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Despite advances in HIV prevention and treatment during the past decade, more than 39 000 HIV diagnoses were made in the United States in 2016. In addition, persistent disparities in HIV acquisition and care, particularly among men who have sex with men (MSM) and racial/ethnic minority groups, make it difficult to end HIV. To focus our nation’s efforts toward this goal, the first comprehensive National HIV/AIDS Strategy for the United States was released in July 2010 with 4 goals: (1) reduce new HIV infections, (2) increase access to care and improve health outcomes for people with HIV, (3) reduce HIV-related disparities and health inequities, and (4) achieve a more coordinated national response within the federal government and between the federal government and state, local, territorial, and tribal governments.2 In 2015, the National HIV/AIDS Strategy was updated and extended to 2020.3 During the past 8 years, the National HIV/AIDS Strategy has helped focus HIV prevention and care research, programs, and community advocacy. This supplemental issue of Public Health Reports focuses on demonstration projects led or co-led by the Centers for Disease Control and Prevention’s (CDC’s) Division of HIV/AIDS Prevention and funded by the US Department of Health and Human Services (HHS) Secretary’s Minority AIDS Initiative Fund (SMAIF). These projects targeted HIV prevention and improving health outcomes among racial/ethnic minority populations disproportionately affected by HIV.

The Malaria Elimination Demonstration Project (MEDP) in Mandla, Madhya Pradesh was started in the year 2017 for a period of 5 years (2017-22) as a first-ofits-kind public-private-partnership between the ICMR, Government of Madhya Pradesh and the Foundation for Disease Elimination and Control of India established by Sun Pharmaceutical Industries Ltd. as a not-for-profit entity. [...]undetected cases may support continuation of transmission. [...]more studies are warranted to understand role of more sensitive diagnostic tools such as PCR and LAMP in combination with conventional methods in case detection particularly in low transmission settings to achieve malaria elimination (Unpublished report). ACKNOWLEDGEMENTS The authors are grateful to the Indian Council of Medical Research for the facilities and support provided to carry out the research activities. Das LK, Sahu SS, Krishnamoorthy N. Tolerability, efficacy and operational feasibility of artesunate combination therapy (ACT) (artesunate-sulphadoxine-pyrimethamine): As 1st line antimalarial drug for falciparum malaria control in a tribal area of Odisha state, India.

Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families' knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.

Public demonstration projects are receiving increasing and often sceptical attention, especially when developing economies attempt to accelerate the emergence of new industries through government intervention. The aim of this paper is to ascertain whether these demonstration policies can promote industrial emergence, at least in China, and to explore the mechanisms of their influence. A survey with 1500 respondents was conducted to investigate China's electric vehicle demonstration project, known as the 'Ten Cities, One Thousand Vehicles' programme. Structural-equation modelling was used to analyse the 437 valid questionnaires returned. The results show that this public demonstration project has improved product information, application and diffusion. In addition, the results validate the use of a model that illustrates the effects of demonstration policies on industrial innovation in terms of the policies' testing and showing functions. The paper offers insight into the use of demonstration policies as a form of intervention to promote industrial emergence, and the results will be of interest to policy makers, industrialists and academics.

Although much attention has been focused on individual-level drivers of burnout in primary care settings, examining the structural and cultural factors of practice environments with no burnout could identify solutions. In this cross-sectional analysis of survey data from 715 small-tomedium-size primary care practices in the United States participating in the Agency for Healthcare Research and Quality's EvidenceNOW initiative, we found that zero-burnout practices had higher levels of psychological safety and adaptive reserve, a measure of practice capacity for learning and development. Compared with high-burnout practices, zero-burnout practices also reported using more quality improvement strategies, more commonly were solo and clinician owned, and less commonly had participated in accountable care organizations or other demonstration projects. Efforts to prevent burnout in primary care may benefit from focusing on enhancing organization and practice culture, including promoting leadership development and fostering practice agency.

To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.

For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. Therefore, we implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA to promote PrEP uptake among high-risk clients. The Fulton County Board of Health PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as “persistent”, whereas clients with a lapse in follow-up of > 6 months were defined as “not persistent.” Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Between October 2015 and June 2017, 399 clients were screened for PrEP, almost all were eligible [392/399 (98%)]; however, 158/392 (40%) did not return to start PrEP after screening. Of 234 patients, 216 (92%) received a prescription for PrEP. As of June 2017, only 69/216 (32%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was age ≥ 30 years (OR 1.86, 95% CI 1.02, 3.42). Implementation of PrEP in the county health department setting is feasible; however, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.

Performance-based evaluation criteria (PBEC) are vital for selecting high-quality suppliers and achieving a PPP procurement performance. Through theoretical and institutional analysis, we found that the selection of PBEC centered on operations depends on the discretion of the purchaser. However, in an emerging and transforming PPP market, many factors have affected the scientific exercise of the purchaser’s discretion. This means that PPP projects must focus on construction and neglect operation in a certain period. Furthermore, to explore the influencing factors of the definition of PBEC, based on data of 9082 PPP projects between 2009 and 2021 in China, we adopted Ordinary Least Squares to empirically analyze two factors that influence the level of attention that is paid to the operation plan: corruption and accountability. The results indicate that the attention paid to the operation plan significantly increased with the reduction in corruption and the improvement in accountability. Robustness tests demonstrate the robustness of the results. A further heterogeneity analysis shows that the above factors have a more significant impact on non-state demonstration projects and projects with large investments. The contributions of this study are as follows: (1) Theoretically, this paper supplements the relevant research on evaluation criteria and provides new evidence on the impact of corruption and accountability on the defining PBEC. (2) Institutionally, it provides specific paths to limit the discretion of procurement officials when defining evaluation criteria. (3) In practice, it helps procurement officials to scientifically define PBEC and promote the realization of procurement performance.

Community health workers (CHWs) have a long, rich global history of extending essential health services and helping address social determinants of health for underserved populations.1 The 1978 Declaration of Alma-Ata, which called for the achievement of \"health for all,\" explicitly defined a role for CHWs as an integral member of primary health care teams.2 In the United States, CHWs have historically been patient health educators and advocates, particularly for patients who have limited health knowledge or whose first language is not English. The 2010 Affordable Care Act called for the integration of CHWs into primary care settings to help improve the provision of care to culturally diverse patients. Despite these efforts, the CHW workforce in the United States has been underrecognized and underutilized, and many have called for policy change to better integrate CHWs into the US health system.3,4 CHWs have been largely neglected in health workforce planning, with existing programs often led by multiple actors without coordination, with fragmented or disease-specific foci, unclear links to the health system, and unclear identities because of wide-ranging job titles. Small programs and demonstration projects have shown the efficacy and promise of CHWs to improve population health outcomes,5,6 but monitoring and evaluation systems for large-scale CHW programs have been weak, and evidence of their real-world effectiveness and cost-effectiveness has been limited.In this issue of AJPH, Heisler et al. (p. 766) describe an innovative multisector partnership between Medicaid health plans, a local health department, community-based organizations, and academia that implemented and evaluated a health plan-led CHW program in a low-income neighborhood in Detroit, Michigan. One year in, the study found that emergency department visits and costs were lower in the intervention group of Medicaid beneficiaries randomized to the CHW program compared to beneficiaries who received usual care. Outpatient ambulatory care costs were higher in the intervention group. Although total costs did not differ between the two groups, increases in ambulatory care use among low-income, medically underserved populations are a clear marker of success, and future longitudinal studies may demonstrate important implications for long-term savings and health outcomes.

Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services. Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid's Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness. Context The Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports. Methods We conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, nonprofit housing staff, and consultants. We supplemented these interviews with extensive reviews of public documents, media accounts, think‐tank reports, and published literature. We also conducted a systematic inductive qualitative analysis. Findings We identified seven challenges to the successful implementation of tenancy support demonstration projects: resolving the housing supply and NIMBY, removing silos between health care and homeless services providers, enrolling and retaining the target populations in Medicaid, contracting with and paying tenancy support providers, recruiting and retaining key workers, ensuring Medicaid's waiver durability, and reducing administrative crowd‐out and waiver burden. Conclusions Notwithstanding these challenges, three of the four states have made significant progress in launching their initiatives. At this point, the fourth state has delayed its start‐up to consider alternatives to a Medicaid demonstration waiver to provide tenancy supports. The experience of the four states suggests lessons for Medicaid officials in other jurisdictions that are interested in pursuing tenancy support initiatives. Nevertheless, the limitations of tenancy support waiver programs suggest that federal policymakers should consider allowing states to more directly subsidize housing costs for those experiencing or at risk of homelessness as an optional Medicaid benefit.