scholarly journals Potential Contributions of Clinical and Community Testing in Identifying Persons with Undiagnosed HIV Infection in the United States

2020 ◽  
Vol 19 ◽  
pp. 232595822095090
Author(s):  
James G. Kahn ◽  
Eran Bendavid ◽  
Patricia M. Dietz ◽  
Angela Hutchinson ◽  
Hacsi Horvath ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Clinical Care ◽  
The United States ◽  
Low Risk ◽  
Published Data ◽  
Community Settings ◽  
Undiagnosed Hiv

Background: An estimated 166,155 individuals in the United States have undiagnosed HIV infection. We modeled the numbers of HIV-infected individuals who could be diagnosed in clinical and community settings by broadly implementing HIV screening guidelines. Setting: United States. Methods: We modeled testing for general population (once lifetime) and high-risk populations (annual): men who have sex with men, people who inject drugs, and high-risk heterosexuals. We used published data on HIV infections, HIV testing, engagement in clinical care, and risk status disclosure. Results: In clinical settings, about 76 million never-tested low-risk and 2.6 million high-risk individuals would be tested, yielding 36,000 and 55,000 HIV diagnoses, respectively. In community settings, 30 million low-risk and 4.4 million high-risk individuals would be tested, yielding 75,000 HIV diagnoses. Conclusion: HIV testing in clinical and community settings diagnoses similar numbers of individuals. Lifetime and risk-based testing are both needed to substantially reduce undiagnosed HIV.

scholarly journals Incorporating Rapid HIV Testing into Partner Counseling and Referral Services

2008 ◽  
Vol 123 (3_suppl) ◽  
pp. 126-135 ◽  
Author(s):  
Elin B. Begley ◽  
Alexandra M. Oster ◽  
Binwei Song ◽  
Linda Lesondak ◽  
Kelly Voorhees ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
The United States ◽  
High Risk Population ◽  
Newly Diagnosed ◽  
Infected People ◽  
Rapid Hiv Testing ◽  
Undiagnosed Hiv ◽  
Locating Information

Objectives. Partner counseling and referral services (PCRS) provide a unique opportunity to decrease transmission of human immunodeficiency virus (HIV) by notifying sex and drug-injection partners of HIV-infected individuals of their exposure to HIV. We incorporated rapid HIV testing into PCRS to reduce barriers associated with conventional HIV testing and identify undiagnosed HIV infection within this high-risk population. Methods. From April 2004 through June 2006, HIV-infected people (index clients) were interviewed, and their partners were notified of their potential exposure to HIV and offered rapid HIV testing at six sites in the United States. The numbers of index clients participating and the numbers of partners interviewed and tested were compared by site. Descriptive and bivariate analyses were performed. Results. A total of 2,678 index clients were identified, of whom 779 (29%) provided partner locating information. A total of 1,048 partners were elicited, of whom 463 (44%) were both interviewed and tested for HIV. Thirty-seven partners (8%) were newly diagnosed with HIV. The number of index clients interviewed to identify one partner with newly diagnosed HIV infection ranged from 10 to 137 at the participating sites. Conclusions. PCRS provides testing and prevention services to people at high risk for HIV infection. Incorporating rapid HIV testing into PCRS and identifying previously undiagnosed infections likely confer individual and public health benefits. Further evaluation is needed to determine the best methods of identifying partners with previously unrecognized HIV infection.

Douching Practices Among Women at High Risk of HIV Infection in the United States

2002 ◽  
Vol 29 (7) ◽  
pp. 406-410 ◽  
Author(s):  
BERYL A. KOBLIN ◽  
KENNETH MAYER ◽  
ANTHONY MWATHA ◽  
PAMELA BROWN-PETERSIDE ◽  
RENEE HOLT ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
The United States

scholarly journals 2726. Meningococcal Vaccination Among Patients Newly Diagnosed at High-Risk for Meningococcal Disease in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S959-S960 ◽  
Author(s):  
Lindsay Bengtson ◽  
Gary S Marshall ◽  
Ami R Buikema ◽  
Eleena Koep ◽  
Patricia Novy ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
Meningococcal Disease ◽  
Index Date ◽  
The United States ◽  
Vaccine Uptake ◽  
Newly Diagnosed ◽  
Medical Claims ◽  
Meningococcal Vaccines

Abstract Background Quadrivalent conjugate and polysaccharide meningococcal vaccines (MenACWY) have been recommended in the United States for patients at high-risk due to functional or anatomic asplenia, complement component deficiency (CD) and human immunodeficiency virus (HIV) infection. Serogroup B vaccines (MenB) are recommended for patients ≥10 years of age with asplenia or CD. Little is currently known about meningococcal vaccine uptake and time to vaccination among patients with incident high-risk diagnoses. Methods Patients newly diagnosed (1 inpatient or ≥2 outpatient medical claims with evidence of the condition ≥30 days apart) with functional or anatomic asplenia (excluding sickle cell disease), CD or HIV infection were identified in the Optum Research Database. Continuous enrollment for ≥12 months before and ≥6 months after the diagnosis date (index date) was required. Patients with evidence of pre-existing conditions were excluded. MenACWY uptake was assessed among patients ≥2 years of age at index date from January 1, 2010 for asplenia and CD, and January 1, 2016 for HIV infection, through March 31, 2018; and MenB uptake among patients ≥10 years of age at index date from January 1, 2015 through March 31, 2018. Current Procedural Terminology and National Drug Codes on medical claims were used to capture vaccinations. For each condition, Kaplan–Meier analysis was used to estimate uptake and time to receipt of ≥1 dose of each vaccine for up to 5 years post-index date; vaccinations within 90 days before the index date were also included in calculations. Results Among asplenia patients, the percentage with receipt of ≥1 dose of MenACWY at 1, 2.5, and 5 years post-index date was 6.6%, 9.4%, and 13.3%, respectively; for CD patients the corresponding percentages were 2.2%, 4.8%, and 8.3%; and for HIV patients at 1 and 2.5 years post-index date the percentages were 10.8% and 19.8% (Figure 1). Receipt of ≥1 dose of MenB at 1 and 2.5 years post-index date was 1.7% and 3.1%, respectively, for asplenia patients and 1.1% and 2.5%, respectively, for CD patients (Figure 2). Conclusion Uptake of meningococcal vaccines in patients newly diagnosed with high-risk conditions is very low and the time to vaccination is long, leaving patients vulnerable to invasive meningococcal disease for extended periods of time. Disclosures All authors: No reported disclosures.

scholarly journals Promoting Responsible Lung Cancer Screening Across the United States: Lessons From The Lung Cancer Alliance Screening Centers of Excellence

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 143s-143s
Author(s):  
A. Criswell ◽  
A. Ciupek ◽  
A. Copeland ◽  
J. King
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Data Collection ◽  
Lung Cancer Screening ◽  
The United States ◽  
Community Settings ◽  
Centers Of Excellence ◽  
High Quality

Background and context: In 2010, the National Lung Screening Trial was halted in the United States after showing a 20% reduction in mortality for high risk individuals when three years of annual lung cancer screening was performed by low dose computed tomography (LDCT). Many questions remained about whether this type of screening could be properly implemented in nonacademic, community settings. Aim: Our aim was to promote high-quality, responsible lung cancer screening throughout the United States, including in community settings where most lung cancer is diagnosed. Strategy/Tactics: Lung Cancer Alliance developed a National Framework for Excellence in Lung Cancer Screening and Continuum of Care in 2012 and began a nationwide network dedicated to responsible lung cancer screening. The Screening Center of Excellence designation requires a center to ensure shared decision-making, comply with best practice standards, work with a multidisciplinary care team, refer for smoking cessation, provide results in a timely manner, and meet standards set by the American College of Radiology. Program/Policy process: From 2012 through 2016, over 500 centers were designated as Screening Centers of Excellence. These centers represented 42 states and more than 60% were from community/nonacademic community centers. High-risk individuals who come to the Lung Cancer Alliance Web site or contact the organization by phone to find a screening center are directed to a Center of Excellence. A data collection effort in 2017 collected comprehensive information about the state of lung cancer screening and care at their institution. Nearly 70% of centers responded to the survey. Outcomes: This program has helped promoted high quality lung cancer screening throughout the United States. Our program data shows that screening is being performed widely across the United States, including in nonacademic centers. For centers who were able to provide numbers of screenings performed and diagnoses, we identified a clear trend in diagnosis of Stage 1 lung cancer, indicating these screenings are able to find lung cancer early. We also identified a number of implementation challenges around referral patterns, insurance and billing, and determining appropriate risk criteria. What was learned: We have shown that a patient advocacy group working with medical professionals can help deliver high quality care to a broad population. Data collection from the Screening Centers of Excellence provides a snapshot of the state of lung cancer screening in the United States that underscores the success of LDCT and the importance of early detection but also identifies barriers in implementation that still need to be addressed.

scholarly journals Disease Characteristics of Minority Patient Populations with Polycythemia Vera: An Analysis from the Reveal Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4735-4735 ◽  
Author(s):  
Ivy Altomare ◽  
Philomena Colucci ◽  
Shreekant Parasuraman ◽  
Dilan Chamikara Paranagama ◽  
Anas Al-Janadi
Keyword(s):  
United States ◽  
High Risk ◽  
The United States ◽  
Low Risk ◽  
Employment Equity ◽  
Disease Characteristics ◽  
Reveal Study ◽  
High Risk Disease ◽  
Caucasian Patients ◽  
Equity Ownership

Abstract Introduction: Polycythemia vera (PV) is associated with increased blood cell counts, risk of thrombosis, and symptoms including fatigue and pruritus. Few studies have examined the presence or absence of racial/ethnic disparities among patients with PV. The objective of this analysis is to describe differences in disease characteristics, diagnosis, treatment, and quality of life (QOL) among Caucasian and non-Caucasian patients with PV in the United States enrolled in the prospective, observational REVEAL study. Methods: The ongoing REVEAL study (ClinicalTrials.gov ID, NCT02252159) is a prospective, multicenter, observational study of adult patients with PV in the United States. Patients were observed during a 36-month period, during which clinical data were collected from usual care visits. This analysis compared demographics, disease and clinical characteristics, disease management, comorbidities, and QOL between Caucasian and non-Caucasian patients with PV at enrollment. QOL was measured by the European Organisation for Research and Treatment of Cancer Questionnaire C30 (EORTC QLQ-C30) and Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS). Results are summarized with descriptive statistics. Results: Of the 2,510 patients enrolled in REVEAL, 2,237 were Caucasian (89.1%); 199 (7.9%) were non-Caucasian, comprised of African American (5.7%), Asian (1.5%), Native American Indian (0.2%), Pacific Islander (0.1%), and other patients (0.4%); no information was provided regarding race or ethnicity for 74 patients (2.9%). Baseline disease characteristics were similar for Caucasian and non-Caucasian groups with respect to gender and disease duration. There were no differences in method of diagnosis, laboratory values, or overall history of thrombosis between groups (Figure 1A). Mean age was higher among Caucasian patients compared to non-Caucasian patients (66.6 vs 63.8 years, respectively). The proportion of patients from rural areas was higher among Caucasian vs non-Caucasian patients (28.8% vs 12.6%); similarly, the proportion of patients from urban areas was lower among Caucasian vs non-Caucasian patients (23.1% vs 46.7%). The proportion of patients with some college or higher level of education was higher among Caucasian vs non-Caucasian patients (64.1% vs 50.3%). A higher proportion of Caucasian vs non-Caucasian patients were retired (52.0% vs 43.2%); a higher proportion of non-Caucasian patients reported being unable to work or were disabled (3.8% vs 10.1%). More Caucasian patients had high-risk disease (78.0%) compared with non-Caucasian patients (71.4%), and patients with high-risk disease were managed similarly between groups. However, Caucasian patients with low-risk disease received more phlebotomies (56.6%) than non-Caucasian patients with low-risk disease (40.4%), and over twice as many non-Caucasian patients received hydroxyurea (38.6%) than Caucasian patients (15.6%) (Figure 1B). MPN-SAF TSSs were higher for non-Caucasian patients compared with Caucasian patients, suggesting a worse symptom burden. Similarly, non-Caucasian patients reported lower functional and symptom outcomes on the EORTC QLQ-C30, including a disparity in financial difficulties, compared to Caucasian patients (Figure 1C). Conclusions: This analysis evaluated a cohort of racial/ethnic minority patients with PV treated in the United States. As in other cancer-related trials, there is a risk that racial and ethnic minorities may be underrepresented in REVEAL. With this limitation in mind, in this analysis, differences were not observed among Caucasian and non-Caucasian patients with respect to method of diagnosis, duration of disease, thrombosis rates, or management of high-risk disease. Non-Caucasian patients demonstrated higher rates of low-risk disease and cytoreductive therapy for low-risk disease yet had worse symptom burden, lower functional scores, and greater disability. This study underscores the importance of symptom assessment and ancillary resource availability for patients with PV Disclosures Altomare: Bayer: Consultancy; Genentech: Consultancy; Ipsen: Other: Advisory Board Member; Celgene: Other: Advisory Board Member; Incyte: Consultancy; Novartis: Consultancy; Amgen: Consultancy. Colucci:Incyte: Employment, Equity Ownership. Parasuraman:Incyte: Employment, Equity Ownership. Paranagama:Incyte: Employment, Equity Ownership.

scholarly journals Heroin Type, Injecting Behavior, and HIV Transmission. A Simulation Model of HIV Incidence and Prevalence

2019 ◽  
Author(s):  
Georgiy V. Bobashev ◽  
Sarah Mars ◽  
Nicholas Murphy ◽  
Clinton Dreisbach ◽  
William Zule ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Transmission ◽  
Simulation Analysis ◽  
The United States ◽  
Hiv Prevalence ◽  
Low Risk ◽  
Transmission Risk ◽  
Model Parameters ◽  
The Impact

ABSTRACTBackground and AimsUsing mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV over time. From 1997 to 2010 PH reaching the United States was manufactured overwhelmingly by Colombian suppliers and distributed in the eastern states of the United States. Recently Mexican cartels that supply the western U.S. states have started to produce PH too, replacing Colombian distribution to the east. This raises the possibility that BTH in the western U.S. may be replaced by PH in the future.DesignWe used an agent-based model to evaluate the impact of use of different heroin formulations in high- and low-risk injecting drug user populations who use different types of syringes (high vs. low dead space) and injecting practices. We obtained model parameters from peer-reviewed publications and ethnographic research.ResultsHeating of BTH, additional syringe rinsing, and subcutaneous injection can substantially decrease the risk of HIV transmission. Simulation analysis shows that HIV transmission risk may be strongly affected by the type of heroin used. We reproduced historic differences in HIV prevalence and incidence. The protective effect of BTH is much stronger in high-risk compared with low-risk populations. Simulation of future outbreaks show that when PH replaces BTH we expect a long-term overall increase in HIV prevalence. In a population of injectors with mixed low- and high-risk clusters we find that local HIV outbreaks can occur even when the overall prevalence and incidence are low. The results are dependent on evidence-supported assumptions.ConclusionsThe results support harm-reduction measures focused on a reduction in syringe sharing and promoting protective measures of syringe rinsing and drug solution heating.

scholarly journals Cost-Effectiveness of Frequent HIV Testing of High-Risk Populations in the United States

2016 ◽  
Vol 71 (3) ◽  
pp. 323-330 ◽  
Author(s):  
Angela B. Hutchinson ◽  
Paul G. Farnham ◽  
Stephanie L. Sansom ◽  
Emine Yaylali ◽  
Jonathan H. Mermin
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
High Risk ◽  
Hiv Testing ◽  
The United States ◽  
High Risk Populations
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