Background: With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion: As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion: Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94–2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82–2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46–0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients.

Context: Health disparities and health inequities can lead to poor health outcomes. However, health disparities continue to persist in communities across the United States, presenting a crucial public health challenge. Persisting budget cuts and workforce challenges tend to hinder local health departments' (LHDs') ability to assess and address health disparities. Objectives: To examine the extent to which LHDs' use of informatics effects their engagement in strategies and activities addressing health disparities. Methods: Data from the 2016 Profile of LHDs were used in examining the association of informatics with 9 activities addressing health disparities/inequities. Results: Fifty-nine percent of LHDs used data and described health disparities in their jurisdiction, and 12% conducted original research to link health disparities to differences in social or environmental conditions. Less than 40% of LHDs prioritized resources for the reduction of health disparities. LHDs that implemented information systems had increased odds of describing the disparities in their jurisdiction (P < .01) and having prioritized resources for the reduction of disparities (P < .01). Per capita expenditures, participation in a national accreditation program process, and a larger LHD population were also positively associated with 7 of 9 activities for addressing health disparities/inequities. Conclusions: As LHDs advance efforts to reduce health disparities and inequities, leadership will find informatics a useful strategy. National initiatives aimed to boost LHDs' engagement in the reduction of disparities might benefit from our findings, positing a positive influence of informatics.

Interruptions in the continuum of care for HIV can inadvertently increase a patient’s risk of poor health outcomes such as uncontrolled viral load and a greater likelihood of developing drug resistance. Retention of people living with HIV (PLHIV) in care and determinants of attrition, such as adherence to treatment, are among the most critical links strengthening the continuum of care, reducing the risk of treatment failure, and assuring viral load suppression. Objective: To analyze the variation in, and factors associated with, retention of patients enrolled in HIV services at outpatient clinics in the provinces of Kinshasa and Haut-Katanga, Democratic Republic of the Congo (DRC). Methods: Data for the last visit of 51,286 patients enrolled in Centers for Disease Control (CDC)-supported outpatient HIV clinics in 18 health zones in Haut-Katanga and Kinshasa, DRC were extracted in June 2020. Chi-square tests and multivariable logistic regressions were performed. Results: The results showed a retention rate of 78.2%. Most patients were classified to be at WHO clinical stage 1 (42.1%), the asymptomatic stage, and only 3.2% were at stage 4, the severest stage of AIDS. Odds of retention were significantly higher for patients at WHO clinical stage 1 compared to stage 4 (adjusted odds ratio (AOR), 1.325; confidence interval (CI), 1.13–1.55), women as opposed to men (AOR, 2.00; CI, 1.63–2.44), and women who were not pregnant (vs. pregnant women) at the start of antiretroviral therapy (ART) (AOR, 2.80; CI, 2.04–3.85). Odds of retention were significantly lower for patients who received a one-month supply rather than multiple months (AOR, 0.22; CI, 0.20–0.23), and for patients in urban health zones (AOR, 0.75; CI, 0.59–0.94) rather than rural. Compared to patients 55 years of age or older, the odds of retention were significantly lower for patients younger than 15 (AOR, 0.35; CI, 0.30–0.42), and those aged 15 and <55 (AOR, 0.75; CI, 0.68–0.82). Conclusions: Significant variations exist in the retention of patients in HIV care by patient characteristics. There is evidence of strong associations of many patient characteristics with retention in care, including clinical, demographic, and other contextual variables that may be beneficial for improvements in HIV services in DRC.

The 2019 coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus has affected the social determinants of health, worsening health inequities and deteriorating healthcare capacities around the globe. The objective of this study is to investigate the COVID-19 prevention behaviors within the framework of the Health Belief Model in the city of Depalpur in the Okara District of Pakistan in May 2020. Using an observational, cross-sectional, and quantitative study design, a face-to-face field survey was conducted during the epidemic of COVID-19 in district Okara, Pakistan. A sample of 500 adults was selected from the city of Depalpur the in Okara district of Pakistan, using a two-stage sampling design with cluster sampling in stage one and systematic random sampling at stage two. A COVID-19 prevention behavior scale was computed based on twelve dichotomous items. Descriptive statistics, analysis of variance (ANOVA), and negative binomial regression analyses were performed. The most common prevention behavior among study participants was avoiding going for walks in the parks (81.0%), followed by not leaving home during the lockdown (72.6%), and washing hands every day with soap and water for 20 s after going out of their home (64.0%). Fewer people exhibited prevention behaviors such as social distancing (e.g., staying at least six feet away from other people) which in the EU was recommended to be a minimum of 1.5–2 m (44.4%) and following all of the basic protective measures (e.g., hand washing, use of a face covering in public, social distancing) in order to protect against COVID-19 (33.0%). The results from the negative binomial regression analysis showed that after controlling for the other HBM constructs and sociodemographic factors, only the perceived benefits of preventative actions showed significant association with the prevention behavior scale (IRR, 1.16; CI, 1.061–1.276; p < 0.001). The study findings show that public health interventions attempting to control the spread of COVID-19 in Pakistan may want to affect a change in people’s perceived benefits of preventative actions through mass awareness-raising campaigns.

Context: Despite a growing consensus in public health to address health inequities and leverage social determinants of health (SDoH), the level of public health practitioners' readiness to become the agents of change in promoting health equity and shaping SDoH is not well researched.Objectives: To examine (1) the level of public health agency employees' perceived desirability for impacting health equity and SDoH, and (2) the impact of employee characteristics such as a (PH WINS) public health degree and awareness of health in all policies on such desirability.Methods: Data from the 2017 Public Health Workforce Interests and Needs Survey were used in examining the sense of desirability among agency employees for affecting health equity and SDoH in the agency jurisdictions.Results: Fifty-seven percent of health agency employees believed that their agencies should be very involved in affecting health equity in their jurisdictions. Fairly smaller proportions of employees believed in the desirability of affecting SDoH, and the proportions who believed that the agency should bevery involvedin affecting specific SDoH were 17.8% for affecting the quality of transportation, 18.5% for affecting the economy, 22.2% for quality of housing, 22.4% for quality of the built environment, 25.4% for K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (P< .05) of believing that the agency should be very involved in affecting health equity.Conclusions: With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in the public health workforce's perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity. Our study findings imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. Fostering cross-sector partnerships with a focus on Health in All Policies (HiAP), SDoH, and health equity must be a high priority for public health agencies, which can be formalized through organizational strategic plans.