Stephen Bonett

Background: Cardiovascular disease (CVD) is the leading cause of death in the USA, with significant disparities affecting racial/ethnic minority populations particularly in Philadelphia. Although effective self-management can improve outcomes for those with CVD risk factors, social and economic barriers often impede implementation of recommended health behaviours in underserved communities. This study aims to (1) determine the effectiveness of the Decision-making Education for Choices in Diabetes Everyday (DECIDE)+ intervention in improving CVD self-management skills among Philadelphia residents with CVD risk factors and unmet social needs compared with standard community health worker (CHW) engagement and (2) assess the reach, adoption, fidelity and maintenance of DECIDE+. Methods and analysis: Using a type 1 hybrid effectiveness-implementation design, this quasi-experimental study will compare outcomes between participants who enrol in the DECIDE+ group (n=250) or receive standard CHW services (n=250). DECIDE+ combines a structured nine-session problem-solving programme for chronic disease management with ongoing CHW support addressing social needs. Both groups will be randomly assigned to either monthly or biweekly CHW follow-up to examine the impact of contact frequency on health behaviour outcomes. Primary outcomes include CVD self-management skills measured by the Self-care of Chronic Illness Inventory. Implementation outcomes will be assessed through a mixed-methods approach including structured interviews with CHWs and analysis of programme-level data. Ethics and dissemination: This study was approved by the University of Pennsylvania Institutional Review Board (Protocol #856216). Written informed consent is obtained from all participants prior to enrolment. This pragmatic trial addresses cardiovascular health disparities by simultaneously enhancing problem-solving skills for chronic disease management and addressing social and environmental barriers to effective self-management. The study will provide valuable insights into the effectiveness of multilevel CHW-delivered interventions and optimal implementation strategies in real-world community settings. Findings will be disseminated through peer-reviewed publications and scientific conference presentations. Trial registration number: NCT06732102 .

Federal investment in HIV research has transformed HIV from a fatal disease into a manageable chronic condition through advances in prevention, treatment, implementation, and care. On May 29, 2026, the U.S. Office of Management and Budget proposed revisions to the Uniform Guidance governing federal financial assistance that could influence how federally funded HIV research is reviewed, awarded, and sustained. This commentary examines the proposed revisions from the perspective of the Association of Nurses in AIDS Care (ANAC), emphasizing the importance of scientific integrity, independent peer review, and sustained federal investment in advancing HIV research and improving health outcomes. HIV research demonstrates that long-term, community-engaged, interdisciplinary science has produced substantial public health benefits across the lifespan. ANAC supports responsible stewardship of federal resources while urging policymakers to preserve the scientific principles that have enabled decades of progress in HIV prevention, treatment, and care.

Community health workers (CHWs) serve as bridges between clinical care and community-based social support, yet they are often excluded from the design of the health interventions they implement. User Journey Mapping (UJM) is a tool that can enhance health behavior interventions and their implementation. As part of formative planning for the Philadelphia Community Engagement Alliance (Philly CEAL), we employed UJM methods to engage CHWs as co-designers in the implementation of an adapted chronic disease self-management intervention to promote heart health while addressing social needs. We conducted semi-structured interviews ( n = 8) with seven CHWs and one supervisor from Philadelphia’s Office of Community Empowerment and Opportunity. During the interviews, participants co-created visual workflow maps documenting daily tasks, emotional experiences, pain points, and opportunities. Individual maps were synthesized into comprehensive team maps and validated through follow-up sessions with the CHW team. Analysis revealed a four-part CHW process: community-based responsibilities, individual case management, in-office duties, and supervisory functions. Themes were identified related to the specialized skills and strengths associated with the CHW role, systemic challenges related to service workflows, and persistent emotional and psychological role-related stressors. UJM methods used in this formative work generated actionable insights for intervention refinement while positioning CHWs as expert co-designers rather than solely as the implementers of the intervention. The findings underscore the importance of integrating frontline expertise early in intervention planning to ensure programs are operationally efficient, emotionally attuned, and contextually grounded. We propose a set of methodological recommendations for embedding UJM within future public health planning, implementation, and evaluation efforts.

Community health workers (CHW) programs are effective at reducing hospitalizations, improving mental health, and supporting health‐promoting behaviors. Research suggests awareness and use of CHW services remain uneven across communities nationally. This study describes awareness, use and satisfaction with a city‐wide CHW program among racial/ethnic minority individuals in Philadelphia. Data come from a web‐based health survey conducted February–March 2024. Participants reported sociodemographic characteristics, health conditions, barriers to social resources, and awareness and use of the city's CHW program. Among 522 participants, the majority were Black (55.4%), women (70.1%), with mean age 39 years. Less than half (44.6%) were aware of the CHW program; of those, 30.5% (13.6% of whole sample) had used it. Among users, 80.3% reported being satisfied with services. In multivariate models, Asian, Hispanic/Latine, privately insured, unemployed, those without barriers to social resources, those with chronic conditions, and West Philadelphia residents had lower odds of awareness. Education, income, and anxiety symptoms were not associated with program awareness. Awareness and use of this CHW program is low to moderate among key populations in Philadelphia. Given variations in awareness, scale‐up of CHW programs should include evaluation of program reach, especially to individuals who are not employed and have chronic health conditions.

Background: HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool, yet uptake and retention among populations vulnerable to HIV acquisition remain below target levels. Telehealth has emerged as a promising strategy to overcome barriers to accessing PrEP. However, significant gaps remain in our understanding of the implementation of telehealth programs for PrEP. This study examines implementation barriers and facilitators in the Philadelphia TelePrEP Program (PTP), assesses program acceptability, usability and satisfaction, and investigates associations between client characteristics and implementation outcomes. Methods: We conducted a mixed-methods evaluation from October 2023 to February 2025 of the PTP using web-based surveys with 113 participants and in-depth interviews with 5 staff members. We assessed implementation outcomes (i.e., program acceptability, usability, and satisfaction) and explored implementation determinants through qualitative analysis guided by the Consolidated Framework for Implementation Research. We used linear regression to examine associations between sociodemographic and clinical characteristics of participants and implementation outcomes. Results: Survey participants were predominantly cisgender men with diverse racial/ethnic backgrounds. Participants reported high levels of acceptability, usability, and satisfaction with the PTP, though those with less than full-time employment reported significantly lower acceptability and usability compared to those with full-time employment. Mixed-methods analysis identified patient navigators as a central facilitator of program success, with both staff and clients emphasizing their role in creating a supportive, stigma-free care environment. Key implementation barriers included billing complexity, platform integration challenges, and privacy concerns. Although designed as a fully remote program, substantial demand for in-person services (particularly for injectable PrEP) emerged as a central implementation theme, underscoring the need for flexible hybrid service models. Staff also identified gaps in reaching priority populations, including Black and Latine communities, despite the program’s broad digital outreach efforts. Conclusions: TelePrEP programs can achieve high user satisfaction when supported by dedicated navigation services and flexible care options. However, realizing the full potential of this model may require additional strategies to enhance program reach, streamline multi-organizational coordination, and support hybrid service models that accommodate diverse patient preferences and socioeconomic circumstances.

PurposeThis paper presents the results of a holistic evaluation of VaxUpPhillyFamilies (VaxUp), a program aimed to increase pediatric COVID-19 vaccine uptake in Philadelphia, PA by connecting with parents and caregivers.MethodsTwenty-four participants were engaged in the VaxUp program. Participants completed Vaccine Information Champions (VIC) and social determinants of health (SDOH) training sessions prior to beginning the program. Each week, participants completed activities surveys to document their engagement with the program. Participants also completed midpoint and final evaluation surveys to provide feedback to the study team. Survey data were analyzed for engagement trends as well as participants’ knowledge and comfort with program content.ResultsAmbassadors found that the training sessions were useful and engaging. Conversations with the community, written information distribution, and Facebook were the most common forms of weekly ambassador engagement. Participants who completed the final evaluation survey reported more confidence in talking about the COVID-19 vaccine after program participation. All participants believed that their community viewed them as a more trusted messenger since participating. The trainings prior to the start of the program improved their communication with the community. Through this program, ambassadors were able to increase their confidence as trusted messengers both personally and when engaging with community members.ConclusionThe VaxUp program was an effective community-based initiative that addresses COVID-19 vaccine hesitancy.ImplicationsThese findings showcase that training community members to be trusted health ambassadors is essential. Engaging community members as partners in messaging health information is relevant for pediatric nurses, regardless of practice setting.

HIV criminalization statutes continue to disproportionately impact Black queer and trans individuals, particularly Black transgender and gender-expansive people and sex workers, and have historically served as a way to inequitably punish communities for a disease that affects them because of inequitable systems rooted in the legacy of slavery. To achieve the Centers for Disease Control and Prevention’s 2030 goals for Ending the HIV Epidemic in the US, it is essential to take bold steps to decriminalize HIV and interrogate the role of criminalization in reinforcing stigma, exacerbating the social determinants of health, and further disenfranchising marginalized communities. Through the analysis of the theory of racial capitalism, we aim to make the argument for complete decriminalization of HIV as a small step in the ultimate goal of prison abolition and decarceration of all peoples. We advocate rejecting efforts aiming to modernize statutes that further concretize the punitive role prisons play in a capitalist society and systematically revoke HIV-affected communities’ right to freedom. Multilevel policies must address the racialized nature of HIV criminalization. ( Am J Public Health. 2025;115(7):1157–1165. https://doi.org/10.2105/AJPH.2025.308110 )

Expanding access to pre-exposure prophylaxis (PrEP) is crucial for ending the HIV epidemic in the United States and reducing disparities in HIV incidence among marginalized populations. Telehealth models for the delivery of PrEP have the potential to improve access, acceptability, and adherence. In 2022, Philadelphia established the Philadelphia TelePrEP Program to deliver HIV prevention services through telehealth. This qualitative descriptive study aims to identify implementation determinants for telehealth PrEP services in Philadelphia. We completed nine in-depth interviews with staff at the Philadelphia TelePrEP Program (n = 5) and external stakeholders in the HIV prevention workforce (n = 4) using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR). Thematic analysis was used to identify key facilitators and barriers to implementation. Interviews revealed that telePrEP improved convenience and flexibility in accessing PrEP, but online marketing may exclude certain populations with limited digital presence. Dedicated patient navigators and ongoing staff training were key facilitators, whereas limited provider capacity was a challenge. Sustainable funding through grants and 340B revenue enabled the Philadelphia TelePrEP Program to serve uninsured patients. The digital divide, lack of PrEP awareness, and competition from commercial telePrEP providers were identified as potential barriers to engaging priority populations. TelePrEP has the potential to expand the availability of PrEP services and reach communities that currently face barriers to access. However, overcoming key structural and social barriers around public awareness, technology access, and organizational capacity will be critical for successful implementation.

Internalized homophobia (IH) negatively impacts the mental health of adolescent sexual minority men (ASMM), while self-esteem is posited to bolster their mental health. In a repeated-measures study with 599 ASMM (Mean age = 16.2 [ SD = 1.3]; 75.6% racial and ethnic minorities), longitudinal structural equation models investigated the relationships among IH, self-esteem, and mental health (depression and anxiety), as well as the mediating role of self-esteem. Higher self-esteem at earlier time points was significantly associated with lower anxiety and depressive symptoms. The hypothesized mediation pathways were not statistically significant. Subgroup analyses revealed that the protective effect of self-esteem against anxiety was significant for racial and ethnic minority ASMM but not for their non-Hispanic White counterparts. These findings highlight the need for tailored interventions that address the unique experiences of ASMM from diverse racial and ethnic backgrounds.