scholarly journals Improved HIV case finding among key populations after differentiated data driven community testing approaches in Zambia

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0258573
Author(s):  
Joseph Kamanga ◽  
Kayla Stankevitz ◽  
Andres Martinez ◽  
Robert Chiegil ◽  
Lameck Nyirenda ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Case Finding ◽  
Data Driven ◽  
Key Populations ◽  
Total Quality ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Monthly Average ◽  
Management Interventions ◽  
The Impact

Introduction Open Doors, an HIV prevention project targeting key populations in Zambia, recorded low HIV positivity rates (9%) among HIV testing clients, compared to national adult prevalence (12.3%), suggesting case finding efficiency could be improved. To close this gap, they undertook a series of targeted programmatic and management interventions. We share the outcomes of these interventions, specifically changes in testing volume, HIV positivity rate, and total numbers of key populations living with HIV identified. Methods The project implemented a range of interventions to improve HIV case finding using a Total Quality Leadership and Accountability (TQLA) approach. We analyzed program data for key populations who received HIV testing six months before the interventions (October 2017–March 2018) and 12 months after (April 2018–March 2019). Interrupted time series analysis was used to evaluate the impact on HIV positivity and total case finding and trends in positivity and case finding over time, before and after the interventions. Results While the monthly average number of HIV tests performed increased by only 14% post-intervention, the monthly average number of HIV positive individuals identified increased by 290%. The average HIV positivity rate rose from 9.7% to 32.4%. Positivity rates and case finding remained significantly higher in all post-intervention months. Similar trends were observed among FSW and MSM. Conclusions The Open Doors project was able to reach large numbers of previously undiagnosed key populations by implementing a targeted managerial and technical intervention, resulting in a significant increase in the HIV positivity rate sustained over 12 months. These results demonstrate that differentiated, data-driven approaches can help close the 95-95-95 gaps among key populations.

Peer assisted HIV self-testing increases positivity rates among key populations in Burundi: descriptive analysis of routine programmatic data (Preprint)

2020 ◽  
Author(s):  
Tiffany Lillie ◽  
Dorica Boyee ◽  
Gloriose Kamariza ◽  
Alphonse Nkunzimana ◽  
Dismas Gashobotse ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Descriptive Analysis ◽  
Case Finding ◽  
Hiv Positive ◽  
Key Populations ◽  
Standard Testing ◽  
Art Initiation ◽  
Treatment Standard ◽  
Self Testing

BACKGROUND In Burundi, given the low testing numbers among key populations, peer assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people (TG) to provide another testing option. HIVST was provided by existing peer outreach workers (POWs) who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics or in facilities. OBJECTIVE The objective was to improve access to HIV testing to underserved KP members, increase HIV positivity rates, and link those who were confirmed HIV positive with life-saving treatment for epidemic control. METHODS A descriptive analysis of routine programmatic data was conducted from a nine-month implementation period (June 2018-March 2019) of peer assisted HIVST among FSWs, MSM, and TG in six provinces where the USAID- and PEPFAR-funded LINKAGES Burundi project worked. Chi-squared tests were used to compare case-finding rates among individuals tested through HIVST versus standard testing. RESULTS A total of 2,198 HIVST test kits were administered (1,791 FSWs, 363 MSM, 44 TG). Three hundred and sixty-six people (17%) were reactive to HIV screening (296 FSWs, 60 MSM, 10 TG); 314 (14%) were confirmed HIV positive (257 FSWs, 47 MSM, 10 TG); and 301 (96%) (251 FSWs, 40 MSM, 10 TG) of those confirmed were initiated on treatment. HIV case-finding rates were significantly higher with HIVST compared to standard testing for FSW and MSM but not TG: FSWs (14% vs. 9%, P < .001); MSM (13% vs. 4%, P < .001); and TG (23% vs. 17%, P > .10). ART initiation rates were significantly lower for MSM confirmed HIV positive through HIVST than through standard testing (85% vs. 99%, P < .001) but not among FSWs or TG (FSWs: 98% vs. 97%, P > .10; TG: 100% vs. 100%). CONCLUSIONS The results demonstrate the potential effectiveness of HIVST in identifying individuals who are living with HIV.

The Impact of the Change in Payment System for German Psychiatric Clinics on Treatment Success: An Interrupted Time Series Analysis

2019 ◽  
Vol 82 (06) ◽  
pp. 559-567
Author(s):  
Christina Niedermeier ◽  
Andrea Barrera ◽  
Eva Esteban ◽  
Ivana Ivandic ◽  
Carla Sabariego
Keyword(s):  
Time Series ◽  
Negative Impact ◽  
Treatment Success ◽  
Interrupted Time Series ◽  
Sensitivity Analyses ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Intervention Point ◽  
The Impact ◽  
New System

Abstract Background In Germany a new reimbursement system for psychiatric clinics was proposed in 2009 based on the § 17d KHG Psych-Entgeltsystem. The system can be voluntary implemented by clinics since 2013 but therapists are frequently afraid it might affect treatment negatively. Objectives To evaluate whether the new system has a negative impact on treatment success by analysing routinely collected data in a Bavarian clinic. Material and methods Aggregated data of 1760 patients treated in the years 2007–2016 was analysed with segmented regression analysis of interrupted time series to assess the effects of the system on treatment success, operationalized with three outcome variables. A negative change in level after a lag period was hypothesized. The robustness of results was tested by sensitivity analyses. Results The percentage of patients with treatment success tends to increase after the new system but no significant change in level was observed. The sensitivity analyses corroborate results for 2 outcomes but when the intervention point was shifted, the positive change in level for the third outcome became significant. Conclusions Our initial hypothesis is not supported. However, the sensitivity analyses disclosed uncertainties and our study has limitations, such as a short observation time post intervention. Results are not generalizable as data of a single clinic was analysed. Nevertheless, we show the importance of collecting and analysing routine data to assess the impact of policy changes on patient outcomes.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals The impact of China’s lockdown policy on the incidence of CoVID-19: An Interrupted time series analysis

2020 ◽  
Author(s):  
Mooketsi Molefi ◽  
John Tlhakanelo ◽  
Thabo Phologolo ◽  
Shimeles G. Hamda ◽  
Tiny Masupe ◽  
...  
Keyword(s):  
Time Series ◽  
Linear Trend ◽  
Effective Means ◽  
Interrupted Time Series ◽  
Ordinary Least Squares ◽  
World Health ◽  
Least Squares Regression ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
The Impact

Abstract BackgroundPolicy changes are often necessary to contain the detrimental impact of epidemics such as the coronavirus disease (COVID-19). China imposed strict restrictions on movement on January 23rd, 2020.Interrupted time series methods were used to study the impact of the lockdown on the incidence of COVID-19. MethodsThe number of cases of COVID-19 reported daily from January 12thto March 30th, 2020 were extracted from the World Health Organization (WHO) COVID-19 dashboard ArcGIS® and matched to China’s projected population of 1 408 526 449 for 2020 in order to estimate daily incidences. Data were plotted to reflect daily incidences as data points in the series. A deferred interruption point of 6thFebruary was used to allow a 14-day period of diffusion. The magnitude of change and linear trend analyses were evaluated using the itsafunction with ordinary least-squares regression coefficients in Stata® yielding Newey-West standard errors.ResultsSeventy-eight (78) daily incidence points were used for the analysis, with 11(14.10%) before the intervention. There was a daily increase of 163 cases (β=1.16*10-07, p=0.00) in the pre-intervention period. Although there was no statistically significant drop in the number of cases reported daily in the immediate period following 6thFebruary 2020 when compared to the counterfactual (p=0.832), there was a 241 decrease (β=-1.71*10-07, p=0.00) in cases reported daily when comparing the pre-intervention and post-intervention periods. A deceleration of 78(47%) cases reported daily. ConclusionThe lockdown policy managed to significantly decrease the incidence of CoVID-19 in China. Lockdown provides an effective means of curtailing the incidence of COVID-19.

scholarly journals Somewhere to go: Assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020

2021 ◽  
Author(s):  
Heather Kathleen Amato ◽  
Douglas Martin ◽  
Christopher Michael Hoover ◽  
Jay Paul Graham
Keyword(s):  
Public Health ◽  
San Francisco ◽  
Fecal Contamination ◽  
The United States ◽  
Public Health Issue ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Open Defecation ◽  
The Impact

Abstract Background Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco’s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. Methods We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions in ten San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. Results Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). The rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change=-0.024 [95% CI=-0.033, -0.014]). Reports also declined after new restroom installations in the Mission and Golden Gate Park, and after the provision of attendants in the Mission, Castro/Upper Market, and Financial District/South Beach. Conclusions Increased access to public toilets and the addition of restroom attendants reduced fecal contamination in San Francisco, especially in neighborhoods with people experiencing homelessness. Programs that improve access to public restrooms should be evaluated at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.

scholarly journals Impact of process improvements on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 96-105 ◽  
Author(s):  
Alexander K. Leung ◽  
Shawn D. Whatley ◽  
Dechang Gao ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Initial Assessment ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Process Improvements ◽  
Left Without Being Seen ◽  
Clinically Significant ◽  
The Impact

AbstractObjectiveTo study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures.MethodsThis was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained.ResultsPatients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005).ConclusionA combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

scholarly journals Sulawesi Crested Macaque (Macaca nigra) Grooming Networks Are Robust to Perturbation While Individual Associations Are More Labile

2020 ◽  
Vol 41 (1) ◽  
pp. 105-128 ◽  
Author(s):  
Veronica B. Cowl ◽  
Keith Jensen ◽  
Jessica M. D. Lea ◽  
Susan L. Walker ◽  
Susanne Shultz
Keyword(s):  
Social Networks ◽  
Social Groups ◽  
Group Level ◽  
Post Intervention ◽  
Social Responses ◽  
Captive Group ◽  
Management Interventions ◽  
Macaca Nigra ◽  
Reproductive Male ◽  
The Impact

AbstractSocial and environmental disturbance occurs naturally, and species in bonded social groups should be resilient to it. Empirical evidence of social responses to disturbance in primates, however, remains limited. We constructed social networks using group-level scan samples (N = 299) to test the robustness of grooming networks in a captive group of 20 Sulawesi crested macaques (Macaca nigra) to two management interventions involving environmental and social disturbance. During the first, the institution removed six castrated males and one female, contracepted six of the nine remaining females, and moved the group to a new enclosure. The second involved the introduction of a novel, reproductive male five weeks later. Networks remained stable following the first intervention. However, after introduction of the male, the number of grooming partners and the frequency of grooming with non-maternal kin increased in female-only networks. We observed less marked increases in the grooming frequency and number of grooming partners in whole group networks. Ten weeks later, network structure was more similar to that of pre-intervention networks than post-intervention networks. Our results suggest that reproductive males play a more important role in structuring Sulawesi crested macaque social networks than castrated males, as networks expanded and relationships between non-maternal kin occurred more frequently after introduction of the reproductive male. However, network responses to interventions appeared to be temporary as networks following a period of acclimation more closely resembled pre-intervention networks than post-intervention networks. Our study demonstrates the utility of social network analysis for understanding the impact of disturbance on stable social groups.

Education and devices to prevent blood and body fluid exposures

2019 ◽  
Vol 70 (1) ◽  
pp. 38-44 ◽  
Author(s):  
S Cheetham ◽  
H Ngo ◽  
J Liira ◽  
E Lee ◽  
C Pethrick ◽  
...  
Keyword(s):  
Body Fluid ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Incidence Rates ◽  
Full Time ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
The Impact

Abstract Background Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. Aims To assess the impact of an education and SEDs workplace programme on rates of reported exposures. Methods A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. Results A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7–17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6–4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18–20) incidents per 1000 FTE pre-intervention to 11 (CI 10–12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. Conclusions The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

Can Physician Incentives Improve Continuity of Care For Patients Receiving Depression Treatment in the Primary Care Setting?

2016 ◽  
Vol 33 (S1) ◽  
pp. S481-S481
Author(s):  
P. Joseph ◽  
A. Kazanjian
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Continuity Of Care ◽  
Mental Health Treatment ◽  
Financial Incentives ◽  
Vital Statistics ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Physician Incentives ◽  
The Impact

IntroductionIn 2008, the province of British Columbia, Canada introduced financial incentives to encourage general practitioners (GPs) to assume the role of major source of care for patients seeking mental health treatment in primary care. If successful, this intervention could strengthen GP–patient attachment and consequently improve continuity of care. The impact of this intervention, however, has never been investigated.AimTo estimate the population level impact of physician incentives on continuity of care (COC).MethodThis retrospective study examined linked health administrative data from physician claims, hospital separations, vital statistics, and insurance plan registries. Monthly cohorts of individuals with depression were identified and their GP visits tracked for 12 months, following receipt of initial diagnosis. COC indices were created, one for any visits (AV) and another for mental health visits (MHV) only. COC (range: 0–100) was calculated using published formula that accounts for the number of visits and number of GPs visited. Interrupted time series analysis was used to estimate the changes in COC before (01/2005–12/2007) and after (01/2008–12/2012) the introduction of physician incentives.ResultsThe monthly number of people diagnosed with depression ranged from 7497 to 10,575; yearly rates remained stable throughout the study period. At the start of the study period, mean COC for AV and MHV were 75.6 and 82.2 respectively, with slopes of –0.11 and –0.06. Post-intervention, the downward trend was disrupted but did not reverse.ConclusionsPhysician incentives failed to enhance COC. However, results suggest that COC could have been worse without the incentives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals LB-16. Association Between Universal Face Shield in a Quaternary Care Center and Reduction of SARS-COV2 Infections Among Healthcare Personnel and Hospitalized Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S851-S851
Author(s):  
Vagesh Hemmige ◽  
Becky Winterer ◽  
Todd Lasco ◽  
Bradley Lembcke
Keyword(s):  
Time Series ◽  
Care Center ◽  
Interrupted Time Series ◽  
Hospitalized Patients ◽  
Healthcare Personnel ◽  
Segmented Regression ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
The Impact

Abstract Background SARS-COV2 transmission to healthcare personnel (HCP) and hospitalized patients is a significant challenge. Our hospital is a quaternary healthcare system with more than 500 beds and 8,000 HCP. Between April 1 and April 17, 2020, we instituted several infection prevention strategies to limit transmission of SARS-COV2 including universal masking of HCP and patients, surveillance testing every two weeks for high-risk HCP and every week for cluster units, and surveillance testing for all patients on admission and prior to invasive procedures. On July 6, 2020, we implemented universal face shield for all healthcare personnel upon entry to facility. The aim of this study is to assess the impact of face shield policy on SARS-COV2 infection among HCP and hospitalized patients. Figure 1- Interrupted time series Methods The preintervention period (April 17, 2020-July 5, 2020) included implementation of universal face masks and surveillance testing of HCP and patients. The intervention period (July 6, 2020-July 26, 2020) included the addition of face shield to all HCP (for patient encounters and staff-to-staff encounters). We used interrupted time series analysis with segmented regression to examine the effect of our intervention on the difference in proportion of HCP positive for SARS-COV2 (using logistic regression) and HAI (using Poisson regression). We defined significance as p values &lt; 0.05. Results Of 4731 HCP tested, 192 tested positive for SARS-COV2 (4.1%). In the preintervention period, the weekly positivity rate among HCP increased from 0% to 12.9%. During the intervention period, the weekly positivity rate among HCP decreased to 2.3%, with segmented regression showing a change in predicted proportion positive in week 13 (18.0% to 3.7%, p&lt; 0.001) and change in the post-intervention slope on the log odds scale (p&lt; 0.001). A total of 14 HAI cases were identified. In the preintervention period, HAI cases increased from 0 to 5. During the intervention period, HAI cases decreased to 0. There was a change between pre-intervention and post-intervention slope on the log scale was significant (p&lt; 0.01). Conclusion Our study showed that the universal use of face shield was associated with significant reduction in SARS-COV2 infection among HCP and hospitalized patients. Disclosures All Authors: No reported disclosures

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