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Lee DU, Bhowmick K, Kolachana S, Schuster K, Bahadur A, Harmacinski A, Schellhammer S, Fan GH, Lee KJ, Sun C, Chou H, Lominadze Z. Inpatient Cost Burdens of Treating Chronic Hepatitis B in US Hospitals: A Weighted Analysis of a National Database. Dig Dis Sci 2024:10.1007/s10620-024-08448-z. [PMID: 38658506 DOI: 10.1007/s10620-024-08448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS This study evaluates the cost burdens of inpatient care for chronic hepatitis B (CHB). We aimed to stratify the patients based on the presence of cirrhosis and conduct subgroup analyses on patient demographics and medical characteristics. METHODS The 2016-2019 National Inpatient Sample was used to select individuals diagnosed with CHB. The weighted charge estimates were derived and converted to admission costs, adjusting for inflation to the year 2016, and presented in United States Dollars. These adjusted values were stratified using select patient variables. To assess the goodness-of-fit for each trend, we graphed the data across the respective years, expressed in a chronological sequence with format (R2, p-value). Analysis of CHB patients was carried out in three groups: the composite CHB population, the subset of patients with cirrhosis, and the subset of patients without cirrhosis. RESULTS From 2016 to 2019, the total costs of hospitalizations in CHB patients were $603.82, $737.92, $758.29, and $809.01 million dollars from 2016 to 2019, respectively. We did not observe significant cost trends in the composite CHB population or in the cirrhosis and non-cirrhosis cohorts. However, we did find rising costs associated with age older than 65 (0.97, 0.02), white race (0.98, 0.01), Hispanic ethnicity (1.00, 0.001), and Medicare coverage (0.95, 0.02), the significance of which persisted regardless of the presence of cirrhosis. Additionally, inpatients without cirrhosis who had comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) were also observed to have rising costs (0.96, 0.02). CONCLUSIONS We did not find a significant increase in overall costs with CHB inpatients, regardless of the presence of cirrhosis. However, certain groups are more susceptible to escalating costs. Therefore, increased screening and nuanced vaccination planning must be optimized in order to prevent and mitigate these growing cost burdens on vulnerable populations.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | - Kuntal Bhowmick
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Sindhura Kolachana
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Kimberly Schuster
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Aneesh Bahadur
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Ashton Harmacinski
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Sophie Schellhammer
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Gregory Hongyuan Fan
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Ki Jung Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Catherine Sun
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Hannah Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Zurabi Lominadze
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
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2
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Jonas MC, Sheu YS, Wright K, Peyton L, Bishop RC, Basra S, Sarwar F, Winn G, Chesbrough K. A care coordination program to support patients with hepatitis B virus at Kaiser Permanente Mid-Atlantic States. BMC Health Serv Res 2024; 24:482. [PMID: 38637807 PMCID: PMC11027294 DOI: 10.1186/s12913-024-10907-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Eliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B. METHODS Here, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer). This study describes the HBV Pathway steps and reports sociodemographic factors of patients by initiation and completion. RESULTS Results showed a 72.5% completion rate (defined as completing all Pathway steps including the final specialty visit) among patients who initiated the Pathway. Differences in completion were observed by age, race, ethnicity, and service area, with higher rates for younger ages, Asian race, non-Hispanic ethnicity, and lower rates for patients within one service area. Of those who completed the specialty visit, 59.5% were referred for hepatocellular carcinoma surveillance. CONCLUSIONS The HBV Pathway offers dual benefits- care coordination support for patients to promote Pathway completion and a standardized testing and referral program to reduce physician burden. This program provides an easy and reliable process for patients and physicians to obtain updated clinical information and initiate treatment and/or liver cancer screening if needed.
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Affiliation(s)
- M Cabell Jonas
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
| | - Yi-Shin Sheu
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Kara Wright
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Lauren Peyton
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - R Clayton Bishop
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Sundeep Basra
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Fariha Sarwar
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Grace Winn
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Karen Chesbrough
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
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3
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Zhou K, Sumethasorn M, Wong C, Terrault NA. Country-Specific Screening, Prevalence, and Immunity Rates for Hepatitis B Infection in a Large US Safety-Net System. Open Forum Infect Dis 2024; 11:ofad699. [PMID: 38274550 PMCID: PMC10810062 DOI: 10.1093/ofid/ofad699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Country- and region-specific estimates of hepatitis B virus (HBV) screening, prevalence, and immunity rates are provided for 202 868 adults from 174 unique countries in a large urban safety-net system. Of these, 41.8% (95% confidence interval, 41.5%-42.0%) were screened, with age-adjusted HBV prevalence of 0.9% (.9%-1.0%); 55.3% (54.9%-55.7%) had immunity testing, and 32.4% (31.9%-33.0%) were immune.
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Affiliation(s)
- Kali Zhou
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
- Research Center for Liver Diseases, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California, USA
| | - Matt Sumethasorn
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California, USA
| | - Christopher Wong
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Norah A Terrault
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
- Research Center for Liver Diseases, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California, USA
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4
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Vaidya R, Unger JM, Loomba R, Hwang JP, Chugh R, Tincopa MA, Arnold KB, Hershman DL, Ramsey SD. Universal Viral Screening of Patients with Newly Diagnosed Cancer in the United States: A Cost-efficiency Evaluation. CANCER RESEARCH COMMUNICATIONS 2023; 3:1959-1965. [PMID: 37707388 PMCID: PMC10541082 DOI: 10.1158/2767-9764.crc-23-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/11/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Recommendations for universal screening of patients with cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are inconsistent. A recent multisite screening study (S1204) from the SWOG Cancer Research Network found that a substantial number of patients with newly diagnosed cancer had previously unknown viral infections. The objective of this study was to determine the cost-efficiency of universal screening of patients with newly diagnosed cancer. We estimated the cost-efficiency of universal screening of new cancer cases for HBV, HCV, or HIV, expressed as cost per virus detected, from the health care payer perspective. The prevalence of each virus among this cohort was derived from S1204. Direct medical expenditures included costs associated with laboratory screening tests. Costs per case detected were estimated for each screening strategy. Secondary analysis examined the cost-efficiency of screening patients whose viral status at cancer diagnosis was unknown. Among the possible options for universal screening, screening for HBV alone ($581), HCV alone ($782), HBV and HCV ($631) and HBV, HCV, and HIV ($841) were most efficient in terms of cost per case detected. When screening was restricted to patients with unknown viral status, screening for HBV alone ($684), HBV and HCV ($872), HBV and HIV ($1,157), and all three viruses ($1,291) were most efficient in terms of cost per newly detected case. Efficient viral testing strategies represent a relatively modest addition to the overall cost of managing a patient with cancer. Screening for HBV, HCV, and HIV infections may be reasonable from both a budget and clinical standpoint. SIGNIFICANCE Screening patients with cancer for HBV, HCV, and HIV is inconsistent in clinical practice despite national recommendations and known risks of complications from viral infection. Our study shows that while costs of viral screening strategies vary by choice of tests, they present a modest addition to the cost of managing a patient with cancer.
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Affiliation(s)
- Riha Vaidya
- Fred Hutchinson Cancer Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Joseph M. Unger
- Fred Hutchinson Cancer Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Rohit Loomba
- University of California San Diego, Moores Cancer Center, San Diego, California
| | - Jessica P. Hwang
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Rashmi Chugh
- University of Michigan, Rogel Cancer Center, Ann Arbor, Michigan
| | | | - Kathryn B. Arnold
- Fred Hutchinson Cancer Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
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5
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Razavi-Shearer D, Estes C, Gamkrelidze I, Razavi H. Cost-effectiveness of treating all hepatitis B-positive individuals in the United States. J Viral Hepat 2023; 30:718-726. [PMID: 37260095 DOI: 10.1111/jvh.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
Chronic hepatitis B virus (HBV) infection is a leading cause of liver disease and related mortality globally. However, most of the infected individuals in the United States remain undiagnosed and untreated. There is a need to understand more completely the economic and disease burden impact of removing treatment restrictions and increasing diagnosis and treatment. The PRoGReSs model, a dynamic HBV model that tracks the infected population by year, disease stage, and gender, was used to quantify the disease and economic burden of chronic HBV infection in the United States from 2020 to 2050 based on four scenarios: a status quo (base) scenario and three treat-all scenarios, in which screening, diagnosis, and treatment were maximized at different annual treatment price levels of $5382, $2000 and $750. Compared to the base scenario, the treat-all scenarios would avert 71,100 acute and 11,100 chronic incident cases of HBV, and 169,000 liver-related deaths from 2020 to 2050. At an annual treatment cost of $2000, treating all HBV infections would be highly cost-effective, and at $750 would be cost saving and would achieve a positive return on investment before 2050. Maximizing the diagnosed and treated HBV population in the United States would avert a significant number of cases of advanced liver disease and related mortality. Such interventions can also be cost-effective compared to the status quo strategy, and cost saving at a treatment price threshold of $750 annually, above the current lowest annual treatment cost of $362.
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Affiliation(s)
| | - Chris Estes
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
| | | | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
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6
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Rao G, Ruiz JM, Stevermer JJ, Tsevat J, Underwood SM, Wong JB. Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 330:736-745. [PMID: 37606666 DOI: 10.1001/jama.2023.14461] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Importance An estimated 1.2 million persons in the US currently have HIV, and more than 760 000 persons have died of complications related to HIV since the first cases were reported in 1981. Although treatable, HIV is not curable and has significant health consequences. Therefore, effective strategies to prevent HIV are an important public health and clinical priority. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of preexposure prophylaxis with antiretroviral therapy for the prevention of HIV acquisition, and the diagnostic accuracy of risk assessment tools to identify persons at increased risk of HIV acquisition. Population Adolescents and adults who do not have HIV and are at increased risk of HIV. Evidence Assessment The USPSTF concludes with high certainty that there is a substantial net benefit from the use of effective antiretroviral therapy to reduce the risk of acquisition of HIV in persons at increased risk of acquiring HIV. Recommendation The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV. (A recommendation).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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7
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Forbes C, Lavoie L, Satram S, Shen L, Thanawala V, Arizpe A, Terrault N. Global importance of new treatment strategies to efforts to control hepatitis B virus. Expert Rev Anti Infect Ther 2023; 21:847-862. [PMID: 37322901 DOI: 10.1080/14787210.2023.2225771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Hepatitis B Virus (HBV) infection can progress to chronic HBV (CHB) disease, thereby increasing the risk of severe forms of liver disease (i.e. liver cirrhosis and hepatocellular carcinoma) and resulting in a high global burden of morbidity, mortality, and health-care utilization. AREAS COVERED We discuss how future therapeutic strategies and treatment guidelines may address the large unmet medical needs among patients with CHB. EXPERT OPINION Complexity and a lack of consensus in current CHB treatment guidelines may limit their effective implementation. To minimize poor outcomes in patients not currently receiving treatment (including immune-tolerant and inactive carriers), a simplified harmonized treatment approach is needed across guidelines. Current treatment recommendations focus on nucleot(s)ide analogs (NAs) and pegylated interferon (Peg-IFN), both of which have limitations. NAs provide clinical benefits, but treatment is prolonged and has little impact on functional cure rates. Peg-IFN offers the potential for functional cure but has notable safety and tolerability issues. A shift toward finite treatments with acceptable safety and tolerability profiles is needed. CONCLUSION The key to achieving World Health Organization targets for the global eradication of HBV involves enhanced diagnosis with new treatments and/or combinations of existing treatments alongside globally aligned and simplified treatment guidelines for untreated/inadequately treated populations.
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Affiliation(s)
| | - Louis Lavoie
- Evidence Synthesis, Evidera Inc, Montreal, Canada
| | - Sacha Satram
- Evidence, Value & Access, Vir Biotechology Inc, San Francisco, CA, USA
| | - Ling Shen
- Biostatistics, Vir Biotechnology Inc, San Francisco, CA, USA
| | | | - Andre Arizpe
- Clinical Research, Vir Biotechnology Inc, San Francisco, CA, USA
| | - Norah Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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8
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So S, Terrault N, Conners EE. Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination. JAMA 2023; 329:1639-1640. [PMID: 36897598 PMCID: PMC10959250 DOI: 10.1001/jama.2023.2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
This Viewpoint describes new recommendations from the CDC regarding universal screening of adults for hepatitis B virus infection.
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Affiliation(s)
- Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Norah Terrault
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Erin E Conners
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Wang AE, Terrault NA, Fong TL, Zhou K. Disparities in presentation and management of chronic hepatitis B among Hispanics in a diverse safety net system. Hepatol Commun 2023; 7:e0081. [PMID: 36972389 PMCID: PMC10043583 DOI: 10.1097/hc9.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Chronic hepatitis B (HBV) prevalence is highest in foreign-born Asian and African individuals in the US, though Hispanics make up the largest proportion of the immigrant population. Differences in the diagnosis and management of chronic HBV in Hispanics might exist due to the lower awareness of risk. We aim to examine racial/ethnic disparities in the diagnosis, presentation, and immediate management of chronic HBV in a diverse safety net system enriched for Hispanics. METHODS In a large urban safety-net hospital system, we retrospectively identified patients with chronic HBV by serological data and categorized them into mutually exclusive self-identified racial/ethnic groups: Hispanics, Asians, Blacks, and Whites. We then examined differences in screening, disease phenotype and severity, follow-up testing, and referral by race/ethnicity. RESULTS Among 1063 patients, 302 (28%) were Hispanics, 569 (54%) Asians, 161 (15%) Blacks, and 31 (3%) Whites. More Hispanics (30%) were screened in the acute setting (defined as inpatient or emergency department encounters) than Asians (13%), Blacks (17%), or Whites (23%) (p<0.01). Hispanics also had lower rates of follow-up testing after HBV diagnosis than Asians including HBeAg status (43% vs. 60%, p<0.01) and HBV DNA levels (42% vs. 58%, p<0.01) and lower rates of linkage to specialty care (32% vs. 55%, p<0.01). Among those with available testing, however, the presence of immune-active chronic HBV was infrequent and similar across racial/ethnic groups. 25% of Hispanics had cirrhosis at initial presentation, proportionally higher than other groups (p<0.01). CONCLUSION Our results underscore the importance of raising chronic HBV awareness and increasing both screening and linkage to care among Hispanic immigrants in addition to the existing risk groups, with the goal of mitigating downstream liver-related complications.
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Affiliation(s)
- Allison E. Wang
- Department of Medicine, LAC+USC Medical Center, Los Angeles, California, USA
| | - Norah A. Terrault
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, California, USA
- Liver Program, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Kali Zhou
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, California, USA
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10
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Conners EE, Panagiotakopoulos L, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, Rogers-Brown JS, Wester C, Nelson NP. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023. MMWR Recomm Rep 2023; 72:1-25. [PMID: 36893044 PMCID: PMC9997714 DOI: 10.15585/mmwr.rr7201a1] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available. This report updates and expands CDC's previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection (MMWR Recomm Rep 2008;57[No. RR-8]) regarding screening for HBV infection in the United States. New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years. The report also expands risk-based testing recommendations to include the following populations, activities, exposures, or conditions associated with increased risk for HBV infection: persons incarcerated or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. In addition, to provide increased access to testing, anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.
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Affiliation(s)
- Erin E. Conners
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | | | - Megan G. Hofmeister
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Liesl M. Hagan
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Aaron M. Harris
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jessica S. Rogers-Brown
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Noele P. Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
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11
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Liang PS, Kwon SC, Cho I, Trinh-Shevrin C, Yi S. Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion. Gastroenterology 2023; 164:320-324. [PMID: 36822735 PMCID: PMC10983115 DOI: 10.1053/j.gastro.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Peter S Liang
- Department of Medicine Department of Population Health, NYU Grossman School of Medicine, New York, New York; Department of Medicine, VA New York Harbor Health Care System, New York, New York
| | - Simona C Kwon
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Ilseung Cho
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Chau Trinh-Shevrin
- Department of Medicine Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Stella Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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12
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Liang PS, Kwon SC, Cho I, Trinh-Shevrin C, Yi S. Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion. Clin Gastroenterol Hepatol 2023; 21:567-571. [PMID: 36828600 DOI: 10.1016/j.cgh.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 02/26/2023]
Affiliation(s)
- Peter S Liang
- Department of Medicine; Department of Population Health, NYU Grossman School of Medicine, New York, New York; Department of Medicine, VA New York Harbor Health Care System, New York, New York.
| | - Simona C Kwon
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Ilseung Cho
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Chau Trinh-Shevrin
- Department of Medicine; Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Stella Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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13
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Estimating the lifetime risk of a false positive screening test result. PLoS One 2023; 18:e0281153. [PMID: 36791062 PMCID: PMC9931091 DOI: 10.1371/journal.pone.0281153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023] Open
Abstract
False positive results in screening tests have potentially severe psychological, medical, and financial consequences for the recipient. However, there have been few efforts to quantify how the risk of a false positive accumulates over time. We seek to fill this gap by estimating the probability that an individual who adheres to the U.S. Preventive Services Task Force (USPSTF) screening guidelines will receive at least one false positive in a lifetime. To do so, we assembled a data set of 116 studies cited by the USPSTF that report the number of true positives, false negatives, true negatives, and false positives for the primary screening procedure for one of five cancers or six sexually transmitted diseases. We use these data to estimate the probability that an individual in one of 14 demographic subpopulations will receive at least one false positive for one of these eleven diseases in a lifetime. We specify a suitable statistical model to account for the hierarchical structure of the data, and we use the parametric bootstrap to quantify the uncertainty surrounding our estimates. The estimated probability of receiving at least one false positive in a lifetime is 85.5% (±0.9%) and 38.9% (±3.6%) for baseline groups of women and men, respectively. It is higher for subpopulations recommended to screen more frequently than the baseline, including more vulnerable groups such as pregnant women and men who have sex with men. Since screening technology is imperfect, false positives remain inevitable. The high lifetime risk of a false positive reveals the importance of educating patients about this phenomenon.
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14
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Block PD, Lim JK. Chronic Hepatitis B Virus: What an Internist Needs to Know. Med Clin North Am 2023; 107:435-447. [PMID: 37001946 DOI: 10.1016/j.mcna.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Chronic hepatitis B virus (HBV) infection is a bloodborne infection which affects approximately 1.6 million persons in the U.S. and 292 million persons worldwide and is associated with significant morbidity and mortality due to cirrhosis and hepatocellular carcinoma. HBV disproportionately affects foreign-persons from endemic regions such as sub-Saharan Africa and the Asian-Pacific region. Chronic HBV is diagnosed with positive HBsAg and detectable HBV DNA. Patients with immunoactive disease (elevated HBV DNA and serum ALT) may require antiviral therapy with peg-interferon or oral nucleos(t)ide analogues which suppress viral replication, and are associated with a decreased risk for liver events.
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Affiliation(s)
- Peter D Block
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Joseph K Lim
- Section of Digestive Diseases and Yale Liver Center, Yale School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, USA.
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15
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O’Brien SF, Reedman CN, Osiowy C, Bolotin S, Yi QL, Lourenço L, Lewin A, Binka M, Caffrey N, Drews SJ. Hepatitis B Blood Donor Screening Data: An Under-Recognized Resource for Canadian Public Health Surveillance. Viruses 2023; 15:v15020409. [PMID: 36851623 PMCID: PMC9966614 DOI: 10.3390/v15020409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Hepatitis B surveillance is essential to achieving Canada's goal of eliminating hepatitis B by 2030. Hepatitis B rates, association of infection with vaccine age-eligibility, and risk factors were analyzed among 1,401,603 first-time Canadian blood donors from 2005 to 2020. Donors were classified as having likely chronic or likely resolved/occult infections based on hepatitis B surface antigen, anti-hepatitis B core antigen, and hepatitis B nucleic acid test results. Likely chronically infected and control donors (ratio 1:4) participated in risk-factor interviews. The 2019 rate of likely chronic infection was 61.9 per 100,000 (95% CI 46.5-80.86) and 1449.5 per 100,000 for likely resolved/occult infections (95% CI 1370.7-1531.7). Likely chronic infections were higher in males (OR 3.2; 95% CI 2.7-3.7) and the vaccine-ineligible birth cohort (OR 1.9; 95% CI 1.6-2.2). The main risk factors were living with someone who had hepatitis (OR 12.5; 95% CI 5.2-30.0) and ethnic origin from a high-prevalence country (OR 8.4; 95% CI 5.9-11.9). Undiagnosed chronic hepatitis B may be more prevalent in Canada than currently determined by traditional passive hepatitis B reporting. Blood donor data can be useful in informing hepatitis B rates and evaluating vaccination programs in Canada.
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Affiliation(s)
- Sheila F. O’Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence: ; Tel.: +1-613-739-2144
| | - Cassandra N. Reedman
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada
- Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3P6, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Shelly Bolotin
- Center for Vaccine Preventable Disease, University of Toronto, Toronto, ON M5S, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S, Canada
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
| | - Qi-Long Yi
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Antoine Lewin
- Héma-Québec, Montreal, QC H4R 2W7, Canada
- Faculty of Medicine & Health Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Niamh Caffrey
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada
| | - Steven J. Drews
- Medical Microbiology Department, Canadian Blood Services, Edmonton, AB T6G 2R3, Canada
- Department of Laboratory Medicine & Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Edmonton, AB T6G 2R3, Canada
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16
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Min E, Min J, Kim R. Age-specific seroprotection after Hepatitis B virus vaccination among Korean American pediatric population in Queens, New York. Hum Vaccin Immunother 2022; 18:2053404. [PMID: 35378050 PMCID: PMC9225381 DOI: 10.1080/21645515.2022.2053404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Hepatitis B Virus (HBV) infection is a major health issue among Asian Americans. The prevalence of chronic Hepatitis B infection in New York City is estimated to be 2.7% compared with .3% in the overall United States. The efficacy and long-term immunity of HBV vaccination in the Korean American pediatric population in Queens, NY, are not well explored. This study aimed to 1) determine the age-specific prevalence of anti-HBs seropositivity in the Korean American pediatric population and 2) assess biologic/demographic factors influencing immunologic response to HBV vaccine. We performed a retrospective chart review of patients registered to a pediatric health clinic located in Queens, NY, from October 2014 to October 2020. Out of 604 medical records of patients aged ≤18 years who received a completed series of HBV vaccines during infancy, we analyzed 91 medical records where HBV serology test (HBsAg and anti-HBs) results were available. Three out of 91 subjects were born to HBsAg-positive mothers. Eight out of 91 subjects were born in South Korea. Overall, 54.9% of subjects were anti-HBs-seropositive. The seropositive rate in the 15 to 18-years-old-age group (14.3%) was significantly lower than that in other age groups: < 1 year (100%) (p = .015), 1–4 years (52.6%) (p = .033), 5–9 years (63.3%) (p = .0034), and 10–14 years (64%) (p = .0063). The mean duration since vaccination in seropositive subjects was 96.5 ± 53.9 months, and that in seronegative subjects was 121.7 ± 64.2 months (p < .047). Gender, BMI, and foreign birth were not significant risk factors affecting the nonseroprotective status. The role of routine screening of anti-HB titers and booster vaccination in this endemic community needs to be further explored.
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Affiliation(s)
- Esther Min
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.,Herricks High School, New Hyde Park, NY, USA
| | - Jae Min
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Roger Kim
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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17
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Khalili M, Kim NJ, Tsoh JY, Walsh JME, Goldman LE, Gildengorin G, Wong C, Tran MT, Yu E, Sharp MT, LeTran VH, Nguyen VV, Nguyen TT. Health Within Reach-a Patient-Centered Intervention to Increase Hepatitis B Screening Among Asian Americans: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:3242-3250. [PMID: 34993863 PMCID: PMC9550928 DOI: 10.1007/s11606-021-07232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are few studies to date of interventions to increase viral hepatitis screening among Asian Americans, who have high rates of chronic hepatitis B (HBV) infection. OBJECTIVE To develop, implement, and test the efficacy of a mobile application (Hepatitis App) delivered in four languages to increase HBV screening among Asian Americans. DESIGN Cluster-randomized clinical trial. PARTICIPANTS Four hundred fifty-two Asian American patients ≥ 18 years of age, who had no prior HBV testing, and received primary care within two healthcare systems in San Francisco, CA. INTERVENTIONS The intervention group received the Hepatitis App, delivering interactive video education on viral hepatitis in English, Cantonese, Mandarin, or Vietnamese and a provider printout (Provider Alert) and Provider Panel Notification. The comparison group received a mobile application delivering nutrition and physical activity education and Provider Panel Notification. MAIN MEASURES Primary outcomes were patient-provider discussion about HBV and documentation of a HBV screening test within 3 months post-intervention. Secondary outcome was documentation of an order for a HBV screening test. KEY RESULTS Participants had a mean age of 57 years and were 64% female, 80% foreign-born, and 44% with limited English fluency. At post-visit, over 80% of intervention participants reported they liked using the Hepatitis App. At 3-month follow-up, the intervention group was more likely than the comparison group (all P < 0.001) to have discussed HBV with their provider (70% vs.16%), have a HBV test ordered (44% vs.10%), and receive a HBV test (38% vs.8%). In multivariable analyses, the intervention odds ratio for HBV test ordering was 7.6 (95% CI: 3.9, 14.8) and test receipt was 7.5 (95% CI: 3.6, 15.5). CONCLUSIONS A multi-lingual educational intervention using a mobile application in primary care clinics was well received by Asian American patients, enhanced patient-provider communication about HBV, and increased HBV screening. Technology can improve healthcare quality among Asian Americans. TRIAL REGISTRATION ClinicalTrials.gov NCT02139722 ( https://clinicaltrials.gov/ct2/show/NCT02139722 ).
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Affiliation(s)
- Mandana Khalili
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
| | - Nicole J Kim
- Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - Janice Y Tsoh
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Judith M E Walsh
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - L Elizabeth Goldman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ching Wong
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mi T Tran
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edgar Yu
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Michael Thanh Sharp
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vivian H LeTran
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vi-Van Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tung T Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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18
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Wang AE, Hsieh E, Turner BJ, Terrault N. Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts. J Gen Intern Med 2022; 37:3435-3443. [PMID: 35484367 PMCID: PMC9551010 DOI: 10.1007/s11606-022-07628-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
Elimination of hepatitis C virus (HCV), a leading cause of liver disease in the USA and globally, has been made possible with the advent of highly efficacious direct acting antivirals (DAAs). DAA regimens offer cure of HCV with 8-12 weeks of a well-tolerated once daily therapy. With increasingly straightforward diagnostic and treatment algorithms, HCV infection can be managed not only by specialists, but also by primary care providers. Engaging primary care providers greatly increases capacity to diagnose and treat chronic HCV and ultimately make HCV elimination a reality. However, barriers remain at each step in the HCV cascade of care from screening to evaluation and treatment. Since primary care is at the forefront of patient contact, it represents the ideal place to concentrate efforts to identify barriers and implement solutions to achieve universal HCV screening and increase curative treatment.
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Affiliation(s)
- Allison E Wang
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric Hsieh
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Barbara J Turner
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Norah Terrault
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA.
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA, USA.
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19
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Wong JB. Screening for Syphilis Infection in Nonpregnant Adolescents and Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2022; 328:1243-1249. [PMID: 36166020 DOI: 10.1001/jama.2022.15322] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Syphilis is a sexually transmitted infection that can progress through different stages (primary, secondary, latent, and tertiary) and cause serious health problems if left untreated. Reported cases of primary and secondary syphilis in the US increased from a record low of 2.1 cases per 100 000 population in 2000 and 2001 to 11.9 cases per 100 000 population in 2019. Men account for the majority of cases (83% of primary and secondary syphilis cases in 2019), and rates among women nearly tripled from 2015 to 2019. OBJECTIVE To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update focusing on targeted key questions evaluating the performance of risk assessment tools and the benefits and harms of screening for syphilis in nonpregnant adolescents and adults. POPULATION Asymptomatic, nonpregnant adolescents and adults who have ever been sexually active and are at increased risk for syphilis infection. EVIDENCE ASSESSMENT Using a reaffirmation process, the USPSTF concludes with high certainty that there is a substantial net benefit of screening for syphilis infection in nonpregnant persons who are at increased risk for infection. RECOMMENDATION The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (A recommendation).
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Affiliation(s)
| | | | | | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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20
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Ekwueme DU, Halpern MT, Chesson HW, Ashok M, Drope J, Hong YR, Maciosek M, Pesko MF, Kenkel DS. Health Economics Research in Primary Prevention of Cancer: Assessment, Current Challenges, and Future Directions. J Natl Cancer Inst Monogr 2022; 2022:28-41. [PMID: 35788376 PMCID: PMC9609253 DOI: 10.1093/jncimonographs/lgac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the past 2 decades, the demand for information on health economics research to guide health care decision making has substantially increased. Studies have provided evidence that eliminating or reducing tobacco use; eating a healthy diet, including fruit and vegetables; being physically active; reducing alcohol consumption; avoiding ultraviolet radiation; and minimizing exposure to environmental and occupational carcinogenic agents should substantially reduce cancer incidence in the population. The benefits of these primary prevention measures in reducing cancer incidence are not instantaneous. Therefore, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention. This article provides an overview of health economics research related to primary prevention of cancer. We addressed the following questions: 1) What are the gaps and unmet needs for performing health economics research focused on primary prevention of cancer? 2) What are the challenges and opportunities to conducting health economics research to evaluate primary prevention of cancer? and 3) What are the future directions for enhancing health economics research on primary prevention of cancer? Modeling primary prevention of cancer is often difficult given data limitations, long delays before the policy or intervention is effective, possible unintended effects of the policy or intervention, and the necessity of outside expertise to understand key inputs or outputs to the modeling. Despite these challenges, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention of cancer.
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Affiliation(s)
- Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Harrell W Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mahima Ashok
- Health Transformation & Network Management, Blue Shield of California, Oakland, CA, USA
| | - Jeffrey Drope
- Health Policy and Administration Division of the School of Public Health at University of Illinois, Chicago, Chicago, IL, USA
| | - Young-Rock Hong
- Department of Health Service Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | | | - Michael F Pesko
- Department of Economics, Georgia State University, Atlanta, GA, USA
| | - Donald S Kenkel
- Department of Economics, Cornell University, Ithaca, NY, USA
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21
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Digestive Health in Sexual and Gender Minority Populations. Am J Gastroenterol 2022; 117:865-875. [PMID: 35537864 DOI: 10.14309/ajg.0000000000001804] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/22/2022] [Indexed: 12/11/2022]
Abstract
It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender-diverse minorities (LGBTQI+, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individuals still face discrimination and harassment due to their sexual orientation or gender identity. As such, the National Institute on Minority Health and Health Disparities has identified SGM communities as a "health disparity population." Broadly, there are higher rates of sexually transmitted infections, substance use and abuse, mental health conditions, obesity and eating disorders, certain cancers (breast, cervical, and anorectal), and cardiovascular disease in SGM communities. Transgender patients, especially those of color, are more likely to be uninsured, experience discrimination, and be denied health care than cisgender patients. In addition, SGM individuals have twice the risk of lifetime exposure to emotional, physical, and sexual trauma compared with heterosexuals. It is expected all these factors would negatively affect digestive health as well. This review summarizes the effects of social determinants of health and discrimination on health care access, highlights important digestive diseases to consider in the SGM population, and offers solutions to improve and prioritize the health of these communities. We aim to draw attention to SGM-specific issues that affect gastrointestinal health and spur research that is desperately lacking.
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22
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Ramrakhiani NS, Chen VL, Le M, Yeo YH, Barnett SD, Waljee AK, Zhu J, Nguyen MH. Optimizing hepatitis B virus screening in the United States using a simple demographics-based model. Hepatology 2022; 75:430-437. [PMID: 34496066 DOI: 10.1002/hep.32142] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Chronic hepatitis B (CHB) affects >290 million persons globally, and only 10% have been diagnosed, presenting a severe gap that must be addressed. We developed logistic regression (LR) and machine learning (ML; random forest) models to accurately identify patients with HBV, using only easily obtained demographic data from a population-based data set. APPROACH AND RESULTS We identified participants with data on HBsAg, birth year, sex, race/ethnicity, and birthplace from 10 cycles of the National Health and Nutrition Examination Survey (1999-2018) and divided them into two cohorts: training (cycles 2, 3, 5, 6, 8, and 10; n = 39,119) and validation (cycles 1, 4, 7, and 9; n = 21,569). We then developed and tested our two models. The overall cohort was 49.2% male, 39.7% White, 23.2% Black, 29.6% Hispanic, and 7.5% Asian/other, with a median birth year of 1973. In multivariable logistic regression, the following factors were associated with HBV infection: birth year 1991 or after (adjusted OR [aOR], 0.28; p < 0.001); male sex (aOR, 1.49; p = 0.0080); Black and Asian/other versus White (aOR, 5.23 and 9.13; p < 0.001 for both); and being USA-born (vs. foreign-born; aOR, 0.14; p < 0.001). We found that the ML model consistently outperformed the LR model, with higher area under the receiver operating characteristic values (0.83 vs. 0.75 in validation cohort; p < 0.001) and better differentiation of high- and low-risk persons. CONCLUSIONS Our ML model provides a simple, targeted approach to HBV screening, using only easily obtained demographic data.
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Affiliation(s)
- Nathan S Ramrakhiani
- Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Vincent L Chen
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
| | - Michael Le
- Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Yee Hui Yeo
- Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCaliforniaUSA.,Division of General Internal MedicineCedars-Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Scott D Barnett
- Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Akbar K Waljee
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA.,Division of Gastroenterology and HepatologyVeterans Affairs Ann Arbor Health SystemAnn ArborMichiganUSA
| | - Ji Zhu
- Department of StatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Mindie H Nguyen
- Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoCaliforniaUSA.,Department of Epidemiology and Population HealthStanford University Medical CenterPalo AltoCaliforniaUSA
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23
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Cacciola I, Pitrone C, Franzè MS, Mazzeo C, Muscianisi M, Porcari S, Pintabona G, Morace C, Basile G, Cucinotta E, Pollicino T, Raimondo G. Prevalence of hepatitis B and C viral infections in hospitalized patients with increased liver enzyme levels and with no known history of hepatic disease. Ann Hepatol 2022; 27 Suppl 1:100578. [PMID: 34752948 DOI: 10.1016/j.aohep.2021.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/27/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Identification of asymptomatic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriers is fundamental to reach the World Health Organization objective to eradicate viral hepatitis. The aim of this study was to evaluate the HBV and HCV prevalence among patients hospitalized for a non-liver-related disease but showing increased liver enzyme values. PATIENTS AND METHODS All consecutive patients without history of hepatic disease but showing increased amino-transferase and/or gamma-glutamil-transpeptidase levels at admission to the Internal Medicine and Surgery divisions of the Messina University Hospital from 1st January to 31st December 2019 ("study group") were tested for HBV surface antigen (HBsAg) and anti-HCV antibody. Analogously, HBsAg and anti-HCV were tested for in all the individuals with normal liver enzyme values consecutively admitted from October 1st to December 31st, 2019 ("control group"). RESULTS Of the 332 "study group" patients, 13 (3.9%) were anti-HCV positive versus 5/306 (1.6%) patients of the "control group" (p=0.008). HCV RNA was detected in 11/13 and in 0/5 anti-HCV patients of the "study group" and "control group", respectively (p=0.001). HBsAg was detected in 5 (1.5%) "study group" patients and in none of the "control group" (p=0.03). Prevalence of diabetes, arterial hypertension, and dyslipidaemia was comparable between the two groups, whereas 75/332 (22.3%) patients of the "study group" and 34/306 (11.1%) patients of the "control group" drank > 2 alcohol units/day (p < 0.001). CONCLUSION Testing HBsAg and anti-HCV in subjects showing increased liver enzyme values may represent an efficacious tool to identify asymptomatic carriers of hepatitis virus infections.
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Affiliation(s)
- Irene Cacciola
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Concetta Pitrone
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Maria Stella Franzè
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Carmelo Mazzeo
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy
| | - Marco Muscianisi
- Division of Internal Medicine, University of Messina and University Hospital of Messina, Italy
| | - Serena Porcari
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Giusy Pintabona
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy
| | - Carmela Morace
- Division of Internal Medicine, University of Messina and University Hospital of Messina, Italy
| | - Giorgio Basile
- Division of Geriatrics, University of Messina and University Hospital of Messina, Italy
| | - Eugenio Cucinotta
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy; Department of Human Pathology, University of Messina and University Hospital of Messina, Italy
| | - Teresa Pollicino
- Department of Human Pathology, University of Messina and University Hospital of Messina, Italy; Laboratory of Molecular Hepatology University of Messina and University Hospital of Messina, Italy.
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy.
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24
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Lawson RM. HIV and Other Sexually Transmitted Infections: Screening Recommendations. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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25
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Stevermer J, Tseng CW, Wong JB. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:949-956. [PMID: 34519796 DOI: 10.1001/jama.2021.14081] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons. POPULATION Asymptomatic, sexually active adolescents and adults, including pregnant persons. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. RECOMMENDATION The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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26
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Wong RJ, Brosgart CL, Welch S, Block T, Chen M, Cohen C, Kim WR, Kowdley KV, Lok AS, Tsai N, Ward J, Wong SS, Gish RG. An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States. Hepatology 2021; 74:607-626. [PMID: 33655536 PMCID: PMC8453838 DOI: 10.1002/hep.31782] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. APPROACH AND RESULTS We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates. CONCLUSIONS Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA.,Division of Gastroenterology and HepatologyVeterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| | - Carol L Brosgart
- Department of Medicine, Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCA
| | | | - Tim Block
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | | | - Chari Cohen
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | - W Ray Kim
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA
| | | | - Anna S Lok
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI
| | | | - John Ward
- Coalition for Global Hepatitis EliminationTask Force for Global HealthDecaturGA
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 730] [Impact Index Per Article: 243.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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28
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Ellington TD, Momin B, Wilson RJ, Henley SJ, Wu M, Ryerson AB. Incidence and Mortality of Cancers of the Biliary Tract, Gallbladder, and Liver by Sex, Age, Race/Ethnicity, and Stage at Diagnosis: United States, 2013 to 2017. Cancer Epidemiol Biomarkers Prev 2021; 30:1607-1614. [PMID: 34244156 DOI: 10.1158/1055-9965.epi-21-0265] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/09/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few population-based studies have examined incidence and mortality of cancers of the biliary tract, including intrahepatic bile duct, extrahepatic bile duct, ampulla of Vater, and overlapping or other lesions of the biliary tract in one study. METHODS To further the understanding of recent rates of biliary tract cancers, we used population-based data, to examine incidence and mortality during 2013 to 2017. We examined how rates varied by sex, age, race/ethnicity, U.S. census region, and stage at diagnosis. RESULTS Intrahepatic bile duct was the most common biliary tract cancer, with an incidence rate of 1.49 per 100,000 persons. Cancer incidence rates per 100,000 persons were 0.96 for extrahepatic bile duct, 0.45 for ampulla of Vater, and 0.24 for overlapping or other lesions of the biliary tract. Cancer death rates per 100,000 persons were 1.66 for intrahepatic bile duct and 0.45 for other biliary tract. Intrahepatic bile duct incidence and death rates were higher among males than females, higher among Hispanic and Asian and Pacific Islander persons compared with non-Hispanic Whites, and higher in the Northeast and in urban counties. CONCLUSIONS This report provides national estimates of these rare biliary tract cancers. IMPACT Key interventions targeted to high-risk populations may help reduce incidence and mortality of cancers of the biliary tract by improving primary prevention through strategies to reduce tobacco and alcohol use, control overweight and obesity, and promote hepatitis B vaccination and use of syringe service programs meant to curb the transmission of infectious diseases such as viral hepatitis.
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Affiliation(s)
- Taylor D Ellington
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee. .,Division of Cancer Prevention and Control, NCCDPHP, CDC
| | | | - Reda J Wilson
- Division of Cancer Prevention and Control, NCCDPHP, CDC
| | - S Jane Henley
- Division of Cancer Prevention and Control, NCCDPHP, CDC
| | - Manxia Wu
- Division of Cancer Prevention and Control, NCCDPHP, CDC
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29
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Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021. [DOI: 10.4292/wjg.v12.i4.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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30
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Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021; 12:56-78. [PMID: 34316384 PMCID: PMC8290928 DOI: 10.4292/wjgpt.v12.i4.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.
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Affiliation(s)
- Niraj James Shah
- Department of Internal Medicine, Digestive Disease, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Neil Rohit Sharma
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Kumar Pallav
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
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31
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Zeidan AR, Strey K, Vargas MN, Reveles KR. Sexually transmitted infection laboratory testing and education trends in US outpatient physician offices, 2009-2016. Fam Med Community Health 2021; 9:e000914. [PMID: 34144971 PMCID: PMC8215241 DOI: 10.1136/fmch-2021-000914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe national rates of sexually transmitted infection (STI) testing and education overall and among patient subgroups in US outpatient physician offices from 2009 to 2016. DESIGN This was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Data weights were applied to extrapolate to national estimates. SETTING Data were collected from a systematic random sample of outpatient physician office visits throughout USA. Physician office types include free standing clinics, private or group setting practices, centres offering community and mental health services, family planning clinics and health maintenance organisations/other prepaid clinics. PARTICIPANTS All sampled patient visits were eligible for inclusion and were assessed for the provision of STI prevention education and STI testing for chlamydia, gonorrhoea, hepatitis, human papillomavirus (HPV) and HIV. RESULTS Of 7.6 billion total visits, 123 million included an STI test. Hepatitis was the most commonly tested STI (9.12 per 1000), followed by chlamydia (6.67 per 1000), gonorrhoea (6.00 per 1000), HIV (5.40 per 1000) and HPV (5.03 per 1000). Testing rates for the three STIs measured for the entire 8-year period increased over time and peaked in 2015 compared with 2009: chlamydia (R2=0.36), HPV (R2=0.28) and HIV (R2=0.51). Testing was highest among women (21.93 per 1000), 15-24-year olds (46.04 per 1000), non-Hispanic blacks (37.33 per 1000) and those seen by obstetrics/gynaecology specialists (103.75 per 1000). STI prevention education was provided to 4.89 per 1000 patients and remained relatively unchanged from 2013 to 2016. CONCLUSION STI testing in outpatient physician offices increased over the study period but varied by patient characteristics and site of care. Few patients received STI prevention education, highlighting a potential gap in resource utilisation in these settings.
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Affiliation(s)
- Amina R Zeidan
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kelsey Strey
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michelle N Vargas
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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32
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Gonzalez HC, Trudeau S, Gordon SC. Editorial: Changing trends in the US prevalence of hepatitis B core antibody provide important perspectives into future screening and vaccination strategies. J Infect Dis 2021; 224:747-748. [PMID: 33903913 DOI: 10.1093/infdis/jiab225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Humberto C Gonzalez
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sheri Trudeau
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
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33
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Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, Soh CR. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020; 67:732-745. [PMID: 32162212 PMCID: PMC7090449 DOI: 10.1007/s12630-020-01620-9] [Citation(s) in RCA: 395] [Impact Index Per Article: 98.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.
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Affiliation(s)
- Jolin Wong
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Qing Yuan Goh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Zihui Tan
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sui An Lie
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yoong Chuan Tay
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shin Yi Ng
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Chai Rick Soh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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