Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison

In the United States, hepatitis C virus (HCV) transmission is rising among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modeling, we investigated the impact of scaling up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky, and San Francisco, California, where HCV seroprevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban San Francisco (established community) than in rural Perry County (young, expanding community). We modeled the proportion of HCV-infected PWID needing HCV treatment annually to reduce HCV incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (Perry County only) from 2017. With current MAT and SSP coverage during 2017–2030, HCV incidence would increase in Perry County (from 21.3 to 22.6 per 100 person-years) and decrease in San Francisco (from 12.9 to 11.9 per 100 person-years). With concurrent MAT and SSP scale-up, 5% per year of HCV-infected PWID would need HCV treatment in Perry County to achieve incidence targets—13% per year without MAT and SSP scale-up. In San Francisco, a similar proportion would need HCV treatment (10% per year) irrespective of MAT scale-up. Reaching the same impact by 2025 would require increases in treatment rates of 45%–82%. Achievable provision of HCV treatment, alongside MAT and SSP scale-up (Perry County) and MAT scale-up (San Francisco), could reduce HCV incidence.

Effectiveness of a Pharmacist-Led Cardiovascular Risk Reduction Clinic in Rural Perry County, Alabama

Background.The Cardiovascular Risk Reduction Clinic (CRRC) in Perry County, Alabama, provides free pharmacist-led services. Clinic goals include improving health outcomes and reducing cardiovascular risk factors.Objective.To investigate the effectiveness of the CRRC in rural Perry County, Alabama. The reduction of the modifiable cardiovascular risk factors, blood pressure and body mass index, was evaluated to measure a decrease from baseline to last clinic date.Methods.This retrospective chart review identified 130 patients with at least two blood pressure and BMI measurements from baseline to June 30, 2010. The patients’ paper files were used to collect baseline data and most recent measurements, which were recorded on a data collection sheet.Results.There was a statistically significant reduction in systolic blood pressure of 4.08 mmHg, 3.25 mmHg reduction in diastolic blood pressure, and 0.42 kg/m2reduction in mean BMI. At their last visit prior to June 30, 2010, 59% of hypertensive patients and 35% of diabetic patients were meeting their blood pressure goals.Conclusion.Pharmacist-led management of patients with cardiovascular risk factors significantly reduced blood pressure and allowed more patients to meet their hypertension treatment goals. Despite being modest, reductions in blood pressure and BMI help reduce overall cardiovascular risks.

Sex in the Witness Stand: Erotic Sensationalism, Voyeurism, Sexual Boasting, and Bawdy Humor in Nineteenth-Century Illinois Courts

Twenty-something John Dunn remembered July 17, 1872 well. A witness for the defense in both a bastardy trial brought by 15-year-old Mary Morgan and a later seduction suit brought by her father, John would recount that summer day by drawing on the rough, sexual slang he likely used in conversations with male friends. After he was sworn in, John informed the legal participants and curious local spectators gathered at the Perry County Circuit Court that the July 17 buggy ride with young Mary had presented him with the opportunity to “feel of her titties and monkey.” John's testimony was hardly the most vulgar given during the proceedings. Another character witness, Robert B. Ward, disclosed a particularly salacious conversation he had overheard while in the “privy” behind a DuQuoin general store. Eavesdropping, Ward listened to two young men discuss Mary Morgan's “condition” with one another. The man Ward recognized, Thomas Williams, told his friend he would leave the state rather than marry a girl who “ran around screwing this one and that one,” if Mary did happen to “swear the child on him.” Thomas's buddy agreed that dodging the law would be preferable to matrimony with Mary for she had not “behaved herself.” “I have screwed her as often as I have fingers and toes, or oftener, and you know it,” he confided to Thomas. “Yes I know that,” Thomas replied, “She don't know more than a hog whose child it is.”