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1. Advancing Equitable Outcomes in Child Welfare: A Toolkit for Sustainability. The Family Stabilization Initiative

Author

Chapin Hall at the University of Chicago, McCrae, Julie S., Broxton, Alyssa T., Steinmetz, Samantha, and Casillas, Katherine L.

Abstract

The Family Stabilization Initiative (FSI) Sustainability Toolkit was developed by Chapin Hall at the University of Chicago in partnership with Lutheran Services in America. Chapin Hall designed and implemented a multifaceted approach to gain comprehensive understanding of the FSI and its core sustainability components. The Sustainability Toolkit is intended for any organization interested in applying race equity and sustainability best practice principles to their implementation of evidence-based or evidence-informed programming. The toolkit includes: (1) guidelines for creating a learning collaborative; (2) wraparound service delivery model options; (3) clear guiding principles for advancing race equity; (4) key components for equity-centered sustainability; (5) a list of barriers to addressing race equity; (6) examples of diversity in partnership and asset mobilization; and (7) steps and messaging for effective change management. The toolkit demonstrates how issues of race can be centered in program implementation and sustainability efforts. Ultimately, the goal of this work is to not only dismantle racial disparities in child welfare, but also to accelerate the shift in child welfare from intervention to prevention. [This Toolkit was produced through collaboration between Chapin Hall at the University of Chicago and Lutheran Services in America.]

Published
2023

2. Viral suppression among adults with HIV receiving routine dolutegravir-based antiretroviral therapy and 3 months weekly isoniazid-rifapentine.

Author

Chaisson, Lelia, Semitala, Fred, Nangobi, Florence, Steinmetz, Samantha, Marquez, Carina, Armstrong, Derek, Opira, Bishop, Kamya, Moses, Phillips, Patrick, Dowdy, David, and Yoon, Christina

Subjects
Adult, Humans, Female, Male, Isoniazid, Viremia, HIV Infections, Uganda, Drug Therapy, Combination, Antitubercular Agents, Latent Tuberculosis
Abstract

OBJECTIVE: We aimed to evaluate safety of 3 months weekly isoniazid-rifapentine (3HP) for tuberculosis (TB) prevention when co-administered with dolutegravir-based antiretroviral therapy (TLD), and compare viral suppression among those initiating TLD + 3HP vs. TLD alone. DESIGN/METHODS: We analyzed data from an ongoing Phase 3 randomized trial comparing TB screening strategies among adults with CD4 + ≤350 cells/μl initiating routine antiretroviral therapy (ART) in Kampala, Uganda. TB screen-negative participants without contraindications are referred for self-administered 3HP. HIV viral load is routinely measured at 6 and 12 months. Here, we included TB-negative participants who initiated TLD with or without 3HP. We determined the number who discontinued 3HP due to drug toxicity. In addition, we assessed viral suppression at 6 and 12 months and used log-binomial regression to assess risk of viremia at 6 months for participants who initiated TLD + 3HP vs. TLD alone. RESULTS: Of 453 participants initiating TLD (287 [63.4%] female, median age 30 years [interquartile range (IQR) 25-37], median pre-ART CD4 + cell count 188 cells/μl [IQR 86-271]), 163 (36.0%) initiated 3HP. Of these, 154 (94.5%) completed 3HP and one (0.6%) had treatment permanently discontinued due to a possible 3HP-related adverse event. At 6 months, for participants who received TLD + 3HP, risk of viremia >50 copies/ml was 1.51 [95% confidence interval (CI) 1.07-2.14] times that of participants who received TLD alone. There was no difference in viral suppression between those who received TLD + 3HP vs. TLD alone at 12 months. CONCLUSIONS: Co-administration of TLD + 3HP was well tolerated. However, those who received TLD + 3HP were less likely to achieve viral suppression within six-months compared to those who received TLD alone.

Published
2023

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