Enacting Relational Public Health: Federally Qualified Health Centers During the COVID-19 Pandemic.

Federally Qualified Health Centers (FQHCs) proved to be critical points of access for people of color and other underserved populations during the COVID-19 pandemic, administering 61% of their COVID-19 vaccinations to people of color, compared to the 40% rate for the overall United States' vaccination effort. To better understand the approaches and outcomes of FQHCs in pandemic response, we conducted semi-structured interviews with FQHC health care providers and outreach workers and analyzed them using an inductive qualitative methodology.

"We're Here to Take Care of Our Community": Lessons Learned From the U.S. Federal Health Center Covid-19 Vaccine Program.

Equitable access to vaccination is crucial to mitigating the disproportionate impact of Covid-19 on low-income communities and people of color in the United States. As primary care clinics for medically underserved patients, Federally Qualified Health Centers (FQHCs) emerged as a success story in the national effort to vaccinate the U.S. public against Covid-19. In February 2021, the Federal Health Center Covid-19 Vaccine Program began allocating vaccine supply directly to FQHCs in an effort to improve vaccine equity. This qualitative study documents how FQHCs in two states successfully mitigated barriers to vaccine access, responded to patient concerns about vaccination, and worked to maintain and grow community trust in a climate of uncertainty and fear during early vaccine roll-out to the general population. Using a socio-ecological model, we show how FQHCs intervened at multiple levels to advance vaccine equity, revealing valuable lessons for health promotion practice in primary care settings or underserved communities. Our findings provide descriptive context for existing quantitative evidence showing FQHCs' greater success in vaccinating people of color, and foreground valuable and innovative strategies for trustworthy health communication practices and equitable resource allocation to medically underserved patients and populations.

All of Us and the Promise of Precision Medicine: Achieving Equitable Access for Federally Qualified Health Center Patients.

The United States National Institutes of Health's (NIH) All of Us (AoU) initiative recruits participants from diverse backgrounds to improve the makeup of biobanks, considering nearly all biospecimens used in research come from people of European ancestry. Participants who join AoU consent to provide samples of blood, urine, and/or saliva and to submit their electronic health record to the program. In addition to diversifying precision medicine research studies, AoU will return genetic results back to many participants, which may require further follow-up care (i.e., more frequent cancer screening or mastectomy after a BRCA result). To help achieve its goals, AoU has partnered with Federally Qualified Health Centers (FQHCs), which is a type of community health center whose patient base is comprised largely of people who are uninsured, underinsured, or on Medicaid. Our NIH-funded study convened FQHC providers involved in AoU to better understand precision medicine in community health settings. Drawing from our findings, we present barriers community health patients and their providers face when accessing diagnostics and specialty care after genetic results necessitate medical follow-up care. We also propose several policy and financial recommendations to help overcome the challenges discussed, stemming from a commitment to equitable access to precision medicine advances.

Becoming Institutionalized: Incarceration as a Chronic Health Condition.

This article examines incarceration as a chronic condition with social, biological, and psychological elements. We do so through the lens of "institutionalization," a concept that emerged during interviews conducted with 26 people incarcerated in Washington state prisons as a chronic and often disabling state resulting from prolonged incarceration. We argue that institutionalization helps conceptualize how the social inequities of mass incarceration become embodied as health inequities, and how social harms become physical harms. [prison, incarceration, institutionalization, chronic, inequality].

The 'indirect costs' of underfunding foreign partners in global health research: A case study.

This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work. ABBREVIATIONS: MGH: Massachusetts General Hospital; MUST: Mbarara University of Science and Technology; NIH: National Institutes of Health; UCSF: University of California San Francisco; URI: Uganda Research Institute.

Inequality and ethics in paediatric HIV remission research: From Mississippi to South Africa and back.

In 2013, physician-researchers announced that a baby in Mississippi had been 'functionally cured' of HIV [Persaud, D., Gay, H., Ziemniak, C. F., Chen, Y. H., Piatak, M., Chun, T.-W., … Luzuriaga, K. (2013b, March). Functional HIV cure after very early ART of an infected infant. Paper presented at the 20th conference on retroviruses and opportunistic infections, Atlanta, GA]. Though the child later developed a detectable viral load, the case remains unprecedented, and trials to build on the findings are planned [National Institute of Allergy and Infectious Diseases. (2014). 'Mississippi baby' now has detectable HIV, researchers find. Retrieved from http://www.niaid.nih.gov/news/newsreleases/2014/pages/mississippibabyhiv.aspx ]. Whether addressing HIV 'cure' or 'remission', scrutiny of this case has focused largely on scientific questions, with only introductory attention to ethics. The social inequalities and gaps in care that made the discovery possible - and their ethical implications for paediatric HIV remission - have gone largely unexamined. This paper describes structural inequalities surrounding the 'Mississippi baby' case and a parallel case in South Africa, where proof-of-concept studies are in the early stages. We argue that an ethical programme of research into infant HIV remission ought to be 'structurally competent', and recommend that paediatric remission studies consider including a research component focused on social protection and barriers to care.

Great expectations: using an analysis of current practices to propose a framework for the undergraduate inorganic curriculum.

The undergraduate inorganic chemistry curriculum in the United States mirrors the broad diversity of the inorganic research community and poses a challenge for the development of a coherent curriculum that is thorough, rigorous, and engaging. A recent large survey of the inorganic community has provided information about the current organization and content of the inorganic curriculum from an institutional level. The data reveal shared "core" concepts that are broadly taught, with tremendous variation in content coverage beyond these central ideas. The data provide an opportunity for a community-driven discussion about how the American Chemical Society's Committee on Professional Training's vision of a foundation and in-depth course for each of the five subdisciplines maps onto an inorganic chemistry curriculum that is consistent in its coverage of the core inorganic concepts, yet reflects the diversity and creativity of the inorganic community. The goal of this Viewpoint is to present the current state of the diverse undergraduate curriculum and lay a framework for an effective and engaging curriculum that illustrates the essential role inorganic chemistry plays within the chemistry community.

Adverse events and placebo effects: African scientists, HIV, and ethics in the 'global health sciences'.

This paper builds on the growing literature in 'postcolonial technoscience' by examining how science and ethics travel in transnational HIV research. I use examples of two controversial US-funded studies of mother-to-child transmission in Africa as case studies through which to explore quandaries of difference and inequality in global health research. My aim is not to adjudicate the debates over these studies, but rather to raise some questions about transnational research, science, and ethics that often get lost in public controversies over the moral status of such trials. Using interviews conducted with American and Ugandan HIV researchers as well as relevant material published in the popular and medical press, I argue that debates over research practice and the conditions under which practices are deemed ethically legitimate or questionable reflect the challenges faced by African researchers seeking to participate in global health science. In doing so, I show how questions of scientific legitimacy and authority are played out in debates over who decides what constitutes 'the normal' in human biological research and who can legitimately 'speak for Africa' regarding the ethics of research design and practice. I conclude that researchers from'resource-poor settings' must often walk a tightrope between claims of difference from the global North and assertions of sameness, in which a claim too forceful in either direction can undermine the ethical--and thus scientific--legitimacy of their research.

Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time.

We conducted a study to assess the effect of family-based treatment on adherence amongst HIV-infected parents and their HIV-infected children attending the Mother-To-Child-Transmission Plus program in Kampala, Uganda. Adherence was assessed using home-based pill counts and self-report. Mean adherence was over 94%. Depression was associated with incomplete adherence on multivariable analysis. Adherence declined over time. Qualitative interviews revealed lack of transportation money, stigma, clinical response to therapy, drug packaging, and cost of therapy may impact adherence. Our results indicate that providing ART to all eligible HIV-infected members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential barrier to adherence. Further study is necessary to assess the long-term impact of this family treatment model on adherence to ART in resource-limited settings.

Depression and drug use impact health status among marginally housed HIV-infected individuals.

A representative sample of HIV-positive homeless and marginally housed individuals completed SF-36 health surveys and responses were analyzed for associations with sociodemographic, health, health care, and drug use variables. Among 330 respondents, 83% were male, 43% were African American, and the median age was 39 years. Negative associations were found between female gender and vitality as well as physical functioning; older age and physical functioning; drug use or drug treatment and role-emotional, social functioning, body pain, as well as vitality; health care utilization and depression with all scales. It appeared that depression and drug-related variables were associated with multiple dimensions of health status in this population. Interventions to treat depression and addiction may improve the health status of HIV-infected HMH.

"Come back when you're dying:" the commodification of AIDS among California's urban poor.

As with any other long-term illness, the decline in health that accompanies symptomatic HIV infection often has a profound negative impact on employment and personal finances. However, research to date on the financial consequences of AIDS has focused largely on middle-class working individuals, and cannot account for the experiences of those who are already poor and unemployed at the time of their infection. We conducted in-depth qualitative interviews with 33 Californian heterosexual couples in which one partner was infected with HIV and the other was HIV-negative. Most couples interviewed were low-income, marginally housed, and either former or active substance users. Unlike their middle-class counterparts, it became clear through the course of our study that many participating couples were living in a world in which a positive HIV antibody test or an AIDS diagnosis could result in an improved quality of life by allowing for increased access to Supplemental Security Income, subsidized housing, food and services. This situation is in part a consequence of recent policy decisions related to the "War on Drugs" and welfare reform. These policies have contributed to the creation of an economy of poverty in which the sick, needy, and addicted must compete against each other for scarce resources. Within such an economy, an HIV or AIDS diagnosis may actually operate as a commodity.