Andrea Mantsios

Latina immigrant transgender women are disproportionately affected by the HIV epidemic in the United States yet are rarely the focus of HIV-prevention research. This longitudinal concurrent mixed-methods study examined pre- and post-exposure prophylaxis (PrEP and PEP) awareness, use, and preferences among 37 HIV-negative Latina immigrant transgender women living in the Washington, DC metropolitan area. Overall, awareness, use, and preference were higher for PrEP than PEP. Many participants, however, expressed interest in PEP once learning about it and nearly all expressed the intention to use PEP in the case of risk exposure. When asked to explain their preferences, three key themes emerged from the qualitative data: PrEP and PEP in the body, familiarity and access, and self-perceived risk. Despite the higher awareness, preference, and use of PrEP, there is interest in PEP among Latina immigrant transgender women. For individuals who are unsuitable candidates for PrEP - due to infrequent HIV exposure or unpredictable sexual risk - PEP remains a reliable and effective method of HIV prevention. Both PrEP and PEP are important strategies that should be promoted as part of the menu of HIV prevention options for this population.

Purpose The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) provides funding to support Centers of Excellence (CoE) to prepare the next generation of Maternal and Child Health (MCH) leaders through specialized training and mentorship. This study describes the impact of Tulane University’s workforce development program in MCH. Description We utilized a holistic evaluation approach to examine the impact of Tulane University’s CoE, from the program’s inception in 2000 through 2024, in building the MCH workforce. Assessment Utilizing a retrospective evaluation design, routinely collected quantitative and qualitative enrollment and follow-up survey data from program alumni were analyzed. Data reveal the following: (1) the program has trained a broad group of MCH professionals from a wide range of backgrounds, strengthening a workforce prepared to respond to needs of varied communities, (2) alumni overwhelmingly continue to work in MCH after graduation, frequently serving populations with significant unmet health needs and in collaboration with Title V (MCH) agencies, and (3) the majority of trainees go on to serve in leadership positions in policy, practice, academia, or clinical settings. Conclusions A well-trained MCH workforce is contingent upon high-quality education and preparation for leadership roles. Through funding from HRSA’s MCH Workforce Development Division, Tulane University’s CoE has trained people from varied backgrounds, including from populations not well represented in health sciences and communities disproportionately affected by adverse health outcomes, to assume leadership roles and contribute substantively to the field. These results can inform MCH training programs to further strengthen their impact on developing the MCH workforce.

There is a critical need for community engagement in the process of adopting artificial intelligence (AI) technologies in public health. Public health practitioners and researchers have historically innovated in areas like vaccination and sanitation but have been slower in adopting emerging technologies such as generative AI. However, with increasingly complex funding, programming, and research requirements, the field now faces a pivotal moment to enhance its agility and responsiveness to evolving health challenges. Participatory methods and community engagement are key components of many current public health programs and research. The field of public health is well positioned to ensure community engagement is part of AI technologies applied to population health issues. Without such engagement, the adoption of these technologies in public health may exclude significant portions of the population, particularly those with the fewest resources, with the potential to exacerbate health inequities. Risks to privacy and perpetuation of bias are more likely to be avoided if AI technologies in public health are designed with knowledge of community engagement, existing health disparities, and strategies for improving equity. This viewpoint proposes a multifaceted approach to ensure safer and more effective integration of AI in public health with the following call to action: (1) include the basics of AI technology in public health training and professional development; (2) use a community engagement approach to co-design AI technologies in public health; and (3) introduce governance and best practice mechanisms that can guide the use of AI in public health to prevent or mitigate potential harms. These actions will support the application of AI to varied public health domains through a framework for more transparent, responsive, and equitable use of this evolving technology, augmenting the work of public health practitioners and researchers to improve health outcomes while minimizing risks and unintended consequences.

UNSTRUCTURED There is a critical need for community engagement in the process of adopting artificial intelligence (AI) technologies in public health. Public health practitioners and researchers have historically innovated in areas like vaccination and sanitation but have been slower in adopting emerging technologies such as generative AI. However, with increasingly complex funding, programming, and research requirements, the field now faces a pivotal moment to enhance its agility and responsiveness to evolving health challenges. Participatory methods and community engagement are key components of many current public health programs and research. The field of public health is well positioned to ensure community engagement is part of AI technologies applied to population health issues. Without such engagement, the adoption of these technologies in public health may exclude significant portions of the population, particularly those with the fewest resources, with the potential to exacerbate health inequities. Risks to privacy and perpetuation of bias are more likely to be avoided if AI technologies in public health are designed with knowledge of community engagement, existing health disparities, and strategies for improving equity. This viewpoint proposes a multifaceted approach to ensure safer and more effective integration of AI in public health with the following call to action: (1) include the basics of AI technology in public health training and professional development; (2) use a community engagement approach to co-design AI technologies in public health; and (3) introduce governance and best practice mechanisms that can guide the use of AI in public health to prevent or mitigate potential harms. These actions will support the application of AI to varied public health domains through a framework for more transparent, responsive, and equitable use of this evolving technology, augmenting the work of public health practitioners and researchers to improve health outcomes while minimizing risks and unintended consequences.

[This corrects the article DOI: 10.2196/43101.].

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Intersecting forms of stigma including both HIV and sex work stigma have been known to impede HIV prevention and optimal treatment outcomes among FSW. Recent research has indicated that intersectional stigma can be resisted at the community and individual level. We assessed pathways between HIV stigma, sex work stigma, social cohesion and viral suppression among a cohort of 210 FSW living with HIV in the Dominican Republic. Through Poisson regression we explored the relationship between HIV outcomes and internalized, anticipated and enacted HIV and sex work stigma, and resisted sex work stigma. We employed structural equation modeling to explore the direct effect of various forms of stigma on HIV outcomes, and the mediating effects of multi-level stigma resistance including social cohesion at the community level and occupational dignity at the individual level. 76.2% of FSW were virally suppressed and 28.1% had stopped ART at least once in the last 6 months. ART interruption had a significant negative direct effect on viral suppression (OR = 0.26, p < 0.001, 95% CI: 0.13–0.51). Social cohesion had a significant positive direct effect on viral suppression (OR = 2.07, p = 0.046, 95% CI: 1.01–4.25). Anticipated HIV stigma had a significant negative effect on viral suppression (OR = 0.34, p = 0.055, 95% CI: 0.11–1.02). This effect was mediated by the interaction between cohesion and dignity which rendered the impact of HIV stigma on viral suppression not significant. Findings demonstrate that while HIV stigma has a negative impact on viral suppression among FSW, it can be resisted through individual and collective means. Results reinforce the importance of community-driven, multi-level interventions.

Background: Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. Objective: This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Methods: Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Results: Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. Conclusions: The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity.

BACKGROUND Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. OBJECTIVE This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. METHODS Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. RESULTS Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. CONCLUSIONS The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity.

Despite documented interest among female sex workers (FSW), uptake of oral pre-exposure prophylaxis (PrEP) for HIV prevention has been low. Recent trials and regulatory approval of long-acting injectable (LAI) PrEP offer new hope for the potential of this biomedical intervention. We examined FSW’s PrEP-related interest and preferences regarding both oral and LAI PrEP situating these dynamics within their specific social and occupational realities. We conducted this work using qualitative methods across two distinct contexts by conducting 40 in-depth interviews with FSW in Tanzania and the Dominican Republic. Textual data was coded using iterative thematic content analysis. Analytic summaries were developed and reviewed to identify recurring themes. We systematically organized themes within each country and then compared across settings. Women in both settings expressed strong interest in PrEP seeing it as an important option to protect themselves in their work. Most participants preferred LAI PrEP due to expectations of reduced stigma and concerns about daily pill adherence and side effects. Occupational factors such as alcohol use, overnight dates with clients, and fear of violence from clients were identified as barriers to daily oral PrEP. LAI PrEP was seen as having the potential to reduce stress related to oral PrEP. Women who preferred pills discussed fear of needles, skepticism about the injections, and others relayed that taking a daily pill would not be challenging for them. There was a predominant sentiment that women know best whether they are better suited for oral or LAI PrEP. Participants stressed the importance of FSW understanding both options to ensure informed decision-making around PrEP and described community-led peer education as key to delivering trusted information. Community empowerment approaches led by FSW which address structural and psychosocial constraints and promote safe work environments may facilitate equitable access and uptake of PrEP among FSW across settings.