scholarly journals 904. Improving Infectious Disease Screening and Hepatitis C Care Cascade Outcomes Among Adults Receiving Medication Assisted Treatment

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S543-S544
Author(s):  
Sarah Hoehnen ◽  
Audra B Blood ◽  
Rachel Austermiller
Keyword(s):  
Treatment Outcomes ◽  
People Who Inject Drugs ◽  
Published Data ◽  
Hiv Screening ◽  
Hcv Treatment ◽  
Medication Assisted Treatment ◽  
Care Cascade ◽  
Opt Out ◽  
Hcv Screening ◽  
One Year

Abstract Background This initiative increased infectious disease (ID) screening in an adult medication assisted treatment (MAT) population at a Federally Qualified Health Center (FQHC) by implementing opt-out screening for HIV, viral hepatitis, and sexually transmitted infections (STIs), and assessed the success of a co-located hepatitis C (HCV) treatment program. Methods ID providers maintained a standing lab order for HIV, hepatitis A, hepatitis B, HCV, syphilis, chlamydia/gonorrhea (GC/CT), and trichomoniasis (trich), with reflex to confirmatory for HIV/HCV/syphilis. For all existing and new adult MAT patients, a MAT RN provided education, ensured lab draw on the day of MAT induction, and scheduled an ID follow-up visit. The patient then had an in-person or telemedicine visit with the ID provider to review results, discuss risk reduction, and initiate treatment (HIV PrEP or treatment for STI, HCV, or HIV) as indicated. Data was compiled and monitored by a Prevention RN. Plan, Do, Study, Act (PDSA) Model PDSA model demonstrating implementation approach Results The rate of testing among MAT patients increased over a one-year period. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). HCV Care Cascade Outcomes HCV screening and treatment outcomes within HCV Care Cascade model Screening Outcomes Screening rates among adult MAT population over a one-year measurement period Conclusion This study documents the successful implementation of an opt-out screening program among an adult substance use disorder (SUD) treatment population across urban, mixed, and designated rural environments. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). Barriers to implementation included acceptance among patients with long-term MAT participation, acceptance/adoption by behavioral health nursing and provider staff, and functional workflow development – establishment of protocol, lab availability, scheduling, and “tough sticks.” Modifications that increased effectiveness included an interdisciplinary approach and dedicated staff for monitoring results completion and patient outreach. Run chart: HIV screening rates over a one-year period HIV screening change among adult MAT patients over a one-year period Run chart: HCV screening rates over a one-year period HCV screening change among adult MAT patients over a one-year period HCV Care Cascade: HCV screening and treatment outcomes HCV screening and treatment outcomes presented in HCV Care Cascade for adult MAT population Disclosures All Authors: No reported disclosures

scholarly journals Vaccine completion and infectious diseases screening in a cohort of adult refugees following resettlement in the U.S.: 2013–2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amir M. Mohareb ◽  
Bryan Brown ◽  
Kevin S. Ikuta ◽  
Emily P. Hyle ◽  
Aniyizhai Annamalai
Keyword(s):  
Infectious Diseases ◽  
Hepatitis A ◽  
Medical Data ◽  
Hiv Screening ◽  
Consensus Guidelines ◽  
Active Infection ◽  
Vaccine Completion ◽  
Hcv Screening ◽  
One Year ◽  
The U.S

Abstract Background Refugees are frequently not immune to vaccine-preventable infections. Adherence to consensus guidelines on vaccination and infectious diseases screening among refugees resettling in the U.S. is unknown. We sought to determine rates of vaccine completion and infectious diseases screening in refugees following resettlement. Methods We conducted a retrospective cohort study of refugees resettling in a region in the U.S. using medical data from June 2013–April 2015. We determined the proportion of vaccine-eligible refugees vaccinated with measles-mumps-rubella (MMR), hepatitis A/B, tetanus, diphtheria, and acellular pertussis (Tdap), and human papillomavirus (HPV) following resettlement. We also determined the proportion of refugees who completed HIV and hepatitis C (HCV) screening. Results One hundred and eleven subjects were included, primarily from Iraq (53%), Afghanistan (19%), and Eritrea (11%). Of the 84 subjects who were vaccine-eligible, 78 (93%) initiated and 42 (50%) completed vaccinations within one year of resettlement. Odds of completing vaccination were higher for men (OR: 2.38; 95%CI:1.02–5.71) and for subjects with English proficiency (OR: 3.70; 95%CI:1.04–17.49). Of the 78 subjects (70%) completing HIV screening, two (3%) were diagnosed with HIV. Nearly all subjects completed screening for HCV, and one had active infection. Conclusion While most refugees initiate vaccinations, only 50% completed vaccinations and 70% completed HIV screening within 1 year of resettlement. There is a need to emphasize vaccine completion and HIV screening in refugee patients following resettlement.

scholarly journals A220 THE EFFECT OF HOMELESSNESS ON HCV TREATMENT OUTCOMES AMONG PEOPLE WHO INJECT DRUGS

2018 ◽  
Vol 1 (suppl_1) ◽  
pp. 384-384 ◽  
Author(s):  
A Singh ◽  
G Kiani ◽  
R Shahi ◽  
A Alimohammadi ◽  
T Raycraft ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
People Who Inject Drugs ◽  
Hcv Treatment

The evaluation of homelessness on HCV treatment outcomes among current and former people who inject drugs

2017 ◽  
Vol 66 (1) ◽  
pp. S403
Author(s):  
A. Singh ◽  
A. Alimohammadi ◽  
T. Raycraft ◽  
R. Shahi ◽  
G. Kiani ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
People Who Inject Drugs ◽  
Hcv Treatment

scholarly journals 1274. Universal HIV and HCV Screening in San Diego Emergency Departments: Implications for Other Settings With a High Density of Free of Charge HIV Screening Programs

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S388-S388
Author(s):  
Martin Hoenigl ◽  
Chris Coyne ◽  
Jill Blumenthal ◽  
Gary Vilke ◽  
Susan Little
Keyword(s):  
Birth Cohort ◽  
San Diego ◽  
High Density ◽  
Hiv Screening ◽  
Newly Diagnosed ◽  
Screening Programs ◽  
Opt Out ◽  
Hiv Test ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background While HIV and HCV testing targeted to high-risk groups results in substantially higher proportions of HIV diagnoses, universal HIV and HCV screening in emergency department (ED) settings is expected to reach populations who do not perceive themselves to be at risk or are otherwise less likely to participate in HIV and HCV testing. As a consequence the CDC recommends routine HIV screening for persons 13–64 years of age, and routine HCV screening for the birth cohort (born between 1945–1965). The objective of this analysis was to evaluate the yield of universal opt-out HIV and HCV screening in the two EDs at the University of California San Diego (UCSD). Methods In July 2017, electronic medical record (EMR) based universal opt-out HIV screening (Architect HIV antibody [Ab]/HIV p24 antigen detection) for persons aged 13–64 years (excluding persons known HIV+ or reporteing an HIV test within the last 12 months) was implemented in our EDs. The EMR algorithm also identified HIV+ individuals who had been out of care for >12 months. In March 2018, EMR based universal HCV screening for birth cohort was added in both EDs. Results Over a period of 9 months 7,303 HIV tests were conducted, resulting in 24 (0.3%) new HIV diagnoses, of which 21 were successfully linked to care. In five individuals without HIV infection Architect gave a false-positive result (specificity 99.93%). In addition, the EMR algorithm identified 38 out of care HIV+ individuals of which 21 were successfully relinked to care. During the 1-month HCV birth cohort screening 963 HCV Ab tests were conducted, of which 106 (11%) resulted positive. At the time being 78 of those seropositive individuals had HCV RNA testing, of which 36 (53%) resulted positive (3.7% of all participants). Conclusion In San Diego, a setting with a high density of free-of charge HIV screening programs, 1/300 HIV tests in the ED yielded a new HIV diagnosis and in total 21 newly diagnosed individuals were linked to care. Identification of HIV+ out of care individuals yielded in an equivalent number of individuals relinked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >10-fold outlining the importance of screening for HCV in the ED. Disclosures All authors: No reported disclosures.

scholarly journals Factors and HCV treatment outcomes associated with smoking among people who inject drugs on opioid agonist treatment: secondary analysis of the PREVAIL randomized clinical trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Irene Pericot-Valverde ◽  
Moonseong Heo ◽  
Matthew J. Akiyama ◽  
Brianna L. Norton ◽  
Linda Agyemang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cigarette Smoking ◽  
Treatment Outcomes ◽  
Randomized Clinical Trial ◽  
People Who Inject Drugs ◽  
Treatment Completion ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Cocaine Use ◽  
High Prevalence

Abstract Background Cigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV). People who inject drugs (PWID) represent the largest group of adults infected with HCV in the US. However, cigarette smoking remains virtually unexplored among this population. This study aimed at (1) determining prevalence and correlates of cigarette smoking among HCV-infected PWID enrolled in opiate agonist treatment programs; (2) exploring the association of smoking with HCV treatment outcomes including adherence, treatment completion and sustained virologic response (SVR); and 3) exploring whether cigarette smoking decreased after HCV treatment. Methods Participants were 150 HCV-infected PWID enrolled in a randomized clinical trial primarily designed to test three intensive models of HCV care. Assessments included sociodemographics, presence of chronic health and psychiatric comorbidities, prior and current drug use, quality of life, and HCV treatment outcomes. Results The majority of the patients (84%) were current cigarette smokers at baseline. There was a high prevalence of psychiatric and medical comorbidities in the overall sample of PWID. Alcohol and cocaine use were identified as correlates of cigarette smoking. Smoking status did not influence HCV treatment outcomes including adherence, treatment completion and SVR. HCV treatment was not associated with decreased cigarette smoking. Conclusions The present study showed high prevalence of cigarette smoking among this population as well as identified correlates of smoking, namely alcohol and cocaine use. Cigarette smoking was not associated with HCV treatment outcomes. Given the detrimental effects that cigarette smoking and other co-occurring, substance use behaviors have on HCV-infected individuals’ health, it is imperative that clinicians treating HCV also target smoking, especially among PWID. The high prevalence of cigarette smoking among PWID will contribute to growing morbidity and mortality among this population even if cured of HCV. Tailored smoking cessation interventions for PWID along with HCV treatment may need to be put into clinical practice. Trial registration NCT01857245. Registered May 20, 2013.

scholarly journals 1073. The Time is Now for Rapid Initiation of Hepatitis C Virus (HCV) Treatment

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S564-S564
Author(s):  
Colton P Radford ◽  
Paulina Deming ◽  
Carla Walraven
Keyword(s):  
New Mexico ◽  
Task Force ◽  
Clinical Success ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Hcv Treatment ◽  
Access To Treatment ◽  
Care Cascade ◽  
Hcv Screening

Abstract Background An estimated 65,000 New Mexicans are infected with HCV, accounting for ~3% of the state’s population with intravenous drug use being the most common risk factor for the acquisition of HCV. In 2020, the US Preventive Service Task Force recommended universal HCV screening for all adults aged 18 to 79 years old. HCV screening requires a two-step process involving a HCV antibody (Ab) test followed by a confirmatory HCV ribonucleic acid (RNA) test to detect active infection. Acute HCV infections are typically asymptomatic leaving many individuals unaware of their diagnosis for years. New Mexico was one of the first states to abandon the requirement for specialist referral, fibrosis staging, and abstinence from substance abuse to facilitate HCV treatment. Despite removal of these barriers, major gaps in access to HCV treatment still persist. The objective was to develop a HCV connect-to-care cascade for the University of New Mexico Hospital (UNMH) to understand the potential barriers preventing patients from receiving appropriate care. Methods This was a retrospective, single center, descriptive study conducted at UNMH, a level 1 trauma, tertiary care academic medical center with 527 beds. All patients with a positive HCV Ab, RNA, or genotype obtained in 2018 were included in this study. There were no exclusions. Results In 2018, over 11,000 unique patients received HCV testing in any form resulting in a total of 14,566 HCV tests being performed. 2018 UNMH Connect-to-Care Cascade Conclusion Of the patients who screened positive, only 61.7% were referred for treatment, representing the largest gap in the cascade. However, once patients were seen in the clinic, 88.5% completed treatment with 100% having sustained virologic response (SVR). With the pan-genotypic HCV treatments having fewer side effects and high clinical success rates, it’s feasible that HCV treatment may no longer require a specialist. Similar to the rapid initiation of antiretrovirals in newly diagnosed HIV patients, where immediate access to treatment within days of diagnosis resulted in improved retention in care, decreased time to viral suppression, and decreased viral transmission, rapid initiation of HCV treatment may be the wave of the future. Disclosures All Authors: No reported disclosures

scholarly journals 917. Accessible HCV Care for People Who Inject Drugs: Randomized Clinical Trial Comparing Low-Threshold Treatment at a Syringe Service Program Versus Facilitated Referral

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S550-S550
Author(s):  
Benjamin Eckhardt ◽  
Yesenia Aponte-Melendez ◽  
Chunki Fong ◽  
Shashi Kapadia ◽  
La Davis ◽  
...  
Keyword(s):  
Usual Care ◽  
People Who Inject Drugs ◽  
Treatment Programs ◽  
Hcv Rna ◽  
Hcv Treatment ◽  
Service Program ◽  
Research Support ◽  
The Past ◽  
Care Cascade ◽  
Low Threshold

Abstract Background To achieve hepatitis C virus (HCV) elimination, treatment programs need to be developed to engage, treat, and cure people who inject drugs (PWID). Methods We present final data from the Accessible Care Trial for curing HCV in PWID. The randomized clinical trial compared on-site, low-threshold HCV treatment with care-coordination at a NYC syringe service program (Accessible Care) with facilitated referral to local providers through a patient navigation program (Usual Care). Eligible participants were HCV RNA+ and had injected drugs in the past 90 days. Participants were randomized 1:1 to the Accessible Care or Usual Care arm. The primary endpoint was achievement of sustained virologic response (SVR12) within 12 months of enrollment. Secondary endpoints examined rates HCV care cascade step completion from referral to clinician, attending clinical visit, baseline lab testing, treatment initiation, and cure. Results Among the 572 participants screened, 167 met eligibility criteria and were enrolled, with two excluded post-randomization (N=165). Demographics were similar with a median age of 41 years; 22% women; 59% Hispanic and 5% non-Hispanic black. At baseline, 84% of participants had injected drugs in the past 30 days with those averaging 22 injections/month, 70% were receiving either methadone or buprenorphine, 57% were recently homeless, 7% were HIV+, and 11% were HCV treatment experienced. In the intention-to-treat analysis, 55/82 (67.1%) of the Accessible Care arm and 19/83 (22.9%) of the Usual Care arm achieved SVR12 (p< 0.001). The SVR12 rates of those starting therapy were 55/64 (85.9%) and 19/22 (86.3%) in the two arms (p=0.96). Loss to follow-up (12.2% and 16.9%, p=0.51) was similar in the two arms. Significantly more participants in the Accessible Care arm achieved all steps in the care cascade with the greatest attrition in the Usual Care arm seen in referral to clinician and attending clinical visit. Conclusion Among HCV RNA+ PWID significantly higher rates of cure were achieved using the Accessible Care model focused on low-threshold, destigmatized, flexible HCV care compared to facilitated referral. To achieve HCV elimination, expansion of treatment programs specifically geared toward engaging PWID is paramount. Disclosures Benjamin Eckhardt, MD, MS, Gilead Sciences (Grant/Research Support) Shashi Kapadia, MD, Gilead Sciences Inc (Grant/Research Support) Kristen Marks, MD, Gilead Sciences (Grant/Research Support)

scholarly journals Impact of Coronavirus Outbreaks on Science and Society: Insights from Temporal Bibliometry of SARS and COVID-19

Entropy ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 626
Author(s):  
Ramya Gupta ◽  
Abhishek Prasad ◽  
Suresh Babu ◽  
Gitanjali Yadav
Keyword(s):  
Published Data ◽  
Science And Society ◽  
Time Dimension ◽  
Scientific Publications ◽  
The Past ◽  
Economic Trends ◽  
Global Events ◽  
One Year ◽  
Personal Devices ◽  
Share Information

A global event such as the COVID-19 crisis presents new, often unexpected responses that are fascinating to investigate from both scientific and social standpoints. Despite several documented similarities, the coronavirus pandemic is clearly distinct from the 1918 flu pandemic in terms of our exponentially increased, almost instantaneous ability to access/share information, offering an unprecedented opportunity to visualise rippling effects of global events across space and time. Personal devices provide “big data” on people’s movement, the environment and economic trends, while access to the unprecedented flurry in scientific publications and media posts provides a measure of the response of the educated world to the crisis. Most bibliometric (co-authorship, co-citation, or bibliographic coupling) analyses ignore the time dimension, but COVID-19 has made it possible to perform a detailed temporal investigation into the pandemic. Here, we report a comprehensive network analysis based on more than 20,000 published documents on viral epidemics, authored by over 75,000 individuals from 140 nations in the past one year of the crisis. Unlike the 1918 flu pandemic, access to published data over the past two decades enabled a comparison of publishing trends between the ongoing COVID-19 pandemic and those of the 2003 SARS epidemic to study changes in thematic foci and societal pressures dictating research over the course of a crisis.

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