What we're asking in public health

Do innovative approaches to teen pregnancy prevention reduce high-risk sexual behaviors in youth?

Teen pregnancy is associated with serious negative maternal health and educational outcomes, including greater risk for pregnancy complications and decreased likelihood of obtaining higher education. Children of teen mothers are at an even higher likelihood of adverse consequences, including cognitive and developmental delays. Despite considerable declines in the last three decades, the U.S. maintains higher teen pregnancy and birth rates than other western industrialized nations. Within the U.S., birth rates for non-Hispanic white teens are significantly lower than rates reported for other races and ethnicities. It is therefore critical to address persistent social inequities and identify evidence-based interventions that can effectively contribute to the reduction of risky sexual behaviors for all U.S. adolescents, with an eye towards reducing the overall incidence of teen pregnancy.

Can electronic notification or patient navigation systems help people with HIV link to and remain in care?

Over one million people in the U.S. live with HIV. For these individuals, effective antiretroviral therapy (ART) can suppress viral load, improve health outcomes, prevent AIDS, and reduce the risk of transmitting HIV to others. To be effective, ART must be administered consistently with long-term adherence. For a variety of reasons, many people living with HIV fall out of care or fail to remain in continuous care. Finding ways to improve re-engagement and retention will improve health outcomes for people with HIV and reduce the risk of transmission. Though surveillance systems are widely recommended as tools for systematically tracking new diagnoses and lapses in care, little evidence is available on evidence-based interventions focused on reengagement and retention in HIV care. Through the implementation of large-scale quasi-experimental studies focusing on Louisiana’s most-affected communities, PRG’s research examines the potential impact that statewide surveillance systems can have on linking and retaining disconnected individuals into the HIV care continuum.  

Do financial incentives directed toward individuals with HIV improve treatment retention and viral suppression?

Inconsistent adherence to antiretroviral therapy (ART) for HIV can pose a number of threats to health outcomes for individuals living with HIV, including reduced treatment efficacy, the development of more resistant viral strains, and progression to AIDS. Previous research suggests that failure to attend clinic visits is a significant predictor of treatment failure, and that individuals living with HIV face personal, structural, and sociological barriers to healthcare maintenance. There is limited research available on the effectiveness of financial incentives programs to improve health outcomes along the HIV continuum of care and even less available on the acceptability of these programs among healthcare providers who facilitate them. Employing approaches that range from a large-scale quasi-experimental study, a city-wide outcome study, and in-depth interviews with healthcare providers, PRG aims to address the gap in current research regarding the effectiveness and acceptability of financial incentive programs to improve health outcomes for individuals living with HIV.

What are the current care service needs of people living with HIV in Louisiana?

Over 20,000 Louisiana residents are living with HIV; of these, roughly half have an AIDS diagnosis. In 2017, Louisiana ranked 4th in the nation for HIV case rates (22.1 per 100,000 population) and 10th in the estimated number of HIV cases. Comparatively high rates are also seen for AIDS in Louisiana. Of large metropolitan areas in the U.S., Baton Rouge and New Orleans have among the highest HIV and AIDS case rates. Support services – such as medical and dental care, housing assistance, and supplemental nutrition – can increase viral load suppression rates, decrease transmission rates, and improve quality of life for people living with HIV (PLWH).

Since 2008, PRG has worked with the New Orleans Office of Public Health (OPH) STD/HIV program to conduct a biennial statewide needs assessment for PLWH. The needs assessment provides OPH with cross-sectional data of HIV-related background characteristics, health behaviors, service needs, and service gaps.

Which communities are most vulnerable to the rapid spread of HIV and Hepatitis C due to injection drug use?

In 2014, an outbreak of HIV and hepatitis C virus (HCV) among persons who inject drugs in Scott County, Indiana raised concerns among public health experts about the potential for the opioid epidemic (and increased illicit injection opioid use) to drive dual HIV and HCV epidemics. The Centers for Disease Control and Prevention (CDC) indicate that from 2014 to 2015, 181 individuals residing in Scott County were newly diagnosed with HIV; 92% of these individuals were coinfected with HCV. Previously, fewer than 5 cases of HIV were diagnosed each year. The case of Scott County underscores the intersection of HIV, HCV, and the opioid epidemic. It has highlighted a need to identify places particularly vulnerable to the rapid spread of bloodborne infections due to opioid misuse in order to intervene early and prevent outbreak. PRG’s research addresses this need by examining opioid and infectious disease vulnerability and risk of HCV outbreak across Louisiana.