1
|
Enns B, Sui Y, Guerra‐Alejos BC, Humphrey L, Piske M, Zang X, Doblecki‐Lewis S, Feaster DJ, Frye VA, Geng EH, Liu AY, Marshall BDL, Rhodes SD, Sullivan PS, Nosyk B. Estimating the potential value of MSM-focused evidence-based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model-based analysis. J Int AIDS Soc 2024; 27 Suppl 1:e26265. [PMID: 38965982 PMCID: PMC11224592 DOI: 10.1002/jia2.26265] [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: 08/30/2023] [Accepted: 04/23/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Improving the delivery of existing evidence-based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state-level policy changes; however, suboptimal implementation can be addressed directly through interventions designed to improve the reach, effectiveness, adoption or maintenance of available interventions. Our objective was to estimate the cost-effectiveness and potential epidemiological impact of six real-world implementation interventions designed to address these barriers and increase the scale of delivery of interventions for HIV testing and pre-exposure prophylaxis (PrEP) in three US metropolitan areas. METHODS We used a dynamic HIV transmission model calibrated to replicate HIV microepidemics in Atlanta, Los Angeles (LA) and Miami. We identified six implementation interventions designed to improve HIV testing uptake ("Academic detailing for HIV testing," "CyBER/testing," "All About Me") and PrEP uptake/persistence ("Project SLIP," "PrEPmate," "PrEP patient navigation"). Our comparator scenario reflected a scale-up of interventions with no additional efforts to mitigate implementation and structural barriers. We accounted for potential heterogeneity in population-level effectiveness across jurisdictions. We sustained implementation interventions over a 10-year period and evaluated HIV acquisitions averted, costs, quality-adjusted life years and incremental cost-effectiveness ratios over a 20-year time horizon (2023-2042). RESULTS Across jurisdictions, implementation interventions to improve the scale of HIV testing were most cost-effective in Atlanta and LA (CyBER/testing cost-saving and All About Me cost-effective), while interventions for PrEP were most cost-effective in Miami (two of three were cost-saving). We estimated that the most impactful HIV testing intervention, CyBER/testing, was projected to avert 111 (95% credible interval: 110-111), 230 (228-233) and 101 (101-103) acquisitions over 20 years in Atlanta, LA and Miami, respectively. The most impactful implementation intervention to improve PrEP engagement, PrEPmate, averted an estimated 936 (929-943), 860 (853-867) and 2152 (2127-2178) acquisitions over 20 years, in Atlanta, LA and Miami, respectively. CONCLUSIONS Our results highlight the potential impact of interventions to enhance the implementation of existing evidence-based interventions for the prevention and diagnosis of HIV.
Collapse
Affiliation(s)
- Benjamin Enns
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | - Yi Sui
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | | | - Lia Humphrey
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | - Micah Piske
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | - Xiao Zang
- School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Susanne Doblecki‐Lewis
- Division of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Daniel J. Feaster
- Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Elvin H. Geng
- Center for Dissemination and ImplementationInstitute for Public HealthDivision of Infectious DiseasesDepartment of MedicineSchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Albert Y. Liu
- Bridge HIVSan Francisco Department of Public HealthSan FranciscoCaliforniaUSA
| | - Brandon D. L. Marshall
- Department of EpidemiologySchool of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Scott D. Rhodes
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Bohdan Nosyk
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | | |
Collapse
|
2
|
Kurz M, Guerra-Alejos BC, Min JE, Barker B, Pauly B, Urbanoski K, Nosyk B. Influence of physician networks on the implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia. Implement Sci 2024; 19:3. [PMID: 38184548 PMCID: PMC10771688 DOI: 10.1186/s13012-023-01331-x] [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: 08/02/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Characterizing the diffusion of adopted changes in policy and clinical practice can inform enhanced implementation strategies to ensure prompt uptake in public health emergencies and other rapidly evolving disease areas. A novel guidance document was introduced at the onset of the COVID-19 pandemic in British Columbia (BC), Canada, which supported clinicians to prescribe opioids, stimulants, and benzodiazepines. We aimed to determine the extent to which uptake and discontinuation of an initial attempt at a prescribed safer supply (PSS) program were influenced through networks of prescribers. METHODS We executed a retrospective population-based study using linked health administrative data that captured all clinicians who prescribed to at least one client with a substance use disorder from March 27, 2020, to August 31, 2021. Our main exposure was the prescribing patterns of an individuals' peers, defined as the proportion of a prescribers' professional network (based on shared clients), which had previously prescribed PSS, updated monthly. The primary outcome measured whether a clinician had prescribed their initial PSS prescription during a given calendar month. The secondary outcome was the discontinuation of PSS prescribing, defined as an absence for PSS prescriptions for at least 3 months. We estimated logistic regression models using generalized estimated equations on monthly repeated measurements to determine and characterize the extent to which peer networks influenced the initiation and discontinuation of PSS prescribing, controlling for network, clinician, and caseload characteristics. Innovators were defined as individuals initiating PSS prior to May 2020, and early adopters were individuals initiating PSS after. RESULTS Among 14,137 prescribers treating clients with substance use disorder, there were 228 innovators of prescribed safer supply and 1062 early adopters through the end of study follow-up, but 653 (50.6%) were no longer prescribing by August 2021. Prescribers with over 20% of peers whom had adopted PSS had a nearly fourfold higher adjusted odds of PSS prescribing themselves (aOR: 3.79, 95% CI: (3.15, 4.56)), compared to those with no connected safer supply prescribers. CONCLUSIONS The uptake of PSS in BC was highly dependent on the behavior of prescribers' peer networks. Future implementation strategies to support PSS or other policies would benefit from leveraging networks of prescribers.
Collapse
Affiliation(s)
- Megan Kurz
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, V5A 1S6, Canada
| | | | - Jeong Eun Min
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Brittany Barker
- Faculty of Health Sciences, Simon Fraser University, Burnaby, V5A 1S6, Canada
- First Nations Health Authority, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Bernadette Pauly
- Department of Nursing, University of Victoria, Victoria, BC, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Karen Urbanoski
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, V5A 1S6, Canada.
| |
Collapse
|
3
|
Krakower DS, Naja-Riese GM, Edelstein ZR, Gandhi AD, Wahnich A, Fischer MA. Academic Detailing to Increase Prescribing of HIV Pre-exposure Prophylaxis. Am J Prev Med 2021; 61:S87-S97. [PMID: 34686295 DOI: 10.1016/j.amepre.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
Although HIV pre-exposure prophylaxis can decrease new cases of HIV by up to 99%, many patients who could benefit from pre-exposure prophylaxis never receive prescriptions for it. Because pre-exposure prophylaxis is indicated for patients who do not have an infectious disease, increasing pre-exposure prophylaxis prescribing by primary care and generalist clinicians represents a key element of the Ending the HIV Epidemic in the U.S. initiative. This review provides an overview of academic detailing and how it is currently being used to increase pre-exposure prophylaxis prescribing. Academic detailing is outreach education that engages with clinicians in 1-to-1 or small group interactions focused on identifying and addressing an individual clinician's needs to increase their use of evidence-based practices. Academic detailing has been proven in multiple previous research studies, and the principles required for successful implementation include interactivity, clinical relevance of content, and focus on defined behavior change objectives. Clinician barriers to pre-exposure prophylaxis prescribing may occur in the domains of knowledge, attitudes, or behavior, and academic detailing has the potential to address all of these areas. State and local health departments have developed academic detailing programs focused on pre-exposure prophylaxis prescribing and other elements of HIV prevention-sometimes describing the approach as public health detailing. Few studies of academic detailing for pre-exposure prophylaxis have been published to date; rigorous evaluation of HIV-specific adaptations and innovations of the approach would represent an important contribution. In the setting of the COVID-19 pandemic, interest in virtual delivery of academic detailing has grown, which could inform efforts to implement academic detailing in rural communities and other underserved areas. Increasing this capacity could make an important contribution to Ending the HIV Epidemic in the U.S. and other HIV prevention efforts.
Collapse
Affiliation(s)
- Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Beth Israel Lahey Health, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gary M Naja-Riese
- San Francisco Department of Public Health, Population Health Division, Center for Learning and Innovation, San Francisco, California
| | - Zoe R Edelstein
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Anisha D Gandhi
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Amanda Wahnich
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Michael A Fischer
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
4
|
Luu MN, Wada PY, Levine-Hall T, Hurley L, Ramalingam N, Tran HN, Slome SB. Using a report card to increase HIV screening in a large primary care group practice. BMJ Open Qual 2021; 10:bmjoq-2020-000988. [PMID: 33414253 PMCID: PMC7797258 DOI: 10.1136/bmjoq-2020-000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite increased efforts to promote HIV screening, a large proportion of the US population have never been tested for HIV. Objective To determine whether provider education and personalised HIV screening report cards can increase HIV screening rates within a large integrated healthcare system. Design This quality improvement study provided a cohort of primary care physicians (PCPs) a brief educational intervention and personalised HIV screening report cards with quarterly performance data. Participants Participants included a volunteer cohort of 20 PCPs in the department of adult and family medicine. Main measures Per cent of empaneled patients screened for HIV by cohort PCPs compared with PCPs at the Kaiser Permanente Oakland Medical Center (KPOAK) and the non-Oakland Medical Centers in Northern California region (Kaiser Permanente Northern California (KPNC)). Key results Of the 20 participating PCPs, 13 were female and 7 were male. Thirteen were internal medicine and seven family medicine physicians. The average age was 40 years and average practice experience was 9 years after residency. During the 12-month intervention, the estimated increase in HIV screening in the cohort PCP group was 2.6% as compared with 1.9% for KPOAK and 1.8% for KPNC. Conclusions These findings suggest that performance-related report cards are associated with modestly increased rates of HIV screening by PCPs.
Collapse
Affiliation(s)
- Mitchell N Luu
- Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Paul Y Wada
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Leo Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Nirmala Ramalingam
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - H Nicole Tran
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Sally B Slome
- Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| |
Collapse
|
5
|
Rogal SS, Chinman M, Gellad WF, Mor MK, Zhang H, McCarthy SA, Mauro GT, Hale JA, Lewis ET, Oliva EM, Trafton JA, Yakovchenko V, Gordon AJ, Hausmann LRM. Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative. Implement Sci 2020. [PMID: 32576214 DOI: 10.1186/s13012‐020‐01005‐y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates. METHODS Facility points of contact completed a survey assessing their facility's use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews. RESULTS Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR 16-31) strategies. The median case review completion rate was 71% (IQR 48-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were using the STORM dashboard (97%), working with local opinion leaders (80%), and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being ≤ 35 years old (incidence rate ratio, IRR 1.35, 95% CI 1.09-1.67) and having < 5 years in their primary role (IRR 1.23; 95% CI 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR 1.40, 95% CI 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included (1) monitoring and adjusting practices (adjusted IRR (AIRR) 1.40, 95% CI 1.11-1.77), (2) identifying adaptations while maintaining core components (AIRR 1.28, 95% CI 1.03-1.60), (3) conducting initial training (AIRR 1.16, 95% CI 1.02-1.50), and (4) regularly sharing lessons learned (AIRR 1.32, 95% CI 1.09-1.59). CONCLUSIONS In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in the current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not. TRIAL REGISTRATION This project is registered at the ISRCTN Registry with number ISRCTN16012111. The trial was first registered on May 3, 2017.
Collapse
Affiliation(s)
- Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. .,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,RAND Corporation, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Hongwei Zhang
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sharon A McCarthy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Genna T Mauro
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Eleanor T Lewis
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA.,VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Elizabeth M Oliva
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA.,VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Jodie A Trafton
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA.,VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vera Yakovchenko
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
6
|
Rogal SS, Chinman M, Gellad WF, Mor MK, Zhang H, McCarthy SA, Mauro GT, Hale JA, Lewis ET, Oliva EM, Trafton JA, Yakovchenko V, Gordon AJ, Hausmann LRM. Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative. Implement Sci 2020; 15:48. [PMID: 32576214 PMCID: PMC7313133 DOI: 10.1186/s13012-020-01005-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates. METHODS Facility points of contact completed a survey assessing their facility's use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews. RESULTS Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR 16-31) strategies. The median case review completion rate was 71% (IQR 48-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were using the STORM dashboard (97%), working with local opinion leaders (80%), and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being ≤ 35 years old (incidence rate ratio, IRR 1.35, 95% CI 1.09-1.67) and having < 5 years in their primary role (IRR 1.23; 95% CI 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR 1.40, 95% CI 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included (1) monitoring and adjusting practices (adjusted IRR (AIRR) 1.40, 95% CI 1.11-1.77), (2) identifying adaptations while maintaining core components (AIRR 1.28, 95% CI 1.03-1.60), (3) conducting initial training (AIRR 1.16, 95% CI 1.02-1.50), and (4) regularly sharing lessons learned (AIRR 1.32, 95% CI 1.09-1.59). CONCLUSIONS In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in the current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not. TRIAL REGISTRATION This project is registered at the ISRCTN Registry with number ISRCTN16012111. The trial was first registered on May 3, 2017.
Collapse
Affiliation(s)
- Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Hongwei Zhang
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sharon A McCarthy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Genna T Mauro
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Eleanor T Lewis
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Elizabeth M Oliva
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Jodie A Trafton
- VA Office of Mental Health and Suicide Prevention, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- VA Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vera Yakovchenko
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Ard KL, Edelstein ZR, Bolduc P, Daskalakis D, Gandhi AD, Krakower DS, Myers JE, Keuroghlian AS. Public Health Detailing for Human Immunodeficiency Virus Pre-exposure Prophylaxis. Clin Infect Dis 2020; 68:860-864. [PMID: 30020422 DOI: 10.1093/cid/ciy573] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
Despite the promise of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), PrEP remains underutilized, often due to clinician factors. Academic or public health detailing is a process by which university and/or government groups employ the marketing practices of pharmaceutical companies to improve clinical practice. We describe the novel application of detailing to increase PrEP prescribing and related care in New York City and New England. Detailing can play a crucial role in PrEP implementation.
Collapse
Affiliation(s)
- Kevin L Ard
- The National LGBT Health Education Center, The Fenway Institute, Boston.,Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | | | - Philip Bolduc
- Department of Family Medicine and Community Health, University of Massachusetts, Worcester
| | | | | | - Douglas S Krakower
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Julie E Myers
- New York City Department of Health and Mental Hygiene.,Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
| | - Alex S Keuroghlian
- The National LGBT Health Education Center, The Fenway Institute, Boston.,Department of Psychiatry, Massachusetts General Hospital, Boston
| |
Collapse
|
8
|
Syphilis Is (Still) Here: How Must Sexually Transmitted Disease Public Health Programs Adapt? Sex Transm Dis 2019; 45:S63-S64. [PMID: 29465665 DOI: 10.1097/olq.0000000000000779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Traynor SM, Rosen-Metsch L, Feaster DJ. Missed Opportunities for HIV Testing Among STD Clinic Patients. J Community Health 2019; 43:1128-1136. [PMID: 29796786 DOI: 10.1007/s10900-018-0531-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current HIV testing guidelines recommend that all adolescents and adults aged 13-64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April-December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.
Collapse
Affiliation(s)
- Sharleen M Traynor
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1066, Miami, FL, 33136, USA.
| | - Lisa Rosen-Metsch
- School of General Studies, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1059, Miami, FL, 33136, USA
| |
Collapse
|
10
|
Knudsen HK, Cook J, Lofwall MR, Walsh SL, Studts JL, Havens JR. A mixed methods study of HIV-related services in buprenorphine treatment. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:37. [PMID: 28814313 PMCID: PMC5559779 DOI: 10.1186/s13011-017-0122-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers' medical specialty and across practice settings. METHODS Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers' medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states. RESULTS Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings. CONCLUSIONS Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 204, Lexington, KY, 40508, USA.
| | - Jennifer Cook
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 214, Lexington, KY, 40508, USA
| | - Michelle R Lofwall
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 203, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 202, Lexington, KY, 40508, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building, Room 127, Lexington, KY, 40536-0086, USA
| | - Jennifer R Havens
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 201, Lexington, KY, 40508, USA
| |
Collapse
|
11
|
DeRose J, Zucker J, Cennimo D, Swaminathan S. Missed Testing Opportunities for HIV Screening and Early Diagnosis in an Urban Tertiary Care Center. AIDS Res Treat 2017; 2017:5708620. [PMID: 28744377 PMCID: PMC5514340 DOI: 10.1155/2017/5708620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 11/18/2022] Open
Abstract
Newark, New Jersey, is disproportionally affected by HIV with one of the highest prevalence rates in the United States. Rutgers New Jersey Medical School is a major healthcare provider to Newark's underserved population and has implemented a HIV testing program that can diagnose and link newly diagnosed individuals to care. We conducted a retrospective chart review of all new patients seen in the Infectious Disease Practice from January 1, 2013, to December 31, 2014, to determine the proportion of patients with a missed testing opportunity (MTO) (patients with a new HIV diagnosis with an encounter at the institution in the 1 year prior to their first appointment). 117 newly diagnosed patients were identified. 36 (31%) had at least one MTO. A total of 34 (29%) of newly diagnosed patients had AIDS at presentation and 17% had CD4 counts of 50 cells/μL (p value 0.5). The two most common locations of a missed testing opportunity were the hospital ED (45%) and subspecialty clinics (37%). This study demonstrates that, even in a high prevalence institution with HIV counseling, testing, and referral service, HIV screening is lacking at multiple points of care and patients are missing opportunities for earlier diagnosis and treatment.
Collapse
Affiliation(s)
- Joseph DeRose
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jason Zucker
- Departments of Medicine and Pediatrics, Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - David Cennimo
- Departments of Medicine and Pediatrics, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shobha Swaminathan
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
12
|
Greenberg AE, Gordon CM, Purcell DW. Promotion of Research on the HIV Continuum of Care in the United States: The CFAR HIV Continuum of Care/ECHPP Working Group. J Acquir Immune Defic Syndr 2017; 74 Suppl 2:S75-S80. [PMID: 28079716 PMCID: PMC5336363 DOI: 10.1097/qai.0000000000001243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Alan E. Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
- District of Columbia Center for AIDS Research, Washington, DC
| | | | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
13
|
Leidel S, McConigley R, Boldy D, Wilson S, Girdler S. Australian health care providers' views on opt-out HIV testing. BMC Public Health 2015; 15:888. [PMID: 26369954 PMCID: PMC4570459 DOI: 10.1186/s12889-015-2229-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients’ consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs’ attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. Methods In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. Results Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants’ views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. Conclusion Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2229-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stacy Leidel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Ruth McConigley
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Duncan Boldy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sally Wilson
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| |
Collapse
|
14
|
Leidel S, Wilson S, McConigley R, Boldy D, Girdler S. Health-care providers' experiences with opt-out HIV testing: a systematic review. AIDS Care 2015; 27:1455-67. [PMID: 26272473 DOI: 10.1080/09540121.2015.1058895] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.
Collapse
Affiliation(s)
- Stacy Leidel
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sally Wilson
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Ruth McConigley
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Duncan Boldy
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sonya Girdler
- b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| |
Collapse
|
15
|
Addressing the challenges of the HIV continuum of care in high-prevalence cities in the United States. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S1-7. [PMID: 25867773 DOI: 10.1097/qai.0000000000000569] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In summary, addressing the challenges of the HIV care continuum is critical so that the goals of the NHAS can be achieved. CDC is working closely with federal partners, public health departments, and communities throughout the United States on multiple surveillance, programmatic, and research initiatives to inform and improve outcomes along the HIV care continuum. Currently, a large number of research projects are being conducted to describe the care continuum in various populations, assess and model the impact of interventions, and monitor the quality of care. To contribute to this knowledge base, NIH is working with its academic partners to support research that will inform the optimization of HIV treatment and prevention programs. As part of this focus, the CFAR/APC HIV Continuum of Care Working Group was formed to encourage communication between academic investigators and their local DOHs and to support joint research initiatives that are both timely and relevant to their own cities and environments. Finally, the results presented in this supplement may have implications for jurisdictions beyond those in which the studies were conducted.
Collapse
|
16
|
NIH support of Centers for AIDS Research and Department of Health Collaborative Public Health Research: advancing CDC's Enhanced Comprehensive HIV Prevention Planning project. J Acquir Immune Defic Syndr 2013; 64 Suppl 1:S1-6. [PMID: 23982663 DOI: 10.1097/qai.0b013e3182a99bc1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department–supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS.
Collapse
|