scholarly journals Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055142
Author(s):  
Jessica Markby ◽  
Sonjelle Shilton ◽  
Xiaohui Sem ◽  
Huan Keat Chan ◽  
Rosaida Md Said ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Observational Study ◽  
Primary Healthcare ◽  
Scale Up ◽  
Load Test ◽  
Cirrhotic Patients ◽  
Primary Healthcare Clinics ◽  
The Impact ◽  
Hcv Testing

IntroductionTo achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.MethodsThis observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.ResultsDuring the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).ConclusionsThis study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

scholarly journals Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain: a longitudinal observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e020120 ◽  
Author(s):  
Mariona Pons-Vigués ◽  
Yolanda Rando-Matos ◽  
Teresa Rodriguez-Blanco ◽  
Josep Lluís Ballvé-Moreno ◽  
Joana Ripoll ◽  
...  
Keyword(s):  
Observational Study ◽  
Primary Healthcare ◽  
Prevalence Rate ◽  
Smoking Behaviour ◽  
Incidence Rates ◽  
Balearic Islands ◽  
Annual Percent Change ◽  
Longitudinal Observational Study ◽  
Significant Downward Trend ◽  
The Impact

ObjectiveThis study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex.DesignLongitudinal observational study conducted between 2008 and 2013.Setting66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain).ParticipantsPopulation over 15 years of age assigned to PHC teams.Primary and secondary outcomes measuresQuarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change.ResultsThe overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre.ConclusionsTrends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL.

scholarly journals Improving Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Treatment Monitoring in South Africa: Evaluation of an Advanced TB/HIV Course for Healthcare Workers

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Sean Galagan ◽  
Suzanne Jed ◽  
Jeri Sumitani ◽  
Jennifer M. Gilvydis ◽  
Albert Bakor ◽  
...  
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Treatment Monitoring ◽  
Load Test ◽  
Hiv Care ◽  
Intensive Phase ◽  
Viral Load Test ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background South Africa has dual epidemics of human immunodeficiency virus (HIV) and tuberculosis (TB). Nurse-focused training was combined with onsite mentoring for nurses to improve HIV and TB care. A pre-/postevaluation was conducted in 3 districts in South Africa to assess the effects of the course on clinical patient monitoring and integration of TB and HIV care. Methods Two cross-sectional, unmatched samples of patient charts at 76 primary healthcare facilities were collected retrospectively in 2014 to evaluate the impact of training on treatment monitoring. Proportions of HIV patients receiving a viral load test 6 months after initiating antiretroviral therapy (ART) and TB patients receiving end of intensive phase sputum testing were compared pre- and posttraining. Analysis of creatinine clearance testing and integration of TB and HIV care were also performed. Results Data were analyzed from 1074 pretraining and 1048 posttraining records among patients initiating ART and from 1063 pretraining and 1008 posttraining among patients initiating TB treatment. Documentation of a 6-month viral load test was 36.3%, and a TB test at end of intensive phase was 70.7%, and neither increased after training. Among patients with a viral load test, the percentage with viral load less than 50 copies/mL increased from 48.6% pretraining compared with 64.2% posttraining (P = .001). Integration of TB and HIV care such as isoniazid preventive therapy increased significantly. Conclusions The primary outcome measures did not change after training. However, the evaluation documented many other improvements in TB and HIV care that may have been supported by the course.

scholarly journals Population Size Estimation of High-Risk Behavior in Isfahan, Iran: Using the Network Scale-up Method in 2018

2021 ◽  
Author(s):  
Meysam Abshenas Jami ◽  
Mohamadreza Baneshi ◽  
Maryam Nasirian
Keyword(s):  
High Risk ◽  
Sexual Behaviors ◽  
Scale Up ◽  
Risky Behaviors ◽  
Size Estimation ◽  
Sexual Relations ◽  
Sex Worker ◽  
Network Scale ◽  
History Of ◽  
The Impact

Background and Objective: Due to the impact of risky behaviors in the community and the need for getting information and planning in this regard, the number of people with high-risk sexual behaviors in Isfahan will be indirectly estimated by the network scale-up method. Method:In a cross-sectional study conducted in June2018in14districts of Isfahan, a sample of1000 people was recruited by a non-random multistage method and interviewed using a standard questionnaire to identify people with high-risk sexual behavior. Data are analyzed based on a network scale-up method in the STATA application. Results:According to a report by men, the prevalence of male Extra marital sexual relations (N=2437) and relation with paying prostituted women (N=1211), with non-paying prostituted women (N=298), Homosexuality (N=696) and history of traveling for sexual relations (N =880/100,000); And according to a report by women, the prevalence of female Extra marital sexual relations (N=1386) and Sex Worker women (Monetary) (N=946), Sex Worker women (Non-Monetary) (N=258), and history of travelling for sexual relations (N=13/100,000). In both sexes, the age group of18 to 30years was more at risk for sexual behaviors than other groups.  Discussion and Conclusion: It seems that the prevalence of sexual high-risk behaviors in Isfahan is remarkable as the increased prevalence of sexually transmitted diseases, including HIV, but unfortunately, the required training is low in this regard, more attention should be paying to train people to prevent the prevalence of these high-risk sexual behaviors in society.

scholarly journals 934. Epidemiology and Outcomes of Epstein-Barr Virus DNAemia in Adult Solid Organ Transplant Recipients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S559-S560
Author(s):  
Sara W Dong ◽  
Barbra M Blair ◽  
Carolyn D Alonso
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Epstein Barr Virus ◽  
Univariate Analysis ◽  
Categorical Variables ◽  
Solid Organ ◽  
Intermediate Risk ◽  
Barr Virus ◽  
Epstein Barr ◽  
The Impact

Abstract Background Immunosuppression in solid organ transplantation (SOT) increases the risk of Epstein-Barr virus (EBV) DNAemia, which may herald development of post-transplant lymphoproliferative disease (PTLD). The objective of this study was to characterize the epidemiology and risk factors for EBV DNAemia and to describe the impact of these factors on development of PTLD in a cohort of SOT recipients. Methods We retrospectively examined adult (≥18 years) SOT recipients between 1/1/2015 to 12/31/2019. Demographics, immunosuppression, and clinical outcomes were examined. Subjects were stratified as having a positive (EBV viral load &gt; 200 copies/mL) or negative viral load. Sustained EBV DNAemia was defined as EBV DNA detection ( &gt; 200 copies/mL) on at least 3 consecutive samples. Categorical variables were analyzed using chi-square or Fishers exact test. Mann-U Whitney test was used for continuous variables. Results 442 SOT recipients (258 kidney, 141 liver, 22 kidney-pancreas (KP), 15 kidney-liver, 6 pancreas) were examined. Most subjects (430, 97%) were EBV intermediate risk (recipient (R)+). 8 subjects (2%) were EBV high risk (donor (D)+, R-) and 4 (1%) were EBV low risk (D-/R-). EBV viral loads were obtained in 177/442 (40.0%) recipients. DNAemia was detected in 18/442 subjects (4.1%). It was most common in pancreas recipients(1/6; 16.7%) compared with kidney (10/258; 3.9%), liver (5/141; 3.5%), and KP recipients (1/22; 4.5%). DNAemia was most frequently observed in the D+/R- (3/8; 37.5%) group compared to intermediate risk (R+) (15/430; 3.5%) and D-/R- (0%) groups. Median time to EBV viral load detection was 14 months (range 3-60). In univariate analysis, EBV high-risk serostatus was the factor most strongly associated with development of EBV DNAemia (p&lt; 0.001). Sustained DNAemia (median viral load 1829 copies/mL; peak viral load 1.9 million copies/mL) was observed in 8 subjects (1.8%). PTLD developed in 6 subjects (1.4%); 50% had sustained DNAemia prior to diagnosis. Conclusion While uncommon, development of sustained EBV DNAemia was associated with subsequent development of PTLD in our cohort of adult SOT recipients. These data provide guidance for identifying subjects at risk for PTLD above and beyond baseline EBV high-risk serostatus. Disclosures All Authors: No reported disclosures

scholarly journals The Influence of Cannabis and Alcohol Use on Sexuality: An Observational Study in Young People (18–30 Years)

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 71
Author(s):  
Pablo Roman ◽  
Ana Ortiz-Rodriguez ◽  
Ana Romero-Lopez ◽  
Miguel Rodriguez-Arrastia ◽  
Carmen Ropero-Padilla ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Alcohol Use ◽  
Young People ◽  
Observational Study ◽  
Sexual Function ◽  
Short Form ◽  
Alcohol Problems ◽  
Not At Risk ◽  
The Impact

The consumption of cannabis and alcohol results in a variety of effects on the psychic functions of young users. Notwithstanding their widespread and prevalent use, the impact of these drugs on sexual health remains unknown. Thus, the aim of this study is to analyse the influence of alcohol and cannabis consumption on sexual function in young people. An observational study was conducted in 274 participants aged 18–30 years. The following selection tools were used: Alcohol Use Disorders Identification Test, Cannabis Abuse Screening Test (CAST), and Changes in Sexual Functioning Questionnaire Short-Form. Participants who were at high risk of having cannabis-related problems performed better on the CAST concerning sexual function, arousal, and orgasm. Participants at high risk had higher arousal and orgasm scores than those who were not at risk for cannabis problems. Improvements in sexual function were found between people who were at high risk of having alcohol problems and those who were not at risk. Sexual function in young people who use cannabis and alcohol more frequently was shown to be better than in those who do not use either, highlighting the need for more information aimed at the young population.

scholarly journals Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261953
Author(s):  
Paula Zamorano ◽  
Paulina Muñoz ◽  
Manuel Espinoza ◽  
Alvaro Tellez ◽  
Teresita Varela ◽  
...  
Keyword(s):  
High Risk ◽  
Integrated Care ◽  
Impact Analysis ◽  
Linear Models ◽  
Hospital Admissions ◽  
Scale Up ◽  
Intervention Strategy ◽  
Implementation Process ◽  
Care Plan ◽  
The Impact

During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovación en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG®, intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40–0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovación en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.

The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Camilla de Laurentis ◽  
Julius Höhne ◽  
Claudio Cavallo ◽  
Francesco Restelli ◽  
Jacopo Falco ◽  
...  
Keyword(s):  
Observational Study ◽  
Pediatric Population ◽  
Cns Tumors ◽  
Surgical Removal ◽  
The Impact
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