Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relative short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrates important economic benefits.

Convergence of geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) raise concerns that HIV co-infection may worsen CL burden, complicating already lengthy and costly CL treatments and highlighting a need for newer therapies. We constructed two Markov decision models to quantify impact of HIV on CL and help establish a target product profile for new CL treatments, accounting for co-infection. The HIV co-infection increased lifetime cost per CL case 11–371 times ($1,349–45,683) that of HIV-negative individuals ($123) and Brazil's CL burden from $1.6–16.0 million to $1.6–65.5 million. A new treatment could be a cost saving at ≤ $254 across several ranges (treatments seeking probabilities, side effect risks, cure rates) and continues to save costs up to $508 across treatment-seeking probabilities with a drug cure rate of ≥ 50%. The HIV co-infection can increase CL burden, suggesting more joint HIV and CL surveillance and control efforts are needed.

UNSTRUCTURED COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus that causes COVID-19. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities. Yet, they are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital healthcare services. Additionally, issues such as language barriers and the complexity of the healthcare system are among many structural challenges that impede access to health information and services. Dialogue-based, participatory health literacy interventions may help mitigate mistrust and increase access to health information and services, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community and faith-based organizations, and the Westchester County Department of Correction will co-develop a health education program for community members, correctional officers, and incarcerated jail residents in the county of Westchester, NY. Grounded in dialogic learning, the program entails training Trusted Messengers to lead culturally sensitive and linguistically appropriate COVID-19 focused information sessions with a healthcare professional’s support. Over a 2-year period, 160 community-based Trusted Messengers will be trained to reach 16,000 community members in the county’s high-risk zip codes. Correctional staff with experience delivering educational programs will be trained as Trusted Messengers in the correctional facility setting, reaching 400 correctional facility resident inmates and 800 correctional staff, respectively. Pre- and post-surveys will assess changes in health behaviors, attitudes, and perceptions. Few studies evaluate the effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in the current knowledge about how to address health literacy among marginalized populations and motivate healthy behaviors. This evidence-based framework can remedy COVID-19 disparities and address health literacy among populations at high risk for a host of health-related issues, potentially serving as a best practice model for future health programs.

Background COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. Objective To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. Methods Grounded in dialogic learning, the program entails training community-based “trusted messengers” and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. Results Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. Conclusions Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19–specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. International Registered Report Identifier (IRRID) PRR1-10.2196/37713