Continuity Of Care Research Articles

Effective Treatment for Mental and Substance Use Disorders in 21 Countries.

Accurate baseline information about the proportion of people with mental disorders who receive effective treatment is required to assess the success of treatment quality improvement initiatives. To examine the proportion of mental and substance use disorders receiving guideline-consistent treatment in multiple countries. In this cross-sectional study, World Mental Health (WMH) surveys were administered to representative adult (aged 18 years and older) household samples in 21 countries. Data were collected between 2001 and 2019 and analyzed between February and July 2024. Twelve-month prevalence and treatment of 9 DSM-IV anxiety, mood, and substance use disorders were assessed with the Composite International Diagnostic Interview. Effective treatment and its components were estimated with cross-tabulations. Multilevel regression models were used to examine predictors. The main outcome was proportion of effective treatment received, defined at the disorder level using information about disorder severity and published treatment guidelines regarding adequate medication type, control, and adherence and adequate psychotherapy frequency. Intermediate outcomes included perceived need for treatment, treatment contact separately in the presence and absence of perceived need, and minimally adequate treatment given contact. Individual-level predictors (multivariable disorder profile, sex, age, education, family income, marital status, employment status, and health insurance) and country-level predictors (treatment resources, health care spending, human development indicators, stigma, and discrimination) were traced through intervening outcomes. Among the 56 927 respondents (69.3% weighted average response rate), 32 829 (57.7%) were female; the median (IQR) age was 43 (31-57) years. The proportion of 12-month person-disorders receiving effective treatment was 6.9% (SE, 0.3). Low perceived need (46.5%; SE, 0.6), low treatment contact given perceived need (34.1%; SE, 1.0), and low effective treatment given minimally adequate treatment (47.0%; SE, 1.7) were the major barriers, but with substantial variation across disorders. Country-level general medical treatment resources were more important than mental health treatment resources. Other than for the multivariable disorder profile, which was associated with all intermediate outcomes, significant predictors were largely mediated by treatment contact. In addition to the gaps in treatment quality, these results highlight the importance of increasing perceived need, the largest barrier to effective treatment; the importance of training primary care treatment clinicians in recognition and treatment of mental disorders; the need to improve the continuum of care, especially from minimally adequate to effective treatment; and the importance of bridging the effective treatment gap for men and people with lower education.

Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

Barriers and facilitators to maternal healthcare in East Africa: a systematic review and qualitative synthesis of perspectives from women, their families, healthcare providers, and key stakeholders

BackgroundIn East Africa, women face significant challenges accessing maternal healthcare during pregnancy, childbirth, and the postnatal period. While several studies have examined barriers and facilitators to maternal care, there is no comprehensive review reflecting the various perspectives of women, their families, healthcare providers, and key stakeholders. We systematically reviewed qualitative literature on maternal healthcare in East Africa, synthesizing insights from multiple perspectives and exploring barriers and facilitators across socioecological levels.MethodsA qualitative evidence synthesis focused on studies from East Africa published between January 2015 and June 2024. We searched electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, and used citation tracking to find additional references. Eligible studies were critically appraised using the Critical Appraisal Skills Program, and a thematic synthesis was performed to identify barriers and facilitators.ResultsOf the 3181 records identified, 81 studies (63 qualitative and 18 mixed method) met the inclusion criteria, representing 4816 individuals from six East African countries. This review identified barriers at various levels: individual barriers included a lack of awareness and knowledge, fear of being treated poorly, and financial constraints; interpersonal barriers comprised limited family support, communication challenges, and a lack of decision-making autonomy; health facility barriers included poor quality of healthcare, poor infrastructure, limited medical supplies, provider shortages, abusive behaviors from healthcare providers, lack of transportation, and high service costs; community-level barriers involved socio-cultural norms, societal stigma, and gender-based disparities; and policy-level barriers included poor focus on maternal health, a lack of male accompaniment policies, and conflicts. Key facilitators identified included improved healthcare understanding and women's self-efficacy at the individual level, family support and positive social influences at the interpersonal level, high-quality services, reliable transportation, compassionate care, and health education at the health facility level, community initiatives, gender equality, and maternity waiting homes at the community level, as well as free maternity services and health extension programs at the policy level.ConclusionThe synthesis identified key barriers and facilitators to the maternal healthcare in East African countries, ranging from individual to policy levels. We recommend that future initiatives focus on addressing these barriers while enhancing facilitators across individual, interpersonal, health facility, community, and policy levels through woman-centered, evidence-based strategies. Moreover, fostering collaboration among governments, healthcare providers, and communities is essential for improving access to the maternal continuum of care.

Impact evaluation of a digital health platform empowering Kenyan women across the pregnancy-postpartum care continuum: A cluster randomized controlled trial.

Accelerating improvements in maternal and newborn health (MNH) care is a major public health priority in Kenya. While use of formal health care has increased, many pregnant and postpartum women do not receive the recommended number of maternal care visits. Even when they do, visits are often short with many providers not offering important elements of evaluation and counseling, leaving gaps in women's knowledge and preparedness. Digital health tools have been proposed as a complement to care that is provided by maternity care facilities, but there is limited evidence of the impact of digital health tools at scale on women's knowledge, preparedness, and the content of care they receive. We evaluated a digital health platform (PROMPTS (Promoting Mothers in Pregnancy and Postpartum Through SMS)) composed of informational messages, appointment reminders, and a two-way clinical helpdesk, which had enrolled over 750,000 women across Kenya at the time of our study, on 6 domains across the pregnancy-postpartum care continuum. We conducted an unmasked, 1:1 parallel arm cluster randomized controlled trial in 40 health facilities (clusters) across 8 counties in Kenya. A total of 6,139 pregnant individuals were consented at baseline and followed through pregnancy and postpartum. Individuals recruited from treatment facilities were invited to enroll in the PROMPTS platform, with roughly 85% (1,453/1,700) reporting take-up. Our outcomes were derived from phone surveys conducted with participants at 36 to 42 weeks of gestation and 7 to 8 weeks post-childbirth. Among eligible participants, 3,399/3,678 women completed antenatal follow-up and 5,509/6,128 women completed postpartum follow-up, with response rates of 92% and 90%, respectively. Outcomes were organized into 6 domains: knowledge, birth preparedness, routine care seeking, danger sign care seeking, newborn care, and postpartum care content. We generated standardized summary indices to account for multiple hypothesis testing but also analyzed individual index components. Intention-to-treat analyses were conducted for all outcomes at the individual level, with standard errors clustered by facility. Participants recruited from treatment facilities had a 0.08 standard deviation (SD) (95% CI [0.03, 0.12]; p = 0.002) higher knowledge index, a 0.08 SD (95% CI [0.02, 0.13]; p = 0.018) higher birth preparedness index, a 0.07 SD (95% CI [0.03, 0.11]; p = 0.003) higher routine care seeking index, a 0.09 SD (95% CI [0.07, 0.12]; p < 0.001) higher newborn care index, and a 0.06 SD (95% CI [0.01, 0.12]; p = 0.043) higher postpartum care content index than those recruited from control facilities. No significant effect on the danger sign care seeking index was found (95% CI [-0.01, 0.08]; p = 0.096). A limitation of our study was that outcomes were self-reported, and the study was not powered to detect effects on health outcomes. Digital health tools indicate promise in addressing shortcomings in pregnant and postpartum women's health care, amidst systems that do not reliably deliver a minimally adequate standard of care. Through providing women with critical information and empowering them to seek recommended care, such tools can improve individuals' preparation for safe childbirth and receipt of more comprehensive postpartum care. Future work is needed to ascertain the impact of at-scale digital platforms like PROMPTS on health outcomes. ClinicalTrials.gov ID: NCT05110521; AEA RCT Registry ID: R-0008449.

Continuum of Care - Building bridges between different phases of the patient's pathway

Continuum of Care - Building bridges between different phases of the patient's pathway

Patient-reported outcomes in GI cancer: Leading change to meet the needs of the gastrointestinal cancer community.

813 Background: According to the World Health Organization International Agency for Research on Cancer, globally gastrointestinal (GI) cancers account for 1 in 4 cancer cases and 1 in 3 cancer deaths, with an estimated 4.8 million new cases and 3.4 million GI cancer deaths reported annually. Understanding the global burden of GI cancers and the importance of understanding the real-world impact of a GI cancer diagnosis, the GI Cancers Alliance (GICA) conducted a 12-month patient-reported outcomes (PRO) research initiative that included a workshop at the 2023 American Society of Clinical Oncology (ASCO) annual meeting. In addition, our PRO research was published in the Journal of Clinical Oncology (J Clin Oncol 42, 2024 suppl 3; abstr 731) with a poster presented at the 2024 ASCO Gastrointestinal Cancers Symposium. Methods: Based on our 2022-2023 PRO research of 1,122 patients highlighting the unmet needs and critical gaps in services of the GI cancers community, we developed a series of follow-up initiatives. Nutrition education 17%, biomarker/precision medicine education 19%, patient-centered care education 11% and caregiver support 16% were four of the highest levels of unmet need based on our global research. Subsequently, in 2023 we created the ‘GI Cancers Patient &amp; Caregiver Advisory Board’ representing all GI cancers. The board hosts educational forums supporting patients and caregivers throughout the care continuum. Our pilot nutrition program launched at the 2024 ASCO annual meeting, consisting of in-person and online video components, and an extensive nutrition guide with recipes tailored for GI cancer patients. In 2024, we partnered with our gastric cancer advocates to develop ‘Test Your Biomarkers’ enhancing education and awareness of biomarker testing and precision medicine. Results: Implementing direct patient feedback from our published research, we are creating actionable solutions to unmet needs and gaps in services. Our ‘Patient &amp; Caregiver Advisory Board’ continues to amplify the patient and caregiver voice participating in global engagement opportunities. GICA provided 10,000 nutrition guides to community oncology centers, and our online messaging reached 250,000 individuals across digital platforms and partner websites in the first three months from launch. In the first six months of the ‘Test Your Biomarkers’ campaign our messaging reached 1.7 million individuals across all digital platforms, campaign, and partner websites. Conclusions: Our PRO research provides the roadmap for new initiatives and programming to meet the needs of our GI cancer community. The GI Cancers Alliance will proceed to collaborate with our 100+ partner organizations to activate change by targeting the needs of our patient community while eliminating critical gaps in services. By doing so, we will continue to provide greater patient impact through the amplification of the patient voice.

Hepatitis C Care Continuum Among People who Inject Drugs in King County, WA

Hepatitis C Care Continuum Among People who Inject Drugs in King County, WA

Empowering continuous maternal health and emergency care: the implementation of ARIMBI in Tirtorahayu Village

Empowering continuous maternal health and emergency care: the implementation of ARIMBI in Tirtorahayu Village

Abstract TP136: STRACK: A Continuum of Stroke Care, Improving Post-Stroke and Cardiometabolic Patient Outcomes

Background: The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension. Collaboration between primary care centers and hospital staff was essential for the project’s success by delivering personalized care and home monitoring devices to patients through access to a digital platform. STRACK was launched with a european value-based contracting process and Roche Diag. as partner. Methods: The three-year project was launched in May 2021, during first year all specialties and professionals participated in the development and planning of the project and were trained in the use of the devices and own digital platform. First STRACK patient was enrolled in May 2022. Once these post-stroke patients have been identified, they are given a personalized monitoring plan depending on the individuals’ risk factors, the personalized care and rehabilitation plans are tracked and followed. For a year post-discharge, a nursing and administrative team follows the data that the patient enters remotely or is automatically available on their mobile application. Results: STRACK has evolved the continuum of care by 421patient in July 2024 and ongoing, by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes, atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan, identified as key to avoiding stroke recurrence and improving control of vascular risk factors are monitored. Preliminary results of 231 patients (May 2022-2023) with full one year follow-up comparing with historical cohort (May 2018-2019) showed: Reduction in unnecessary visits (weighted): -26,3%. Reduction in admissions for stroke recurrence or related to stroke, (heart attack, angina, peripheral embolism, etc.): Stroke, 30days: -100%; Related to stroke, (365d: -47,7%; 30d: -57,0%). Reduction in cardiovascular admissions ( 30d: -100%; 365d: -31,4%). Best treatment adherence: 81,2% (72% previously) Conclusion: The great value of STRACK is knowing the evolution of stroke patients post-discharge through strict self-monitoring of clinical parameters, following prior health education. STRACK has managed to achieve reduction in stroke recurrence and adverse events and readmissions for cardiovascular risk factors, reducing emergency visits for vascular events.

Characterizing disparities in the HIV care continuum among U.S. transgender and cisgender medicare beneficiaries, 2008–2017

ABSTRACT Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008–2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender (male, female) beneficiaries with HIV and explored within and between gender group differences in the predicted probability of engagement in the HIV Care Continuum. Transgender and gender-diverse individuals had a higher predicted probability of every HIV-related care outcome vs. cisgender individuals, with TFN individuals showing the highest probability of HIV care visit engagement, sexually transmitted infection screening, and antiretroviral treatment receipt and persistence. Notably, except for sexually transmitted infection screening, cisgender females and TMN people had a slightly lower probability of engaging in HIV-related care than TFN people and cisgender males. Although transgender and gender-diverse beneficiaries living with HIV had better engagement in the HIV Care Continuum than cisgender individuals, findings highlight disparities in engagement for TMN individuals and cisgender females, though engagement was still low for Medicare beneficiariesof all genders. Interventions are needed to reduce HIV care engagement barriers for all Medicare beneficiaries.

The value of integrating the nutritional ecology into the nutrition care continuum – a conceptual and systems approach

The value of integrating the nutritional ecology into the nutrition care continuum – a conceptual and systems approach

Abstract TP156: Stroke Survivor and Caregiver Perspectives on Seeking Acute Care: A Qualitative Study

Introduction: Early recognition of acute stroke and activation of emergency medical services (EMS) is a critical first step in the stroke care continuum. Failure to call 9-1-1 and other delays in seeking care contribute to prolonged prehospital delays, often limiting access to time-sensitive treatment. To identify challenges in early initiation of EMS, we sought to understand stroke survivor and caregiver perspectives on seeking acute stroke care. Methods: We conducted individual, semi-structured interviews with a convenience sample of adult stroke survivors and caregivers for patients with acute stroke that occurred in central North Carolina. In virtual interviews, participants were asked about stroke signs and symptoms experienced, their response, and care received from EMS and in the ED and hospital. Interviews were recorded, transcribed, and analyzed by two individual coders. Deductive coding and rapid thematic analysis focused on care-seeking behaviors and perspectives. Results: Of 16 interviews conducted thus far, 10 were with stroke survivors and 6 were with accompanying caregivers (14 Non-Hispanic White; 13 used EMS). Stroke onset was promptly recognized when the patient/caregiver had prior experience with stroke, exposure to stroke education, or access to healthcare professionals among their personal circles. Early stroke recognition prompted over half of the caregivers or other bystanders (spouses, adult children, or neighbors) to call 9-1-1 right away. Symptoms perceived by the patient/caregiver as a non-stroke issue (e.g., migraine, seizure) or not severe enough led a third of the participants/caregivers to delay or fail to call 9-1-1. Some participants reported being aware of EMS costs; however, none reported delaying care-seeking due to these concerns. Other concerns with calling 9-1-1 included general apprehension of medical professionals and fear of being perceived as “the boy who cried wolf.” Conclusion: Stroke survivors’ and caregivers’ perspectives highlighted accurate and early stroke recognition as a facilitator of prompt EMS initiation. Conversely, symptoms associated with other neurologic conditions or perceived as mild created delays in seeking care. Further recruitment is in progress until reaching at least 30 participants, focusing on racial and ethnic minority groups and underserved rural populations. Study findings will be used to develop effective solutions to challenges in seeking acute stroke care.

The Advancement of Elderly Care: Development and Application of an Interdisciplinary Outpatient Dementia Care Consultation Module

With population aging, dementia has become a significant global health issue. Most people with dementia live in the community, are cared for by family members, and face complex and multifaceted care challenges. In line with Taiwan's Long-Term Care 2.0 policy, the Integrated Dementia Care Centers now established in many hospitals and linked with dementia clinic systems at the local level provide home care consultations and referrals. However, the primary focus of these centers remains on basic health education and post-diagnosis resource referral services. Thus, they lack an interdisciplinary approach, making it difficult to offer tailored, integrated care for people with dementia and their families. Therefore, integrating care intervention strategies from various fields to provide tailored and continuous care services is important. This article explores existing domestic and international dementia care consultation modules, introduces the integrated "Dementia Interdisciplinary Care Consultation Module" developed by our team, and discusses the applicability of and offers recommendations regarding this module. The developed module is intended to serve as a reference resource for outpatient medical staff and dementia case managers during health education consultations, and may be adopted into the training materials used by dementia care professionals and referenced in future domestic dementia care policy formulation work. The overall goal is to enhance the efficiency of outpatient dementia care consultations by ameliorating / resolving issues such as resource fragmentation, poor coordination, and service overlap, thereby improving the quality of family care provided to people with dementia.

Chronic Pain, Mental Health, and Sense of Purpose in Life Among Women Living with HIV Compared to HIV-Negative Women in the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study.

Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.

Case report: Holistic approach to pregnant adolescents

Introduction: Teenage pregnancy is a global health problem with significant impacts on physical, mental, social, and economic health. In Indonesia, the prevalence of teenage pregnancy reaches 10%, with East Java recording a higher rate (12%). Factors such as lack of sexual education, limited access to contraceptives, social stigma, and low family support exacerbate this condition. Case Report: A 14-year-old adolescent girl in Surabaya experienced an unplanned pregnancy and faced limited family support and economic problems. During pregnancy, she experienced eating disorders, anxiety, and limited access to health services. A holistic approach was taken by a midwife, nutritionist, and psychologist, including family counseling, nutrition education, and planning for delivery by caesarean section to prevent complications. Discussion: Teenage pregnancy involves biological, psychosocial, and economic factors. Family and health professional support is essential to reduce the risk of complications such as anemia, preterm labor, and mental health disorders. 5 A holistic approach includes nutrition education, psychological counseling, and family and community support to improve the quality of life of mothers and babies. Continuity of Care (COC) ensures continuity of care from pregnancy, labor, to postpartum. Conclusion: A holistic approach and COC are effective in addressing the challenges of teenage pregnancy with a focus on the following aspects keywords.

The Multilevel Limb-loss and Preservation Rehabilitation Continuum model (MLPRC): An evidence-based implementation model integrating multiple perspectives to improve outcomes for people facing limb loss.

The patient journey from threatened to actual limb loss, subsequent rehabilitation, and limb preservation through the health system is complicated and prone to delays, attrition, and inequities. A shared multi(socioecological)-level conceptualization of this journey among the multiple stakeholders is the first step for systematically improving limb care through identification of bottlenecks and gaps, contributory factors, and responsive interventions and implementation strategies. To meet this knowledge gap by presenting a novel implementation model, the Multilevel Limb-loss and Preservation Rehabilitation Continuum (MLPRC), that can be used to develop multilevel applications. MLPRC was developed in three overlapping steps: (1) design of the patient journey through the health system (horizontal element), (2) addition of multilevel perspectives along the journey (vertical element), and (3) implementation facilitation by incorporating implementation model constructs (concentric cells element). MLPRC is an implementation model for limb loss and preservation with three concentric cells: inner context cell (horizontal time-ordered patient journey at patient level, based on phases of amputation rehabilitation and patient journey concepts, and corresponding care delivery at provider/organization-level, based on the continuum of care and lower limb loss rehabilitation continuum concepts, on the journey timeline), less influenceable outer context cell (community, system and policy level perspectives), and outermost implementation cell, based on Proctor Model of Implementation Research, that utilizes inner and outer context cells (concept derived from Exploration, Preparation, Implementation, Sustainment framework) information to define responsive metrics, interventions and implementation strategies. Examples of MLPRC use as a blueprint for multilevel applications include patient level (education and navigation instruments), provider level (integrated practice clinic, referral streams), organization level (limb care continuum programs), and community, system, and policy level (interdisciplinary organizational partnerships, data repositories). MLPRC is among the first implementation model to present both a unified picture of the field of limb loss and preservation and a blueprint for multilevel applications.

Traditional Chinese Baduanjin Exercise With Nursing and Peer Group Support in the Care of Patients After Allogeneic Hematopoietic Stem Cell Transplantation: Evaluation of Application and Survival Analysis.

Sleep problems and anxiety are imperative for continuity of care and rehabilitation in patients following an allogeneic hematopoietic stem cell transplantation (allo-HSCT). The aim of this study was to investigate the impact on anxiety, sleep quality, and survival of integrating traditional Chinese Baduanjin exercises to track the control of continuous care in patients receiving an allo-HSCT. A total of 75 patients discharged after receiving an allo-HSCT were included. The control group received routine continuity of care, whereas the intervention group carried out Baduanjin exercises combined with 3C (company, clinical nurse, community nurse) support. Follow-up data were compared between the 2 groups using the Generalized Anxiety Disorder 7-item scale score for anxiety and the Pittsburgh Sleep Quality Index for sleep quality. Both the control and intervention groups showed that continuity of care measures were effective for improving sleep quality (P < .05). The continuity of care model and the time effect in the intervention group during the first 6 months of follow-up were associated with patient anxiety (P < .05). The median survival time was 26 months in the control group and 41 months in the intervention group, with this difference being statistically significant (P = .0239). The 3C support group improved patients' compliance with continuity of care. Also, integrating Baduanjin exercises with continuous care alleviated anxiety, improved sleep quality, and prolonged median survival time in patients after an allo-HSCT. The results indicate this model of care is potentially suitable for clinical promotion and application of allo-HSCT patients.

Youth Inpatient and Residential Treatment Psychiatric Beds: National Trends and Potential Causal Factors, 2010-2022.

Youth inpatient and residential treatment psychiatric services are essential components of the continuum of care. Concern has grown about the diminished availability of these services and the increasing need for them. This study aimed to examine the number of youths treated at inpatient and residential psychiatric facilities over a 12-year period and to assess the perceptions of state mental health authorities (SMHAs) about the reasons for changes in availability. In this multimodal study, the authors conducted a secondary analysis of a national survey (including all 50 states, Washington, D.C., and Puerto Rico) of mental health facilities that was administered seven times between 2010 and 2022. In addition, the study relied on 2023 data from a survey of SMHAs (N=34 respondents). Most states experienced a decline in the number of youths in inpatient (79%) and residential treatment psychiatric facilities (94%). Although some people posit that increased use of outpatient services may explain such declines, 81% of states had a reduction in community outpatient psychiatric care for youths during the study period. SMHAs reported that the impact of the COVID-19 pandemic and preexisting workforce shortages contributed to the reduction of youths treated. These findings show a nationwide decline in the number of youths treated in inpatient and residential treatment psychiatric facilities over time. Determining causal factors in these declines is challenging, and it is critical to develop a monitoring and reporting system for the number of youths requiring services and the capacity within each state for addressing youth needs.

Trends and determinants of maternal health services utilization in India from 2015 to 2021

Continuum of care (CoC) in maternal health services refers to a pathway spanning from pregnancy and childbirth to post-pregnancy, covering routine antenatal care (ANC), institutional delivery (ID), and post-natal services (PNC). The current study aims to investigate the distribution, trends, dropouts, and determinants of maternal health services (ANC, ID, and PNC) utilization along the CoC pathway using NFHS-4 and NFHS-5 datasets from 2015 to 2021. The binary logistic regression examined the association between the continuum of maternal health services utilization and the predictor variables. The complete CoC utilization was 50% during NFHS 5, an 11.3%-point increase from NFHS-4. During the same period, the largest dropout was in the uptake of full ANC (41.5%). Odds of completing CoC were higher among women aged 25–34 (AOR:1.18; 95% CI: 1.09–1.27), with higher education (AOR:1.74; 95% CI: 1.58–1.92), urban women (AOR:1.09; 95% CI:1.01–1.19), in richer household (AOR: 1.42; 95% CI: 1.29–1.56), and with health insurance (AOR: 1.24; 95% CI: 1.15–1.35). Strengthening the public health system and addressing bottlenecks of government maternal health schemes remains an important consideration for improving the continuum of maternal care in India. Context-specific multi-sectoral strategies may be leveraged to increase the uptake of maternal health services, especially in high-focus states.

P-472. Development of a Local HIV Care Continuum for the Kansas City Metropolitan Area (KCMA)

Abstract Background There were 36,136 new HIV diagnoses in the USA in 2021. Still, an estimated 13% of persons living with HIV (PLHIV) are unaware of their infection. The status of the HIV epidemic can be better understood by constructing an HIV care continuum.Figure 1.Diagnosis-Based KCMA HIV Care Continuums 2019-2022Local diagnosis-based care continuums for 2019-2022 compared with the most recent national HIV surveillance data. Methods HIV surveillance data reported to the Kansas Department of Health and Environment (KDHE) and Missouri Department of Health and Senior Services (DHSS) were utilized to create diagnosis-based HIV care continuums for 2019-2022. This included data from Johnson, Wyandotte, and Leavenworth counties in Kansas, and Jackson, Clay, and Platte counties in Missouri. Prevalence-based care continuums were constructed for Kansas City, Missouri for 2019-2021 utilizing the CD4-depletion model employed by CDC. Diagnosis, receipt of care, retention in care and viral suppression are per CDC definitions.Figure 2.Prevalence-Based Kansas City, MO HIV Care Continuums 2019-2021Local prevalence-based care continuums for 2019-2021 compared with the most recent national HIV surveillance data. Results From 2019 to 2021, receipt of HIV care in KCMA remained stable, while retention in care (49% to 41.6%) and HIV viral suppression (65.6% to 57.2%) decreased (Figure 1). From 2019 to 2021, HIV diagnosis rates in the 3 counties of Kansas City, Missouri, remained stable at about 87%, but receipt of care rates decreased (41.7% to 35.9%), with stable viral suppression rates (∼54%) (Figure 2). Linkage to care improved from 70% to 75% for the 6-county KCMA from 2019 to 2022 (Figure 3).Figure 3.KCMA Linkage to HIV Care 2019-2022Local linkage to HIV care estimates compared with the most recent national linkage to care estimates. Conclusion Knowledge of status appeared to approximate national estimates. However, linkage to care was significantly lower (70-75% vs 82%), which likely negatively impacted downstream stages of the continuum. Local estimates for receipt of care, retention in care, and viral suppression were consistently below national levels. This highlights the importance of ongoing initiatives targeted at the more proximal stages. Reaching undiagnosed PLHIV requires a robust public health infrastructure which utilizes innovative diagnostic approaches to meet at-risk individuals in the spaces where they live and interact. Optimizing more distal stages of the continuum is contingent upon ongoing efforts to ensure all diagnosed PLHIV are efficiently linked to care and started on antiretroviral therapy (ART) in a timely fashion. Disclosures Wissam El Atrouni, MD, ViiV Healthcare: Advisor/Consultant