Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan (preprint)

HIV early detection (CD4 counts ≥350 cells/μL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors including physical, cultural, structural, and financial barriers have contributed to HIV late detection. This is the first-of-its-kind study on the regional differences in early detection of HIV within Tajikistan and any country in the Central Asia region. Utilizing Tajikistan Ministry of Health's national HIV data (N=10,700) spanning 2010 to 2023, we developed median regression models with median CD4 cell count as the outcome and as predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old are more likely to be detected early for HIV, whereas those older than 39 years are more prone to late detection. Given their active engagement in age-related and sexual activities, those older than 39 years face a higher risk of HIV transmission to others if diagnosed late. Therefore, they require further attention and targeted interventions. Females are detected earlier compared to their male counterparts, regardless of region of residence. Rural populations are detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. These fluctuations in early detection may signify a shift in attention and resource allocation, potentially affecting efforts to address access gaps during the initial year of the COVID-19 pandemic. There are significant health inequities among different demographic and geographic groups which warrant further attention.

A Practical Framework for Conducting Video Telemedicine Visits with Trainees (preprint)

Background:Due to COVID-19, traditional clinical education for senior medical students has largely halted. In response to social distancing, many outpatient practices have transitioned to Telemedicine (TM). While TM has been integrated into undergraduate medical education curricula at many institutions, a published roadmap for incorporating learners into TM is not readily available.Aim:To describe one healthcare system’s transition to TM and propose a framework for including learners in video TM visitsSetting:Primary care clinics at an academic medical centerParticipants:Medical students, facultyProgram Description:Training protocols were distributed to providers and students. Multi-provider video visits were enabled for distance teaching. Students tested potential workflow models and provided feedback, facilitating creation of a 4-phase construct to guide inclusion of learners in video TM encounters.Program Evaluation:We employed a rapid feedback cycle to improve workflow process and to modify trainee and preceptor instructions. We analyzed student comments for narrative themes to plan for future evaluation of video TM encounters.Discussion:TM will be increasingly used in the provision of medical care. Clinician-educators will need to innovate in order to meet patient and learner expectations. TM will be an integral teaching tool and may enhance the educational experience.