HJBR May/Jun 2023

PUBLIC HEALTH AND MEDICINE 28 MAY / JUN 2023 I  HEALTHCARE JOURNAL OF BATON ROUGE that we are doing are working with our partners to develop new multi-pathogen technology to facilitate testing diagnosis and linkage to prevention or treatment for multiple infections. This includes things like having a hep A and B vaccine or screening for hep B and C and HIV in patients. Really important when somebody is there in your front door at your point of care to be able to address multiple things. What I think is really neat is when we’re doing things like our prep guidelines around HIV, we have found that it lowers sexually transmitted infections because of the increased testing diagnosis and treat- ment that we’re doing and shortening the infectious time period. Also, doing things like co-locating treatment and services — HIV, STI, and viral hepatitis prevention ser- vices — really allows us to maximize health outcomes. We’ve done about 30 years of research at CDC now on syringe service programs. We have seen that they decrease HIV and hep C infections by about 50%. And when you couple that with treatment for opioid use disorder, it decreases transmis- sion by about 60%. These are really impor- tant things that we can be doing. We have a bold goal, and that’s to end new HIV infections, 90% of them, by 2030. To do this, we need to be looking at the communi- ties with the highest rates and looking at the most at-risk populations, diagnosing, hav- ing treatment readily available. In treating, we make sure we are reaching those viral suppression levels, so people aren’t trans- mitting. And I always think that this is one of those really great things to where treat- ment is prevention. This does prevent future infections. And then certainly responding when we have outbreaks oftentimes related to injection drug use. One example was in Scott County, Indi- ana. Many of you’ll probably remember that HIV outbreak; I think it was 2015. After that, we were able to institute the first legal syringe service program in that area. What they found was after it was in place, the county had less than expected cases of new HIV, and they saw decreases in hepatitis C cases. They also saw that of the more than 1300 participants, they had over 11,000 visits or linkages to treatment. In addition, about 2,500 doses of Naloxone were given, and 600 were reported to be used. Again, when you think about the syndemic and all the ways that you’re able to impact multiple aspects of health, I thought that was really powerful. Those of you that know me know that my background was really in violence pre- vention. I think healthcare providers have such an important role in the community — in hospitals, in schools, in homes. One of the most simple things we can do is a trauma-informed approach in patient care. If somebody comes in, I’m not just cutting their clothes off with trauma shears, I’m tell- ing themwhat’s going to happen with them. I am not retriggering or making their expe- rience worse. I’m trying to approach them in an unbiased way to really explain what we are doing and then offer them resources afterward. There are also things like hospital-based violence intervention programs like “Caught in the Crossfire.” This is a peer interven- tion that was started in California, where it links clients with trauma-informed care, but also resources — sometimes it’s school- ing or job support. They found that 98% of the clients were not rehospitalized for any violence-related injuries, and 90% who’d come from a juvenile justice system were not rearrested. “SafeER Teens” is something we’ve been funding. It’s being done in Michigan right now, and it uses motivational interview- ing skill building, such as conflict resolu- tion, with teens who come into the ER after a violent assault. It also uses cool things like cell phones to provide text messaging and GPS tracking. If you’re going to an area to where you might have a violent conflict, it reminds you that that’s one of the things that you’ve talked about. What they have found is that this has caused reductions in perpetration, in victimization of peer vio- lence, alcohol use, as well as increased self- efficacy in avoiding fighting. We can also talk about safe storage of firearms. When we talk about childhood injuries as well as suicide prevention, stor- ing a firearm in the house safely is very important to do. There’s an intervention called “Emergency Department Counseling “I think healthcare providers have such an important role in the community — in hospitals, in schools, in homes. One of the most simple things we can do is a trauma-informed approach in patient care. If somebody comes in, ... try to approach them in an unbiased way to really explain what we are doing and then offer them resources afterward.”