Nirsevimab is recommended to prevent severe respiratory syncytial virus (RSV)-associated illness among American Indian/Alaska Native (AI/AN) children <20 months of age. In a test-negative case-control analysis among 291 AI/AN children hospitalized during the 2023-2024 season, nirsevimab was 86.0% and 87.9% effective among children entering their first and second RSV seasons, respectively.

Purpose: There is extensive evidence linking Potentially Inappropriate Medication (PIM) use and adverse health outcomes. The VIONE core team and VA multidisciplinary partners created, implemented and disseminated the VIONE methodology across VA sites nationwide to facilitate and track deprescribing, through coaching, medical informatics and integration with the electronic health record. The purpose of this article is to report 3 sites in the federal health system (2 VA and 1 Indian Health Services) unique experiences of implementing and adapting VIONE locally while maintaining fidelity to fundamental VIONE intervention strategies. Methods: Three VA sites reported experiences of implementing VIONE, including an overview of the clinical workflow, clinicians involved, facilitators and barriers of implementation, and results. Results: The VIONE intervention was adapted for site-specific implementation. Personnel included trainees, clinical pharmacists, and home based primary care programs. Local and national dashboards were used to identify Veterans at high risk for polypharmacy and to track deprescribing. Implementation remained consistent with the VIONE core characteristics and facilitated education and conversations about medications with patients and caregivers. Adaptations were made at each site to meet that site's needs. Implementation resulted in safe deprescribing practices and staff empowerment with significant cost savings. Conclusion: The VIONE methodology and tools are adaptable across clinical settings with inherent flexibility to local workflows and practice preferences by end users. VIONE presents a standardized, easy-to-use method for promoting medication review for older adults. Further evaluation may help identify best practices to promote positive outcomes related to deprescribing and reducing polypharmacy in older adults.

Tribal communities face barriers to care. This is especially true for American Indian Alaskan Native children needing pediatric-subspecialty care. We created a new pediatric rheumatology hybrid clinic using telemedicine to enhance access. A combination of telemedicine clinics and face-to-face clinics onsite at the Northern Navajo Medical Center was offered. The new clinic reduced the wait time for care for pediatric rheumatology conditions by 95%.

Vulvovaginal candidiasis (VVC) is an infection caused by the yeast Candida that affects more than 50% of women in their lifetime. We aimed to describe VVC among American Indian/Alaska Native (AI/AN) girls and women who were receiving care in the Indian Health Service (IHS) system during 2016-2022. We calculated the annual VVC prevalence per 1000 IHS user population and examined underlying medical conditions, previous diagnoses, and antifungal treatment. Among 6 million female patient-years, 70 766 patients had ≥1 VVC diagnosis code (2022 prevalence: 14.2 per 1000 IHS user population). Frequent previous or concurrent diagnoses included diabetes (24.8%), urinary tract infection (13.6%), screening for sexually transmitted infection (13.2%), and unspecified acute vaginitis or vulvitis (13.0%). Approximately one-third (33.1%) of patients received fluconazole, and 25.7% received prescription topical antifungal medication. VVC was a common condition among AI/AN patients who accessed care in the IHS health care system. VVC prevalence among AI/AN patients was similar to the prevalence among the broader US population. These data provide a baseline for future studies to evaluate diagnostic and treatment practices for VVC among AI/AN people.

Chromoblastomycosis, phaeohyphomycotic abscesses, and sporotrichosis are fungal diseases usually caused by traumatic inoculation that cause substantial morbidity and can lead to long-term sequalae and inability to work. Few studies have analyzed the epidemiological and clinical characteristics of these mycoses in the United States, particularly among minority populations. We estimated prevalence and described features of American Indian and Alaska Native (AI/AN) persons with these diseases using Indian Health Service (IHS) data during 2016-2022. Chromoblastomycosis and phaeohyphomycotic abscess prevalence was 9 per 1,000,000, and sporotrichosis prevalence was 5 per 1,000,000 IHS user population. Prevalence was highest in the Southern Plains region for both diseases. Several patients experienced amputation, tissue fibrosis or scarring, or lymphedema. These findings provide baseline data for monitoring prevalence or changes in geographic distribution of implantation mycoses in AI/AN persons. Although cases are rare, these findings underscore the need for standardized clinical guidance to prevent long-term disability and decreased quality of life.

COVID-19 causes significant morbidity in the USA, particularly among American Indian/Alaska Native (AI/AN) persons. Estimates of COVID-19 burden among AI/AN communities are needed to identify health outcome disparities and inform prevention strategies, but under-ascertainment of AI/AN status in national data may result in underestimation of COVID-19 disease burden. Surveillance for acute respiratory illness was conducted among AI/AN persons at eight healthcare facilities in Arizona and Alaska to identify COVID-19-associated hospitalizations and outpatient visits. Weekly and annual incidence rates of COVID-19-associated hospitalizations per 100,000 persons were calculated overall and by site and age. Risk factors for COVID-19-associated hospitalizations (versus outpatient visits) were assessed. From January 2021 to December 2022, 1159 COVID-19-associated hospitalizations were identified. Incidence rates were 439.8 per 100,000 in 2021 and 332.6 per 100,000 in 2022 and highest among adults ≥ 65 years at all sites. Compared to national estimates from 2021 to 2022, incidence rates by time and age were similar among older adults, whereas incidence rates among AI/AN children were over twice as high. Among adults, older age, chronic lung disease, chronic kidney disease, and diabetes increased the risk of hospitalization; frequent mask use outside the home and COVID-19 vaccination were protective, particularly if vaccinated within the past year. Among children, younger age and heart conditions increased the risk of hospitalization. The findings demonstrate a substantial burden of COVID-19 in AI/AN persons and provide critically needed data regarding the risks for severe outcomes. AI/AN children experience a disproportionate burden of COVID-19 disease.

Latent Autoimmune Diabetes in Adults (LADA) is a type of diabetes that can phenotypically resemble type 2 diabetes upon initial presentation but expresses the autoimmune component of type 1 diabetes. While technically classed as type 1 diabetes, LADA is distinct from type 1 and 2 diabetes because of its intermediate progression that may or may not lead to complete insulin dependence. Differentiation is made with the presence or absence of autoantibodies and C-peptide. This is demonstrated in the following case. A 29-year-old Black female with a history of gestational diabetes and two-year history of prediabetes was ultimately diagnosed with type 2 diabetes with an A1c of 6.6% and was treated with metformin 500mg twice daily. Her blood glucose suddenly rose to > 400mg/dL and A1c to 8.6% after 8 months of therapy. Her BMI was 22.45kg/m2. Her provider ordered a C-peptide which measured 1.3 ng/mL (normal 0.8-5.2 ng/mL). Since this was technically normal, the provider continued with the type 2 diabetes diagnosis. Recognizing the C-peptide was low-normal, the clinical pharmacist ordered autoantibody tests, discovering a positive glutamic acid decarboxylase antibody (GADA) > 250 IU/mL (normal < 0.0-5.0 IU/mL) and confirming the diagnosis of LADA. The pharmacist discontinued metformin and initiated a basal/bolus insulin regimen with titration. Autoantibody testing is crucial to determine the proper diagnosis when the C-peptide is low-normal and should be prioritized. Recognition of the signs of LADA and proper diagnostic testing can lead to earlier optimal treatment and prevention of diabetes complications.

This cross-sectional study compares characteristics of Indian Health Services hospitals and rural hospitals with Graduate Medical Education programs.