Elizabeth F. Bair

Background: Men living with HIV (MLWHIV) in Sub-Saharan Africa are less likely than women to know their HIV status, initiate and remain on antiretroviral therapy (ART), and achieve viral suppression. This reduces healthy lifespans and threatens epidemic control. Treatment as prevention (TasP) or Undetectable=Untransmittable (U=U) messaging could close this gap. We hypothesized that brief, peer-delivered positive U=U messaging could promote uptake of HIV testing services and linkage to care among MLWHIV. Methods: We conducted a pragmatic cluster-randomised controlled trial of peer-delivered U=U messaging on men’s uptake of community-based HIV testing and ART initiation in South Africa’s Eastern Cape and Western Cape provinces. HIV testing service site-days were randomised to U=U or standard-of-care (SoC) messaging. Trained male peers invited adolescent boys 15 and older and adult men in the vicinity of mobile testing sites to test for HIV, using an invitation script and card. Mobile testing site-days were randomised to either U=U or standard-of-care (SoC) invitation scripts and cards. The primary outcome was clinic- or laboratory-confirmed initiation or reinitiation of ART within 30 days of testing, assessed by intent-to-treat analysis. Findings: Between March 31, 2023 and April 30, 2024, testing site-days were randomised to U=U (200 days, 13,331 invitations) or SoC (209 days, 14,285 invitations). We observed initiation or reinitiation of ART within 30 days of testing in 0.03% of in the U=U arm vs. 0.05% men in the SoC arm (difference: -0.019%) Interpretation: A light-touch, behaviourally informed community-based intervention communicating the concept of U=U to men did not increase ART initiations. As reported in previous trials of similar interventions, U=U messaging alone may not be enough to affect linkage to care after receiving an HIV-positive result. Future research should investigate the mechanisms by which U=U messaging influences behaviour including its role in reducing motivational barriers to testing.

Background/Aims: Clinical trials are commonly believed to benefit from the involvement of an academic principal investigator who accepts responsibility for design, conduct, and reporting. Little evidence exists, however, about the importance that diverse stakeholders assign to the principal investigator’s role in leadership of trials. Furthermore, few studies have examined whether and how beliefs about the role of the principal investigator might vary by funding source. Methods: We conducted parallel Delphi panel surveys with seven stakeholder groups (principal investigators, patient advocates, journal editors, public funders, industry representatives, United States Food and Drug Administration officials, and clinical trial cooperative-group chairs) to assess the extent to which respondents believed leadership of a multicenter randomized controlled trial by an academic principal investigator to be important, considering publicly and industry-funded trials separately. We then surveyed an international sample of principal investigators (N = 92) who had recently published a multicenter randomized controlled trial in a high-impact general medical, oncology, cardiovascular, or psychiatry journal to assess their normative views on the importance of the academic principal investigator in leading both publicly and industry-funded trials. Results: Several patterns emerged from the Delphi panel surveys. First, panelists viewed involvement of an identified academic principal investigator as most important at the design and planning and the interpretation and dissemination phases of a trial, as compared with the implementation and data collection phase. Second, panelists generally viewed involvement of an identified academic principal investigator as more important in publicly funded than in industry-funded trials. Finally, panelists representing industry stakeholders and United States Food and Drug Administration officials viewed involvement of an identified academic principal investigator as less important, especially for industry-funded trials, than did other groups. Respondents to the normative principal investigator survey generally endorsed the importance of academic principal investigators in leading multicenter randomized controlled trials, both overall (median rating 6 on the 0–6 point scale) and for trial-specific tasks. Both overall and with respect to specific tasks, however, respondents viewed an academic principal investigator’s leadership as more important when considering publicly funded as compared with industry-funded trials. Conclusion: Although members of most stakeholder groups participating in Delphi surveys view involvement of an academic principal investigator with overall responsibility for a multicenter randomized controlled trial as very important, there are notable differences depending on the respondent’s perspective, the specific trial-related task, and the source of funding for the trial. In addition, principal investigators generally view an academic principal investigator as more important to the validity of a publicly funded multicenter randomized controlled trial than to the that of an industry-funded trial. These findings highlight the need to clarify the real-world practices of clinical trial leadership across diverse settings and to assess how those practices align with widely shared norms.

We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2 percent subsequently were vaccinated, whereas 20.9 percent (3.7 percent of active employees) were terminated because of noncompliance with the mandate.

The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to “deaths of despair.” Increasing automation—the use of industrial robots to perform tasks previously done by human workers—is one structural force driving the decline of manufacturing jobs and wages. In this study, we examine the impact of automation on age- and sex-specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993–2007 led to substantive increases in all-cause mortality for both men and women aged 45–54. Disaggregating by cause, we find evidence that automation is associated with increases in drug overdose deaths, suicide, homicide, and cardiovascular mortality, although patterns differ by age and sex. We further examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids.

The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to ‘deaths of despair’. Increasing automation—the use of industrial robots to perform tasks previously done by human workers—is one major structural force driving the decline of manufacturing jobs and wages. In this study we examine the impact of automation on age-sex specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993–2007 led to substantive increases in all-cause mortality for both men and women aged 45-54. Disaggregating by cause, we find evidence automation is associated with increases in drug overdose deaths, suicide, homicide and cardiovascular mortality although patterns differ across age-sex groups. We go on to examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids.

Twenty states have pursued community engagement requirements (ie, work requirements) as a condition for Medicaid eligibility among adults considered able-bodied. Work requirements seek to improve health by incentivizing work,¹ but may result in coverage losses.²