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BackgroundDespite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.ObjectiveTo review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.DiscussionCurrent national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered care, empowering patients through counseling and support, maintaining a rights-based approach while acknowledging the responsibility of health care systems in providing comprehensive care, and prioritizing critical research gaps.ConclusionIt is time to re-invent our understanding of adherence in drug-resistant TB and HIV by focusing attention on the complex clinical, behavioral, social, and structural needs of affected patients and communities.

Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 ( n = 398) and 2018 ( n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.

Despite evidence showing rising suicidality among lesbian, gay, and bisexual (LGB) and Black adolescents, separately, there is scant research on suicide risk trajectories among youth groups across both racial and sexual identities. Thus, we examined trajectories of self-reported suicidal ideation and attempt and their associations with bullying among New York City-based adolescents. We analyzed 2009-2019 NYC Youth Risk Behavior Survey data. We ran weighted descriptive and logistic regression analyses to test for trends in dichotomous suicidal ideation, suicide attempt, bullying at school, and e-bullying variables among students across both race/ethnicity and sexual identity. We assessed associations between suicidality trends and bullying with logistic regressions. Models controlled for age and sex. Suicidal ideation and attempt were 2 and 5 times more likely among LGB than heterosexual participants, respectively. Bullying at school and e-bullying were 2 times more likely among LGB than heterosexual participants. Black LGB participants were the only LGB group for which both suicidal ideation (AOR = 1.04, SE = .003, p < .001) and attempt (AOR = 1.04, SE = .004, p < .001) increased over time. Both increased at accelerating rates. Conversely, White LGB participants were the only LGB group for which both suicidal ideation (AOR = 0.98, SE = .006, p < .001) and attempt (AOR = 0.92, SE = .008, p < .001) decreased over time. These changes occurred in parallel with significant bullying increases for Black and Latina/o/x LGB adolescents and significant bullying decreases for White LGB adolescents. Bullying was positively associated with suicidal ideation and attempt for all adolescents. Findings suggest resources aimed at curbing rising adolescent suicide should be focused on Black LGB youth., (© 2024. The Author(s).)

Background: There is a lack of established clinical outcomes for patients with myelofibrosis (MF) receiving fedratinib following ruxolitinib failure. This study examined real-world patient characteristics, treatment patterns, and clinical outcomes of patients with MF treated with fedratinib following ruxolitinib failure in US clinical practice., Patients and Methods: This retrospective patient chart review included adults with a physician-reported diagnosis of MF, who initiated fedratinib after discontinuing ruxolitinib. Descriptive analyses characterized patient characteristics, clinical outcomes, and treatment patterns from MF diagnosis through ruxolitinib and fedratinib treatment., Results: Twenty-four physicians abstracted data for 150 eligible patients. Approximately 55.3% of the patients were male, 68.0% were White, and median age at MF diagnosis was 68 (range, 35-84) years. Median duration of ruxolitinib therapy was 7.6 (range, 0.7-65.5) months. At initiation of fedratinib, 88.0% of patients had palpable spleen and a mean spleen size of 16.0 (standard deviation [SD], 5.9) cm. Spleen size decreased by 19.4% to 13.2 (SD, 7.9) cm at month 3 (P = .0001) and by 53.4% to 7.2 (SD, 7.4) cm at month 6 (P = .01) of fedratinib treatment, respectively. Almost one-third (26.8%) of patients had achieved ≥ 50% spleen reduction by month 6. Mean number of symptoms also decreased significantly at month 3 (P < .0001) and month 6 (P = .01)., Conclusion: Fedratinib appears to deliver spleen and symptom benefits in real-world patients with MF previously treated with ruxolitinib., Competing Interests: Disclosure J.M. reports research funding paid to institution from AbbVie, BMS, CTI BioPharm, Geron, Incyte, Kartos, Novartis, PharmaEssentia, and Roche; consulting fees from AbbVie, BMS, CTI BioPharm, Galecto, Geron, GSK, Incyte, Kartos, Karyopharm, MorphoSys, Novartis, PharmaEssentia, Roche, and Sierra Oncology. C.H. reports research funding from BMS/Celgene, Constellation Pharmaceuticals, a MorphoSys Company, and Novartis; and advisory role and speaker funding from Abbvie, AOP Orphan Pharmaceuticals, BMS/Celgene, CTI BioPharma, Galacteo, Geron, Gilead, Janssen, Keros, Novartis, Promedior, Roche, and Shire. T.A.S., D.L., M.G., and T.A.M. report employment with Cardinal Health. S.M. and A.M. report employment with BMS. D.T. and I.S.D. report employment with and stock ownership in BMS. P.A. reports no conflicts of interest. J.K. reports employment with and stock ownership in Cardinal Health at the time this study was conducted. B.A.F. reports research funding from BMS; and stock ownership in and employment with Cardinal Health. A.T.G. reports consulting for AbbVie, BMS/Celgene, CTI BioPharma, Constellation Pharmaceuticals, a MorphoSys Company, GSK/Sierra Oncology, Incyte, Kartos, Novartis, and PharmaEssentia., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: SM reports consultancy, research funding from AbbVie and Blueprint Medicines; consultancy, research funding, honoraria from Acceleron Pharma and BMS/Celgene; honoraria from Aplastic Anemia and MDS International Foundation and Partnership for Health Analytic Research, LLC; consultancy from BioPharm and Genentech; consultancy, honoraria from EUSA Pharma; research funding from Jazz Pharmaceuticals; honoraria, hematology‐oncology board review editor from McGraw Hill; and consultancy, research funding from Novartis. CB‐B, EB, and JL report employment from Cardinal Health Specialty Solutions. AF and MG report employment at the time of this study from Cardinal Health Specialty Solutions. AYM reports employment and stock ownership from Bristol Myers Squibb. DH and AM report employment from Bristol Myers Squibb.

Communities marginalized because of racism, heterosexism, and other systems of oppression have a history of being aggressively policed, and in those contexts, researchers have observed associations between a range of negative experiences with police and poor physical, mental, and behavioral health outcomes. However, past studies have been limited in that experiences of police contacts were aggregated at the neighborhood level and, if police contacts were self-reported, the sample was not representative. To address these limitations, we employed NYC Department of Health and Mental Hygiene 2017 Social Determinants of Health Survey (n = 2335) data to examine the associations of self-reported police contacts and discrimination by police and the courts with measures of physical (poor physical health), mental (poor mental health, serious psychological distress), and behavioral health (binge drinking). Residents marginalized because of racial, ethnic, and sexual minority status were more likely to be stopped, searched, or questioned by the police; threatened or abused by the police; and discriminated against by the police or in the courts; those experiences were associated with poor physical, mental, and behavioral health outcomes. The associations between experiences with police and poor health outcomes were strongest among Black residents and residents aged 25-44. Our findings suggest that the health of NYC residents who have had exposure to police and experienced discrimination by the police and courts is poorer than those who have not, and build on a growing body of evidence that aggressive policing practices have implications for public health., (© 2021. The Author(s).)

Background and Objectives: Engaging communities in authentic partnerships is increasingly accepted as best practice in both medicine and public health, despite the many barriers to doing so. New medical schools have an opportunity to incorporate community engagement into their very foundation. In rural northeast Pennsylvania, a new medical school used a regional health assessment to engage community partners across the 16 counties it serves., Methods: A community health advisory board guided the development and implementation of a key informant focus group methodology. Twenty-three focus groups were held. Themes were generated using content analysis involving 21 observers along with the principal investigators., Results: A total of 221 representatives of 195 agencies from across the region participated. Twelve themes relating to needs were discussed in more than 75% of focus groups. The findings revealed barriers to improving health in the region, including lack of access to preventive services, to primary care and specialty providers, and to basic mental health services. Consistent themes related to strengths and expectations for the new medical school also emerged., Conclusions: Holding focus groups across the region allowed community service providers to connect to a new medical school, despite distances in the rural region. Partnerships with community agencies and providers are evolving. Findings from the study regarding needs and strengths in rural communities have been incorporated into the school's curriculum and research agenda. Dissemination efforts have focused on communicating findings to community partners in formats and venues that are useful for them.

Background: Barriers to prenatal care have been extensively investigated in low-income and inner-city communities. Less attention has been directed to the study of prenatal care among middle- and upper-class pregnant women. This study describes perceived barriers and factors associated with late initiation of prenatal care in a predominantly middle- to upper-class midwestern community., Methods: Consenting women in Olmsted County, Minnesota, who were attending a clinic for their first obstetric visit completed a self-administered questionnaire that queried the presence of factors making it difficult to receive prenatal care, perception about the importance of prenatal care, expectations at the first prenatal care visit, and sociodemographic factors., Results: Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women reported external barriers to receiving prenatal care. These factors included difficulty in getting an appointment (46.9%), problems finding child care (26.5%), and lack of transportation (14.3%). In multivariable logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very important (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7-9.7); external barriers to prenatal care (OR = 2.9, 95% CI, 1.6-5.4); annual income < $17,000 (OR = 2.9, 95% CI, 1.5-5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3-3.5). Multiparous women and women older than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5-14.6 and OR = 2.9, 95% CI, 1.2-6.8, respectively)., Conclusions: These findings suggest that perceptions about the importance of prenatal care may play a greater role in the initiation of care among this group of women than is recognized. Women with more experience with pregnancy appear to place slightly less importance on prenatal care.