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Open Access Publications from the University of California

Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2023)

BackgroundHIV pre-exposure prophylaxis (PrEP) is a key to the United States’ (US) Ending the HIV Epidemic plan. This research aims to 1) evaluate PrEP utilization in jurisdictions with the highest HIV new diagnosis incidence, 2) determine PrEP correlation with new HIV diagnoses, income, geopolitical, race and/or geo-spatial factors.

MethodsAnalysis of 2012-2019 PrEP data implementing linear mixed methods statistical modeling. The dependent variable was county PrEP rate. Fixed effects were HIV diagnoses, state income, percentage of black, indigenous and people of color (BIPOC) in state populations and governor political affiliation. Random effects were regions and counties of the US. Only the 50 US jurisdictions with the highest new HIV diagnosis rates were analyzed.

Results For each 10,000 U.S. dollar increase in mean income, there was a significant increase in PrEP utilization by 66.4/100,000 persons (95%CI 58.6-74.3, p<0.001). Jurisdictions with higher HIV diagnosis rates have reduced PrEP utilization -2.73/100,000 for each new 1 diagnosis per 100,000 in the population (95%CI -3.71 – -1.80,p <0.001). For each increase of BIPOC by 1 percentile point, PrEP utilization decreased by a rate of -522.34 per 100,000 prescriptions (95%CI -958.4 – -134.8,p <0.05).

ConclusionFindings suggest lower income, higher rates of HIV diagnoses, and higher proportion of BIPOC persons correlate to lower rates of PrEP use. Regional location and political party of state governors was not associated with PrEP uptake.

    Cover page: PrEP Utilization in the United States, A sub-study of the Triumph Project at UCSD
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2024)
    The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.
      Cover page: Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic.
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