Ten Sites, 10 Years, 10 Lessons: Scale-up of Routine HIV Testing at Community           Health Centers in the Bronx, New York

Abstract Background: The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.Method: Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N=28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.Results: Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) male, 3 (10.7%) female, 8 (28.6%) transgender male, 10 (35.7%) transgender female, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a ‘cisgender lens”, distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.Conclusion: Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.

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467. COVID-19 Infection in Persons Living with HIV in a Network of Community Health Centers in New York

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.666 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S335-S336

Author(s):

Aisha S Khan ◽

Christine A Kerr ◽

Jenny Doyle ◽

Sonia Punj ◽

Julie Coleman ◽

...

Keyword(s):

New York ◽

Community Health ◽

Community Health Centers ◽

New York State ◽

Antibody Test ◽

Health Centers ◽

River Health ◽

York State ◽

Persons Living With Hiv ◽

Living With Hiv

Abstract Background COVID-19 infection amongst persons living with HIV (PLWH) at Federally Qualified Healthcare Centers (FQHC) is not yet well understood. FQHC patients are frequently impoverished and marginalized due to socioeconomic instability and structural inequities. The virus has a wide-ranging clinical presentation, and little is known about how it affects specific populations such as PLWH and whether specific patterns of immunocompromise confer increased risk. Patients in community health centers and those living with HIV are often underrepresented from clinical trials. Patients seen at FQHC’s are more likely to be uninsured or living in poverty, or of Black or Latinx racial and ethnic backgrounds. Sun River Health is a not-for-profit, New York State licensed Article 28 Diagnostic & Treatment Center and FQHC. Sun River Health provides HIV primary care and supportive services caring for more than 2,500 PLWH primarily concentrated in 16 sites throughout the region. This study is a retrospective analysis of a vulnerable community at the heart of this pandemic. Methods We gathered COVID-19 diagnosis related data from the clinic’s electronic medical record and the New York State Health Information Exchange (HIE). We did chart reviews on 122 PLWH who had positive COVID PCR or antibody test between March 10 2020 and June 10 2020. Data collected included presence of symptoms, presence of comorbidities, CD4 counts, Hospitalization rate, ICU admission, and number of deaths. Results 71.3% of cases occurred between the ages of 40-69 years. There were 85 cases (69.7%) in men and 37 cases (30.3%) in women. 54 cases (44.3%) occurred in African Americans, and 46 cases (37.7%) in Caucasians. 48 cases (39.3%) occurred in Latinx individuals, and 68 cases (55.7%) in Non-Hispanics. 91 cases (74.6%) were symptomatic and had either a positive COVID-19 PCR or antibody test. Symptomatic COVID-19 was present at higher rates in those with multiple predisposing comorbidities. 101 cases (82.8%) were virally suppressed. 89 cases (72.9%) were not hospitalized while 27 cases (22.1%) were hospitalized. Conclusion Most PLWH with COVID-19 were managed on an outpatient basis. PLWH with COVID-19 are not at a greater risk of severe disease or death as compared to HIV negative patients. Disclosures Christine A. Kerr, MD, Galileo Health (Employee, Shareholder)

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HIV Testing Trends at Visits to Physician Offices, Community Health Centers, and Emergency Departments — United States, 2009–2017

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6925a2 ◽

2020 ◽

Vol 69 (25) ◽

pp. 776-780

Author(s):

Karen W. Hoover ◽

Ya-Lin A. Huang ◽

Mary L. Tanner ◽

Weiming Zhu ◽

Naomie W. Gathua ◽

...

Keyword(s):

United States ◽

Hiv Testing ◽

Community Health ◽

Emergency Departments ◽

Community Health Centers ◽

Health Centers

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Challenges with Scale-up of GeneXpert MTB/RIF® in Uganda: a Health Systems Perspective

10.21203/rs.2.10689/v1 ◽

2019 ◽

Author(s):

Talemwa Nalugwa ◽

Priya B. Shete ◽

Mariam Nantale ◽

Katherine Farr ◽

Christopher Ojok ◽

...

Keyword(s):

Health System ◽

Community Health ◽

Health Systems ◽

Community Health Centers ◽

Scale Up ◽

Health Centers ◽

Data Sources ◽

Cross Sectional ◽

Hub And Spoke ◽

System Factors

Abstract Background Many high burden countries are scaling-up GeneXpert® MTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify health system factors that may enhance or prevent high-quality implementation of Xpert testing services. Methods We conducted a cross-sectional study triangulating quantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Results Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2,241 patients eligible for TB testing, only 580 (26%) were referred for Xpert testing. Of those, 57 (9.6%) were Xpert confirmed positive just over half initiated treatment within 14 days (n=33, 58%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n=14, X%) for sputum testing and lack of telephone/mobile communication (n=21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once a week, 2x/week or 3x/week at 10 (43%), 9 (39%) and 4 (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only 2 health centers. Of the 15 Xpert testing sites, 5 (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates >5%. Conclusions Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration.

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