Public Health Commons^™

Ask Your Doctor About: Prescribing Activism For Eco-Anxiety In Adolescents, Lexi Nutkiewicz

Master's Projects and Capstones

Climate change is an ongoing public health crisis. Efforts to protect future generations' physical and mental health are more urgent than ever. Youth, in particular, are experiencing eco-anxiety, a specific form of anxiety relating to stress or distress caused by environmental changes and one’s knowledge of them due to the climate crisis. This scoping review provides a better understanding of the value of youth climate change activism as a strategy to mitigate eco-anxiety. This review evaluates the current definitions of eco-anxiety, the risk factors for eco-anxiety among adolescents, and considers the benefits and drawbacks of youth activism. To identify relevant …

The Impact Of Psychosocial Stress On Maternal Health Outcomes: A Multi-State Prams 8 (2016-2018) Analysis, Blessing Chidiuto Lawrence, Anna Kheyfets, Keri Carvalho, Shubhecchha Dhaurali, Marwah Kiani, Alison Moky, Ndidiamaka Amutah-Onukagha

Journal of Health Disparities Research and Practice

Introduction: Significant racial disparities persist in maternal morbidity rates, disproportionately affecting Black women. Experiencing high levels of stress during pregnancy is associated with increased risk for preterm birth, infant mortality, and preeclampsia. This study investigates the impact of psychosocial life stressors on maternal morbidity and racial disparities utilizing the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset.

Methods: Participants (N=24,209) included were from Phase 8 (2016-2018) of the PRAMS survey across five states. Stressors were grouped into traumatic, partner-related, financial, or emotional. Maternal outcomes included gestational diabetes, hypertensive disorders of pregnancy, prenatal depression, and postpartum depression. The association between life stressors …

From A Place Of Love: The Experiences Of Birthing In A Black-Owned Culturally-Centered Community Birth Center, J'Mag Karbeah, Rachel Hardeman, Numi Katz, Dimpho Orionzi, Katy Kozhimannil

Journal of Health Disparities Research and Practice

Introduction: Racial and ethnic disparities in perinatal health outcomes are among the greatest threats to population health in the United States. Black birthing communities are most impacted by these inequities due to structural racism throughout society and within health care settings. Although multiple studies have shown that structural racism and the disrespect associated with this system of inequity are the root causes of observed perinatal inequities, little scholarship has centered the needs of Black birthing communities to create alternative care models. Leaning on reproductive justice and critical race theoretical frameworks, this study explores good birth experiences as described by Black …

Moving Towards Justice: Reducing Encounters Of Preeclampsia In Adolescent Maternal Health, Shaunesse' Jacobs Plaisimond, George Hodulik, Molly Wilde

Journal of Health Disparities Research and Practice

Using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), several relationships were explored between nutrition and diet, likely attributed to education, culture, training, and habits around food. While these factors remain relevant and worth pursuing, data analysis implied that the most significant issue remaining is access to healthcare. Across race, age, and nutrition consumption, if pregnant people make higher incomes—inferring better access to healthcare and higher-quality nutrients, then their risk of preeclampsia is reduced. Accordingly, this paper performs an extensive literature review of the intersection of extreme maternal age and nutrient intake as a significant factor for preeclampsia. …

Defining Birth Equity In Kansas, Oluoma Obi, Michelle L. Redmond, Joi Wickliffe, Sapphire Garcia-Lies, Sharla Smith

Journal of Health Disparities Research and Practice

Background: While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States and Kansas, Black women are three times more likely to die from a pregnancy-related complication than white women.

Description: The Kansas Birth Equity Network (KBEN), is an initiative developed to address racial disparities in maternal and child health outcomes. We used a community-centered approach to collect stakeholder perceptions of birth equity and develop a case definition of birth equity.

Methods: An open-ended online survey was designed to collect stakeholders’ definition of birth equity, their organization’s birth equity missions, …

Birth Justice Philly: Equitable Community Engagement In Action, Simone N. Snead, Imani Davis, Samantha Shuster, Elizabeth Guman, Cynthia Estremera Gauthier, Aasta D. Mehta

Journal of Health Disparities Research and Practice

This article describes how a multi-sector coalition focusing on carrying out recommendations of the Philadelphia Maternal Mortality Review Committee (MMRC) engages community participation through the development of equitable strategies that culminate in the implementation of actionable methods to improve perinatal outcomes.

The U.S. maternal mortality crisis continues to impact countless families and communities. Despite having some of the finest academic medical centers in the nation and a functioning county-level maternal mortality review committee, the maternal mortality rate in Philadelphia, Pennsylvania is far above the national average. Vital statistics show that Philadelphia’s rate of pregnancy-related deaths from 2012 to 2018 was …

Addressing Racial Disparities In Maternal Health: The Case For An Equity Birth Plan, Alice Trye, Damali Campbell Oparaji, Natalie Roche, Lisa Gittens Williams

Journal of Health Disparities Research and Practice

Birth equity can be defined as “The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort.” (Birth Equity |California Maternal Quality Care Collaborative, n.d.). Complex explanations exist for adverse maternal outcomes, but unequal health care, socioeconomic and racial inequalities pose risks to women and their babies (“Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” 2003). The data is clear: Maternal death rates have increased and are 3 to 4 times higher for black women than white women (Zaharatos et al., 2018). These …

Editor's Notes, Nekeshia Jones, Sharla Smith, Melva Thompson-Robinson

Journal of Health Disparities Research and Practice

These Editors' Notes introduce the first special issue of the Journal of Health Disparities Research and Practice based on the work the National Maternal Health Research Network.

Hellp Syndrome: Hemolysis, Elevated Liver Enzymes, Low Platelets, Kimberly Roman

Nursing Student Class Projects (Formerly MSN)

The research provided was to understand a rare, life-threatening condition that occurs in pregnant women or recently postpartum women. The topic searched was HELLP Syndrome, an acronym for Hemolysis, Elevated Liver Enzymes, and Low Platelets. This syndrome is named this due to the underlying conditions in women who experience this disorder. Women can recover from HELLP Syndrome if detected early and treated appropriately, but symptoms are vague and difficult to diagnose. The best way to understand and detect this disorder is by promoting awareness and understanding the mechanisms and treatment involved. A search was conducted about the topic through research …

Longitudinal Reduction In Diversity Of Maternal Gut Microbiota During Pregnancy Is Observed In Multiple Low-Resource Settings: Results From The Women First Trial, Minghua Tang, Nicholas E. Weaver, Daniel N. Frank, Diana Ir, Charles E. Robertson, Jennifer F. Kemp, Jamie Westcott, Kartik Shankar, Sumera Aziz Ali, Sarah Saleem

Community Health Sciences

Objective: To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala).
Methods: Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm …

Overlaps And Gaps Of Preterm Birth Programs In The Triangle Area Of North Carolina, Amber Bobbitt

Capstone Experience: Master of Public Health

Background: Preterm birth rates are a long-standing issue that has yet to be adequately addressed and prioritized. Nationally about 1 in every 10 infants are born prematurely in the United States. In the state of North Carolina, 1 in every 9 live births was preterm in the year 2020. The aim of the study was to determine the strategies organizations use in North Carolina to reduce preterm births in comparison to the CDC’s Five Strategy framework and to understand how the organizations address health equity and measure/evaluate the success of their initiatives.

Methods: Semi-structured one-on-one interviews were conducted with four …

Mechanism Of Neonatal Hypoglycemia After Late Preterm Steroids: Are Fetal Metabolic Effects Responsible?, Ashley N Battarbee, Grecio J Sandoval, Cynthia Gyamfi-Bannerman, Sean C Blackwell, Alan T N Tita, Uma M Reddy, Lucky Jain

Faculty, Staff and Student Publications

OBJECTIVE:

Betamethasone administration in the late preterm period(340/7–365/7 weeks’ gestation) not only reduces neonatal respiratory morbidity but also increases neonatal hypoglycemia through an uncertain mechanism.¹ Based on data from pregnant individuals with diabetes, excessive amounts of maternal glucose can cross the placenta and cause fetal hyperinsulinemia, which can cause neonatal hypoglycemia at birth.² Given that betamethasone can also increase maternal glucose levels,³ our objective was to explore the potential mechanisms for late preterm steroid-induced neonatal hypoglycemia by measuring the fetal metabolic effects of antenatal late preterm betamethasone and assessing the relationship of the fetal metabolic effects with …

Placental Pathology In Spontaneous And Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features, Lucy T Brink, Drucilla J Roberts, Colleen A Wright, Daan G Nel, Pawel T Schubert, Theonia K Boyd, David R Hall, Hein Odendaal

Faculty, Staff and Student Publications

INTRODUCTION: Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The aim of this study was to investigate these relationships.

METHODS: Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13.

RESULTS: In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) …

Maternal Iron Deficiency Programs Rat Offspring Hypertension In Relation To Renin-Angiotensin System And Oxidative Stress, Ya-Hui Chang, Wan-Hsuan Chen, Chung-Hao Su, Hong-Ren Yu, You-Lin Tain, Li-Tung Huang, Jiunn-Ming Sheen

Faculty, Staff and Student Publications

Hypertension is an important public health challenge, affecting up to 30-50% of adults worldwide. Several epidemiological studies indicate that high blood pressure originates in fetal life-the so-called programming effect or developmental origin of hypertension. Iron-deficiency anemia has become one of the most prevalent nutritional problems globally. Previous animal experiments have shown that prenatal iron-deficiency anemia adversely affects offspring hypertension. However, the underlying mechanism remains unclear. We used a maternal low-iron diet Sprague Dawley rat model to study changes in blood pressure, the renal renin-angiotensin system, oxidative stress, inflammation, and sodium transporters in adult male offspring. Our study revealed that 16-week-old …

Mothers’ Reflections On Cat Ownership For A Child With Autism Spectrum Disorder During Covid-19, Saskia Keville, Sophia De Vita, Amanda K. Ludlow

People and Animals: The International Journal of Research and Practice

Animal- assisted interventions are increasingly used as a complementary therapy in clinical practice to support people with autism spectrum disorder (ASD), with promising outcomes compared to traditional therapies. Less is understood about the therapeutic benefits of more accessible and affordable small pet ownership for families with a child with ASD, alongside the pets’ welfare living in these homes. This study explored the experiences of cat ownership for young people with ASD from the perspective of their mothers during a time of transition generated by COVID-19. Semi-structured interviews were conducted with six mothers and transcripts analyzed using reflexive thematic analysis. Three …

A Comparison Of American Women's Experiences With Both Gestational Surrogate Pregnancies And Spontaneous Pregnancies, Jennifer Lahl, Kallie Fell, Kate Bassett, Frances H. Broghammer, William M. Briggs

Dignity: A Journal of Analysis of Exploitation and Violence

This article evaluates the pregnancy experiences of American women by comparing their spontaneous or non-surrogate pregnancies with their gestational surrogate pregnancies. Data were collected through structured interviews using an online video platform. In total, 96 interviews were conducted. Data revealed that a woman was more likely to have a pregnancy that was high-risk during a surrogate pregnancy than during a non-surrogate pregnancy, independent of maternal age or gravidity (OR 11.4, 3.5-36.6; p<.0001). A surrogate pregnancy had three times higher odds of resulting in a cesarean section (p<.0001) and was five times more likely to deliver at an earlier gestational age (p<.0001). Women in this study were significantly more likely to experience postpartum depression following the delivery of surrogate children than after delivering their non-surrogate children (p=.01), and overall, they were more likely to have adverse outcomes during a surrogate pregnancy. The rate of new post-surrogacy chronic health issues for women of color was significantly higher than for women identified as white (p<.0001). We found that women’s economic disadvantage was a major contributor to the decision to proceed with surrogacy. This study confirms that health disparities exist for women with surrogate pregnancies compared to non-surrogate pregnancies, which can lead to long-term complications after a surrogate pregnancy. In terms of biomedical ethics, it raises important social, economic, and political issues related to surrogacy, all requiring further exploration. Future research will build on the present work in further helping us to understand the circumstances and consequences involved for women in surrogacy.

“The Worst Part About My Pregnancy Was Stuff That Didn’T Have To Do With My Pregnancy”: Medicaid Beneficiaries’ Pregnancy Intentions & Experiences In South Carolina, Andrew Michael Chen

Senior Theses

Low-income women and women of color experience adverse birth outcomes at disproportionately higher rates in the United States than most people who give birth. This thesis examines individual interviews conducted with 30 low-income women whose most recent birth was covered by Medicaid, the United States’ largest means-tested public health insurance program. The aim of this thesis is to examine how the women in the study thought about pregnancy, and how they described their intentions to become or avoid becoming pregnant at various times in their life. While public health researchers often frame pregnancy as an event that is either intended …

Hypertension In Pregnancy And Adverse Outcomes Among Low-Risk Nulliparous People Expectantly Managed At Or After 39 Weeks: A Secondary Analysis Of A Randomized Controlled Trial, Michal Fishel Bartal, Ashish Premkumar, Madeline Murguia Rice, Uma M Reddy, Alan T N Tita, Robert M Silver, Yasser Y El-Sayed, Ronald J Wapner, Dwight J Rouse, George R Saade, John M Thorp, Maged M Costantine, Edward K Chien, Brian M Casey, Sindhu K Srinivas, Geeta K Swamy, Hyagriv N Simhan, Eunice Kennedy Shriver National Institute Of Child Health And Human Development (Nichd) Maternal-Fetal Medicine Units (Mfmu) Network

Faculty, Staff and Student Publications

OBJECTIVE: To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous women expectantly managed at or after 39 weeks of gestation are associated with adverse outcomes.

DESIGN: Secondary analysis of a randomised trial.

SETTING: Multicentre, USA.

POPULATION: Individuals in the expectantly managed group who delivered on or after 39 weeks.

METHODS: Multivariable analysis to estimate adjusted relative risks (aRR) for binomial outcomes, adjusted odds ratios (aOR) for multinomial outcomes and 95% CI.

MAIN OUTCOME MEASURES: Composite adverse maternal outcome including placental abruption, pulmonary oedema, postpartum haemorrhage, postpartum infection, venous thromboembolism or intensive care unit admission. Secondary outcomes included a …

A Pilot Study To Determine The Incidence, Type, And Severity Of Non-Routine Events In Neonates Undergoing Gastrostomy Tube Placement, Daniel J France, Emma Schremp, Evan B Rhodes, Jason Slagle, Sarah Moroz, Peter H Grubb, Leon D Hatch, Matthew Shotwell, Amanda Lorinc, Jamie Robinson, Marlee Crankshaw, Timothy Newman, Matthew B Weinger, Martin L Blakely

Faculty, Staff and Student Publications

BACKGROUND: Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement.

METHODS: A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's …

Institute For Global Health And Development : Issue 4 - July - Sept 2022, Institute For Global Health And Development

IGHD Newsletters

• Research Highlights
• Key Publications
• News
• Reflections from IGHD’s Associate Faculty
• Reflections from IGHD’s Summer Interns
• Webinars and Dialogues
• Mark your Calendars: Upcoming Event
• Obituary
• Collaborate With Us

2019 Statewide Child Death Report, Nevada Institute For Children’S Research And Policy, Dawn L. Davidson, Elizabeth Holka

Nevada Institute for Children's Research and Policy Reports

The purpose of this report is to provide comprehensive information regarding the circumstances by which children die in Nevada in order to prevent future child deaths and improve the health and safety of children in the state.

Spatial Variations In Family Planning Demand To Limit Childbearing And The Demand Satisfed With Modern Methods In Sub-Saharan Africa, Babayemi O. Olakunde, Jennifer R. Pharr, Daniel A. Adeyinka, Lung-Chang Chien, Rebecca D. Benfield, Francisco S. Sy

Environmental & Global Health Faculty Research

Background: There is an increasing demand for family planning to limit childbearing in sub-Saharan Africa (SSA). However, limited studies have quantified the spatial variations. This study examined: (i) the spatial patterns in the demand for family planning to limit childbearing and satisfied with modern methods, and (ii) the correlates of the demand for family planning to limit childbearing satisfied with modern methods in SSA.

Methods: This study analyzed secondary data on 306,080 married/in-union women obtained from Demographic Health Surveys conducted between 2010 and 2019 in 33 sub-Saharan African countries. We conducted exploratory spatial data analysis, with countries as the unit …

Book Review: Urban Health | Emerging Public Health Perspectives, Demi Miriam

Journal of Research Initiatives

Book Review

Book Title: Urban Health | Emerging public health perspectives

Editors: Fernandes & Grewal, 2021

Publisher: Global South Strategies

Publication: 02 September 2021

City: Mangalore, India

Total No. of Pages: 341

Price (in INR): 950 (Paperback)

ISBN-13: 978-8195336418

An Exploratory Analysis Of Gait Biomechanics And Muscle Activation In Pregnant Females With High And Low Scores For Low Back Or Pelvic Girdle Pain During And After Pregnancy, Jennifer J. Bagwell, Nicholas Reynolds, Jo Armour Smith, Michelle Walaszek, Hannah Runez, Kristina Lam, Julie Peterson, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy.

Methods

Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS

Findings

Nine participants met the high pain group criteria and 11 were low pain. During …

Pneumococcal Carriage In Infants Post-Pcv10 Introduction In Pakistan: Results From Serial Cross-Sectional Surveys, Shahira Shahid, Amala Khan, Muhammad Imran Nisar, Farah Khalid, Muhammad Farrukh Qazi, Sheraz Ahmed, Furqan Kabir, Aneeta Hotwani, Sahrish Muneer, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan

Department of Paediatrics and Child Health

The 10-valent pneumococcal vaccine was introduced in Pakistan's Expanded Program on Immunization (EPI) in 2013 as a 3 + 0 schedule without catchup. We conducted three annual cross-sectional surveys from 2014-2016 to measure vaccine-type (VT) carriage in infants from a rural part of Pakistan. Nasopharyngeal specimens were collected by random sampling of infants from two union councils of Matiari. Samples were then transported to the Infectious Disease Research Laboratory (IDRL) at the Aga Khan University within 6-8 h of collection. Serotypes were established using sequential multiplex PCR. Of the 665 children enrolled across three surveys, 547 were culture-positive for pneumococcus. …

Discharged Against Medical Advice In The Postpartum Period: Why Should We Care?, Gurbani Bedi Bs, Mariam Ayyash Md, Mscr, Monique Swain Md

Medical Student Research Symposium

Objective: To understand reasons and events surrounding postpartum discharges against medical advice (AMA) in an urban population in Detroit, Michigan.

Methods: A retrospective chart review was conducted looking at women who left AMA in the postpartum period from Henry Ford Hospital in Detroit, Michigan between 2013 and 2021.

Results: 111 women (0.18%) left AMA in the postpartum period between 2013 and 2021. 35.1% of women were Black, 53% were White, 11.7% were of other races. 4.5% of women had home births and were brought in by EMS shortly after delivery. 44.1% of women had preterm births. 35.1% delivered via cesarean …

Language Preference Impact On The Outcomes Of Those Lost To Follow-Up After A Diagnosis Of Pregnancy Of Unknown Location, Erin A. Leestma, Mayra A. Shafique, Megan Mcnitt, Annmarie Vilkins

Medical Student Research Symposium

Pregnancy of unknown location (PUL) is a temporary diagnosis when there is a positive pregnancy test but an intrauterine gestational sac and/or fetal pole are not visualized with ultrasonography. The three potential outcomes for such a pregnancy are failed pregnancy, an early intrauterine pregnancy or an ectopic/abnormal pregnancy. Given the serious associated morbidity of ectopic pregnancy, these PUL require strict follow up of bHCG levels to help the clinician determine the likely outcome of the PUL (failed vs early vs ectopic) and choose the best intervention (expectant management, surgical management or medical management). One potential barrier to follow-up identified in …

Associations Of Maternal Lipoprotein Particle Distribution In Mid-Pregnancy With Birth Outcomes: A Pilot Study., Todd C. Rideout, Xiaozhong Wen, Divya Choudhary, Marissa Catanzaro, Richard W. Browne, Vanessa M. Barnabei, Kai Ling Kong

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: An excessive rise in maternal lipids during pregnancy may have detrimental impacts on maternal and fetal health leading to adverse pregnancy outcomes. However, knowledge gaps exist with respect to the association between lipid biomarkers and birth outcomes.

METHODS: We conducted a secondary data analysis of healthy pregnant women (N = 25) with mid-pregnancy fasting serum samples collected at 22-28 weeks of gestation and birth outcome data. Serum was analyzed for conventional lipid profile (total-C, HDL-C, LDL-C, and triglycerides) and lipoprotein subclass distribution, including particle number (nM) and size (nm), for very low-density lipoprotein (VLDL)/chylomicron (CM), low density lipoprotein (LDL), …

Case Report: Successful Treatment Of A Child With Covid-19 Reinfection-Induced Fulminant Myocarditis By Cytokine-Adsorbing Oxiris® Hemofilter Continuous Veno-Venous Hemofiltration And Extracorporeal Membrane Oxygenation, Phuc H Phan, Dung T Nguyen, Nam H Dao, Ha T T Nguyen, An V Vu, Son T Hoang, Lam V Nguyen, Tung V Cao, Dien M Tran

Faculty, Staff and Student Publications

BACKGROUND: Indirect cardiomyocyte damage-related hyperinflammatory response is one of the key mechanisms in COVID-19-induced fulminant myocarditis. In addition to the clinical benefit of using cytokines absorption hemofiltration, the effectiveness of instituting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiac compromise has been reported. However, current literature enunciates a paucity of available data on the effectiveness of these novel modalities.

CASE PRESENTATION: We reported a 9-year-old boy with recurrent COVID-19 infection-causing fulminant myocarditis, who was treated successfully by using novel modalities of

CONCLUSION: We conclude that the novel highly-absorptive hemofilter CVVH and VA-ECMO may be effective treatment modalities in managing SARS-CoV-2-induced …

Impact Of The Covid-19 Pandemic On The Care Continuum Of Youth Living With Hiv: Qualitative Study Of The Scale It Up Program Clinical Sites, Tyra Dark, Sitaji Gurung, Mary Dooley, Kit N. Simpson, Seyram A. Butame, Sylvie Naar

Publications and Research

The study objective was to explore the impact of COVID-19 pandemic restrictions on the clinics’ ability to provide continuous healthcare services to youth (15–24 years) living with HIV (YLWH). One focused semi-structured interview was conducted with each HIV clinic site—resulting in ten interviews. Data were analyzed using thematic analysis techniques assisted by NVIVO coding software and themes indicating barriers and facilitators to providing uninterrupted healthcare were elicited. Six themes were identified that affected the care continuum of YLWH: Timeframe of clinic preparation to address COVID-19 restrictions; impact on treatment cascade monitoring data; impact on patient care; impact on staff and …