Objective A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. Methods We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. Results During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. Conclusion The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

Objectives In 2015, depressive disorders led to over 50 million disability-adjusted life years lost globally, with more than 80% occurring in low- and middle-income countries. Depressive disorders are also risk factors of a number of adverse maternal and child health outcomes. To our knowledge, the Singida Nutrition and Agroecology Project (SNAP-Tz), is the first nutrition-sensitive agriculture (NSA) intervention identified to improve women's probable depression (2020). Food security has been posited to play an important role in the relationship between NSA interventions and depression, yet causal factors have not yet been analyzed quantitatively. Therefore, we investigated food security's mediating role on this impact. Methods SNAP-Tz is a 30-month participatory agroecological intervention aimed to improve sustainable agriculture, nutrition and gender equity in Singida, Tanzania. Food insecure, married, smallholder female farmers with children < 1-year-old at baseline (n = 548) were interviewed annually in Feb 2016–2019. We used multiple logistic regression models to estimate the total effect (TE) of the SNAP-Tz intervention on women's Center for Epidemiological Studies-Depression scores (CESD). We further estimated natural direct effects (NDE) to evaluate mediation through household food insecurity access score (HFIAS); these represent estimates of the effect of SNAP-Tz on CESD if everyone were to receive SNAP-Tz, thereby changing food insecurity (HFIAS). Results SNAP-Tz had a large impact on reducing CESD scores: odds of probable depression were 32% lower in SNAP-Tz women compared to the delayed intervention group after adjusting for gender equity measures and religion (TE OR = 0.68, 95% CI: 0.58–0.80). Mediation by HFIAS explained about one quarter of the intervention's impact (NIE OR = 0.90, 95% CI: 0.84–0.94). Conclusions Improvements in household food security seems to play a substantial mediating role in the strong and unexpected impact of NSA interventions on women's mental health. Other possible pathways include improvements in peer mentoring and farmer experimentation. Future agricultural and nutrition projects should include mental health evaluations to see if this impact can be generalized. Funding Sources This study was funded by the McKnight Foundation, Mabie Global Health Fellowship at Northwestern University; NIH (K01MH098902).

Objective: To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women’s depressive symptoms. Design: We used annual longitudinal data (4 time points) from a cluster-randomized effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project (SNAP-Tz). Structural equation modelling estimation of total, natural direct, and natural indirect effects was used to investigate food security’s role in the intervention’s impact on women’s risk of probable depression (CES-D > 17) across three years. Setting: Rural Singida, Tanzania. Participants: 548 food insecure, married, smallholder women farmers with children < 1-year-old at baseline. Results: At baseline, one third of the women in each group had probable depression (Control: 32.0%, Intervention: 31.9%, p difference=0.97). The intervention lowered odds of probable depression by 43% (OR=0.57, 95% CI: 0.43-0.70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0.90, 95% CI: 0.83-0.95). Conclusions: This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women’s depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e., improvements in mental health, and changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women’s wellbeing in farming communities.

Background The rapid spread of COVID-19 in recent months has caused local and regional governments to enact protective measures that have hindered economies and imposed demanding restrictions on daily life. Households may be experiencing physical, psychological, social, and economic challenges due to these preventative measures. Populations with fewer resources and/or pre-existing conditions may be at higher risk for these negative, life-altering effects. Therefore, we investigated COVID-19 impact on daily life among persons living with HIV (PLH) in Chicago’s under-resourced, largely minority, west and southwest side communities. Methods We modified the EPII, a survey designed to measure pandemic disease impact over nine domains of life, to assess how COVID-19 affected PLH receiving outpatient HIV care. From 5/11–29/2020, participants (n=49) completed the survey online or over the phone and received a $10 grocery gift card. We present the proportion of respondents who reported that they or any household member was impacted by select survey items. Results More than half of respondents reported a household member getting laid off and/or furloughed (63%), increased mental health (45%) or sleep problems (51%), less physical activity (61%), and increased screen time (82%); 45% were unable to pay important bills. Positive changes included eating healthier foods (53%), more time for enjoyable activities (63%), more quality time with friends or family (65%), and paying more attention to personal health (76%). We observed differences by gender, age, and race/ethnicity over all domains (Table 1). Finally, 80% of those who participated in telehealth services were satisfied with their experience. Table 1. Conclusion Overall, respondents struggled with employment, emotional and physical health effects of COVID-19, yet also experienced aspects of positive life change. In the future, these results should be compared with results from a general population to determine whether PLH are disproportionately burdened. Regardless, COVID-19 has negatively impacted daily life for everyone, including PLH, and these individuals may need additional resources compared to their less resource-challenged counterparts. Disclosures All Authors: No reported disclosures