BACKGROUND Patient activation is critical to improving patient selfmanagement and reducing avoidable emergency department visits and hospitalizations. Less recognized, however, is that social disadvantage (e.g., poverty, minority race, born outside USA, non-English speaking) contributes to disparities in health care through lower patient activation. 1 HIV is a prime example where low patient activation among socially disadvantaged persons living with HIV (PLWH) contributes to disparities in adherence, 2, 3 viral suppression, 4, 5 and ultimately, to disparities in HIV treatment outcomes, 6-8 such as hospitalizations and mortality. 9, 10 Compared to non-Latino white and/or more affluent PLWH, poor and minority PLWH miss more office visits, 11 ask fewer questions during their visits, 12 report less confidence in self-management and more frequently miss doses, 13 or stop taking their antiretroviral therapy. 14 Death from HIV-related causes represents a top ten leading cause of death among Blacks and Latinos ages 20-54 years. 15 Among Blacks ages 35-44 years, HIV ranks in the top five causes of death. 15 Therefore, improvements in patient Electronic supplementary material The online version of this article (

BACKGROUND Infectious diseases, such as Hepatitis C and Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), are emerging health issues. OBJECTIVES The CA-MRSA Project (CAMP1) extended its learning collaborative to the barbershop/hair salon settings to increase awareness and prevention of CA-MRSA and Hepatitis C infections. METHODS Education sessions on CA-MRSA and Hepatitis C were conducted with 43 estheticians at 9 barbershop/hair salons in New York City. All completed pre-post intervention knowledge tests. Low-cost primary care referral cards were also distributed in the CA-MRSA education project. RESULTS Knowledge about CA-MRSA risks (p<0.0003) and infection prevention measures (p<0.0001), as well as Hepatitis C knowledge and prevention (both p<0.0001) increased. Nine shops received referral cards (N=500) and 4% of the cards (n=19) were distributed to clients. No self-referrals were reported. CONCLUSIONS CAMP1 successfully recruited and trained a cadre of estheticians on CA-MRSA and Hepatitis C prevention increasing their health knowledge deepening our engagement with the community.

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Clinical trial recruitment is challenging, 1 particularly for socially disadvantaged patients. 2 The COVID-19 pandemic has amplified this challenge. In this research letter, we report on adaptations we made to participant recruitment processes for a clinical trial conducted across three geographic regions impacted by COVID-19 and their impact on recruitment. The trial, Implementation Research: Translating the ABCS into HIV Care (5U01HL142107-02), is a stepped wedge, cluster, randomized trial to test implementation strategies designed to promote uptake of evidencebased cardiovascular interventions for People Living with HIV. 3 Implementation strategies target patient, clinician and practice participants. The trial involves recruitment of 600, largely low-income and minority patients and 40-60 clinicians who care for these patients across nine separate practices, largely serving lowincome and minority patients from three geographic regions (NYC; Rochester, NY; and Dallas, TX). 4 Patients must have HIV, be 40-75 years, at ø5% 10year risk for atherosclerotic cardiovascular disease using the ASCVD Risk Estimator Plus, 4 be willing to participate, be proficient in English or Spanish, own a cell phone with texting capabilities and be approved by the consented clinician. Recruitment involves identification of potentially eligible participants using electronic health record data, 5 communication between the clinician and research assistant, referral by the clinician and communication between the prospective participant and the research assistant. Beginning 9-10 March 2020, all sites from Dallas, NYC and Rochester experienced a sudden, institutionally, COVID-19-mandated shutdown of in-person clinical and research activities. Hospitals and Federally Qualified Health Centers quickly transitioned all nonemergent/urgent patient visits to telehealth visits by video or phone, often from clinicians' homes. 6 These transformative changes required immediate adaptations for our research interventions, 7 for example, shifting

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