People living with HIV can experience the full benefits of retention when they are continuously engaged in care. Continuous engagement in care promotes improved adherence to ART and positive health outcomes. An infectious disease clinic has implemented a protocol to primarily improve patient retention. The retrospective, facility-based, costing study took place in an infectious disease clinic in Washington DC. Retention was defined in two ways and over a 12-month period. Micro-costing direct measurement methods were used to collect unit costs in time series. Return on investment accounted for the cost of treatment based on CD4 strata. ROI was expressed in 2016USD. The difference in CD4 and viral load levels between the two periods of analysis were determined for active patients, infected with HIV. The year before the intervention was compared to the year of the intervention. Total treatment expenditure decreased from $2,435,653.00 to $2,283,296.23, resulting in a $152,356.77 gain from investment for the healthcare system over a 12-month investment period. The viral load suppression rate increased from 81 to 95 (p = 0.04) over the investment period. The number of patients in need of HIV related opportunistic infection prophylaxis decreased from 21 to 13 (p = 0.06). Improved immunologic, virologic and healthcare expenditure outcomes can be linked to the quality of retention practice.

We examined clinical and geospatial factors associated with frequent emergency department (ED) use and identifi ed neighborhood ED "hotspots" over a two-year period . Emergency department patients were classifi ed into three categories:(1) infrequent users (<3 ED visits); (2) semi-frequent users (3 or more visits in a year); and (3) persistent users (3 or more visits in both years). Persistent users were more likely to be female, aged 45-64, and have insurance compared with infrequent and semi-frequent users. Th irty percent of persistent users had both a mental and chronic health condition. Persistent and semi-frequent users were no more likely than infrequent users to use the ED for non-emergent conditions, but were more likely to use the ED for primary care treatable and preventable conditions. Emergency department hotspots were located closer to federally qualifi ed health centers, closer to the main ED, had higher rates of mental health and other chronic conditions.

The United States (US) is in the midst of a mental health crisis. More than one in four (26.2%) adults experience a diagnosable mental health disorder each year, and 46% of the population will do so in their lifetime. Collectively, mental health disorders are a leading cause of disability and account for one-third of all years lived with disability and premature mortality. Black Americans constitute about 12% of the US population, but they make up more than 18% of the population affected by mental disorders. Black men are 30% more likely than non-Hispanic white men to report having a mental illness but are less likely to receive proper diagnosis and treatment. Black adults are 20% more likely to report serious psychological distress than white adults. Despite this, many Black people do not seek mental health care for various reasons. Causes of higher morbidity and non-care seeking behavior in Black people and Black men in particular include racism, discrimination, stigma, and distrust of the healthcare system. Across the District of Columbia (DC), Black Americans are twice as likely as other ethnicities to report a serious mental disorder, especially if they live in poverty and did not complete high school. In the project service area of Ward 8 in Southeast DC, 92% of the population is Black, 30.7% live in poverty, and only 85% of the population age 25+ completed high school. Evidence shows common mental health disorders are distributed according to a gradient of economic disadvantage across society; the poor and disadvantaged suffer disproportionately from common mental health disorders. In Southeast DC, this negative impact on mental health is compounded by the geographic concentration of underemployment, lack of economic opportunity, poverty, and underutilization of mental health services. Improving mental health literacy is a non-systemic intervention shown to increase mental health care-seeking behaviors. Mental health literacy is the knowledge of, attitude about, and behavior toward mental health issues and mental health services. The goal of the Mental Health Improvement through Study, Teaching, Rebranding, Embedded Education, and Technology or (MHISTREET) initiative is to improve mental health in Black men through embedded education in non-traditional spaces such as barbershops.