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.
Jenner, E., Jenner, L. W., Walsh, S., Demby, H., Gregory, A., & Davis, E. (2016). Impact of an intervention designed to reduce sexual health risk behaviors of African American adolescents: Results of a randomized controlled trial. American Journal of Public Health, 106(S1), S78-S84.
Jenner, E., & Walsh, S. (2016). Adolescent pregnancy prevention programs and research: A time to revisit theory. American Journal of Public Health, 106(S1), S28-S29.
Davis, E., Demby, H., Jenner, L. W., Gregory, A., & Broussard, M. (2016). Adapting an evidence-based model to retain adolescent study participants in longitudinal research. Evaluation and Program Planning, 54, 102-111.
Walsh, S., Jenner, E., Leger, R., & Broussard, M. (2015). Effects of a sexual risk reduction program for African-American adolescents on social cognitive antecedents of behavior change. American Journal of Health Behavior, 39(5), 610-622.
Demby, H., Gregory, A., Broussard, M., Dickherber, J., Atkins, S., & Jenner, L. W. (2014). Implementation lessons: The importance of assessing organizational “fit” and external factors when implementing evidence-based teen pregnancy prevention programs. Journal of Adolescent Health, 54(3), S37-S44.
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.
Improving engagement in HIV care using a data-to-care and patient navigation system in Louisiana.
An estimated 57% of persons living with HIV (PLWH) in the United States are not connected to regular medical care or have lapsed from regular care (Centers for Disease Control and Prevention, 2018), increasing risk for disease progression and transmission of HIV, and delaying viral suppression. Louisiana has consistently ranked in the top five U.S. states for HIV case rates. We evaluated the impact of a combined data-to-care and patient navigation system that was implemented in 3 cities in Louisiana from 2013-2015. This program, LA Links, used a surveillance system to identify PLWH who were not in regular health care and connected them to a patient navigator. During the intervention period, persons who lapsed from care were 17% more likely to reengage in care than persons in the comparison group, and persons newly diagnosed during the intervention period were 56% more likely to link to care.
Anderson, S., Henley, C., Lass, K., Burgess, S., & Jenner, E. Improving engagement in HIV care using a data-to-care and patient navigation system in Louisiana. Journal of the Association of Nurses in AIDS Care.
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.
Perspectives of HIV clinic staff on the implementation of a client financial incentives program targeting viral suppression
Using data from in-depth interviews with HIV healthcare providers, this paper examines the acceptability of a financial incentive program implemented at three HIV healthcare clinics in Louisiana. Though research suggests that incentives may be an effective method for improving medication adherence for persons living with HIV, the success of incentive programs is dependent in part on their acceptability to the healthcare providers who facilitate these programs. Understanding staff and leadership perceptions of such programs, which can be unfamiliar and potentially controversial, can inform planning and ultimately improve the implementation of these programs. This study, published in the Journal of the Association of Nurses in AIDS Care in 2017, finds that among the providers who were interviewed, most found the program to be helpful in caring for their patients and for clinic operations in general.
Anderson S., Jenner E., Lass K. & Burgess S. (2017). Perspectives of HIV clinic staff on the implementation of a client financial incentives program targeting viral suppression, Journal of the Association of Nurses in AIDS Care, doi: 10.1016/j.jana.2017.05.007.
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.
Louisiana Needs Assessment
The Louisiana Needs Assessment provides an estimate of the extent of PLWH’s unmet primary care and HIV-related support service needs, experiences in accessing services, and knowledge of services available throughout the state. The report below presents 2019 results from the New Orleans Eligible Metropolitan Area; findings indicate that PLWH in New Orleans are in greatest need of emergency financial assistance and housing support services.
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.
Opioids Vulnerability Assessment
In collaboration with The Louisiana Department of Health’s Office of Public Health STD, HIV, and Hepatitis (OPH SHP) program, PRG conducted a statewide vulnerability assessment identifying areas in Louisiana most vulnerable to outbreak of injection drug-related HIV, HCV, or overdose death.
PRG interviewed experts on the opioid epidemic and bloodborne illnesses in Louisiana and compiled a list of potential indicators that could be predictive of high-risk injection drug use in Louisiana. We then used data reduction techniques to develop a parsimonious model that predicted the rate of chronic HCV in persons under the age of 40 (our proxy measure of high-risk injection drug use) and mapped predicted vulnerability across the state. We solicited feedback on the assessment of vulnerability from local experts who identified high impact services and resources that are needed across the state; where data were available resources and gaps in services in vulnerable areas were also mapped.
Detailed findings – including a map depicting predicted vulnerability in Louisiana – can be found below.