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BackgroundGetting and maintaining Hepatitis C Virus (HCV) cure is challenging among people experiencing homelessness (PEH) as a result of critical social determinants of health such as unstable housing, mental health disorders, and drug and alcohol use.ObjectivesThe purpose of this exploratory pilot study was to compare a registered nurse/community health worker (RN/CHW)-led HCV intervention tailored for PEH, "I am HCV Free," with a clinic-based standard of care (cbSOC) for treating HCV. Efficacy was measured by sustained virological response at 12 weeks after stopping antivirals (SVR12), and improvement in mental health, drug and alcohol use, and access to healthcare.MethodsAn exploratory randomized controlled trial design was used to assign PEH recruited from partner sites in the Skid Row Area of Los Angeles, California, to the RN/CHW or cbSOC programs. All received direct-acting antivirals. The RN/CHW group received directly observed therapy in community-based settings, incentives for taking HCV medications, and wrap-around services, including connection to additional healthcare services, housing support, and referral to other community services. For all PEH, drug and alcohol use and mental health symptoms were measured at month 2 or 3 and 5 or 6 follow-up, depending on HCV medication type, while SVR12 was measured at month 5 or 6 follow-up.ResultsAmong PEH in the RN/CHW group, 75% (3 of 4) completed SVR12 and all three attained undetectable viral load. This was compared with 66.7% (n = 4 of 6) of the cbSOC group who completed SVR12; all four attained undetectable viral load. The RN/CHW group, as compared to the cbSOC, also showed greater improvements in mental health, and significant improvement in drug use, and access to healthcare services.DiscussionWhile this study shows significant improvements in drug use and health service access among the RN/-CHW group, the sample size of the study limits the validity and generalizability of the results. Further studies using larger sample sizes are necessitated.

Posttraumatic stress symptoms are a pressing issue among women experiencing incarceration and homelessness. Baseline data were collected among formerly incarcerated homeless women (N = 130) who were on average 38.9 (SD = 11.36, range 19-64) years of age and recruited into a pilot randomized control trial (RCT) intervention program. A logistic regression was used to assess correlates of PTSD symptoms. The majority of the sample self-reported witnessing violence (85%) and had moderate PTSD symptoms (M = 1.61, SD = 1.62, range: 0-4). No past month drug use (p = 0.006), higher anger scores (p = 0.002), greater emotional support (p = 0.009), and psychological frailty (p = 0.02) were significantly associated with higher odds of PTSD symptoms. Moreover, women who experienced minor family conflicts had lower odds of PTSD symptoms relative to those that had family conflicts most of the time (p = 0.02). Similarly, controlling for all other variables, women who had a higher positive social interaction score also had lower odds of PTSD symptoms (p = 0.006). These findings are a call to action for academicians, service providers, and health practitioners to develop an intervention which integrates comprehensive PTSD screening, and discussion of ways to build coping skills, relationships with family and social networks, and utilizes a trauma-informed approach during reentry.

People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post‐traumatic stress disorder as compared with the general population. Heart rate variability‐biofeedback (HRV‐BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV‐BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV‐BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV‐BF or an active HP control group and received eight weekly, 30‐min sessions over two months, delivered by a nurse‐led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8‐week session, and/or 2‐month follow‐up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV‐BF and HP interventions showed significant increases in HRV from baseline to 2‐month follow‐up, with no significant difference between the intervention groups. The HRV‐BF programme revealed a somewhat greater, although non‐significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV‐BF and HP intervention. [ABSTRACT FROM AUTHOR]

We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6 months (p = 0.016) and adherence, with adherence decreasing with each additional OI for 0-5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence.

* Context.--Small case series have evaluated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in formalin-fixed, paraffin-embedded tissue using reverse transcription-polymerase chain reaction, immunohistochemistry (IHC), and/or RNA in situ hybridization (RNAish). Objective.--To compare droplet digital polymerase chain reaction, IHC, and RNAish to detect SARS-CoV-2 in formalin-fixed, paraffin-embedded tissue in a large series of lung specimens from coronavirus disease 2019 (COVID-19) patients. Design.--Droplet digital polymerase chain reaction and RNAish used commercially available probes; IHC used clone 1A9. Twenty-six autopsies of COVID-19 patients with formalin-fixed, paraffin-embedded tissue blocks of 62 lung specimens, 22 heart specimens, 2 brain specimens, and 1 liver, and 1 umbilical cord were included. Control cases included 9 autopsy lungs from patients with other infections/inflammation and virus-infected tissue or cell lines. Results.--Droplet digital polymerase chain reaction had the highest sensitivity for SARS-CoV-2 (96%) when compared with IHC (31%) and RNAish (36%). All 3 tests had a specificity of 100%. Agreement between droplet digital polymerase chain reaction and IHC or RNAish was fair ([kappa] = 0.23 and [kappa] = 0.35, respectively). Agreement between IHC and in situ hybridization was substantial (k = 0.75). Interobserver reliability was almost perfect for IHC ([kappa] = 0.91) and fair to moderate for RNAish ([kappa] = 0.380.59). Lung tissues from patients who died earlier after onset of symptoms revealed higher copy numbers by droplet digital polymerase chain reaction (P =.03, Pearson correlation = -0.65) and were more likely to be positive by RNAish (P =.02) than lungs from patients who died later. We identified SARS-CoV-2 in hyaline membranes, in pneumocytes, and rarely in respiratory epithelium. Droplet digital polymerase chain reaction showed low copy numbers in 7 autopsy hearts from ProteoGenex Inc. All other extrapulmonary tissues were negative. Conclusions.--Droplet digital polymerase chain reaction was the most sensitive and highly specific test to identify SARS-CoV-2 in lung specimens from COVID-19 patients. (Arch Pathol Lab Med. 2021;145:785-796; doi: 10.5858/arpa.2021-0008-SA), Coronavirus disease 2019 (COVID-19), the disease that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can be life-threatening, largely because of development of acute respiratory distress syndrome. [...]

The number of HIV-AIDS cases among African American women (AAW) continues to rise. AAW currently account for about 65% of AIDS diagnoses among women in the United States. Furthermore, among AAW living with HIV-AIDS, heterosexual transmission remains the leading cause of HIV spread. Indeed, examining AAWs sex partner selection patterns will be a key step in understanding how to support HIV prevention for this population. A grounded-theory study was conducted to examine what factors influence AAW's alternation between monogamous and nonmonogamous sexual relationships. To explore this phenomenon, we recruited 14 urban AAW between the ages of 18 and 30 for interviews. The findings revealed that AAW's sex partner selection patterns in consensual sexual relationships were influenced by the "getting-to-know" process, the male's relationship preference, a woman's risk perception, and how the role of sex is defined. The results of this study can provide insights for future interventions seeking to curb HIV rates among AAW from urban communities. © The Author(s) 2012.

BackgroundThe Centers for Disease Control and Prevention (CDC) has reported that the number of new cases of HIV infection has been underreported annually by at least 40,000 cases. In 2006, the CDC recommended that voluntary HIV counseling and testing (VCT) was given to all patients aged 13 to 64 years in ambulatory care settings. The purpose of this qualitative study was to explore primary care providers' (PCP) perspectives on and experiences of facilitators and barriers to offering VCT as part of annual screening.MethodsThis was a descriptive, exploratory study where fifteen primary care providers were individually interviewed. Only community-based primary care providers were interviewed, and no obstetrician/gynecologists were enrolled, as VCT is standard of care in that specialty.ResultsBarriers included doubts about the CDC recommendation, time constraints, fear, and assumptions about age and marital status. Facilitators included normalizing HIV testing and the availability of resources and training. PCPs' role as an advocate and their professional style had the paradoxical potential of being both a barrier and a facilitator to VCT. Providers' ability to connect patients to community resources was linked to their persistence and experience.ConclusionsFindings suggest more effort is needed by PCPs to facilitate HIV counseling and testing more frequently to their ambulatory care patients.