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Background: Coronavirus Disease 2019 (COVID-19) pandemic disrupted routine program implementation worldwide with significant impact on quality and extent of technical oversight of implementation. Diverse digital reporting solutions and online meetings were some strategies designed to bridge program implementation supervision and reporting gaps worldwide. This paper evaluates usefulness and efficiency of digital solutions deployed by USAIDNigeria to ensure adequate oversight to sustain access and reporting of HIV viral load (VL) services Methods: To promote accountability and encourage peer-to-peer review and learning among USAID Implementing Partners, daily reporting via digital platforms and virtual weekly peer-review meetings were introduced. This enabled USAID team to monitor IPs' performance at health facilities and during community VL drives against set targets of 100% and 95% patient VL coverage and suppression (VLC/S) respectively. The platforms include National Laboratory Information Management System, remote sample login and Googlebased VL Status and Daily Lab Performance dashboards. This study assesses uptake of VL services and clinical outcomes in 16 states of Nigeria between October2019 through March2021 during various levels of COVID-19 lock down. Chi Square test was used to compare the pre-COVID (October2019-March2020), during lockdown (April2020-September2020) and post-COVID lockdown (October2020-March2021) performances at 95 confidence interval and < 0.05 level of significance. Result(s): Significant improvements in VL indicators were reported among eight USAID partners across 16 states. Pre-COVID, 591,906 clients on treatment were eligible for VL monitoring, 455,099 were tested and had documented VL results with a 76.9% and 89% VLC/S. During-COVID lockdown, 685,915 became eligible for VL monitoring, 531,371 had documented VL results, with 77.5% and 90% VLC/S. VLC/S increased to 93% each post-COVID lockdown, when 771,149 had documented VL out of 833,463 eligible. There was a significant increase number of clients on treatment who became eligible for VL test and had documented VL results and suppression from pre- during-COVID, and post-COVID lockdown (p=0.001) Conclusion(s): Digital solutions deployed by USAID were instrumental to sustaining service delivery with significant growth in access and efficiency to HIV VL services in 16 States in Nigeria despite impact of COVID-19. Program managers should continue to explore cost-efficient innovative approaches for program oversight.
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Purpose: In the U.S., 30 million people have an eating disorder (ED) and 95% are between 12 and 25. ED diagnoses are increasing and have high mortality. EDs require frequent medical visits for optimal care. However, ED specialty care in the U.S. is limited by both number of available providers and geographic location. The COVID-19 pandemic forced organizations to rely on telehealth to provide medical care, including specialty services. The impact of availability and quality of telehealth on the medical management of eating disorders is largely unknown. We hypothesize telehealth provides expanded access for eating disorder medical care and quality of care is preserved, whether patients are seen in person versus telehealth. Methods: We conducted a retrospective analysis of patients, ages 10-26, seen at Stanford Children's Health Eating Disorder Clinic (EDC) with ED related ICD10 codes. Two time periods represent pre pandemic period (pre, February 2018 to 2020) and post pandemic period (post, June 2020 to 2022). Data were ed from the Stanford Research Repository Tool. Preliminary analyses were conducted: descriptive statistics explored the cohort's demographic characteristics, telehealth and in-person visits, visit status (completed or missed) and hospital admissions. Results: There were 525 patients seen in EDC in the pre and 703 seen post. For completed EDC visits pre, there were 5.96 completed clinic visits per patient, largely in-person with a small number of telehealth visits (0.12 per patient). Post there were 2.82 completed clinic visits per patient in-person only, 5.25 completed clinic visits per patient via telehealth only, and 9.81 completed clinic visits per patient using both medians. For length of stay pre was 6.9 days vs. 8.4 days for those seen in person and via telehealth. Interestingly, patients seen via telehealth only had a length of stay of 4.8 days and 6.9 days for in-person only. On average, there were 0.79 hospital admissions per patient Pre compared to 0.91 hospital admissions per patient seen via telehealth and in-person Post. (Table 1) There is an increase of patients in EDC during post compared to pre. There is an increase in clinic visits for patients seen via both telehealth and in-person compared to telehealth or in-person only. There is an increase in hospital length of stay in post compared to pre, and an increasing trend of length of stay in-person visits only, telehealth visits only to a combination of both during post. There is also an increasing trend of admissions in-person visits only, telehealth visits only to a combination of both during post. Conclusions: Analysis revealed an overall increase in patients seen for eating disorders in the post-pandemic period, with trends that overall utilization (clinic visits, length of stay and hospital admissions) are higher for patients engaging both telehealth and in-person. Next steps include an evaluation of variables associated with in-person and telehealth visits, particularly as they impact quality of care. Sources of Support: N/A.
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Two economists take readers on a tour of the economics of legal and illegal weed, showing where cannabis regulation has gone wrong and how it could do better. Cannabis "legalization" hasn't lived up to the hype. Across North America, investors are reeling, tax collections are below projections, and people are pointing fingers. On the business side, companies have shut down, farms have failed, workers have lost their jobs, and consumers face high prices. Why has legal weed failed to deliver on many of its promises? Can Legal Weed Win? takes on the euphoric claims with straight dope and a full dose of economic reality. This book delivers the unadulterated facts about the new legal segment of one of the world's oldest industries. In witty, accessible prose, economists Robin Goldstein and Daniel Sumner take readers on a whirlwind tour of the economic past, present, and future of legal and illegal weed. Drawing upon reams of data and their own experience working with California cannabis regulators since 2016, Goldstein and Sumner explain why many cannabis businesses and some aspects of legalization fail to measure up, while others occasionally get it right. Their stories stretch from before America's first medical weed dispensaries opened in 1996 through the short-term boom in legal consumption that happened during COVID-19 lockdowns. Can Legal Weed Win? is packed with unexpected insights about how cannabis markets can thrive, how regulators get the laws right or wrong, and what might happen to legal and illegal markets going forward. © 2022 by Robin S. Goldstein and Daniel A. Summer.
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Background: Since 2004, USAID Nigeria has supported the provision of antiretroviral therapy (ART) to 575,000 people living with HIV (PLHIV) in Nigeria through PEPFAR. Six decentralized drug distribution (DDD) ART delivery models were implemented in Akwa Ibom and Cross River states to improve continuous access to treatment for PLHIV, with the goal of achieving long-term retention in care and viral suppression. Methods: A retrospective analysis of 85,245 treatment patients who began ART between October 2001 and December 2020 was conducted. Patient data was extracted from electronic record systems and anonymized. All patients on first-line ART were included. Retention was defined as being alive and remaining on ART after initiation for at least 12 months after starting ART. While eligibility to all DDD models was restricted to stable patients, Community Pharmacy ART Refills Program (CPARP), Community ART Refill Clubs (CARCs), Family-Centered ART Refills Groups (F-CARGs), Fast-track clinic, and Adolescents Refill Clubs (ARCs) were all expanded to include stable and unstable patients after the onset of COVID-19. The Self-forming Community ART Refill Groups (S-CARG) model remained open only to stable patients. The Kaplan-Meier method was used to estimate retention probabilities, and Cox Proportional Hazards model was used to examine factors associated with retention. Results: Of the total sample, 63,175 (74%) remained on treatment and 13,800 (16%) experienced treatment interruption/LTFU. Median age at ART initiation was 39 years (IQR:32-47) and 69% of the cohort was female. Overall retention probability was 95%, 72% and 62% at 12, 24 and 36 months, respectively. The median retention time in the CPARP model was 73 months (95%CI: 71-74) compared to 49, 47, 18, 16, and 14 months in the CARC, Fast-track, ARC, F-CARG, and S-CARG models, respectively, log-rank test (p<.001). CARC DDD model [Hazard Ratio (HR):0.70 (0.66-0.73), ref: ARC], CPARP [HR:0.56 (0.53-0.60), ref: ARC], Fast-track [HR:0.70 (0.79-0.83), ref: ARC], female sex [HR:0.96 (0.94-0.97), ref: male], and 15+ years Age [HR:0.80 (0.77-0.84), ref: <15 years] were associated with long-term retention;while unemployed Occupation [HR:1.10 (1.08-1.13), ref: employed] and senior secondary Education [HR:1.20 (1.14-1.26), ref: junior secondary] were associated with short-term retention. Conclusion: Decentralized Drug Delivery models were associated with improved rates of continuity of ART treatment in a large real-world cohort in Nigeria.
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Drug addiction is on the rise during these COVID-19 times that intensify the factors contributing to relapse and overdose across drugs of abuse and continents. Using a multimodal approach (neuropsychology, fMRI, ERP), human neuroimaging studies in my lab have elucidated core mechanisms underlying drug addiction, with a focus on the role of the dopaminergic mesocorticolimbic circuit, especially the prefrontal cortex, in higher-order cognitive and emotional dysfunction in this population. Our theoretical model is called iRISA (Impaired Response Inhibition and Salience Attribution), postulating that abnormalities in the orbitofrontal cortex and anterior cingulate cortex (and other cortical regions underlying higher order executive function), contribute to the core clinical symptoms in addiction. Specifically, our program of research is guided by the working hypothesis that drug addicted individuals disproportionately attribute salience and value to their drug of choice at the expense of other reinforcing stimuli, with a concomitant decrease in the ability to inhibit maladaptive drug use. Our complex and multifaceted dataset has allowed us to study the impact of abstinence on recovery in these brain-behavior compromises in treatment-seeking addicted individuals, where non-linear relationships exemplify incubation of craving while other trajectories of change, including in white matter tracks and for small subcortical regions (such as the habenula), are also explored. Novel paradigm shifts in the lab include the use of naturalistic and dynamic stimuli for enhanced generalizability and validity, in addition to development of effective neurorehabilitation strategies (including cognitive reappraisal, mindfulness, and transcranial direct current stimulation) in drug addiction. Keywords: Neuroimaging, drug addiction
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Background and Aim: The American College of Gastroenterology recommendations are that adults over age 50 years old, with Inflammatory Bowel Disease (IBD), including those on immunosuppression, should be vaccinated against Herpes Zoster (HZ). Recently a recombinant HZ vaccine that is safe for people on immunosuppression called Shingrix, was approved and is administered as a 2-dose series with the second dose given 2 to 6 months after the first. The aim of this study is to improve HZ vaccination rates in IBD patients seen in the gastroenterology (GI) clinic at a Houston county hospital serving an indigent population over a 1-year period to over 75%. Methods We performed a retrospective analysis of IBD patients over age 50 years old, that have been seen in the GI clinic over a 2-month period at a 323-bed county hospital in northeast Houston that serves an uninsured/ underinsured lower socioeconomic population. We found that only 4.8% (1/21) of these patients were vaccinated for HZ. We then implemented a series of QI interventions as follows 1) Stakeholders had a 10-minute informal training session about the latest vaccination guidelines, vaccination side effects and safe practices with a stepwise algorithm placed at all clinic computer stations 2) A standardized IBD template was created with hard prompts to record vaccination status and 3) Nurses were educated on performing 2nd dose vaccination series on clinic follow up. Results During the past 4 months, 41 patients have met the vaccination criteria. Out of those 41 patients, 80.5% (33/41) received vaccinations, while 12.2% (5/41) did not receive immunizations and 3 declined immunizations when offered (Figure 1). At this time, 18.2% (6/33) patients have received their second Shingrix dose with no recorded side effects to date. Discussion A query of ICD-10 codes of HZ infections in IBD patients seen in our clinic over the past 5 years, revealed that 15 patients had experienced significant HZ flares;of whom 20 % (3/15) developed a secondary flair during that 5-year period and another 20% (3/15) developed herpes zoster opthalmicus, causing unilateral blindness in 2 out of those 3 patients (Figure 2). Through our QI implementation, we have successfully increased HZ vaccination rates from 4.8% to 80.5%. We hope to increase our 2nd dose vaccination rates in the following year, which has largely been impacted by a decrease in in person clinic visits due to COVID-19. This will help prevent HZ flares and serious complications from HZ in the future (Image Presented) (Image Presented) (Table Presented)
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Background: Individuals with SCI face the same difficulties related to COVID-19 as others with disabilities, but also experience challenges related to the nature of SCI. Objective: Understand how concerns about medical rationing, access to personal care attendants (PCAs) and medical supplies, and resilience are related to overall and mental health in the context of the COVID-19 pandemic. Design: Cross-sectional findings from a longitudinal study. Methods: Data were collected online between May and August 2020 (N = 187). Primary outcomes were mental health, depression (PHQ-8) symptoms, anxiety symptoms (GAD-7), and quality of life (QoL Basic Data Set). Primary predictors were resilience and concerns about medical rationing, financial stability, access to PCAs and medical supplies, and social isolation. Ordinal logistic regression and generalized linear models were used to analyze the data. Results Observed: Perceived mental health was negatively associated with concern about medical rationing, social isolation, and age and positively associated with resilience. Anxiety was positively associated with concern about medical rationing and personal finances and negatively associated with resilience. Depressive symptoms were greater in those with incomplete compared to complete injury, positively associated with concern about medical rationing, social isolation, and personal finances and negatively associated with resilience. QoL was negatively associated with concern about medical rationing, social isolation, and personal finances and positively associated with resilience. Conclusions: Interventions increasing resilience and addressing concerns regarding medical rationing, social isolation, and financial insecurity may have positive mental health benefits for individuals with SCI during the COVID-19 pandemic.
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The COVID-19 pandemic has made virus transmission a significant factor in designing buildings to ensure a safe and resilient environment. Simulation has been applied to analyze the potential risk of virus transmission within built spaces. Still, most existing simulations focused on a small region of the building, over a short period of time. Here we cover how we leveraged an occupancy simulation to inform and visualize the longitudinal impacts of virus transmission, in relation to a given building design and associated dynamic occupant behaviours. The flexibility of our system makes our simulation scalable and adaptable so that it can be applied to any building or context, with various types of occupants. © 2021 Owner/Author.
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The COVID-19 pandemic changed our lives, forcing us to reconsider our built environment, architectural designs, and even behaviours. Multiple stakeholders, including designers, building facility managers, and policy makers, are making decisions to reduce SARS-CoV-2 virus transmission and make our environment safer;however, systems to effectively and interactively evaluate virus transmission in physical spaces are lacking. To help fill this gap, we propose OccSim, a system that automatically generates occupancy behaviours in a 3D model of a building and helps users analyze the potential effect of virus transmission from a large-scale and longitudinal perspective. Our participatory evaluation with four groups of stakeholders revealed that OccSim could enhance their decision making processes by identifying specific risks of virus transmission in advance, and illuminating how each risk relates to complex human-building interactions. We reflect on our design and discuss OccSim's potential implications in the domains of gdesign evaluation,' ggenerative design,' and gdigital twins.' © 2021 ACM.
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Background: Nigeria recorded the first case of COVID 19 in February 2020 and imposed non pharmaceutical interventions including full-scale lockdown from April-May 2020. The lockdown and ensuing restrictions had an impact on routine HIV/AIDS services delivery among key population individuals (e.g. men who have sex with men, people who inject drugs, sex workers, transgender individuals and people in prisons). This study analyzed the impact of COVID-19 lockdown and restrictions on HIV/AIDS services including testing, identification of positives and linkage to treatment on a PEPFAR program in North Eastern Nigeria. Methods: A multi-centric retrospective study conducted in two states to assess the impact of COVID 19 on access to HIV services (testing, positives identified and linkage to HIV treatment). HIV services data from November 2019 to September 2020 was collected from source documents. We classified this period into four: pre-COVID (September 2019-March 2020), COVID lockdown (April-May 2020), COVID restrictions (June-July 2020) and relaxed restrictions (August-September 2020). A simple trend analysis of HIV services was done using a combination chart. Linear regression was conducted to understand the impact of COVID-19 on HIV services. The model for the Linear regression curve was plotted to compare the observed values with predicted (Linear) values. Results: We observed a sharp dip in HIV services during COVID lockdown and restriction (figure 1). The plots indicated a linear relationship between the month services were provided and HIV service outcome. The months services were conducted significantly predicted the number of testing (F(1, 9) = 20.689, p = .001), positives (F(1,9) = 15.857, p=0.003) and treatment (F(1,9) = 16.699, p=0.003) provided, accounting for 66.3%, 59.8% and 61.1% of the variation in number of HIV tests conducted, total HIV positive clients identified and clients placed on treatment respectively with adjusted R2 = 0.663, 0.598, and 0.611 for testing, positive and treatment respectively. The linear curve estimation showed that the actual HIV services outcome were below the projected estimated target in the months most affected by COVID 19 lockdown and restrictions. Conclusion: New pandemics can have negative effects on the control of other diseases such as HIV where health gains have been achieved in the past. Hence, a robust pandemic readiness plan must be developed for a possible second wave of COVID-19 to sustain the gains from several years of HIV intervention efforts.