Tanya Telfair LeBlanc

The status of HIV prevention efforts for women in correctional facilities.

In the United States, women are a significant proportion of the correctional population. Women also account for an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) cases. When compared with white women, black women have higher incarceration rates and represent more of the newly diagnosed HIV cases. Correctional facilities offer an opportunity to provide women with HIV testing and prevention services so that they will know their status and receive HIV/sexually transmitted disease (STD) risk-reduction counseling and other preventive services. In this report, we describe incarcerated population statistics and HIV surveillance epidemiology for women. We also describe HIV prevention activities undertaken by the Centers for Disease Control and Preventions National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Additional research, program development, and implementation are needed to improve HIV prevention efforts for high-risk women.

Progress in Public Health Emergency Preparedness—United States, 2001–2016

Objectives To evaluate the Public Health Emergency Preparedness (PHEP) programs progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. Methods All 62 PHEP awardees completed the Centers for Disease Control and Preventions self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. Results Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. Conclusions Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.

From Anthrax to Zika: Fifteen Years of Public Health Emergency Preparedness

An introduction is presented in which the authors discuss various reports within the journal on topics including public health emergency preparedness in the twenty-first century, competencies in biosurveillance, and funding from the U.S. Centers for Disease Control and Prevention.

Vulnerabilities Associated with Post-disaster Declines in HIV-testing: Decomposing the Impact of Hurricane Sandy

Introduction: Using Interrupted Time Series Analysis and generalized estimating equations, this study identifies factors that influence the size and significance of Hurricane Sandy’s estimated impact on HIV testing in 90 core-based statistical areas from January 1, 2011 to December 31, 2013. Methods: Generalized estimating equations were used to examine the effects of sociodemographic and storm-related variables on relative change in HIV testing resulting from Interrupted Time Series analyses. Results: There is a significant negative relationship between HIV prevalence and the relative change in testing at all time periods. A one unit increase in HIV prevalence corresponds to a 35% decrease in relative testing the week of the storm and a 14% decrease in relative testing at week twelve. Building loss was also negatively associated with relative change for all time points. For example, a one unit increase in building loss at week 0 corresponds with an 8% decrease in the relative change in testing (p=0.0001) and a 2% at week twelve (p=0.001). Discussion: Our results demonstrate that HIV testing can be negatively affected during public health emergencies. Communities with high percentages of building loss and significant HIV disease burden should prioritize resumption of testing to support HIV prevention.

The Impact of a Case of Ebola Virus Disease on Emergency Department Visits in Metropolitan Dallas-Fort Worth, TX, July, 2013–July, 2015: An Interrupted Time Series Analysis

Background: The first Ebola virus disease (EVD) case in the United States (US) was confirmed September 30, 2014 in a man 45 years old. This event created considerable media attention and there was fear of an EVD outbreak in the US. Methods: This study examined whether emergency department (ED) visits changed in metropolitan Dallas-Fort Worth, Texas (DFW) after this EVD case was confirmed. Using Texas Health Services Region 2/3 syndromic surveillance data and focusing on DFW, interrupted time series analyses were conducted using segmented regression models with autoregressive errors for overall ED visits and rates of several chief complaints, including fever with gastrointestinal distress (FGI). Date of fatal case confirmation was the “event.” Results: Results indicated the event was highly significant for ED visits overall (P<0.05) and for the rate of FGI visits (P<0.0001). An immediate increase in total ED visits of 1,023 visits per day (95% CI: 797.0, 1,252.8) was observed, equivalent to 11.8% (95% CI: 9.2%, 14.4%) increase ED visits overall. Visits and the rate of FGI visits in DFW increased significantly immediately after confirmation of the EVD case and remained elevated for several months even adjusting for seasonality both within symptom specific chief complaints as well as overall. Conclusions: These results have implications for ED surge capacity as well as for public health messaging in the wake of a public health emergency.

The Impact of Hurricane Sandy on HIV Testing Rates: An Interrupted Time Series Analysis, January 1, 2011‒December 31, 2013

Background: Hurricane Sandy made landfall on the eastern coast of the United States on October 29, 2012 resulting in 117 deaths and 71.4 billion dollars in damage. Persons with undiagnosed HIV infection might experience delays in diagnosis testing, status confirmation, or access to care due to service disruption in storm-affected areas. The objective of this study is to describe the impact of Hurricane Sandy on HIV testing rates in affected areas and estimate the magnitude and duration of disruption in HIV testing associated with storm damage intensity. Methods: Using MarketScan data from January 2011‒December 2013, this study examined weekly time series of HIV testing rates among privately insured enrollees not previously diagnosed with HIV; 95 weeks pre- and 58 weeks post-storm. Interrupted time series (ITS) analyses were estimated by storm impact rank (using FEMA’s Final Impact Rank mapped to Core Based Statistical Areas) to determine the extent that Hurricane Sandy affected weekly rates of HIV testing immediately and the duration of that effect after the storm. Results: HIV testing rates declined significantly across storm impact rank areas. The mean decline in rates detected ranged between -5% (95% CI: -9.3, -1.5) in low impact areas and -24% (95% CI: -28.5, -18.9) in very high impact areas. We estimated at least 9,736 (95% CI: 7,540, 11,925) testing opportunities were missed among privately insured persons following Hurricane Sandy. Testing rates returned to baseline in low impact areas by 6 weeks post event (December 9, 2012); by 15 weeks post event (February 10, 2013) in moderate impact areas; and by 17 weeks after the event (February 24, 2013) in high and very high impact areas. Conclusions: Hurricane Sandy resulted in a detectable and immediate decline in HIV testing rates across storm-affected areas. Greater storm damage was associated with greater magnitude and duration of testing disruption. Disruption of basic health services, like HIV testing and treatment, following large natural and man-made disasters is a public health concern. Disruption in testing services availability for any length of time is detrimental to the efforts of the current HIV prevention model, where status confirmation is essential to control disease spread.

Performance of Point of Dispensing Setup Drills for Distribution of Medical Countermeasures: United States and Territories, 2012–2016

Objectives To describe results of points of dispensing (POD) medical countermeasure drill performance among local jurisdictions. Methods To compare POD setup times for each year, we calculated descriptive statistics of annual jurisdictional POD setup data submitted by over 400 local jurisdictions across 50 states and 8 US territories to a Centers for Disease Control and Prevention (CDC) program monitoring database from July 2012 to June 2016. Results In data collected from July 2012 to June 2015, fewer than 5% of PODs required more than 240 minutes to set up, although the proportion increased from July 2015 to June 2016 to almost 12%. From July 2012 to June 2016, more than 60% of PODs were set up in less than 90 minutes, with 60 minutes as the median setup time during the period. Conclusions Our results yield evidence of national progress for response to a mass medical emergency. Technical assistance may be required to aid certain jurisdictions for improvement. Public Health Implications The results of this study may inform future target times for performance on POD setup activities and highlight jurisdictions in need of technical assistance.

Public Health Emergencies: Unpacking Medical Countermeasures Management for Preparedness and Response Introduction and Contents of the Volume

An introduction is presented in which the authors discuss various reports within the journal on topics including the distribution and dispensing of medical countermeasures in American public health emergencies, the U.S. Strategic National Stockpile, and just-in-time training for medical personnel.

Medical Countermeasures: Mission, Method, and Management

An introduction is presented in which the authors discuss various reports within the journal on topics including best practices and innovation in the provision of medical countermeasures (MCMs) for large-scale public health emergencies, influenza pandemic treatments, and health care coalitions.

Medical Countermeasure Actions—A Historical Perspective

An editorial is presented which addresses the authors views about the historic aspects of medical countermeasure programs and public health emergency preparedness as of 2018, and it mentions a Sarin gas attack in Tokyo, Japan in 1995 and Americas Strategic National Stockpile (SNS) program. According to the article, the SNS contains four classes of assets which include pharmaceuticals, medical supplies, and containers of medications to treat specific nerve agent exposure patients.