Existing research literature has shown that traffic fatalities increase at higher speed limits. A related issue is the establishment of maximum speed limits for trucks and buses. As of 2014, eight states have a differential speed limit in place that establishes a higher limit for passenger vehicles than for trucks and buses. This study aimed to inform the continuing debate regarding the safety impacts of speed limits by comparing states with various speed limit policies. The study included a longitudinal comparison of state-level rural Interstate fatalities in the United States from 1999 through 2011. In addition to an examination of differences in traffic fatalities as a function of maximum speed limits, comparisons were also made between states with differential limits for truck and buses. Random parameter negative binomial models were estimated for annual total and truck-involved fatalities. A random parameter framework allowed for consideration of temporal correlation in annual fatality counts within states as well as for unobserved heterogeneity across states. The results of this study provided further evidence that both overall and truck-involved fatalities increased with maximum speed limits. States with differential speed limits were found to have marginal differences in total fatalities as compared with states with uniform speed limits. However, truck-involved fatalities were significantly lower in states where differential limits were in place. The effects of speed limit policies as well as other covariates were found to vary significantly across states. The random parameter models demonstrated significantly improved goodness of fit as compared with standard Poisson and negative binomial models.

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BackgroundHIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool; however, little is known about PrEP uptake, initiation, and persistence among patients prescribed PrEP in STD clinics.MethodsBetween July 2016 and March 2017, STD clinic staff compiled reports detailing the eligibility and initiation of PrEP in the Detroit STD Clinic. Staff called all patients prescribed PrEP to determine whether they had started PrEP, were still on PrEP, and their reasons for never initiating or discontinuing PrEP. We used chi-square tests to evaluate differences in PrEP initiation and discontinuation by age and race, calculated the population’s mean duration on PrEP (persistence), and used proportional hazards regression to assess differences in persistence by age and race.ResultsA total of 161 STD clinic patients were eligible for PrEP, of whom 71 (44%) were prescribed PrEP. Of the 71 patients prescribed PrEP, staff successfully interviewed 45 (63%) a median of 113 days following their receipt of prescription. Thirty-four (76%) interviewed patients had initiated PrEP, of whom 17 (50%) had subsequently discontinued their medication a mean of 92 days (95% confidence interval [CI]: ± 23.8) following receipt of a prescription. Figure 1 illustrates the PrEP care continuum for our clinic. There was no significant difference in PrEP initiation or discontinuation by age or race. There was no significant difference in persistence by race. Ages 18–24 had the shortest mean persistence (62 days, 95% CI: ±37.5), while those ages 35–44 had the longest mean persistence (146 days, 95% CI: ± 47.3) though this was not a significant difference (hazard ratio 0.39, P = 0.28). The most common reason for not initiating or discontinuing PrEP was concern about side effects (29%).ConclusionClinicians in the Detroit STD clinic prescribed PrEP for less than half of PrEP-eligible patients, only 76% of those prescribed PrEP ever filled their first prescription, and the mean duration of use among those who filled a first prescription was under 6 months. Our findings highlight the need for further evaluation of why eligible patients are not prescribed PrEP, intensified support services to encourage PrEP persistence, and improved patient counseling about potential side effects.Disclosures All authors: No reported disclosures.

Child Labour: Action-Research-Innovation in South and South-Eastern Asia (CLARISSA) has a participatory and child-centred approach that supports children to gather evidence, analyse it themselves and generate solutions to the problems they identify. The life story collection and collective analysis processes supported children and young people involved in the worst forms of child labour in Kathmandu to share and analyse their life stories. Four hundred life stories were collected and then analysed by children and young people engaged in and affected by the worst forms of child labour, including those who had previously been life storytellers and/or life story collectors. The data was collectively analysed using causal mapping, resulting in children’s life stories becoming the evidence base for revealing the macro-level system dynamics that drive the worst forms of child labour. This paper is a record of the children and young people’s analysis of the life stories and the key themes they identified, which formed the basis of a series of eight child-led Participatory Action Research groups based in Kathmandu.