An Analysis of Social Determinants of Health and Their Implications for Hepatitis C Virus Treatment in People Who Inject Drugs: The Case of Baltimore

Background

Sixty-eight percent of the nearly 3.5 million people living with hepatitis C virus (HCV) in the United States are people who inject drugs (PWID). Despite effective treatments, uptake remains low in PWID. We examined the social determinants of health (SDoH) that affect the HCV care cascade.

Methods

We conducted a secondary analysis of data from 720 PWID in a cluster-randomized trial. We recruited PWID from 12 drug-affected areas in Baltimore. Inclusion criteria were injection in the prior month or needle sharing in the past 6 months. Intake data consisted of a survey and HCV testing. Focusing on SDoH, we analyzed self-report of (1) awareness of HCV infection (in those with active or previously cured HCV) and (2) prior HCV treatment (in the aware subgroup). We used descriptive statistics and logistic regression for statistical analyses.

Results

The 342 participants were majority male and Black with a median age of 52 years. Women were more likely to be aware of their status but less likely to be treated. Having a primary care provider and HIV-positive status were associated with increased awareness and treatment. Unhoused people had 51% lower odds of HCV treatment. People who reported that other PWID had shared their HCV status with them had 2.3-fold higher odds of awareness of their own status.

Conclusions

Further study of gender disparities in HCV treatment access is needed. Increased social support was associated with higher odds of HCV treatment, suggesting an area for future interventions. Strategies to identify and address SDoH are needed to end HCV.

Results of Leveraging Pharmaceutical Patient Assistance Programs to Expand Access to High Cost Medications in a Student-Run Free Clinic

High costs make many medications inaccessible to patients in the United States. Uninsured and underinsured patients are disproportionately affected. Pharmaceutical companies offer patient assistance programs (PAPs) to lower the cost-sharing burden of expensive prescription medications for uninsured patients. PAPs are used by various clinics, particularly oncology clinics and those caring for underserved communities, to expand patients' access to medications. Prior studies describing the implementation of PAPs in student-run free clinics have demonstrated cost-savings during the first few years of using PAPs. However, there is a lack of data regarding the efficacy and cost savings of longitudinal use of PAPs across several years. This study describes the growth of PAP use at a student-run free clinic in Nashville, Tennessee over ten years, demonstrating that PAPs can be used reliably and sustainably to expand patients' access to expensive medications. From 2012 to 2021, we increased the number of medications available through PAPs from 8 to 59 and the number of patient enrollments from 20 to 232. In 2021, our PAP enrollments demonstrated potential cost savings of over $1.2 million. Strategies, limitations, and future directions of PAP use are also discussed, highlighting that PAPs can be a powerful tool for free clinics in serving underserved communities.

Facilitating rural access to quality health information through Little Free Libraries

Background

In 2020 the Health Science Center Libraries (HSCL) at the University of Florida collaborated with the Okeechobee County Public library (OCPL) on their plan to install Little Free Libraries (LFLs) within their community. It was agreed that the HSCL would provide consumer health-related materials for the Little Free Libraries and training with the goal of improving health literacy, precision medicine, and increasing rural access to consumer health materials and services.

Case Presentation

Using census data, the County Health Improvement Plan, and OCPL circulation data the team identified minority population groups, potential accessibility issues, and local consumer health information needs and barriers to select appropriate resources. Additionally, partnerships were created with the local Health Department, Parks and Recreation services, the Rotary Club, and other local organizations to make the project a success. A total of 424 books were selected for the LFLs and 40 unique online resources were selected, printed, and shipped to OCPL to be used during LFL reference sessions. Technology was purchased to assist OCPL with their planned community health reference outreach sessions. HSCL created and provided online training on facilitating consumer health outreach, conducting health information reference services, and promoting community engagement for OCPL.

Discussion

LFLs have become an important resource for lower-income rural families in Okeechobee. There are 7 LFLs in Okeechobee County, with a goal of eventually establishing 15 total to provide vital health resources and books. Over 2,456 items have been circulated among the 7 LFLs since May 2020. Overall, the project has been successful with positive feedback received from the community and with OCPL planning to continue to expand the project.

The Impact of the Appalachian Career Training in Oncology (ACTION) Program on High School Participants

OBJECTIVE

Kentucky ranks first in the nation in cancer incidence and mortality. The Appalachian region of the state experiences the highest cancer disparities due to inequities in many social determinants of health as well as poor health behaviors. As a strategy for addressing cancer and education disparities in the region, the Appalachian Career Training in Oncology (ACTION) Program at the University of Kentucky Markey Cancer Center engages Appalachian-native high school students in cancer education, research, and outreach activities.

METHODS

Entry and exit surveys were administered to participants. Classical test theory and exploratory factor analysis were used to examine the instruments used for program evaluation, whereas repeated measures ANOVA was used to determine if there were significant differences in means between entry and exit timepoints.

RESULTS

There was an increase in students' understanding and comfort with cancer-related topics between entry and exit survey administrations. Students indicated that the program improved their research skills and career planning skills. Furthermore, students had positive perceptions of all aspects of the program.

CONCLUSION

Data suggest that ACTION has a positive impact on high school students. Specifically, results show increased understanding and comfort with cancer-related topics, research skills, and career planning.

Preventive Cancer Screening in Asian Americans: Need for Community Outreach Programs

Background:

Asian Americans (AA) are the only racial group in the United States to experience cancer as the number one cause of mortality. Yet, Asian Americans have one of the lowest rates of cancer screenings of all minority groups in the United States.

Methods:

A cross-sectional and population-based study design was used. Cross-sectional data was collected from 1,650 AA participants via a survey given during two annual community health festivals in 2017 and 2018. Survey variables included sociodemographic measures, self-reported English-language proficiency level, access to primary care, attitudes on preventative cancer screening, current screening status and barriers to undergoing cancer screening.

Results:

Nearly 66% (n=1,081) reported not having a primary care physician (PCP). While the majority of the participants (n=1,510, 92%) stated that preventative cancer screenings were important, only a small portion (n=1,091, 16%) were up-to-date on cancer screening procedures. The biggest barriers to preventative cancer screening were: 1) Lack of insurance (n=840, 40%); 2) Cost of seeing a physician (n=517, 24%); and 3) Do not feel the need (n=299, 14%).

Conclusions:

To overcome the barriers we identified and effectively increase cancer screenings in Asian Americans, community outreach should be considered to provide linkage to primary care physicians and navigation to low-cost screening programs.

COVID-19 mitigation for high-risk populations in Springfield Massachusetts USA: a health systems approach

BACKGROUND

Numerous reports have demonstrated the disproportionate impact that COVID-19 has had on vulnerable populations. Our purpose is to describe our health care system's response to this impact.

METHODS

We convened a Workgroup with the goal to mitigate the impact of COVID-19 on the most medically vulnerable people in Springfield, Massachusetts, USA, particularly those with significant social needs. We did this through (1) identifying vulnerable patients in high-need geographic areas, (2) developing and implementing a needs assessment/outreach tool tailored to meet cultural, linguistic and religious backgrounds, (3) surveying pharmacies for access to medication delivery, (4) gathering information about sources of food delivery, groceries and/or prepared food, (5) gathering information about means of travel, and (6) assessing need for testing. We then combined these six elements into a patient-oriented branch and a community outreach/engagement branch.

CONCLUSIONS

Our highly intentional and methodical approach to patient and community outreach with a strong geographic component has led to fruitful efforts in COVID-19 mitigation. Our patient-level outreach engages our health centers' clinical teams, particularly community health workers, and is providing the direct benefit of material and service resources for our at-risk patients and their families. Our community efforts leveraged existing relationships and created new partnerships that continue to inform us-healthcare entities, healthcare employees, and clinical teams-so that we can grow and learn in order to authentically build trust and engagement.

Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation

Background:

The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India.

Methods:

Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial “screen and treat” protocol was transitioned to “screen, test, and treat” using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations.

Results:

Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under “screen and treat”, 56/156 (35.9%) women accepted same-day treatment. Under “screen, test, and treat”, 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies.

Conclusions:

Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.

Pediatric Case Finding in Madagascar: A Controlled, Prospective Population-based Assessment of Key Informant Productivity and Cost

Purpose: The Key Informant (KI) case finding method, which trains community members to screen children for eye problems and refer them to eye services, is a common strategy to identify and refer children with blindness and visual impairment. However, studies to date have not determined the benefit and cost of adding KIs to routine outreach activities.Methods: Four eye programs in Madagascar with established outreach camps added KIs to a portion of their camps distributed equally throughout their service region over a one year period. KIs recorded children screened and their attendance at an outreach camp. Outreach personnel used standardized registration forms to gather age, sex, visual acuity, diagnosis and treatment data. Costs were gathered for the KI program and outreach camps.Results: In one year, the 4 eye programs held 138 outreach camps, 43 with KIs. The KI camps were more productive than regular camps seeing an average of 61 and 24 children and 50 and 19 children with an eye problem, for KI and regular camps, respectively. The KI camps also saw more children with moderate or severe visual impairment or blindness with 21 and 8 children (per 10 camps) for KI and regular camps, respectively. A KI camp cost $463 ($642 vs. $179) more than a regular camp and $3 ($8 vs. $11) more per child seen.Conclusion: The KI method significantly increased the number of children attending outreach camps, at all levels of visual impairment and blindness, at a modest increase in costs.

Assessing student knowledge, confidence, accuracy, and proficiency in providing Medicare Part D assistance

PURPOSE

To assess the impact of coordinated didactic, simulation-based, and experiential learning on pharmacy students' knowledge and confidence with Medicare Part D and their accuracy and proficiency with the Medicare Plan Finder Tool.

EDUCATIONAL ACTIVITY

Forty-two pharmacy students participated in a two-semester Medicare Part D elective course in which didactic, simulation-based and experiential learning methods were employed. Students' knowledge, confidence, accuracy, and proficiency were assessed at three course time points: first day of class, last day of in-class education, and after completion of outreach.

FINDINGS

Student confidence with Part D and efficiency using the Plan Finder Tool significantly improved at each successive time point (p<0.01). Student knowledge was significantly improved both on the last day of class and after outreach completion as compared to the first day of class (p<0.01).

SUMMARY

Basic Part D knowledge improved with the didactic and simulation-based portion of the course. The experiential component improved student confidence and efficiency in helping Medicare beneficiaries.