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Pinkney J, Tong Y, Hoeppner S, Derrick C, Talente G, Hurtado R, Psaros C, Ojikutu BO, Bogart LM, Albrecht H, Ahuja D, Hyle E. Who declines "opt-out" HIV/HCV testing? Experience of an internal medicine resident continuity clinic serving a predominantly Black adult population in South Carolina. J Natl Med Assoc 2024; 116:351-361. [PMID: 39079827 PMCID: PMC11365769 DOI: 10.1016/j.jnma.2024.07.009] [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: 12/11/2023] [Revised: 01/25/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Universal "opt-out" human immunodeficiency virus (HIV) or hepatitis C virus (HCV) testing involves testing individuals for HIV or HCV regardless of symptoms, unless they decline. Little is known about the characteristics of individuals who decline. METHODS We conducted a retrospective, medical record review of adults evaluated at an outpatient clinic in South Carolina. "Opt-out" HIV/HCV testing was implemented in Feb 2019; we reviewed medical records of individuals evaluated in May - July 2019. We excluded individuals who did not meet age-based screening criteria (HIV: 18-65 years; HCV: 18-74 years), had a prior HIV/HCV diagnosis, were tested for HIV/HCV within the preceding 12 months, and whose "opt-out" decision was not documented. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for "opt-out" decision, with age, sex, race/ethnicity, insurance status, visit type, and genitourinary vs. non-genitourinary chief complaints as predictors. RESULTS The final analyses included 706 individuals for HIV and 818 for HCV. Most individuals were non-Hispanic Black (77 % and 78 %) and female (66 % and 64 %). The mean ages were 49.1 (±11.9) and 51.9 (±13.2). Nearly one-third of individuals declined HIV and HCV testing (31 % and 30 %). Black males were more likely to decline HIV and HCV testing than Black females (aOR = 1.61 [95 % CI. 1.08 - 2.40] and aOR = 1.50 [95 %CI. 1.04 - 2.16]). CONCLUSION Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status. MAIN POINT Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.
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Affiliation(s)
- Jodian Pinkney
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Yao Tong
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susanne Hoeppner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caroline Derrick
- Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Gregg Talente
- Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Rocio Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Psaros
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bisola O Ojikutu
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Boston Public Health Commission, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Helmut Albrecht
- Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Divya Ahuja
- Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Emily Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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2
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Simmons R, Plunkett J, Cieply L, Ijaz S, Desai M, Mandal S. Blood-borne virus testing in emergency departments - a systematic review of seroprevalence, feasibility, acceptability and linkage to care. HIV Med 2023; 24:6-26. [PMID: 35702813 DOI: 10.1111/hiv.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Blood-borne viruses (BBVs) cause significant morbidity and mortality worldwide. Emergency departments (EDs) offer a point of contact for groups at increased risk of BBVs who may be less likely to engage with primary care. We reviewed the literature to evaluate whether BBV testing in this setting might be a viable option to increase case finding and linkage to care. METHODS We searched PubMed database for English language articles published until June 2019 on BBV testing in EDs. Studies reporting seroprevalence surveys, feasibility, linkage to care, enablers and barriers to testing were included. Additional searches for grey literature were performed. RESULTS Eight-nine articles met inclusion criteria, of which 14 reported BBV seroprevalence surveys in EDs, 54 investigated feasibility and acceptability, and 36 investigated linkage to care. Most studies were HIV-focused and conducted in the USA. Seroprevalence rates were in the range 1.5-17% for HCV, 0.7-1.6% for HBV, and 0.8-13% for HIV. For studies that used an opt-in study design, testing uptake ranged from 2% to 98% and for opt-out it ranged from 16% to 91%. There was a wide range of yield: 13-100% of patients received their test result, 21-100% were linked to care, and 50-91% were retained in care. Compared with individuals diagnosed with HIV, linkage to and retention in care were lower for those diagnosed with hepatitis C. Predictors of linkage to care was associated with certain patient characteristics. CONCLUSIONS Universal opt-out BBV testing in EDs may be feasible and acceptable, but linkage to care needs to be improved by optimizing implementation. Further economic evaluations of hepatitis testing in EDs are needed.
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Affiliation(s)
- Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - James Plunkett
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Lukasz Cieply
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Samreen Ijaz
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK.,Blood Borne Virus Unit, Virus Reference Department, UK Health Security Agency, London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
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3
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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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4
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Williams J, Vickerman P, Smout E, Page EE, Phyu K, Aldersley M, Nebbia G, Douthwaite S, Hunter L, Ruf M, Miners A. Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:60. [PMID: 36376920 PMCID: PMC9664679 DOI: 10.1186/s12962-022-00388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on 2 long-term studies of the real-world effectiveness of testing in 2 large ED’s in the UK. Methods A Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5–0.9% and an HCV RNA prevalence of 0.9–1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89–94% likely to be cost-effective at the threshold, while HCV testing was 94–100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥ 0.25% HBsAg prevalence, and ≥ 0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study. Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00388-7.
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Abstract
OBJECTIVE To understand the impact of clinical decision support systems (CDSSs) on improving HIV testing and diagnosis. DESIGN An original global systematic review (PROSPERO Number: CRD42020175576) of peer-reviewed articles reporting on electronic CDSSs that generate triggers encouraging healthcare providers to perform an HIV test. METHODS Medline, Embase, Cochrane CENTRAL and CINAHL EBSCOhost were searched up to 17 November 2020 and reference lists of included articles were checked. Qualitative and quantitative syntheses (using meta-analyses) of identified studies were performed. RESULTS The search identified 1424 records. Twenty-two articles met inclusion criteria (19 of 22 non-HIV endemic settings); 18 clinical and four laboratory-driven reminders. Reminders promoted 'universal' HIV testing for all patients without a known HIV infection and no recent documented HIV test, or 'targeted' HIV testing in patients with clinical risk-factors or specific diagnostic tests. CDSSs increased HIV testing in hospital and nonhospital setting, with the pooled risk-ratio amongst studies reporting comparable outcome measures in hospital settings (n = 3) of 2.57 [95% confidence interval (CI) 1.53-4.33, random-effect model] and in nonhospital settings (n = 4) of 2.13 (95% CI 1.78-4.14, random effect model). Results of the clinical impact of CDSSs on HIV diagnosis were mixed. CONCLUSION CDSSs improve HIV testing and may, potentially, improve diagnosis. The data support the broader study of CDSSs in low- and high prevalent HIV settings to determine their precise impact on UNAIDS goals to reach universal HIV testing and treatment coverage.
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Abstract
An enhanced cascade of care should include a younger population, helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population. Furthermore, enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus (HCV) infection in the pediatric population. The present work discusses and comments on the topic "cascade of care in HCV chronic pediatric patients".
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Affiliation(s)
- Nouhoum Bouare
- Biomedical Sciences, National Institute of Public Health, Bamako 1771, Mali.
| | - Mamadou Keita
- Department of Prevention, Medical and Psychosocial Management, CSLS-HIV-TB-H, Bamako E 595, Mali
| | - Jean Delwaide
- Department of Gastroenterology and Hepatology, CHULiege, Liege 4000, Belgium
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7
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Bouare N, Keita M, Delwaide J. Comment on review article: Chronic hepatitis C virus infection cascade of care in pediatric patients. World J Gastroenterol 2022; 28:1494-1498. [PMID: 35582673 PMCID: PMC9048473 DOI: 10.3748/wjg.v28.i14.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/20/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
An enhanced cascade of care should include a younger population, helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population. Furthermore, enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus (HCV) infection in the pediatric population. The present work discusses and comments on the topic "cascade of care in HCV chronic pediatric patients".
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Affiliation(s)
- Nouhoum Bouare
- Biomedical Sciences, National Institute of Public Health, Bamako 1771, Mali
| | - Mamadou Keita
- Department of Prevention, Medical and Psychosocial Management, CSLS-HIV-TB-H, Bamako E 595, Mali
| | - Jean Delwaide
- Department of Gastroenterology and Hepatology, CHULiege, Liege 4000, Belgium
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8
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Bouare N, Keita M, Delwaide J. Comment on review article: Chronic hepatitis C virus infection cascade of care in pediatric patients. World J Gastroenterol 2022. [PMID: 35582673 DOI: 10.3748/wjg.v28.i14.1494 bouare n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nouhoum Bouare
- Biomedical Sciences, National Institute of Public Health, Bamako 1771, Mali.
| | - Mamadou Keita
- Department of Prevention, Medical and Psychosocial Management, CSLS-HIV-TB-H, Bamako E 595, Mali
| | - Jean Delwaide
- Department of Gastroenterology and Hepatology, CHULiege, Liege 4000, Belgium
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9
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Hsieh YH, Rothman RE, Solomon SS, Anderson M, Stec M, Laeyendecker O, Lake IV, Fernandez RE, Dashler G, Mehta R, Kickler T, Kelen GD, Mehta SH, Cloherty GA, Quinn TC. A Tale of Three Pandemics – SARS-CoV-2, HCV, and HIV in an Urban Emergency Department in Baltimore, Maryland. Open Forum Infect Dis 2022; 9:ofac130. [PMID: 35392453 PMCID: PMC8982772 DOI: 10.1093/ofid/ofac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background We sought to determine the prevalence and sociodemographic and clinical correlates of acute and convalescent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among emergency department (ED) patients in Baltimore. Methods Remnant blood samples from 7450 unique patients were collected over 4 months in 2020 for SARS-CoV-2 antibody (Ab), HCV Ab, and HIV-1/2 antigen and Ab. Among them, 5012 patients were tested by polymerase chain reaction for SARS-CoV-2 based on clinical suspicion. Sociodemographics, ED clinical presentations, and outcomes associated with coinfections were assessed. Results Overall, 729 (9.8%) patients had SARS-CoV-2 (acute or convalescent), 934 (12.5%) HCV, 372 (5.0%) HIV infection, and 211 patients (2.8%) had evidence of any coinfection (HCV/HIV, 1.5%; SARS-CoV-2/HCV, 0.7%; SARS-CoV-2/HIV, 0.3%; SARS-CoV-2/HCV/HIV, 0.3%). The prevalence of SARS-CoV-2 (acute or convalescent) was significantly higher in those with HCV or HIV vs those without (13.6% vs 9.1%, P < .001). Key sociodemographic disparities (race, ethnicity, and poverty) and specific ED clinical characteristics were significantly correlated with having any coinfections vs no infection or individual monoinfection. Among those with HCV or HIV, aged 18–34 years, Black race, Hispanic ethnicity, and a cardiovascular-related chief complaint had a significantly higher odds of having SARS-CoV-2 (prevalence ratios: 2.02, 2.37, 5.81, and 2.07, respectively). Conclusions The burden of SARS-CoV-2, HCV, and HIV co-pandemics and their associations with specific sociodemographic disparities, clinical presentations, and outcomes suggest that urban EDs should consider implementing integrated screening and linkage-to-care programs for these 3 infections.
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Affiliation(s)
- Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sunil S Solomon
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Michael Stec
- Abbott Laboratories, Abbott Park, IL, United States
| | - Oliver Laeyendecker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, United States
| | - Isabel V Lake
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gaby Dashler
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Radhika Mehta
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Thomas Kickler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gabor D Kelen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Thomas C Quinn
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, United States
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Barter L, Cooper CL. The impact of electronic medical record system implementation on HCV screening and continuum of care: a systematic review. Ann Hepatol 2022; 24:100322. [PMID: 33549734 DOI: 10.1016/j.aohep.2021.100322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis C (HCV) screening is imperative to meet WHO elimination targets including increased detection and reduced mortality. An electronic medical record (EMR) system can be utilized in health care centers to indicate if a patient should be targeted for HCV screening, thus increasing the number of those offered testing. MATERIALS AND METHODS We examined English language publications reporting on the impact of EMR system utilization on HCV screening and the HCV continuum of care. Relevant papers were identified using multiple search engines to search key terms. Clinical outcomes considered included any or no change in HCV screening rates following EMR system introduction, as well as any or no change in rates of patients progressing along the HCV cascade of care after diagnosis once an EMR system was implemented. RESULTS From a search pool of 18 studies, 11 meet inclusion criteria and reported on the selected clinical outcomes. Each outcome assessed indicated that use of an EMR system increased the proportion of patients offered and/or receiving HCV testing. We were unable to conclude if an EMR system had an impact on the number of patients progressing along the HCV cascade of care following a positive test result. Overall, all methods of implementation of an EMR system had the same outcome of increasing screening rates. CONCLUSIONS EMR system utilization had a positive impact on increasing HCV screening. However, the clinical effectiveness of utilizing an EMR system to help eliminate transmission and increase HCV treatment cure rates requires further study.
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Affiliation(s)
- Lauren Barter
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Curtis L Cooper
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada; University of Ottawa, Ottawa, Ontario, Canada.
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11
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Universal HIV Screening in Ambulatory Care Settings. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Burrell CN, Sharon MJ, Davis S, Feinberg J, Wojcik EM, Nist J, Lander O, Boley V, Burns J, Martin IBK. Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department. BMC Health Serv Res 2021; 21:524. [PMID: 34051774 PMCID: PMC8164230 DOI: 10.1186/s12913-021-06482-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/06/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. METHODS EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. RESULTS The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. CONCLUSION HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.
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Affiliation(s)
- Carmen N Burrell
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA. .,Department of Family Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
| | - Melinda J Sharon
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA
| | - Stephen Davis
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA.,Department Of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Department of Medicine, Division of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Elena M Wojcik
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA
| | - Julia Nist
- West Virginia University Medicine, Information Technology, Morgantown, West Virginia, USA
| | - Owen Lander
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA
| | - Valerie Boley
- West Virginia University Medicine, Emergency Service, JW Ruby Memorial Hospital, Morgantown, West Virginia, USA
| | - Justin Burns
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia, 26506, USA
| | - Ian B K Martin
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Assessing State Variation in Plastic Surgeons' Risk of Hepatitis C Exposure: Revisit in Methodology. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3220. [PMID: 33173710 PMCID: PMC7647602 DOI: 10.1097/gox.0000000000003220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Background: As the national opioid epidemic escalates, rates of the Hepatitis C (HCV) infection have similarly risen. Surgeons exposed intraoperatively secondary to sharp instrument or needle-sticks are affected both socioeconomically and physically. Current treatment strategies involve antiretroviral agents that have not been universally available. This study evaluates the current risk of surgeon exposure to HCV. Methods: CDC data regarding state-by-state HCV diagnosis reporting were combined with the plastic surgery workforce data from the ASPS. Proxy variables for exposure risk to HCV were generated for each state and compared. Results: West Virginia plastic surgeons were found to have a significantly elevated risk of exposure (60.0 versus 18.7, P < 0.0001). Their exposure risk is a notable outlier compared with the rest of the country (Risk >3 × IQR + 75th percentile). Similarly, states within the Ohio Valley were found to be at increased risk (34.8 versus 16.0, P = 0.05). States most heavily burdened by the opioid crisis were found to be at an increased risk for HCV exposure (40.8 versus 13.6, P = 0.0003). Conclusions: Plastic surgeons employed in states within the Ohio Valley were found to be at an increased risk of exposure to HCV. Plastic surgeons operating in states severely impacted by the opioid crisis were found to be at an increased risk of exposure. These findings underscore the importance of reducing the risk in the operating room and the need for better data collection to better understand this association and mitigate the risk to the operating surgeon.
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Wojcik EM, Sharon MJ, Davis SM, Lander OM, Burrell CN. Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adopt Universal Screening in an Appalachian Emergency Department. Acad Emerg Med 2020; 27:844-852. [PMID: 32017316 DOI: 10.1111/acem.13932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends screening baby boomers and high-risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody-positive (Ab+) and ribonucleic acid (RNA)-confirmed-positive patients identified via two screening models in an Appalachian emergency department (ED). METHODS This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk-based and the universal screening models. RESULTS Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p < 0.001). A consistently large proportion of diagnoses were new (71%). There was no statistically significant decrease between the RNA-confirmed-positive patients during the risk factor model (76, 60%) and universal model (186, 58%) time periods (p = 0.72). The models had high rates of reported intravenous drug use, and the universal screening adoption was modest at 33%. CONCLUSION This study was the first to present characteristics of HCV Ab+ and RNA-confirmed-positive patients identified during the transition to a universal screening model in an Appalachian ED. Most diagnoses were new regardless of screening model, but more patients screened HCV Ab+, and a similar proportion were RNA-confirmed-positive, under the universal model. Given that adoption of universal screening was modest, and risk factors remained similar, future research should investigate how to more effectively implement a universal screening model on a wider scale to identify early infections.
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Affiliation(s)
- Elena M. Wojcik
- From the Department of Emergency MedicineSchool of Medicine, West Virginia University Morgantown WV
| | - Melinda J. Sharon
- From the Department of Emergency MedicineSchool of Medicine, West Virginia University Morgantown WV
| | - Stephen M. Davis
- From the Department of Emergency MedicineSchool of Medicine, West Virginia University Morgantown WV
- the Department of Health Policy, Management, and LeadershipSchool of Public Health, West Virginia University Morgantown WV
| | - Owen M. Lander
- From the Department of Emergency MedicineSchool of Medicine, West Virginia University Morgantown WV
| | - Carmen N. Burrell
- From the Department of Emergency MedicineSchool of Medicine, West Virginia University Morgantown WV
- and the Department of Family Medicine School of Medicine, West Virginia University Morgantown WV
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Hepatitis C in 2020: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper. J Pediatr Gastroenterol Nutr 2020; 71:407-417. [PMID: 32826718 DOI: 10.1097/mpg.0000000000002814] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 1989, a collaboration between the Centers for Disease Control (CDC) and a California biotechnology company identified the hepatitis C virus (HCV, formerly known as non-A, non-B hepatitis virus) as the causative agent in the epidemic of silent posttransfusion hepatitis resulting in cirrhosis. We now know that, the HCV genome is a 9.6 kb positive, single-stranded RNA. A single open reading frame encodes a 3011 amino acid residue polyprotein that undergoes proteolysis to yield 10 individual gene products, consisting of 3 structural proteins (core and envelope glycoproteins E1 and E2) and 7 nonstructural (NS) proteins (p7, NS2, NS3, NS4A, NS4B, NS5A, and NS5B), which participate in posttranslational proteolytic processing and replication of HCV genetic material. Less than 25 years later, a new class of medications, known as direct-acting antivirals (DAAs) which target these proteins, were introduced to treat HCV infection. These highly effective antiviral agents are now approved for use in children as young as 3 years of age and have demonstrated sustained virologic responses exceeding 90% in most genotypes. Although tremendous scientific progress has been made, the incidence of acute HCV infections has increased by 4-fold since 2005, compounded in the last decade by a surge in opioid and intravenous drug use. Unfortunately, awareness of this deadly hepatotropic virus among members of the lay public remains limited. Patient education, advocacy, and counseling must, therefore, complement the availability of curative treatments against HCV infection if this virus is to be eradicated.
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