Patrick Janulis

Cities across the United States are experimenting with civilian-led alternatives to policing, yet rigorous evidence of their effectiveness remains scarce. This study evaluates a large-scale civilianized public safety program in San Francisco that deploys unarmed “safety practitioners” to high-crime intersections to provide consistent presence, de-escalation, and service referrals in place of traditional law enforcement. Using a generalized synthetic control design covering 624 intersections from 2018 to 2023, we estimate the causal impact of practitioner deployment on reported crime. We find that deployments significantly reduced total and behavioral health-related crimes, with smaller yet meaningful reductions in drug and violent crimes, and no change in property crime. These effects persisted across robustness checks comparing daytime (operating) to nighttime (nonoperating) hours, suggesting that observed declines are attributable to practitioner presence rather than secular trends. The findings indicate that civilianized safety practitioners—drawn largely from communities affected by incarceration, addiction, and homelessness—can function as capable guardians who lower public disorder without relying on coercive authority. By embedding trusted, nonpolice actors in high-need public spaces, cities may improve safety while reducing harmful police contact and expanding workforce opportunities for people historically excluded from the formal economy.

Background: The COVID-19 pandemic prompted an abrupt transition to telemedicine for HIV care, necessitating the exploration of provider attitudes and experiences to understand its ongoing viability and impact. Objective: This study aimed to assess providers’ attitudes toward and experiences with telemedicine at HIV clinics in the Chicago area during the COVID-19 pandemic at 2 time points and at 2 clinical sites. Methods: We conducted a convergent mixed methods study to evaluate and explore providers’ attitudes toward and experiences with telemedicine at HIV clinics in the Chicago area during the COVID-19 pandemic, applying the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the updated Consolidated Framework for Implementation Research. This study assessed HIV providers via surveys at 2 time points, capturing responses on the acceptability, appropriateness, feasibility, and maintenance of telemedicine. Semistructured key informant interviews were conducted on a random selection of 10 participants to explore perceived experiences with telemedicine. Results: Among emailed providers, 43 of 83 (51.8%) and 27 of 82 (32.9%) responded to survey 1 and survey 2, respectively. The first survey recorded telemedicine usage at 75%, which decreased to 58% by the second survey. Overall, the majority of respondents agreed with statements that assessed telemedicine as appropriate, acceptable, and feasible. There were overall few statistical differences in responses between sites, although more providers at the community site indicated at least some potential value in telemedicine when compared to providers at the university hospital (100% agree or strongly agree vs 82.3%; P =.04) in survey 1. In survey 1, providers with more than 10 years of experience were less likely to report telemedicine helped them see more patients (31.6% agree or strongly agree vs 70.6% for providers with ≤10 y of experience; P =.008). Fewer experienced providers felt they could talk about private issues with their patients during telemedicine (57.9% of more experienced vs 88.3% of less experienced providers; P =.03). Key informant interviews provided qualitative insights into telemedicine integration, revealing mixed sentiments; providers appreciated the flexibility and accessibility that telemedicine offered but preferred in-person visits for their thoroughness, especially for physical examinations and laboratory tests. Despite initial barriers such as technical challenges and patient preferences for in-person visits, telemedicine was deemed feasible for maintaining communication and care quality. Providers highlighted the need for better technological support and ongoing training to optimize telemedicine usage. Conclusions: Our study underscores telemedicine as a sustainable adjunct to traditional HIV care, emphasizing the importance of addressing technological and training barriers to enhance its efficacy.

Patients with Alzheimer disease commonly rely on family caregivers for daily functioning. Research shows that relationships between caregivers and persons with memory loss have important effects on the health and well-being of both caregivers and persons with memory loss. However, most studies rely on a single caregiver-person with memory loss dyad as the unit of analysis, thereby neglecting the broader network of caregivers who collectively shape care experiences and outcomes. This study develops a conceptual and methodological framework for studying caregiver networks and investigates how the properties of caregiver networks relate to health and well-being outcomes for both persons with memory loss and caregivers. It measures and maps the social networks of caregivers of persons with memory loss while examining population heterogeneity in caregiver relationships and identifying network-based predictors of well-being for both caregivers and persons with memory loss. Our team is conducting a large multilocation (Illinois, Indiana, and Hawaii) study comprising 200 caregiver networks of persons with memory loss, supported by data from persons with memory loss and their caregivers. Networks will be collected using cutting-edge Network Canvas software tools, developed by members of our team within the Complex Data Collective, and analyzed using both quantitative and mixed methods. This study was funded in August 2023 by the National Institutes of Health (R01AG083034), with an expected end date of July 2028. This study protocol was approved by the institutional review board of Northwestern University (STU00219675) and was piloted internally before participant recruitment began in January 2025. As of March 2026, a total of 155 participants have been enrolled. Enrollment is planned to end by April 2027, with results expected between August 2027 and November 2027. This study advances research on caregivers of persons with memory loss by operationalizing a scalable and replicable approach to measuring caregiver networks. The ability to easily measure and identify structural features of caregiver systems helps in identifying predictors of caregiver experiences and outcomes and provides large benefits for the caregiver-person with memory loss research community.

BACKGROUND Patients with Alzheimer’s disease (AD) commonly rely on family caregivers for daily function. Research shows caregiver-person with memory loss (PWML) relationships have important effects on health and well-being for both caregivers and PWML. However, most studies rely on a single caregiver-PWML dyad as the unit of analysis, thereby neglecting the broader network of caregivers who collectively shape care experiences and outcomes. OBJECTIVE This protocol paper describes the conceptual and methodological framework for a study of caregiver networks. Study aims are to measure and map the social networks of caregivers of PWML while examining population heterogeneity in caregiver relationships and identify network-based predictors of well-being for both caregivers and PWML. METHODS Our team will conduct a large multi-location (IL, IN, HI) study of 200 PWML caregiver networks supported by data from PWML and their caregivers. Networks will be collected using our team’s cutting edge Network Canvas software tools and analyzed using both quantitative and mixed methods. RESULTS This study was awarded in August 2023 and is currently in its second year of data collection. CONCLUSIONS This project advances PWML caregiver research by operationalizing a scalable and replicable approach to measuring caregiver networks. The ability to easily measure and identify structural features of caregiver systems helps identify predictors of caregiver experiences and outcomes, and provides large benefits for the caregiver-PWML research community.

In the United States, the incidence rate of new HIV diagnoses continues to increase among young men who have sex with men (YMSM). Despite the availability of effective preventive strategies such as pre-exposure prophylaxis (PrEP), the rate of PrEP adherence remains markedly low especially among YMSM. Previous studies have primarily relied on structured surveys with predefined responses to identify barriers to PrEP adherence which may not fully capture the complexities behind the barriers. This is a secondary data analysis of data from a prospective cohort study focusing on YMSM vulnerable to HIV. A total of 581 participants provided free-text responses regarding reasons for discontinuing PrEP, which served as the primary outcome for the analysis. Natural language processing was conducted to identify potential barriers to PreP adherence and to uncover any previously unidentified barriers in this population. A total of nine categories were identified, with the most prevalent being lack of sexual activity (n = 128), followed by issues related to monogamy/partnership/long-term relationship (n = 73), specific insurance or coverage issues (n = 52), medication-related concerns (n = 41), side effects/health concerns (n = 39), forgetfulness/inconvenience associated with the medication regimen (n = 33), limited healthcare access (n = 26), personal reasons (n = 9), and financial insecurity (n = 8). The NLP analysis demonstrated moderate performance via support vector machine, random forest, gradient boost, and random forest (F-score = 0.75). Our study provides critical insights into specific barriers faced by high-risk YMSM, emphasizing the need for development of targeted interventions aimed at these barriers to improve PrEP access and utilization.

Young sexual and gender minority (SGM) people assigned male at birth who use substances are at elevated risk of HIV acquisition. This brief report leverages a large cohort of SGM people assigned male at birth to estimate substance use homophily (i.e., same-same substance use status) in sexual partnerships. We found substance use homophily in this sexual network for marijuana, poppers, methamphetamine, and hallucinogens but not heavy episodic drinking, cocaine, or ecstasy. These results suggest substance use is associated with sexual network structure and may increase HIV disparities between individuals who do and do not use substances.

Viral suppression with antiretroviral therapy (ART) is a critical component of UNAIDS objectives to end the HIV epidemic. Youth living with HIV (YLH) have worse viral suppression rates than adults. The aim of this study was to identify risk factors for viral non-suppression among YLH in Nigeria. A secondary analysis of enrollment data from the iCARE Nigeria study, collected April–October 2021 for 541 YLH comprised demographic, psychosocial, behavioral, clinical variables, and viral load quantification. Viral non-suppression was defined as viral load ≥ 200 copies/mL. Generalized linear models using Akaike information criterion for selection of indicator variables in a stepwise approach were used to determine the risk factors for viral non-suppression. The final analytic sample was 491 and the proportion of non-suppressed participants at baseline was 40%. In the final model, substance use (other than alcohol, tobacco and/or cannabis) (aOR = 3.20 [95% CI: 1.05, 10.34]), missed medication doses (aOR = 1.09 [95% CI: 1.04, 1.15]), and a higher number of self-reported medication barriers (e.g., forgot, busy, change in routine) (aOR = 1.08 [95% CI: 1.00, 1.16]) were associated with a higher likelihood of viral non-suppression. Being prescribed a first-line regimen (aOR = 0.28 [95% CI: 0.17, 0.44]), disclosure to at least one brother (aOR = 0.64 [95% CI: 0.42, 0.97]), and higher treatment outcome expectancies (e.g., taking medication will improve health) (aOR = 0.81 [95% CI: 0.66, 0.98]), were all associated with a lower likelihood of viral non-suppression. Viral non-suppression among YLH in Nigeria is associated with psychosocial and behavioral factors, including missed doses, medication barriers, treatment outcome expectancies, and disclosure, that are potential targets for intervention to achieve ART goals.

Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016‐2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16‐29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a “social network” to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10‐2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11‐0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack’d and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50‐4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago’s YMSM-YTW.