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Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection Among High-Risk Heterosexuals in New York City.

ABSTRACT: Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venue-based sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.

SUBMITTER: Gwadz M

PROVIDER: S-EPMC5341134 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:There has been little research into the thermal condition of the sleeping environment. Even less well documented and understood is how the sleeping thermal environment is affected by occupant behaviors such as the use of air-conditioning (AC) and electric fans, or window operations. In this paper we present results from a questionnaire survey administered to assess summertime bedroom thermal satisfaction and heat-coping strategies among New York City (NYC) residents. Specifically, we investigated current AC usage in bedrooms and examined alternate cooling strategies, cooling appliance usage patterns, and the motivations that drove these patterns during the 2015 summer. Among survey respondents (n=706), AC was the preferred heat-coping strategy, and for 30% of respondents was the only strategy used. Electric fan use and window opening were deemed ineffective for cooling by many respondents. Indeed, less than a quarter of all respondents ever opened windows to alleviate heat in their bedrooms. In general, people utilized strategies that modify the environment more than the individual person. Unsurprisingly, the frequency and overall use of AC were significantly associated with greater bedroom thermal satisfaction; however, setting AC to a lower temperature provided no additional benefit. In contrast, more frequent use of electric fans was associated with lower thermal satisfaction. In addition, 14.7% of all respondents did not have AC in their sleeping environment and 5.8% were without any AC at home. Despite the high penetration of AC ownership, usage cost was still a major concern for most. This work contributes to a better understanding of bedtime heat-coping strategies, cooling appliance usage patterns, and associated thermal satisfaction in NYC. The findings of this study suggest resident AC usage patterns may not be optimized for thermal satisfaction. Potential alternative cooling approaches could be explored to better balance maximizing thermal comfort while reducing energy consumption and environmental impact.

Project description:Importance:Internationally imported cases of measles into the United States can lead to outbreaks requiring extensive and rapid control measures. Importation of measles from an unvaccinated adolescent in 2013 led to what has been the largest outbreak of measles in New York City, New York, since 1992. Objective:To describe the epidemiology and public health burden in terms of resources and cost of the 2013 measles outbreak in New York City. Design, Setting, and Participants:This epidemiologic assessment and cost analysis conducted between August 15, 2013, and August 5, 2014, examined all outbreak-associated cases of measles among persons residing in New York City in 2013. Exposures:Measles virus. Main Outcomes and Measures:Numbers of measles cases and contacts. Total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene (DOHMH), calculated as the sum of inputs (supplies and materials, equipment, and logistics) and personnel time (salary and fringe benefits). Results:Between March 13, 2013, and June 9, 2013, 58 persons in New York City with a median age of 3 years (range, 0-32 years) were identified as having measles. Among these individuals, 45 (78%) were at least 12 months old and were unvaccinated owing to parental refusal or intentional delay. Only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH at the initial clinical suspicion. Many case patients were not immediately placed into airborne isolation, resulting in exposures in 11 health care facilities. In total, 3351 exposed contacts were identified. Total direct costs to the New York City DOHMH were $394?448, and a total of 10?054 hours were consumed responding to and controlling the outbreak. Conclusions and Relevance:Vaccine refusals and delays appeared to have propagated a large outbreak following importation of measles into the United States. Prompt recognition of measles along with rapid implementation of airborne isolation of individuals suspected of measles infection in health care facilities and timely reporting to public health agencies may avoid large numbers of exposures. The response and containment of measles outbreaks are resource intensive.

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Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection Among High-Risk Heterosexuals in New York City.

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