American journal of preventive medicine
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This study aims to assess the public health impact of eliminating a longstanding routine HIV screening program and replacing it with targeted testing. In addition, costs, outcomes, and cost effectiveness of routine screening are compared with those of targeted testing in the Fulton County Jail, Atlanta, Georgia. ⋯ Routine HIV screening in high-prevalence jails is cost effective and has a larger impact on public health than targeted testing. Prioritizing sustained funding for routine, jail-based HIV screening programs in high-prevalence areas may be important to realizing the national HIV prevention goals.
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The Southeast U.S. and Georgia in particular are disproportionally affected by HIV. A major barrier in Georgia to meeting the goals of Ending the HIV Epidemic in the U.S is lack of proximity to HIV care. To address this and other barriers, Georgia implemented a comprehensive HIV telehealth system, including telemedicine to provide remote care through clients' local medical homes. In addition, a telementoring program (Project Extension for Community Healthcare Outcomes) was initiated to strengthen the HIV provider workforce in Georgia. ⋯ In Georgia, HIV telehealth has been successful at bridging gaps in patient care and in training local providers to offer comprehensive HIV care. Continuing challenges include integration of electronic health records with the telehealth platform, privacy and data security, equitable reimbursement, and lack of digital devices and Internet service access among some rural patients.
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Review Meta Analysis
Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis.
Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). ⋯ Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.
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The HIV epidemic in King County, Washington has traditionally been highly concentrated among men who have sex with men, and incidence has gradually declined over 2 decades. In 2018, King County experienced a geographically concentrated outbreak of HIV among heterosexual people who inject drugs. ⋯ This outbreak shows the vulnerability of people who inject drugs to HIV infection, even in areas with robust syringe service programs and declining HIV epidemics. Although molecular HIV surveillance did not identify this outbreak, it may have done so with a lower threshold for defining clusters and more rapid receipt and analyses of HIV genetic sequences.