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Philpott DC, Bonacci RA, Weidle PJ, Curran KG, Brooks JT, Khalil G, Feldpausch A, Pavlick J, Wortley P, O'Shea JG. Low CD4 Count or Being Out of Care Increases the Risk for Mpox Hospitalization Among People With Human Immunodeficiency Virus and Mpox. Clin Infect Dis 2024; 78:651-654. [PMID: 37590957 PMCID: PMC10873466 DOI: 10.1093/cid/ciad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated immunosuppression may increase the risk of hospitalization with mpox. Among persons diagnosed with mpox in the state of Georgia, we characterized the association between hospitalization with mpox and HIV status. People with HIV and a CD4 count <350 cells/mm3 or who were not engaged in HIV care had an increased risk of hospitalization.
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Affiliation(s)
- David C Philpott
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert A Bonacci
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul J Weidle
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John T Brooks
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George Khalil
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jesse G O'Shea
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Saldana CS, Burkhardt E, Pennisi A, Oliver K, Olmstead J, Holland DP, Gettings J, Mauck D, Austin D, Wortley P, Ochoa KVS. Development of a Machine Learning Modelling Tool for Predicting HIV Incidence Using Public Health Data from a County in the Southern United States. Clin Infect Dis 2024:ciae100. [PMID: 38393832 DOI: 10.1093/cid/ciae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Recent advancements in Machine Learning (ML) have significantly improved the accuracy of models predicting HIV incidence. These models typically utilize electronic medical records and patient registries. This study aims to broaden the application of these tools by utilizing de-identified public health datasets for notifiable sexually transmitted infections (STIs) from a southern U.S. County known for high HIV incidence rates. The goal is to assess the feasibility and accuracy of ML in predicting HIV incidence, which could potentially inform and enhance public health interventions. METHODS We analyzed two de-identified public health datasets, spanning January 2010 to December 2021, focusing on notifiable STIs. Our process involved data processing and feature extraction, including sociodemographic factors, STI cases, and social vulnerability index (SVI) metrics. Various ML algorithms were trained and evaluated for predicting HIV incidence, using metrics such as accuracy, precision, recall, and F1 score. RESULTS The study included 85,224 individuals, with 2,027 (2.37%) newly diagnosed with HIV during the study period. The ML models demonstrated high performance in predicting HIV incidence among males and females. Influential predictive features for males included age at STI diagnosis, previous STI information, provider type, and SVI. For females, they included age, ethnicity, previous STIs information, overall SVI, and race. CONCLUSIONS The high accuracy of our ML models in predicting HIV incidence highlights the potential of using public health datasets for public health interventions such as tailored HIV testing and prevention. While these findings are promising, further research is needed to translate these models into practical public health applications.
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Affiliation(s)
- Carlos S Saldana
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta - GA, United States
| | | | - Alfred Pennisi
- Georgia Department of Public Health, Atlanta - GA, United States
| | - Kirsten Oliver
- Georgia Department of Public Health, Atlanta - GA, United States
| | - John Olmstead
- Georgia Department of Public Health, Atlanta - GA, United States
| | - David P Holland
- Mercy Care Health Systems, Atlanta - GA, United States
- Fulton County Board of Health, Atlanta GA, United States
| | - Jenna Gettings
- Georgia Department of Public Health, Atlanta - GA, United States
| | - Daniel Mauck
- Georgia Department of Public Health, Atlanta - GA, United States
| | - David Austin
- Georgia Department of Public Health, Atlanta - GA, United States
| | - Pascale Wortley
- Georgia Department of Public Health, Atlanta - GA, United States
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Hassan R, Saldana CS, Garlow EW, Gutierrez M, Hershow RB, Elimam D, Adame JF, Andía JF, Padilla M, Gonzalez Jimenez N, Freeman D, Johnson EN, Reed K, Holland DP, Orozco H, Pedraza G, Hayes C, Philpott DC, Curran KG, Wortley P, Agnew-Brune C, Gettings JR. Barriers and Facilitators to HIV Service Access among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in Metropolitan Atlanta-a Qualitative Analysis. J Urban Health 2023; 100:1193-1201. [PMID: 38012505 PMCID: PMC10728373 DOI: 10.1007/s11524-023-00809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.
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Affiliation(s)
- Rashida Hassan
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA.
| | - Carlos S Saldana
- Fulton County Board of Health, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mariana Gutierrez
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - Rebecca B Hershow
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Dena Elimam
- Georgia Department of Public Health, Atlanta, GA, USA
| | - Jose F Adame
- Georgia Department of Public Health, Atlanta, GA, USA
| | - Jonny F Andía
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - Mabel Padilla
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | | | - Dorian Freeman
- Gwinnett, Newton, and Rockdale County Health Department, Lawrenceville, GA, USA
| | | | - Karrie Reed
- Cobb and Douglas Public Health, Marietta, GA, USA
| | - David P Holland
- Fulton County Board of Health, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Craig Hayes
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - David C Philpott
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Kathryn G Curran
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | | | - Christine Agnew-Brune
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - Jenna R Gettings
- Georgia Department of Public Health, Atlanta, GA, USA
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA
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Hill M, Smith J, Elimam D, Mustafaa G, Wortley P, Taylor B, Harris O. Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA. PLoS One 2023; 18:e0283764. [PMID: 36996143 PMCID: PMC10062590 DOI: 10.1371/journal.pone.0283764] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Efforts to mitigate HIV transmission among gay and bisexual men have not been sufficient to level persistent racial inequities which now extend to the use of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. Community-involved ethnographic research is crucial to galvanizing collaboration between patients, researchers, and policymakers to identify the social determinants of emerging PrEP inequities. In partnership with community key informants, we conducted a Rapid Ethnographic Assessment (REA) of multilevel PrEP use determinants among young Black gay and bisexual (YBGBM) men in the metropolitan Atlanta area to inform the development and coordination of local HIV programs. METHODS In the assessment, we drew upon the perspectives of local clinicians, community-based organization leaders, health educators, and PrEP clients to identify barriers and facilitators to PrEP use among YBGBM through interviews (N = 23). Data were collected from September 2020 -to January 2021 and were analyzed through a staged deductive-inductive thematic analysis. The themes were later summarized and presented to community stakeholder participants to facilitate member-checking. RESULTS Our analyses revealed structural, cultural, relationship, and developmental factors which shaped PrEP use. The most prominent being "ease of access to PrEP" (structural level), "provider support" (interpersonal), and "life-stage traits" (individual). Our results also contribute novel information concerning the axes of intersectional stigma (spatial, racial, sexual identity, and HIV) among YBGBM in Atlanta and its divergent effects on PrEP use. CONCLUSION Increased PrEP use among YBGBM, particularly among those living in the south, is essential to ending the domestic HIV epidemic. Altogether, our results emphasize the need for PrEP program modifications, which increase flexibility in methods and modes of access and are culturally adapted to the needs of YBGBM. There is also a need for resources that holistically focus on mental health, trauma, and racism as critical components of support.
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Affiliation(s)
- Miranda Hill
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Justin Smith
- Positive Impact Health Centers, Atlanta, Georgia, United States of America
| | - Dena Elimam
- Georgia HIV Behavioral Surveillance, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Genetha Mustafaa
- Georgia HIV Behavioral Surveillance, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Pascale Wortley
- Georgia HIV Behavioral Surveillance, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Brittany Taylor
- Georgia State University, Atlanta, Georgia, United States of America
| | - Orlando Harris
- School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
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Saldana C, Philpott DC, Mauck DE, Hershow RB, Garlow E, Gettings J, Freeman D, France AM, Johnson EN, Ajmal A, Elimam D, Reed K, Sulka A, Adame JF, Andía JF, Gutierrez M, Padilla M, Jimenez NG, Hayes C, McClung RP, Cantos VD, Holland DP, Scott JY, Oster AM, Curran KG, Hassan R, Wortley P. Public Health Response to Clusters of Rapid HIV Transmission Among Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex with Men - Metropolitan Atlanta, Georgia, 2021-2022. MMWR Morb Mortal Wkly Rep 2023; 72:261-264. [PMID: 36893048 PMCID: PMC10010755 DOI: 10.15585/mmwr.mm7210a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
During February 2021-June 2022, the Georgia Department of Public Health (GDPH) detected five clusters of rapid HIV transmission concentrated among Hispanic or Latino (Hispanic) gay, bisexual, and other men who have sex with men (MSM) in metropolitan Atlanta. The clusters were detected through routine analysis of HIV-1 nucleotide sequence data obtained through public health surveillance (1,2). Beginning in spring 2021, GDPH partnered with health districts with jurisdiction in four metropolitan Atlanta counties (Cobb, DeKalb, Fulton, and Gwinnett) and CDC to investigate factors contributing to HIV spread, epidemiologic characteristics, and transmission patterns. Activities included review of surveillance and partner services interview data,† medical chart reviews, and qualitative interviews with service providers and Hispanic MSM community members. By June 2022, these clusters included 75 persons, including 56% who identified as Hispanic, 96% who reported male sex at birth, 81% who reported male-to-male sexual contact, and 84% of whom resided in the four metropolitan Atlanta counties. Qualitative interviews identified barriers to accessing HIV prevention and care services, including language barriers, immigration- and deportation-related concerns, and cultural norms regarding sexuality-related stigma. GDPH and the health districts expanded coordination, initiated culturally concordant HIV prevention marketing and educational activities, developed partnerships with organizations serving Hispanic communities to enhance outreach and services, and obtained funding for a bilingual patient navigation program with academic partners to provide staff members to help persons overcome barriers and understand the health care system. HIV molecular cluster detection can identify rapid HIV transmission among sexual networks involving ethnic and sexual minority groups, draw attention to the needs of affected populations, and advance health equity through tailored responses that address those needs.
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Saldana CS, Hershow R, Philpott D, Hassan R, Curran K, Gettings J, Garlow E, Mauck D, Cantos VD, Holland DP, Freeman D, Johnson E, Reed K, Adame J, Orozco H, Wortley P. 797. Investigation of HIV Clusters Among Hispanic/Latino Gay or Bisexual Men in Metro Atlanta, Georgia. Open Forum Infect Dis 2022. [PMCID: PMC9752836 DOI: 10.1093/ofid/ofac492.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In Metro Atlanta, Georgia, annual HIV diagnoses among Hispanic/Latino (H/L) adolescents and adults have increased since 2014 (Figure 1), and four HIV molecular clusters, consisting primarily of Hispanic/Latino gay or bisexual men and other men who have sex with men (HLGBM), were identified in 2021. In March 2022, the Georgia Department of Public Health, the Centers for Disease Control and Prevention, and four health districts of Metro Atlanta (Fulton, Gwinnett, DeKalb, and Cobb) launched an investigation to characterize the clusters, assess barriers to accessing HIV care and prevention services, and inform improvements to service delivery. Methods We described the four clusters using HIV surveillance data. We conducted semi-structured qualitative interviews with 29 HLGBM and 28 providers through purposive sampling. Iterative analyses were conducted daily, comparing findings across interviews to identify commonly mentioned barriers to accessing HIV care and prevention services. Results The four clusters varied in size (5–42 members) and proportion of H/L members (41–100%); one cluster included members reporting injection drug use (14%) (Table 1). Viral suppression among cluster members was high across clusters (87–100%). Overarching reported barriers to accessing medical services included lack of culturally and linguistically concordant services, fear of deportation, transportation, and financial barriers (Table 2). LGBTQ and HIV stigma, low STD/HIV awareness, low access to primary care and HIV screening in primary and urgent care settings, and limited community outreach and marketing were common barriers to accessing HIV prevention services. For pre-exposure prophylaxis (PrEP) specifically, fear of being perceived as promiscuous, limited PrEP knowledge, and concerns with side effects were barriers. Navigating the healthcare system was noted as the primary challenge in HIV care. Conclusion The investigation of four clusters affecting HLGBM identified opportunities to improve access to HIV prevention and PrEP services for this population. State and local partners are planning cluster response activities, including ways to provide low-barrier culturally and linguistically concordant services (Table 3). Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | - Rebecca Hershow
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Philpott
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rashida Hassan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn Curran
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jenna Gettings
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniel Mauck
- Georgia Department of Public Health, Atlanta, Georgia
| | | | | | - Dorian Freeman
- Gwinnett, Newton & Rockdale County Health Departments, Lawrenceville, Georgia
| | | | - Karrie Reed
- Cobb & Douglas Public Health, Marrietta, Georgia
| | - Jose Adame
- Georgia Department of Public Health, Atlanta, Georgia
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Adams C, Wortley P, Chamberlain A, Lopman BA. Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022; 72:57-64. [PMID: 35649472 PMCID: PMC9148435 DOI: 10.1016/j.annepidem.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. METHODS We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. RESULTS Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04). CONCLUSIONS After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.
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Affiliation(s)
- Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, State of Georgia Building, Atlanta, GA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Gopalsamy SN, Shah NS, Marconi VC, Armstrong WS, del Rio C, Pennisi E, Wortley P, Colasanti JA. The Impact of Churn on HIV Outcomes in a Southern United States Clinical Cohort. Open Forum Infect Dis 2022; 9:ofac338. [PMID: 35899283 PMCID: PMC9314921 DOI: 10.1093/ofid/ofac338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Persons with human immunodeficiency virus (PWH) may experience a cycle of engaging and disengaging in care referred to as “churn.” While human immunodeficiency virus (HIV) churn is predicted to be more prevalent in the southern United States (US), it has not been well characterized in this region. Methods We conducted a retrospective cohort study involving PWH newly establishing care at a large urban clinic in Atlanta, Georgia, from 2012 to 2017, with follow-up data collected through 2019. The primary exposure was churn, defined as a ≥12-month gap between routine clinic visits or viral load (VL) measurements. We compared HIV metrics before and after churn and assessed the risk of future churn or loss to follow-up. Results Of 1303 PWH newly establishing care, 81.7% were male and 84.9% were Black; 200 (15.3%) experienced churn in 3.3 years of median follow-up time. The transmissible viremia (TV) rate increased from 28.6% prechurn to 66.2% postchurn (P < .0001). The 122 PWH having TV on reengagement had delayed time to subsequent viral suppression (adjusted hazard ratio, 0.59 [95% confidence interval {CI}, .48–.73]), and PWH returning to care contributed disproportionately to the community viral load (CVL) (proportion of CVL/proportion of patients, 1.96). Churn was not associated with an increased risk of subsequent churn (adjusted odds ratio [aOR], 1.53 [95% CI, .79–2.97]) or loss to follow-up (aOR, 1.04 [95% CI, .60–1.79]). Conclusions The rate of churn in a southern US clinic was high, and those who experienced churn had increased TV at reentry and disproportionately contributed to the CVL and likely contributing to ongoing HIV transmission.
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Affiliation(s)
| | - N Sarita Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA , USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine and Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA , USA
- Atlanta VA Medical Center , Decatur, GA , USA
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University , Atlanta, GA , USA
- Grady Health System , Atlanta, GA , USA
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University , Atlanta, GA , USA
- Grady Health System , Atlanta, GA , USA
| | - Eugene Pennisi
- HIV/AIDS Epidemiology Section, Georgia Department of Public Health , Atlanta, GA , USA
| | - Pascale Wortley
- HIV/AIDS Epidemiology Section, Georgia Department of Public Health , Atlanta, GA , USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University , Atlanta, GA , USA
- Grady Health System , Atlanta, GA , USA
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Harrington P, Onwubiko U, Qi M, Holland DP, Wortley P, Chamberlain AT. Factors Associated with HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case-Control Study. AIDS Patient Care STDS 2020; 34:124-131. [PMID: 32109142 DOI: 10.1089/apc.2019.0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Compared to knowledge about HIV risk factors among men in the south, less is known about risk factors for women. We conducted an individually matched case-control study to identify factors associated with HIV seroconversion among women. Cases had a clinician-assisted visit (CAV) between 2011 and 2016 at an Atlanta-based public health clinic before HIV diagnosis. Controls were women who visited the clinic but remained HIV negative. Controls were matched to cases in a 2:1 ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a best-fitting model for characterizing HIV risk. Of 18,281 women who were HIV negative at their first visit, 110 (0.6%) seroconverted before 2019. Of these, 80 (73%) had a CAV before HIV diagnosis. Having multiple gonorrhea episodes, a syphilis episode, a greater number of sex partners in the past 2 months, anal sex, history of drug use, history of exchanging drugs or money for sex, and heterosexual sex with >1 sex partner in the last month were individually associated with HIV seroconversion. In multivariate analyses, having a syphilis episode [odds ratio (OR) = 4.7, 95% confidence interval (CI): 1.3-16.3], anal sex (OR = 2.8, 95% CI: 1.0-8.1), and injection drug or crack cocaine use (OR = 33.5, 95% CI: 3.6-313.3) remained associated with HIV. Women having all three risk factors were six times more likely to seroconvert compared to women without these factors. Our results offer insights into which women in a southern HIV "hotspot" may be at greatest risk for HIV.
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Affiliation(s)
- Pauline Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Udodirim Onwubiko
- Division of Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia
| | - Mingli Qi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - David P. Holland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Pascale Wortley
- HIV Epidemiology Department, Georgia Department of Public Health, Atlanta, Georgia
| | - Allison T. Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Epidemiology, Fulton County Board of Health, Atlanta, Georgia
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Harrington P, Onwubiko U, Qi M, Holland D, Wortley P, Chamberlain A. 1964. Predictive Factors for HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case–control Study in Atlanta, GA. Open Forum Infect Dis 2019. [PMCID: PMC6808744 DOI: 10.1093/ofid/ofz359.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background In 2019, Fulton County, GA was named one of 48 priority “hotspots” to target in renewed efforts to end the HIV epidemic in the United States. To more accurately predict women at greatest risk for HIV, we conducted an individually matched case–control study among women who attended a Fulton County health clinic to identify risk factors associated with HIV seroconversion. Methods We obtained data about women who sought care at Fulton County Board of Health Sexual Health Clinic (SHC) between 2011 and 2016. Cases were women with at least one clinician-assisted visit (CAV) at the SHC prior to HIV diagnosis date. Controls were women who visited the clinic in this same period but remained HIV negative. Controls were individually matched to cases in a 2:1 matching ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a model for predicting probability of and identifying risk factors for HIV seroconversion. Results Of 18,281 women who were HIV negative at their first visit to the SHC between 2011 and 2016, 110 (0.6%) seroconverted before 2018. Of these, 80 (73%) had a CAV prior to HIV diagnosis. Using these 80 cases and 160 matched controls, having a history of gonorrhea, multiple gonorrhea episodes, a history of syphilis, a greater number of sex partners in the past 2 months, anal sex, history of injection drug or crack cocaine use, a history of exchanging drugs/money for sex, and heterosexual sex with more than one sex partner in the last month were associated with HIV seroconversion in bivariate analyses. After conducting backward selection from a fully adjusted model, predictors remaining were: having a history of syphilis (OR = 4.9, 95% CI: 1.4, 16.9), anal sex (OR = 2.9, 95% CI: 1.0, 8.3), and injection drug or crack cocaine use (OR = 34.8, 95% CI: 3.7, 328.1). Women having all three risk factors were six times more likely to seroconvert compared with matched controls without these risk factors. Conclusion Our results offer clinical insights into which women are most at-risk for HIV and are therefore best candidates for initiating HIV prevention interventions like pre-exposure prophylaxis (PrEP) within a HIV “hotspot” in the South. Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | - David Holland
- Fulton County Board of Health, Atlanta, Georgia
- Emory University, Atlanta, Georgia
| | | | - Allison Chamberlain
- Fulton County Board of Health, Atlanta, Georgia
- Emory University, Atlanta, Georgia
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11
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Sharp J, Angert CD, Mcconnell T, Wortley P, Pennisi E, Roland L, Mehta CC, Armstrong WS, Shah B, Colasanti JA. Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System. Open Forum Infect Dis 2019; 6:ofz402. [PMID: 31660364 PMCID: PMC6785665 DOI: 10.1093/ofid/ofz402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background Public health information exchanges (HIEs) link real-time surveillance and clinical data and can help to re-engage out-of-care people with HIV (PWH). Methods We conducted a retrospective cohort study of out-of-care PWH who generated an HIE alert in the Grady Health System (GHS) Emergency Department (ED) between January 2017 and February 2018. Alerts were generated for PWH who registered in the GHS ED without Georgia Department of Public Health (GDPH) CD4 or HIV-1 RNA in the prior 14 months. The alert triggered a social work (SW)–led re-linkage effort. Multivariate logistic regression analyses used HIE-informed SW re-linkage efforts as the independent variable, and linkage to care and 3- and 6-month viral suppression (HIV-1 RNA < 200 c/mL) as primary outcomes. Patients admitted to the hospital were excluded from primary analysis. Results One hundred forty-seven out-of-care patients generated an alert. Ninety-eight were included in the primary analysis (mean age [SD], 41 ± 12 years; 70% male; 93% African American), and 20 received the HIE-informed SW intervention. Sixty percent of patients receiving the intervention linked to care in 6 months, compared with 35% who did not. Patients receiving the intervention were more likely to link to care (adjusted risk ratio [aRR], 1.63; 95% confidence interval [CI], 0.99–2.68) and no more likely to achieve viral suppression (aRR, 1.49; 95% CI, 0.50–4.46) than those who did not receive the intervention. Conclusions An HIE-informed, SW-led intervention systematically identified out-of-care PWH and may increase linkage to care for this important population. HIEs create an opportunity to intervene with linkage and retention strategies.
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Affiliation(s)
- Joseph Sharp
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine D Angert
- Department of Biostatistics and Bioinformatics, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Eugene Pennisi
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
| | - Wendy S Armstrong
- Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bijal Shah
- Grady Health System, Atlanta, Georgia, USA.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Colasanti
- Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Global Health, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
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12
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Smith SL, Chahroudi AM, Camacho-Gonzalez AF, Gillespie S, Wynn BA, Badell ML, Swartzendruber A, Hazra R, Wortley P, Chakraborty R. Evaluating Facility Infrastructure for Prevention of Mother-to-Child Transmission of HIV-A 2015 Assessment of Major Delivery Hospitals in Atlanta, Georgia. J Pediatric Infect Dis Soc 2018; 7:e102-e106. [PMID: 29986059 PMCID: PMC6097576 DOI: 10.1093/jpids/piy058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/12/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our goal was to evaluate the infrastructure of programs for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) in major delivery units in the Atlanta, Georgia, metropolitan statistical area and to assess the knowledge, attitude, and practice of providers in these facilities around PMTCT. METHODS Hospital assessments and individual knowledge and practices were surveyed among 71 healthcare providers from March 2015 to March 2016 in 11 hospitals that deliver 40000 infants annually, which represents 70% of all deliveries in the Atlanta metropolitan statistical area. Included were questions about HIV testing for mother-infant pairs, test result turnaround times, policies and procedures for PMTCT, opt-out versus opt-in testing, availability of rapid point-of-care testing on labor and delivery units, and postnatal prophylaxis. RESULTS Seventy-three percent (8 of 11) of the hospitals had limitations in their PMTCT infrastructure, and 36% (4 of 11) reported no standardized policies for care of HIV-infected women. Three labor and delivery units used opt-in HIV testing of women. Only 27% (3 of 11) of the hospitals reported nucleic acid testing of HIV-exposed infants. Oral zidovudine for infant prophylaxis was available in all the hospitals, but 64% (7 of 11) of them did not stock nevirapine. Fifty-nine percent (24 of 44) of the obstetricians did not routinely offer rapid testing at delivery without a third-trimester HIV test, and 78% (n = 32 of 41) of them did not offer testing at delivery if the woman declined antenatal testing. The facility with the most annual births in Georgia did not offer rapid testing at delivery for women with an unknown HIV status. CONCLUSION We identified several limitations in PMTCT infrastructure that might have contributed to perinatal HIV transmissions. The need to address these healthcare gaps to eliminate mother-to-child transmission of HIV in the United States is urgent.
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Affiliation(s)
- Somer L Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Correspondence: S. L. Smith, PharmD, BCPS, AAHIVP, 2015 Uppergate Dr., Suite 500, Atlanta, GA 30322 ()
| | - Ann M Chahroudi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andres F Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Bridget A Wynn
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Martina L Badell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, Atlanta
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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13
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McCree DH, Beer L, Prather C, Gant Z, Harris N, Sutton M, Sionean C, Dunbar E, Smith J, Wortley P. An Approach to Achieving the Health Equity Goals of the National HIV/AIDS Strategy for the United States Among Racial/Ethnic Minority Communities. Public Health Rep 2018; 131:526-30. [PMID: 27453595 DOI: 10.1177/0033354916662209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Donna Hubbard McCree
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Linda Beer
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Cynthia Prather
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Zanetta Gant
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Norma Harris
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Madeline Sutton
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Catlainn Sionean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Erica Dunbar
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Jennifer Smith
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Pascale Wortley
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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Abstract
Recent advances in science, program, and policy could better position the nation to achieve its vision of the USA as a place where new HIV infections are rare. Among these developments, passage of the Patient Protection and Affordable Care Act (ACA) in 2010 may prove particularly important, as the health system transformations it has launched offer a supportive foundation for realizing the potential of other advances, both within and beyond the clinical arena. This article summarizes opportunities to expand access to high-impact HIV prevention interventions under the ACA, examines whether available evidence indicates that these opportunities are being realized, and considers potential challenges to further gains for HIV prevention in an era of health reform. This article also highlights the new roles that HIV prevention programs and providers may assume in a health system no longer defined by fragmentation among public health, medical care, and community service providers.
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Affiliation(s)
- Abigail H Viall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, 30329, GA, USA.
| | - Eugene McCray
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, 30329, GA, USA
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Pascale Wortley
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, 30329, GA, USA
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15
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Hood JE, Buskin SE, Anderson BJ, Gagner A, Kienzle J, Maggio D, Markey K, Reuer J, Benbow N, Wortley P. A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act. AIDS Care 2016; 29:511-515. [PMID: 27550614 DOI: 10.1080/09540121.2016.1222055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The impact of the Affordable Care Act (ACA) on HIV care patients, aged 18-64, was evaluated in three jurisdictions with Medicaid expansion (Chicago, New York State, and Washington) and three jurisdictions without Medicaid expansion (Georgia, Texas, and Virginia) using data from the Medical Monitoring Project. Multivariate regression models were used to evaluate insurance status that was reported pre- and post-ACA; self-reported impact of ACA on HIV care was explored with descriptive statistics. The likelihood of having insurance was significantly greater post-ACA compared to pre-ACA in Chicago (aRR = 1.33, 95%CI = 1.20, 1.47), Washington (aRR = 1.15, 95%CI = 1.08, 1.22), and Virginia (aRR = 1.14, 95%CI = 1.00, 1.29). In Washington and Chicago, the likelihood of being Medicaid-insured was greater post-ACA compared to pre-ACA implementation (Chicago: aRR = 1.25, 95%CI = 1.03,1.53; Washington: aRR = 1.66 95% CI = 1.30, 2.13). No other significant differences were observed. Only a subset of HIV care patients (range: 15-35%) reported a change in insurance that would have coincided with the implementation of ACA; and within this subset, a change in medical care costs was the most commonly noted issue. In conclusion, the influence of ACA on insurance coverage and other factors affecting HIV care likely varies by jurisdiction.
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Affiliation(s)
- Julia E Hood
- a Public Health - Seattle & King County , HIV/STD Program , Seattle , WA , USA.,b Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Susan E Buskin
- a Public Health - Seattle & King County , HIV/STD Program , Seattle , WA , USA.,b Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Bridget J Anderson
- c New York State Department of Health , AIDS Institute , Albany , NY , USA
| | - Alexandra Gagner
- d Chicago Department of Public Health , Communicable Disease Program , Chicago , IL , USA
| | - Jennifer Kienzle
- e Virginia Department of Health , Division of Disease Prevention , Richmond , VA
| | - David Maggio
- f Georgia Department of Public Health , Division of Health Protection , Atlanta , GA , USA
| | - Katie Markey
- c New York State Department of Health , AIDS Institute , Albany , NY , USA
| | - Jennifer Reuer
- g Washington State Department of Health , Infectious Disease Assessment Unit , Tumwater , WA , USA
| | - Nanette Benbow
- h Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Pascale Wortley
- f Georgia Department of Public Health , Division of Health Protection , Atlanta , GA , USA
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16
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Heier Stamm JL, Serban N, Swann J, Wortley P. Quantifying and explaining accessibility with application to the 2009 H1N1 vaccination campaign. Health Care Manag Sci 2015; 20:76-93. [DOI: 10.1007/s10729-015-9338-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022]
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17
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Irwin K, Huang A, Wortley P, Patel A, Dumitru G. 073 Implementing Updated US Federal Government Recommendations about HIV Prevention for Persons with HIV: A High-Impact Approach for HIV Prevention. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Bardenheier B, Wortley P, Shefer A, McCauley MM, Gravenstein S. Racial inequities in receipt of influenza vaccination among nursing home residents in the United States, 2008-2009: a pattern of low overall coverage in facilities in which most residents are black. J Am Med Dir Assoc 2012; 13:470-6. [PMID: 22420974 PMCID: PMC4554484 DOI: 10.1016/j.jamda.2012.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Nationwide among nursing home residents, receipt of the influenza vaccine is 8 to 9 percentage points lower among blacks than among whites. The objective of this study was to determine if the national inequity in vaccination is because of the characteristics of facilities and/or residents. DESIGN Cross-sectional study with multilevel modeling. SETTING AND PARTICIPANTS States in which 1% or more of nursing home residents were black and the difference in influenza vaccination coverage between white and black nursing home residents was 1 percentage point or higher (n = 39 states and the District of Columbia). Data on residents (n = 2,359,321) were obtained from the Centers for Medicare & Medicaid Service's Minimum Data Set for October 1, 2008, through March 31, 2009. MEASUREMENTS Residents' influenza vaccination status (vaccinated, refused vaccine, or not offered vaccination). RESULTS States with higher overall influenza vaccination coverage among nursing home residents had smaller racial inequities. In nursing homes with higher proportions of black residents, vaccination coverage was lower for both blacks and whites. The most dramatic inequities existed between whites in nursing homes with 0% blacks (L1) and blacks in nursing homes with 50% or more blacks (L5) in states with overall racial inequities of 10 percentage points or more. In these states, more black nursing home residents lived in nursing homes with 50% or more blacks (L5); in general, the same homes with low overall coverage. CONCLUSION Inequities in influenza vaccination coverage among nursing home residents are largely because of low vaccination coverage in nursing homes with a high proportion of black residents. Findings indicate that implementation of culturally appropriate interventions to increase vaccination in facilities with larger proportions of black residents may reduce the racial gap in influenza vaccination as well as increase overall state-level vaccination.
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Affiliation(s)
- Barbara Bardenheier
- Health Services Research and Evaluation Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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19
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Santibanez TA, Singleton JA, Santibanez SS, Wortley P, Bell BP. Socio-demographic differences in opinions about 2009 pandemic influenza A (H1N1) and seasonal influenza vaccination and disease among adults during the 2009-2010 influenza season. Influenza Other Respir Viruses 2012; 7:383-92. [PMID: 22568588 PMCID: PMC5779826 DOI: 10.1111/j.1750-2659.2012.00374.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In April 2009, a novel influenza A virus emerged in the United States. By the end of July, influenza A (H1N1) 2009 monovalent (2009 H1N1) vaccine had been developed, licensed, and recommended by the Advisory Committee on Immunization Practices. Initial target groups for vaccination were identified and the first vaccine was publicly available in early October 2009. Objective This study examines socio‐demographic differences in opinions about 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza disease and vaccines and the association with receipt of influenza vaccinations during the 2009–2010 influenza season. Changes in opinions over the course of the pH1N1 pandemic were also examined. Methods Data from the 2009 National H1N1 Flu Survey (NHFS) were analyzed. The NHFS was a CDC‐sponsored telephone survey initiated in response to the 2009 pH1N1 pandemic to obtain weekly within‐season estimates of vaccination coverage, opinions, and other information. Results Opinions about influenza vaccine and disease varied significantly by race/ethnicity, income, and education level. In multivariable logistic regression analysis, adjusted 2009 H1N1 vaccination coverage was most strongly associated with opinions about the effectiveness of the vaccine and personal risk of disease, varying from 7 to 11% among adults who believed the vaccine to have low effectiveness and themselves at low risk of influenza, to 50–53% among those who thought vaccine effectiveness to be high and themselves at high risk of influenza. Conclusion Improving communication about personal risk and the effectiveness of influenza vaccines may improve vaccination coverage. The findings of difference in opinions could be used to target communication.
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Affiliation(s)
- Tammy A Santibanez
- Centers for Disease Control and Prevention, 1600 Clifton Road, NE; Mailstop A-19, Atlanta, GA 30333, USA.
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20
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Kempe A, Wortley P, O'Leary S, Crane LA, Daley MF, Stokley S, Babbel C, Dong F, Beaty B, Seewald L, Suh C, Dickinson LM. Pediatricians' attitudes about collaborations with other community vaccinators in the delivery of seasonal influenza vaccine. Acad Pediatr 2012; 12:26-35. [PMID: 21900066 DOI: 10.1016/j.acap.2011.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/19/2011] [Accepted: 07/28/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Achieving universal influenza vaccination among children may necessitate collaborative delivery involving both practices and community vaccinators. We assessed among pediatricians nationally their preferences regarding location of influenza vaccination for patient subgroups and their attitudes about collaborative delivery methods. METHODS The design/setting was a national survey conducted from July 2009 to October 2009. Participants included a representative sample of pediatricians from the American Academy of Pediatrics. RESULTS The response rate was 79% (330 of 416). Physicians felt strongly that vaccination should occur in their practice for children with chronic conditions (52%) and healthy 6-24-month-old infants (48%), but few felt strongly about healthy 5-18-year-olds (17%). Most (78%) thought having multiple delivery sites increased vaccination rates, and 86% thought that influenza vaccine should be available at school. Physicians reported being very/somewhat willing to hold joint community clinics with public health entities (76%) and to suggest to patient subgroups that they receive vaccine at community sites, including public clinics or pharmacies (76%). The most frequently reported barriers to collaborative delivery with community sites or school-located delivery included concerns about the following: estimating the amount of vaccine to order if children are vaccinated elsewhere (community 56%; school 80%); transfer of vaccine records (community 57%; school 78%); and reluctance of families to go outside of the office (community 45%; school 74%). CONCLUSIONS Most physicians are in favor of school-located or collaborative influenza vaccine delivery with community vaccinators, especially for healthy school-aged children. Collaborative approaches will require planning to ensure transfer of records, effective targeting of subgroups, and provisions to protect providers from being left with extra influenza supply.
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Affiliation(s)
- Allison Kempe
- Department of Pediatrics, University of Colorado Denver, USA.
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21
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Willis BC, Wortley P, Wang SA, Jacques-Carroll L, Zhang F. Gaps in hospital policies and practices to prevent perinatal transmission of hepatitis B virus. Pediatrics 2010; 125:704-11. [PMID: 20211952 DOI: 10.1542/peds.2009-1831] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to examine hospital policies and practices to prevent perinatal transmission of hepatitis B virus (HBV) in the United States and to and identify gaps. METHODS In March 2006, a nationally representative sample of 242 delivery hospitals in the 50 states, District of Columbia, and Puerto Rico (with at least 100 annual births) were surveyed about hospital perinatal hepatitis B prevention policies and asked to review paired maternal-infant medical records for 25 consecutive live births. Main outcome measures were hospital policies related to the prevention of perinatal transmission of hepatitis B and the proportion of infants who received recommended care. RESULTS A total of 190 of 242 hospitals responded to the survey and completed medical record reviews for 4762 mothers and 4786 infants. The proportion of hospitals that reported each of the 6 policies examined ranged from 63.0% to 80.6%. Among infants who were born to the 18 hepatitis B surface antigen (HBsAg)-positive women with documented prenatal test results, 62.1% received both hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours, but 13.7% were unvaccinated and 19.7% did not receive hepatitis B immunoglobulin before hospital discharge. Among infants who were born to the 320 women with unknown HBsAg status, only 52.4% were vaccinated within 12 hours of birth and 20.1% were unvaccinated before discharge. Among infants who were born to HBsAg-negative mothers, 69.1% received the hepatitis B vaccine before hospital discharge. The strongest predictor of vaccine administration was having a written hospital policy for newborn hepatitis B vaccination. CONCLUSIONS These findings indicate that significant gaps persist in hospital policies and practices to prevent perinatal HBV transmission in the United States. Efforts to avoid medical errors through appropriate implementation and monitoring of hospital practices are needed to eliminate perinatal HBV transmission.
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Affiliation(s)
- Bayo C Willis
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E52, Atlanta, GA 30333, USA.
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22
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Bardenheier BH, Wortley P, Ahmed F, Hales C, Shefer A. Influenza immunization coverage among residents of long-term care facilities certified by CMS, 2005-2006: the newest MDs quality indicator. J Am Med Dir Assoc 2009; 11:59-69. [PMID: 20129216 DOI: 10.1016/j.jamda.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/17/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND In October 2005, the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected beginning in the influenza season, 2005-2006. This is the first year immunization coverage can be reported based on a census of LTC residents. OBJECTIVES Report influenza immunization coverage for LTC residents by state, resident, and facility characteristics. Identify uses of the data and areas in need of improvement. METHODS Analysis of CMS' Minimum Data Set of 1,851,676 residents in nursing homes from October 1 through December 31 but who could have been discharged between January 1 and March 31 merged with data for 14,493 non-hospital-based facilities from the Online Survey and Certification Assessment Reporting System. RESULTS Overall, 83% of residents were offered the vaccine and 72% had received the vaccine. Almost 10% refused to receive the vaccine, 14% were not offered the vaccine, 1% were ineligible, and 3% were missing vaccination status. Vaccination coverage varied significantly among states (range: 49% to 87%). Fewer African Americans and Hispanics than whites were offered the vaccine (79% and 79% versus 84%, respectively) and received it (65% and 66% versus 73%, respectively); more African Americans refused the vaccine (12%) than residents of other races and/or ethnicities. Residents of Medicaid-certified-only facilities had higher levels of vaccination than residents of other facilities (82% versus < or =73%). CONCLUSION MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Wray RJ, Buskirk TD, Jupka K, Lapka C, Jacobsen H, Pakpahan R, Gary E, Wortley P. Influenza vaccination concerns among older blacks: a randomized controlled trial. Am J Prev Med 2009; 36:429-434.e6. [PMID: 19269130 DOI: 10.1016/j.amepre.2009.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 11/03/2008] [Accepted: 01/13/2009] [Indexed: 11/16/2022]
Abstract
CONTEXT Vaccination can decrease the morbidity and mortality caused by influenza, yet vaccination rates remain low, especially among minority groups. Previous studies have found that important barriers to vaccination include the fear of adverse reactions and concern that the vaccine causes influenza. BACKGROUND This research aimed to assess the effects of messages designed to address concerns about the safety and effectiveness of vaccination among blacks aged >or=50 years. DESIGN In a randomized controlled trial conducted in 2007 with pre-exposure and post-exposure measurements, participants were randomly assigned to read either the vaccine safety messages (VSM) developed for the study (treatment condition) or the vaccine information statement (VIS) currently given to those getting the vaccine (control condition). SETTING/PARTICIPANTS A total of 108 participants participated in the study. Data were collected in either participants' residences, community settings, or university conference rooms. MAIN OUTCOME MEASURES Influenza vaccine-related beliefs and intention to receive vaccination were assessed. RESULTS Data analysis in 2007 and 2008 found that the randomization hypotheses of equal groups were retained. Participants exposed to the VSM showed greater improvement in post-exposure beliefs about how the vaccine works (p=0.0006) and the transmission of the flu (p=0.0034) as well as greater post-exposure disagreement with the belief that the vaccine causes influenza (p=0.0411). CONCLUSIONS The VSM affected beliefs about vaccine safety and effectiveness to a greater degree than did the VIS. These findings show that VSM are effective in changing beliefs empirically linked with influenza vaccination and vaccination disparities. The dissemination of VSM to older blacks may increase vaccination rates and reduce vaccination disparities.
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Affiliation(s)
- Ricardo J Wray
- Department of Community Health, Saint Louis University School of Public Health, St. Louis, Missouri 63104, USA.
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O'Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P. Young adults' perceptions of cigarette warning labels in the United States and Canada. Prev Chronic Dis 2007; 4:A27. [PMID: 17362618 PMCID: PMC1893125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION For the past 20 years, there have been no changes to the text-only cigarette warning labels in the United States. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of this study was to investigate the reactions of U.S. young adult smokers and nonsmokers aged 18 to 24 years to Canadian cigarette label text and graphic warnings. The study focused on determining their perceptions and the potential impact of Canadian labels on smoking, and study participants were asked for suggestions for modifications of U.S. cigarette warning labels so they would be effective for smoking deterrence and cessation. METHODS During January and February 2002, 11 focus groups consisting of 54 smokers and 41 nonsmokers were conducted in the Detroit metropolitan area. Current smokers were defined as those who had smoked a cigarette within the past 30 days. Participants were asked about their knowledge and perceptions of current U.S. cigarette warning labels and their impressions of Canadian cigarette warning labels. ANALYSIS A content analysis and a word index were applied to the transcripts of all focus groups to identify and clarify themes and domains that appeared in group discussions and to compare results across different groups. RESULTS Focus group participants reported that Canadian cigarette warning labels were more visible and informative than U.S. cigarette warning labels. Messages perceived to be relevant to smokers were considered effective. Education level did not appear related to how participants responded to warning labels. There were some differences for warning labels that had sex-specific messages. DISCUSSION Warning labels are one component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger U.S. public health educational effort.
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Affiliation(s)
- Michelle O'Hegarty
- Centers for Disease Control and Prevention, Office of Smoking and Health, 4770 Buford Hwy, NE, Mailstop K-50, Atlanta, GA 30341-3717, USA.
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Gazmararian JA, Orenstein WA, Wortley P, Buehler JA, Elon L, Koplan JP, Schild L, Dixon T, Weiss P, Stephens DS. Preventing influenza: vaccine systems and practices in the Southeast. Public Health Rep 2007; 121:684-94. [PMID: 17278403 PMCID: PMC1781910 DOI: 10.1177/003335490612100608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine from state and local health departments: (1) how they purchase, distribute, and fund influenza vaccine; (2) whether they experienced a shortage in 2003/04; (3) how the shortages were handled; and (4) how they prepared for distribution in 2004/05. METHODS A web-based survey was completed from June to August 2004 in eight Southeastern states. RESULTS Data were obtained from each state and 222 local health departments. Major differences between and within states were found with regard to purchasing, distributing, and funding influenza vaccine. Although the majority of health departments experienced periods of shortages in 2003/2004, surpluses of vaccine remained at the end of the season. There was little evidence of interaction between the public and private sectors to share vaccine resources in response to shortages. Tracking systems for redistribution of vaccine or follow-up were often not in place. Entering the 2004/05 season, 25% of states and 11% of counties were not developing any special procedures to deal with shortages beyond what was in place earlier. CONCLUSIONS Better systems and funding are needed, especially for adult influenza vaccine delivery and for redistribution of influenza vaccine in response to shortages.
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Affiliation(s)
- Julie A Gazmararian
- Emory Center on Health Outcomes and Quality, Dept. of Health Policy and Management, Rollins School of Public Health, Emory Univ., 1518 Clifton Rd. NE, Atlanta, GA 30322, USA.
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Willis BC, Wortley P. Nurses' attitudes and beliefs about influenza and the influenza vaccine: a summary of focus groups in Alabama and Michigan. Am J Infect Control 2007; 35:20-4. [PMID: 17276787 DOI: 10.1016/j.ajic.2006.07.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 07/10/2006] [Accepted: 07/11/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The U.S. Advisory Committee on Immunization Practices (ACIP) recommends influenza immunization among United States health care workers (HCWs) to reduce the spread of influenza to and from workers and patients. Despite these recommendations, influenza immunization coverage of health care workers is less than 50%. PARTICIPANTS AND METHODS Eight focus groups of registered nurses (RNs) were conducted in Birmingham, Alabama (n = 34) and Detroit, Michigan (n = 37). In each city, the focus groups consisted of 2 groups each of vaccinated and unvaccinated RNs. RESULTS These focus groups revealed that many nurses were concerned about influenza vaccine effectiveness and safety; their lack of information about the vaccine plays a part in their willingness to promote it to patients. Unvaccinated nurses tended to be less aware of the ACIP recommendations for HCW vaccination, and overall, nurses were not aware of the rationale for HCW vaccination. Attitudes were mixed regarding mandatory influenza vaccination programs, including the hope that such programs would result in higher vaccination rates and concern about potential disciplinary action if vaccine was declined. Participants believed that increasing convenience was the key to increasing HCW vaccination. CONCLUSIONS Our findings confirm the importance of comprehensive approaches that combine education and convenience, and suggest that emphasizing the rationale for HCW vaccination may contribute to increasing vaccination rates.
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Affiliation(s)
- Bayo C Willis
- Centers for Disease Control and Prevention, Health Services Research and Evaluation Branch, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia 30333, USA.
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Abstract
Influenza virus causes annual epidemics and occasional pandemics. Frequent mutations in circulating influenza strains ("antigenic drift") result in the need for annual vaccination. More than two-thirds of persons in the U.S. are recommended for annual vaccination. Because influenza vaccine is available seasonally, mass vaccination strategies are well suited to its delivery. Although doctors offices are the most frequent setting for influenza vaccination overall, workplaces, clinics, and community sites (retail stores and pharmacies) also are common vaccination settings. Influenza vaccination also is delivered in mass vaccination clinics to health care workers and military personnel. Universal influenza vaccination, which has been recommended as a strategy to improve prevention by increasing vaccination coverage and providing indirect protection of adults by decreasing infection and transmission among children, would require expanded use of mass vaccination, for example in schools, as well as in the community. Influenza pandemics occur when a new influenza A subtype is introduced into the population ("antigenic shift"). Most or all of the population is susceptible to the pandemic virus and two doses of vaccine may be needed for protection. U.S. pandemic preparedness and response plans indicate that the entire population should be vaccinated beginning with defined priority groups including those who provide essential services including healthcare and those at highest risk of severe illness and death. Pandemic influenza vaccination will occur primarily through the public sector in mass clinic settings. Vaccination program planning must consider issues including coordination, staffing, clinic location and lay-out, security, record keeping, and communications. Exercising vaccination clinics is important for preparedness and can be done in the context of annual influenza vaccination.
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Affiliation(s)
- B Schwartz
- Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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O'Hegarty M, Pederson LL, Nelson DE, Mowery P, Gable JM, Wortley P. Reactions of young adult smokers to warning labels on cigarette packages. Am J Prev Med 2006; 30:467-73. [PMID: 16704939 DOI: 10.1016/j.amepre.2006.01.018] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 01/13/2006] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND In 1984, the United States Congress enacted legislation requiring four new warning labels for cigarettes; warning labels in the United States have not changed since then. Other countries, such as Canada, have taken a more active and aggressive approach. The purpose of this study was to examine how U.S. smokers and former smokers might respond to stronger and more graphic warnings for U.S. cigarettes packages. METHODS Data were collected in 2003 and analyzed in 2004. The perceived impact and effectiveness of the more-explicit Canadian labels was examined among young adult smokers (n=572) and former smokers (n=191) between the ages of 18 and 24 years in the United States, using a web-based survey that allowed participants to view both the text-only and the text-plus-graphic warning labels. RESULTS Both current and former smokers thought that cigarette warning labels with text plus graphics were substantially more of a deterrent than text-only labels. The perceived effectiveness of these labels was not only higher overall, but also for the specific areas of smoking-related health effects, prevention, cessation, and maintenance of abstinence. Few differences were noted by gender. CONCLUSIONS The findings from this study support previous research that has found that text-plus-graphic warning labels are more salient and potentially more effective than text-only labels.
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Affiliation(s)
- Michelle O'Hegarty
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
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Lorick S, Wortley P, Lindley M, Bardenheier B, Euler G. Correlates of not Receiving Influenza Vaccination Among Healthcare Personnel -United States, 2004–2005. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s133-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shefer A, Santoli J, Wortley P, Evans V, Fasano N, Kohrt A, Fontanesi J, Szilagyi P. Status of Quality Improvement Activities to Improve Immunization Practices and Delivery. Journal of Public Health Management and Practice 2006; 12:77-89. [PMID: 16340519 DOI: 10.1097/00124784-200601000-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Centers for Disease Control and Prevention convened a symposium on 22-23 October 2003 to bring together investigators and stakeholders working to apply the quality improvement (QI) approaches to immunization delivery in individual medical practices. The goal was to identify effective program components and further development of model programs. A call for projects was widely disseminated; of 61 submissions received, eight projects were selected. Three of the eight programs used the "train the trainer" approach, three used site-specific training, one used a "practice collaborative" approach, and one employed the use of tracking and outreach workers to effect change. At the symposium, invited experts reviewed each program. Common program features that appeared effective included involvement of a variety of staff within the office environment, collection and review of site-specific performance measurements to identify gaps in delivery, periodic monitoring of performance measurement to revise interventions and maintain the improvements, and provision of formal continuing education credits. While research is needed on ways to promote and integrate QI into practices, it is likely that a variety of QI strategies will be shown to be effective, depending on the clinical settings. The field will benefit from standardized outcome measures, cost analysis, and evaluation, so comparisons can be made among different programs.
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Affiliation(s)
- Abigail Shefer
- Health Services Research & Evaluation Branch, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA.
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Fishbein DB, Willis BC, Cassidy WM, Marioneaux D, Bachino C, Waddington T, Wortley P. Determining indications for adult vaccination: patient self-assessment, medical record, or both? Vaccine 2005; 24:803-18. [PMID: 16455167 DOI: 10.1016/j.vaccine.2005.07.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 07/29/2005] [Indexed: 10/25/2022]
Abstract
CONTEXT Eight or more vaccines may be indicated for adults in the United States. Determining if any vaccines are needed requires integrating information on the patient's demographic and behavioral risk factors and health status, the health status of the patient's close contacts, and the patient's immunization history. This process can be time consuming for providers and their staff. We used patient self-assessment as a method of determining which vaccines are indicated for a patient and whether indicated vaccines had been received. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional convenience sample of 300 adults in three family practice settings. Participants completed a self-assessment tool to determine if influenza, pneumococcal, measles, mumps, and rubella (MMR), tetanus, hepatitis A and hepatitis B vaccines were indicated and previously received. A chart audit was then performed to obtain similar information. MAIN OUTCOME MEASURES Agreement (kappa statistic [< 0.00: poor agreement; 0.00-0.20: slight; 0.21-0.40: fair; 0.41-0.60: moderate; 0.61-0.80: substantial; 0.81-1.00: almost perfect]) between the self-assessment tool and the audit for (1) indicated vaccines and (2) previous receipt of indicated vaccines indicated according to both the assessment form and the audit. RESULTS Agreement between the self-assessment tool and chart review was substantial or better only for pneumococcal and MMR vaccines (kappa=0.65 and 0.85, respectively). For influenza vaccine, agreement improved (from kappa = 0.56 to kappa = 0.74) when indications attributable to health conditions of family members were excluded. Agreement regarding receipt of vaccines was highest for influenza vaccine (kappa = 0.70). Only 57% of patients correctly recalled tetanus vaccination that were documented in the medical record (kappa = -0.04). Kappa statistics were unreliable for hepatitis A and B vaccines because so few vaccinations had been received. CONCLUSIONS Discrepancies in agreement regarding indications for vaccines appeared to result from absence of information in the medical record regarding high risk behaviors and family contacts. Lack of agreement regarding vaccines that had been previously been received appeared due to both poor recall and lack of documentation. Combining medical record audit with self-assessment may be the most complete assessment of vaccination status of adults, but requires reconciling disagreements. Electronic medical records and registries that contain information about risk factors and previously administered vaccines may be necessary to overcome some these problems.
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Affiliation(s)
- Daniel B Fishbein
- Centers for Disease Control and Prevention, Health Services Research and Evaluation Branch, Immunization Services Division, National Immunization Program, MS E-52, Room 4128, Bldg. 12, Corporate Square, Atlanta, GA 30333, USA.
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Bardenheier B, Wortley P, Winston C, Washington ML, Lindley M. 013: Using Cluster Analysis to Examine Patterns of Knowledge, Attitudes, and Practices Related to Influenza Immunization Among Older Adults: Results of the Racial and Ethnic Adult Disparities in Immunization Initiative (Readii) Survey, 2004. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Bardenheier
- Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - P Wortley
- Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - C Winston
- Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - M L Washington
- Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - M Lindley
- Centers for Disease Control and Prevention, Atlanta, GA 30333
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Lindley M, Wortley P, Schwartz B. 358: Program Characteristics Related to Vaccine Uptake by Healthcare Workers During the National Smallpox Pre-Event Vaccination Program. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s90a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Lindley
- Centers for Disease Control & Prevention, Atlanta, GA, 30333
| | - P Wortley
- Centers for Disease Control & Prevention, Atlanta, GA, 30333
| | - B Schwartz
- Centers for Disease Control & Prevention, Atlanta, GA, 30333
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Wortley P. Who's getting shots and who's not: racial/ethnic disparities in immunization coverage. Ethn Dis 2005; 15:S3-4-S3-6. [PMID: 15945359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
This brief report provides data from the National Health Interview Survey (1989-2002) and offers commentary on reasons for the racial/ethnic disparities in immunization coverage for both influenza and pneumococcal vaccines for persons aged > or = 65 years. The findings in this report indicate that, although influenza and pneumococcal vaccination rates have increased for non-Hispanic Blacks and Hispanics, substantial gaps by race/ethnicity persist. Differences are observed even among individuals with similar characteristics (eg, education levels, similar numbers of healthcare visits, and similar insurance status) but from different ethnic groups. In addition, rates of vaccination for ethnic/racial groups have not increased at a sufficient rate to reach the national health objective for 2010 (90% of persons aged > 64 years receiving annual influenza vaccination and having ever received pneumococcal vaccination). By examining the successes of new initiatives such as the READII (Racial Ethnic Adult Disparities in Immunization) demonstration projects, researchers hope that progress can be made to close these racial/ethnic disparities.
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Affiliation(s)
- Pascale Wortley
- Centers for Disease Control and Prevention, National Immunization Program, Health Services Branch, Atlanta, Georgia 30333, USA.
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Singleton JA, Wortley P, Lu PJ. Influenza vaccination of persons with cardiovascular disease in the United States. Tex Heart Inst J 2004; 31:22-7. [PMID: 15061622 PMCID: PMC387428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
People who have cardiovascular disease are at increased risk of hospitalization or death associated with influenza infection, and are included among the high-risk groups for whom annual influenza vaccination is recommended. To measure the progress toward the national year 2000 and 2010 objectives of a 60% annual influenza vaccination of adults with high-risk conditions aged 18 to 64 years, we analyzed data from the 1997 to 2001 National Health Interview Surveys (NHIS) regarding persons with cardiovascular disease. The NHIS is an annual, cross-sectional survey representative of the U.S., noninstitutionalized, civilian population. Estimated percentages of persons with heart disease reporting influenza vaccination were relatively stable during the 1996-97 through 2000-2001 influenza seasons, with the highest levels in most groups occurring in 1999-2000: 49.2% (95% confidence interval [CI], 44.1%-54.3%) among persons aged 50 to 64 years; and 22.7% (95% CI, 18.2%-27.2%) among persons aged 18 to 49 years. Influenza vaccine coverage among adults aged 18 to 64 years with cardiovascular disease is substantially below the national objective. Multiple strategies are needed to improve vaccination coverage, such as increasing the awareness of and demand for vaccination by persons with heart disease; increasing implementation by providers of practices that have been shown to increase vaccination levels; and adopting of influenza vaccination by primary care providers and specialists as a standard of care for persons diagnosed with cardiovascular disease.
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Affiliation(s)
- James A Singleton
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Lansky A, Jones JL, Wan PC, Lindegren ML, Wortley P. Trends in zidovudine prescription for pregnant women infected with HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 18:289-92. [PMID: 9665508 DOI: 10.1097/00042560-199807010-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this analysis was to describe trends in zidovudine prescription during pregnancy among women infected with HIV. METHODS We used data from the Adult and Adolescent Spectrum of Disease Surveillance Project, which collects information on HIV-related conditions through medical record review. Women who were reported pregnant from 1990 through 1996 were included in the analysis. RESULTS From 1990 through 1996, of 7047 women in the project, 714 (10%) were pregnant for a total of 782 pregnancies. We found a high proportion (82%) of pregnancies during which zidovudine was prescribed for women with CD4+ T-lymphocyte count of 0 to 199 cells/microl (n = 125), but no trend over time. In contrast, from 1990 through 1996 zidovudine was prescribed for an increasing proportion of pregnancies in which the woman's CD4+ count was 200 to 499 cells/microl (62%-78%; p = .01; n = 337) and > or = 500 cells/microl (22%-55%; p = .001; n = 250). CONCLUSIONS Our study demonstrated differences in zidovudine prescription over time by CD4+ count; these differences may be based on the woman's health and guidelines for perinatal prevention.
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Affiliation(s)
- A Lansky
- Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention--Surveillance and Epidemiology, Atlanta, GA 30333, USA.
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Abstract
We evaluated vasectomy as a potential risk factor for urolithiasis. Vasectomy is a common method of contraception among otherwise healthy men. This is also the population at highest risk for urolithiasis. We conducted a case-control study of patients in a large prepaid health maintenance organization. Cases were men experiencing initial episodes of urolithiasis, ascertained by reviewing radiology logs and medical records. The age-matched controls were men with no history of urolithiasis. In logistic regression models, the relative risk of urolithiasis for men with vasectomies compared with men without vasectomies was 1.9 for men younger than 46 years of age (95% confidence interval = 1.2 to 3.1, P = 0.005), and the relative risk was 0.9 (95% confidence interval = 0.5 to 1.5, P > 0.8) for men who were at least 46 years old. The relative risk of urinary calculi was 2.0 (95% confidence interval 1.0 to 4.1, P < 0.05) for men with vasectomies 0 to 4 years before evaluation compared with men without vasectomies, and the excess risk persisted as long as 14 years postvasectomy. Vasectomy was associated with a twofold increased risk for urolithiasis in men younger than 46 years of age. This increased risk may persist for up to 14 years postvasectomy. Given the large number of men who undergo vasectomy worldwide each year, the increased risk for urolithiasis among vasectomized men may result in substantial excess morbidity.
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Affiliation(s)
- R A Kronmal
- Department of Biostatistics, University of Washington, School of Public Health and Community Medicine, Seattle 98195, USA
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Krieger JN, Kronmal RA, Coxon V, Wortley P, Thompson L, Sherrard DJ. Dietary and behavioral risk factors for urolithiasis: potential implications for prevention. Am J Kidney Dis 1996; 28:195-201. [PMID: 8768913 DOI: 10.1016/s0272-6386(96)90301-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Few studies have examined urolithiasis in primary care populations, and limited data are available on non-drug interventions to reduce the risk for urinary calculi. Therefore, we conducted a case control study of patients enrolled in a large prepaid health maintenance organization. The 240 study cases were men experiencing initial episodes of urolithiasis, ascertained by reviewing radiology procedure logs and medical records. The 392 controls were age-matched men with no history of urolithiasis chosen from a list of randomly selected men. Data were collected using standardized telephone interviews. Odds ratios were calculated for potential risk factors. In logistic regression analyses the risk for urinary tract calculi was related to both consumption variables, such as a low-fat or weight reduction diet (adjusted odds ratio, 0.41; P < 0.0005) and beer drinking (adjusted odds ratio, 0.41; P < 0.0001), and to demographic variables, such as African-American ethnicity (adjusted odds ratio, 0.29; P = 0.03) and a positive family history (adjusted odds ratio, 2.22; P < 0.001). These findings suggest the need to evaluate appropriate behavioral interventions to reduce the morbidity associated with urolithiasis. Prospective studies should evaluate the possibilities that beer drinking, even in modest amounts, and a low-fat or weight reduction diet are associated with substantial reductions in risk.
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Affiliation(s)
- J N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle 98195, USA
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Wortley P, Chu SY, Blostein J, Farley T, Morrison L, Kovacs A, Thompson S. Care of pregnant women infected with HIV. JAMA 1994; 271:271-2. [PMID: 7905034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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