenship rights. Community-based organisations (CBOs) have emerged to advocate for and serve migrants' social and welfare needs; analysis of CBO projects reveals an uneven application of rights to migrants. Using a comparative case study from Canada, this project contributes to understanding how civil-society helps to activate different types of health care rights for migrants, and to create an informed policy that provides migrant workers with access to a wider range of human and health rights.

Mobility, Latino Migrants, and the Geography of Sex Work: Using Ethnography in Public Health Assessments

Recent studies have documented frequent use of female sex workers among Latino migrant men in the southeastern United States, yet little is known about the context in which sex work takes place, or the women who provide these services. As anthropologists working in applied public health, we use rapid ethnographic assessment as a technical assistance tool to document local understandings of the organization and typology of sex work and patterns of mobility among sex workers and their Latino migrant clients. By incorporating ethnographic methods in traditional public health needs assessments, we were able to highlight the diversity of migrant experiences and better understand the health needs of mobile populations more broadly. We discuss the findings in terms of their practical implications for HIV/STD prevention and call on public health to incorporate the concept of mobility as an organizing principle for the delivery of health care services.

Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis

AIMS

The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data.

METHODS

Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities.

RESULTS

Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106 715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [OR = 2.09, 95% confidence interval (CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR = 2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs-I(2)  = 75.3%: interquartile range = 1.38-3.56-and an approximate Gaussian distribution of the log ORs.

CONCLUSIONS

Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.

Are cultural values and beliefs included in U.S. based HIV interventions?

OBJECTIVE

To determine the extent to which current United States based human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages.

METHOD

A comprehensive literature review was conducted to determine which published human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions incorporated aspects of cultural beliefs.

RESULTS

This review of 166 human immunodeficiency virus (HIV) prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts.

CONCLUSION

human immunodeficiency virus (HIV) interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual's risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices.

Seeking consent to genetic and genomic research in a rural Ghanaian setting: a qualitative study of the MalariaGEN experience

Background

Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study.

Methods

The study used a rapid assessment incorporating multiple qualitative methods including in depth interviews, focus group discussions and observations of consent processes. Differences between verbal information provided during community engagement processes, and consent processes during the enrolment of cases and controls were identified, as well as the factors influencing the tailoring of such information.

Results

MalariaGEN participants and field staff seeking consent were generally satisfied with their understanding of the project and were familiar with aspects of the study relating to malaria. Some genetic aspects of the study were also well understood. Participants and staff seeking consent were less aware of the methodologies employed during genomic research and their implications, such as the breadth of data generated and the potential for future secondary research.

Moreover, trust in and previous experience with the Navrongo Health Research Centre which was conducting the research influenced beliefs about the benefits of participating in the MalariaGEN study and subsequent decision-making about research participation.

Conclusions

It is important to recognise that some aspects of complex genomic research may be of less interest to and less well understood by research participants and that such gaps in understanding may not be entirely addressed by best practice in the design and conduct of consent processes. In such circumstances consideration needs to be given to additional protections for participants that may need to be implemented in such research, and how best to provide such protections.

Capacity building for research ethics committees with limited familiarity with genetic and genomic research, and appropriate engagement with communities to elicit opinions of the ethical issues arising and acceptability of downstream uses of genome wide association data are likely to be important.

The community-based participatory intervention effect of "HIV-RAAP"

OBJECTIVES

To design and test HIV-RAAP (HIV/AIDS Risk Reduction Among Heterosexually Active African American Men and Women: A Risk Reduction Prevention Intervention) a coeducational, culture- and gender-sensitive community-based participatory HIV risk reduction intervention.

METHODS

A community-based participatory research process included intervention development and implementation of a 7-session coeducational curriculum conducted over 7 consecutive weeks.

RESULTS

The results indicated a significant intervention effect on reducing sexual behavior risk (P=0.02), improving HIV risk knowledge (P=0.006), and increasing sexual partner conversations about HIV risk reduction (P= 0.001).

CONCLUSIONS

The HIV-RAAP intervention impacts key domains of heterosexual HIV transmission.

"Research participants want to feel they are better off than they were before research was introduced to them": engaging cameroonian rural plantation populations in HIV research

BACKGROUND

During a period of evolving international consensus on how to engage communities in research, facilitators and barriers to participation in HIV prevention research were explored in a rural plantation community in the coastal region of Cameroon.

METHODS

A formative rapid assessment using structured observations, focus group discussions (FGD), and key informant interviews (KIIs) was conducted with a purposive non-probabilistic sample of plantation workers and their household members. Eligibility criteria included living or working >1 year within the plantation community and age >18 years. Both rapid and in-depth techniques were used to complete thematic analysis.

RESULTS

Sixty-five persons participated in the study (6 FGDs and 12 KIIs). Participants viewed malaria and gastrointestinal conditions as more common health concerns than HIV. They identified three factors as contributing to HIV risk: concurrent sexual relationships, sex work, and infrequent condom use. Interviewees perceived that the community would participate in HIV research if it is designed to: (1) improve community welfare, (2) provide comprehensive health services and treatment for illnesses, (3) protect the personal information of participants, especially those who test positive for HIV, (4) provide participant incentives, (5) incorporate community input, and (6) minimize disruptions to "everyday life". Barriers to participation included: (1) fear of HIV testing, (2) mistrust of researchers given possible disrespect or intolerance of plantation community life and lack of concern for communication, (3) time commitment demands, (3) medical care and treatment that would be difficult or costly to access, and (4) life disruptions along with potential requirements for changes in behaviour (i.e., engage in or abstain from alcohol use and sex activities).

CONCLUSIONS

Consistent with UNAIDS guidelines for good participatory practice in HIV prevention research, study participants placed a high premium on researchers' politeness, trust, respect, communication, tolerance and empathy towards their community. Plantation community members viewed provision of comprehensive health services as an important community benefit likely to enhance HIV research participation.

Tailoring information provision and consent processes to research contexts: the value of rapid assessments

Guidance requires that consent processes for research be appropriately tailored to their cultural context. This paper discusses the use of rapid assessments to identify cultural and ethical issues arising when explaining research in studies in The Gambia and Ethiopia. The assessments provided insights into appropriate ways of providing information to minimize the risk of stigmatizing vulnerable research populations; research participants' views about the most important information to provide about research and their understandings of research; and perceived constraints upon reaching voluntary decisions about participation. These insights demonstrate that rapid assessments are a relatively quick and inexpensive intervention that can provide valuable information to assist in the tailoring of information provision and consent processes to research context while maintaining and enhancing participants' fundamental protections.

Use of geographic information systems technology to track critical health code violations in retail facilities available to populations of different socioeconomic status and demographics

Research shows that community socioeconomic status (SES) predicts, based on food service types available, whether a population has access to healthy food. It is not known, however, if a relationship exists between SES and risk for foodborne illness (FBI) at the community level. Geographic information systems (GIS) give researchers the ability to pinpoint health indicators to specific geographic locations and detect resulting environmental gradients. It has been used extensively to characterize the food environment, with respect to access to healthy foods. This research investigated the utility of GIS in determining whether community SES and/or demographics relate to access to safe food, as measured by food service critical health code violations (CHV) as a proxy for risk for FBI. Health inspection records documenting CHV for 10,859 food service facilities collected between 2005 and 2008 in Philadelphia, PA, were accessed. Using an overlay analysis through GIS, CHV were plotted over census tracts of the corresponding area. Census tracts (n = 368) were categorized into quintiles, based on poverty level. Overall, food service facilities in higher poverty areas had a greater number of facilities (with at least one CHV) and had more frequent inspections than facilities in lower poverty areas. The facilities in lower poverty areas, however, had a higher average number of CHV per inspection. Analysis of CHV rates in census tracts with high concentrations of minority populations found Hispanic facilities had more CHV than other demographics, and Hispanic and African American facilities had fewer days between inspections. This research demonstrates the potential for utilization of GIS mapping for tracking risks for FBI. Conversely, it sheds light on the subjective nature of health inspections, and indicates that underlying factors might be affecting inspection frequency and identification of CHV, such that CHV might not be a true proxy for risk for FBI.

Recent trends in hospital utilization and mortality for HIV infection: 2000-2005

OBJECTIVE

Ethnic minority populations have been disproportionately affected by the HIV disease. The objective of this report was to assess the prevalence and trend of HIV-related hospitalization and mortality in Florida in 2000 through 2005 by 6 sex- race/ethnic groups.

METHODS

Using data from the Florida Agency for Health Care Administration from 2000 through 2005, discharge records with primary or secondary diagnosis of HIV infection were included, and chi2 and Cochran-Armitage tests and multiple regression models were used in analyses.

RESULTS

Of all HIV-related hospitalizations (N = 159695), about 56%, 28%, and 12% of records belonged to blacks, whites, and Hispanics, respectively. The average proportions of HIV hospitalization during the period of 2000-2005 were approximately 29% (black male), 27% (black female), 22% (white male), 9% (Hispanic male), 6% (white female), and 3% (Hispanic female) (all p < .01). The frequencies of death were the highest among black males followed by black females, white males, Hispanic males, white females, and Hispanic females.

CONCLUSION

Sex-racial/ethnic disparities are evident in the HIV-related hospital utilizations and deaths. Further research is needed to understand the reasons for the disparities among hospitalized patients to reduce both health and economic consequences associated with HIV disease in Florida.