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Ford JS, Morrison JC, Wagner JL, Nangia D, Voong S, Matsumoto CG, Chechi T, Tran N, May L. Sexually Transmitted Infection Co-testing in a Large Urban Emergency Department. West J Emerg Med 2024; 25:382-388. [PMID: 38801045 PMCID: PMC11112655 DOI: 10.5811/westjem.18404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/17/2023] [Accepted: 12/22/2023] [Indexed: 05/29/2024] Open
Abstract
Introduction The incidence of sexually transmitted infections (STI) increased in the United States between 2017-2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED. Methods This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018-May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18-64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics. Results During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%). Conclusion Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.
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Affiliation(s)
- James S. Ford
- University of California San Francisco, Department of Emergency Medicine, San Francisco, California
| | | | - Jenny L. Wagner
- California State University, Department of Public Health, Sacramento, California
| | - Disha Nangia
- University of California Davis, School of Medicine, Sacramento, California
| | - Stephanie Voong
- University of California Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Cynthia G. Matsumoto
- University of California Davis Health, Learning Health System, Department of Population Health and Accountable Care, Sacramento, California
| | - Tasleem Chechi
- University of California Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Nam Tran
- University of California Davis Health, Department of Pathology and Laboratory Medicine, Sacramento, California
| | - Larissa May
- University of California Davis Health, Department of Emergency Medicine, Sacramento, California
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Valero-Verdejo L, Hueso-Montoro C, Pérez-Morente MÁ. Evaluation of HIV screening in hospital emergency services. Systematic review. Int Emerg Nurs 2023; 71:101355. [PMID: 37852058 DOI: 10.1016/j.ienj.2023.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/20/2023]
Abstract
AIM To evaluate HIV screening of people attending emergency services. DESIGN Systematic review. DATA SOURCES CINAHL Complete, Cochrane Library, Cuiden Plus, PubMed, PsycINFO, SCOPUS and Web of Science. REVIEW METHODS The search was carried out between December 2020 and March 2021 following the recommendations set forth in the PRISMA declaration. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the methodological quality of studies. For data extraction, a protocol was prepared. A qualitative synthesis of the main findings was carried out. RESULTS The final sample consisted of 29 articles. There are several aspects that influence the performance of HIV screening in the emergency department, such as: adequacy of place, attitude towards screening, sociodemographic characteristics, risky sexual behaviour, incidence of area, and detection tools or method employed, in addition to other factors such as the stigma associated with the disease. CONCLUSIONS Emergency services are relevant in screening the human immunodeficiency virus. Further research aimed at creating new interventions allowing early detection and adherence to treatment in this population is still a need, particularly in a first-line service like emergency services.
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Affiliation(s)
| | - César Hueso-Montoro
- Faculty of Health Sciences, University of Jaén, Jaén, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Granada, Spain.
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3
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Fisher MC, Fazzari MJ, Felsen UR, Hanna DB, Tappan N, Wyatt CM, Abramowitz MK, Ross MJ. Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy. Kidney Int 2023; 104:1008-1017. [PMID: 37598853 DOI: 10.1016/j.kint.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
In the modern era, it is unknown if people that are virally suppressed with HIV (PWH) are at increased risk for acute kidney injury (AKI) compared to people without HIV and no studies have compared the risk of AKI by viral suppression status. Here, we determined the associations of HIV status and AKI among PWH with and without viral suppression compared to people without HIV. An observational cohort study of PWH and people without HIV hospitalized in a large New York City health system between 2010-2019 was conducted. Multivariable Cox proportional hazards models were used to determine associations between HIV status and risk of AKI, severe AKI and development of chronic kidney disease (CKD). Among 173,884 hospitalized patients, 4,718 had HIV; 2,532 (53.7%) were virally suppressed and 2,186 (46.3%) were not suppressed. Compared to people without HIV, PWH with and without viral suppression were at increased risk of AKI (adjusted hazard ratio 1.27, 95% confidence interval 1.15, 1.40 and 1.73, 1.58, 1.90, respectively) and AKI requiring kidney replacement therapy (1.89, 1.27, 2.84 and 1.87, 1.23, 2.84, respectively). Incremental, graded associations were observed between HIV status and Stage 2 or 3 AKI, and among AKI survivors, and incident CKD. The elevated risk of AKI across ages of PWH was similar in magnitude to older people without HIV. Thus, regardless of virologic control, HIV is an independent risk factor for AKI among hospitalized patients. Future studies should determine the mechanisms by which HIV increases susceptibility to AKI and identify strategies to prevent AKI in PWH.
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Affiliation(s)
- Molly C Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA.
| | - Melissa J Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Uriel R Felsen
- Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Nataliya Tappan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Christina M Wyatt
- Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Matthew K Abramowitz
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Michael J Ross
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA; Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
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4
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Chang MH, Moonesinghe R, Truman BI. Emergency department claims among Medicare beneficiaries with HIV, STDs, viral hepatitis or tuberculosis before and during the COVID-19 pandemic. J Public Health (Oxf) 2023; 45:e417-e425. [PMID: 36626306 DOI: 10.1093/pubmed/fdac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/05/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Changes in emergency department (ED) usage among US Medicare beneficiaries (MB) with fee-for-service claims for HIV, viral hepatitis, sexually transmitted diseases (STDs) or tuberculosis (TB) (HHST) services have not been assessed since the COVID-19 pandemic. METHODS During 2006-20, we assessed the annual number of MB with each HHST per 1000 persons with ED claims for all conditions, and changes in demographic and geographic distribution of ED claimants for each HHST condition. RESULTS Of all persons who attended an ED for any condition, 10.5 million (27.5%) were MB with ≥1 ED claim in 2006; that number (percentage) increased to 11.0 million (26.7%) in 2019 and decreased to 9.2 million (22.7%) in 2020; < 5 MB per 1000 ED population had HHST ED claims in 2020. The percentage increase in ED claims was higher for MB with STDs than for those with other HHST conditions, including a 10% decrease for MB with TB in 2020. CONCLUSIONS Trends in ED usage for HHST conditions were associated with changes in demographic and geographic distribution among MB during 2006-20. Updated ED reimbursement policies and primary care practices among MB might improve prevention, diagnosis and treatment of HHST conditions in the future.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, CDC, Atlanta, GA, USA
| | - Benedict I Truman
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Retired in May 2022
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Noiriel N, Williams J. Early cost-utility analysis of hepatitis C virus testing for emergency department attendees in France. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001559. [PMID: 36963042 PMCID: PMC10021824 DOI: 10.1371/journal.pgph.0001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023]
Abstract
Testing for hepatitis C virus (HCV) is currently targeted towards those at high-risk in France. While universal screening was recently rejected, a growing body of research from other high-income countries suggests that HCV testing in emergency departments (ED) can be effective and cost-effective. In the absence of any studies on the effectiveness of HCV testing in ED attendees in France, this study aimed to perform an early economic evaluation of ED-based HCV testing. A Markov model was developed to simulate HCV testing in the ED versus no ED testing. The model captured costs from a French health service perspective, presented in 2020 euros, and outcomes, presented as quality-adjusted life years (QALYs), over a lifetime horizon. Incremental cost-effectiveness ratios (ICER) were calculated as costs per QALYs gained and compared to willingness-to-pay thresholds of €18,592 and €33,817 per QALY. Value of information analyses were also performed. ED testing for HCV was cost-effective at both thresholds when assuming ED prevalence of 1.1%, yielding an ICER of €3,800 per QALY. Testing remained cost-effective when the HCV prevalence amongst ED attendees remained higher than in the general population (0.3%). The maximum value of future research ranged from €10 to €79 million, depending on time horizons and willingness-to-pay thresholds. Our analysis suggests ED-based HCV testing may be cost-effective in France, although there is uncertainty due to the lack of empirical studies available. Further research is of high value, suggesting seroprevalence surveys and pilot studies in French ED settings are warranted.
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Affiliation(s)
- Nicolas Noiriel
- London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Jack Williams
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
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Zucker J, Purpura L, Sani F, Huang S, Schluger A, Ruperto K, Slowkowski J, Olender S, Scherer M, Castor D, Gordon P. Individualized Provider Feedback Increased HIV and HCV Screening and Identification in a New York City Emergency Department. AIDS Patient Care STDS 2022; 36:106-114. [PMID: 35289689 PMCID: PMC8971984 DOI: 10.1089/apc.2021.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Efforts to end the HIV and hepatitis C virus (HCV) epidemics begin with ascertainment of a person's infection status through screening. Despite its importance as a site of testing, missed opportunities for screening in the Emergency Department (ED) are common. We describe the impact of implementing an individualized provider feedback intervention on HIV and HCV testing in a quaternary ED. We conducted an interrupted time series analysis to evaluate the impact of the intervention on weekly HIV and HCV screening in an observational cohort of patients seeking care in the ED. The intervention included a physician champion individualized feedback with peer comparisons to all providers in the ED and an existing HIV/HCV testing and response team. Data were abstracted from the electronic medical record (EMR) for 30 weeks before, during, and after implementing the intervention. We used Poisson regression analysis to estimate changes in the weekly counts and rates of HIV and HCV testing. The incidence rate ratios (IRRs) of HIV testing were 1.94 [95% confidence interval (CI) 1.85-2.04] and 1.38 (95% CI 1.31-1.45) times higher for the intervention and post-intervention period compared with the pre-intervention period. The IRRs of HCV testing was 6.96 (95% CI 6.40-7.58) and 4.70 (95% CI 4.31-5.13) for the intervention and post-intervention periods. There were no meaningful differences in demographic characteristics during the observation period. The intervention meaningfully increased HIV and HCV testing volume and positive case detection, including testing in high-risk groups like young adults and individuals without prior testing. Although diminished, the intervention effect sustained in the 30-week period following implementation.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,Address correspondence to: Jason Zucker, MD, Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, 622 West 168th Street 8th Floor, New York, NY 10032, USA
| | - Lawrence Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Fereshteh Sani
- Acute Care Services, Attending Physician, Emergency Medicine, Permanente Medicine, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Simian Huang
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Aaron Schluger
- Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Kenneth Ruperto
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jacek Slowkowski
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Matt Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
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Martel-Laferriere V, Baril JG, Alarie I, Leblanc J, Côté J, Jourdenais E, Horth D, Lambert G, Tremblay C. Opt-out universal HCV and HIV screening in a Canadian emergency room: a cross-sectional study. BMJ Open 2022; 12:e048748. [PMID: 35042704 PMCID: PMC8768931 DOI: 10.1136/bmjopen-2021-048748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the prevalence of undiagnosed hepatitis C virus (HCV) and HIV cases in a population sample tested in the emergency room (ER) and to evaluate linkage-to-care. SETTING Canadian university hospital. PARTICIPANTS Adults born after 1945 who consulted at ER for any condition and on any shift were included. Patients unable to opt-out were excluded. INTERVENTIONS ER nurse confirmed patients' eligibility and provided them with the option to opt-out. A physician met patients with a new diagnosis. Linkage-to-care was assessed 3 months postdiagnosis. Patients newly diagnosed with HCV were considered linked if they had an HCV RNA test, genotype, liver fibrosis evaluation, and if indicated, treatment prescription. Patients newly diagnosed with HIV were considered linked to care if they had an HIV serology confirmation test, viral load, CD4 cell count and started antiretroviral therapy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary objective: to determine the prevalence (overall and undiagnosed cases) of HIV and HCV among the patients who consult the ER. Secondary objectives: to determine the proportion of patients who opt-out, assess the adherence of emergency staff to the offer of testing, determine the proportion of patients linked to care at 3 months. RESULTS Among 6350 eligible patients informed of the screening programme, 62.1% of patients were tested for at least one virus (HIV: 3905; HCV: 3910). 25% patients opted-out, 12% were not tested for organisational reasons, 0.3% (18) patients were HCV-HIV coinfected. Overall prevalence of HCV and HIV cases were 1.9% and 1.2%, respectively. Prevalence of new cases was 0.23% (95% CI 0.12% 0.45%) for HCV and 0.05% (95% CI 0.01% to 0.20%) for HIV. Among the new cases, only two HCV-infected and one HIV-infected patients were linked-to-care 3 months postdiagnosis. CONCLUSIONS Identification of new cases of HCV and HIV through universal screening at the ER and linkage-to-care were both low. TRIAL REGISTRATION NUMBER NCT03595527; Results.
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Affiliation(s)
- Valerie Martel-Laferriere
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Guy Baril
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Clinique médicale urbaine du Quartier-Latin, Montreal, Québec, Canada
| | - Isabelle Alarie
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, CHUS, Sherbrooke, Québec, Canada
| | - Judith Leblanc
- AP-HP Greater Paris University Hospital, AP-HP.Sorbonne Université, Clinical Research Platform of East of Paris, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, SUMO, Paris, France
| | - José Côté
- CRCHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuelle Jourdenais
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Damy Horth
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Quebec, Canada
| | - Cécile Tremblay
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Wyatt B, Perumalswami PV, Mageras A, Miller M, Harty A, Ma N, Bowman CA, Collado F, Jeon J, Paulino L, Dinani A, Dieterich D, Li L, Vandromme M, Branch AD. A Digital Case-Finding Algorithm for Diagnosed but Untreated Hepatitis C: A Tool for Increasing Linkage to Treatment and Cure. Hepatology 2021; 74:2974-2987. [PMID: 34333777 PMCID: PMC9299620 DOI: 10.1002/hep.32086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Although chronic HCV infection increases mortality, thousands of patients remain diagnosed-but-untreated (DBU). We aimed to (1) develop a DBU phenotyping algorithm, (2) use it to facilitate case finding and linkage to care, and (3) identify barriers to successful treatment. APPROACH AND RESULTS We developed a phenotyping algorithm using Java and SQL and applied it to ~2.5 million EPIC electronic medical records (EMRs; data entered January 2003 to December 2017). Approximately 72,000 EMRs contained an HCV International Classification of Diseases code and/or diagnostic test. The algorithm classified 10,614 cases as DBU (HCV-RNA positive and alive). Its positive and negative predictive values were 88% and 97%, respectively, as determined by manual review of 500 EMRs randomly selected from the ~72,000. Navigators reviewed the charts of 6,187 algorithm-defined DBUs and they attempted to contact potential treatment candidates by phone. By June 2020, 30% (n = 1,862) had completed an HCV-related appointment. Outcomes analysis revealed that DBU patients enrolled in our care coordination program were more likely to complete treatment (72% [n = 219] vs. 54% [n = 256]; P < 0.001) and to have a verified sustained virological response (67% vs. 46%; P < 0.001) than other patients. Forty-eight percent (n = 2,992) of DBU patients could not be reached by phone, which was a major barrier to engagement. Nearly half of these patients had Fibrosis-4 scores ≥ 2.67, indicating significant fibrosis. Multivariable logistic regression showed that DBUs who could not be contacted were less likely to have private insurance than those who could (18% vs. 50%; P < 0.001). CONCLUSIONS The digital DBU case-finding algorithm efficiently identified potential HCV treatment candidates, freeing resources for navigation and coordination. The algorithm is portable and accelerated HCV elimination when incorporated in our comprehensive program.
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Affiliation(s)
- Brooke Wyatt
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY,Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI,Gastroenterology SectionVeterans AffairsAnn Arbor Healthcare SystemAnn ArborMI
| | - Anna Mageras
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Mark Miller
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Alyson Harty
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Ning Ma
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Chip A. Bowman
- Department of MedicineIcahn School of Medicine Mount SinaiNew YorkNY
| | - Francina Collado
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Jihae Jeon
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Lismeiry Paulino
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Amreen Dinani
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Douglas Dieterich
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Li Li
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Maxence Vandromme
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
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Zucker J, Carnevale C, Theodore D, Castor D, Meyers K, Gold J, Winetsky D, Scherer M, Cohall A, Gordon P, Sobieszczyk M, Olender S. Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees. AIDS Patient Care STDS 2021; 35:180-187. [PMID: 33901410 PMCID: PMC8106251 DOI: 10.1089/apc.2021.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Carnevale
- New York-Presbyterian Hospital HIV Prevention Program, New York, New York, USA
| | - Deborah Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center at Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jeremy Gold
- Department of Internal Medicine and Columbia University Irving Medical Center, New York, USA
| | - Daniel Winetsky
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Scherer
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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#Testathome: Implementing 2 Phases of a HIV Self-Testing Program Through Community-Based Organization Partnerships in New York City. Sex Transm Dis 2021; 47:S48-S52. [PMID: 32149962 DOI: 10.1097/olq.0000000000001151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Access to human immnodeficiency virus (HIV) testing in New York City (NYC) has increased, but disparities in testing rates still exist among most communities impacted by HIV. HIV self-tests (HIVSTs) present an opportunity to address testing barriers, but HIV-affected communities experience difficulties accessing HIVSTs, including lack of awareness and cost. To support increased access to HIVSTs, the NYC Health Department launched a partnership with select organizations to pilot distribution of free HIVSTs in 2 phases among priority populations across NYC. METHODS Organizations that were diverse in their missions, experiences, capacities and populations served were recruited through a formal application process. The program initially launched with 10 organization partners (phase 1); as the pilot continued, partners identified necessary revisions to the program and launched a second phase in year 2. Both phases included outreach to NYC priority populations, HIVST distribution/redemption, and a follow-up survey. RESULTS From March 2017 to August 2019, organizations distributed 75 HIVSTs during phase 1 and 252 during phase 2. All intended priority populations were reached, notably, those who had never tested before: 35% in phase 1 and 12% in phase 2. Over half of the follow-up survey respondents reported testing sooner. Respondents reported liking the HIVST because it did not require a visit to a clinic (84%) and preferred an HIVST to testing in a clinic (92%). CONCLUSIONS Through 2 phases of implementation, this innovative partnership was able to reach and offer HIVSTs to priority populations across NYC. This program supports the feasibility of distributing HIVSTs through close partnerships with diverse organizations.
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Patel AA, Bui A, Prohl E, Bhattacharya D, Wang S, Branch AD, Perumalswami PV. Innovations in Hepatitis C Screening and Treatment. Hepatol Commun 2021; 5:371-386. [PMID: 33681673 PMCID: PMC7917266 DOI: 10.1002/hep4.1646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
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Affiliation(s)
- Arpan A. Patel
- Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
| | - Aileen Bui
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Eian Prohl
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Debika Bhattacharya
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
- Division of Infectious DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Su Wang
- Saint Barnabas Medical CenterLivingstonNJUSA
- World Hepatitis AllianceLondonUnited Kingdom
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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Hepatitis C virus infection and risk factors among patients and health-care workers of Ain Shams University hospitals, Cairo, Egypt. PLoS One 2021; 16:e0246836. [PMID: 33556152 PMCID: PMC7870060 DOI: 10.1371/journal.pone.0246836] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hospitals are suspected of playing a key role in HCV epidemic dynamics in Egypt. This work aimed at assessing HCV prevalence and associated risk factors in patients and health-care workers (HCWs) of Ain Shams University (ASU) hospitals in Cairo. Methods We included 500 patients admitted to the internal medicine or surgery hospital from February to July, 2017, as well as 50 HCWs working in these same hospitals. Participants were screened for anti-HCV antibodies and HCV RNA. A questionnaire was administered to collect data on demographic characteristics and medical/surgical history. For HCWs, questions on occupational exposures and infection control practices were also included. Results The overall prevalence of anti-HCV antibodies was 19.80% (95% CI: 16.54–23.52) among participating patients, and 8.00% (95% CI: 0.48–15.52) among participating HCWs. In HCWs, the only risk factors significantly associated with anti-HCV antibodies were age and profession, with higher prevalence in older HCWs and those working as cleaners or porters. In patients, in a multivariate logistic regression, age over 50 (aOR: 3.4 [1.9–5.8]), living outside Cairo (aOR: 2.1 [1.2–3.4]), admission for liver or gastro-intestinal complaints (aOR: 4.2 [1.8–9.9]), and history of receiving parenteral anti-schistosomiasis treatment (aOR: 2.7 [1.2–5.9]) were found associated with anti-HCV antibodies. Conclusions While HCV prevalence among patients has decreased since the last survey performed within ASU hospitals in 2008, it is still significantly higher than in the general population. These results may help better control further HCV spread within healthcare settings in Egypt by identifying at-risk patient profiles upon admission.
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Patel VV, Felsen UR, Fisher M, Fazzari MJ, Ginsberg MS, Beil R, Akiyama MJ, Anastos K, Hanna DB. Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19. J Acquir Immune Defic Syndr 2021; 86:224-230. [PMID: 33433966 PMCID: PMC8720497 DOI: 10.1097/qai.0000000000002578] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data exist about clinical outcomes and levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus and by HIV viral suppression. SETTING Large tertiary care health system in the Bronx, NY, USA. METHODS We conducted a retrospective cohort study of 4613 SARS-CoV-2 PCR-positive patients admitted between March 10, 2020, and May 11, 2020. We examined in-hospital intubation, acute kidney injury (AKI), hospitalization length, and in-hospital mortality by HIV serostatus, and by HIV-viral suppression and CD4 counts among people living with HIV (PLWH) using adjusted competing risks regression. We also compared immune and inflammatory marker levels by HIV serostatus and viral suppression. RESULTS Most patients were either non-Hispanic Black (36%) or Hispanic (37%); 100/4613 (2.2%) were PLWH, among whom 15 had detectable HIV viral load. PLWH compared to patients without HIV had increased intubation rates (adjusted hazard ratio 1.73 [95% CI: 1.12 to 2.67], P = 0.01). Both groups had similar rates of AKI, length of hospitalization, and death. No (0%) virally unsuppressed PLWH were intubated or died, versus 21/81 (26%, P = 0.04) and 22/81 (27%, P = 0.02) of virally suppressed PLWH, respectively. Among PLWH, higher CD4 T-cell counts were associated with increased intubation rates. C-reactive protein, IL-6, neutrophil counts, and ferritin levels were similar between virally suppressed PLWH and patients without HIV, but significantly lower for unsuppressed PLWH (all P < 0.05). CONCLUSIONS PLWH had increased risk of intubation but similarly frequent rates of AKI and in-hospital death as those without HIV. Findings of no intubations or deaths among PLWH with unsuppressed HIV viral load warrant further investigation.
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Affiliation(s)
- Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Uriel R. Felsen
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Molly Fisher
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Melissa J. Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Mindy S. Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Robert Beil
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Matthew J. Akiyama
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
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Nontargeted Hepatitis C Screening in an Urban Emergency Department in New York City. J Emerg Med 2020; 60:299-309. [PMID: 33213988 DOI: 10.1016/j.jemermed.2020.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previously the Centers for Disease Control and Prevention (CDC) recommended targeted hepatitis C virus (HCV) screening for adults born between 1945 and 1965 and individuals with HCV risk factors. In April 2020, the CDC updated their recommendations to now include all individuals 18 years of age and older in settings with HCV prevalence > 0.1%. Few emergency departments (EDs) currently employ this nontargeted screening approach. OBJECTIVES We examined how a shift from targeted to nontargeted screening might affect HCV case identification. We hypothesized that nontargeted screening could improve HCV case identification in our ED. METHODS Retrospective review of prospectively collected nontargeted screening data from June 6, 2018 to June 5, 2019 in a large urban academic ED. Patients 18 years of age and older, triaged to the adult or pediatric ED and able to provide consent for HCV testing, were eligible for study inclusion. RESULTS There were 83,864 ED visits and 40,282 unique patients deemed eligible for HCV testing. Testing occurred in 10,630 (26.4%) patients, of which 638 (6%) had positive HCV antibody (Ab+) tests and 214 (2%) had a positive viral load (VL+). Birth cohort-targeted screening would have identified 48% of the patients with Ab+ tests and 47% of those who were VL+. Risk-based targeted screening would increase the number of Ab+ patients to 67% and VL+ to 72%. CONCLUSIONS Nontargeted ED-based HCV screening can identify a large number of patients with HCV infection. A shift from targeted to nontargeted screening may result in fewer missed infections but requires further study.
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Aronson ID, Bennett AS, Freeman R. Toward a human-centered use of technology: a stakeholder analysis of harm reduction and CBO staff. Harm Reduct J 2020; 17:77. [PMID: 33076911 PMCID: PMC7570409 DOI: 10.1186/s12954-020-00422-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Technology can enable syringe service programs (SSPs) and other community-based organizations (CBOs) operating under a harm reduction framework to work with an increased number of clients and can also enable organizations to offer services more effectively (e.g., offering HIV testing in ways participants may be more likely to accept). In the current time of COVID-19 social distancing, technology can also help organizations more safely provide services to people with compromised immune systems and to clients who might otherwise not be reached. However, technology projects implemented in harm reduction settings are frequently conceptualized and developed by researchers or technology specialists rather than by SSP staff or clients. Methods To more effectively meet the needs of SSPs and other CBOs across the USA, our team conducted qualitative interviews with 16 individuals who have extensive backgrounds working in the field of harm reduction. Interviews were digitally recorded and professionally transcribed, and the transcripts were checked for accuracy by the interviewers. The resulting transcripts were coded and analyzed to determine emerging themes. Results Interviewees mentioned the ability of technology to deliver consistent quality messaging to multiple clients at the same time and the potential to customize or tailor technology-based messaging to specific client populations as positive benefits. Clear barriers to technology use also emerged, in particular regarding privacy, data security, and the need to maintain client trust when discussing sensitive issues (e.g., illicit drug use). Conclusions Technology offers the potential to deliver consistently high-quality health communication and maintain contact with clients who may have no other access to care. If designed and managed effectively, technology can also address issues related to providing services during times when physical contact is limited due to COVID-19 social distancing measures.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, USA. .,New York University, School of Global Public Health, New York, USA.
| | - Alex S Bennett
- Digital Health Empowerment, Brooklyn, USA.,New York University, School of Global Public Health, New York, USA
| | - Robert Freeman
- New York University, School of Global Public Health, New York, USA
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16
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Shitole SG, Kuniholm MH, Hanna DB, Boucher T, Peng AY, Berardi C, Shah T, Bortnick AE, Christia P, Scheuer J, Kizer JR. Association of human immunodeficiency virus and hepatitis C virus infection with long-term outcomes post-ST segment elevation myocardial infarction in a disadvantaged urban community. Atherosclerosis 2020; 311:60-66. [PMID: 32947199 PMCID: PMC7572633 DOI: 10.1016/j.atherosclerosis.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND HIV and HCV have been linked to an increased risk of cardiovascular disease (CVD). Their impact on long-term outcomes following ST-segment myocardial infarction (STEMI) has not been previously studied. METHODS We leveraged data from a STEMI registry (n = 1208) at an inner-city health system to assess the influence of HIV and HCV on post-STEMI outcomes. Cox regression was used to compare HIV-monoinfected (n = 22), HCV-monoinfected (n = 26) and HIV-HCV-coinfected patients (n = 8) with the neither-infected group (n = 1152) with regard to death, death or any readmission, and death or CVD readmission. RESULTS The cohort was majority black or Hispanic. Median follow-up was 4.3 years. Compared to the neither-infected group, the HIV-monoinfected group showed near-significantly higher risks of death or any readmission (HR = 1.62, 95% CI = 0.96, 2.74) and death or CVD readmission (HR = 1.82, 95% CI = 0.98, 3.39) after full adjustment. On similar comparison, the HCV-monoinfected group exhibited significantly higher risks of death (HR = 2.09, 95% CI = 1.05, 4.15) and death or any readmission (HR = 1.68, 95% CI = 1.07, 2.65), whereas the HIV-HCV-coinfected group showed higher risk of death (HR = 6.51, 95% CI = 2.28, 18.61). CONCLUSIONS In this cohort composed mostly of race-ethnic minorities, HIV monoinfection tended to be associated with 1.6-to-1.8-fold higher risk of death or readmission for any cause or CVD over long-term follow-up compared to neither infection, whereas HCV monoinfection was associated with 1.7-to-2.1-fold higher risk of death and death or any readmission, and HIV-HCV coinfection with 6.5-fold higher risk of death. These associations require further study in larger populations, but highlight the importance of identifying and treating HIV and HCV in patients presenting with STEMI.
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Affiliation(s)
- Sanyog G Shitole
- University of California San Francisco and San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA.
| | - Mark H Kuniholm
- University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - David B Hanna
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Thomas Boucher
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Angel Y Peng
- Montefiore Health System, 3311 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Cecilia Berardi
- Yale-New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA
| | - Tina Shah
- Montefiore Health System, 3311 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Anna E Bortnick
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA; Montefiore Health System, 3311 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Panagiota Christia
- Mount Sinai Heart-Mount Sinai Medical Center, 1468 Madison Avenue, New York, NY, 10029, USA
| | - James Scheuer
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA; Montefiore Health System, 3311 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Jorge R Kizer
- University of California San Francisco and San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
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Mendlowitz AB, Naimark D, Wong WWL, Capraru C, Feld JJ, Isaranuwatchai W, Krahn M. The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation. Liver Int 2020; 40:1282-1291. [PMID: 32267604 DOI: 10.1111/liv.14458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. METHODS We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. RESULTS For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. CONCLUSIONS ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Naimark
- Department of Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,University Health Network - Toronto General Hospital, Toronto, ON, Canada
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18
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Branch AD. Escape from planned obsolescence: Hepatitis C, the cirrhotic liver, and clonal expansions. J Exp Med 2020; 217:133817. [PMID: 33002101 PMCID: PMC7062522 DOI: 10.1084/jem.20191070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 11/04/2022] Open
Abstract
Eliminating the burden of disease caused by hepatitis C virus infection is proving difficult, despite the availability of curative drug treatments. Progress will require innovations in healthcare delivery and a deeper understanding of how the liver and other vital organs survive damage caused by chronic injury.
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Aronson ID, Cleland CM, Rajan S, Marsch LA, Bania TC. Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients. AIDS Behav 2020; 24:475-483. [PMID: 31049808 DOI: 10.1007/s10461-019-02517-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
More than 10 years after the Centers for Disease Control and Prevention recommended routine HIV testing for patients in emergency departments (ED) and other clinical settings, as many as three out of four patients may not be offered testing, and those who are offered testing frequently decline. The current study examines how participant characteristics, including demographics and reported substance use, influence the efficacy of a video-based intervention designed to increase HIV testing among ED patients who initially declined tests offered by hospital staff. Data from three separate trials in a high volume New York City ED were merged to determine whether patients (N = 560) were more likely to test post-intervention if: (1) they resembled people who appeared onscreen in terms of gender or race; or (2) they reported problem substance use. Chi Square and logistic regression analyses indicated demographic concordance did not significantly increase likelihood of accepting an HIV test. However, participants who reported problem substance use (n = 231) were significantly more likely to test for HIV in comparison to participants who reported either no problem substance use (n = 190) or no substance use at all (n = 125) (x2 = 6.830, p < 0.05). Specifically, 36.4% of patients who reported problem substance use tested for HIV post-intervention compared to 30.5% of patients who did not report problem substance use and 28.8% of participants who did not report substance use at all. This may be an important finding because substance use, including heavy alcohol or cannabis use, can lead to behaviors that increase HIV risk, such as sex with multiple partners or decreased condom use.
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Winetsky D, Zucker J, Carnevale C, Theodore D, Scherer M, Sani F, Elkington K, Cohall A, Sobieszczyk ME, Gordon P, Olender S. Attitudes, practices and perceived barriers to hepatitis C screening among medical residents at a large urban academic medical center. J Viral Hepat 2019; 26:1355-1358. [PMID: 31325394 PMCID: PMC6800582 DOI: 10.1111/jvh.13181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
Infections with hepatitis C virus (HCV) are increasing among adolescents and adults born after 1965. Screening strategies may need to be adapted for this changing population. We surveyed trainees in different specialties about attitudes and practices related to HCV screening and identified specific barriers to screening across various healthcare settings. Constraints related to health system resources and the provider's role were among the most common barriers cited across specialties, but paediatrics residents also cited barriers specific to their population, which can likely be addressed with targeted education.
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Affiliation(s)
- Daniel Winetsky
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY,HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY
| | - Jason Zucker
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY,Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Caroline Carnevale
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY
| | - Deborah Theodore
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Matthew Scherer
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Fereshteh Sani
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY
| | - Katherine Elkington
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Alwyn Cohall
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Magdalena E. Sobieszczyk
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Peter Gordon
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Susan Olender
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
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21
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Felsen UR, Torian LV, Futterman DC, Stafford S, Xia Q, Allan D, Esses D, Cunningham CO, Weiss JM, Zingman BS. An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection: insights from a blinded serosurvey. AIDS Care 2019; 32:202-208. [PMID: 31146539 DOI: 10.1080/09540121.2019.1619663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Screening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5%) were offered HIV screening and 543 (38.7% of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25%): six among those offered screening (0.4%), and six among those not offered screening (0.2%). Among those with undiagnosed HIV, two (16.7%) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80% of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.
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Affiliation(s)
- Uriel R Felsen
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Lucia V Torian
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Donna C Futterman
- Adolescent AIDS Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stephen Stafford
- Adolescent AIDS Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qiang Xia
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - David Allan
- Department of Emergency Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - David Esses
- Department of Emergency Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey M Weiss
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Barry S Zingman
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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22
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Scognamiglio P, Navarra A, Orchi N, De Carli G, Pittalis S, Mastrorosa I, Visco Comandini U, Agrati C, Antinori A, Puro V, Ippolito G, Girardi E. Unawareness of HCV serostatus among persons newly diagnosed with HIV. J Infect Public Health 2019; 12:733-737. [PMID: 30737128 DOI: 10.1016/j.jiph.2019.01.055] [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] [Received: 08/28/2018] [Revised: 12/27/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Treatment of chronic HCV infection with direct acting antivirals can achieve high rates of sustained viral response in persons with HIV. In the perspective of HCV elimination in this population, high rates of HCV detection will be needed. We evaluated the unawareness of HCV infection in 2927 persons newly diagnosed with HIV during 2004-2015 in Rome, Italy. Two-hundred-fifty persons (8.5%) were anti-HCV positive. The proportion of HCV-unaware individuals at the time of HIV diagnosis was 58.0% (145/250), without significant variations over time, 17.2% showed an advanced fibrosis stage. The absence of previous HIV testing was significantly associated with HCV unawareness.
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Affiliation(s)
- Paola Scognamiglio
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Assunta Navarra
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy.
| | - Nicoletta Orchi
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Gabriella De Carli
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Silvia Pittalis
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ubaldo Visco Comandini
- Clinical Division of Hepatology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Chiara Agrati
- Laboratory of Virology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Vincenzo Puro
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
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