scholarly journals Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model among Persons Experiencing Homelessness

2021 ◽  
Author(s):  
Jesse Powell ◽  
Margaret Ricco ◽  
Jessica Naugle ◽  
Catherine Magee ◽  
Hayat Hassan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
San Francisco ◽  
Illicit Drugs ◽  
Clinic Visit ◽  
Homeless Shelters ◽  
Prior Therapy ◽  
The Past ◽  
Hcv Therapy ◽  
Visit Adherence ◽  
Active Alcohol

Abstract Background Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to HCV therapy following HCV education in a shelter-based care model. Methods Prospective study conducted at 4 homeless shelters in Minneapolis, MN and San Francisco, CA from 11/2018–1/2021. Sixty-three patients underwent HCV education and treatment. Multivariable modeling evaluated factors associated with (1) medication and (2) overall (composite score of medication, laboratory, and clinic visit) adherence. Results Median age was 56, 73% male, 43% Black, 52% had psychiatric illness, and 81% used illicit drugs and 60% used alcohol in the past year. Following education, 52% were extremely confident in their ability to be adherent to HCV therapy. Medication adherence by patient and provider report was 88% and 48% respectively and 81% achieved HCV cure. Active alcohol use was associated with less confidence in medication adherence (43% vs. 78%, P=0.04). Older age was positively (Coef=0.3) associated with overall adherence to HCV treatment while prior therapy was associated with both medication (OR=0.08) and overall treatment (Coef=-0.87) non-adherence. Conclusions Despite imperfect adherence, SVR rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.

scholarly journals Routine HIV clinic visit adherence in the African Cohort Study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicole Dear ◽  
Allahna Esber ◽  
Michael Iroezindu ◽  
Emmanuel Bahemana ◽  
Hannah Kibuuka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Virologic Failure ◽  
Clinical Care ◽  
Clinic Visit ◽  
People Living With Hiv ◽  
The Past ◽  
Visit Adherence ◽  
Missed Visits ◽  
History Of ◽  
Clinic Visits

Abstract Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

scholarly journals Telemedicine Chronic Viral Hepatitis C Treatment during the Lockdown Period in Romania: A Pilot Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3694
Author(s):  
Irina Paula Doica ◽  
Dan Nicolae Florescu ◽  
Carmen Nicoleta Oancea ◽  
Adina Turcu-Stiolica ◽  
Mihaela-Simona Subtirelu ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Medication Adherence ◽  
Pilot Study ◽  
Multidisciplinary Approach ◽  
Therapy Monitoring ◽  
Antiviral Agents ◽  
Item Score ◽  
Hcv Therapy ◽  
Viral Hepatitis C ◽  
Significant Difference

The COVID-19 pandemic is currently delaying the process of chronic hepatitis C (HCV) eradication, since most of the chronic diseases are neglected. Thus, there is a need for alternative programs for HCV therapy implementation and disease monitoring. Our aim was to provide a multidisciplinary approach, so that HCV-infected patients from distant locations may benefit from HCV antivirals during the COVID-19 outbreak and within the lockdown period in Romania. Previously diagnosed HCV patients willing to participate in this telemedicine pilot study were included. Patient characteristics and medical adherence were assessed and compared to the year preceding the pandemic. We proposed a multidisciplinary approach by using a telemedicine program for HCV therapy monitoring. Patients also received a satisfaction questionnaire after delivering the sustained virologic response (SVR) result. A total of 41 patients agreed to participate in this study. The medication adherence was 100% for patients included in the telemedicine group, with a statistically significant difference from the medication adherence of the patients treated in 2019. The satisfaction item score was 4.92 out of 5 and our results (r = −0.94, p < 0.0001) suggested that older patients embraced the telemedicine program less, but with the same success in terms of SVR (100%) and medication adherence (100%). Our pilot study offers the first example of a telemedicine program in Romania for HCV therapeutic management. During the lockdown period, telemedicine has served as a reliable tool and novel alternative for conventional monitoring of patients treated with direct antiviral agents and should be further considered even following the pandemic.

scholarly journals Improved PrEP Awareness and Use among Trans Women in San Francisco, California

2021 ◽  
Author(s):  
Erin C. Wilson ◽  
Christopher J. Hernandez ◽  
Susan Scheer ◽  
Dillon Trujillo ◽  
Sean Arayasirikul ◽  
...  
Keyword(s):  
San Francisco ◽  
Anal Intercourse ◽  
Receptive Anal Intercourse ◽  
The Past ◽  
National Hiv Behavioral Surveillance ◽  
Trans Women ◽  
Gender Based ◽  
Prep Awareness ◽  
Almost All ◽  
Exposure Prophylaxis

AbstractTransgender women face a serious risk of HIV infection. Despite this, there is limited knowledge and use of Pre-exposure prophylaxis (PrEP). We measured the continuity of prevention across services in the PrEP cascade and correlates of PrEP use among trans women in San Francisco enrolled in the 2019/20 National HIV Behavioral Surveillance Study. Knowledge and use of PrEP among trans women in San Francisco increased in recent years; almost all (94.0%) had heard about PrEP, 64.7% had discussed PrEP with a healthcare provider, and 44.8% had taken PrEP in the past 12 months. PrEP use was associated with participation in a PrEP demonstration project (aOR = 31.44, p = 0.001) and condomless receptive anal intercourse (aOR = 3.63, p = 0.024). Injection drug use was negatively associated (aOR = 0.19, p = 0.014). Efforts are needed to combat the gender-based stigma and discrimination faced by trans women, which can result in avoidance and mistrust of the medical system.

scholarly journals Supporting Restoration Decisions through Integration of Tree-Ring and Modeling Data: Reconstructing Flow and Salinity in the San Francisco Estuary over the Past Millennium

Water ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 2139
Author(s):  
Paul H. Hutton ◽  
David M. Meko ◽  
Sujoy B. Roy
Keyword(s):  
San Francisco ◽  
Tree Ring ◽  
San Francisco Estuary ◽  
Salinity Intrusion ◽  
Estuarine Ecosystem ◽  
Freshwater Flow ◽  
The Past ◽  
Decadal Scale ◽  
Tree Ring Data ◽  
Past Millennium

This work presents updated reconstructions of watershed runoff to San Francisco Estuary from tree-ring data to AD 903, coupled with models relating runoff to freshwater flow to the estuary and salinity intrusion. We characterize pre-development freshwater flow and salinity conditions in the estuary over the past millennium and compare this characterization with contemporary conditions to better understand the magnitude and seasonality of changes over this time. This work shows that the instrumented flow record spans the range of runoff patterns over the past millennium (averaged over 5, 10, 20 and 100 years), and thus serves as a reasonable basis for planning-level evaluations of historical hydrologic conditions in the estuary. Over annual timescales we show that, although median freshwater flow to the estuary has not changed significantly, it has been more variable over the past century compared to pre-development flow conditions. We further show that the contemporary period is generally associated with greater spring salinity intrusion and lesser summer–fall salinity intrusion relative to the pre-development period. Thus, salinity intrusion in summer and fall months was a common occurrence under pre-development conditions and has been moderated in the contemporary period due to the operations of upstream reservoirs, which were designed to hold winter and spring runoff for release in summer and fall. This work also confirms a dramatic decadal-scale hydrologic shift in the watershed from very wet to very dry conditions during the late 19th and early 20th centuries; while not unprecedented, these shifts have been seen only a few times in the past millennium. This shift resulted in an increase in salinity intrusion in the first three decades of the 20th century, as documented through early records. Population growth and extensive watershed modification during this period exacerbated this underlying hydrologic shift. Putting this shift in the context of other anthropogenic drivers is important in understanding the historical response of the estuary and in setting salinity targets for estuarine restoration. By characterizing the long-term behavior of San Francisco Estuary, this work supports decision-making in the State of California related to flow and salinity management for restoration of the estuarine ecosystem.

Diverging trends in US male-female condom use by STI risk factors: a nationally representative study

2020 ◽  
pp. sextrans-2020-054642
Author(s):  
Casey E Copen ◽  
Patricia J Dittus ◽  
Jami S Leichliter ◽  
Sagar Kumar ◽  
Sevgi O Aral
Keyword(s):  
Risk Factors ◽  
Condom Use ◽  
Illicit Drugs ◽  
Female Condom ◽  
Cross Sectional ◽  
The Past ◽  
Representative Study ◽  
The Usa ◽  
Over Time ◽  
Sex Partner

ObjectiveCondom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors.MethodsTo examine condom use over time among MSW aged 15–29, we used three cross-sectional surveys from the 2002, 2006–2010 and 2011–2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner).ResultsWe observed a divergence in trends in condom use at last sex between men aged 15 –29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011–2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15–19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%–26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed.ConclusionsWhile STIs have been increasing, men aged 15–29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors.

Medication Adherence Reminder System for Virtual Home Assistants: Mixed Methods Evaluative Study (Preprint)

2021 ◽  
Author(s):  
Cynthia F. Corbett ◽  
Elizabeth M. Combs ◽  
Peyton S. Chandarana ◽  
Isabel Stringfellow ◽  
Karen Worthy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Medication Adherence ◽  
Feasibility Study ◽  
Global Public Health ◽  
Constructive Feedback ◽  
The Past ◽  
Significant Difference ◽  
Mcnemar’S Test ◽  
Medication Reminder ◽  
Mcnemar's Test

BACKGROUND Medication non-adherence is a global public health challenge that results in sub-optimal health outcomes and increases healthcare costs. Forgetting to take medicines is one of the most common reasons for unintentional non-adherence. Research findings indicate that voice-activated virtual home assistants (VHAs), such as Amazon Echo and Google Home devices, may be useful in promoting medication adherence. OBJECTIVE Create a medication adherence app (skill) for Amazon Echo devices and measure the use, usability, and usefulness of that skill. METHODS A single-group mixed methods cohort feasibility study was conducted with females who took oral contraceptives (n=25). Participants were undergraduate students (mean age = 21.8, SD 6.2) at an urban university in the Southeast United States. Participants were given an Amazon Echo Dot with MedBuddy, a new medication reminder skill for Echo devices created by our team, attached to their study account, which they used for 60 days. Participants self-reported baseline and post-study medication adherence. MedBuddy use was objectively evaluated by tracking the participants’ interaction with MedBuddy through Amazon Alexa. The usability and usefulness of MedBuddy were evaluated through a post-study interview with participants responding to both quantitative and qualitative questions. RESULTS Participants’ interactions with MedBuddy, as tracked through Amazon Alexa, only occurred on half of the study days (mean of 50.97, SD 29.5). Compared to baseline, at study end participants reported missing their medication less in the past one and six months (χ 2 = .884 and .420 respectively, McNemar’s test p < .001 for both). However, there was no significant difference in participants’ reported adherence to consistently taking medication within the same two-hour time frame each day the past one or six months at the end of the study compared to baseline (χ 2 = 3.544 and 5.526 respectively, McNemar’s test p = .63 and p = .13 respectively). Overall feedback about usability was positive, and participants provided constructive feedback about features of the skill that could be improved. Participants’ evaluation of the usefulness of Medbuddy was overwhelmingly positive. Most participants (65.2%, n=15) said they would continue to use MedBuddy as a medication reminder in the future if provided the opportunity and the majority (91.3%, n=21) said they would recommend it to others. MedBuddy features that participants enjoyed were an external prompt separate from their phone, being able to hear the reminder prompt from a separate room, multiple reminders, and verbal responses as prompts. CONCLUSIONS The results of this feasibility study indicate the MedBuddy medication reminder skill may be useful in promoting medication adherence, but the skill could benefit from further usability enhancements.

scholarly journals “They Always Call Me an Investment”: Gendered Familism and Latino/a College Pathways

2020 ◽  
Author(s):  
Sarah Ovink
Keyword(s):  
High School ◽  
Gender Differences ◽  
San Francisco ◽  
College Enrollment ◽  
College Attainment ◽  
The Past ◽  
College Going ◽  
College Choices ◽  
Gender Reversal ◽  
Racial Ethnic

In the past 20 years, Latinas have begun to outperform Latinos in high school completionand college enrollment, tracking the overall “gender reversal” in college attainment thatfavors women. Few studies have examined what factors contribute to Latinas’ increasingeducational success. This article focuses on gender differences in college-going behavioramong a cohort of 50 Latino/a college aspirants in the San Francisco East Bay Area.Through 136 longitudinal interviews, I examine trends in Latinos/as’ postsecondary pathwaysand life course decisions over a two-year period. Findings suggest evidence forgendered familism, in which gender and racial/ethnic beliefs intersect to differentiallyshape Latinos/as’ attitudes, behaviors, and college choices. Gendered familism encouragedLatinas to seek a four-year degree as a means of earning independence, whileLatinos expressed a sense of automatic autonomy that was not as strongly tied to educationaloutcomes.

Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Valy Fontil ◽  
Lucia Pacca ◽  
Brandon Bellows ◽  
Elaine Khoong ◽  
Charles McCulloch ◽  
...  
Keyword(s):  
Racial Differences ◽  
San Francisco ◽  
Structural Equation ◽  
Safety Net ◽  
Clinic Visit ◽  
Treatment Intensification ◽  
Missed Opportunities ◽  
Black Patients ◽  
Missed Visits ◽  
Equitable Treatment

Introduction: Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity. Hypothesis: We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities. Methods: We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP<140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes. Results: The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p<0.001) and missed more visits (β=0.37, p<0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure). Conclusion: Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.

Guitar Forum: The Flute, Viola, Guitar Trio: Its History, Literature and Performance

1986 ◽  
Vol 36 (4) ◽  
pp. 73-76
Author(s):  
Douglas Hensley
Keyword(s):  
New York ◽  
Chamber Music ◽  
San Francisco ◽  
Classical Guitar ◽  
The West ◽  
Master's Degrees ◽  
Private Lessons ◽  
Additional Information ◽  
The Past ◽  
And Performance

Douglas Hensley has been an active chamber musician ever since he took up serious study of the classical guitar. He received bachelor and master's degrees under the direction of David Tanenbaum from the San Francisco Conservatory of Music and he has studied with many other musicians in private lessons and master classes. Over the past ten years he has premiered close to fifty new compositions, performed numerous U.S. premieres and the West Coast premiere of Elliott Carter's “Changes” for solo guitar. For Opus One Records in New York he has recorded Larry Polansky's “Hensley Variations” and David Loeb's “Trois Cansos” with flautist Kenneth Kramer and violist John Casten. He has also recorded a collection of duets with Japanese shakuhachi master Masayuka Koga, “Autumn Mist,” for Fortuna Records of Novato, California. His principal activities are as cofounder (with violist/violinist John Casten) and guitarist of the San Francisco-based contemporary performance ensemble ISKRA, which is made up of flute, clarinet, guitar, violin/viola, doublebass and soprano voice. Anyone with additional information about flute, viola, guitar trios (or other chamber music with guitar), or queries, is urged to contact him at 607-A Frederick St., San Francisco, CA 94117.

Telemedicine in a pediatric headache clinic

Neurology ◽  
2018 ◽  
Vol 90 (19) ◽  
pp. e1702-e1705 ◽  
Author(s):  
William Qubty ◽  
Irene Patniyot ◽  
Amy Gelfand
Keyword(s):  
San Francisco ◽  
Cost Effective ◽  
Family Satisfaction ◽  
Clinic Visit ◽  
Survey Study ◽  
Daily Routine ◽  
Patient Centered ◽  
Pediatric Headache ◽  
Headache Clinic

ObjectiveThe aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care.MethodsThis was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit.ResultsFifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486.ConclusionThis prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction.

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