Jesse Canchola

High costs and supply chain disruptions pose real-world challenges to the implementation of decentralized molecular platforms for Mycobacterium tuberculosis (MTB) detection in resource-limited settings. This study evaluated the cost, feasibility, and acceptability of integrating Cobas MTB and MTB-RIF/INH assays (Roche Diagnostics GmBH, Mannheim, Germany) into high-throughput HIV workflows using the Cobas 8800 system in Busia County, Kenya. Sample and testing volume data were collected from Port Victoria Hospital. Remnant sputum specimens (n = 1208) collected for testing on the decentralized GeneXpert (Cepheid, Sunnydale, CA, USA) platform (standard of care) were analyzed on the centralized Cobas 8800 system. Unit costs were estimated using an ingredients-based approach parameterized within the Testing Platform Cost Model, using real-world throughput data. Operational feasibility and technician acceptability of integrated testing on the Cobas 8800 system were assessed through qualitative surveys and workflow analysis. The integrated, high-throughput Cobas 8800 system maintained consistent testing volumes (median, 94 samples/day), whereas throughput was sporadic on decentralized GeneXpert platforms (median, four samples/day) because of supply chain disruptions and stockouts. The unit cost of the integrated approach ranged from $16.04 (best-case) to $18.97 (worst-case). The GeneXpert unit cost was $23.53 under expected utilization but $78.63 in the worst-case scenario. Operational feasibility and acceptability were high. This study was conducted in Busia county, Kenya, potentially limiting generalizability to regions with different health infrastructure or testing volumes. The analysis did not assess clinical impacts (e.g. time to treatment initiation), and assumed the availability of underutilized capacity on existing high-throughput platforms. Integrating molecular MTB testing into established high-throughput HIV workflows provided superior economic stability versus a decentralized infrastructure, and was feasible and acceptable for laboratory personnel. Strategic scaling of integrated, high-throughput diagnostics to complement near-patient testing may mitigate cost volatility, optimize underutilized testing capacity, and help bridge the national TB diagnostics gap in high-burden, resource-constrained environments.

Research suggests that the impact of childhood sexual trauma (CST) on adult well-being varies in relation to characteristics of CST experiences (e.g., age of onset and duration/frequency) that influence the degree of trauma severity. Yet there remains a need for a CST severity measure that consistently delineates survivors with an elevated risk of adverse adult outcomes (AAOs) and accounts for correlations between severity characteristics. We compared two theory-based, categorical proxy measures of CST severity (duration and developmental timing) in their relationship with three AAOs, among a national probability sample of U.S. adult CST survivors (N = 568). We found a strong relationship between CST duration and developmental timing (p < 0.001), and redundancy in their impact on AAOs (i.e., no meaningful difference in how well they predicted AAOs). Participants with more chronic CST (≥4 years duration or occurring across childhood and adolescence) were twice as likely to report AAOs as other participants. Findings support the importance of assessing trauma chronicity in research and practice, to focus prevention and intervention strategies on CST survivors with the greatest long-term health risk. A categorical CST duration measure offers a theory-based assessment strategy that accounts for both the temporal and developmental effects of trauma severity on health outcomes.

Background/Objectives: Children with severe physical and communication disabilities face many challenges. They have very limited opportunities for upright, hands-free, self-initiated mobility. Current findings in neuroscience and theories on child development suggest that self-initiated mobility can have positive cascading effects on various developmental areas, including language and communication. This study was conducted to examine the current use of hands-free support walkers with children who have severe physical and communication disabilities and use augmentative and alternative communication and to identify the benefits and problems perceived by their parents and professionals from different disciplines. Methods: Online surveys were utilized to collect information from 127 participants, including 31 parents and 96 professionals or paraprofessionals. Results: The participants reported that these children could perform various motor activities in the hands-free support walkers to achieve different goals. Benefits identified by both parents and professionals included providing a way to exercise and stay active, improving motor control, enhancing independence, and bringing enjoyment. Professionals also observed positive impacts on communication, vocalization, use of eye contact, and problem solving. Conclusions: Results suggest that children with severe physical and communication disabilities can benefit from the upright, hands-free, self-initiated mobility provided by hands-free support walkers. Clinical implications and needs for future research are discussed.

Background: Ending the HIV epidemic requires increasing HIV testing among at-risk persons, including addressing the limitations of venue-based testing. Using a community-based intervention (My Test/My Choice; MT/MC), we delivered free oral HIV self-tests (OHSTs) through LGBTQ+ businesses in Multnomah County, OR. We examined if disseminating OHST negatively impacted other segments of the HIV testing system. Methods: We compared dissemination rates for Multnomah County’s clinic-based and online HIV testing programs across three periods: (i) preintervention (July–September 2022), (ii) MT/MC intervention period (October 2022–March 2023), and (iii) postintervention (April–July 2023). We used analysis of variance to examine for changes in county programs during/after MT/MC. Data from all other Oregon counties were analyzed to distinguish county-specific and statewide changes in testing. Results: MT/MC disseminated slightly more HIV tests (n = 2698; 50%/6 months) to the county system than clinic-based dissemination (n = 2561; 48%) and substantially more than online dissemination (n = 78; 2%). There were no significant changes in clinic-based dissemination over time in the county [F (2,10) = 1.83; P = 0.21]. Significant declines in online dissemination occurred in Multnomah County [F (2,10) = 5.95; P = 0.02] and other Oregon counties [F (2,10) = 4.5; P = 0.04], suggesting that statewide, an unknown factor negatively influenced online dissemination. Conclusions: MT/MC positively impacted the local HIV testing system by adding new clients, rather than reducing the number of clients attending other testing programs. Our study provides unique data on the effects of disseminating a new health program on ongoing programs of a similar nature.

Background: The Push–Pull–Infrastructure (PPI) model is proposed as a strategy for disseminating health innovations. Using a PPI model, we developed and examined the feasibility of a community-based intervention to disseminate oral human immunodeficiency virus (HIV) self-testing (OHST) to men who have sex with men in Portland, OR. Methods: We disseminated OHST kits through a network of commercial businesses (n = 6) serving the Lesbian, Gay, Bisexual, Transgender, and Queer plus community. Data were collected weekly on the number of kits distributed. Street intercepts were conducted with customers to assess the impact of promotional efforts on intervention awareness. Using a quasi-experimental design, we examined variation in the intensity of the promotional component on OHST dissemination. Results: Over a 24-week period, we disseminated 2698 OHSTs. Dissemination rates were found to vary significantly with the intensity of the promotional campaign in a dose–response manner (e.g. high intensity = more dissemination). Customer awareness of the campaign increased significantly in the first 9 weeks (from 22% to 60%, P < .001). Within the geographic area studied, we found our dissemination rate to be comparable to or in excess of rates obtained by other county-level HIV-testing programs (i.e. 2698 OHSTs vs. 2561 in-person clinic-based tests; vs. 78 OHSTs disseminated online). Conclusions: A PPI model based on a community commercial network approach was highly successful. The promotional component successfully increased customers’ awareness of the intervention. Formative work, using a single-case changing-intensity design, provided evidence that warrants more extensive research on strategies for mounting a promotional component that builds on the principle of “more for less.”

The aim of this study was to describe how professionals from multiple disciplines (e.g., speech-language pathologists, teachers, occupational therapists) in the United States reported challenges they face in delivering services to children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC). Three surveys were utilized to identify barriers to and priorities for improving educational and clinical services and in-service and preservice education from the perspectives of professionals in school, community, and university settings. Results suggest that current service delivery models may not be meeting the needs of either children with CVI who use AAC or the professionals whose job it is to provide them with services. Professionals in community-based settings appeared to encounter more barriers. Findings help to support a discussion about approaching AAC interventions for children with CVI who use AAC by adopting interprofessional collaborative practice (IPCP) and interprofessional education (IPE) models, which reflect long-standing best practice guidelines for AAC service delivery and are encouraged by multiple professional organizations.

Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.

BACKGROUND Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. OBJECTIVE The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. METHODS Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). RESULTS Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. CONCLUSIONS Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.