Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

Impact of COVID-19 on Life Experiences of Essential Workers Attending a Dental Testing Facility.

OBJECTIVES: 1) To compare the impact of COVID-19 on the life experiences of essential workers attending a COVID-19 antibody testing clinic at a dental school. 2) To compare responses of dental, non-dental health care, and non-health care essential workers. 3) To assess acceptability/satisfaction of testing done in a dental setting. METHOD: A total of 984 participants completed a self-administered online questionnaire. RESULTS: Over 90% were healthy (i.e., not in a high-risk health-related group for COVID-19), did not have COVID-19 symptoms within 30 d, and always/frequently engaged in preventive measures. Fifty-eight percent thought that they had a 0% to 25% chance of having immunity/antibodies to COVID-19. Non-dental health care workers thought that their chance was significantly higher (P < 0.05) than others. Over 70% were sometimes, frequently, or always worried about their friends and loved ones getting COVID-19 and of resulting financial problems. Dental workers were significantly less afraid than non-dental health care and non-health care providers. For all groups, more than half of the respondents stated that the pandemic had a negative (somewhat worse or worse) impact on daily life (59%), interactions with others (65%), stress levels (66%), and enjoyment of life (56%). There were significant differences among all 3 groups regarding the percentage of individuals with a negative impact on job security (dental, 47%; non-dental health care, 34%; non-health care, 31%). However, more than half of the respondents stated that the pandemic had a positive impact (same, somewhat better, or much better) on caring about one another, self-care, and exercise. Knowing the results of an antibody test would decrease the level of stress and anxiety in 67% of respondents. Over 80% found a COVID-19 test received in a dental setting acceptable, were "definitely" satisfied, and would "definitely" recommend it to a friend, family, or coworker. CONCLUSIONS: These findings support that dental workers are as vulnerable as other essential workers to threats and psychological impacts of COVID-19. They also support the acceptability and satisfaction of testing for a pandemic done in a dental setting. KNOWLEDGE TRANSFER STATEMENT: The results of this study highlight the impact that pandemics such as COVID-19 can have on life experiences of essential workers, including dentists. It also highlights a role that dentistry can play within the broader health care system, during and beyond the current pandemic, to help with surveillance efforts of community health. Testing may also help alleviate stress and anxiety associated with these pandemics.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond.

AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.