Conducting HIV Prevention Programs for the Severely Mentally Ill: An Assessment of Capacity Among HIV Prevention Programs Providers in the City and County of San Francisco

Recent studies have shown that the severely mentally ill (SMI) are at higher risk for HIV infection than the general population. At the same time, the number of HIV prevention programs available for this priority population is extremely low. The purpose of this study was to identify the extent to which community-based organizations conduct HIV prevention for severely mentally ill people. Telephone interviews with HIV prevention program managers in San Francisco were conducted over two weeks in 2003. Of the 21 agencies funded by the San Francisco Department of Public Health, only three agencies included severely mentally ill people as a priority population for their prevention efforts. However, 16 agencies reported that they provided prevention services to the SMI, even though they were not considered a priority risk population. Three providers reported no SMI among the population they served. Additional studies are also needed to examine the capacity building elements that are necessary for HIV prevention program providers to plan, design, and implement prevention programs tailored for SMI individuals

WHO Global Situational Alert System: a mixed methods multistage approach to identify country-level COVID-19 alerts

Background Globally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched.Methods The process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of ‘High’ or above were added to an operational watchlist and assistance was deployed as needed.Results Since June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%–67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available.Conclusions The system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators