Protocol for evaluating external facilitation as a strategy to nationally implement a novel stigma reduction training tool for healthcare providers.

BACKGROUND: Identity Development Evolution and Sharing (IDEAS) is a theatre-based intervention for reducing healthcare provider stigma. IDEAS films are created by collecting narratives from people who have experienced discrimination and healthcare inequity, partnering with professional playwrights to create theatrical scripts that maintain the words of the narratives while arranging them into compelling storylines involving several interviews, and hiring professional actors to perform and record scenes. IDEAS implementation requires a moderator to establish a respectful learning environment, play the filmed performance, set ground rules for discussion, and moderate a discussion between healthcare providers who viewed the film and invited panelists who are members of the minoritized population being discussed. IDEAS' impact on provider stigma is measured via pre/post Acceptance and Action Questionnaire - Stigma (AAQ-S) data collected from participating providers. The objectives of this manuscript are to provide narrative review of how provider stigma may lead to healthcare inequity and health disparities, describe the conceptual frameworks underpinning the IDEAS intervention, and outline methods for IDEAS implementation and implementation evaluation. METHODS: This manuscript describes a hybrid type 3 design study protocol that uses the Consolidated Framework for Implementation Research (CFIR) to evaluate external facilitation, used as an implementation strategy to expand the reach of IDEAS. CFIR is also used to assess the impact of characteristics of the intervention and implementation climate on implementation success. Implementation success is defined by intervention feasibility and acceptability as well as self-efficacy of internal facilitators. This manuscript details the protocol for collection and evaluation of implementation data alongside that of effectiveness data. The manuscript provides new information about the use of configurational analysis, which uses Boolean algebra to analyze pathways to implementation success considering each variable, within and across diverse clinical sites across the USA. DISCUSSION: The significance of this protocol is that it outlines important information for future hybrid type 3 designs wishing to incorporate configurational analyses and/or studies using behavioral or atypical, complex, innovative interventions. The current lack of evidence supporting occupational justice-focused interventions and the strong evidence of stigma influencing health inequities underscore the necessity for the IDEAS intervention.

How social class identity influences students' leadership and advocacy development.

Social class identity, namely disadvantaged social class status, as a site for leadership development is explored in this chapter. The authors position the forms of resistance, resource, and savvy disadvantaged students display on campus as opportunities for broader social progress and individual leadership development.

Early Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease: Insights and Findings From the Care and Support Access (CASA) Study 2013-2019.

Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients' Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients' disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.

Understanding the Needs of Older (Mature) Black Men who have Sex with Men: Results of a Community-based Survey.

Older (mature) Black men who have sex with men (BMSM) are an understudied group disproportionately affected by HIV/AIDS and experience competing priorities such as medical comorbidities, social isolation, and financial stressors. The purpose of this study was to assess the needs and priorities of a sample of urban mature BMSM to inform HIV prevention programming. A cross-sectional survey of BMSM ages 40 and older was conducted among men recruited from community-based organizations. Men ranked priorities from seven domains: financial and housing stability, physical health, mental health, relationships with family, relationships with partners, HIV prevention. Men were also asked whether mature BMSM should mentor younger BMSM. Financial and housing stability and HIV prevention were ranked in the top three by a majority. Desired program features included a safe physical space for socializing that provides information and aid. The majority of the sample agreed that mature BMSM should mentor younger BMSM.

Transcarotid artery stenting for carotid artery pseudoaneurysm using flow reversal technique.

Carotid artery pseudoaneurysm results mostly from direct trauma, prior endarterectomy, prior dissection, radiation, and infections. There are many different surgical and endovascular treatment options for repair, and the choice of treatment depends on patient-, surgeon-, and institute-related factors. Studies have reported the efficacy of various endovascular techniques for aneurysm repair, including stent graft placement and coil embolization, with promising short- and long-term outcomes. In this report, we describe two cases of carotid artery pseudoaneurysm (after trauma and after carotid endarterectomy) treated successfully through transcarotid artery stenting using the flow reversal technique to minimize the risk of embolization and stroke.

Characteristics of Black Men Who Have Sex With Men in Baltimore, Philadelphia, and Washington, D.C.: Geographic Diversity in Socio-Demographics and HIV Transmission Risk.

BACKGROUND: Baltimore, Philadelphia, and Washington, DC are geographically proximate cities with high HIV prevalence, including among black men who have sex with men (BMSM). Using data collected among BMSM in CDC's National HIV Behavioral Surveillance project, we compared socio-demographic characteristics, HIV risk behaviors, and service utilization to explore similarities and differences that could inform local and regional HIV intervention approaches. METHODS: BMSM were recruited through venue time location sampling, June-December, 2011. Participants completed identical socio-behavioral surveys and voluntary HIV testing. Analyses were conducted among the full sample and those aged 18-24. FINDINGS: Participants included 159 (DC), 364 (Baltimore), and 331 (Philadelphia) eligible BMSM. HIV prevalence was 23.1% (DC), 48.0% (Baltimore), 14.6% (Philadelphia) with 30.6%, 69.0%, 33.3% unrecognized HIV infection, respectively. Among BMSM 18-24, HIV prevalence was 11.1% (DC), 38.9% (Baltimore), 9.6% (Philadelphia) with unrecognized HIV infection 0.0%, 73.8%, 60.0% respectively. Compared with the other 2 cities, Baltimore participants were less likely to identify as gay/homosexual; more likely to report unemployment, incarceration, homelessness, sex exchange; and least likely to use the internet for partners. DC participants were more likely to have a college degree and employment. Philadelphia participants were more likely to report gay/homosexual identity, receptive condomless anal sex, having only main partners, and bars/clubs as partner meeting places. Sexually transmitted disease testing was universally low. CONCLUSIONS: Analyses showed especially high HIV prevalence among BMSM in Baltimore including among young BMSM. Socio-demographic characteristics and HIV infection correlates differed across cities but unrecognized HIV infection and unknown partner status were universally high.