Lessons Learned From Implementing a Virtual Diabetes Prevention Program among African Immigrants: The AFRO-DPP.

Black persons, including immigrants, in the US disparately experience poor cardiometabolic health (CMH). Limited research on the effect of lifestyle interventions that improve CMH among African immigrant populations is available. To test the effectiveness of a culturally adapted, virtual lifestyle intervention on control of blood pressure (BP) and hemoglobin A1c (HbA1c) levels among African immigrants with CMH risk factors. Afro-DPP (Diabetes Prevention Program), a pilot cluster-randomized clinical trial, evaluated the effectiveness of a multicomponent CMH intervention. The study took place in 2 churches with predominantly African immigrant congregations in the Baltimore-Washington, DC, metropolitan area from January 1, 2022, to July 31, 2023. Participants were adults aged 25 to 75 years with at least 2 CMH risk factors who self-identified as African immigrants and belonged to the participating churches. Analyses followed the intention-to-treat principle. Participants received a 6-month culturally adapted lifestyle intervention based on the National DPP curriculum, delivered via virtual group sessions by a lifestyle coach of African origin. The delayed intervention began 6 months later with a follow-up time of 6 months. The intervention also included remote BP and weight monitoring. Primary outcomes were changes in systolic and diastolic BP and HbA1c levels from baseline to 6 months. Secondary outcomes included reduced body weight and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). The analytic population included 60 participants (mean [SD] age, 50.6 [11.9] years; 40 [66.7%] women). In the first intervention group (n = 30), systolic BP decreased by 9.2 (95% CI, 2.5-15.9) mm Hg, diastolic BP by 6.1 (95% CI, 2.1-10.0) mm Hg, body weight by 4.9 (95% CI, 1.0-8.7) kg, and BMI by 1.1 (95% CI, 0.4-1.7) at 6 months. In the delayed intervention group (n = 30), systolic BP decreased by 11.4 (95% CI, 2.4-20.5) mm Hg, diastolic BP by 10.3 (95% CI, 5.4-15.2) mm Hg, and body weight by 3.3 (95% CI, 0.01-6.5) kg, while BMI increased by 0.3 (95% CI, -1.5 to 2.0). Trial findings indicate that interventions incorporating cultural adaptation and virtual components could help address CMH disparities in this population. ClincalTrials.gov Identifier NCT05144737.

To minimize COVID-19 transmission, the University of Iowa suspended all in-person fall injury prevention programs in March 2020. However, falls continued to be the leading cause of injury-related mortality in Iowa; therefore, the university converted its in-person Tai Chi for Arthritis and Fall Prevention (TCAFP) program to a virtual program. Here, the authors describe the virtual TCAFP program and participants' overall experience. Among 83 older adults who participated in the first three virtual programs, 61 (73.5%) completed the programs. Of the 31 (37.3%) participants who filled out the postprogram satisfaction surveys, 30 (96.8%) found the Zoom platform easy to use and said the program met their expectations, 28 (90.3%) were happy with the quality of the instruction, and 29 (93.5%) said they learned the tai chi forms taught during the program and used an online video to practice between classes. Judging by the largely positive participant feedback, the authors considered the implementation of a virtual TCAFP program a success. The potential for the use of such a program beyond the pandemic to improve injury prevention efforts in rural environments warrants further exploration.

BackgroundThe Diabetes Prevention Program (DPP) is a nationally disseminated lifestyle intervention shown to prevent type 2 diabetes (diabetes). However, enrollment in the program remains variable. We sought to identify patient characteristics associated with enrollment in a virtual DPP program among women Veterans to inform ongoing diabetes prevention efforts.MethodsWe conducted a retrospective analysis of 2021–2024 Department of Veterans Affairs (VA) data collected through the VA Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 Program, an effectiveness-implementation trial to expand access to preventative health services for women Veterans. We included women meeting DPP eligibility criteria (BMI ≥ 25 kg/m2 [or ≥ 23 if Asian] with ≥ 1 risk factor for diabetes [e.g., prediabetes]) who received care at six VA sites implementing virtual DPP. We used logistic regression to examine the association between DPP enrollment and prior use of VA preventive services for weight management or diabetes prevention including the VA MOVE! clinic, Whole Health visits, nutrition visits, weight loss medications, and/or metformin. We adjusted for sociodemographic factors, comorbidities, number of DPP recruitment contacts, and site.ResultsA total of 1473 women Veterans received DPP outreach. On average, their age was 53 years (range 20–96), BMI 34 kg/m2, HbA1c 5.9%, 0.7% were Asian, 44% Black, 2% Hispanic, and 44% White. In our adjusted models, prior use of VA preventative services was not significantly associated with DPP enrollment. Younger women (OR:0.97, p = 0.002) and those who received more recruitment contacts (OR:2.63, p < 0.001), were significantly more likely to enroll in DPP. Women with housing instability were significantly less likely to enroll (OR:0.44, p = 0.029).ConclusionsWe found no difference in women Veterans’ enrollment in DPP based on prior use of VA weight management and prevention services. Frequency of outreach by VA sites may increase engagement in lifestyle interventions. Virtual DPP may support engagement in preventive lifestyle interventions for diverse groups of women Veterans, as a first program or as a complement to other VA services.Trial registrationClinicalTrials.gov, NCT05050266. Registered on 20 September 2021.

Background: Chronic hepatitis B virus (HBV) infection disproportionally affects individuals born in Africa and Asia and is the leading cause of hepatocellular carcinoma worldwide. While current guidelines recommend HBV screening for persons with high risk for infection, routine testing has not been initiated. Because HBV infection is preventable by vaccination, disaggregation of HBV infection demographic data is beneficial for targeted prevention against liver cancer. Chronic hepatitis C virus (HCV) infection also leads to hepatocellular carcinoma and liver-related mortality. While no vaccination exists for HCV, education and early detection is important to reduce HCV transmission and complications. Screening recommendations suggest testing populations at high risk, especially people who have used injectable drugs and those who may have been exposed to contaminated medical procedures. Currently, epidemiology information for HCV infection in immigrants is limited. This study aims to assess the prevalence of HBV infection, HBV immunity, and HCV infection among immigrants in the Baltimore-Washington metropolitan area, screened from 2009-2014, by age, gender, and country of birth. Method: Cross-sectional data was obtained from 52 free community screening events in Washington, D.C., Maryland, and northern Virginia from November 2009 to December 2014. A total of 4439 individuals, 18 years and older participated. Each participant's blood sample was evaluated for the presence of HBV surface antigen (HBsAg) and HBV surface antibody (HBsAb). HCV antibody testing was implemented from March 2013 onward (1698 subjects). Positive results for HBV infection (HBsAg+/HBsAb-), HBV vulnerability (HBsAg-/HBsAb-, at risk for infection), and HCV infection (HCVAb+) were analyzed according to age, gender, and country of birth. Prevalence of viral hepatitis infection was calculated for African and Asian countries which were represented by at least 50 immigrant participants. Results: Among the 4136 individuals tested, the prevalence of HBV infection was 5.1%. 41.1% were unprotected and at risk for infection, and 53.8% were protected (HBsAg-/HBsAb+). There were differences in HBsAg+ prevalence depending on birth continent: 5.8% for Asia (N = 2765), 4.6% for Africa (N = 367). High prevalence (≥ 8%) of infection was evident in immigrants from Vietnam (9.0%) and China (8.8%). Intermediate prevalence (2%-7%) was evident in Ethiopia (7.8%), Nigeria (5.1%), Korea (4.4%), and Myanmar (4.1%). Gender differences between the birth continents for HBsAg+ immigrants were significant among African immigrants (8.6% for males vs. 1.6% for females, p&amp;lt;.001) and Asian immigrants (7.1% for males vs. 5.1% for females, p&amp;lt;.05). Detected HBV infection in African and Asian immigrants differed in age patterns: highest rates were found in those in the 41-50 age group (47%) for Africa, and those 51-60 (27.8%) for Asia. For countries with at least 50 participants represented, 30.4%-54.7% of immigrants from each screened country were unprotected from HBV and needed vaccination. The prevalence of HCV infection was 1.5% for the 1698 individuals screened. Differences in prevalence were seen in birth continent, with 1.5% for Asia (N = 1206) and 2.4% for Africa (N = 150). Myanmar had the highest prevalence at 4.6%. Gender differences in HCV infection by birth continent were not statistically significant. HCV+ Asian and African immigrants differed by age group: highest rates were found in those in the 71+ age group (33.3%) for Africa, and those 31-40 (33.3%) for Asia. Conclusion: This study suggests better estimates of the true burden of HBV and HCV infection among immigrants from Asia and Africa. By disaggregating screening data into age, gender, and country of birth, programs for prevention, earlier diagnosis, and linkage to care can be improved. Citation Format: Emmeline Ha, Frederic Kim, Jane Pan, Dan-Tam Phan Hong, Hee-Soon Juon. Prevalence of viral hepatitis B and C infection among immigrants in the Baltimore-Washington metropolitan area screened from 2009-2014. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B37.

Background: Black people and immigrants in the US are disproportionately affected by poor cardiometabolic health. Aim: To test the effectiveness of a virtual, culturally tailored lifestyle intervention with remote blood pressure (BP) monitoring on BP control among African immigrants. Methods: In this pilot cluster-randomized trial (NCT05144737), two churches were randomly assigned to first intervention or delayed intervention groups. African immigrants aged 25-75 years with a smartphone and &amp;ge; 2 of the following were enrolled: body-mass index (BMI) &amp;ge; 25 kg/m 2 , HbA1c 5.7-6.5%, systolic BP (SBP) &amp;ge; 140 mmHg or diastolic BP (DBP) &amp;ge; 90 mmHg. Intervention involved lifestyle coaching using the diabetes prevention program curriculum, adapted to African immigrants, Bluetooth-enabled BP monitor synced to a mobile app (Sphygmo TM ), allowing for remote BP readings. The primary outcome was 6-month change in BP. Results: A total of 60 participants, 30 per site, were recruited; mean age 50.6(±11.9). At baseline, mean SBP was 144.5 mmHg in the first intervention group and 148.3 mmHg in the delayed intervention group. At 6 months, there was 11.32 mmHg SBP, 9.73 mmHg DBP reduction in the first intervention group and 9.31 mmHg SBP, 5.34 mmHg DBP reduction in the delayed intervention group ( Figure ); mean SBP reduction was 4.35 mm Hg greater in the first intervention group (95% CI, -13.56, 4.87). Additional BP control (&amp;lt; 130/80 mmHg) was achieved in 22% of participants in the first intervention group, and 10% in the delayed intervention group. Conclusions: Among African immigrants at risk for cardiovascular disease, a culturally tailored, lifestyle intervention led to BP reduction.

Funding Acknowledgements Type of funding sources: None. OnBehalf Our Hearts Our Minds Purpose Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme. Background The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme Methods Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided) Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs Bimonthly virtual coaching consultation for monitoring/goal resetting Bimonthly group video education sessions Results From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below. The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face. Conclusion Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service. Table 1 below exhibits the clinical and patient-reported outcomes.

Effectiveness of Youth Risk Prevention Programs When Virtually Adapted

Reducing the Risk of Developing Diabetes

The increasing prevalence and incidence of diabetes and its long-term complications in sub-Saharan Africa (SSA) could have devastating human and economic toll if the trends remain unabated in the future. Approximately 90% or majority of patients with diabetes belongs to the adult onset, type 2 diabetes category while 10% have type 1 diabetes in SSA. However, because of the paucity of metabolic and clinical data, a clear understanding of the natural history of both diseases and the classification of diabetes subtypes has been hampered. Nevertheless, we have attempted to provide a concise review of the pathophysiology of both type 1 and type 2 diabetes as well as phenotypic and clinical variations in patients residing in SSA. The limited metabolic data, (albeit increasing), from high-risk and diabetic individuals in the SSA, have contributed significantly to the understanding of the pathogenetic mechanisms of diabetes and the variations in the presentation of the disease. Sub-Saharan African patients with type 1 diabetes have essentially absolute insulin deficiency. In addition, patients with type 2 diabetes in SSA region also manifest severe insulin deficiency with varying degrees of insulin resistance. Although the exact genetic markers of both diseases are unknown, we believe studies in patients of SSA origin who reside in diverse geographic environments (African diaspora) could potentially contribute to our understanding of the genetic and environmental mediators of both diseases. However, many intrinsic, individual and societal obstacles such as poor education and illiteracy, low socio-economic status and lack of access to health care make uncertain the translation of diabetes research in SSA. In this regard, effective management and/or prevention of diabetes in SSA individuals should adopt multidisciplinary approaches. Finally, innovative health care delivery and educational models will be needed to manage diabetes and its long-term complications in SSA.

Black and Latino men are at increased risk for poor diabetes health outcomes but are underrepresented in lifestyle interventions for weight loss and diabetes prevention. Although relatively few men participate in the National Diabetes Prevention Program (NDPP), it remains the most widely available evidence-based approach to type 2 diabetes prevention in the United States. Thus, an NDPP tailored to Black and Latino men has the potential to address prior limitations of NDPP implementation and reduce gender, racial, and ethnic diabetes disparities. It also provides an opportunity to define a population for targeted outreach and evaluate the reach of our recruitment methods and interventions. We tailored the US Centers for Disease Control and Prevention Prevent T2 curriculum for the NDPP for Black and Latino men, called Power-Up, and will evaluate its effects in comparison to standard mixed-gender NDPP groups via virtual delivery. The primary aim of the project is to assess the effect of Power-Up versus NDPP on weight loss among men with prediabetes. The secondary aim is to compare the engagement and retention of men with prediabetes in Power-Up versus NDPP. We will also examine the reach of our recruitment methods and engagement in our screening, consenting, and assessment procedures prior to the point of randomization. We hypothesized that men randomized to Power-Up would achieve greater percent weight loss from baseline at 16 weeks (end of Core sessions) and 1 year (end of Maintenance sessions) than men randomized to standard, mixed-gender NDPP. Power-Up is also expected to have better engagement and retention. Using the electronic health record (EHR) systems of a large academic medical center and a network of small to medium independent primary care practices throughout New York City, we identified Black and Latino men who met eligibility criteria for NDPP and enrolled them in a randomized controlled trial in which they were assigned 1:1 to receive Power-Up or the standard, mixed-gender NDPP over 1 year via online videoconferencing. Coaches delivering these interventions were trained according to the standards for the NDPP. Power-Up will be delivered by men coaches. Weight will be collected with home-based electronic scales for primary outcome analyses. Engagement will be assessed by session attendance logs. We identified 11,052 men for outreach based on EHR data, successfully screened 26% of them, consented and enrolled 22% of these, and randomly assigned 48% of consented participants. Primary and secondary outcome analyses will be assessed among randomized men. This study highlights the effort required to reach and engage Black and Latino men for virtually delivered diabetes prevention programs. Forthcoming trial results for weight loss and engagement will further inform efforts to address disparities in diabetes prevention through tailored programming for Black and Latino men. ClinicalTrials.gov NCT04104243; https://clinicaltrials.gov/study/NCT04104243. DERR1-10.2196/64405.

This study aimed to describe the proportion of HIV testing among an African immigrant population in Portugal and identify the socio-demographic factors that may be associated. A questionnaire was applied to 522 African immigrants (53% men) who attend the National Immigrant Support Centre, in Lisbon. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated through logistic regression to analyse the relationships between HIV testing and other variables. Around 52% of participants reported having been HIV tested, mostly women. After adjusting for potential confounders, age and educational level were significantly associated with HIV testing for both women and men. Searching for HIV information at NHS was also significantly associated with HIV testing, but only among men. This study points out interesting challenges for HIV prevention programs among African immigrants and may help in the development of tailored projects focused on the promotion of HIV testing among these populations.

Prostate cancer (PCa) is the second leading cause of cancer-related death among Black men who present with higher incidence, mortality, and survival compared to other racial groups. African immigrant men, however, are underrepresented in PCa research and thus this research sought to address that gap. This study applied a social determinants of health framework to understand the knowledge, perceptions, and behavioral tendencies regarding PCa in African immigrants. African immigrant men and women residing in different parts of the country (California, Texas, Colorado, Oklahoma, and Florida) from various faith-based organizations, African community groups, and social groups were recruited to participate in key informant interviews (n = 10) and two focus groups (n = 23). Four themes were identified in this study: (a) PCa knowledge and attitudes—while knowledge is very limited, perceptions about prostate health are very strong; (b) culture and gender identity strongly influence African health beliefs; (c) preservation of manhood; and (d) psychosocial stressors (e.g., financial, racial, immigration, lack of community, and negative perceptions of invasiveness of screening) are factors that play a major role in the overall health of African immigrant men. The results of this qualitative study unveiled perceptions, attitudes, beliefs, and knowledge of PCa among African immigrants that should inform the planning, development, and implementation of preventive programs to promote men’s health and PCa awareness.

Rehabilitation therapists have traditionally been key players in the development and delivery of community-based programs, and the value of those programs is well documented. The onset of COVID-19 necessitated the closure or shift of many of these programs to virtual delivery, resulting in a change in the role of the rehabilitation therapist. The challenges and opportunities of traditional and virtual programming are explored. Factors influencing the participation of seniors in these programs are examined. The impact of COVID-19 and the resulting digital resources on future community-based practice is discussed.

BackgroundPrediabetes affects 26.4 million people aged 65 years or older (48.8%) in the United States. Although older adults respond well to the evidence-based Diabetes Prevention Program, they are a heterogeneous group with differing physiological, biomedical, and psychosocial needs who can benefit from additional support to accommodate age-related changes in sensory and motor function.ObjectiveThe purpose of this paper is to describe adaptations of the Centers for Disease Control and Prevention’s Diabetes Prevention Program aimed at preventing diabetes among older adults (ages ≥65 years) and findings from a pilot of 2 virtual sessions of the adapted program that evaluated the acceptability of the content.MethodsThe research team adapted the program by incorporating additional resources necessary for older adults. A certified lifestyle coach delivered 2 sessions of the adapted content via videoconference to 189 older adults.ResultsThe first session had a 34.9% (38/109) response rate to the survey, and the second had a 34% (30/88) response rate. Over three-quarters (50/59, 85%) of respondents agreed that they liked the virtual program, with 82% (45/55) agreeing that they would recommend it to a family member or a friend.ConclusionsThis data will be used to inform intervention delivery in a randomized controlled trial comparing in-person versus virtual delivery of the adapted program.

Comparative Effectiveness of Three Different Delivery Models for a Community-Based Diabetes Prevention and Management Education Program in Older Adults