ABSTRACT
Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).
Subject(s)
HIV Infections , Sexual and Gender Minorities , HIV Infections/prevention & control , HIV Serosorting , Homosexuality, Male , Humans , Male , New York City , TrustABSTRACT
Objective: This study is conducted to find out prevalence, risk factor and outcome of acute kidney injury (AKI) in patients admitted with COVID-19 in Pakistani population. Study Design: Retrospective, Observational Study Place and Duration of Study: This study was conducted at the PAF hospital Islamabad from April, 2020 to December, 2020. Materials and Methods: It involved a review of data from electronic hospital records of patients who were aged18 years or older with laboratory-confirmed COVID-19. We describe the frequency of AKI and, AKI recovery, dialysis requirement and adjusted odds ratios (aORs) with mortality. Results: Total 191 COVID-19 patients were enrolled, AKI occurred in total 38 (19.8%) patients and out of them 8(4.2%) patients had severe AKI and required dialysis. Regarding AKI staging, stage 1 was present among 18 (9.4%) patients, 06 (3.1%) had stage 2 and 14 (7.3%) had stage 3 AKI. The patients in ICU developed AKI more frequently stage 1 15.4%, stage 2, 7.7%, and stage 3 by 13.5% respectively. Patients with AKI were more likely to have admission in ICU, requirement for mechanical ventilation and requirement for inotropic support. Mortality was very high among patient with AKI 60.5% as compared to patient with no AKI 13.7%. Conclusion: We found in our study that AKI is a relatively common complication observed among patients hospitalized with COVID-19. It is linked to poor outcome and high mortality.
Subject(s)
COVID-19 , Immunity, Innate , Vitamin D Deficiency , Vitamin D , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , Humans , Immunity, Innate/drug effects , Immunity, Innate/physiology , Protective Agents/metabolism , SARS-CoV-2 , Severity of Illness Index , Vitamin D/blood , Vitamin D/metabolism , Vitamin D/pharmacology , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/metabolism , Vitamin D Deficiency/therapy , Vitamin D Deficiency/virology , Vitamins/blood , Vitamins/metabolism , Vitamins/pharmacologyABSTRACT
OBJECTIVES: With the advent of COVID-19 in Pakistan, the already fragmented blood transfusion services (BTS) received a severe blow, putting the lives of transfusion-dependent thalassemia children on stake. This study aimed to assess the impact of the COVID-19 on blood transfusion therapy (BTT) of thalassemia patients and suggest ways to ensure safe and reliable blood supplies amid such health crises. MATERIAL AND METHODS: A retrospective, cross-sectional study was conducted from October 2019 (before COVID-19) to July 2020 (during COVID-19) based on the data provided by a thalassemia center, named Help International Welfare Trust, Karachi, Pakistan. SPSS version 24.0 was used for the data analysis. Data were described in the form of means and percentages. RESULTS: There was a significant reduction in the consumption of PRBCs bags after the emergence of COVID-19 (P=0.002). Moreover, the number of thalassemia patients receiving BTT was dropped by 10.56% during the pandemic. There was a strong negative correlation observed between the rising cases of COVID-19 in Pakistan and the number of patients missing their therapy sessions (r=-0.914, P=0.030). A considerable decline in the reserves of all Rhesus-negative blood groups amid the COVID-19 outbreak was also observed. CONCLUSION: The COVID-19 pandemic adversely affected the already suboptimal care catered to thalassemia patients in Karachi, Pakistan. The fear of the virus contraction coupled with the lockdown and restricted mobility has disrupted the entire transfusion chain from donor to the recipient. Collaborated efforts by the government and healthcare authorities are essential to ensure sufficient blood for thalassemia patients amid the pandemic.