Gaps In Coverage Research Articles

Optimizing Disaster Response through Efficient Path Planning of Mobile Aerial Base Station with Genetic Algorithm

The use of unmanned aerial vehicles (UAVs), or drones, as mobile aerial base stations (MABSs) in Disaster Response Networks (DRNs) has gained significant interest in addressing coverage gaps of user equipment (UE) and establishing ubiquitous connectivity. In the event of natural disasters, the traditional base station is often destroyed, leading to significant challenges for UEs in establishing communication with emergency services. This study explores the deployment of MABS to provide network service to terrestrial users in a geographical area after a disaster. The UEs are organized into clusters at safe locations or evacuation shelters as part of the communication infrastructure. The main goal is to provide regular wireless communication for geographically dispersed users using Long-Term Evolution (LTE) technology. The MABS traveling at an average speed of 50 km/h visits different cluster centroids determined by the Affinity Propagation Clustering (APC) algorithm. A combination of graph theory and a Genetic Algorithm (GA) was used through mutators with a fitness function to obtain the most efficient flyable paths through an evolution pool of 100 generations. The efficiency of the proposed algorithm was compared with the benchmark fitness function and analyzed using the number of serviced UE performance indicators. System-level simulations were used to evaluate the performance of the proposed new fitness function in terms of the UEs served by the MABS after the MABS deployment, fitness score, service ratio, and path smoothness ratio. The results show that the proposed fitness function improved the overall service of UEs after MABS deployment and the fitness score, service ratio, and path smoothness ratio under a given number of MABS.

Enhancing wireless sensor network connectivity and coverage using Hybrid GWO‐HSA algorithm

SummaryWireless sensor networks (WSNs) are essential in environmental monitoring, healthcare, and industrial automation. Persistent connectivity and coverage challenges in WSN stem from intermittent node connectivity due to obstacles, signal interference, node failures, and compromised data reliability. Existing solutions, while useful, exhibit limitations in fully addressing these concerns. To confront these challenges, a proposed system introduces the Hybrid Grey Optimizer–Harmony Search Algorithm (Hybrid GWO‐HSA), merging adaptive routing protocols and efficient deployment techniques. The Hybrid GWO‐HSA system conducts an initial environmental analysis to pinpoint factors affecting node communication. It strategically deploys additional nodes to bridge coverage gaps, using the Grey Wolf Algorithm's capabilities to optimize node placement. Moreover, it employs the Harmony Search Algorithm to dynamically adjust communication paths based on real‐time network conditions, ensuring robust data transmission. The system workflow involves an environmental assessment followed by node deployment guided by the Grey Wolf Algorithm. Subsequently, the Harmony Search adapts communication paths to enhance connectivity. Simulations and practical experiments across diverse environments validate the Hybrid GWO‐HSA system's effectiveness. Results showcase substantial improvements: network lifetime of 13,200 s, a network delay of 37 ms, a coverage rate of 0.88, and an energy consumption of 590 J. This Hybrid GWO‐HSA‐based system establishes a resilient and efficient WSN infrastructure vital for reliable data collection and transmission in challenging settings. The Hybrid GWO‐HSA system offers a comprehensive approach to WSN connectivity and coverage issues by leveraging firefly and genetic algorithms, and it significantly enhances WSN performance and reliability across multifaceted application domains.

A Study on the Assessment of the Impact of Extreme Weather on the Insurance Industry and Response Strategies Based on SEIR Modeling

This paper investigates the impact of extreme weather on the insurance industry and proposes a new model for assessing the value of insurance underwriting. The study first collected data on nine indicators from 50 regions, categorized these indicators into three categories: extreme weather, insurance, and region, and then used the hierarchical analysis method (AHP), entropy weighting method (EWM), and CRITIC method to calculate the composite weights to derive the Underwriting Value Index (UVI). In addition, underwriting values for St. Louis and Kingman were evaluated using the ALARP criteria and the EIR model. In order to help communities and real estate developers to carry out rational development, the EIR model was improved to form the SEIR model, which was applied to score the development value of nine municipalities in Fujian Province, which showed that Xiamen scored the highest and was recommended to be developed and built in Xiamen. The methodological validation of this study shows that there is a significant correlation between the UVI score and the insurance coverage gap (Pearson correlation coefficient R=0.869), which indicates that the model has good rationality and practicality.

Gap analysis between skills requirements for research support services and LIS/IM curricula

The primary goal of this study was to identify gaps in curriculum coverage and required skills for research support services (RSS) in university libraries in the Punjab province of Pakistan. A convergent parallel mixed methods design was used to meet its objective. To collect data for the quantitative strand, a cross-sectional survey with a closed-ended questionnaire was conducted. The population for the cross-sectional survey was reference/research librarians working in university libraries in the Punjab province. SPSS was used to analyze quantitative data. In the qualitative strand, the curriculum documents of seven LIS/IM schools in the Punjab province were examined by using the content analysis technique. Results of both strands were compared for gap analysis. The findings revealed a gap between the skills required for RSS and the offerings of LIS/IM schools. The findings have practical implications for LIS/IM schools that will help to realign their curricula to meet market needs.

Vibration attenuation and wave propagation analysis of 3D star-shaped resonant plate structures and their derivatives with ultra-wide band gap

Based on the local resonance effect of elastic waves, three single-phase acoustic metamaterials are proposed in this paper. Based on the finite element method and Bloch's theorem, the energy band structure diagrams and vibration modes are plotted, and the band gap properties and band gap opening mechanism of these structures are explored. New structures possessing lower frequency band gaps are obtained by topological optimization. The transmission curves verify the accuracy of the band gap and the vibration attenuation ability of the structure. Finally, the structural parameters were adjusted and the effect of each parameter change on the band gap characteristics was analyzed. The results show that the proposed structure has a maximum band gap coverage of 72.4 % and a strongest attenuation peak of less than −400 (dB) due to the occurrence of a local resonance. This paper provides a methodology for analyzing the vibration and noise reduction performance of single-phase material phononic crystals, as well as a three-dimensional phononic crystal with potential for practical applications.

Coverage of Indoor Smoking and Vaping Restrictions in the U.S., 1990–2021

Secondhand smoke exposure increases the risk of premature death and disease in children and non-smoking adults. As a result, many US states and local jurisdictions have enacted comprehensive indoor smoking restrictions (ISR). Indoor vaping restrictions (IVR) have also been adopted to protect against exposure to secondhand e-cigarette aerosol. This study aimed to quantify state and national US coverage of policies restricting indoor cigarette and e-cigarette use over time. Data from the American Nonsmokers Rights' Foundation on US ISR from 1990 to 2021 and IVR from 2006 to 2021 were analyzed. Combining these data with 2015 US Census population estimates, the percentage of state and national residents covered by partial and comprehensive restrictions in bars, restaurants, and workplaces, were calculated (analysis in 2023-2024) over time. Between 1990-2021, national coverage of comprehensive ISR increased for bars (0% to 67.3%), restaurants (0% to 78.2%), and workplaces (0% to 77.5%). Partial ISR coverage decreased for bars (14.8% to 13.9%), restaurants (40.2% to 15.4%) and workplaces (40.2% to 22.5%). From 2006 to 2021, comprehensive IVR coverage increased for bars (0% to 43.5%), restaurants (0% to 51.5%), and workplaces (0% to 53.2%). Despite these increases in coverage, by the end of 2021, <50% of the population was protected by comprehensive ISR for bars, restaurants, and workplaces in 19, 12, and 14 states, respectively. The percentage of the US population protected by ISR and IVR has increased over time. However, gaps in coverage remain, which may contribute to disparities in tobacco-related disease and death.

Impact of a Remote Primary Care Telehealth Staffing Model on Primary Care Access in the Veterans Health Administration.

The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access. To evaluate PC wait times before and after CRH implementation. Comparative interrupted time series analysis among a retrospective observational cohort of PC clinics who did and did not use CRH during pre-implementation (October 2018-September 2019) and post-implementation (October 2019-February 2020) periods. Clinics completing ≥10 CRH visits per month for 2 consecutive months and propensity matched control clinics. Two measures of patient access (i.e., established, and new patient wait times) and one measure of clinic capacity (i.e., third next available appointment) were assessed. Clinics using CRH were 1:1 propensity score matched across clinical and demographic characteristics. Comparative interrupted time series models used linear mixed effects regression with random clinic-level intercepts and triple interaction (i.e., CRH use, pre- vs. post-implementation, and time) for trend and point estimations. PC clinics using CRH (N = 79) were matched to clinics not using CRH (N = 79). In the 12-month pre-implementation, third next available time increased in CRH clinics (0.16 days/month; 95% CI = [0.07, 0.25]), and decreased in the 5 months post-implementation (-0.58 days/month; 95% CI = [-0.90, -0.27]). Post-implementation third next available time also decreased in control clinics (-0.48 days/month; 95% CI = [-0.81, -0.17]). Comparative differences remained non-significant. There were no statistical differences in established or new patient wait times by CRH user status, CRH implementation, or over time. In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary.

Building Data Triangulation Capacity for Routine Immunization and Vaccine Preventable Disease Surveillance Programs to Identify Immunization Coverage Inequities.

The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including poor data accessibility and lack of timely analysis, contributing to missed vaccinations, immunity gaps, and, consequently, VPD outbreaks in populations with limited access to immunization and basic healthcare services. Data triangulation, or the integration of multiple data sources, can be used to improve the availability of key indicators for identifying immunization coverage gaps, under-immunized (UI) and un-immunized (zero-dose (ZD)) children, and for assessing program performance at all levels of the healthcare system. Here, we describe the data triangulation processes, prioritization of indicators, and capacity building efforts in Bangladesh, Nigeria, and Rwanda. We also describe the analyses used to generate meaningful data, key indicators used to identify immunization coverage inequities and performance gaps, and key lessons learned. Triangulation processes and lessons learned may be leveraged by other countries, potentially leading to programmatic changes that promote improved access and utilization of vaccination services through the identification of UI and ZD children.

Coverage and Access Changes During Medicaid Unwinding

States resumed Medicaid eligibility redeterminations, which had been paused during the COVID-19 public health emergency, in 2023. This unwinding of the pandemic continuous coverage provision raised concerns about the extent to which beneficiaries would lose Medicaid coverage and how that would affect access to care. To assess early changes in insurance and access to care during Medicaid unwinding among individuals with low incomes in 4 Southern states. This multimodal survey was conducted in Arkansas, Kentucky, Louisiana, and Texas from September to November 2023, used random-digit dialing and probabilistic address-based sampling, and included US citizens aged 19 to 64 years reporting 2022 incomes at or less than 138% of the federal poverty level. Medicaid enrollment at any point since March 2020, when continuous coverage began. Self-reported disenrollment from Medicaid, insurance at the time of interview, and self-reported access to care. Using multivariate logistic regression, factors associated with Medicaid loss were evaluated. Access and affordability of care among respondents who exited Medicaid vs those who remained enrolled were compared, after multivariate adjustment. The sample contained 2210 adults (1282 women [58.0%]; 505 Black non-Hispanic individuals [22.9%], 393 Hispanic individuals [17.8%], and 1133 White non-Hispanic individuals [51.3%]) with 2022 household incomes less than 138% of the federal poverty line. On a survey-weighted basis, 1564 (70.8%) reported that they and/or a dependent child of theirs had Medicaid at some point since March 2020. Among adult respondents who had Medicaid, 179 (12.5%) were no longer enrolled in Medicaid at the time of the survey, with state estimates ranging from 7.0% (n = 19) in Kentucky to 16.2% (n = 82) in Arkansas. Fewer children who had Medicaid lost coverage (42 [5.4%]). Among adult respondents who left Medicaid since 2020 and reported coverage status at time of interview, 47.8% (n = 80) were uninsured, 27.0% (n = 45) had employer-sponsored insurance, and the remainder had other coverage as of fall 2023. Disenrollment was higher among younger adults, employed individuals, and rural residents but lower among non-Hispanic Black respondents (compared with non-Hispanic White respondents) and among those receiving Supplemental Nutrition Assistance Program benefits. Losing Medicaid was significantly associated with delaying care due to cost and worsening affordability of care. The results of this survey study indicated that 6 months into unwinding, 1 in 8 Medicaid beneficiaries reported exiting the program, with wide state variation. Roughly half who lost Medicaid coverage became uninsured. Among those moving to new coverage, many experienced coverage gaps. Adults exiting Medicaid reported more challenges accessing care than respondents who remained enrolled.

Combined search for electroweak production of winos, binos, higgsinos, and sleptons in proton-proton collisions at s=13 TeV

A combination of the results of several searches for the electroweak production of the supersymmetric partners of standard model bosons, and of charged leptons, is presented. All searches use proton-proton collision data at s=13 TeV recorded with the CMS detector at the LHC in 2016–2018. The analyzed data correspond to an integrated luminosity of up to 137 fb−1. The results are interpreted in terms of simplified models of supersymmetry. Two new interpretations are added with this combination: a model spectrum with the bino as the lightest supersymmetric particle together with mass-degenerate Higgsinos decaying to the bino and a standard model boson, and the compressed-spectrum region of a previously studied model of slepton pair production. Improved analysis techniques are employed to optimize sensitivity for the compressed spectra in the wino and slepton pair production models. The results are consistent with expectations from the standard model. The combination provides a more comprehensive coverage of the model parameter space than the individual searches, extending the exclusion by up to 125 GeV, and also targets some of the intermediate gaps in the mass coverage. © 2024 CERN, for the CMS Collaboration 2024 CERN

Factors Involved in Anti-VEGF Treatment Decisions for Neovascular Age-Related Macular Degeneration: Insights from Real-World Clinical Practice.

Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although studies have investigated patient choice of anti-VEGF agent, little is known regarding factors that influence physician preference of anti-VEGF agent for their patients. To describe physician rationale and challenges in prescribing anti-VEGF treatments for patients with nAMD. Data were drawn from the Adelphi Real World nAMD Disease Specific Programme™, a cross-sectional survey with retrospective data capture of physicians and their patients with nAMD in the United States between October 2021 and May 2022. Physicians (n = 56) reported data for up to 13 consecutively consulting patients (n = 451), including current anti-VEGF treatments used, factors affecting physicians' choice of anti-VEGF agent and treatment strategy, and restrictions on specific agents. Most physicians prefer employing a "treat-and-extend" treatment strategy, over "fixed interval" or "pro re nata" strategies. However, in routine clinical practice, "treat-and-extend" was reported for less than half of nAMD-diagnosed eyes. Top factors influencing physician choice of anti-VEGF agent and treatment strategy included maximizing clinical benefit (eg visual acuity gains and fluid control), patient convenience, and reducing out-of-pocket costs. However, physicians also reported facing substantial roadblocks in prescribing their choice of anti-VEGF agent, including restrictions on approved agents and gaps in insurance coverage. Persistent fluid was the most common physician-selected reason for switching a patient away from an anti-VEGF agent. Physicians face barriers to prescribing their preferred anti-VEGF agents in real-world healthcare settings. Overcoming these challenges may improve treatment outcomes for patients with nAMD.

Patient-reported treatment-related symptoms and use of the PRO-CTCAE for multiple myeloma clinical trials: A qualitative interview study.

e19516 Background: Therapeutic regimens for multiple myeloma (MM) involve multiple pharmacological agents, including steroids. Many cause treatment-related symptoms that add to patient burden or may trigger treatment cessation. This study gathered qualitative data about the patient experience with MM treatments, including regimens with steroids. Findings were summarized and compared to the Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), to assess its comprehensiveness and relevance in MM clinical trials. Methods: Individual, semi-structured interviews were conducted virtually with a diverse sample of 16 US-based, English-speaking adults (38% male, 25% Black, 13% Hispanic) to explore their experiences with MM and treatments, including perspectives on steroids and potential benefits of steroid-sparing regimens. Content analysis was used to summarize and compare terminology participants used to describe their experiences with treatments. Results: Participants reported a diverse set of treatment-related symptoms impacting their overall experience, indicating the importance of assessing regimen tolerability in clinical trials. Steroids were linked to increased energy that interfered with sleep or functioning, irritability, taste changes, weight gain, increased appetite, and cognitive symptoms like brain fog. Participants reported that most symptoms were tolerable, but they would prefer to avoid steroids if treatment benefits did not diminish. Many reported symptoms were included in the PRO-CTCAE items (see Table), but several symptoms related to regimens with steroids are not covered: excess energy, bitter/metallic taste, taste sensitivity, brittle nails, irritability, hunger/increased appetite, and muscle weakness. Conclusions: MM patients experience a range of treatment-related symptoms, many of which impact their quality of life. If given the option, patients would prefer a steroid-free regimen if there was proven clinical benefit. While the PRO-CTCAE covers most of the treatment-related symptoms, proving to be an option for multiple myeloma clinical trials, additional PRO instruments may be needed to cover specific gaps in the PRO-CTCAE item library content coverage. [Table: see text]

Spatial interpolation techniques comparison and evaluation: The case of ground-based gravity and elevation datasets of the central Main Ethiopian rift

The ground-based gravity data reveals diverse anomaly signatures in areas of the Main Ethiopian rift where active volcanic and tectonic activities are dominant. In such a region ground-based data collection is restricted to existing roads and relies on accessible stations. These resulted in gaps in data, either missing, uneven, or insufficient spatial coverage that must be estimated with proper interpolation techniques. Comparison and evaluations of the spatial interpolation methods that are commonly used in potential field geophysical data analysis were made for the terrestrial gravity and elevation data of the central Main Ethiopian rift. In this research, two widely used interpolation techniques, minimum curvature interpolation, and Ordinary Kriging were compared and assessed. A 10 % hold-out validation was employed, where 90 % of the data points were used to generate interpolated surfaces, which were then evaluated against the remaining 10 %. Following interpolation with each technique, the generated grid was converted into discrete data points (estimated values). These are then compared with the available gravity data, which were deliberately excluded from the gridding process (10 % remaining dataset). The accuracy of each method was assessed by evaluation metrics such as mean value, variance, Mean Absolute Error (MAE), Root Mean Square Error (RMSE), correlation coefficient (r), and R-squared. The results showed that the ordinary Kriging interpolation method outperformed the minimum curvature interpolants for gravity data with all performance metrics, while both interpolants seem to perform equally well for the elevation dataset. Therefore, it is proposed to use the Kriging interpolation method for potential field gravity studies conducted in the central Main Ethiopia rift.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists

IntroductionThis study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. MethodsSurveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. ResultsThe response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. ConclusionsLimited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Varicella Vaccine: Recognizing the Gap Years of Inadequate Vaccine Immunity

Varicella vaccination programs introduced in 1995 significantly reduced morbidity and mortality of the disease in the United States. Initiated as a single-dose vaccine, studies evaluating efficacy identified periodic reports of outbreaks prompting the implementation of the 2-dose varicella vaccination in 2007. The single-vaccine dose period, 1995 to 2007, produced a gap of 2-dose coverage for many individuals, now in their late teens to late 30s. Those in the vaccine gap are likely unaware of possible compromised immunity and may be at risk. Primary care providers should screen patients in this gap population, administer a second vaccine dose as needed, as well as be alerted to recognize symptoms of breakthrough disease in this cohort.

Bridging the vitamin A and deworming coverage gap among underserved populations in India through government and civil society organization partnerships

BackgroundVitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (< 70 µmol/L). This study aims to (1) evaluate vitamin A supplementation (VAS) and deworming (VAS + D) coverage in Nagaland state through government and civil society organization (CSO) partnerships, (2) examine socio-demographic barriers and facilitators to VAS + D coverage, (3) examine associations between socio-demographic characteristics and source of VAS coverage (i.e., government vs. CSOs), and (4) estimate the impact of VAS on health outcomes due to increased coverage through government and CSO partnerships.MethodsA cross-sectional statewide coverage survey was conducted in Nagaland, India with 1,272 caregivers of children 6–59 months. Household socio-demographic data and VAS + D exposure variables were collected via quantitative survey. Univariate analyses were used to assess the associations between the independent and outcome variables; odds ratios were computed to measure the strength of the association at a significance level of < 0.05. The Lives Saved Tool (LiST) was used to estimate the impact of increased VAS coverage on child undernutrition, morbidity and mortality.ResultsMost children (77.2%) received VAS in the past six months, with 28.1% receiving VAS in capsule form (provided primarily by CSOs) and 70.2% received VAS in syrup form (provided primarily by government). Total deworming coverage was 74.2%, with 43.5% receiving both VAS and deworming. Lower pre-school enrollment was a barrier to receiving VAS (47.4% not enrolled vs. 80.9% enrolled, p < 0.001). A barrier to receiving VAS + D was lack of knowledge of benefits (p < 0.001). Based on LiST modeling, increasing VAS coverage by 22% through CSOs resulted in an estimated 114 stunting cases averted, 25,017 diarrhea cases averted, and 9 lives saved in 2019 in Nagaland State.ConclusionsGovernment and CSO partnerships can reduce disparities in VAS coverage and decrease under-five child morbidity and mortality.

Health Insurance and Access to Care in U.S. Working-Age Adults Experiencing Long COVID

IntroductionLong COVID encompasses a wide range of health problems that emerge, persist, or recur following acute COVID-19 illness. Given that the prevalence of self-reported Long COVID is highest among U.S. adults in their prime working years, it is important to identify unmet needs and gaps in healthcare access and coverage among working age adults. MethodsPrevalences (95% CI) of health insurance coverage and access to care by Long COVID status were estimated among adults 18-64 years (n = 18,117), accounting for survey design and weighted to the U.S. non-institutionalized population in the 2022 National Health Interview Survey. Analyses were conducted in 2023. ResultsOverall, 3.7% (95% CI 3.4, 4.0) of respondents were experiencing Long COVID. Adults experiencing Long COVID were less likely to report being uninsured relative to adults not experiencing Long COVID (P=0.004); however, 49.0% (95% CI 43.2, 54.7) had high deductible health plans. Adjusting for sociodemographic characteristics, adults experiencing Long COVID were more likely to access healthcare compared to adults not experiencing Long COVID (P<0.01 for seeing a doctor, telemedicine appointments, ≥2 urgent care visits, ≥2 emergency department visits, and hospitalized overnight). Despite more frequent healthcare use, adults experiencing Long COVID were also more likely to abstain from and delay medical care, therapy, and prescriptions due to cost compared to adults not experiencing Long COVID (P<0.0001 for all comparisons). ConclusionsThese findings may be used to inform healthcare planning for adults experiencing Long COVID and highlight the ongoing need to improve access and affordability of quality and comprehensive care.

The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth.

The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth. Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022. Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome. Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09). More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes

IntroductionLong-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY. MethodsIndividual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 – Dec 31, 2019) and post-policy changes (Apr 1, 2020 – Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation. ResultsThe number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55–0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period. ConclusionsLAI-bup access, utilization, and retention increased after several policy changes.