• Characterizing discrepancies in school recovery after disasters

      Shah, Hazel; Georgia State University (Georgia Public Health Association, 2019-01-30)
      Background: Academic institutions provide consistency and routine to children. When disasters damage schools, students often suffer in a variety of ways, and racial minority students are often impacted disproportionately. However, minimal research exists exploring these discrepancies. This presentation examines racial disparities in school systems affected by Hurricane Ike (2008). Methods: This study, funded by the National Science Foundation, uses publicly available Texas Education Agency data from approximately 600 schools affected by Hurricane Ike. Schools were included in the study based on two criteria: if they were declared “disaster areas” by FEMA and if they were closed for at least 10 school days after Hurricane Ike. Results: Descriptive analyses were conducted comparing school characteristics and pass rates for all students in grades 3-11 on the Texas Assessment of Knowledge and Skills (TAKS) standardized test during pre- and post-hurricane school years (i.e., 2003 – 2011). Mean pass rates on the TAKS varied greatly by race/ethnicity and other factors. Of African American students, 60.7% (SD=17.4) passed the TAKS in 2004 compared to 69.9% in 2011 (SD=15.0); 68.0% (SD=15.7) of Hispanic students passed in 2004 as opposed to 76.23% (SD=12.2) in 2011; 78.8% (SD=14.8) of White students passed in 2004 versus 83.1% in 2011. Further analyses will explore various other determinants influencing academic performance. Conclusions: Preliminary findings show discrepancies at baseline in academic outcomes between racial/ethnic groups. These discrepancies persisted post-hurricane, though all groups saw an increase in pass-rates. Further research utilizing advanced statistical approaches and geographic information system (GIS) analysis could yield insights on variation of academic performance between schools and school districts, as well as physical exposure and risk factors. These insights can inform strategies for improving schools’ academic trajectories after disasters and optimizing community recovery as a whole.
    • Leveraging partnerships in order to increase notifiable disease reporting

      Dekalb County Board of Health (Georgia Public Health Association, 2017)
      Background: Notifiable disease reporting, although required by law, does not always occur. For this reason, it is crucial for local public health agencies to leverage new partnerships for reporting of notifiable diseases. Schools represent sites within communities that experience relatively high numbers of cases of notifiable disease and clusters of illness. By leveraging partnerships with schools, an increase in disease reporting can occur within communities. Methods: DeKalb County Board of Health has developed an infectious disease protocol for the two major school systems in the county and one large private school: DeKalb County School District, City Schools of Decatur and the Waldorf School of Atlanta. This protocol was developed to outline each party’s responsibilities regarding disease reporting, surveillance and infection control within the schools. This protocol template was then used to develop an infectious disease protocol in partnership with two county school districts and a university within the North Central Health District and in a private school system in the DeKalb Health District. Results: Through education of notifiable disease reporting, the health district developed and implemented two protocols and has three pending protocols with schools. This has improved the relationships between the health district and the school systems through better communication and surveillance within the schools. Conclusions: Response to public health situations requires coordination across multiple sectors and effective use of existing resources within communities. It is essential for local public health agencies to build innovative partnerships that can then form the foundations for an increase in notifiable disease reporting and disease surveillance.
    • Analysis of hypertension control rates among participants in the Georgia Hypertension Management and Outreach Program

      Byers, Sara; O'connor, Jean; Powell-Threets, Kia; Padgett,Kia; Hallow, Melissa; University of Georgia, Emory University, Georgia Department of Health (Georgia Public Health Association, 2017)
    • Implementation of the SafeCare model in Georgia for preventing child maltreatment

      Whitaker, Daniel; Glasheen, Theresa; Georgia State University (Georgia Public Health Association, 2017)
      Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes on-going quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impact of SafeCare will require increased implementation of the model to increase reach.
    • Zika virus communication preferences of pregnant women: Beyond the verbal

      Ellingston, Mallory; Chamberlain, Allson; Emory University (Georgia Public Health Association, 2017)
      Background: Pregnant women are frequently a priority group during public health emergencies, including the current Zika virus outbreak. These women turn to prenatal care providers for health information, but providers may not have the time for discussions with every patient. Knowing alternative ways to communicate key Zika-related information to pregnant women is important. Methods: To determine pregnant women’s preferences for obtaining Zika information from their prenatal providers, a 27-item survey was administered to 408 pregnant women at four prenatal care clinics in Atlanta between May 5th, 2016 and June 20th, 2016. The anonymous survey evaluated women’s preferences for receiving information about three topics: Zika virus, maternal vaccines and safe medications. Chi-square and Fisher’s exact tests were used to determine statistical significance of associations between these topics and selected patient characteristics. Significance was evaluated at α=0.05. Results: Educational brochures (63.8%), e-mails (55.2%) and their provider’s practice website (40.2%) were women’s most preferred modalities for receiving information about Zika virus beyond verbal communication. Most women (73.2%) use the CDC website as their primary source of information about Zika virus; only 19.2% seek that information on their provider’s website. Conclusions: Conveying Zika-related information to pregnant women is essential. As public health practitioners create and refine provider-to-patient communications, they can use these findings to ensure their messages align with how women want to receive information (e.g., brochures, emails, provider websites) and take advantage of existing modalities (e.g. their own websites) that providers may not be fully utilizing.
    • Trends in HIV testing among adults in Georgia: Analysis of the 2011-2015 BRFSS data

      Ansa, Benjamin; Augusta University (Georgia Public Health Association, 2017)
      Background: Georgia is ranked fifth highest among states for rates of HIV diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2011 and 2015. Methods: The 2011-2015 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed. Results: A total of 31,094 persons aged ≥18 years were identified who responded to the question “Have you ever been tested for HIV?” Overall, there were 11,286 (44.2%) respondents who had been tested for HIV, with a slight decrease in percentage from 45.6% in 2011 to 43.7% in 2015 (APC= -0.98, not significant). Factors associated with HIV testing were being female (p=0.004), black (p<0.001), younger than 55 years (p<0.001), single (p<0.001), attaining education level above high school (p<0.001), and earning annual income of $50,000 or less (p=0.028). Conclusions: Overall in Georgia, there has been a slight decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV.
    • Coastal septic tank inventory: data resources for future wastewater management planning

      Alcorn, Jessica; University of Georiga (Georgia Public Health Association, 2017)
      Background: The US Environmental Protection Agency estimates that more than one in five homes are served by decentralized wastewater treatment systems—commonly known as septic tanks. In coastal areas where it is impossible to extend sewer service due to either financial or hydrogeological constraints, septic tanks are an integral part of wastewater treatment. When maintained adequately and installed under appropriate conditions, septic tanks remove excess nutrients and dangerous pathogens from wastewater. As coastal infrastructure is increasingly threatened by recurrent flooding, extreme weather events, and future sea level rise, coastal communities will need to assess the adequacy of their wastewater management systems and plan for future changes. Methods: Through funding from the Coastal Resource Division of the Department of Natural Resources, UGA’s Marine Extension has completed digitization of historic septic tank records into the Digital Health Department database in five coastal counties. This presentation will discuss how septic tank records have been linked to unique parcel identification numbers; the methodology for identification of potential undocumented septic tanks; and online, interactive GIS mapping features to allow expanded access and applications of the data. The septic tank inventory offers two primary benefits. First, digitization of septic tank records increases the efficiency of local public health departments in fulfilling information requests. Second, mapping the septic tank data allows for identification of areas in the county where septic tanks might be at the highest risk of failure or where targeted water sampling might be beneficial. Results and Conclusions: This presentation will focus on enhancing awareness of the data resource that has been created and potential uses in local wastewater management planning that incorporates climate considerations. This presentation will also demonstrate how other relevant GIS datasets can be integrated with the septic tank inventory.
    • Characteristics of reported symptoms among confirmed and suspect cases of Zika virus in Georgia, 2016

      Thompson, Ashton; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: In May 2015, Zika virus was detected in Brazil. The virus has since spread through several countries in the Americas. Knowledge of the major symptoms of Zika virus infection was based on historic data from two previous outbreaks in the Pacific Islands. Currently-known Zika-specific symptoms include rash, conjunctivitis, arthralgia, and fever. Epidemiologists at the Georgia Department of Public Health (GDPH) began surveillance for travel-related Zika virus infections in January 2016. Surveillance data from GDPH contributes to better characterization of the current Zika clinical picture and more efficient triage of suspect cases for laboratory testing and prevention measures. Methods: For each patient approved for Zika testing, GDPH epidemiologists created an entry in the Zika Active Monitoring System (ZAMS) within the State Electronic Notifiable Disease Surveillance System (SendSS). Patients are categorized as “asymptomatic” or “symptomatic” and reported symptoms are noted. For symptomatic patients, clinical data are compared to determine differences in the distribution of symptoms in Zika negative and positive patients. Results: GDPH has approved testing for 383 symptomatic suspect Zika patients as of October 19, 2016; 88 (23%) were confirmed Zika infections. Among symptomatic positive patients, the most common Zika-specific symptom was maculopapular rash (95%); other common symptoms were headache and myalgia (27%). Among symptomatic Zika-negative patients, the most common Zika specific symptom was fever (62%), and the most common non-Zika specific symptom was headache (19%). Conclusions: Maculopapular rash is the most suggestive symptom of a true Zika virus infection, with 95% of symptomatic Zika positive patients in Georgia exhibiting the symptom. These data can be taken into consideration when updating the testing criteria for Zika virus. GDPH currently does not approve a patient for testing based on fever or non-Zika specific symptoms alone, and that guideline is reaffirmed by these results.
    • Differences in reported benefits in older adults after participation in a nutrition incentive program

      Cook, Miranda; Kane, Rachael; Emory University (Georgia Public Health Association, 2017)
      Background: A healthy food incentive program doubles the value of food stamp dollars at farmers’ markets, addressing financial barriers to healthy eating for low-income Supplemental Nutrition Assistance Program (SNAP), or food stamps, recipients. Older adults sometimes have more trouble purchasing and eating healthy food due to illness, a lack of social support, or mobility problems, in addition to financial reasons. Methods: Surveys were administered to 87 SNAP recipients redeeming healthy food incentives at farmers’ markets. Data were stratified by age in order to test benefits experienced from program participation and the program’s efficacy in reducing barriers to healthy eating. Results: Older program participants (aged 66+) were less likely to report experiencing community benefits from the program than younger participants (age 66+: 20.0% vs. age 18-65: 62.9%; p=0.0292). However, older participants were more likely to report experiencing other benefits (age 66+: 60% vs. age 18-65: 8.6%; p=0.054). Reported health benefits did not differ significantly by age group (age 66+: 40.0% vs. age 18-65: 54.3%; p = 0.09502). Additionally, no difference was detected between age groups reporting price as their biggest barrier to healthy eating (p = 0.2569). However, older program participants were less likely to report that the healthy food incentive program addressed their barrier (age 66+: 66.7% vs. age 18-65: 96.1%; p=0.0092). Conclusions: Older program participants may be experiencing different benefits than younger ones, with younger participants reporting more community benefits such as feeling more connected to one’s community or supporting local farmers more often and older program participants reporting other benefits more frequently.
    • Geographic modelling of sickle cell trait in four US regions

      Bhattacharya, Anunay; Tabi, Marian (Georgia Public Health Association, 2017)
      Background: Many studies have been done concerning the prevalence of sickle cell trait, its incidence and screening techniques. It is most commonly observed in the Black and Hispanic population in the United States. This study used retrospective data from the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR – December 12, 2014) to model, analyze, and substantiate the geographic distribution of sickle cell trait, its incidence, prevalence and screening in 44 states divided into 4 regions in the United States. Methods: We conducted data modelling of geographic regions in the United States. The four regions were West, Midwest, South and Northeast. The research question was: How is screening rate related to sickle cell trait in the regions of the United States? The data were pooled in an Excel file and analyzed using linear regression and generalized linear modelling in SAS 9.4. Results: The results showed that (1) there is a significant relationship between incidence and the number of infants screened for region 2 (Midwest), p=0.0020; (2) a significant relationship between incidence and sickle cell trait for region 2 (Midwest), p=0.000; (3) incidence with screening and trait for region 1 (West), region 2 (Midwest) and region 3 (South), p<0.05. (4) Generalized linear modelling was also significant with interactions for the region 1, region 2, and region 3, with p<0.05. Conclusions: Findings indicate that more screening is needed to diagnose sickle cell trait, particularly among Black and Hispanic infants from the region 2 (Midwest) states. There should be more intervention programs implemented to promote early screening among newborns to reduce disparities and the burden of prevalence.
    • Mock Me! A guide to developing a first rate training tool on a second rate budget

      Baxter, Galen; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Working closely with county Environmental Health Specialists through the Standardization Process, a critical need was identified. Assistance was needed in prioritizing inspections based on risk levels identified in restaurant kitchens during inspections. Additionally, more training was needed to help them identify other areas in food service establishments that require further assessment. Methods: Tight budget constraints prevented the purchase of expensive training equipment; however, with a little creativity and team work, a mock kitchen made entirely out of cardboard, tape and a couple of aluminum pans was created as a portable, hands-on training tool that could be easily transported around the state. Results: Overwhelming positive feedback was received from the districts that experienced training using the tool. Environmental Health Specialists suddenly had an opportunity to practice and apply what they had learned within a controlled environment and increase their confidence in assessing and prioritizing during inspections. Conclusions: Solutions to problems can sometimes be found using a very simple approach. A little bit of creativity and a willingness to literally “think outside the box” can go a long way in providing viable, alternative solutions to common roadblocks in government. The key to creating an effective training tool is to accurately identify training gaps in the intended audience.
    • Reducing sexual risk behaviors and intentions among rural African American youth

      Brown, Natasha; Georgia State University (Georgia Public Health Association, 2017)
      Background: In spite of dramatic declines in teen pregnancy and childbearing in every state and amongst all racial groups, progress to-date remains unbalanced and disparities persist. Blacks, Hispanics, and youth residing in southern states or rural areas continue to experience the highest teen pregnancy rates in the nation. In an effort to enhance protective factors that help youth avoid behaviors placing them at risk for pregnancy, between September 2011 and May 2013, a public school district in rural southeast U.S. implemented an evidence-based youth development program designed to address these issues. Methods: A single-group, repeated measures design was employed to assess changes over time in past sexual risk behaviors, intentions regarding future behaviors, use of contraceptives, and pregnancy. The main questions answered were: does the program make a difference in the lives of youth involved, and to what extent? To answer these questions, participants completed brief self-administered surveys during the first and last sessions of the intervention (pre-/post-intervention surveys). Results: 447 predominantly African American (98%) students in grades 8-12 were enrolled; 94% completed the program. There were significant improvements in participants’ self-reported behaviors and intentions. For instance, when asked about their sexual activity during the three months before the pre-test, 69.0% of the students surveyed had sex at least once, but only 47.6% at post. Of those, 48.8% at pre and 58.2% at post reported having used a condom; 52.9% (pre) versus 69.6% (post) used some form of birth control. Conclusions: Students participating in this youth development program reported reductions in sexual risk behaviors and greater intentions to engage in safer sex practices in the future. Among the many lessons learned was the importance of offering incentives throughout the program’s duration to retain participants for the 9-month, 25-session intervention period.
    • A clinical trial to increase the identification, genetic counseling referral and genetic testing of women at risk for hereditary breast and/or ovarian cancer

      Bellcross, Cecelia; Stanislaw, Christine; Hermstad, April (Georgia Public Health Association, 2017)
      Background: Approximately 1/300 individuals in the general population are at risk for hereditary breast and ovarian cancer due to an inherited mutation in the BRCA1/BRCA2 genes. BRCA mutations are associated with dramatically increased risks for breast cancer, especially at younger ages, in addition to ovarian cancer. Enhanced screening and risk reduction strategies can significantly reduce associated morbidity and mortality. The United States Preventive Services Task Force (USPSTF) recommends identifying women at-risk for BRCA mutations for receipt of genetic counseling and if appropriate, testing. The Breast Cancer Genetics Referral Screening Tool (B-RST) is a validated screen endorsed by USPSTF to facilitate this process. This implementation study seeks to evaluate the most effective means of follow-up for screen-positive women to maximize the number who are referred to, and receive, cancer genetic counseling (CGC) services. Methods: B-RST (v3.0) was used in three Emory Healthcare breast-imaging centers. Screen-positive women were randomized into three methods of follow-up (patient initiated, physician notification, or staff phone call). Primary outcomes were to compare the number of screen positive individuals who were referred for, scheduled, and completed a CGC appointment among the three groups. Results: Of 3,419 women approached, 63% participated and 579 (27%) screened positive. Appointments were scheduled by 7% of Group 1 participants, 17% of Group 2 individuals, and 11% of Group 3 (p<0.001). Scheduling challenges included physician non-response to notification and unsuccessful direct contact. Of those scheduled, 73% completed the CGC appointment. Conclusions: Genomic medicine is receiving increased attention in the public health arena. Screening with B-RST 3.0 in mammography settings can improve identification of individuals at-risk for BRCA mutations and facilitate referral to CGC services. Despite B-RST’s ability to easily and accurately identify individuals appropriate for CGC, additional strategies are needed to facilitate completion of CGC in routine clinical practice.
    • Randomness and inference in medical and public health research

      Hayat, Matthew J; Knapp, Thomas; Georgia State University, Ohio State University (Georgia Public Health Association, 2017)
      Background: The purpose of this study was to provide a basis for describing the types of randomness used and statistical inferences reported in the medical and public health research literature. Methods: A study was conducted to quantify the types of research designs and analyses used and reported in medical and public health research studies. A stratified random sample of 198 articles from three top-tier medical and public health journals was reviewed, and the presence or absence of random assignment, random sampling, p-values, and confidence intervals, as well as type of research design, were quantified. Results: Random sampling was used in 58 (29.3%) and random assignment in 21 (10.6%) articles. Most (n=125; 63.1%) research studies did not report random assignment or random sampling; however, statistical inference was applied in more than 90%. Conclusions: Results revealed a concerning overuse of statistical inference. Incorrectly applying statistical inference when not warranted has potentially damaging medical and public health consequences. Researchers should carefully consider the appropriateness of using statistical inference in medical and public health research.
    • Operational and financial performance of Georgia’s Critical Access Hospitals

      Kimsey, Linda; Apentenge, Bettya; Mase, William; Opoku, Samuel; Hanna, Mark; Boakye, Kwabena; Carhuff, Lisa; Owens, Charles; Peden, Angela; Tedders, Stuart; et al. (Georgia Public Health Association, 2017)
      Background: Georgia’s Critical Access Hospitals (CAHs) face increasingly complex threats to financial sustainability, as demonstrated by the disproportionally high number of closures in comparison to other states in the nation. Methods: Financial performance measures (including profitability, revenue, liquidity, debt, utilization, and productivity), site visits, key personnel interviews, and a revenue cycle management assessment were used to assess the strategic landscape of CAHs in Georgia, analyze financial and operational performance, and provide recommendations. Results: For CAHs in Georgia, financial and operating performance indicators, interviews, and assessments depict a challenging operating environment, but opportunities for improvement exist through implementation of a Lean Six Sigma program and improved benchmarking processes. Conclusions: Georgia’s CAHs operate in a challenging environment, but operational improvement strategies (such as a Lean Six Sigma program) and benchmarking directed towards business processes, including revenue cycle management, provide opportunities for sustainability in the future.
    • Medicaid savings continue in the year after end of participation in the program, Money Follows the Person

      Landers, Glenn; Fuller, Kristi; Zhou, Mei; Georgia State University (Georgia Public Health Association, 2017)
      Background: The aim of this analysis was to compare Georgia’s Medicaid expenditures for participants in the Money Follows the Person (MFP) six months before, 12 months during, and 12 months after MFP participation. Methods: Differences in Medicaid expenditures for three populations of MFP participants (individuals with developmental disabilities, individuals with physical disabilities, and older adults) were compared by use of repeated measures t-tests. Results: Per-member per-month Medicaid expenditures were lower across the three populations when comparing six months prior to transition from an institution to 12 months after leaving the MFP program. Conclusions: The incorporation of features from programs such as MFP into existing state Medicaid long-term services and supports may assist in reducing the growth of future expenditures.
    • Cross-training and sustainability in environmental health-based mosquito control programs

      Kelly, Rosmarie; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: In Georgia, only a few county environmental health programs still do mosquito surveillance and control. This is partly due to a lack of sustainability in these seasonal programs and a pressure to move personnel from mosquito control to programs that are mandated by the state. There is also a lack of training available for mosquito control workers. Methods: Richmond County Mosquito Control (RCMC), a program within the Richmond County Environmental Health office, is one of the sustainable programs, and the RCMC program has dealt with these issues in some innovative ways. It is sustainable because it partners with other agencies to provide an integrated mosquito management (IMM) approach to local mosquito control. Because training and education are important components of an IMM program, RCMC provides annual training for all mosquito control personnel. Because mosquito control is largely a seasonal program in Georgia, Richmond County has hired retired people to do mosquito control work during the mosquito season. These employees are seasonal workers; one person is kept on full time to manage the program. Richmond County Mosquito Control collaborates with the Phinizy Center for Water Sciences to provide surveillance and mosquito identification. Richmond County Mosquito Control approaches training in several ways. First, RCMC is active in the Georgia Mosquito Control Association. Second, by collaborating with the Phinizy Center for Water Sciences both students and mosquito control employees can learn from one another to the benefit of both programs. Finally, there is a yearly training for all employees with guest speakers providing information on various topics of interest, including: a review of the data that have been collected, information on new and existing treatments and practices, a review of the National Pollutant Discharge Elimination System (NPDES) pesticide discharge management plan procedures, and an overview of business decisions to improve the program and update procedures. Results: Recently, the RCMC program has expanded to deal with the potential threat of Zika virus transmission in Georgia. In addition to its swimming pool remediation project and its goats in retention basin enclosure project, the special projects group has added another project, maintaining retention/detention ponds to help reduce local mosquito breeding. In order to train the mosquito control employees and Phinizy Center students to do this job, they are working with the county engineer to learn the inspection requirements for an MS-4 permit. Finished inspection forms are provided to the county and to the Environmental Protection Division of the Georgia Department of Natural Resources. In addition, employees are training at the Phinizy Center to learn mosquito identification and surveillance, and to look at the fate of stormwater after it exits the ponds.
    • Physician attitudes toward the ethics of pre-exposure prophylaxis (PrEP): Cost, safety, and resource allocation

      Grippo, Jessica; Smallwood, Stacy; Pincura, Katherine; Wright, Tamara; Masa, WIlliam (Georgia Public Health Association, 2017)
      Background: In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods: The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review. Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions: Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP.
    • Triple-negative breast cancer in Georgia: Burden, disparities, and connections to Georgia’s Breast Cancer Genomics Project

      Berzen, Alissa; Bayakly, Rana (Georgia Public Health Association, 2017)
      Background: Triple negative breast cancer (TNBC) is typically aggressive and unresponsive to traditional cancer treatment, and disproportionately affects young and Black women. Approximately 60%-80% of breast cancers in women with the breast cancer gene (BRCA) mutation are TNBC, and children of a parent with a BRCA mutation have a 50% chance of inheriting it. Current guidelines recommend women diagnosed with TNBC receive genetic testing and counseling. Georgia’s Breast and Cervical Cancer Program (BCCP) routinely screens clients for increased risk of genetic mutation via an online screening tool. Methods: Using data from the Georgia Comprehensive Cancer Registry (GCCR) for 2010-2013, we calculated TNBC percentages/rates, diagnosis stage, and case fatality rate based on vital status. By using TNBC data as a proxy for BRCA gene mutation prevalence, we assessed the burden of TNBC and racial/age disparities to inform Georgia’s genomics efforts. Results: The percentage of invasive breast cancers, versus in-situ, was the same for Georgia Black and White women; however, Black women had almost double the percentage of TNBC as compared to White women. Black women under 40 had a 20% higher breast cancer incidence rate than similarly aged White women, but had almost double the TNBC rate. Georgia TNBC cases were about twice as likely as non-TNBC cases to be deceased, and Black TNBC cases had higher fatality rates than White cases (almost twice as high in women under 40). Conclusions: Georgia’s genomics program began screening in 2012, and participating counties offer screening to all women’s health clients. Awareness of hormone receptor status (and furthermore, possible presence of genetic mutation) for women diagnosed with breast cancer can guide the proper course of treatment. Additionally, family members of women diagnosed with TNBC in Georgia may take advantage of the screening for risk of genetic mutation through the genomics program prior to a cancer diagnosis, and receive counseling where appropriate.
    • A unified integrated public health approach: Zika response

      Kagey, Betsy; Burkholder, Jennifer; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Zika virus planning in Georgia has involved many units within the Georgia Department of Public Health (GDPH). Their roles and responsibilities include identifying potential vectors, alerting and educating the public on how to ‘tip n toss’, preparing and testing for Zika virus infection at the Georgia Public Health Laboratory (GPHL), monitoring travelers, including pregnant women, infected with Zika virus, direct messaging for pregnant women, mothers of newborns and women who are considering pregnancy, and education on sexual transmission for men and women. Methods: With no locally transmitted case of Zika virus infection within Georgia, the focus has been on public messaging and answering the myriad calls about Zika virus from health care providers and the public. This unified response involves numerous GDPH units: Epidemiology, Maternal and Child Health, GPHL, Emergency Preparedness and Response (EPR), Environmental Health, Risk Communication, WIC, and others. Conclusions: The Office of Public Health Emergency Preparedness and Response is one member of this multi-unit team. This session will identify the roles and responsibilities of each of these units in the unified response to Zika virus within Georgia both at the state and district level. Lessons learned from this approach build upon GDPH’s overall capacity to provide an integrated respond to public health threats and emergencies within the state.