TY - JOUR AU - Patel, Pragna AU - Kerzner, Michael AU - Reed, B. Jason AU - Sullivan, Sean Patrick AU - El-Sadr, M. Wafaa PY - 2022/6/7 TI - Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review JO - JMIR Public Health Surveill SP - e37479 VL - 8 IS - 6 KW - HIV KW - pre-exposure prophylaxis KW - COVID-19 KW - virtual service delivery KW - HIV prevention KW - public health KW - systematic review KW - virtual service KW - health intervention KW - digital intervention KW - health technology KW - social media platform KW - telehealth KW - public health message N2 - Background: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. Objective: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19?related service interruptions. Methods: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included ?telemedicine,? ?telehealth,? ?mobile health,? ?eHealth,? ?mHealth,? ?telecommunication,? ?social media,? ?mobile device,? and ?internet,? among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies? methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. Results: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. Conclusions: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses. UR - https://publichealth.jmir.org/2022/6/e37479 UR - http://dx.doi.org/10.2196/37479 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486813 ID - info:doi/10.2196/37479 ER - TY - JOUR AU - Ostropolets, Anna AU - Ryan, B. Patrick AU - Schuemie, J. Martijn AU - Hripcsak, George PY - 2022/6/17 TI - Characterizing Anchoring Bias in Vaccine Comparator Selection Due to Health Care Utilization With COVID-19 and Influenza: Observational Cohort Study JO - JMIR Public Health Surveill SP - e33099 VL - 8 IS - 6 KW - COVID-19 KW - vaccine KW - anchoring KW - comparator selection KW - time-at-risk KW - vaccination KW - bias KW - observational KW - utilization KW - flu KW - influenza KW - index KW - cohort N2 - Background: Observational data enables large-scale vaccine safety surveillance but requires careful evaluation of the potential sources of bias. One potential source of bias is the index date selection procedure for the unvaccinated cohort or unvaccinated comparison time (?anchoring?). Objective: Here, we evaluated the different index date selection procedures for 2 vaccinations: COVID-19 and influenza. Methods: For each vaccine, we extracted patient baseline characteristics on the index date and up to 450 days prior and then compared them to the characteristics of the unvaccinated patients indexed on (1) an arbitrary date or (2) a date of a visit. Additionally, we compared vaccinated patients indexed on the date of vaccination and the same patients indexed on a prior date or visit. Results: COVID-19 vaccination and influenza vaccination differ drastically from each other in terms of the populations vaccinated and their status on the day of vaccination. When compared to indexing on a visit in the unvaccinated population, influenza vaccination had markedly higher covariate proportions, and COVID-19 vaccination had lower proportions of most covariates on the index date. In contrast, COVID-19 vaccination had similar covariate proportions when compared to an arbitrary date. These effects attenuated, but were still present, with a longer lookback period. The effect of day 0 was present even when the patients served as their own controls. Conclusions: Patient baseline characteristics are sensitive to the choice of the index date. In vaccine safety studies, unexposed index event should represent vaccination settings. Study designs previously used to assess influenza vaccination must be reassessed for COVID-19 to account for a potentially healthier population and lack of medical activity on the day of vaccination. UR - https://publichealth.jmir.org/2022/6/e33099 UR - http://dx.doi.org/10.2196/33099 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482996 ID - info:doi/10.2196/33099 ER - TY - JOUR AU - Urbanin, Gabriel AU - Meira, Wagner AU - Serpa, Alexandre AU - Costa, Souza Danielle de AU - Baldaçara, Leonardo AU - da Silva, Paula Ana AU - Guatimosim, Rafaela AU - Lacerda, Mendes Anísio AU - Oliveira, Araújo Eduardo AU - Braule, Andre AU - Romano-Silva, Aurélio Marco AU - da Silva, Geraldo Antônio AU - Malloy-Diniz, Leandro AU - Pappa, Gisele AU - Miranda, Marques Débora PY - 2022/6/15 TI - Social Determinants in Self-Protective Behavior Related to COVID-19: Association Rule?Mining Study JO - JMIR Public Health Surveill SP - e34020 VL - 8 IS - 6 KW - social determinants KW - data mining KW - self-protective behavior KW - COVID-19 KW - protection KW - behavior KW - sanitation KW - characteristic KW - Brazil KW - compliance KW - public health KW - policy KW - mask KW - risk N2 - Background: Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. Objective: Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. Methods: We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern?mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. Results: The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. Conclusions: Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. Trial Registration: Not applicable. UR - https://publichealth.jmir.org/2022/6/e34020 UR - http://dx.doi.org/10.2196/34020 UR - http://www.ncbi.nlm.nih.gov/pubmed/35704360 ID - info:doi/10.2196/34020 ER - TY - JOUR AU - Staudt, Andreas AU - Freyer-Adam, Jennis AU - Meyer, Christian AU - Bischof, Gallus AU - John, Ulrich AU - Baumann, Sophie PY - 2022/6/30 TI - The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e33345 VL - 8 IS - 6 KW - drinking KW - brief intervention KW - screening KW - school education KW - public health KW - prevention N2 - Background: The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective: The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods: We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results: Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions: The efficacy of an individualized brief alcohol intervention was moderated by the participants? educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached. Trial Registration: German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274 UR - https://publichealth.jmir.org/2022/6/e33345 UR - http://dx.doi.org/10.2196/33345 UR - http://www.ncbi.nlm.nih.gov/pubmed/35771621 ID - info:doi/10.2196/33345 ER - TY - JOUR AU - Oh, Jimin AU - Bonett, Stephen AU - Kranzler, C. Elissa AU - Saconi, Bruno AU - Stevens, Robin PY - 2022/6/17 TI - User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study JO - JMIR Public Health Surveill SP - e32718 VL - 8 IS - 6 KW - HIV prevention KW - social media KW - public health KW - young adults KW - LASSO KW - HIV KW - Twitter KW - digital health N2 - Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. UR - https://publichealth.jmir.org/2022/6/e32718 UR - http://dx.doi.org/10.2196/32718 UR - http://www.ncbi.nlm.nih.gov/pubmed/35713945 ID - info:doi/10.2196/32718 ER - TY - JOUR AU - Silva, Martha AU - Walker, Jonathan AU - Portillo, Erin AU - Dougherty, Leanne PY - 2022/6/28 TI - Strengthening the Merci Mon Héros Campaign Through Adaptive Management: Application of Social Listening Methodology JO - JMIR Public Health Surveill SP - e35663 VL - 8 IS - 6 KW - social media KW - health communication KW - young people KW - reproductive health N2 - Background: Between 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10% to 30%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics. Objective: This paper details the process used by the U.S. Agency for International Development?funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, Côte d?Ivoire, Niger, and Togo for the adaptive management of the Merci Mon Héros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns. Methods: The process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign?s social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data. Results: We analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign?s content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health. Conclusions: Prior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology?s use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence. UR - https://publichealth.jmir.org/2022/6/e35663 UR - http://dx.doi.org/10.2196/35663 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763319 ID - info:doi/10.2196/35663 ER - TY - JOUR AU - Ren, Ningjun AU - Li, Yuansheng AU - Wang, Ruolan AU - Zhang, Wenxin AU - Chen, Run AU - Xiao, Ticheng AU - Chen, Hang AU - Li, Ailing AU - Fan, Song PY - 2022/6/14 TI - The Distribution of HIV and AIDS Cases in Luzhou, China, From 2011 to 2020: Bayesian Spatiotemporal Analysis JO - JMIR Public Health Surveill SP - e37491 VL - 8 IS - 6 KW - HIV and AIDS KW - reported incidence KW - Bayesian model KW - spatio-temporal distribution N2 - Background: The vastly increasing number of reported HIV and AIDS cases in Luzhou, China, in recent years, coupled with the city?s unique geographical location at the intersection of 4 provinces, makes it particularly important to conduct a spatiotemporal analysis of HIV and AIDS cases. Objective: The aim of this study is to understand the spatiotemporal distribution of HIV and the factors influencing this distribution in Luzhou, China, from 2011 to 2020. Methods: Data on the incidence of HIV and AIDS in Luzhou from 2011 to 2020 were obtained from the AIDS Information Management System of the Luzhou Center for Disease Control and Prevention. ArcGIS was used to visualize the spatiotemporal distribution of HIV and AIDS cases. The Bayesian spatiotemporal model was used to investigate factors affecting the spatiotemporal distribution of HIV and AIDS, including the gross domestic product (GDP) per capita, urbanization rate, number of hospital beds, population density, and road mileage. Results: The reported incidence of HIV and AIDS rose from 8.50 cases per 100,000 population in 2011 to 49.25 cases per 100,000 population in 2020?an increase of 578.87%. In the first 5 years, hotspots were concentrated in Jiangyang district, Longmatan district, and Luxian county. After 2016, Luzhou?s high HIV incidence areas gradually shifted eastward, with Hejiang county having the highest average prevalence rate (41.68 cases per 100,000 population) from 2011 to 2020, being 2.28 times higher than that in Gulin county (18.30 cases per 100,000), where cold spots were concentrated. The risk for the incidence of HIV and AIDS was associated with the urbanization rate, population density, and GDP per capita. For every 1% increase in the urbanization rate, the relative risk (RR) increases by 1.3%, while an increase of 100 people per square kilometer would increase the RR by 8.7%; for every 1000 Yuan (US $148.12) increase in GDP per capita, the RR decreases by 1.5%. Conclusions: In Luzhou, current HIV and AIDS prevention and control efforts must be focused on the location of each district or county government; we suggest the region balance urban development and HIV and AIDS prevention. Moreover, more attention should be paid to economically disadvantaged areas. UR - https://publichealth.jmir.org/2022/6/e37491 UR - http://dx.doi.org/10.2196/37491 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700022 ID - info:doi/10.2196/37491 ER - TY - JOUR AU - Choi, Ki Seul AU - Golinkoff, Jesse AU - Michna, Mark AU - Connochie, Daniel AU - Bauermeister, José PY - 2022/6/27 TI - Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e33867 VL - 8 IS - 6 KW - paradata KW - mobile health KW - mHealth KW - digital health intervention KW - risk reduction KW - HIV prevention KW - public health KW - digital health KW - sexual health KW - sexual risks N2 - Background: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users? engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. Objective: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM?s online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants? engagement (ie, the number of log-ins and the number of sessions viewed). Methods: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM?s baseline characteristics on their DHI engagement. We then examined the association between the participants? engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. Results: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [?]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM (?=.27; P=.002), higher education attainment (?=.22; P=.003), higher perceived usefulness of online dating for hookups (?=.13; P=.002) and perceived loneliness (?=.06; P=.004), as well as lower experienced online discrimination (?=?.01; P=.007) and limerence (?=?.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia (?=?.06; P<.001) and with changes in perceived usefulness of online dating for hookups (?=?.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants? behaviors at the 90-day follow-up. Conclusions: DHI engagement is linked to participants? sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention?s effectiveness, DHIs with personalized intervention components that consider the individuals? differences could increase the overall engagement and efficacy of DHIs. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060. UR - https://publichealth.jmir.org/2022/6/e33867 UR - http://dx.doi.org/10.2196/33867 UR - http://www.ncbi.nlm.nih.gov/pubmed/35759333 ID - info:doi/10.2196/33867 ER - TY - JOUR AU - Li, Yiping AU - Wang, Qinjian AU - Liang, Shu AU - Feng, Chuanteng AU - Yang, Hong AU - Yu, Hang AU - Yuan, Dan AU - Yang, Shujuan PY - 2022/6/24 TI - Effect of Switching Antiretroviral Treatment Regimen in Patients With Drug-Resistant HIV-1 Infection: Retrospective Observational Cohort Study JO - JMIR Public Health Surveill SP - e33429 VL - 8 IS - 6 KW - HIV KW - antiretroviral therapy KW - drug resistance KW - protease inhibitors KW - parametric g-formula N2 - Background: Evidence on the efficacy of antiretroviral therapy (ART) regimen switches on the mortality of patients with HIV drug resistance (HIVDR) is limited. Objective: We aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regime switches for people living with HIV and HIV-1 drug resistance. Methods: This retrospective observational cohort study included 179 people living with HIV and HIV-1 drug resistance from 2011 to 2020. The time that participants switched treatment regimens either to protease inhibitor (PI)?based ART regimens (PIs) or nonnucleoside reverse transcriptase inhibitor (NNRTI)?based ART regimens (NNRTIs) was taken as an observation starting point and followed up every 12 months. The parametric g-formula was used to estimate the 5-year risk of mortality under the situations of (1) natural course, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, and (4) if CD4(+) T cells<200 switched to PIs. Results: The follow-up time of the 179 patients ranged from 30 to 119 months. The median follow-up time was 90 months. During a follow-up of 15,606 person-months, 27 individuals died in the cohort. The estimated 5-year risk of mortality under natural course, immediate switch to NNRTIs, immediate switch to PIs, and if CD4(+), and switch to PIs if T cells<200 were 11.62% (95% CI 7.82-17.11), 31.88% (95% CI 20.79-44.94), 2.87% (95% CI 0.32-7.07), and 5.30% (95% CI 2.07-10.21), respectively. The risk ratios (RRs) of immediate switch to NNRTIs, immediate switch to PIs, and switch to PIs if CD4(+) T cells<200, compared with natural course mortality rate, were 2.74 (95% CI 2.01-3.47), 0.25 (95% CI: 0.04-0.54), and 0.46 (95% CI 0.22-0.71), respectively. The risk differences were 20.26% (95% CI 10.96-28.61), ?8.76% (95% CI ?13.34 to ?5.09) and ?6.32% (95% CI ?9.75 to ?3.11), respectively. Conclusions: Our study found that a PI-based ART regimen was beneficial for reducing mortality in people living with HIV and HIV-1 drug resistance. More effort should be given to find HIV-1 drug resistance earlier to ensure a timely adjustment to PI-based ART, thereby maximizing the benefit of early switch treatment for people living with HIV and HIV-1 drug resistance. UR - https://publichealth.jmir.org/2022/6/e33429 UR - http://dx.doi.org/10.2196/33429 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749212 ID - info:doi/10.2196/33429 ER - TY - JOUR AU - Ayala, George AU - Arreola, Sonya AU - Howell, Sean AU - Hoffmann, J. Thomas AU - Santos, Glenn-Milo PY - 2022/6/27 TI - Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Data Sets from Two Global Online Surveys Via File Concatenation With Adjusted Weights JO - JMIR Public Health Surveill SP - e33538 VL - 8 IS - 6 KW - COVID-19 KW - HIV services KW - gay and bisexual men KW - sexual health N2 - Background: Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men?s ability to access services is not fully understood. Objective: The aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic. Methods: Our study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men?s Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one?s health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. Results: With 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=?1.39, 95% CI ?1.42 to ?1.36; P<.001). Conclusions: HIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide. UR - https://publichealth.jmir.org/2022/6/e33538 UR - http://dx.doi.org/10.2196/33538 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377321 ID - info:doi/10.2196/33538 ER - TY - JOUR AU - Couture, Alexia AU - Iuliano, Danielle A. AU - Chang, H. Howard AU - Patel, N. Neha AU - Gilmer, Matthew AU - Steele, Molly AU - Havers, P. Fiona AU - Whitaker, Michael AU - Reed, Carrie PY - 2022/6/2 TI - Estimating COVID-19 Hospitalizations in the United States With Surveillance Data Using a Bayesian Hierarchical Model: Modeling Study JO - JMIR Public Health Surveill SP - e34296 VL - 8 IS - 6 KW - COVID-19 KW - SARS-CoV-2 KW - hospitalization KW - Bayesian KW - COVID-NET KW - extrapolation KW - hospital KW - estimation KW - prediction KW - United States KW - surveillance KW - data KW - model KW - modeling KW - hierarchical KW - rate KW - novel KW - framework KW - monitoring N2 - Background: In the United States, COVID-19 is a nationally notifiable disease, meaning cases and hospitalizations are reported by states to the Centers for Disease Control and Prevention (CDC). Identifying and reporting every case from every facility in the United States may not be feasible in the long term. Creating sustainable methods for estimating the burden of COVID-19 from established sentinel surveillance systems is becoming more important. Objective: We aimed to provide a method leveraging surveillance data to create a long-term solution to estimate monthly rates of hospitalizations for COVID-19. Methods: We estimated monthly hospitalization rates for COVID-19 from May 2020 through April 2021 for the 50 states using surveillance data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) and a Bayesian hierarchical model for extrapolation. Hospitalization rates were calculated from patients hospitalized with a lab-confirmed SARS-CoV-2 test during or within 14 days before admission. We created a model for 6 age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ?85 years) separately. We identified covariates from multiple data sources that varied by age, state, and month and performed covariate selection for each age group based on 2 methods, Least Absolute Shrinkage and Selection Operator (LASSO) and spike and slab selection methods. We validated our method by checking the sensitivity of model estimates to covariate selection and model extrapolation as well as comparing our results to external data. Results: We estimated 3,583,100 (90% credible interval [CrI] 3,250,500-3,945,400) hospitalizations for a cumulative incidence of 1093.9 (992.4-1204.6) hospitalizations per 100,000 population with COVID-19 in the United States from May 2020 through April 2021. Cumulative incidence varied from 359 to 1856 per 100,000 between states. The age group with the highest cumulative incidence was those aged ?85 years (5575.6; 90% CrI 5066.4-6133.7). The monthly hospitalization rate was highest in December (183.7; 90% CrI 154.3-217.4). Our monthly estimates by state showed variations in magnitudes of peak rates, number of peaks, and timing of peaks between states. Conclusions: Our novel approach to estimate hospitalizations for COVID-19 has potential to provide sustainable estimates for monitoring COVID-19 burden as well as a flexible framework leveraging surveillance data. UR - https://publichealth.jmir.org/2022/6/e34296 UR - http://dx.doi.org/10.2196/34296 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452402 ID - info:doi/10.2196/34296 ER - TY - JOUR AU - Johnson, K. Randi AU - Marker, M. Katie AU - Mayer, David AU - Shortt, Jonathan AU - Kao, David AU - Barnes, C. Kathleen AU - Lowery, T. Jan AU - Gignoux, R. Christopher PY - 2022/6/13 TI - COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study JO - JMIR Public Health Surveill SP - e37327 VL - 8 IS - 6 KW - COVID-19 KW - surveillance KW - pandemic KW - biobank KW - EHR KW - public health KW - integrated data KW - population health KW - health monitoring KW - electronic health record KW - eHealth KW - health record KW - emergency response KW - vaccination status KW - vaccination KW - testing KW - symptom KW - disease impact N2 - Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a ?confirmed case? of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. UR - https://publichealth.jmir.org/2022/6/e37327 UR - http://dx.doi.org/10.2196/37327 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486493 ID - info:doi/10.2196/37327 ER - TY - JOUR AU - Zhao, Xixi AU - Li, Meijia AU - Haihambo, Naem AU - Jin, Jianhua AU - Zeng, Yimeng AU - Qiu, Jinyi AU - Guo, Mingrou AU - Zhu, Yuyao AU - Li, Zhirui AU - Liu, Jiaxin AU - Teng, Jiayi AU - Li, Sixiao AU - Zhao, Ya-nan AU - Cao, Yanxiang AU - Wang, Xuemei AU - Li, Yaqiong AU - Gao, Michel AU - Feng, Xiaoyang AU - Han, Chuanliang PY - 2022/6/23 TI - Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study JO - JMIR Public Health Surveill SP - e35343 VL - 8 IS - 6 KW - class B infectious disease KW - COVID-19 KW - event-related trough KW - infection selectivity KW - oscillation KW - public health interventions KW - pandemic KW - surveillance KW - health policy KW - epidemiology KW - prevention policy KW - public health KW - risk prevention N2 - Background: COVID-19 was first reported in 2019, and the Chinese government immediately carried out stringent and effective control measures in response to the epidemic. Objective: Nonpharmaceutical interventions (NPIs) may have impacted incidences of other infectious diseases as well. Potential explanations underlying this reduction, however, are not clear. Hence, in this study, we aim to study the influence of the COVID-19 prevention policies on other infectious diseases (mainly class B infectious diseases) in China. Methods: Time series data sets between 2017 and 2021 for 23 notifiable infectious diseases were extracted from public data sets from the National Health Commission of the People?s Republic of China. Several indices (peak and trough amplitudes, infection selectivity, preferred time to outbreak, oscillatory strength) of each infectious disease were calculated before and after the COVID-19 outbreak. Results: We found that the prevention and control policies for COVID-19 had a strong, significant reduction effect on outbreaks of other infectious diseases. A clear event-related trough (ERT) was observed after the outbreak of COVID-19 under the strict control policies, and its decreasing amplitude is related to the infection selectivity and preferred outbreak time of the disease before COVID-19. We also calculated the oscillatory strength before and after the COVID-19 outbreak and found that it was significantly stronger before the COVID-19 outbreak and does not correlate with the trough amplitude. Conclusions: Our results directly demonstrate that prevention policies for COVID-19 have immediate additional benefits for controlling most class B infectious diseases, and several factors (infection selectivity, preferred outbreak time) may have contributed to the reduction in outbreaks. This study may guide the implementation of nonpharmaceutical interventions to control a wider range of infectious diseases. UR - https://publichealth.jmir.org/2022/6/e35343 UR - http://dx.doi.org/10.2196/35343 UR - http://www.ncbi.nlm.nih.gov/pubmed/35649394 ID - info:doi/10.2196/35343 ER - TY - JOUR AU - Yang, Liuqing AU - Ji, Lili AU - Wang, Qiang AU - Xu, Yan AU - Yang, Guoping AU - Cui, Tingting AU - Shi, Naiyang AU - Zhu, Lin AU - Xiu, Shixin AU - Jin, Hui AU - Zhen, Shiqi PY - 2022/6/20 TI - Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis JO - JMIR Public Health Surveill SP - e34666 VL - 8 IS - 6 KW - vaccine KW - theory of planned behavior KW - attitude KW - subjective norms KW - perceived behavior control KW - moderator KW - mediation N2 - Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases. Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices. Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior?in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation?to test the validity of the theoretical framework. Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (?=?0.052, P<.001) and subjective norms (?=?0.028, P=.006) with perceived behavioral control were significant. Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior. UR - https://publichealth.jmir.org/2022/6/e34666 UR - http://dx.doi.org/10.2196/34666 UR - http://www.ncbi.nlm.nih.gov/pubmed/35723904 ID - info:doi/10.2196/34666 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Lorenzo-Redondo, Ramon AU - Hultquist, F. Judd AU - Hawkins, A. Claudia AU - Ozer, A. Egon AU - Welch, B. Sarah AU - Prasad, Vara P. V. AU - Achenbach, J. Chad AU - White, I. Janine AU - Oehmke, F. James AU - Murphy, L. Robert AU - Havey, J. Robert AU - Post, A. Lori PY - 2022/6/3 TI - Overlapping Delta and Omicron Outbreaks During the COVID-19 Pandemic: Dynamic Panel Data Estimates JO - JMIR Public Health Surveill SP - e37377 VL - 8 IS - 6 KW - Omicron variant of concern KW - Delta KW - COVID-19 KW - SARS-CoV-2 KW - B.1.1.529 KW - outbreak KW - Arellano-Bond estimator KW - dynamic panel data KW - stringency index KW - surveillance KW - disease transmission metrics N2 - Background: The Omicron variant of SARS-CoV-2 is more transmissible than prior variants of concern (VOCs). It has caused the largest outbreaks in the pandemic, with increases in mortality and hospitalizations. Early data on the spread of Omicron were captured in countries with relatively low case counts, so it was unclear how the arrival of Omicron would impact the trajectory of the pandemic in countries already experiencing high levels of community transmission of Delta. Objective: The objective of this study is to quantify and explain the impact of Omicron on pandemic trajectories and how they differ between countries that were or were not in a Delta outbreak at the time Omicron occurred. Methods: We used SARS-CoV-2 surveillance and genetic sequence data to classify countries into 2 groups: those that were in a Delta outbreak (defined by at least 10 novel daily transmissions per 100,000 population) when Omicron was first sequenced in the country and those that were not. We used trend analysis, survival curves, and dynamic panel regression models to compare outbreaks in the 2 groups over the period from November 1, 2021, to February 11, 2022. We summarized the outbreaks in terms of their peak rate of SARS-CoV-2 infections and the duration of time the outbreaks took to reach the peak rate. Results: Countries that were already in an outbreak with predominantly Delta lineages when Omicron arrived took longer to reach their peak rate and saw greater than a twofold increase (2.04) in the average apex of the Omicron outbreak compared to countries that were not yet in an outbreak. Conclusions: These results suggest that high community transmission of Delta at the time of the first detection of Omicron was not protective, but rather preluded larger outbreaks in those countries. Outbreak status may reflect a generally susceptible population, due to overlapping factors, including climate, policy, and individual behavior. In the absence of strong mitigation measures, arrival of a new, more transmissible variant in these countries is therefore more likely to lead to larger outbreaks. Alternately, countries with enhanced surveillance programs and incentives may be more likely to both exist in an outbreak status and detect more cases during an outbreak, resulting in a spurious relationship. Either way, these data argue against herd immunity mitigating future outbreaks with variants that have undergone significant antigenic shifts. UR - https://publichealth.jmir.org/2022/6/e37377 UR - http://dx.doi.org/10.2196/37377 UR - http://www.ncbi.nlm.nih.gov/pubmed/35500140 ID - info:doi/10.2196/37377 ER - TY - JOUR AU - Li, Jingwei AU - Huang, Wei AU - Sia, Ling Choon AU - Chen, Zhuo AU - Wu, Tailai AU - Wang, Qingnan PY - 2022/6/16 TI - Enhancing COVID-19 Epidemic Forecasting Accuracy by Combining Real-time and Historical Data From Multiple Internet-Based Sources: Analysis of Social Media Data, Online News Articles, and Search Queries JO - JMIR Public Health Surveill SP - e35266 VL - 8 IS - 6 KW - SARS-CoV-2 KW - COVID 19 KW - epidemic forecasting KW - disease surveillance KW - infectious disease epidemiology KW - social medial KW - online news KW - search query KW - autoregression model N2 - Background: The SARS-COV-2 virus and its variants pose extraordinary challenges for public health worldwide. Timely and accurate forecasting of the COVID-19 epidemic is key to sustaining interventions and policies and efficient resource allocation. Internet-based data sources have shown great potential to supplement traditional infectious disease surveillance, and the combination of different Internet-based data sources has shown greater power to enhance epidemic forecasting accuracy than using a single Internet-based data source. However, existing methods incorporating multiple Internet-based data sources only used real-time data from these sources as exogenous inputs but did not take all the historical data into account. Moreover, the predictive power of different Internet-based data sources in providing early warning for COVID-19 outbreaks has not been fully explored. Objective: The main aim of our study is to explore whether combining real-time and historical data from multiple Internet-based sources could improve the COVID-19 forecasting accuracy over the existing baseline models. A secondary aim is to explore the COVID-19 forecasting timeliness based on different Internet-based data sources. Methods: We first used core terms and symptom-related keyword-based methods to extract COVID-19?related Internet-based data from December 21, 2019, to February 29, 2020. The Internet-based data we explored included 90,493,912 online news articles, 37,401,900 microblogs, and all the Baidu search query data during that period. We then proposed an autoregressive model with exogenous inputs, incorporating real-time and historical data from multiple Internet-based sources. Our proposed model was compared with baseline models, and all the models were tested during the first wave of COVID-19 epidemics in Hubei province and the rest of mainland China separately. We also used lagged Pearson correlations for COVID-19 forecasting timeliness analysis. Results: Our proposed model achieved the highest accuracy in all 5 accuracy measures, compared with all the baseline models of both Hubei province and the rest of mainland China. In mainland China, except for Hubei, the COVID-19 epidemic forecasting accuracy differences between our proposed model (model i) and all the other baseline models were statistically significant (model 1, t198=?8.722, P<.001; model 2, t198=?5.000, P<.001, model 3, t198=?1.882, P=.06; model 4, t198=?4.644, P<.001; model 5, t198=?4.488, P<.001). In Hubei province, our proposed model's forecasting accuracy improved significantly compared with the baseline model using historical new confirmed COVID-19 case counts only (model 1, t198=?1.732, P=.09). Our results also showed that Internet-based sources could provide a 2- to 6-day earlier warning for COVID-19 outbreaks. Conclusions: Our approach incorporating real-time and historical data from multiple Internet-based sources could improve forecasting accuracy for epidemics of COVID-19 and its variants, which may help improve public health agencies' interventions and resource allocation in mitigating and controlling new waves of COVID-19 or other relevant epidemics. UR - https://publichealth.jmir.org/2022/6/e35266 UR - http://dx.doi.org/10.2196/35266 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507921 ID - info:doi/10.2196/35266 ER - TY - JOUR AU - Yu, Hanzhi AU - Du, Runming AU - Wang, Minmin AU - Yu, Fengyun AU - Yang, Juntao AU - Jiao, Lirui AU - Wang, Zhuoran AU - Liu, Haitao AU - Wu, Peixin AU - Bärnighausen, Till AU - Xue, Lan AU - Wang, Chen AU - McMahon, Shannon AU - Geldsetzer, Pascal AU - Chen, Simiao PY - 2022/6/7 TI - Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China JO - JMIR Public Health Surveill SP - e33484 VL - 8 IS - 6 KW - COVID-19 vaccines KW - China KW - global allocation KW - public attitudes KW - cross-sectional KW - survey KW - vaccines KW - COVID-19 KW - pandemic KW - public health KW - health policy KW - epidemiology N2 - Background: COVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public?s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates. Objective: The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics. Methods: We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights. Results: A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%). Conclusions: Among our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers? actions on COVID-19 vaccine distribution with the preferences of their constituencies. UR - https://publichealth.jmir.org/2022/6/e33484 UR - http://dx.doi.org/10.2196/33484 UR - http://www.ncbi.nlm.nih.gov/pubmed/35483084 ID - info:doi/10.2196/33484 ER - TY - JOUR AU - Piltch-Loeb, Rachael AU - Su, Max AU - Hughes, Brian AU - Testa, Marcia AU - Goldberg, Beth AU - Braddock, Kurt AU - Miller-Idriss, Cynthia AU - Maturo, Vanessa AU - Savoia, Elena PY - 2022/6/20 TI - Testing the Efficacy of Attitudinal Inoculation Videos to Enhance COVID-19 Vaccine Acceptance: Quasi-Experimental Intervention Trial JO - JMIR Public Health Surveill SP - e34615 VL - 8 IS - 6 KW - attitudinal inoculation KW - intervention KW - COVID-19 vaccine KW - vaccine hesitancy KW - COVID-19 KW - vaccine KW - vaccination KW - public health KW - health intervention KW - misinformation KW - infodemiology KW - vaccine misinformation N2 - Background: Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. Objective: This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. Methods: We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical (?Narrative?) presentation of information, intervention video 2 focusing on delivering a fact-based information (?Fact?), and intervention video 3 using a hybrid design (?Hybrid?). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics (?Recognize?), willingness to share misinformation (?Share?), and willingness to take the COVID-19 vaccine (?Willingness?). Results: There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). Conclusions: Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation. UR - https://publichealth.jmir.org/2022/6/e34615 UR - http://dx.doi.org/10.2196/34615 UR - http://www.ncbi.nlm.nih.gov/pubmed/35483050 ID - info:doi/10.2196/34615 ER - TY - JOUR AU - Yao, Yan AU - Chai, Ruiyu AU - Yang, Jianzhou AU - Zhang, Xiangjun AU - Huang, Xiaojie AU - Yu, Maohe AU - Fu, Geng-feng AU - Lan, Guanghua AU - Qiao, Ying AU - Zhou, Qidi AU - Li, Shuyue AU - Xu, Junjie PY - 2022/6/30 TI - Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis JO - JMIR Public Health Surveill SP - e33995 VL - 8 IS - 6 KW - COVID-19 vaccine KW - vaccine hesitancy KW - PLWHA KW - structural equation modeling N2 - Background: Many countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA. Objective: This study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA. Methods: The study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy. Results: Among 1735 participants, 41.61% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making. Conclusions: COVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA?s trust of medical professionals. UR - https://publichealth.jmir.org/2022/6/e33995 UR - http://dx.doi.org/10.2196/33995 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486810 ID - info:doi/10.2196/33995 ER - TY - JOUR AU - Stocks, Jacob AU - Ibrahim, Saduma AU - Park, Lawrence AU - Huchko, Megan PY - 2022/6/7 TI - Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study JO - JMIR Public Health Surveill SP - e28885 VL - 8 IS - 6 KW - cell phone KW - mobile health KW - mHealth KW - cervical cancer screening KW - Kenya KW - human papillomavirus KW - HPV testing N2 - Background: Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective: This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message?guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods: This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)?based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results: Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV?positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions: Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process. UR - https://publichealth.jmir.org/2022/6/e28885 UR - http://dx.doi.org/10.2196/28885 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671089 ID - info:doi/10.2196/28885 ER -