Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

A Cascade of Care Model for Suicide Prevention

The rising rates of suicide in the United States, particularly among young people of color, requires urgent attention. While the healthcare system is a critical service sector for suicide prevention given high levels of utilization by people at risk of suicide, it is not sufficient. Only approximately 50% of those identified as at-risk in an Emergency Department, agree to be connected to outpatient services, with even small proportions engaging in these services. This “care cascade” parallels health services challenges in other domains, such as HIV. Corresponding Cascade of Care (COC) models have been galvanizing public health frameworks, as they can be utilized to track both patient-level outcomes and leveraged to form aspirational goals to improve systems of care for those in need. We aim to delineate a COC model specific to suicide prevention efforts, to help frame existing challenges and unify efforts to address these gaps. Given the complexity of suicidal thoughts and behaviors, solutions are needed that address care at multiple levels of the socio-ecological framework and build multisectoral networks into an integrated system of care. Defining and delineating this COC model can help structure local and national efforts to comprehensively address the suicide epidemic in the United States.

Health care utilization during the Covid-19 pandemic in Mexico: the cascade of care

Objective. The objective of the study is to describe trends in selected services offered at public health facilities and utilization patterns during the Covid-19 epidemic in Mexico. Materials and methods. We used administrative data and the National Health and Nutrition Survey Covid-19, 2020. Results. We found a reduction in the rates of diabetes and detection screening during 2020 compared to 2014-2019. From the demand side, we found that 18.6% of the population reported health needs, and only 34% of them received care in public health facilities. The use of private health services was extensive even among the population with social security. The uninsured and the population with high and medium socioeconomic status had a lower probability of receiving care in public health facilities. Conclusion. We document trends in selected services, as well as the cascade of care during the Covid-19 epidemic in Mexico and its potential impact on displaced health care.

The Covid-19 cascade of care in Mexico: symptoms, positivity, and health care seeking decisions amid the pandemic

Objective. The study describes health care services utilization contextualized by the needs of the Mexican population during the Covid-19 pandemic. Materials and methods. We used data from the National Health and Nutrition Survey, Covid-19. Among the population with symptoms compatible with Covid-19, we describe the proportion who sought care, received care, were tested, were diagnosed positive, and survived, and whether they received care in public or private services. We estimated factors associated with the probability of seeking and receiving care. Results. Out of 7.1% of the population with symptoms compatible with Covid-19, 64.4% received care, and 15.4% tested positive; 74.5% received care in the private sector, even among the population with social security. Those with social security, in contact with a suspected or confirmed Covid-19 case, and with at least one comorbidity had a higher probability of seeking and receiving care. Conclusions. The most relevant finding of our study is the large proportion of the population with Covid-19 symptoms who sought and received care in private facilities an essential aspect for decision-makers to consider as the current health reform moves forward in Mexico.

1407. The Latent Tuberculosis Infection Cascade of Care during the COVID-19 Pandemic Response in a Mid-Sized US City

Background The COVID-19 pandemic response may unintendedly disrupt multiple public health services, including tuberculosis control programs. We aimed to assess the cascade of care of latent tuberculosis infection (LTBI) in an urban US city during the COVID-19 pandemic response. Methods We conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. We defined 01/2019 to 02/2020 as the pre-COVID-19 response period, and 04/2020 to 12/2020 as the COVID-19 pandemic response period. We reviewed electronic medical records and extracted sociodemographic information, medical history, and follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period. Results Data from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p=0.02) and LTBI evaluations (median, 17.5 vs. 7, p< 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p< 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p< 0.01) during COVID-19. The proportion of people who were recommended LTBI treatment was similar before and during COVID-19 (76% vs. 81%, p=0.41), as well as the LTBI treatment acceptance rates (56% vs. 64%, p=0.28), and LTBI treatment completion rates (65% vs. 63%, p=0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA use, no comorbidities, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period. Conclusion We observed a significant decline in the number of monthly LTBI referrals and evaluations during COVID-19. Our findings indicate an unintended negative impact of the COVID-19 response in LTBI screening efforts in our region. LTBI treatment acceptance and completion rates were not affected during COVID-19. Disclosures All Authors: No reported disclosures