Epidemiology of HIV Infection in Large Urban Areas in the United States

Background: While the U.S. HIV epidemic continues to be primarily concentrated in urban area, local epidemiologic profiles may differ and require different approaches in prevention and treatment efforts. We describe the epidemiology of HIV in large urban areas with the highest HIV burden. Methods/Principal Findings: We used data from national HIV surveillance for 12 metropolitan statistical areas (MSAs) to determine disparities in HIV diagnoses and prevalence and changes over time. Overall, 0.3 % to 1 % of the MSA populations were living with HIV at the end of 2007. In each MSA, prevalence was.1 % among blacks; prevalence was.2 % in Miami, New York, and Baltimore. Among Hispanics, prevalence was.1 % in New York and Philadelphia. The relative percentage differences in 2007 HIV diagnosis rates, compared to whites, ranged from 239 (San Francisco) to 1239 (Baltimore) for blacks and from 15 (Miami) to 413 (Philadelphia) for Hispanics. The epidemic remains concentrated, with more than 50 % of HIV diagnoses in 2007 attributed to male-to-male sexual contact in 7 of the 12 MSAs; heterosexual transmission surpassed or equaled male-to-male sexual transmission in Baltimore, Philadelphia, and Washington, DC. Yet in several MSAs, including Baltimore and Washington, DC, AIDS diagnoses increased among men-who-have sex with men in recent years. Conclusions/Significance: These data are useful to identify local drivers of the epidemic and to tailor public health effort

Big Cities Health Inventory: The Health of Urban America, 2007

The importance of having state, county, and local health-related data has been recognized in a number of studies. The availability of local level data, both general and related to specific issues, continues to improve in this technological age.10-13 Among these are several reports and data sources that have been produced to describe the relationship between levels of urbanization and health. The purpose of this document is to focus specifically on the health of people living in large cities in the United States. In so doing, the report attempts to increase knowledge of the issues large cities face and stimulate dialogue that will lead to a healthier city population. In addition to improving our understanding of the health in large cities, the data in this report will serve as a reference point to monitor cities’ progress in reaching the nation’s Year 2010 objectives

The Health of Urban USA

We are very pleased to release the fifth edition of the Big Cities Health Inventory(BCHI), a compendium of health status indicators produced in a comparative format for the 54 largest metropolitan areas in the United States. This report fills an information gap that, despite great advances in information technology over the past decade, still persists today. Data on the health of our communities are probably more widely available at this time than at any point in the past. The Internet has become a vast repository of statistics on a variety health conditions. But less progress has been made in turning these raw data into usable information, especially for the nation's largest urban areas which face higher rates of poor health status and racial/ethnic disparities in illness and access to health care services

The Health of Urban USA

We are very pleased to release the fifth edition of the Big Cities Health Inventory(BCHI), a compendium of health status indicators produced in a comparative format for the 54 largest metropolitan areas in the United States. This report fills an information gap that, despite great advances in information technology over the past decade, still persists today. Data on the health of our communities are probably more widely available at this time than at any point in the past. The Internet has become a vast repository of statistics on a variety health conditions. But less progress has been made in turning these raw data into usable information, especially for the nation's largest urban areas which face higher rates of poor health status and racial/ethnic disparities in illness and access to health care services.http://www.who.or.jp/urbanheart/US_Big_Cities_Healt_Inventory_2007.pd

AIDSVu Cities’ Progress Toward HIV Care Continuum Goals: Cross-Sectional Study

BackgroundPublic health surveillance data are critical to understanding the current state of the HIV and AIDS epidemics. Surveillance data provide significant insight into patterns within and progress toward achieving targets for each of the steps in the HIV care continuum. Such targets include those outlined in the National HIV/AIDS Strategy (NHAS) goals. If these data are disseminated, they can be used to prioritize certain steps in the continuum, geographic locations, and groups of people. ObjectiveWe sought to develop and report indicators of progress toward the NHAS goals for US cities and to characterize progress toward those goals with categorical metrics. MethodsHealth departments used standardized SAS code to calculate care continuum indicators from their HIV surveillance data to ensure comparability across jurisdictions. We report 2018 descriptive statistics for continuum steps (timely diagnosis, linkage to medical care, receipt of medical care, and HIV viral load suppression) for 36 US cities and their progress toward 2020 NHAS goals as of 2018. Indicators are reported categorically as met or surpassed the goal, within 25% of attaining the goal, or further than 25% from achieving the goal. ResultsCities were closest to meeting NHAS goals for timely diagnosis compared to the goals for linkage to care, receipt of care, and viral load suppression, with all cities (n=36, 100%) within 25% of meeting the goal for timely diagnosis. Only 8% (n=3) of cities were >25% from achieving the goal for receipt of care, but 69% (n=25) of cities were >25% from achieving the goal for viral suppression. ConclusionsDisplay of progress with graphical indicators enables communication of progress to stakeholders. AIDSVu analyses of HIV surveillance data facilitate cities’ ability to benchmark their progress against that of other cities with similar characteristics. By identifying peer cities (eg, cities with analogous populations or similar NHAS goal concerns), the public display of indicators can promote dialogue between cities with comparable challenges and opportunities

“Scaling-out” evidence-based interventions to new populations or new health care delivery systems

Abstract Background Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials. Discussion In this paper, we introduce a new concept for implementation called “scaling-out” when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest. Conclusion In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes “borrow strength” from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper