National Institutes of Health

Approaches to strengthen Data-to-Care (D2C) models are needed. We tested an insurance-based D2C prescription model (D2C-Rx), which used antiretroviral therapy (ART) prescription claims to identify people with HIV who fail to fill ART prescriptions in a timely manner and to provide ART adherence support. The Antiretroviral Improvement among Medicaid EnrolleeS (AIMS) study was the first trial of an insurance-based D2C-Rx program. We describe AIMS study enrollment, focusing on patient-participants in the AIMS program arm. Virginia, United States. AIMS used Virginia Medicaid claims and HIV surveillance data to identify Medicaid enrollees with HIV who were without an ART prescription and their providers; study staff then provided targeted adherence support. The target patient-participant sample size was 1000. The outcome of interest was HIV viral suppression. The study encountered difficulty recruiting patient-participants. Low enrollment prompted major changes to the protocol, including revisions to study design, eligibility criteria, and recruitment methods. These changes were unsuccessful. The trial was terminated because of low patient-participant enrollment (n = 4). Reasons for low patient-participant enrollment may include phone-based recruitment approach, lengthy identity verification and consent procedures, and lack of participant compensation. Although we aimed to identify people with HIV without a current ART prescription refill, several participants reported having their medications available; this discrepancy suggests issues with unexpected participant behavior (eg, stockpiling) or timeliness and accuracy of prescription claims data. Future insurance-based D2C-Rx interventions should account for these challenges, be tailored to context, and be nimble enough to pivot to alternative recruitment methods when needed.

To examine the risk of hospital readmission after an index hospitalization for TBI in older adults. Using data from the Atherosclerosis Risk in Communities (ARIC) study, we used propensity score matching of individuals with an index TBI-related hospitalization to individuals with (1) non-TBI hospitalizations (primary analysis) and (2) orthopedic injury hospitalizations (secondary analysis). The rate of all-cause hospital readmission was estimated using adjusted Fine-Gray proportional hazards regression models within strata defined by time since hospitalization. Follow-up extended from the date of index hospitalization after study enrollment (1987-1989) through December 31, 2019. Six hundred sixty-seven participants with an index TBI-related hospitalization were matched using propensity scores with replacement with a ratio of 1:4-2668 participants with non-TBI-related hospitalizations and 1:3 with 2001 participants with orthopedic injury-related hospitalizations. Median age was 68 years (IQR = 46-95) at index hospitalization. Compared to participants with an index non-TBI-related hospitalization, readmission rates were lower among participants with an index TBI-related hospitalization (HR = 0.80, 95% CI = 0.74, 0.87) over a median follow-up of 2.7 years, although similar readmission rates were observed within the first year of follow-up (HR = 1.03, 95% CI = 0.88, 1.21). Rates of hospital readmission among persons with an index TBI-related hospitalization were similarly decreased compared with persons with an orthopedic injury-related hospitalization (HR = 0.78, 95% CI = 0.72, 0.85) over a median follow-up of 3.1 years. Among community-dwelling older adults with a TBI-related hospitalization, rates of hospital readmission were similar to individuals hospitalized for a non-TBI cause in the first year, but lower subsequently. Targeted interventions in the first year post-hospitalization may be most beneficial for reducing readmissions among individuals with TBI.

This study aimed to assess how food-related behavioral traits, examined with the Three-Factor Eating Questionnaire (TFEQ) and the Perceived Stress Scale (PSS), influence adlibitum intake after fasting and during and after cold exposure compared to thermoneutral conditions, beyond what is explained by energy expenditure alone. Healthy participants (n = 46; 30 males; age 36.9 ± 10.5 years; BMI 32.3 ± 8.7 kg/m2) completed the TFEQ, PSS, and dual-energy x-ray absorptiometry (DXA) scan. The Hunger subscale of the TFEQ was further divided into internal and external hunger based on the methodology of Bond etal. Participants ate adlibitum from a food intake paradigm on five separate occasions, each over 24 h: (1) after a 36-h fast at thermoneutral temperature, (2) during cold exposure (19.0°C) in the chamber, (3) during thermoneutral conditions (23.5°C) in the chamber, (4) after cold exposure, and (5) after thermoneutral exposure. Total hunger score predicted intake across all five conditions (β = 0.58 MJ/day, p = 0.02). Internal and external subscales also predicted intake in separate models (β = 1.04 MJ/day, p = 0.02; β = 1.46 MJ/day, p = 0.01). Participants ate more during the cold condition than during thermoneutrality (mean = 1.69 MJ/day, or 404 kcal/day, p = 0.009). Higher external hunger scores correlated with greater intake (partial r = 0.38; p = 0.01), but internal hunger scores did not (partial r = 0.22, p = 0.16), after accounting for sex, race, fat mass, and fat-free mass. Restraint, disinhibition, and PSS were not associated with intake. Increased susceptibility to hunger cues, particularly external cues, was associated with higher food intake during cold stress. These findings suggest that behavioral approaches, such as reducing responsivity to food cues, are important targets for weight loss interventions. ClinicalTrials.gov: NCT02939404.

Kenyan guidelines recommend syndromic management for sexually transmitted infections (STIs), which may miss many infections. We used nucleic acid amplification testing to screen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at 3 anatomic sites among adolescents and adults with behavioral risk factors in Western Kenya. From December 2021 to April 2023, we enrolled participants without HIV who were aged 14 to 55 years and reported a recent history of an STI, transactional sex, condomless sex with multiple partners, injection drug use, and/or anal sex with male partners. Urine, oropharyngeal swabs, and anorectal swabs were tested using Xpert CT/NG (Cepheid). Multivariable robust Poisson regression models were used to estimate prevalence ratios and 95% confidence intervals for factors potentially associated with the prevalence of both STIs combined. Among 405 participants tested for CT/NG at enrollment, 324 (80.0%) were females, and 324 (80.0%) were aged 14 to 24 years. CT and/or NG was diagnosed in 143 participants (35.3%), including CT in 111 (27.4%) and NG in 76 (18.8%). Infections were most prevalent at the urogenital site, with 124 (30.6%) participants diagnosed with urogenital CT and/or NG. Anorectal CT/NG was observed in 117 (28.9%) and oropharyngeal CT/NG in 14 (3.5%). Females had higher prevalences than males of both urogenital (33.6% vs. 18.5%, P = 0.012) and anorectal CT/NG (31.8% vs. 17.3%, P = 0.015). A theoretical screening approach that only tested for urogenital infections would have missed 18.0% of CT cases and 18.4% of NG cases. In multivariable analyses, there were no statistically significant associations between sociodemographic variables and CT/NG prevalence. Urogenital and anorectal CT/NG infections were common in 2 communities in Western Kenya with behavioral vulnerability but difficult to predict based on sociodemographic variables. Nucleic acid amplification testing-based urogenital and anorectal screening of sexually active adolescents and young adults could reduce CT/NG burden in this population.