American journal of preventive medicine
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Although HIV pre-exposure prophylaxis can decrease new cases of HIV by up to 99%, many patients who could benefit from pre-exposure prophylaxis never receive prescriptions for it. Because pre-exposure prophylaxis is indicated for patients who do not have an infectious disease, increasing pre-exposure prophylaxis prescribing by primary care and generalist clinicians represents a key element of the Ending the HIV Epidemic in the U. S. initiative. ⋯ In the setting of the COVID-19 pandemic, interest in virtual delivery of academic detailing has grown, which could inform efforts to implement academic detailing in rural communities and other underserved areas. Increasing this capacity could make an important contribution to Ending the HIV Epidemic in the U. S. and other HIV prevention efforts.
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Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U. S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. ⋯ Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U. S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.
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The Respond pillar of the Ending the HIV Epidemic in the U. S. initiative, which consists of activities also known as cluster and outbreak detection and response, offers a framework to guide tailored implementation of proven HIV prevention strategies where transmission is occurring most rapidly. Cluster and outbreak response involves understanding the networks in which rapid transmission is occurring; linking people in the network to essential services; and identifying and addressing gaps in programs and services such as testing, HIV and other medical care, pre-exposure prophylaxis, and syringe services programs. ⋯ Efforts to address important gaps in service delivery revealed by cluster and outbreak detection and response can strengthen prevention efforts broadly through multidisciplinary, multisector collaboration. In this way, the Respond pillar embodies the collaborative, data-guided approach that is critical to the overall success of the Ending the HIV Epidemic in the U. S. initiative.
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An important goal of the Ending the HIV Epidemic in the U. S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. ⋯ There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U. S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.
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Cardiovascular disease is the leading cause of death worldwide, and cardiovascular disease burden is increasing in low-resource settings and for lower socioeconomic groups. Machine learning algorithms are being developed rapidly and incorporated into clinical practice for cardiovascular disease prediction and treatment decisions. Significant opportunities for reducing death and disability from cardiovascular disease worldwide lie with accounting for the social determinants of cardiovascular outcomes. This study reviews how social determinants of health are being included in machine learning algorithms to inform best practices for the development of algorithms that account for social determinants. ⋯ Given their flexibility, machine learning approaches may provide an opportunity to incorporate the complex nature of social determinants of health. The limited variety of sources and data in the reviewed studies emphasize that there is an opportunity to include more social determinants of health variables, especially environmental ones, that are known to impact cardiovascular disease risk and that recording such data in electronic databases will enable their use.