A5057229656- Homelessness and Social Issues
- HIV/AIDS Research and Interventions
- HIV, Drug Use, Sexual Risk
- COVID-19 epidemiological studies
- HIV/AIDS drug development and treatment
- Food Security and Health in Diverse Populations
- HIV Research and Treatment
- COVID-19 and Mental Health
- Geriatric Care and Nursing Homes
- Emergency and Acute Care Studies
- SARS-CoV-2 detection and testing
- Housing, Finance, and Neoliberalism
- Health disparities and outcomes
- Oral Health Pathology and Treatment
- Urban, Neighborhood, and Segregation Studies
- Forensic Toxicology and Drug Analysis
- COVID-19 and healthcare impacts
- Empathy and Medical Education
- Autoimmune and Inflammatory Disorders
- Cultural Competency in Health Care
- Medication Adherence and Compliance
- Infection Control and Ventilation
- Innovations in Medical Education
- Chronic Lymphocytic Leukemia Research
- Hepatitis C virus research
University of California, San Francisco
2020-2025
San Francisco General Hospital
2020-2025
University of California System
2021-2024
Sheehan Medical (United States)
2023
Jacobs (United Kingdom)
2023
Southern Nevada Health District
2021
Rhode Island Department of Health
2021
Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers
2013
In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. late March and early April 2020, public health teams responded to clusters (two more cases in preceding 2 weeks) of coronavirus 2019 (COVID-19) residents staff members from five homeless shelters Boston, Massachusetts (one shelter); San Francisco, California (one); Seattle, Washington (three). The investigations...
Abstract Background Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH) based on trials that only included participants viral suppression. We performed the first LAI-ART demonstration project to include PWH unable achieve maintain suppression due challenges adhering oral ART. Methods Ward 86 a large HIV clinic in San Francisco serves publicly insured and underinsured patients. started...
Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) regimen approved for people with HIV (PWH). Long-acting ART holds promise improving outcomes among populations barriers to adherence but PWH who have virologic suppression use of oral before initiating injectables.
We report the public health response to a coronavirus disease 2019 (COVID-19) outbreak in San Francisco shelter where 67% of residents and 17% staff tested positive for severe acute respiratory syndrome 2 (SARS-CoV-2). describe limited utility case investigation, person-based contact tracing symptom screening, benefits mass testing response.
<h3>Importance</h3> Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside hospital setting. <h3>Objective</h3> assess safety of a hotel-based and (I/Q) care system its association with inpatient capacity. <h3>Design, Setting,...
Homeless-experienced populations are at increased risk of exposure to SARS-CoV-2 due their living environments and face an severe COVID-19 disease underlying health conditions. Little is known about testing vaccination acceptability among homeless-experienced populations. To understand the facilitators barriers vaccine adults. We conducted in-depth interviews with participants from July October 2020. purposively recruited (1) a longitudinal cohort older adults in Oakland, CA (n=37) (2)...
Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists implementation strategies this population.
We previously demonstrated at the Ward 86 HIV clinic in San Francisco that long-acting cabotegravir/rilpivirine (LA-CAB/RPV) can rapidly lead to viral suppression (VS) people with (PWH) viremia due adherence challenges. now evaluate VS durability this population.
Problem: Medical students often feel unprepared to care for patients whose cultural backgrounds differ from their own. Programs in medical schools have begun address health: inequities; however, interventions vary intensity, effectiveness, and student experience. Intervention: The authors describe an intensive 2-day diversity, equity, inclusion curriculum orientation week prior starting formal classes. Rather than using solely a knowledge-based “cultural competence” or reflective humility”...
People with HIV experiencing homelessness have low rates of viral suppression, driven by sociostructural barriers and traditional care system limitations. Informed the capability-opportunity-motivation-behavior (COM-B) model patient preference research, we developed POP-UP, an integrated drop-in (nonappointment-based) clinic wrap-around services for persons housing instability nonsuppression in San Francisco.We report suppression (VS; <200 copies/mL), engagement, mortality at 12 months...
Background: Long-acting injectable cabotegravir-rilpivirine (CAB/RPV-LA) is a promising treatment alternative for people with HIV (PWH) who face adherence challenges oral antiretroviral therapy (ART). While its clinical efficacy well-documented, cost-effectiveness data from real-world settings remain limited. Objective: To evaluate the incremental first-year cost and of CAB/RPV-LA versus standard care (SoC) ART among PWH challenges, perspective healthcare payer. Methods: A cohort 59...
Homelessness adversely impacts continuity of care for people with HIV (PWH). The POP-UP program is a low-barrier drop-in model embedded within an clinic in San Francisco and designed to serve PWH experiencing homelessness. We conducted pilot study mobile outreach who remain out-of-care despite the program. mixed-methods evaluate effectiveness through retrospective cohort eligible this semistructured interviews. Patients were if they had (1) viral load ≥200 copies/mL no visit ≥30 days, (2)...
Background: The United States has made significant progress toward achieving the goals of its Ending HIV Epidemic initiative. However, systematic reviews on implementation research have identified problems regarding strategy specification that limit research's transparency and replicability, in turn improvements care real-world practice. Methods: strategies timeline, activities, resources (STAResources) Table, developed as part substance abuse treatment to Care II Project, was completed for...
Objective: Homelessness is the greatest risk factor for HIV viremia in San Francisco. Innovative care models people with (PWH) homelessness or unstable housing (HUH) are needed to address this inequity. We developed a novel low-barrier clinic-based program PWH-HUH an urban safety-net clinic (’POP-UP’) and report outcomes on engagement viral suppression. Design: A prospective cohort study. Setting: Francisco General Hospital Clinic (Ward 86). Participants: enrolled PWH who HUH, viraemic whom...
COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify most effective infection control strategy prevent future outbreaks. We developed a microsimulation model of SARS-CoV-2 transmission shelter and calibrated it data from cross-sectional polymerase chain reaction (PCR) surveys conducted during five three US cities March 28 April 10, 2020. estimated probability averting outbreak when exposed individual is introduced into representative...
Job loss and evictions tied to the Coronavirus Disease 2019 (COVID-19) pandemic are expected increase homelessness significantly in coming months. Reciprocally, many vulnerabilities that inevitably accompany it driving COVID-19 outbreaks US shelters other congregate living situations. Unless we intervene address homelessness, these co-existing synergistic situations will make current public health crisis even worse. Preventing providing permanent affordable housing has reduced ravages of HIV...
Coronavirus disease-2019 (COVID-19) threatens to further worsen HIV outcomes among people experiencing homelessness. We conducted an interrupted time-series analysis of care engagement and viral suppression unhoused individuals in the 'POP-UP' low-barrier, high-intensity primary program during COVID-19. Among 85 patients, did not decrease 5 months following implementation San Francisco's 'shelter-in-place' ordinance. Low-barrier, in-person for homeless may be important maintaining
Objectives. To examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) point prevalence during universal testing at homeless shelters the United States.Methods. SARS-CoV-2 was offered clients staff shelters, irrespective of symptoms. Site assessments were conducted from March 30 June 1, 2020, collect information on practices. We assessed association between characteristics, including 20 by using crude risk...
Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program PLWH experiencing HUH, we quantified patient preferences trade-offs across multiple HIV-service domains using discrete choice experiment (DCE).
People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening response protocols using rRT-PCR homeless expensive, require specialized staff have delays returning results implementing responses.We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) residents congregate-living San Francisco, California, from January 15th February 19th, 2021. We used the...
After coronavirus disease 2019 (COVID-19) shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net human immunodeficiency virus (HIV) clinic in San Francisco, particularly among people living with HIV (PLWH) who are experiencing homelessness. We sought to determine if proactive outreach provide social services, scaling up of in-person visits, and expansion housing programs could reverse this decline.
Background/Setting: In San Francisco, HIV viral suppression is 71% among housed individuals but only 20% unhoused individuals. We conducted a discrete choice experiment at Francisco public clinic to evaluate care preferences people living with (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic. Methods: From July November 2020, we PLH who accessed through (1) an incentivized, drop-in program (POP-UP) or (2) traditional primary care. investigated 5 features: single...