Philadelphia Department of Public Health

IntroductionIn Philadelphia there are racial disparities in health outcomes during the perinatal period, such that Black infants and their parents experience a disproportionately higher burden of poor outcomes compared to their White counterparts. These excess risks are driven at least in part by high rates of poverty and other manifestations of structural racism. The provision of guaranteed income (GI) or unconditional cash payments during and after pregnancy, is a bold and evidence-based approach to advancing equity in financial security and health. The objective of this protocol paper is to describe the community-centered approach to the design of (a) the Philly Joy Bank (PJB), a perinatal GI program in Philadelphia, and (b) the evaluation of PJB’s impact.MethodsPJB was conceived by an established coalition of community partners through a collective impact model. Decisions related to the design and implementation of PJB are made through a consensus building process that centers the voices of Lived Experience Experts (i.e., Black birthing people in Philadelphia). Congruent with the community-driven design of PJB, the evaluation of the impact of PJB is grounded in the principles of community-based participatory research and is co-designed by the community.ResultsThe study purpose is to assess the feasibility and acceptability of PJB (Aim 1); to examine whether and how GI affects ability to meet basic needs and parental stress (Aim 2); and to explore the impact of PJB on parental mental health and the preliminary impact on infant prematurity (low birthweight and preterm birth) (Aim 3). Descriptive statistics, mixed effects regression analyses, and participatory qualitative analysis approaches will be used to achieve study aims.DiscussionGI is a promising upstream structural intervention to address persistent health inequities during the perinatal period: a critical period of the life course. Understanding if and how GI improves health for birthing people and their infants can inform implementation and policy to advance health equity.

Background and objective: Malaria remains a major health issue in Sudan, and physicians' non-adherence to treatment protocols has negatively impacted patient outcomes. The 2023 Sudan Malaria Case Management Protocol advocated new developments per the national and globally WHO-recommended levels, but there are still gaps in clinical practices. To improve physician compliance and standardize malaria care, decision-support tools can be based on artificial intelligence (AI). This study aims to examine the effect of the introduction of an AI-based clinical decision-support system (CDSS) on the adherence of physicians to the 2023 Sudan Malaria Case Management Protocol at Al-Managil Teaching Hospital (Managil, GZ, SDN).Methods: A two-cycle clinical audit was conducted between July and September 2025 (baseline audit followed by AI intervention and then re-audit after AI intervention). The current practice and pre-intervention knowledge (n=50 physicians) were evaluated through questionnaires. An AI-CDSS was implemented together with training, incorporating diagnostics, treatment recommendations, and special group advice (pregnancy, neonatal, and G6PD). Compliance rates before and after the intervention were compared, with statistical testing including effect sizes and 95% confidence intervals.Results: Recognition of the 2023 protocol increased from 38% to 100% (risk difference +62%, 95% CI: 48-76; p<0.001), and awareness of intravenous (IV)/intramuscular (IM) artesunate as first-line treatment rose from 53% to 98% (risk difference +45%, 95% CI: 32-58; p<0.001). Attitudes towards severe malaria improved from 15% to 91% (risk difference +76%, 95% CI: 61-91; p<0.001). The timely initiation of treatment within 24 to 48 hours improved to 100% (p < 0.001). Mean compliance increased from 50.7% (95% CI: 42-59) to 96.8% (95% CI: 92-100, p<0.001). Residual deficiencies persisted in microscopy reporting and G6PD testing.Conclusion: A combination of an AI-driven CDSS and focused training demonstrated a substantial improvement in physician compliance with the 2023 Sudan Malaria Case Management Protocol, particularly in critical care aspects. However, a possible Hawthorne effect and the absence of clinical outcome data (e.g., morbidity, mortality) should be acknowledged as limitations. Greater scale-up of this approach, while addressing infrastructural and digital literacy challenges, could have a major impact on malaria case management and disease burden in Sudan.

People with substance use disorders (SUDs) are at higher risk for infectious diseases (IDs). Co-locating ID screening services within inpatient SUD treatment programs may decrease barriers to care; however, the impact of such screening has not been evaluated. We conducted an effectiveness study evaluating comprehensive ID screening within an 18-bed inpatient SUD program. During usual care (September 2021-June 2022), ID screening was completed at the discretion of the admitting psychiatrist. During the intervention (September 2022-June 2023), an ID-trained nurse met with patients to support completion of screening for HIV, viral hepatitis (hepatitis A [HAV], B [HBV], and C [HCV]), latent tuberculosis [LTBI], and sexually transmitted infections [STI]. Hepatitis vaccinations, HIV preexposure prophylaxis, and/or ID treatments were offered during admission. Demographics were similar between the groups (n = 261, usual care; n = 207, intervention). Screening for ≥1 ID increased significantly during the intervention (60.2% vs 90.8%, P < .001), with the greatest increases in HAV (6.1% vs 90.3%, P < .001), HBV (8.8% vs 91.3%, P < .001), and LTBI (1.9% vs 67.8%, P < .001). HAV and HBV vaccinations increased from 0% to 58% and 71%, respectively. HCV viremia was identified in 15 usual care and 19 intervention patients, of whom 0% and 36.8% initiated direct-acting antiviral therapy within 2 weeks of testing. STIs were identified in 9.2% and 13.5% (P = .09) of the patients in the usual care and intervention groups. Comprehensive ID screening within inpatient SUD programs can increase uptake of testing and facilitate low-barrier delivery of preventive and therapeutic treatment.

Adherence and retention in care are key targets to achieve favorable health outcomes for people with HIV. Challenges with adherence and retention are pronounced for marginalized communities facing intersectional structural oppression. Community health worker delivery of Managed Problem Solving (MAPS+), an evidence-based behavioral intervention, has the potential to improve adherence and retention, yet understanding structural inequities affecting people with HIV is necessary to increase the likelihood of equitable implementation. The current study explores systemic inequities influencing HIV care adherence and retention, and approaches to address these challenges. We conducted semi-structured interviews with 13 clinics and 4 constituent groups: prescribing clinicians, non-prescribing clinical team members (e.g., medical case managers), clinic administrators, and policymakers. Through reflexive thematic analysis within a constructionist paradigm, we identified two key themes. The first elucidated experiences of systemic inequities such as access to resources, healthcare system navigation difficulties, power differentials, medical mistrust, intersectional stigma and potential patient burden associated with MAPS+. The second theme highlighted the ways in which staff and clinicians shoulder the burden of addressing inequities by approaching people with HIV with dignity and developing trusting relationships and how MAPS + can bolster this approach by partnering with and centering patient needs. While these individual and organizational efforts are valuable, ending the HIV epidemic requires structural changes to address systemic inequities directly. This research underscores the complex interplay between structural oppression and HIV care, calling for comprehensive approaches to achieve health equity.

The application of a care continuum model (CCM) can identify gaps in diagnosis, care, and treatment of populations with a common condition, but challenges are inherent in developing a CCM for chronic hepatitis B. In contrast with treatment for HIV or hepatitis C, treatment is not indicated for all people with chronic hepatitis B, clinical endpoints are not clear for those receiving treatment, and those for whom treatment is not indicated remain at risk for complications. This topical review examines the data elements necessary to develop and apply chronic hepatitis B CCMs at the jurisdictional health department level. We conducted a nonsystematic review of US-based publications in Ovid MEDLINE (1946-present), Ovid Embase (1974-present), and Scopus (not date limited) databases, which yielded 724 publications for review. Jurisdictional health departments, if properly supported, could develop locale-specific focused CCMs using person-level chronic hepatitis B registries, updated longitudinally using electronic laboratory reporting data and case reporting data. These CCMs could be applied to identify disparities and improve rates in testing and access to care and treatment, which are necessary to reduce liver disease and chronic hepatitis B mortality. Investments in public health surveillance infrastructure, including substantial enhancements in electronic laboratory reporting and case reporting and the use of supplementary data sources, could enable jurisdictional health departments to develop modified CCMs for chronic hepatitis B that focus, at least initially, on "early" CCM steps, which emphasize optimization of hepatitis B diagnosis, linkage to care, and ongoing clinical follow-up of diagnosed people, all of which can lead to improved outcomes.

BackgroundPre-exposure prophylaxis (PrEP) is an effective HIV prevention method and a key component of Philadelphia’s Community Plan to End the HIV Epidemic (EHE). However, significant barriers to accessing PrEP exist among people at risk for HIV. Low-threshold models for PrEP services that minimize barriers to entry and service engagement could help bolster access to PrEP through community-based clinics. This study aimed to describe the initial implementation of low-threshold PrEP services in three sexual health clinics funded by the Philadelphia Department of Public Health and explore strategies for delivering low-threshold PrEP services.MethodsWe conducted three focus groups with staff (i.e., providers, prevention navigators, and administrative staff, N = 21) at each of three participating PDPH-funded sexual health clinics from November 2021 to January 2022. Discussion topics included details about the PrEP delivery process, clinic strengths and assets, resource gaps, and PrEP implementation goals. Follow-up interviews with staff members (N = 8) between March 2022 and May 2022 focused on identifying successful strategies for PrEP delivery and adaptations needed to optimize low-threshold PrEP service delivery. Rapid qualitative methods and the Consolidated Framework for Implementation Science were used to analyze data from focus groups and interviews.ResultsParticipants collaborated to create process maps that visualized the steps involved in delivering PrEP services within their respective settings. These maps highlighted several stages in PrEP service delivery, such as connecting individuals to services, providing prevention navigation, conducting clinical encounters, and ensuring follow-up care. Participants described effective strategies for implementing PrEP, which included integrating and co-locating services on-site, strengthening staffing resources and capacity, and addressing barriers experienced by clients.ConclusionsLessons from the implementation of low-threshold PrEP service delivery in Philadelphia can guide ongoing local adaptations and future scale-up of these models to improve access to PrEP and advance the goals of the EHE initiative.

Abstract Background Invasive infections involving Group A Streptococcus (iGAS), defined as infections beyond simple skin and soft tissue infection or pharyngitis, are rising nationally. We report an increase in incidence of iGAS at two urban, quaternary care health systems that contain 6 hospitals in the city of Philadelphia. Methods All blood, sterile fluid, and tissue cultures that yielded Streptococcus pyogenes were identified using the laboratory information systems at the Temple University Health System and the University of Pennsylvania Health System. Two cohorts were compared: cases diagnosed between January 1, 2019 and December 31, 2019, and between January 1, 2021 to December 31, 2021. We excluded 2020 data to avoid analysis of disease incidence when hospital admission patterns may have been highly biased due to COVID-19 pandemic. Electronic health records were reviewed and data pertaining to demographics, month of infection, culture site, HIV status, HCV status, housing status, and injection drug use were abstracted. Descriptive statistics were used to summarize findings. Results In 2021, there were 301 unique cases of iGAS (148 involving bacteremia) compared to 169 in 2019 (with 70 cases of bacteremia). This represented an overall increase in iGAS of 178% and a 211% increase in cases involving bacteremia. Of the cases in 2021, 210 (69.8%) were PWID compared to only 54 (32%) in 2019, a 388% increase. In 2021, 7.5% of patients had a diagnosis of HIV compared to 8.9% in 2019, but a large percentage did not have an HIV test (37% in 2019 and 19% in 2021). HCV Antibody positivity was 52.3% in 2021 versus 26.6% in 2019. Housing instability was recorded in 151 cases (50.2%) in 2021 and 31 (18.3%) in 2019, a 487% increase. Table 1 Demographic and clinical characteristics of iGAS cases in 2019 and 2021 Table 2 Age and Sex data in PWID Conclusion From 2019 to 2021, there was an increase in iGAS infections among an adult population in a large metropolitan city. We noted a 178% total increase in iGAS during our study period, with a 388% increase among PWID and 487% increase among those unstably housed. As the overdose crisis continues, public health practitioners and medical providers should be aware of the increase in iGAS when providing empiric treatment for PWID with infections and utilize local and national resources to report and manage cases. Disclosures Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant

Abstract Background Skilled nursing facilities (SNFs) have significant opportunity to improve antibiotic use and reduce multidrug-resistant organism transmission. In the summer of 2022, the Southeast Pennsylvania Long-Term Care Resiliency, Infrastructure Supports, and Empowerment (LTC-RISE) team and the Philadelphia Department of Public Health (PDPH) distributed a survey to all Philadelphia SNFs to understand strengths and opportunities for improvement of antibiotic stewardship programs (ASPs). Methods A REDCap survey was distributed via phone or video call to 47 SNFs addressing all elements in the CDC's Checklist for Core Elements of Antibiotic Stewardship in Nursing Homes. SNFs self-reported survey responses. Survey results were used to provide individualized feedback highlighting SNF performance against peers, and to implement broad-based interventions to strengthen ASPs. Results Thirty-eight SNFs (81%) responded to the survey. All 7 ASP core elements were reported present by 55% of respondents. Only one SNF did not have any core elements present. The elements most commonly reported present and absent were tracking measures of antibiotic use (97%), and monitoring outcomes of antibiotic use (79%), respectively. The ASP lead(s) most commonly identified was the Infection Preventionist (66%), Director/Assistant Director of Nursing (55%), or Medical Director (37%). Infection-specific interventions and resident educational materials were provided in only 42% and 34% of SNFs, respectively. Customized ASP reports were sent to all participating SNFs, with feedback obtained at 3 months after distribution. Survey results were used to create an educational webinar and UTI-focused resource package. Conclusion A majority of Philadelphia SNFs reported having ASPs with all CDC core elements in place, and almost all facilities tracked at least one measure of antibiotic use. Opportunities for improvement included tracking outcomes of antibiotic use, providing infection-specific interventions, and providing educational materials to residents. Insights provided from the survey helped to guide individualized and broad-based ASP interventions across facilities. Disclosures All Authors: No reported disclosures

Purpose Maternal substance use and deaths due to overdoses are increasing nationwide. Evidence suggests that the rate of resumed substance use, and fatal and non-fatal overdose is greatest in the first year after birth, particularly around six months postpartum, compared to other parts of the perinatal period. Doula care has been linked to improvements in perinatal health and outcomes. In response to the opioid epidemic, the Philadelphia Department of Public Health developed and implemented the Doula Support Program (DSP), with a focus on one year of postpartum care for birthing people with a substance use disorder (SUD). In this paper, we describe the program and its formation and report on the early challenges and successes of the program implementation, based on information we received from program founders and managers in a group interview. Assessment Early successes of the program include partnering with local community-based programs to recruit and retain doulas, supplementing traditional doula education with perinatal SUD-specific trainings, and maximizing client referrals by collaborating with local organizations and treatment centers that serve birthing people with SUD. Client retention, however, has proven to be challenging, especially during the COVID-19 pandemic. The DSP continues to grow, and lessons learned will facilitate program improvements. The goal of this paper is to outline the development and launch of the DSP and to act as a model for other state and local health departments