Journal of Community Health最新文献

{"title":"Contribution of Community Health Workers to Strengthening the Health System in Mali: Impact and Challenges, 2010-2024.","authors":"Borodjan Diarra, Oumar Sangho, Bakary Diarra, Cheick Abou Coulibaly, Abdoul Salam Diarra, Abou Sogodogo, Nouhoum Telly, Housseni Dolo, Ibrahim Terera, Hamadoun Sangho","doi":"10.1007/s10900-026-01622-6","DOIUrl":"https://doi.org/10.1007/s10900-026-01622-6","url":null,"abstract":"<p><p>Faced with a critical shortage of qualified personnel (6 health workers per 10,000 inhabitants compared to the 23 per 10,000 recommended by the World Health Organization) and limited access to healthcare, Mali institutionalized community-based essential health care in 2009. This study assessed the contribution and impact of community health workers on maternal and child health from 2010 to 2024. A cross-sectional study was conducted from September 2022 to August 2025. It covered the first five regions ( Kayes, Koulikoro, Sikasso, Ségou, and Mopti) to implement community-based essential health care in Mali. Retrospective modeling was performed using the Lives Saved Tool integrated into the Spectrum software, along with qualitative interviews with 385 stakeholders and beneficiaries. High acceptance of community-based essential health care (97.9%) was observed among users. Between 2010 and 2024, infant and child mortality fell by an average of 42.02 per 1,000 live births nationally, with Kayes recording the largest decrease (45.53 points). Maternal mortality also declined (from 121.88 to 101.28 per 100,000 live births). However, the reduction remained marginal for neonatal mortality (2.52 per 1,000 live births), particularly in Koulikoro (0.33 per 1,000 live births). Regarding gender, 75.2% of respondents believe that female community health workers (CHWs) benefit from greater social acceptance. The Community Health Strategy (CHS) in Mali has proven its effectiveness through a major reduction in infant and child mortality, driven by strong social acceptance and access to care.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and Vaping Use among Adolescents and Adults in Southern Saudi Arabia: A Cross-Sectional Survey.","authors":"Mohammed A Jad, Bandar M Abuageelah, Iman A Ahmed, Abdullah M Bashah, Mohammed M Al Mhary, Aljory M Alqahtani, Muzun S Alkoban, Mohammed B Jandli, Thkra F Abuthamrah, Seham B Mdawi, Mohammed E A Elhussiny, Abdulhakim M Al Jumayh, Fahad H Balharith","doi":"10.1007/s10900-026-01625-3","DOIUrl":"https://doi.org/10.1007/s10900-026-01625-3","url":null,"abstract":"<p><p>Electronic cigarette (e-cigarette) use has increased rapidly, especially among adolescents and young adults, driven by social acceptability and online promotion. Nicotine exposure may lead to dependence, and population-level risks remain uncertain, particularly for young non-smokers. Evidence from Saudi Arabia suggests notable uptake among youth and adults, but data from southern regions are limited, and few studies concurrently assess knowledge, perceptions, and practices with multivariable predictors. A cross-sectional analytical study was conducted among residents aged ≥13 years in Jazan and Aseer, Saudi Arabia. Participants were recruited using a convenience online sample via social media platforms. An Arabic questionnaire adapted from a CDC vaping-related instrument assessed sociodemographics, vaping-related knowledge (categorized as poor/moderate/good), perceptions (negative/neutral/positive), and vaping practices. Chi-square tests examined associations with vaping status, and binary logistic regression identified independent predictors (p < 0.05). A total of 1,305 participants were included (mean age 24.53 ± 7.91 years; range 13-68; 67.7% female). Overall, 34.0% were ever or current vapers. Vaping prevalence peaked at 28-32 years (50.5%) and was lowest in 13-17 years (11.7%) and ≥38 years (19.9%). Most participants had good knowledge (75.8%), while perceptions were mainly negative (59.2%). Knowledge level was not associated with vaping (p = 0.418). Perception showed a strong association: 90.0% of those with positive perceptions and 75.1% with neutral perceptions were vapers, compared with 5.1% with negative perceptions (p < 0.001). In adjusted regression, vaping was independently associated with male sex (OR 4.42; 95% CI 3.22-6.09), age 28-32 years (OR 7.01; 95% CI 3.69-13.31), and perception (neutral vs negative: OR 38.65; 95% CI 25.13-59.45; positive vs negative: OR 135.11; 95% CI 54.12-337.30), while knowledge remained non-significant. Vaping prevalence in southern Saudi Arabia was high and concentrated in early adulthood. Perceptions, not knowledge, were the strongest predictors of vaping, highlighting the need for interventions targeting misperceptions and social norms, particularly among young adults and males.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out of Pocket Expenses for Birthing in Public and Private Birthing Facilities Among Women Aged 15 to 49 Years in Bihar, India.","authors":"Prince Yadav, Dr Shamshad","doi":"10.1007/s10900-026-01610-w","DOIUrl":"https://doi.org/10.1007/s10900-026-01610-w","url":null,"abstract":"<p><p>Institutional delivery refers to the birth of a child in public and private health facilities under the supervision of trained, skilled healthcare professionals, thereby enhancing neonatal survival and reducing maternal mortality rates. The low- and middle-income nations continue to have substantial disparities in the proportion of pregnant women accessing healthcare facilities to give safe and healthy births at affordable out-of-pocket (OOP) expenditure. The entire research work aims to analyse the delivery expenses incurred for availing institutional & non-institutional health services and the relationship with socio-demographic factors among women in their reproductive period in Bihar. The entire research work highlights the importance of addressing health to achieve universal coverage; it is a fundamental component for diminishing mother and child mortality and morbidity within the SDGs-3 framework. This research work is solely based on secondary sources compiled from NFHS-5, 2019-21. By applying ArcGIS techniques and statistical tools, such as binary and multivariate logistic regression analysis. The district boundaries of the state have been considered a small unit of Bihar. The overall analysis of the present study reveals that the proportion of institutional delivery increased from 23.1 per cent in NFHS-1 to 55.8 per cent in NFHS-5. The odds ratio for women aged under 20 years was elevated (OR = 1.127, 95% CI = 1.01-1.22, p = 0.03) and higher education of 12 or more years (OR = 5.63, 95% CI = 5.14 - 36.16, p = 0.00) is strongly positively associated with age of mother, place of birth, mother schooling caste and region, indicating that women with average health expenditure are more likely to deliver in public institutions. The odds ratio for women under 20 years was elevated (OR = 1.127, 95% CI = 1.01-1.22, p = 0.03) are out-of-pocket expenses for delivery in private health facilities are much more than in public health facilities, while scheduled caste women (OR = 0.81, 95% CI = 0.76-0.86, p = 0.00) are significantly less probable to incur average health expenditure than women from other castes. The high out-of-pocket expenses act as an economic and psychological burden on mothers during their gestational period.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of an Educational Intervention on Medical Students' Knowledge and Attitudes Toward Human Papillomavirus.","authors":"Akarsh Lal, Laila Al-Jerdi, Dola Pathak, Thanh Cong Bui, Radhika Gogoi","doi":"10.1007/s10900-026-01630-6","DOIUrl":"https://doi.org/10.1007/s10900-026-01630-6","url":null,"abstract":"<p><p>Human papillomavirus (HPV) is a significant public health concern due to its rising incidence and strong association with cancers of the head, neck, and genitalia. High-risk HPV types are responsible for cervical, oropharyngeal, and various anogenital cancers. Despite proven vaccine efficacy, vaccination rates remain low in adolescents and young adults. This study assessed whether an educational infographic improved medical students' knowledge and attitudes toward HPV. Medical students (years 1-4) at Wayne State University completed electronic pre- and post-intervention surveys regarding an infographic covering HPV, HPV-related cancers, and Centers for Disease Control and Prevention (CDC) vaccination guidelines. Surveys included demographic questions and pre- and post-infographic items assessing HPV knowledge and attitudes using a Likert-scale format. 234 paired responses were analyzed using paired t-tests. Students demonstrated significant post-intervention increases in knowledge of HPV types (p < 0.001), transmissibility (p < 0.001), vaccination schedule (p < 0.001), and side effects (p < 0.001). Likelihood of encouraging vaccination to family members within three months increased (p < 0.001). No significant change was observed in likelihood of recommending vaccination to future patients, likely due to high baseline agreement. Similarly, recommendations for increased HPV-focused education in medical school remained high post-infographic. The educational intervention significantly improved medical students' HPV knowledge and willingness to promote vaccination to family members. These findings highlight knowledge gaps that can be addressed in medical curricula. Future research can assess whether improved knowledge translates into real-world vaccination discussions and explore geographic differences in HPV-related knowledge and attitudes across medical schools.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers, Facilitators, and Training Preferences for HIV PrEP Among Physicians in the State of Louisiana, USA.","authors":"Deborah Gurgel Smith, Patricia Pichilingue-Reto, Catherine G Dean, Corey D Smith, Luis Enrique Espinoza","doi":"10.1007/s10900-026-01627-1","DOIUrl":"https://doi.org/10.1007/s10900-026-01627-1","url":null,"abstract":"<p><p>HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection, yet its implementation remains suboptimal in the Southern United States. This study examined barriers, facilitators, and training preferences related to PrEP implementation among physicians at an academic medical center in North Louisiana. A cross-sectional electronic survey was conducted between January 2024 and April 2025 among physician faculty, residents, and fellows. Participants reported perceived barriers and facilitators to PrEP implementation, preferred training topics and modalities, and demographic characteristics. Descriptive statistics summarized responses, and linear regression identified factors associated with physicians' PrEP implementation training scores. The most commonly reported barriers were lack of provider training, insurance and cost-related concerns, lack of clinical protocols, staffing and time constraints, and limited knowledge of laboratory monitoring. Frequently identified facilitators included access to clinical protocols, peer support, pharmacist support, and electronic medical record (EMR) order sets. Physicians most frequently requested training on PrEP eligibility, side effects and toxicity, and contraindications, with in-person training as the preferred format. Physicians identified substantial educational and structural barriers to PrEP implementation despite strong support for institutional strategies that facilitate prescribing. Expanding physician education while integrating standardized protocols, pharmacist support, and EMR-based decision tools may strengthen PrEP implementation in high HIV-burden regions of the Southern United States.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension Identification using Mobile Health Outreach Project (HI HOPE): A Pilot Study.","authors":"Rose Baumann, Jonathan D Kirsch, Kimberly Clinch, Maggie Eckerstorfer, Rishi Sharma, Ritwick Banjeree, Shahidali Jaffer, Haitham M Hussein","doi":"10.1007/s10900-026-01605-7","DOIUrl":"https://doi.org/10.1007/s10900-026-01605-7","url":null,"abstract":"<p><p>Racial disparities in the management of hypertension, a risk factor for cardiovascular disease, are prevalent. Mobile health clinics, including the University of Minnesota (UMN) Mobile Health Initiative (MHI), seek to mitigate these disparities by providing underserved individuals with access to screening for elevated blood pressure. However, the impact of this process on subsequent care, including diagnosis and management of hypertension, is unknown. Individuals with elevated blood pressure at UMN MHI screening events were provided with a free self-monitoring blood pressure device (SMBP) and a follow-up phone call two weeks after the event. The primary outcome was the percentage of participants reached with a follow-up call; secondary outcomes included SMBP usage and arrangement of primary care follow-up. Fifty-six participants were enrolled, with a mean age of 57 ± 14 years, half were women, and more than 80% self-identified as non-white. Thirty-seven (66%) participants were successfully reached with a follow-up phone call. The average time to reach participants was 36 days. Fifteen (41%) required more than one phone call attempt. Of the 37 participants who were successfully contacted, 33 (89%) had used SMBP, 27 (82%) reported using the SMBP at least weekly, and 21 (57%) had contacted their primary care doctor by the time of the follow-up phone call. Participant use of SMBP devices was high; however, contacting individuals for follow-up via phone calls was challenging. Distribution of SMBP devices and follow-up phone calls may be a useful way for mobile health clinics to help individuals with hypertension improve their management through increased awareness and by creating a bridge to primary care follow-up.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Healthy Are Community Health Workers: Findings from a Chicago-Area Survey.","authors":"Melissa Gutierrez-Kapheim, Patricia Labellarte, Meghan R Fortune, Adlaide Holloway, Jessica Bishop-Royse, Helen Margellos-Anast, Molly Martin","doi":"10.1007/s10900-026-01621-7","DOIUrl":"https://doi.org/10.1007/s10900-026-01621-7","url":null,"abstract":"<p><p>Community health workers (CHWs) are a growing and essential component of the U.S. healthcare workforce, yet little is known about their own health and well-being. The CHWs Our Work + Our Health Pilot Study administered a cross-sectional survey to a convenience sample of CHWs living and/or working in the Chicago metropolitan area. The survey assessed general health, chronic conditions, health behaviors, and mental health using validated, standardized measures. Prevalence estimates were compared to Chicago population data using two-proportion z-tests. The final analytic sample included 179 CHWs, predominantly female (85.5%), Hispanic (63.7%) or non-Hispanic Black (32.4%). CHWs reported significantly worse outcomes than the general Chicago population in general health, mental distress, emotional support, and sleep, while reporting lower rates of hypertension, obesity, and high cholesterol. Nearly one-third reported fair or poor health and nearly 40% reported inadequate emotional support. Economic hardship was substantial, with 35.9% earning below $25,000 annually and 61.9% delaying medical care due to cost. Chicago-area CHWs present a mixed but concerning health profile marked by significant mental health burden and economic precarity, underscoring the need for targeted employer and policy investments to sustain this essential workforce.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Preventive Measures' Adoption Among Men Who Have Sex With Men in West and Central Africa: A Scoping Review On Pre-exposure Prophylaxis and Condom Use.","authors":"Jolayemi Afolabi, Sally Arrey, Ak Narayan Poudel","doi":"10.1007/s10900-026-01600-y","DOIUrl":"https://doi.org/10.1007/s10900-026-01600-y","url":null,"abstract":"<p><p>Pre-exposure prophylaxis (PrEP) and condom use have contributed to a global decline in the incidence of human immunodeficiency virus (HIV) infections. However, despite concerted preventive efforts, HIV infections remain highly prevalent in West and Central Africa (WCA) among key populations, particularly among men who have sex with men (MSM). We conducted a scoping review to gain a better understanding of the status of PrEP adoption and condom use as effective HIV prevention measures among MSM in WCA and identified gaps. The review was conducted based on JBI Scoping Review Guidelines spanning 1 January 2017 to 10 April 2025. A comprehensive search was conducted in PubMed, CINAHL Ultimate, PsycINFO, ProQuest, Scopus, and OpenAIRE. This was supplemented with a manual search of reference lists, websites, and other online sources to capture key information relevant to the review objectives. Emerging patterns from the data were described and synthesised. Of the 713 identified studies, 22 studies comprising 19 quantitative and 3 qualitative studies were included in the final synthesis. The results indicate uneven with generally low to high uptake of PrEP, persistent inconsistencies in condom use, and risk compensation behaviours among MSM in WCA. Given that our findings are primarily from quantitative studies, additional qualitative studies on the lived experiences of MSM regarding these preventive measures are needed. From a policy implementation perspective, emphasis should be placed on MSM-inclusive, context-sensitive, and community-aligned HIV prevention strategies in WCA.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HPV Vaccination Predictors Among College Students.","authors":"Alyssa Lee, Kiley Brady Kirby, Derek Werthmann, Casey L Daniel","doi":"10.1007/s10900-026-01620-8","DOIUrl":"https://doi.org/10.1007/s10900-026-01620-8","url":null,"abstract":"<p><p>College students remain at increased risk for acquiring human papillomavirus (HPV), yet HPV vaccination coverage remains suboptimal despite the availability of a safe and effective vaccine. This study examined predictors of HPV vaccination and HPV- and HPV vaccine-related knowledge, beliefs, and hesitancy among undergraduate students at a southern United States university. An online cross-sectional survey was administered to undergraduate students aged 18-26 years in November 2024. Descriptive statistics summarized participant characteristics, vaccination status, and HPV-related measures. Multinomial logistic regression models were used to examine factors associated with HPV vaccination status while estimating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 1,127 respondents (mean age, 20.1 years), most were female (74.1%), White (74.9%), and insured (90.4%). Overall, 48.4% reported receiving at least one dose of the HPV vaccine, with only 21.7% completion. More than 30% were unsure of their HPV vaccination status. HPV knowledge, HPV vaccine knowledge and beliefs, and vaccine hesitancy were all independently associated with vaccination status (all p < 0.001). Participants with stronger positive HPV vaccine beliefs and lower vaccine hesitancy had significantly greater odds of reporting HPV vaccination. In secondary analyses, both provider and parental recommendation were significantly associated with younger age at initiation. HPV vaccination initiation and completion remain low among college students, with substantial gaps in knowledge, awareness, and confidence. College campuses represent an important setting for interventions that improve HPV-related knowledge, strengthen vaccine confidence, increase awareness of personal vaccination status, and promote vaccination to reduce future HPV-associated cancers.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Profile, Spatial Dynamics, and Survival Outcomes of HIV/AIDS Patients in Brazil (2014-2024): A Nationwide Study of AIDS-stage Notification and Mortality.","authors":"Bruno Almeida-Silva, Claudeir Dias da Silva-Junior, Ronald Rodrigues de Moura, Natalia Pereira da Silva, Bruno Rodrigo Assunção, Houemakou Rimaud Djidonou","doi":"10.1007/s10900-026-01614-6","DOIUrl":"https://doi.org/10.1007/s10900-026-01614-6","url":null,"abstract":"<p><p>Despite universal access to combined antiretroviral therapy in Brazil, substantial inequalities persist in the HIV/AIDS epidemic. This nationwide retrospective study analyzed 753,071 notifications from the Brazilian Notifiable Diseases Information System (SINAN) between 2014 and 2024 to characterize the epidemiological profile, temporal trends, spatial distribution, factors associated with AIDS-stage notification, and predictors of AIDS-related mortality. HIV infection notifications accounted for 491,976 records, while AIDS case notifications accounted for 261,095. HIV infection notifications were concentrated among young adults, particularly men aged 20-29 years, whereas AIDS case notifications were more frequent in older age groups. Spatial analysis showed significant positive autocorrelation of smoothed municipal notification rates (Moran's I = 0.2306; p < 0.001), with significant High-High clusters mainly in the South and Southeast regions. In the multivariable logistic regression model, older age was strongly associated with AIDS-stage notification, reaching the highest odds among individuals aged 60 years or older (AOR = 2.03; 95% CI: 1.96-2.09), while higher education was associated with lower odds. In the Cox model, age at diagnosis was the main predictor of mortality, with increased risk among individuals aged 30-49 years (AHR = 1.42; 95% CI: 1.36-1.49) and 50 years or older (AHR = 1.95; 95% CI: 1.86-2.05). Lower education and injecting drug use were also strongly associated with AIDS-related mortality. These findings indicate that, although AIDS case notifications have declined over time, AIDS-stage notification and mortality remain concentrated in socially and geographically vulnerable groups.</p>","PeriodicalId":15550,"journal":{"name":"Journal of Community Health","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}