January 2021 Highlights from AJPH

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

 American Journal of Public Health January issue highlights:

• Better use of HIV prevention funds could substantially cut new infections
• Study explores link between natural disasters, onset of headaches, digestive and back problems
• Backpack medicine a promising way to reach people who are homeless during COVID-19
• Successful contact tracing programs require a sustainable workforce

Better use of HIV prevention funds could substantially cut new infections

Better allocation of public and private HIV prevention funds could substantially cut the number of new infections, finds a new study in the January issue of AJPH.

To conduct the study, researchers estimated new U.S. infections from 2018 to 2027, as well as spending on HIV prevention and care, and compared current funding allocations to two “optimal” scenarios. The first is a “limited-reach” scenario that expands efforts to those eligible; and the second is an “ideal, unlimited-reach” scenario in which all eligible people can be served. At present, the U.S. reports about 39,000 new HIV infections each year.

The study found that maintaining current estimated allocations of prevention funds over the next 10 years would likely be associated with about 33,100 new HIV cases a year. Current allocations spend a large proportion of prevention funding on testing low-risk, heterosexual people and on providing pre-exposure prophylaxis, better known as PrEP, to men who have sex with men.

In comparison, more optimal funding allocations that increased funding to screen high-risk populations and support people through the HIV care continuum were associated with an increase in people whose HIV infections were diagnosed and who were virally suppressed, which led to a sharp decline in new infections.

Overall, the limited-reach scenario reduced the number of new HIV infections by 69% over 10 years, while the unlimited-reach scenario reduced infections by 94%.

[Author contact: Stephanie L. Sansom, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. “Optimal Allocation of Societal HIV Prevention Resources to Reduce HIV Incidence in the United States”]

Study explores link between natural disasters, onset of headaches, digestive and back problems

The trauma of living through natural disasters can result in new physical symptoms, such as headaches and digestive problems. However, such symptoms are not very likely to persist over time, according to a January AJPH study. 

Using data from a 2003-20018 study of young, low-income mothers who were living in New Orleans when Hurricane Katrina struck in 2005, researchers estimated the odds of developing headaches, migraines, back problems and digestive problems, as well as the odds of recovering from such symptoms. They found the prevalence of each symptom went up after Hurricane Katrina, though the odds of developing symptoms shortly before, versus after Katrina, were comparable.

The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the storm, according to the study. Across the study period, prevalence of headaches or migraines went from a baseline of almost 15% to more than 46% just before Katrina, spiked to over 59% after Katrina, and dropped to about 45% 12 years after the storm.

Overall, symptoms that came on shortly after Katrina were more likely to subside than those developed just before the hurricane.

“As climate change progresses and extreme weather events, including devastating hurricanes, coastal floods, and heat waves become
more frequent, developing effective post-disaster public health responses will be increasingly critical to the well-being of Americans, especially those most vulnerable to adversity,” researchers wrote.

[Author contact: Meghan Zacher, Population Studies and Training Center, Brown University, Providence, Rhode Island. “Physical Health Symptoms and Hurricane Katrina: Individual Trajectories of Development and Recovery More Than a Decade After the Storm”]

Backpack medicine a promising way to reach people who are homeless during COVID-19

Health workers in Ventura County, California, are using an intervention known as “backpack medicine” to help protect people experiencing homelessness during the COVID-19 pandemic, according to a practice article in the January issue of AJPH.

In general, backpack medicine is designed to address the unique needs and circumstances
of homeless residents by meeting them where they are. In California, the Backpack Medicine Program at Ventura County Medical Center, in partnership with the Ventura County Health Care Agency, created the BPM COVID Response Team to best care for this population. Over the course of four weeks, the team tested more than 150 people and identified 24 positive cases. Before the pandemic, the program typically served 240 patients per year.

The COVID response team also set up a dedicated telephone line staffed 24 hours a day by a nurse or physician. The line receives and triages more than 20 to 30 calls a day, the article reported. In response to the pandemic, the Ventura County Health Care Agency provided temporary housing to more than 400 people.

“This intervention aids in preventing outbreaks in Ventura…while providing health care for some of the most vulnerable members of our community,” authors wrote. “Lessons learned from this intervention may be useful in designing targeted public health responses as we transition from sheltering in place to more regular social activities.”

[Author contact: Jemma Alarcón, Family Medicine Residency Program, Ventura County Medical Center, Ventura, California. “Adapting Backpack Medicine in COVID-19 Response for People Experiencing Homelessness in Southern California”]

Successful contact tracing programs require a sustainable workforce

Long-term contact tracing solutions will likely be more effective and reliable if they are built on a foundation of trained professionals who can devote their full time to the effort, concludes a practice article published in the January issue of AJPH.

The article describes the rapid establishment of a volunteer contact tracing program in New Haven, Connecticut, as well as it successes and challenges. The volunteer effort — coordinated by Yale University in partnership with state and local health departments — recruited nearly 200 people, most of them students.

According to authors, program successes included the completion of many case interviews and contact notifications, as well as stronger public health and academic partnerships. Students also reported benefits from their volunteer experiences and expressed a desire to continue contributing to pandemic response. The program also faced challenges, such as a need for new data systems and the sustainability of an all-volunteer workforce.

“Successful programs will require sustainable workforces, new software systems and technological solutions,” authors wrote. “This will require increased governmental funding to be appropriately disbursed to state and local health departments that are tasked with the responsibility of this work. Such well-funded programs will ultimately protect the public’s health by preventing ongoing transmission of COVID-19.”

[Author contact: Linda M. Niccolai, Yale School of Public Health, New Haven, Connecticut. “Community Trace: Rapid Establishment of a Volunteer Contract Tracing Program for COVID-19”]

Check out the full list of AJPH research papers that will be published online November 19, at 4 p.m. ET by AJPH.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to APHA Media Relations. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or email us.

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