Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts

The U.S. Ryan White HIV/AIDS Program (RWHAP) funds comprehensive services for people living with HIV to support viral suppression (VS). We analyzed five years of RWHAP data from the Minneapolis-St. Paul region to (1) assess variation and (2) evaluate the causal effect of each RWHAP service on sustained VS by race/ethnicity. Sixteen medical and support services were included. Descriptive analyses assessed service use and trends over time. Causal analyses used generalized estimating equations and propensity scores to adjust for the probability of service use. Receipt of AIDS Drug Assistance Program and financial aid consistently showed higher probabilities of sustained VS, while food aid and transportation aid had positive impacts on VS at higher levels of service encounters; however, the impact of services could vary by race/ethnicity. For example, financial aid increased the probability of sustained VS by at least 3 percentage points for white, Hispanic and Black/African American clients, but only 1.6 points for Black/African-born clients. This study found that services addressing socioeconomic needs typically had positive impacts on viral suppression, yet service use and impact of services often varied by race/ethnicity. This highlights a need to ensure these services are designed and delivered in ways that equitably serve all clients.

Barriers, opportunities, and potential costs of expanding HIV support services

Experiencing housing instability, food insecurity, and financial stress can negatively impact retention in care and treatment adherence for people living with HIV. Expanding services that support socioeconomic needs could help improve HIV outcomes. Our objective was to investigate barriers, opportunities, and costs of expanding socioeconomic support programs. Semi-structured interviews were conducted with organizations serving U.S. Ryan White HIV/AIDS Program clients. Costs were estimated from interviews, organization documents, and city-specific wages. Organizations reported complex patient, organization, program, and system challenges as well as several opportunities for expansion. The average one-year per-person cost for engaging new clients was $196 for transportation, $612 for financial aid, $650 for food aid, and $2498 for short-term housing (2020 USD). Understanding potential expansion costs is important for funders and local stakeholders. This study provides a sense of magnitude for costs to scale-up programs to better meet socioeconomic needs of low-income patients living with HIV.

Plasma vasopressin concentrations in healthy foals from birth to 3 months of age

BACKGROUND

Arginine vasopressin (AVP) has received increased attention in equine critical care but there is minimal information of AVP concentration in foals. The clinical usefulness of measuring AVP in ill foals depends on knowledge of age-related changes in AVP concentrations in healthy foals.

HYPOTHESIS

Plasma AVP concentrations will be significantly different when measured from birth to 3 months of age in healthy foals.

ANIMALS

Thirteen healthy university-owned foals.

METHODS

Prospective, observational study. Blood was collected from healthy foals at birth and 3, 5, 7, 10, 14, 21, 28, 42, 56, and 84 days of age. Plasma was harvested and plasma AVP concentrations were determined by radioimmunoassay.

RESULTS

No statistically significant differences were detected in plasma AVP concentrations over the study period. Plasma AVP concentrations over the entire study period was 6.2+/-2.5 pg/mL.

CONCLUSIONS AND CLINICAL IMPORTANCE

There was no age-related variation in plasma AVP concentrations detected in healthy foals from birth to 3 months of age suggesting that AVP concentrations are similar across foals of these ages.

Measurement of cashmere yield and mean fibre diameter using the optical fibre diameter analyser

A new technique was developed to measure the yield and mean fibre diameter of cashmere. The fibre diameter distribution of 2-mm snippets measured by the Optical Fibre Diameter Analyser (OFDA) was used to calculate cashmere yield of a goat fleece without dehairing. The total volume of fibres <35 and >35 �m was then calculated from the diameter distribution, and from this it was possible to predict the cashmere yield of 6 standards ranging from 10 to 60% yield (r2 = 0.98, n = 30). In addition, the Shirley Analyser was compared with the OFDA technique for measuring cashmere yield (r2 = 0.59, n = 110). OFDA estimates of cashmere yield were on average 10% higher (standard deviation � 7%) than those of the Shirley Analyser, indicating poor agreement between the 2 techniques. This is likely to be due to the Shirley Analyser and OFDA estimates of cashmere yield being affected by different fibre properties of the fleeces. There was good agreement between the Fibre Diameter Analyser (FDA) and the OFDA for measuring mean fibre diameter (MFD) of dehaired cashmere samples (r2 = 0.97, n = 108). There was also a good agreement in estimates of cashmere MFD between whole fleece and dehaired cashmere samples measured by the OFDA (r2 = 0.97, n = 77). Calculation of cashmere yield and down MFD by the OFDA has shown it to be accurate for measuring standard samples, and as precise as the Shirley Analyser. Therefore, the use of the OFDA is a potential low cost alternative to rank the value of cashmere goats for breeding.