Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19.

Context: Underfunding of the governmental public health system in the United States has been a problem for many years, and the COVID-19 pandemic revealed the significant gaps in public health infrastructure that have resulted from this inadequate funding.

Program: The states of Ohio, Oregon, and Washington received funding in 2016 to define, measure, and advocate for the foundational public health services (FPHS) delivered by the governmental public health system. They have taken unique but related approaches to strengthening work in the areas of categorical public health programs and the underlying infrastructure and capabilities that support the programmatic work.

Using HIV surveillance data to monitor missed opportunities for linkage and engagement in HIV medical care.

Monitoring delayed entry to HIV medical care is needed because it signifies that opportunities to prevent HIV transmission and mitigate disease progression have been missed. A central question for population-level monitoring is whether to consider a person linked to care after receipt of one CD4 or VL test. Using HIV surveillance data, we explored two definitions for estimating the number of HIV-diagnosed persons not linked to HIV medical care.

Medication-related barriers to entering HIV care.

Early entry to HIV care and receipt of antiretroviral therapy improve the health of the individual and decrease the risk of transmission in the community. To increase the limited information on prospective decisions to enter care and how these decisions relate to beliefs about HIV medications, we analyzed interview data from the Never in Care Project, a multisite project conducted in Indiana, New Jersey, New York City, Philadelphia, and Washington State. From March 2008 through August 2010, we completed structured interviews with 134 persons with no evidence of HIV care entry, 48 of whom also completed qualitative interviews.

Comparing Measures of Late HIV Diagnosis in Washington State.

As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4(+) results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis.

The influence of perceptions of HIV infection, care, and identity on care entry.

The benefits of accessing HIV care after diagnosis (e.g., improved clinical outcomes and reduced transmission) are well established.

HIV counseling, testing and referral experiences of persons diagnosed with HIV who have never entered HIV medical care.

The HIV counseling, testing, and referral (CTR) encounter represents an important opportunity to actively facilitate entry into medical care for those who test positive for HIV, but its potential is not always realized. Ways to improve facilitation of linkage to care through the CTR encounter haven't been explored among HIV-infected persons who have not entered care. We conducted 42 structured and qualitative interviews among HIV-infected persons, diagnosed 5-19 months previously, in Indiana, Philadelphia and Washington State, who had not received HIV medical care.

Trends in Neisseria gonorrhoeae Incidence Among HIV-Negative and HIV-Positive Men in Washington State, 1996-2007.

Objectives: We assessed population-level trends in human immunodeficiency virus (HIV) and Neisseria gonorrhoeae co-infection among adult males in Washington State between 1996 and 2007.

Methods: Population-based categorical disease surveillance registries for gonorrhea and for HIV were electronically matched and merged at the record level and incidence rates were calculated for reported HIV-positive and presumed HIV-negative men.

Results: The incidence of gonorrhea infection increased significantly among both HIV-positive and presumed HIV-negative men from 1996 to 2005, and this trend has recently reversed for both groups.