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Westgard LK, Sato T, Bradford WS, Eaton EF, Pilcher F, Hale AJ, Singh D, Martin M, Appa AA, Meyer JP, Weimer MB, Barakat LA, Felsen UR, Akiyama MJ, Ridgway JP, Grussing ED, Thakarar K, White A, Mutelayi J, Krsak M, Montague BT, Nijhawan A, Balakrishnan H, Marks LR, Wurcel AG. National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals. Open Forum Infect Dis 2024; 11:ofae204. [PMID: 38746950 PMCID: PMC11093397 DOI: 10.1093/ofid/ofae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/10/2024] [Indexed: 06/02/2024] Open
Abstract
Background To end the HIV and hepatitis C virus (HCV) epidemics, people who use drugs (PWUD) need more opportunities for testing. While inpatient hospitalizations are an essential opportunity to test people who use drugs (PWUD) for HIV and HCV, there is limited research on rates of inpatient testing for HIV and HCV among PWUD. Methods Eleven hospital sites were included in the study. Each site created a cohort of inpatient encounters associated with injection drug use. From these cohorts, we collected data on HCV and HIV testing rates and HIV testing consent policies from 65 276 PWUD hospitalizations. Results Hospitals had average screening rates of 40% for HIV and 32% for HCV, with widespread heterogeneity in screening rates across facilities. State consent laws and opt-out testing policies were not associated with statistically significant differences in HIV screening rates. On average, hospitals that reflexed HCV viral load testing on HCV antibody testing did not have statistically significant differences in HCV viral load testing rates. We found suboptimal testing rates during inpatient encounters for PWUD. As treatment (HIV) and cure (HCV) are necessary to end these epidemics, we need to prioritize understanding and overcoming barriers to testing.
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Affiliation(s)
| | - Taisuke Sato
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Finlay Pilcher
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Andrew J Hale
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Devika Singh
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Marlene Martin
- Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- University of California, San Francisco, California, USA
| | - Ayesha A Appa
- University of California, San Francisco, California, USA
| | - Jaimie P Meyer
- Yale School of Medicine, New Haven, Connecticut, USA
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Melissa B Weimer
- Yale School of Medicine, New Haven, Connecticut, USA
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Uriel R Felsen
- Montefiore Medical Center, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew J Akiyama
- Montefiore Medical Center, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Emily D Grussing
- Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Maine Medical Center Research Institute, Portland, Maine, USA
- Maine Medical Center, Portland, Maine, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, Maine, USA
| | - Amy White
- Maine Medical Center Research Institute, Portland, Maine, USA
| | - John Mutelayi
- Maine Medical Center Research Institute, Portland, Maine, USA
| | - Martin Krsak
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Brian T Montague
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Ank Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Laura R Marks
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Alysse G Wurcel
- Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
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2
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Forrester N, Keyes JZS, Cajimat R, Burklin Y, Hall MAK, Cobb J. Undiagnosed HIV in Patients on Immunosuppressive Medications Presenting with HIV-Associated Kidney Disease. South Med J 2024; 117:254-259. [PMID: 38701846 DOI: 10.14423/smj.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Approximately 158,500 adults and adolescents in the United States live with undiagnosed human immunodeficiency virus (HIV). Missed or delayed diagnoses adversely affect disease management and outcomes. This is particularly salient for patients receiving immunosuppressive and immunomodulatory therapy for the management of chronic inflammatory conditions, in which additional immunosuppression may increase the risk and severity of opportunistic infections. Despite this risk, comprehensive HIV testing before the initiation of immunosuppressive therapy is not yet the norm. We describe a case series containing the narratives of three patients recently treated with immunosuppressive agents, who presented with signs concerning for HIV-associated kidney diseases and who were found to have undiagnosed HIV later in the treatment course, which, unfortunately, resulted in poor outcomes. Screening for HIV or related illnesses, such as viral hepatitis or mycobacterial co-infections including tuberculosis, is essential before initiating biologic immunosuppression.
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Affiliation(s)
| | | | | | | | | | - Jason Cobb
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
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3
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Bradford W, Akselrod H, Bassler J, Gagnon KW, Burkholder G, Carpenter JE, Steck A, Catalanotti J, Kuo I, McGonigle K, Mai W, Notis M, Brokus C, Kattakuzhy S, Rosenthal E, Eaton EF. Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment. Addict Sci Clin Pract 2024; 19:22. [PMID: 38528590 PMCID: PMC10964564 DOI: 10.1186/s13722-024-00451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Hospitalization is a "reachable moment" for people who inject drugs (PWID), but preventive care including HIV testing, prevention and treatment is rarely offered within inpatient settings. METHODS We conducted a multisite, retrospective cohort study of patients with opioid use disorder with infectious complications of injection drug use hospitalized between 1/1/2018-12/31/2018. We evaluated HIV care continuum outcomes using descriptive statistics and hypothesis tests for intergroup differences. RESULTS 322 patients were included. Of 300 patients without known HIV, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 (59%) had a viral load collected during admission of whom all were viremic and 10 (45%) were successfully linked to care post-discharge. Rates of readmission, Medicaid or uninsured status, and unstable housing were high in both groups. DISCUSSION We observed poor provision of HIV testing, PrEP and other HIV services for hospitalized PWID across multiple U.S. medical centers. Future initiatives should focus on providing this group with comprehensive HIV testing and treatment services through a status neutral approach.
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Affiliation(s)
- William Bradford
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
| | - Hana Akselrod
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - John Bassler
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Kelly W Gagnon
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | | | - Alaina Steck
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Jillian Catalanotti
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, USA
| | - Keanan McGonigle
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - William Mai
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Melissa Notis
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Christopher Brokus
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Sarah Kattakuzhy
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Elana Rosenthal
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Ellen F Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
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D. Grussing E, Pickard B, Khalid A, Smyth E, Childs V, Zubiago J, Nunez H, Jung A, Morales Y, Daudelin DH, Wurcel AG. Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231203410. [PMID: 37936964 PMCID: PMC10548809 DOI: 10.1177/26334895231203410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.
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Affiliation(s)
| | - Bridget Pickard
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
| | - Ayesha Khalid
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
| | - Emma Smyth
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
| | | | - Julia Zubiago
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
| | - Hector Nunez
- Tufts University School of Medicine, Boston, MA, USA
| | - Amanda Jung
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Denise H. Daudelin
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - Alysse G. Wurcel
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
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5
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Serag H, Clark I, Naig C, Lakey D, Tiruneh YM. Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:457. [PMID: 36612775 PMCID: PMC9819288 DOI: 10.3390/ijerph20010457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The Centers for Disease Control and Prevention recommends everyone between 13-64 years be tested for HIV at least once as a routine procedure. Routine HIV screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up routine HIV screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006-2020 in English. The search identified 383 Citations; we screened 220 and excluded 163 (outside the time limit, irrelevant, or outside the U.S.). Of the 220 screened articles, we included 35 and disqualified 155 (did not meet the eligibility criteria). We organized eligible articles under two themes: financial benefits/barriers of routine HIV screening in healthcare settings (9 articles); and Cost-effectiveness of routine screening in healthcare settings (26 articles). The review concluded drawing recommendations in three areas: (1) Finance: Incentivize healthcare providers/systems for implementing HIV routine screening and/or separate its reimbursement from bundle payments; (2) Personnel: Encourage nurse-initiated HIV screening programs in primary care settings and educate providers on CDC recommendations; and (3) Approach: Use opt-out approach.
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Affiliation(s)
- Hani Serag
- Department of International Medicine, School of Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Isabel Clark
- HIV/STD Prevention & Care Unit, Texas Department of State Health Services, Austin, TX 78714, USA
| | - Cherith Naig
- MPH Program, School of Public and Population Health, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - David Lakey
- Administration Division, University of Texas System, Austin, TX 78701, USA
| | - Yordanos M. Tiruneh
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Tyler, Tyler, TX 75799, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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6
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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7
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Lara-Paez G, Zuazo M, Blumenthal J, Coyne CJ, Hoenigl M. HIV and Hepatitis C Virus Screening in the Emergency Department and Linkage to Care During COVID-19: Challenges and Solutions. J Acquir Immune Defic Syndr 2021; 88:e14-e16. [PMID: 34267055 PMCID: PMC8425513 DOI: 10.1097/qai.0000000000002763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George Lara-Paez
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Miriam Zuazo
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Jill Blumenthal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA
| | - Martin Hoenigl
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
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8
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The Potential Impact of One-Time Routine HIV Screening on Prevention and Clinical Outcomes in the United States: A Model-Based Analysis. Sex Transm Dis 2021; 47:306-313. [PMID: 32044862 DOI: 10.1097/olq.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND US guidelines recommend routine human immunodeficiency virus (HIV) screening of all adults and adolescents at least once. The population-level impact of this strategy is unclear and will vary across the country. METHODS We constructed a static linear model to estimate the optimal ages and incremental impact of adding 1-time routine HIV screening to risk-based, prenatal, symptom-based, and partner notification testing. Using surveillance data and published studies, we parameterized the model at the national level and for 2 settings representing subnational variability in the rates and distribution of infection: King County, WA and Philadelphia County, PA. Screening strategies were evaluated in terms of the percent of tests that result in new diagnoses (test positivity), cumulative person-years of undiagnosed infection, and the number of symptomatic HIV/acquired immune deficiency syndrome cases. RESULTS Depending on the frequency of risk-based screening, routine screening test positivity was maximized at ages 30 to 34 years in the national model. The optimal age for routine screening was higher in a setting with a lower proportion of cases among men who have sex with men. Across settings, routine screening resulted in incremental reductions of 3% to 8% in years of undiagnosed infection and 3% to 11% in symptomatic cases, compared with reductions of 36% to 69% and 41% to 76% attributable to risk-based screening. CONCLUSIONS Although routine HIV screening may contribute meaningfully to increased case detection in persons not captured by targeted testing programs in some settings, this strategy will have a limited impact on population-level outcomes. Our findings highlight the importance of a multipronged testing strategy with continued investment in risk-based screening programs.
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9
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Yunxing W. The automatic evaluation model of physical education teaching based on two screening algorithms. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Wang Yunxing
- School of Physical Education, Anqing Normal University, Anqing, Anhui, China
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10
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Hoenigl M, Mathur K, Blumenthal J, Brennan J, Zuazo M, McCauley M, Horton LE, Wagner GA, Reed SL, Vilke GM, Coyne CJ, Little SJ. Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments. Sci Rep 2019; 9:14479. [PMID: 31597939 PMCID: PMC6785532 DOI: 10.1038/s41598-019-51128-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022] Open
Abstract
Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13-64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.
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Affiliation(s)
- Martin Hoenigl
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States.
| | - Kushagra Mathur
- University of San Diego School of Medicine, San Diego, California, United States
| | - Jill Blumenthal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Jesse Brennan
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Miriam Zuazo
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Melanie McCauley
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Lucy E Horton
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Gabriel A Wagner
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Sharon L Reed
- Department of Pathology, University of California San Diego, San Diego, California, United States
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Susan J Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
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11
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Cox J, Gutner C, Kronfli N, Lawson A, Robbins M, Nientker L, Ostawal A, Barber T, Croce D, Hardy D, Jessen H, Katlama C, Mallolas J, Rizzardini G, Alcorn K, Wohlfeiler M, Le Fevre E. A need for implementation science to optimise the use of evidence-based interventions in HIV care: A systematic literature review. PLoS One 2019; 14:e0220060. [PMID: 31425524 PMCID: PMC6699703 DOI: 10.1371/journal.pone.0220060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022] Open
Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare's Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013-2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets.
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Affiliation(s)
- Joseph Cox
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Anna Lawson
- ViiV Healthcare, London, England, United Kingdom
| | | | | | | | - Tristan Barber
- Chelsea and Westminster Hospital, London, England, United Kingdom
| | | | - David Hardy
- Whitman-Walker Centre, Washington, DC, United States of America
| | | | | | | | | | - Keith Alcorn
- NAM publications, London, England, United Kingdom
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12
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Alexandra MO, Carolina PJ, Andrea GR, Patricia VF. Impact and barriers of an HIV rapid test program implementation at an oncological referral center in Mexico. Int J STD AIDS 2018; 29:884-889. [PMID: 29629655 DOI: 10.1177/0956462418762235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the implementation of human immunodeficiency virus (HIV) screening with rapid tests in an oncologic center in Mexico City, report the HIV prevalence, and describe contacts screening and linkage to HIV care while identifying barriers to the performance of the program. In 2014, an HIV rapid test program was implemented in four departments of the hospital "Instituto Nacional de Cancerología". From 2014 to 2016, 3032 HIV rapid tests were performed in the hospital. The overall HIV prevalence was 0.8%, with the highest prevalence in the Hematology Department (2.4%). In the Gynecology Department, prevalence was 0.05%. Only 25 and 22 tests were performed in the lung cancer and germ cell tumor clinic, respectively, with one positive test. The health staff not offering the test was the main limitation to the full implementation of the program in those departments. The contacts screening led to three positive cases. The acceptance of the test was 99%. Patients who tested positive were seen by an infectious diseases physician on the same day the test was performed. Rapid HIV tests are a useful tool to expand HIV diagnosis in patients with cancer and to establish a rapid linkage to HIV care. Staff education needs to be improved to raise awareness of the health staff for a successful scale up of the program.
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Affiliation(s)
| | - Perez-Jimenez Carolina
- 1 Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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13
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Lau L, Wudel B, Lee E, Darraj M, Richert Q, Trajtman A, Bresler K, Bullard J, Kasper K, Becker M, Keynan Y. Evaluation of the Utility of Point-of-Care HIV Testing on a Canadian Internal Medicine Inpatient Unit. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2017; 2017:8495307. [PMID: 29230252 PMCID: PMC5688259 DOI: 10.1155/2017/8495307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 01/23/2023]
Abstract
Point-of-care (POC) HIV testing has been shown to be an acceptable method for increasing HIV testing uptake. To date, no studies have examined the use of POC testing for routine HIV screening on the medicine inpatient unit. A prospective cross-sectional study was conducted over a three-month period in July, August, and October 2016 to evaluate the prevalence of undiagnosed HIV and the attitudes towards routine POC HIV testing. Patients admitted directly to medicine inpatient teaching units at a tertiary hospital in Winnipeg, Canada, were approached for participation. The POC HIV test was administered at the bedside. Reactive and indeterminate tests were confirmed with standard serological HIV testing. Participants were given a questionnaire regarding their attitudes towards POC testing on the unit. Although no cases of previously undiagnosed HIV were identified during the study period, only 35% of participants were found to have ever had HIV testing previously. The majority of participants were satisfied with the POC testing experience and would choose to have the POC testing again. Overall, the low rate of outpatient testing highlights the need for routine HIV testing on an inpatient basis.
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Affiliation(s)
- Lawrence Lau
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Beverly Wudel
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Eugene Lee
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Majid Darraj
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Quinlan Richert
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Adriana Trajtman
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kim Bresler
- Manitoba HIV Program, Health Sciences Centre, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba HIV Program, Health Sciences Centre, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Ken Kasper
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Jazan University, Jazan, Saudi Arabia
| | - Marissa Becker
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba HIV Program, Health Sciences Centre, Winnipeg, MB, Canada
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba HIV Program, Health Sciences Centre, Winnipeg, MB, Canada
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