scholarly journals Infectious diseases screening approach among refugees: results from a single-center study

2021 ◽  
Vol 15 (06) ◽  
pp. 847-852
Author(s):  
Vito Fiore ◽  
Andrea De Vito ◽  
Petrana Martineková ◽  
Elija Princic ◽  
Nicholas Geremia ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Screening Program ◽  
Latent Tuberculosis ◽  
Good Method ◽  
Screening Tests ◽  
Hiv Screening ◽  
Healthcare Provision ◽  
Positive Serology ◽  
Sexually Transmitted ◽  
Demographical Data

Introduction: Our aim was to evaluate a screening program, with active case-finding and treatment for active tuberculosis (TB), latent tuberculosis infection (LTBI), blood-borne viruses (BBV), and sexually transmitted diseases (STDs) among refugees living in facility centers. Methodology: We collected data on refugees arriving to our attention in migrant centers in Sardinia, Italy. Socio-demographical data, anamnesis, and clinical features were collected. TST Mantoux was conducted, and X-ray chest (XRC) was performed if TST was positive. Blood-borne virus screening was proposed to all patients. Screening for STDs was offered according to guidelines, anamnesis, and physical examination. Results: Eighty-one patients were included. Seventy (86.4%) were male, and the mean age was 24.8±5.7 years. Thirty-three (40.7%) had scabies. Overall, 40/81 (49.4%) had a positive TST Mantoux. One (2.5%) was hospitalized and died for multi-drug-resistant TB. One (2.5%) patient had intestinal-TB. 52/81 (64.2%) refused HIV screening, whereas no positivity was found among tested migrants. Sixty-two (76.5%) accepted HCV screening, and one (1.6%) had a positive test. Fifty-eight (71.6%%) accepted HBV testing, and 29 (50%) of them had positive serology. Ten (12.3%) patients had anal or genital lesions due to syphilis, Molluscum contagiosum, and HPV in 7 (70%), 2 (20%), and one (10%) case, respectively. Conclusions: Infectious diseases control and prevention are a key strategy among refugees. The stay in a migrant center is an extraordinary occasion for healthcare provision. This condition could allow a broad screening program in which quick BBV screening tests could be a good method to implement uptake. More information and educational programs would allow a higher understanding and acceptance of HIV screening.

scholarly journals Optimizing Screening for HIV

2020 ◽  
Author(s):  
Antoine Chaillon ◽  
Martin Hoenigl ◽  
Lorri Freitas ◽  
Haruna Feldman ◽  
Winston Tilghman ◽  
...  
Keyword(s):  
At Risk ◽  
Screening Program ◽  
Demographic Data ◽  
The United States ◽  
Hiv Prevalence ◽  
Screening Tests ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
At Risk Populations ◽  
Zip Code

Abstract Background The HIV epidemic is unevenly distributed throughout the United States, even within neighborhoods. This study evaluated how effectively current testing approaches reached persons at risk for HIV infection across San Diego (SD) County, California. Methods HIV case and testing data, sexually transmitted infection (STI) and socio-demographic data for SD County were collected from the SD Health and Human Services Agency and the ‘Early Test’ community-based HIV screening program between 1998 and 2016. Relationships between HIV diagnoses, HIV prevalence, and STI diagnoses with screening at zip code level were evaluated. Results Overall, 379,074 HIV tests were performed. The numbers of HIV tests performed on persons residing in a zip code or region overall strongly correlated with prevalent HIV cases (R2=0.714), new HIV diagnoses (R2=0.798), and STI diagnoses (R2=0.768 [chlamydia],0.836 [gonorrhea], 0.655 [syphilis]) in those regions. Zip codes with the highest HIV prevalence had the highest number of tests per resident and fewest number of tests per diagnosis. Even though most screening tests occurred at fixed venues located in high prevalence areas, screening of residents from lower prevalence areas was mostly proportional to the prevalence of HIV and rates of new HIV and STI diagnoses in those locales. Conclusion This study supported the ability of a small number of standalone testing centers to reach at-risk populations dispersed across SD County. These methods can also be used to highlight geographic areas, or demographic segments that may benefit from more intensive screening.

scholarly journals 1329. Beyond Reporting: Using an Accreditation Council for Graduate Medical Education (ACGME) Milestone-Linked Evaluation System to Improve Clinical Infectious Diseases Rotations for Baylor College of Medicine Internal Medicine (BCM IM) Residents

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S406-S406
Author(s):  
Lauren Nicholas Herrera ◽  
Richard J Hamill ◽  
Stacey R Rose
Keyword(s):  
Internal Medicine ◽  
Infectious Diseases ◽  
Evaluation System ◽  
Latent Tuberculosis ◽  
Ambulatory Setting ◽  
Educational Goals ◽  
Inpatient Setting ◽  
Clinical Exposure ◽  
Sexually Transmitted ◽  
Immune Deficiencies

Abstract Background ACGME requires reporting of trainee performance on specialty-specific “milestones.” Online evaluation platforms facilitate reporting by linking evaluation questions to these milestones. Whether a milestone-linked evaluation system can be used to identify educational strengths and weaknesses within a training program has not been reported. Methods In 2016, the BCM IM residency program implemented a milestone-linked evaluation system to increase transparency to residents regarding educational goals and streamline milestone reporting. Residents are evaluated on rotation-specific educational objectives; scores range from 1 to 5 (Figure 1), or “not observed” if the skill was not observed during the rotation. Evaluation data from residents on infectious diseases (ID) rotations between 2016 and 2018 were analyzed to compare performance by post-graduate year (PGY) and to assess curricular strengths and deficiencies. Results Two hundred five inpatient and 43 ambulatory ID rotation evaluations were analyzed. In the inpatient setting, mean scores for PGY-1, -2, and -3 trainees were 2.62, 3.06, and 3.88. Residents scored highly on communicating consult recommendations and collecting data from the health record. Residents received lower scores on identifying infections associated with immune deficiencies and in knowledge of antimicrobial spectrum/indications. In the ambulatory setting, mean scores for PGY-2 and -3 trainees were 3.44 and 3.61. Relative to the inpatient setting, more objectives on ambulatory rotations were rated as “not observed.” Objectives with high rates of “not observed” ratings included managing infections in returning travelers (70%); testing/treating latent tuberculosis (63%); interpreting viral hepatitis studies (31%); and managing sexually transmitted infections (25%). Conclusion Data from a milestone-linked evaluation system identified educational strengths and weaknesses of clinical ID experiences for internal medicine residents. Objectives with consistently low or “not observed” ratings may be judged as educational deficiencies, and should prompt modifications to the curriculum to provide increased clinical exposure and/or dedicated didactics to help residents develop these important skills. Disclosures All authors: No reported disclosures.

scholarly journals Automated HIV screening in the emergency department –earlier diagnosis, improved clinical outcomes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Vaz Pinto ◽  
M Guimaraes ◽  
V Castro ◽  
C Santos ◽  
A Galiano ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Screening Program ◽  
Public Health Problem ◽  
Undetectable Viral Load ◽  
Late Presentation ◽  
Screening Tests ◽  
Treatment As Prevention ◽  
Hiv Screening ◽  
Opt Out

Abstract Background HIV/AIDS is a public health problem worldwide because undiagnosed patients maintain onward transmission. To stop viral transmission an upscale in diagnostics is needed so that more patients start treatment; patients on treatment and with undetectable viral load do not transmit the virus to other persons (“Treatment as Prevention”). Objectives We aimed at identifying more HIV infections in the emergency Department (ED) and at doing so earlier in the course of disease. Methods we designed an automated and clinician independent HIV screening project in the ED. Electronic Medical Record (EMR) automatically generates a request for HIV antibody (HIV Ab) test when a patient: a) is 18-65 years of age and has a request for any blood test; b) is not identified in the EMR as being HIV infected; c) does not have an HIV Ab in the EMR in the previous year. Nursing staff receive a visual warning of patients' eligibility for screening and an extra tube label is printed out for HIV testing. The patient is informed of screening at the moment of blood drawing and an <<opt-out >> strategy is applied (optional verbal informed consent or <<opt-out >> of screening). Results In 16 months, a total of 21.487 people were eligible for screening. 18.072 HIV Ab screening tests were done. The opt-out rate was 6.3% and there were 44 new HIV diagnostics (prevalence rate 0.24%). Late presenting patients (baseline CD4 counts <350) dropped from an average of 56% in the previous 6 years at our institution to 36.3%. Median CD4 count at diagnostics went up from 192 to 388 cells/mm³. Conclusions An automated and clinician independent HIV screening program in the ED proved to be successful at identifying more HIV patients and at tackling the problem of late presentation. Diagnosing early in the course of infection is beneficial for the individual patient, but also represents a gain in general public health because onward transmission is stopped by starting antiretroviral treatment. Key messages Early diagnosis through universal screening. Treatment as prevention.

scholarly journals 1061. False Positive Human Immunodeficiency Virus Testing Due to Acute Hepatitis A Infection: A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S559-S559
Author(s):  
Maria V Bandres ◽  
Daniel Mueller
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Hepatitis ◽  
Hiv Testing ◽  
False Positive ◽  
Hepatitis A ◽  
Screening Tests ◽  
Hiv Screening ◽  
Immunodeficiency Virus ◽  
Acute Hepatitis A ◽  
Hiv 1

Abstract Background In our urban, underserved patient population, Human Immunodeficiency Virus (HIV) is hyper-endemic, and HIV screening is frequently performed. Although HIV screening tests have high specificity, false positives can occur. Numerous reasons for false positive testing have been cited, including vaccinations, autoimmune diseases, and viral infections. In 2019, Philadelphia experienced a large Hepatitis A outbreak, during which time false positive HIV screening tests were discovered. Our aim was to further describe these patients who had been diagnosed with acute Hepatitis A infection and in whom false positive HIV testing had occurred. Methods We conducted a retrospective chart review of adult patients admitted to our hospital between January 2017 and December 2019 who had a positive Hepatitis A Virus (HAV) IgM. Demographics, HIV tests, viral hepatitis tests, and liver tests were recorded. False positive HIV was defined as a positive HIV screen (p24 antigen and HIV-1 and 2 antibody combo), followed by a negative differentiation assay for HIV-1 and 2 antibodies, combined with a negative HIV PCR. Results A total of 156 unique patients were found to have acute HAV, with 138 cases identified in 2019. Of these, 3 patients had confirmed false positive HIV testing, and 1 patient had suspected false positive HIV testing (HIV-2 differentiation assay indeterminate, with very low local prevalence of HIV-2), for a false positive test rate of 2.6% (4/156). Ages ranged from 36-47 years, 3 were male, and 2 were persons who injected drugs (PWID). Three patients had prior negative HIV testing. Two patients had fevers during admission, but none of the four were febrile at the time of HIV test collection. Three patients had elevated transaminases, and two had abnormal coagulation testing. Coinfection with Hepatitis C was found in three patients. One patient had follow-up HIV testing performed, which was negative. Conclusion To our knowledge, this is the first report of false positive HIV testing related to acute HAV. Prevalence of false positives was low, but awareness can facilitate patient counseling. With low sample size, conclusions cannot be drawn about risk factors related to false positive testing. Disclosures All Authors: No reported disclosures

scholarly journals Assessment of a change of protocol of prenatal screening by inclusion of non-invasive prenatal diagnosis

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Rocío Cabra-Rodríguez ◽  
Guadalupe Bueno Rodríguez ◽  
Cristina Santos Rosa ◽  
Miguel Ángel Castaño López ◽  
Sonia Delgado Muñoz ◽  
...  
Keyword(s):  
Prenatal Screening ◽  
Chromosomal Abnormalities ◽  
Screening Program ◽  
High Sensitivity ◽  
Maternal Blood ◽  
Screening Tests ◽  
Loss To Follow Up ◽  
Non Invasive ◽  
Second Trimester Screening ◽  
Trimester Screening

AbstractObjectivesNon-invasive prenatal screening (NIPS) is a test for the detection of major fetal chromosomal abnormalities in maternal blood during pregnancy. The purpose of this study was to assess the performance of NIPS implemented within the framework of the Screening Program for Congenital Abnormalities of the Andalusian Health System.MethodsA retrospective observational study was undertaken to determine the number of NIPS tests performed since its introduction. The number of invasive diagnostic tests done after the implementation of NIPS in the patients included in the program between March 2016 and August 2017 was also quantified.ResultsA total of 6,258 combined first- and second trimester screening tests were performed, covering 95% of the population. In total, 250 subjects were identified as high risk, of whom 200 underwent NIPS after loss to follow-up. NIPS showed a sensitivity of 100% (95% CI: 76.84–100%) and a specificity of 99.46% (95% CI: 97.04–99.99%).ConclusionsThis test has proven to have a very high sensitivity and specificity. The results obtained demonstrate that the incorporation of NIPS in clinical practice minimizes the rate of miscarriages and reduces the frequency of invasive procedures by 70%.

scholarly journals The Role of Laboratory Tests in Crohn's Disease

2016 ◽  
Vol 9 ◽  
pp. CGast.S38203 ◽  
Author(s):  
Maria Cappello ◽  
Gaetano Cristian Morreale
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Laboratory Tests ◽  
Molecular Mechanisms ◽  
Latent Tuberculosis ◽  
Fecal Calprotectin ◽  
Screening Tests ◽  
Hematological Toxicity ◽  
Therapeutic Drug ◽  
Personalized Care

In the past, laboratory tests were considered of limited value in Crohn's disease (CD). In the era of biologics, laboratory tests have become essential to evaluate the inflammatory burden of the disease (C-reactive protein, fecal calprotectin) since symptoms-based scores are subjective, to predict the response to pharmacological options and the risk of relapse, to discriminate CD from ulcerative colitis, to select candidates to anti-tumor necrosis factors [screening tests looking for hepatitis B virus and hepatitis C virus status and latent tuberculosis], to assess the risk of adverse events (testing for thiopurine metabolites and thiopurine-methyltransferase activity), and to personalize and optimize therapy (therapeutic drug monitoring). Pharmacogenetics, though presently confined to the assessment of thiopurineme methyltransferase polymorphisms and hematological toxicity associated with thiopurine treatment, is a promising field that will contribute to a better understanding of the molecular mechanisms of the variability in response to the drugs used in CD with the attempt to expand personalized care and precision medicine strategies.

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.

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