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Begum TF, Patil VS, Zhu L, Yeh MC, González E, Fraser MA, Lu W, Zhu S, Rubio-Torio N, Ma GX, Tan Y. Assessing Physicians' Recommendations for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Testing Among Minority Populations in Greater Philadelphia and New York City. J Community Health 2024; 49:588-597. [PMID: 38286964 PMCID: PMC11974444 DOI: 10.1007/s10900-023-01316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/31/2024]
Abstract
Deaths from liver cancer are on the rise and disproportionately affect minority racial/ethnic groups. In this study, we examined associations between physicians' recommendations for hepatitis B virus (HBV) and hepatitis C virus (HCV) screening and sociodemographic and lifestyle factors among minority populations in the areas of Greater Philadelphia and New York City. Using Poisson regression with robust variance estimation, we evaluated potential associations for 576 Hispanic American (HA), African American (AA), and Asian Pacific American (APA) adults, using blood tests as an outcome measure, with adjustment for sociodemographic factors We found that APAs (34.2%) were most likely to have a physician recommend HBV and HCV screening tests (34.2% and 27.1%, respectively), while HAs were least likely to receive an HBV recommendation (15.0%) and AAs were least likely to receive an HCV recommendation (15.3%). HAs were significantly likely to have never received a blood test for either HBV or HCV (RR = 1.25, 95% CI: 1.05, 1.49). APAs were significantly more likely to receive a screening recommendation for HBV (RR = 1.10, 95%CI: 1.01, 1.20) and to have a blood test (RR = 1.57, 95% CI: 1.06, 2.33). Our findings show that, among HAs, AAs, and APAs, physician recommendations are strongly associated with patients undergoing blood tests for HBV and HCV and that minority populations should increasingly be recommended to screen for HBV and HCV, especially given their elevated risk.
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Affiliation(s)
- Thoin F Begum
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Vidya S Patil
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY, USA
| | - Evelyn González
- Office of Community Outreach, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | | | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Steven Zhu
- Pennsylvania United Chinese Coalition, Philadelphia, PA, USA
| | | | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Moore JD, Nguyen USDT, Ojha RP, Griner SB, Thompson EL. Physician-level determinants of HCV screening during pregnancy in a U.S. sample. Arch Gynecol Obstet 2024; 309:2491-2498. [PMID: 37454352 DOI: 10.1007/s00404-023-07146-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The purpose of this study was to assess the association between select determinants and HCV screening guideline adherence among physicians who provide prenatal care. RESEARCH QUESTION What factors may act as determinants of guideline adherence to HCV screening among physicians who provide prenatal care? METHODS We surveyed a national sample of physicians who provided prenatal care in 2021. The survey included questions from the Clinician Guideline Determinant (CGD) questionnaire, demographic characteristics, and medical practice characteristics. We estimated odds ratios and 95% confidence intervals (CIs) using semi-Bayesian logistic regression for the association between determinants and guideline adherence. RESULTS Participants included 224 physicians in the United States who reported providing prenatal care. Most physicians practiced in private practice (65%) and the majority were members of the American College of Obstetricians and Gynecologists (ACOG; 91%). Less than half (43%; 95% CI: 36%-49%) of physicians reported regular use of the HCV screening guideline. Physicians who reported general knowledge about HCV (OR = 9.0, 95% CI 3.1-30) or endorsed agreement with ease of implementation (OR = 8.0, 95% CI 2.7-25) had higher odds of adherence to the HCV screening guideline. CONCLUSION Our study suggests that less than half of practicing prenatal care physicians adhere to HCV screening guidelines for pregnant patients. Our results may be useful as a preliminary screening of select determinants of guideline use for further investigation.
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Affiliation(s)
- Jonathan D Moore
- School of Public Health, Department of Epidemiology and Biostatistics, University of North Texas Health Science Center, Fort Worth, USA.
| | - Uyen-Sa D T Nguyen
- School of Public Health, Department of Epidemiology and Biostatistics, University of North Texas Health Science Center, Fort Worth, USA
| | - Rohit P Ojha
- School of Public Health, Department of Epidemiology and Biostatistics, University of North Texas Health Science Center, Fort Worth, USA
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, USA
| | - Stacey B Griner
- School of Public Health, Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, USA
| | - Erika L Thompson
- School of Public Health, Department of Epidemiology and Biostatistics, University of North Texas Health Science Center, Fort Worth, USA
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Sims OT, Truong DN, Wang K, Melton PA, Atim K. Time to HCV Treatment Disfavors Patients Living with HIV/HCV Co-infection: Findings from a Large Urban Tertiary Center. J Racial Ethn Health Disparities 2022; 9:1662-1669. [PMID: 34254269 PMCID: PMC8752646 DOI: 10.1007/s40615-021-01105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/20/2021] [Accepted: 06/24/2021] [Indexed: 12/09/2022]
Abstract
This study aimed to assess time to hepatitis C (HCV) treatment (i.e., the time between the initial clinic visit for HCV evaluation and the HCV treatment start date), to compare clinical characteristics between patients who received HCV treatment ≥ and < 6 months, and to identify predictors of longer time to HCV treatment in patients living with HCV. This study conducted a retrospective secondary analysis of patients living with HCV mono-infection and HIV/HCV co-infection who received HCV treatment with DAAs (n=214) at a HIV Clinic. Binomial logistic regression was used to identify predictors of longer time to treatment (i.e., ≥ 6 months). The median time to HCV treatment was 211 days. Compared to patients who were treated < 6 months, a higher proportion of patients who were treated ≥ 6 months had HIV/HCV co-infection (31% vs. 49%, p=0.01) and chronic kidney disease (8% vs. 18%, p=0.03). In multivariate analysis, HIV/HCV co-infection was positively associated with a longer time to HCV treatment (adjusted odds ratio, aOR=2.0, p=0.03). Time to HCV treatment disparities between African American and White American did not emerge from the analysis, but time to HCV treatment disfavored patients living with HIV/HCV co-infection. Studies are needed to identify and eliminate factors that disfavor patients living with HIV/HCV co-infection.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Integrative Center for Aging Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- African American Studies, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, 3137 University Hall, 1720 2nd Avenue South, Birmingham, AL, 35294-1260, USA.
| | - Duong N Truong
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Collat School of Business, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaiying Wang
- Department of Mathematics and Statistics, College of Arts & Sciences, Georgia State University, Atlanta, GA, USA
| | - Pamela A Melton
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Kasey Atim
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
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Vadaparampil ST, Fuzzell LN, Rathwell J, Reich RR, Shenkman E, Nelson DR, Kobetz E, Jones PD, Roetzheim R, Giuliano AR. HCV testing: Order and completion rates among baby boomers obtaining care from seven health systems in Florida, 2015-2017. Prev Med 2021; 153:106222. [PMID: 32721414 PMCID: PMC7854771 DOI: 10.1016/j.ypmed.2020.106222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
Many U.S. residents infected with hepatitis C virus (HCV) are baby boomers (born 1945-1965), who remain undiagnosed. Past CDC and USPSTF guidelines recommended one-time HCV testing for all baby boomers, with newer guidelines recommending universal screening for all adults. This retrospective cohort study examined electronic medical records for patient visits from 2015 to 2017 within the OneFlorida Data Trust and University of South Florida Health system. We assessed percentages of HCV tests ordered and completed across four age groups (those born before 1945, 1945-1965, 1966-1985, and after 1985). In 2019, we used logistic regression to examine factors associated with HCV test ordering and completion among baby boomers, including age, race, sex, number of primary care visits, HIV status, hepatitis diagnosis, and liver cancer history. All age groups had low rates of HCV test orders. 4.4% of baby boomers had a test ordered in 2015, and 6.7% in 2016. Of those, 94.5% and 89.7% completed testing, respectively. All other races/ethnicities had lower likelihood of testing completion than Whites (Blacks (aOR 0.82, 95%, CI 0.75-0.91); Asians (0.69, 0.52-0.92); Hispanics (0.29, 0.26-0.32)), although test orders were higher for Asians (1.48, 1.37-1.61) and Blacks (1.78, 1.73-1.82). Tests ordered (11.42, 10.94-11.92) and completed (2.25, 1.94-2.60) were more likely among those with hepatitis history. Test orders were more likely for HIV-positive patients (3.68, 3.45-3.93), but completion was less likely (0.67, 0.57-0.78). Interventions are needed to increase testing rates so that HCV infections are treated early, mitigating HCV-related morbidity and mortality, especially related to liver cancer.
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Affiliation(s)
- Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America.
| | - Julie Rathwell
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, United States of America; Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, United States of America
| | - Richard R Reich
- Department of Biostatistics, H. Lee Moffitt Cancer Center, United States of America
| | | | - David R Nelson
- Department of Medicine, University of Florida, United States of America
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States of America
| | - Patricia D Jones
- Department of Medicine, Gastroenterology and Hepatology, University of Miami Miller School of Medicine, United States of America
| | - Richard Roetzheim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America; University of South Florida, Department of Family Medicine, United States of America
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, United States of America; Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, United States of America
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Kamara MTB, Richards VL, Somboonwit C, Park H, Seneadza NAH, Zhi Z, Jayaweera D, Thomas E, Cook RL. Self-reported hepatitis C(HCV) testing among people living with human immunodeficiency virus (PLWH). Heliyon 2021; 7:e07727. [PMID: 34409188 PMCID: PMC8361055 DOI: 10.1016/j.heliyon.2021.e07727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/18/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to identify disparities in self-reported HCV testing among persons living with HIV (PLWH) in Florida. METHODS We utilized a cross-sectional study of 646 PLWH from the Florida Cohort study's baseline survey. Our analysis included chi-squared tests and logistic regression. RESULTS Participants that were 55 years old or above had more than twice the odds of reporting a past HCV test than those 18-34 years old (OR 2.47, 95% CI 1.22-5.0), which contrasted with Non-Hispanic Blacks who had lower odds of reporting a past HCV test than non-Hispanic Whites (OR 0.63, 95% CI 0.35-1.1). Drug use was also associated with higher odds of reporting a past HCV test for injection drugs (OR 2.9, 95% CI 1.0-8.43) and non-injection drugs (OR 1.52 CI 0.99-2.21). Individuals with education beyond high school had higher odds of reporting a past HCV test than those that did not attend/complete high school (OR 1.9 CI 1.11-3.16). CONCLUSION Our findings highlight the success of the Center for Disease Control and the U.S. Preventive Services Task Force's campaign in groups at high risk of HCV, such as baby boomers and Injection Drug Users (IDUs). However, they also reflect the current low HCV testing in PLWH that are 18-34 years old, have a low level of education, and are non-Hispanic Black. Our findings are of crucial public health significance because untreated HCV in PLWH is a major cause of severe liver disease and death. They reveal the current deficiencies in HCV testing, which is the initial step to identify underlying reasons for inadequate testing in specific groups and develop practical solutions.
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Affiliation(s)
- Mustapha Thaim Buya Kamara
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Veronica L Richards
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Charurut Somboonwit
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Haesuk Park
- University of Florida College of Pharmacy, Pharmaceutical Outcomes & Policy, Gainesville, FL, USA
| | - Nana Ayegua Hagan Seneadza
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Zhou Zhi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Dushyantha Jayaweera
- Department of Medicine, University of Miami Miller School of Medicine, 1501 NW 10th Avenue, Miami, Suit 811, FL 33136, USA
| | - Emmanuel Thomas
- Sylvester Cancer Center, University of Miami Miller School of Medicine, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
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Layman RA, Turner BS, Harmon JL, McClymont U. Improving HCV Risk Assessment and Testing in a Federally Qualified Health Center Setting in Baltimore, Maryland. J Community Health 2021; 45:712-716. [PMID: 31897964 DOI: 10.1007/s10900-019-00785-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Approximately 4.1 million adults in the United States have past or current hepatitis C virus (HCV) infection. Despite efforts to test at least once for the 1945-1965 birth cohort population and others identified at risk, the completion of the annual risk assessment tool and testing of these patients has been suboptimal. The aim of this project was to reduce HCV risk assessment and testing barriers and improve both these rates by 30% within a federally qualified health center setting in Baltimore, Maryland. As part of ongoing efforts to promote HCV risk screening and testing, targeted interventions of staff education, streamlined risk screening assessment, automated electronic health record alerts, push reports, and standing orders were integrated into current screening and testing practices. This study examined the risk assessment tool use and testing rates for 1 month before and after project implementation. All patients who were seen for a primary care visit during the month preceding (n = 8911) and following (n = 8228) the intervention were evaluated. A total of 2973 risk assessments and 1831 HCV tests were completed pre-intervention compared to 3708 risk assessments and 3790 tests post-intervention, demonstrating a 35% and 125% improvement respectively. Seropositivity prevalence of 2.1% pre-intervention increased to 2.9% post-intervention. Efficiencies in workflow processes and staff education successfully impacted the HCV risk screening tool completions and testing rates for the birth cohort and non-birth cohort patients. Integrating such strategies in the primary care workflow can increase HCV detection and timely follow up for vulnerable populations.
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Binka M, Butt ZA, McKee G, Darvishian M, Cook D, Wong S, Yu A, Alvarez M, Samji H, Wong J, Krajden M, Janjua NZ. Differences in risk factors for hepatitis B, hepatitis C, and human immunodeficiency virus infection by ethnicity: A large population-based cohort study in British Columbia, Canada. Int J Infect Dis 2021; 106:246-253. [PMID: 33771673 DOI: 10.1016/j.ijid.2021.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Addressing the needs of ethnic minorities will be key to finding undiagnosed individuals living with hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV). To inform screening initiatives in British Columbia (BC), Canada, the factors associated with HBV and/or HCV and/or HIV infection among different ethnic groups within a large population-based cohort were assessed. METHODS Persons diagnosed with HBV, HCV, or HIV in BC between 1990 and 2015 were grouped as East Asian, South Asian, Other Visible Minority (African, Central Asian, Latin American, Pacific Islander, West Asian, unknown ethnicity), and Not a Visible Minority, using a validated name-recognition software. Factors associated with infection within each ethnic group were assessed with multivariable multinomial logistic regression models. RESULTS Participants included 202 521 East Asians, 126 070 South Asians, 65 210 Other Visible Minorities, and 1 291 561 people who were Not a Visible Minority, 14.4%, 3.3%, 4.5%, and 6.3% of whom had HBV and/or HCV and/or HIV infections, respectively. Injection drug use was most prevalent among infection-positive people who were Not a Visible Minority (22.1%), and was strongly associated with HCV monoinfection, HBV/HCV coinfection, and HCV/HIV coinfection, but not with HBV monoinfection among visible ethnic minorities. Extreme material deprivation and social deprivation were more prevalent than injection drug use or problematic alcohol use among visible ethnic minorities. CONCLUSIONS Risk factor distributions varied among persons diagnosed with HBV and/or HCV and/or HIV of differing ethnic backgrounds, with lower substance use prevalence among visible minority populations. This highlights the need for tailored approaches to infection screening among different ethnic groups.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
| | - Zahid Ahmad Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Rosecrans AM, Cheedalla A, Rives ST, Scotti LA, Harris RE, Greenbaum AH, Irvin RR, Ntiri-Reid BA, Brown HT, Alston KE, Smith JA, Page KR, Falade-Nwulia OO. Public Health Clinic-Based Hepatitis C Treatment. Am J Prev Med 2020; 59:420-427. [PMID: 32430222 DOI: 10.1016/j.amepre.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The availability of safe, effective treatments for hepatitis C virus infection has led to a call for the elimination of hepatitis C, but barriers to care persist. METHODS In July 2015, the Baltimore City Health Department sexual health clinics began on-site hepatitis C virus treatment. Investigators conducted a retrospective evaluation of the first 2.5 years of this program. Data were extracted from the medical record through June 2019, and data analysis was completed in September 2019. RESULTS Between July 2015 and December 2017, a total of 560 patients infected with hepatitis C virus accessed care at the Baltimore City Health Department sexual health clinics. Of these patients, 423 (75.5%) were scheduled for hepatitis C virus evaluation at the clinics, 347 (62.0%) attended their evaluation appointment, 266 (47.5%) were prescribed treatment, 227 (40.5%) initiated treatment, and 199 (35.5%) achieved sustained virologic response. Older age was independently associated with hepatitis C virus evaluation appointment attendance (aged 40-59 years: AOR=3.64, 95% CI=1.88, 7.06; aged ≥60 years: AOR=5.61, 95% CI=2.58, 12.21) compared with those aged 20-39 years. Among those who attended hepatitis C virus evaluation appointments, advanced liver disease was independently and positively associated with treatment initiation (AOR=11.89, 95% CI=6.35, 22.25). Conversely, illicit substance use in the past 12 months was negatively associated with hepatitis C virus treatment initiation (AOR=0.49, 95% CI=0.25, 0.96). CONCLUSIONS The integration of hepatitis C virus testing and on-site treatment in public sexual health clinics is an innovative approach to improve access to hepatitis C virus treatment for medically underserved populations.
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Affiliation(s)
- Amanda M Rosecrans
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland.
| | - Aneesha Cheedalla
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah T Rives
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Lisa A Scotti
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Robert E Harris
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Adena H Greenbaum
- Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Risha R Irvin
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Boatemaa A Ntiri-Reid
- Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, Maryland
| | - Holly T Brown
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Karen E Alston
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Jaeson A Smith
- Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Kathleen R Page
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Oluwaseun O Falade-Nwulia
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Coppock D, Chou E, Gracely E, Gross R, Heun-Lee D. Hepatitis C antibody screening and determinants of initial and duplicate screening in the baby boomer patients of six urban primary care clinics. PLoS One 2020; 15:e0235778. [PMID: 32645083 PMCID: PMC7347094 DOI: 10.1371/journal.pone.0235778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/22/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In 2012, the Centers for Disease Control and Prevention released updated guidelines recommending universal, one-time hepatitis C virus screening for all individuals born between 1945 and 1965. Prior to the implementation of these guidelines, testing rates were inappropriately low, but unnecessary duplicate antibody testing was also problematic. In the era of increased efforts to screen "baby boomers", the prevalence and social determinants of initial and duplicate hepatitis C testing have not been well described. METHODS A hepatitis C screening program was implemented at six urban primary care clinics affiliated with Drexel University College of Medicine. Data was collected regarding the screening patterns in these clinics. Annual screening rates for the program were assessed. Multivariate logistic regression analyses were used to examine the association of demographic variables and the outcomes of subjects having ever been tested and subjects having received duplicate testing. RESULTS Following the implementation of the program, the screening rate increased from 16% in the first year of analysis to 82% in the final year of analysis. Of the 6,717 patients screened, 1,207 had duplicate testing, of which 14% had inappropriate duplicate antibody screening. African Americans and Asian patients had a higher odds of being screened. Patients with public insurance had a higher odds of duplicate screening. CONCLUSIONS In the setting of an aggressive hepatitis C screening program, high testing rates may be attained in a target population. However, inappropriate duplicate antibody testing rates may be high, which may be a burden in resource-limited settings.
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Affiliation(s)
- Dagan Coppock
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Edgar Chou
- Department of Medicine, Division of General Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Edward Gracely
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Robert Gross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Dong Heun-Lee
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
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Miller LS, Millman AJ, Lom J, Osinubi A, Ahmed F, Dupont S, Rein D, Vellozzi C, Harris AM. Defining the hepatitis C cure cascade in an Urban health system using the electronic health record. J Viral Hepat 2020; 27:13-19. [PMID: 31505088 DOI: 10.1111/jvh.13199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/10/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022]
Abstract
Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross-sectional analysis of 72 745 GHS patients who received anti-HCV testing from 2004 to 2016. We created a testing cascade: (1) anti-HCV reactive, (2) HCV RNA tested and (3) HCV RNA detectable; and a cure cascade: (1) HCV RNA detectable, (2) engaged in care, (3) treatment prescribed, (4) sustained virologic response (SVR) tested and (5) SVR documented. A total of 9893 (14%) had reactive anti-HCV tests of 72 745 patients tested, 5109 (52%) of these had HCV RNA tested, and 4224 (43%) were HCV RNA detectable. A total of 2738 (65%) of 4224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, using EHR data, we identified high anti-HCV prevalence and noted gaps in HCV RNA testing, linkage to care and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps.
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Affiliation(s)
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Lom
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ademola Osinubi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Farah Ahmed
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Sarah Dupont
- Emory University School of Medicine, Atlanta, GA, USA
| | - David Rein
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron M Harris
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Hatcher SM, Joshi S, Robinson BF, Weiser T. Hepatitis C-Related Mortality Among American Indian/Alaska Native Persons in the Northwestern United States, 2006-2012. Public Health Rep 2020; 135:66-73. [PMID: 31765285 PMCID: PMC7119253 DOI: 10.1177/0033354919887748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AI/AN) persons are commonly misclassified in epidemiologic and administrative data sets. The race-corrected hepatitis C virus (HCV)-related mortality rate among AI/AN persons in the Northwest United States (Idaho, Oregon, and Washington State) is unknown. We quantified the disparity in HCV-related mortality between AI/AN persons and non-Hispanic white (NHW) persons in the Northwest during 2006-2012 after correcting misclassified AI/AN race. METHODS After conducting probabilistic record linkage between death records and the Northwest Tribal Registry, we calculated HCV-related mortality rates for AI/AN and NHW persons by using National Center for Health Statistics bridged-race estimates standardized to the US 2000 standard population. RESULTS The 2006-2012 aggregate age-adjusted HCV-related mortality rate per 100 000 population in the Northwest was 19.6 (95% confidence interval [CI], 17.3-22.2) for AI/AN persons and 5.9 (95% CI, 5.7-6.1) for NHW persons (rate ratio [RR] = 3.3; 95% CI, 3.0-3.8). The disparity was larger among females (RR = 4.6; 95% CI, 3.8-5.5) than among males (RR = 2.9; 95% CI, 2.5-3.4). CONCLUSION The disproportionate rate of HCV-related mortality among AI/AN persons in the Northwest highlights the need to expand HCV education, screening, and treatment among this population.
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Affiliation(s)
- Sarah M. Hatcher
- Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
| | - Sujata Joshi
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
| | - Byron F. Robinson
- Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Weiser
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
- Portland Area Indian Health Service, Portland, OR, USA
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12
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Lier AJ, Smith K, Odekon K, Bronson S, Taub E, Tharakan M, Kelly GJ, Patel P, Marcos LA. Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users. Infect Dis Ther 2019; 8:417-428. [PMID: 31129777 PMCID: PMC6702540 DOI: 10.1007/s40121-019-0249-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Suffolk County, located in Eastern Long Island, has been an epicenter for the opioid epidemic in New York State, yet no studies have examined hepatitis C virus (HCV) prevalence in this population. Additionally, few studies have assessed barriers for linkage to care (LTC) to HCV treatment in people who inject drugs (PWID), a high-risk HCV cohort. We aimed to determine prevalence of HCV infection in a suburban medical center and to assess risk factors associated with LTC in HCV-positive baby boomers and young PWID. METHODS A retrospective chart review was carried out on adult patients with ICD-9/10 diagnostic codes for HCV from January 2016 to December 2018 at Stony Brook Medicine. Data collected included sociodemographics, RNA serostatus, LTC, health insurance, employment, past medical or psychiatric history, and substance or injection drug use. RESULTS Overall, 27,049 individuals were screened for HCV and 1017 were HCV seropositive (3.8%), 437 (42.9%) were HCV RNA-positive and 153 (40.6%) achieved LTC. In multivariate analysis, living with cirrhosis was associated with a positive LTC. Medicaid or Medicare insurance was associated with a negative LTC. Intravenous drug users were more likely to be young and have concomitant polysubstance use and psychiatric disease. A bimodal distribution of HCV-positives is present in our population. CONCLUSION Those with liver cirrhosis are more likely to achieve LTC, as are those with private insurance. Public health efforts to promote awareness of HCV and to facilitate access to treatment among PWID are needed.
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Affiliation(s)
- Audun J Lier
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA.
| | - Kalie Smith
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Kerim Odekon
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Silvia Bronson
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Erin Taub
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Mathew Tharakan
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Gerald J Kelly
- Division of Family and Community Medicine, Department of Family, Population and Preventive Medicine, Stony Brook University Hospital, New York, USA
| | - Pruthvi Patel
- Division of Gastroenterology, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Luis A Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
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13
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Haley SJ, Moscou S, Murray S, Rieckmann T, Wells KL. The availability of alcohol, tobacco and other drug services for adults in New York State Community Health Centers. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2018.1562577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sean J. Haley
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Sharifa Murray
- Ross University School of Medicine, Roseau, Commonwealth of Dominica, West Indies
| | - Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kameron L. Wells
- Department of Clinical Affairs, Community Health Care Association of New York State, New York, NY, USA
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14
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Saab S, Challita YP, Najarian LM, Guo R, Saggi SS, Choi G. Hepatitis C Screening: Barriers to Linkage to Care. J Clin Transl Hepatol 2019; 7:226-231. [PMID: 31608214 PMCID: PMC6783681 DOI: 10.14218/jcth.2018.00063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/04/2019] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background and Aims: Hepatitis C (HCV) is a medical and public health concern. Once infected individuals are identified, management includes not only education but also the use of antiviral therapy. Although screening for HCV is readily available, barriers exist which prevent assessment and treatment in individuals potentially infected with HCV. Methods: This is a retrospective study of patients screened for HCV within the University of California, Los Angeles Health Care System between February 22 and July 9, 2018. We defined linkage to care as: 1) confirmatory HCV RNA test after screening HCV antibody test found a positive result; and 2) follow-up appointment for treatment was established with a specialist. Demographic and baseline laboratory values were collected. Factors potentially associated with prohibiting linkage of care were evaluated. Results: During the study period, 17,512 individuals were screened for HCV. A total of 238 (1.35%) were found to have detectable HCV antibodies. Of the individuals with detectable HCV antibodies, 48 (20%) did not undergo confirmatory testing with viral levels. Of the 190 individuals who underwent further testing, 70 patients were noted to be viremic. Among them, 17 of the 70 (24%) were not linked to a specialist for further care. Younger patients (p = 0.02) and people who inject drugs (p = 0.02) were less likely to be referred for specialty care. Conclusions: The results of our study highlight that younger patients and people who inject drugs are less likely to be referred to specialty care for HCV treatment. Efforts are needed to engage these populations.
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Affiliation(s)
- Sammy Saab
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.,Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Youssef P Challita
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lisa M Najarian
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rong Guo
- Departments of Medicine Statistics Core, University of California at Los Angeles, Los Angeles, CA, USA
| | - Satvir S Saggi
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gina Choi
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.,Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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15
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Lombardi A, Mondelli MU. Hepatitis C: Is eradication possible? Liver Int 2019; 39:416-426. [PMID: 30472772 DOI: 10.1111/liv.14011] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 02/13/2023]
Abstract
Hepatitis C has a relevant global impact in terms of morbidity, mortality and economic costs, with more than 70 million people infected worldwide. In the resolution, "Transforming our world: the 2030 Agenda for Sustainable Development" was included as a focus area in the health-related goal with world leaders pledging to "combat" it by 2030. In response, WHO drafted the Global Viral Hepatitis Strategy carrying the ambitious targets to reduce the number of deaths by two-thirds and to increase treatment rates up to 80%. Despite the availability of highly effective therapeutic regimens based on direct-acting antivirals many barriers to HCV eradication still remain. They are related to awareness of the infection, linkage to care, availability of the therapeutic drug regimens and reinfection. Overall, if an effective prophylactic vaccine will not be available, HCV eradication appears difficult to achieve in the future.
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Affiliation(s)
- Andrea Lombardi
- Division of Infectious Diseases II and Immunology, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mario U Mondelli
- Division of Infectious Diseases II and Immunology, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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16
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Bruce V, Eldredge J, Leyva Y, Mera J, English K, Page K. Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada. Epidemiol Rev 2019; 41:158-167. [PMID: 31781749 PMCID: PMC7305812 DOI: 10.1093/epirev/mxz015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/02/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022] Open
Abstract
American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%-67.60%) and Indigenous populations (2.28%-90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.
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Affiliation(s)
- Veronica Bruce
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jonathan Eldredge
- Health Sciences Library and Informatics Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Office of Research, Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jorge Mera
- Cherokee Nation Health Services, Tahlequah, Oklahoma
| | - Kevin English
- and Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc, Albuquerque, New Mexico
| | - Kimberly Page
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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17
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Wong RJ, Campbell B, Liu B, Baden R, Bhuket T. Sub-optimal Testing and Awareness of HCV and HBV Among High Risk Individuals at an Underserved Safety-Net Hospital. J Community Health 2019. [PMID: 28647860 DOI: 10.1007/s10900-017-0388-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Sub-optimal screening for chronic hepatitis C virus (HCV) and chronic hepatitis B virus (HBV) among high risk groups delays diagnosis and treatment. We aimed to evaluate overall rates of HCV and HBV screening and patient knowledge of their testing result. Adults age ≥18 years undergoing elective outpatient endoscopy at a large, urban safety-net hospital from July 2015 to July 2016 were prospectively evaluated to determine rates of HCV and HBV testing, the results of those completed tests, and patient knowledge of test results among high risk individuals (as determined by U.S. Preventative Services Task Force). Among 1125 patients (52.3% male, 70.4% foreign-born), 66.5% were high risk for chronic HCV; only 30.9% received prior testing. 14.7% had positive chronic HCV infection. Patients born in the 1945-1965 cohort were more likely to have received prior HCV testing compared to those born outside of this cohort (32.7 vs. 16.9%, p = 0.01). Among patients who received HCV screening, 29.3% were aware of test results. Overall, 61.6% were high risk for chronic HBV; only 25.1% received prior testing. 4.1% were positive for chronic HBV. Compared to Caucasians, Asians (19.0 vs. 44.4%, p < 0.001) and Hispanics (20.0 vs. 44.4%, p < 0.001) were less likely to have previous HBV testing. Among patients who received prior HBV screening, 18.4% were aware of test results. Less than one-third of high risk patients received HCV and HBV screening among an ethnically diverse safety-net population. Equally low rates of patient knowledge of testing results were observed.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
| | - Brendan Campbell
- School of Medicine, George Washington University, Washington, DC, USA
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA
| | - Rachel Baden
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA
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18
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Luma HN, Eloumou SA, Noah DN, Eyenga BA, Nko’Ayissi G, Taku TS, Malongue A, Donfack-Sontsa O, Ditah IC. Hepatitis C Continuum of Care in a Treatment Center in Sub-Saharan Africa. J Clin Exp Hepatol 2018; 8:335-341. [PMID: 30563994 PMCID: PMC6286429 DOI: 10.1016/j.jceh.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/07/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major public health challenge in Cameroon with over three million people infected. Government efforts to improve care and treatment are unsatisfactory and need to be assessed. We aimed at studying the several steps along the HCV continuum of care in one of two hepatitis treatment centers in Cameroon. METHODS We undertook a retrospective chart review of anti-HCV positive individuals, who attended the Douala general hospital between 2008 and 2015. We defined the HCV treatment cascade as follows: step 1-HCV RNA testing, step 2-complete pre-therapeutic evaluation (genotyping and liver fibrosis markers), step 3-initiation of treatment, step 4-treatment completion, and step 5-sustained virological response (SRV). Each successive step in the HCV care continuum was dependent on passing through the previous step. RESULTS The mean age of the 669 anti-HCV antibody positive individuals was 57 (sd: ±13) years. Females were 52.8% of the study population. 410 (61.3%) were tested for HCV RNA. Three hundred and sixty-six (54.7%) were confirmed to have viral replication (HCV RNA positive). One hundred and eighty (26.9%) did a complete pre-therapeutic evaluation (both HCV genotyping and liver fibrosis assessment included). Eighty-one (12.1%) initiated treatment with pegylated interferon/ribavirin. Seventy-two (10.8%) completed treatment and 44 (6.6%) had SVR. Sociodemographic characteristics including age, gender, marital status, having medical insurance, and profession were associated with attaining later steps in the care cascade. CONCLUSION This study shows that HCV continuum of care and treatment is less optimal at the Douala general hospital and is highly impacted by socio-economic factors. Continued efforts are needed to improve HCV care.
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Affiliation(s)
- Henry N. Luma
- Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Address for correspondence: Henry Namme Luma, P.O. Box 4856, Douala, Cameroon. Fax: +237 243 37 01 46.
| | - Servais A.F.B. Eloumou
- Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Dominique N. Noah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - B. Aude Eyenga
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Sims OT, Hong BA, Ji S, Pollio DE, North CS. A Systematic Comparison of African American and Non-African American Patients on Psychosocial Aspects of Hepatitis C Infection. JOURNAL OF RELIGION AND HEALTH 2018; 57:1764-1770. [PMID: 29411232 DOI: 10.1007/s10943-018-0565-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to compare African American and non-African American hepatitis C virus (HCV) patients on self-reported symptoms of HCV liver disease and psychosocial characteristics commonly affected by it in a sample of 309 patients enrolled in a randomized controlled trial. African Americans (n = 196) rated a higher reliance on religion/spirituality for coping with HCV compared to non-African Americans. This study's findings are a basis for encouragement of public health efforts and programs to seek partnerships with African American faith and religious communities to identify and treat undiagnosed cases of HCV and promote HCV awareness.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmi, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Barry A Hong
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Shaonin Ji
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Pollio
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
| | - Carol S North
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment. Am J Gastroenterol 2018. [PMID: 29523864 DOI: 10.1038/s41395-018-0033-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite availability of highly effective direct acting antivirals (DAA), barriers in access to these therapies limit our ability to achieve HCV eradication. We aim to evaluate overall rates and predictors of HCV treatment across four community-based health-care systems focusing on race/ethnicity and insurance-specific disparities. METHODS We retrospectively evaluated all adults with chronic HCV at four health care systems from 1 January 2011 to 28 February 2017, which included a large proportion of ethnic minorities, two safety-net systems, and a broad payer mix across four states. Overall and stratified HCV treatment rates were calculated using Kaplan-Meier methods. Multivariate logistic regression models evaluated for predictors of receiving treatment. RESULTS Among 29,544 chronic HCV patients (60.5% male, 38.4% black, 8.8% Hispanic, 18.7% Medicaid, 25.9% Medicare, 22.5% private/commercial), overall annual treatment rates were stable from 2011 (0.5%) to 2013 (2.0%), but increased from 2014 (4.8%) to 2017 (16.9%) after availability of DAAs. While similar treatment rates were observed by sex, significantly lower odds of treatment were observed in Hispanics (OR 0.48, 95% CI 0.39-0.60, p < 0.001) compared to non-Hispanic whites and among those with Medicaid (OR 0.21, 95% CI 0.20-0.24, p < 0.001) compared to commercially insured patients. CONCLUSIONS Among our cohort of 29,544 chronic HCV patients, we observed significant improvements in HCV treatment rates after the availability of DAAs in 2014, but overall treatment rates remained <20% in 2017. The lowest rates of treatment were seen among Hispanics and those with Medicaid or indigent care insurance, which is concerning given these are particularly vulnerable populations.
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21
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Saab S, Ahn T, McDaniel T, Yanny B, Tong MJ. Economic Comparison of Serologic and Molecular Screening Strategies for Hepatitis C Virus. Gastroenterol Hepatol (N Y) 2018; 14:459-462. [PMID: 30302060 PMCID: PMC6170887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background: Hepatitis C virus (HCV) screening is traditionally performed using an enzyme-linked immunosorbent assay (ELISA), and HCV infection is confirmed by measuring the viral load using polymerase chain reaction (PCR). An alternative screening approach is to use only PCR, without the ELISA pretest. Methods: We compared the cost ratio of screening for HCV using 2 approaches: (1) ELISA followed by PCR testing, and (2) PCR testing alone. The results were analyzed using a decision analysis model. A sensitivity analysis and a threshold analysis were performed by varying both the prevalence of HCV infection (to encompass populations in which viral infection is overrepresented) as well as the costs of PCR testing. Results: Under baseline assumptions, the costs of PCR testing alone were substantially greater than the combination of ELISA and PCR testing. The cost per patient screened using combination testing was $42.30, whereas testing with only PCR cost $200.00 per patient. The prevalence of HCV had a greater impact on the cost ratio than did the costs of laboratory tests. The use of PCR testing alone became less costly only when the prevalence of HCV infection was greater than 69.5%. Otherwise, the costs of the 2 approaches were similar when the cost of PCR was 1% of that of ELISA. Conclusion: From a pharmacoeconomic basis, the current approach of HCV screening (ie, using ELISA and PCR testing) was found to be the less expensive screening strategy in a general US population and for most cohorts in which HCV infection was noted to be overrepresented. Screening for HCV is less costly using solely PCR testing only when the prevalence of HCV infection is greater than 69.5%.
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Affiliation(s)
- Sammy Saab
- Dr Saab is a professor in the Departments of Surgery and Medicine at the University of California at Los Angeles in Los Angeles, California
- Mr Ahn and Ms McDaniel are researchers in the Department of Surgery at the University of California at Los Angeles
- Dr Yanny is an attending physician in the Department of Medicine at the University of California at Los Angeles
- Dr Tong is a professor in the Department of Surgery at the University of California at Los Angeles and a professor in the Department of Medicine at the Huntington Research Institute in Pasadena, California
| | - Timothy Ahn
- Dr Saab is a professor in the Departments of Surgery and Medicine at the University of California at Los Angeles in Los Angeles, California
- Mr Ahn and Ms McDaniel are researchers in the Department of Surgery at the University of California at Los Angeles
- Dr Yanny is an attending physician in the Department of Medicine at the University of California at Los Angeles
- Dr Tong is a professor in the Department of Surgery at the University of California at Los Angeles and a professor in the Department of Medicine at the Huntington Research Institute in Pasadena, California
| | - Terina McDaniel
- Dr Saab is a professor in the Departments of Surgery and Medicine at the University of California at Los Angeles in Los Angeles, California
- Mr Ahn and Ms McDaniel are researchers in the Department of Surgery at the University of California at Los Angeles
- Dr Yanny is an attending physician in the Department of Medicine at the University of California at Los Angeles
- Dr Tong is a professor in the Department of Surgery at the University of California at Los Angeles and a professor in the Department of Medicine at the Huntington Research Institute in Pasadena, California
| | - Beshoy Yanny
- Dr Saab is a professor in the Departments of Surgery and Medicine at the University of California at Los Angeles in Los Angeles, California
- Mr Ahn and Ms McDaniel are researchers in the Department of Surgery at the University of California at Los Angeles
- Dr Yanny is an attending physician in the Department of Medicine at the University of California at Los Angeles
- Dr Tong is a professor in the Department of Surgery at the University of California at Los Angeles and a professor in the Department of Medicine at the Huntington Research Institute in Pasadena, California
| | - Myron J Tong
- Dr Saab is a professor in the Departments of Surgery and Medicine at the University of California at Los Angeles in Los Angeles, California
- Mr Ahn and Ms McDaniel are researchers in the Department of Surgery at the University of California at Los Angeles
- Dr Yanny is an attending physician in the Department of Medicine at the University of California at Los Angeles
- Dr Tong is a professor in the Department of Surgery at the University of California at Los Angeles and a professor in the Department of Medicine at the Huntington Research Institute in Pasadena, California
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Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
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Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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23
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Kim RS, Weinberger AH, Chander G, Sulkowski MS, Norton B, Shuter J. Cigarette Smoking in Persons Living with Hepatitis C: The National Health and Nutrition Examination Survey (NHANES), 1999-2014. Am J Med 2018; 131:669-675. [PMID: 29408018 PMCID: PMC5963992 DOI: 10.1016/j.amjmed.2018.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cigarette smoking is common in persons living with hepatitis C (hepatitis C+), but national statistics on this harmful practice are lacking. A better understanding of smoking behaviors in hepatitis C+ individuals may help in the development of targeted treatment strategies. METHODS We extracted data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014. Hepatitis C+ were compared with hepatitis C- adults in the entire sample and in the subset of current smokers. Measures included demographics, current smoking, cigarettes/day, nicotine dependence, other tobacco use, substance use, and medical and psychiatric comorbidities. RESULTS Complete smoking and hepatitis C virus (HCV) data were available for 39,472 (90.1%) of 43,793 adult participants in NHANES during the study years. Hepatitis C+ smoked at almost triple the rate of hepatitis C- adults (62.4% vs 22.9%), with no significant difference between hepatitis C+ men and women (64.5% vs 58.2%). Hepatitis C+ smokers were more likely to smoke daily than hepatitis C- smokers (87.5% vs 80.0%), but had similar levels of nicotine dependence. Hepatitis C+ smokers were more likely to be older (mean age: 47.1 vs 41.5 years), male (69.4% vs 54.4%), Black (21.2% vs 12.1%), less educated (any college: 31.8% vs 42.9%), poor (mean family monthly poverty index: 1.80 vs 2.47), uninsured (43.9% vs 30.4%), use drugs (cocaine: 11.1% vs 3.2%; heroin: 4.0% vs 0.6%), and be depressed (33.2% vs 13.5%). Multivariate analyses revealed significant associations of both hepatitis C infection and cigarette smoking with current depression and hypertension. CONCLUSIONS There is a cigarette smoking epidemic embedded within the hepatitis C epidemic in the United States. The sociodemographic profile of hepatitis C+ smokers suggests that the implementation of effective tobacco treatment will be challenging. Thoughtful treatment strategies that are mindful of the unique characteristics of this group are needed.
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Affiliation(s)
- Ryung S Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; Department of Applied Statistics, Yonsei University, Seoul, South Korea
| | - Andrea H Weinberger
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Brianna Norton
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan Shuter
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
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24
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Abstract
BACKGROUND Hepatitis C (HCV) is more prevalent in African Americans than in any other racial group in the United States. However, African Americans are more likely to be deemed ineligible for HCV treatment than non-African Americans. There has been limited research into the origins of racial disparities in HCV treatment eligibility. AIM The purpose of this study was to compare medical and non-medical characteristics commonly assessed in clinical practice that could potentially contribute to HCV treatment ineligibility disparities between African American and non-African American patients. MATERIAL AND METHODS Patients with confirmed HCV RNA considering treatment (n = 309) were recruited from university-affiliated and VA liver and infectious disease clinics. RESULTS African Americans and non-African Americans did not differ in prevalence of lifetime and current psychiatric disorders and risky behaviors, and HCV knowledge. HCV clinical characteristics were similar between both groups in terms of HCV exposure history, number of months aware of HCV diagnosis, stage of fibrosis, and HCV virologic levels. African Americans did have higher proportions of diabetes, renal disease, and bleeding ulcer. CONCLUSIONS No clinical evidence was found to indicate that African Americans should be more often deemed ineligible for HCV treatment than other racial groups. Diabetes and renal disease do not fully explain the HCV treatment ineligibility racial disparity, because HCV patients with these conditions are priority patients for HCV treatment because of their greater risk for cirrhosis, steatosis, and hepatocellular carcinoma. The findings suggest that an underlying contributor to the HCV treatment eligibility disparity disfavoring African Americans could be racial discrimination.
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Affiliation(s)
- Omar Sims
- Department of Social Work, College of Arts and Sciences. † Department of Health Behavior, School of Public Health. The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Pollio
- Department of Social Work, College of Arts and Sciences. † Department of Health Behavior, School of Public Health. The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barry Hong
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO, USA
| | - Carol North
- Department of Psychiatry, School of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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25
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Barriers in Hepatitis C Treatment in Somali Patients in the Direct Acting Antiviral Therapy Era. J Natl Med Assoc 2018; 110:556-559. [PMID: 30129499 DOI: 10.1016/j.jnma.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) treatment has changed dramatically in the last few years. Our observations suggest that a minority of HCV infected Somalis are treated. In this study, we aimed to evaluate for treatment and health outcome disparities between Somali and non-Somali patients during the direct acting antiviral (DAA) era. METHODS Patients with HCV seen in the gastroenterology clinic in 2015 were included in the study. Patients were identified using ICD9 and 10 codes. Electronic medical records were analyzed to evaluate for treatment candidacy, acceptance and reasons for refusal of treatment. RESULTS Genotype 4 followed by 3 were the most common genotypes in the Somalis while genotype 1 was the most common in the non-Somalis. Majority of patients were offered treatment, active alcohol and substance abuse was a common reason for not offering treatment in non-Somalis while the presence of hepatocellular carcinoma was the most common reason in Somalis. Somalis had higher rates of declining treatment given the asymptomatic nature of their disease and the feeling that treatment is not needed. Sustained virologic response rates were comparable in both groups. CONCLUSIONS Disparities in acceptance of HCV treatment persist in the DAA era. The asymptomatic nature of the infection and potential cultural mistrust makes patients hesitant to undergo treatment. Healthcare providers must find interventions aimed at reducing barriers to treatment and increasing acceptance of HCV treatment.
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26
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Ford MM, Desai PS, Maduro G, Laraque F. Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors. J Urban Health 2017; 94:746-755. [PMID: 28623451 PMCID: PMC5610126 DOI: 10.1007/s11524-017-0174-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.
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Affiliation(s)
- Mary M Ford
- Primary Care Development Corporation, 45 Broadway, New York, NY, 10006, USA.
| | - Payal S Desai
- Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, Long Island City, NY, 11101, USA
| | - Gil Maduro
- New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY, 10013, USA
| | - Fabienne Laraque
- New York City Department of Homeless Services, New York, NY, 10014, USA
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27
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Le AK, Zhao C, Hoang JK, Tran SA, Chang CY, Jin M, Nguyen NH, Yasukawa LA, Zhang JQ, Weber SC, Garcia G, Nguyen MH. Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response. Aliment Pharmacol Ther 2017; 46:605-616. [PMID: 28766727 DOI: 10.1111/apt.14241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/04/2017] [Accepted: 07/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. AIM To evaluate ethnic differences in the natural history of CHC and the impact of SVR. METHODS We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. RESULTS Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. CONCLUSION Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.
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Affiliation(s)
- A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - C Zhao
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai, China
| | - J K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - S A Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - C Y Chang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Biostatistics, Zhejiang University, Hangzhou, China
| | - N H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - L A Yasukawa
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Q Zhang
- Chinese Hospital, San Francisco, CA, USA
| | - S C Weber
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - G Garcia
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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28
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An Electronic Health Record-based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965: A Cluster-randomized Trial. Med Care 2017; 55:590-597. [PMID: 28288075 DOI: 10.1097/mlr.0000000000000715] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. OBJECTIVE To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. DESIGN Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. SUBJECTS AND SETTING Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. INTERVENTION Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. MAIN OUTCOMES HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. RESULTS Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P<0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6-10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3-11.2). CONCLUSIONS An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.
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29
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Coyle C, Kwakwa H, Viner K. Integrating Routine HCV Testing in Primary Care: Lessons Learned from Five Federally Qualified Health Centers in Philadelphia, Pennsylvania, 2012-2014. Public Health Rep 2017; 131 Suppl 2:65-73. [PMID: 27168664 DOI: 10.1177/00333549161310s211] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE An estimated 2.7-3.9 million Americans are infected with hepatitis C virus (HCV). Despite being the most common blood-borne virus in the United States, routine HCV testing is not commonly practiced. To address this gap, we measured the impact of integrated routine HCV testing on patient care. METHODS As part of CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, National Nursing Centers Consortium integrated a routine opt-out HCV testing and linkage-to-care model at five federally qualified health centers in Philadelphia, Pennsylvania, from October 1, 2012, to June 30, 2014. The model included medical assistant-initiated testing, reflex laboratory-based HCV tests, and electronic health record modifications to prompt, track, and facilitate reimbursement for tests performed on uninsured patients. RESULTS During the study period, 4,207 unique patients received HCV antibody (anti-HCV) testing, of whom 488 (11.6%) tested anti-HCV positive. Of those testing positive, 433 (88.7%) received a confirmatory HCV RNA test; of these 433 recipients, 313 (72.3%) were diagnosed with current infection (overall prevalence = 7.4%), of which 243 (77.6%) received their HCV RNA-positive results, 184 (58.8%) were referred to an HCV care provider, and 121 (38.7%) were linked to care. The highest rates of current infection were among non-Hispanic white patients (18.1%, 90/496); patients from the Public Health Management Corporation Care Clinic, which treats HIV and HCV patients on-site (14.3%, 200/1,394); and patients aged 50-69 years (10.7%, 189/1,767). CONCLUSION Our model successfully integrated HCV testing and linkage to care into routine primary care. This study also identified potential successes and barriers that may be experienced by other primary care health centers that are integrating HCV testing.
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Affiliation(s)
- Catelyn Coyle
- National Nursing Centers Consortium, Philadelphia, PA
| | - Helena Kwakwa
- Philadelphia Department of Public Health, HIV Clinical Services, Philadelphia, PA
| | - Kendra Viner
- Philadelphia Department of Public Health, Philadelphia, PA
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30
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Geographic epidemiology of hepatocellular carcinoma, viral hepatitis, and socioeconomic position in New York City. Cancer Causes Control 2017; 28:779-789. [PMID: 28573469 DOI: 10.1007/s10552-017-0897-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 04/18/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Liver cancer (hepatocellular carcinoma (HCC)) incidence and mortality rates are increasing in the United States. New York City (NYC) has a high burden of liver cancer risk factors, including hepatitis C (HCV) and hepatitis B (HBV) infection, which disproportionately affect persons of low socioeconomic position. Identifying neighborhoods with HCC disparities is essential to effectively define targeted cancer control strategies. METHODS New York State Cancer Registry data from 1 January 2001 through 31 December 2012 were matched with NYC HCV and HBV surveillance data. HCC data were aggregated to NYC Zip Code Tabulation Areas (ZCTAs). Moran's I cluster analysis, Poisson regression, and geographically weighted Poisson regression were used to identify hotspots in HCC incidence and to examine the spatial associations with viral hepatitis rates, poverty, and uninsured status. RESULTS Among NYC residents, 8,827 HCC cases were diagnosed during 2001-2012. Significant clustering was detected in the HCC rates (Moran's I = 0.25) with the strongest clustering found in HCC patients with comorbid HCV infection (Moran's I = 0.47). Poverty and uninsured status were associated (p < 0.05) with increased rates of HCC patients with HBV or HCV infection. Neighborhoods with high rates of HCC without viral hepatitis infection had lower rates of poverty and uninsured status. CONCLUSIONS The geographic variation in HCC highlights the need for neighborhood-targeted interventions to address risk factors and barriers to care. The clusters of HCC by viral hepatitis status may serve as a basis for healthcare policymakers and practitioners to prioritize neighborhoods for cancer screening and control efforts.
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31
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Emmanuel B, Shardell MD, Tracy L, Kottilil S, El-Kamary SS. Racial disparity in all-cause mortality among hepatitis C virus-infected individuals in a general US population, NHANES III. J Viral Hepat 2017; 24:380-388. [PMID: 27905175 PMCID: PMC5739320 DOI: 10.1111/jvh.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/01/2016] [Indexed: 12/25/2022]
Abstract
There are few long-term nationally representative studies of all-cause mortality among those infected with hepatitis C virus (HCV). When an additional 5 years of data were made publicly available in 2015, the Third National Health and Nutrition Examination Survey Linked Mortality File became the longest nationally representative study in the United States. Our objective was to update the estimated HCV-associated all-cause mortality in the general US population and determine any differences by sex, age and race/ethnicity. HCV status was assessed in 9117 nationally representative adults aged 18-59 years from 1988 to 1994, and mortality follow-up of the same individuals was completed through 2011 and made publicly available in 2015. There were 930 deaths over a median follow-up of 19.8 years. After adjusting for all covariate risk factors, chronic HCV had 2.63 times (95% CI: 1.59-4.37; P=.0002) higher all-cause mortality rate ratio (MRR) compared with being HCV negative. All-cause MRR was stratified by sex, age and race/ethnicity. Only race/ethnicity was a significant effect modifier of MRR (P<.0001) as the highest MRR of chronic HCV compared to HCV negative was 7.48 (95% CI: 2.15-26.10, P=.001) among Mexican Americans, 2.67 (95% CI: 2.67-5.56, P=.009) among non-Hispanic Whites and 2.02 (95% CI: 1.20-3.40, P=.007) among non-Hispanic Blacks. Racial disparity was seen in the all-cause mortality as Mexican Americans with chronic HCV had approximately seven times higher mortality rate than HCV-negative individuals. This suggests that these at-risk individuals should be targeted for HCV screening and treatment, given the availability of new highly effective HCV therapies.
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Affiliation(s)
- B Emmanuel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M D Shardell
- National Institute of Aging, National Institutes of Health, Bethesda, MD, USA
| | - L Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Office of Biostatistics, Center for Drug Evaluation and Research Food and Drug Administration, Silver Spring, MD, USA
| | - S Kottilil
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S S El-Kamary
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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32
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Stopka TJ, Goulart MA, Meyers DJ, Hutcheson M, Barton K, Onofrey S, Church D, Donahue A, Chui KKH. Identifying and characterizing hepatitis C virus hotspots in Massachusetts: a spatial epidemiological approach. BMC Infect Dis 2017; 17:294. [PMID: 28427355 PMCID: PMC5399408 DOI: 10.1186/s12879-017-2400-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022] Open
Abstract
Background Hepatitis C virus (HCV) infections have increased during the past decade but little is known about geographic clustering patterns. Methods We used a unique analytical approach, combining geographic information systems (GIS), spatial epidemiology, and statistical modeling to identify and characterize HCV hotspots, statistically significant clusters of census tracts with elevated HCV counts and rates. We compiled sociodemographic and HCV surveillance data (n = 99,780 cases) for Massachusetts census tracts (n = 1464) from 2002 to 2013. We used a five-step spatial epidemiological approach, calculating incremental spatial autocorrelations and Getis-Ord Gi* statistics to identify clusters. We conducted logistic regression analyses to determine factors associated with the HCV hotspots. Results We identified nine HCV clusters, with the largest in Boston, New Bedford/Fall River, Worcester, and Springfield (p < 0.05). In multivariable analyses, we found that HCV hotspots were independently and positively associated with the percent of the population that was Hispanic (adjusted odds ratio [AOR]: 1.07; 95% confidence interval [CI]: 1.04, 1.09) and the percent of households receiving food stamps (AOR: 1.83; 95% CI: 1.22, 2.74). HCV hotspots were independently and negatively associated with the percent of the population that were high school graduates or higher (AOR: 0.91; 95% CI: 0.89, 0.93) and the percent of the population in the “other” race/ethnicity category (AOR: 0.88; 95% CI: 0.85, 0.91). Conclusion We identified locations where HCV clusters were a concern, and where enhanced HCV prevention, treatment, and care can help combat the HCV epidemic in Massachusetts. GIS, spatial epidemiological and statistical analyses provided a rigorous approach to identify hotspot clusters of disease, which can inform public health policy and intervention targeting. Further studies that incorporate spatiotemporal cluster analyses, Bayesian spatial and geostatistical models, spatially weighted regression analyses, and assessment of associations between HCV clustering and the built environment are needed to expand upon our combined spatial epidemiological and statistical methods.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Michael A Goulart
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - David J Meyers
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marga Hutcheson
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Kerri Barton
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Shauna Onofrey
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Daniel Church
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Ashley Donahue
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Kenneth K H Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Page K, Yu M, Cohen J, Evans J, Shumway M, Riley ED. HCV screening in a cohort of HIV infected and uninfected homeless and marginally housed women in San Francisco, California. BMC Public Health 2017; 17:171. [PMID: 28173785 PMCID: PMC5297184 DOI: 10.1186/s12889-017-4102-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies. Relatively few studies have assessed HCV infection in homeless populations, and a minority include women. We assessed prevalence and correlates of HCV exposure in a cohort of homeless and unstably housed women in San Francisco, and estimated the proportion undiagnosed. METHODS A probability sample of 246 women were recruited at free meal programs, homeless shelters, and low-cost single room occupancy hotels in San Francisco; women with HIV were oversampled. At baseline, anti-HCV status was assessed using an enzyme immunoassay, and results compared in both HIV-positive and negative women. Exposures were assessed by self-report. Logistic regression was used to assess factors independently associated th HCV exposure. RESULTS Among 246 women 45.9% were anti-HCV positive, of whom 61.1% were HIV coinfected; 27.4% of positives reported no prior screening. Most (72%) women were in the 'baby-boomer' birth cohort; 19% reported recent injection drug use (IDU). Factors independently associated with anti-HCV positivity were: being born in 1965 or earlier (AOR) 3.94; 95%CI: 1.88, 8.26), IDU history (AOR 4.0; 95%CI: 1.68, 9.55), and number of psychiatric diagnoses (AOR 1.16; 95%CI: 1.08, 1.25). CONCLUSIONS Results fill an important gap in information regarding HCV among homeless women, and confirm the need for enhanced screening in this population where a high proportion are baby-boomers and have a history of drug use and psychiatric problems. Due to their age and risk profile, there is a high probability that women in this study have been infected for decades, and thus have significant liver disease. The association with mental illness and HCV suggests that in addition increased screening, augmenting mental health care and support may enhance treatment success.
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Affiliation(s)
- Kimberly Page
- Division of Epidemiology, Biostatistics & Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550; 1 University of New Mexico, Albuquerque, NM USA
| | - Michelle Yu
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, USA
| | - Jennifer Evans
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, USA
| | - Martha Shumway
- Department of Psychiatry, University of California San Francisco, San Francisco, USA
| | - Elise D. Riley
- Department of Medicine, Division of HIV, Infectious Disease and Global Health, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
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Cummins CA, Erlyana E, Fisher DG, Reynolds GL. Hepatitis C Infection Among Hispanics in California. J Addict Dis 2016; 34:263-73. [PMID: 26372008 DOI: 10.1080/10550887.2015.1074500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hispanics in California are more likely to be infected with hepatitis C, and those infected have had their infection detected later. A total of 1,567 Hispanic and Caucasian individuals were tested for antibodies to hepatitis C from 2000 through 2013. Interviewers administered the Risk Behavior Assessment. Hepatitis C-infected Hispanics were incarcerated longer than hepatitis C-infected Caucasians, and they used marijuana less and illicit methadone more. They were more likely to use crack, heroin, speedballs, and to have been in methadone treatment. Hispanics need hepatitis C testing linked to methadone treatment and written information in Spanish and English.
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Affiliation(s)
- Catherine A Cummins
- a School of Nursing, California State University , Long Beach , California , USA
| | - Erlyana Erlyana
- b Department of Health Care Administration , California State University , Long Beach , California , USA
| | - Dennis G Fisher
- c Center for Behavioral Research and Services, Psychology Department , California State University , Long Beach , California , USA
| | - Grace L Reynolds
- c Center for Behavioral Research and Services, Psychology Department , California State University , Long Beach , California , USA
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35
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Larney S, Zaller ND, Dumont DM, Willcock A, Degenhardt L. A systematic review and meta-analysis of racial and ethnic disparities in hepatitis C antibody prevalence in United States correctional populations. Ann Epidemiol 2016; 26:570-578.e2. [DOI: 10.1016/j.annepidem.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 01/19/2023]
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36
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Coyle C, Kwakwa H. Dual-Routine HCV/HIV Testing: Seroprevalence and Linkage to Care in Four Community Health Centers in Philadelphia, Pennsylvania. Public Health Rep 2016; 131 Suppl 1:41-52. [PMID: 26862229 DOI: 10.1177/00333549161310s106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Despite common risk factors, screening for hepatitis C virus (HCV) and HIV at the same time as part of routine medical care (dual-routine HCV/HIV testing) is not commonly implemented in the United States. This study examined improvements in feasibility of implementation, screening increase, and linkage to care when a dual-routine HCV/HIV testing model was integrated into routine primary care. METHODS National Nursing Centers Consortium implemented a dual-routine HCV/HIV testing model at four community health centers in Philadelphia, Pennsylvania, on September 1, 2013. Routine HCV and opt-out HIV testing replaced the routine HCV and opt-in HIV testing model through medical assistant-led, laboratory-based testing and electronic medical record modification to prompt, track, report, and facilitate reimbursement for tests performed on uninsured individuals. This study examined testing, seropositivity, and linkage-to-care comparison data for the nine months before (December 1, 2012-August 31, 2013) and after (September 1, 2013-May 31, 2014) implementation of the dual-routine HCV/HIV testing model. RESULTS A total of 1,526 HCV and 1,731 HIV tests were performed before, and 1,888 HCV and 3,890 HIV tests were performed after dual-routine testing implementation, resulting in a 23.7% increase in HCV tests and a 124.7% increase in HIV tests. A total of 70 currently HCV-infected and four new HIV-seropositive patients vs. 101 HCV-infected and 13 new HIV-seropositive patients were identified during these two periods, representing increases of 44.3% for HCV antibody-positive and RNA-positive tests and 225.0% for HIV-positive tests. Linkage to care increased from 27 currently infected HCV--positive and one HIV-positive patient pre-dual-routine testing to 39 HCV--positive and nine HIV-positive patients post-dual-routine testing. CONCLUSION The dual-routine HCV/HIV testing model shows that integrating dual-routine testing in a primary care setting is possible and leads to increased HCV and HIV screening, enhanced seropositivity diagnosis, and improved linkage to care.
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Affiliation(s)
- Catelyn Coyle
- National Nursing Centers Consortium, Philadelphia, PA
| | - Helena Kwakwa
- Philadelphia Department of Public Health, Clinical HIV Services, Philadelphia, PA
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37
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Torre LA, Goding Sauer AM, Chen MS, Kagawa-Singer M, Jemal A, Siegel RL. Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females. CA Cancer J Clin 2016; 66:182-202. [PMID: 26766789 PMCID: PMC5325676 DOI: 10.3322/caac.21335] [Citation(s) in RCA: 297] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cancer is the leading cause of death among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). In this report, the American Cancer Society presents AANHPI cancer incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among AANHPIs in 2016, there will be an estimated 57,740 new cancer cases and 16,910 cancer deaths. While AANHPIs have 30% to 40% lower incidence and mortality rates than non-Hispanic whites for all cancers combined, risk of stomach and liver cancers is double. The male-to-female incidence rate ratio among AANHPIs declined from 1.43 (95% confidence interval, 1.36-1.49) in 1992 to 1.04 (95% confidence interval, 1.01-1.07) in 2012 because of declining prostate and lung cancer rates in males and increasing breast cancer rates in females. The diversity within the AANHPI population is reflected in the disparate cancer risk by subgroup. For example, the overall incidence rate in Samoan men (526.5 per 100,000) is more than twice that in Asian Indian/Pakistani men (216.8). Variations in cancer rates in AANHPIs are related to differences in behavioral risk factors, use of screening and preventive services, and exposure to cancer-causing infections. Cancer-control strategies include improved use of vaccination and screening; interventions to increase physical activity and reduce excess body weight, tobacco use, and alcohol consumption; and subgroup-level research on burden and risk factors. CA Cancer J Clin 2016;66:182-202. © 2016 American Cancer Society.
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Affiliation(s)
- Lindsey A. Torre
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann M. Goding Sauer
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Moon S. Chen
- Professor and Associate Director for Cancer Control, University of California-Davis Comprehensive Cancer Center, Sacramento, CA
| | - Marjorie Kagawa-Singer
- Professor Emerita, Department of Community Health Sciences and Department of Asian American Studies, University of California-Los Angeles, Los Angeles, CA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L. Siegel
- Director of Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Falade-Nwulia O, Mehta SH, Lasola J, Latkin C, Niculescu A, O’Connor C, Chaulk P, Ghanem K, Page KR, Sulkowski MS, Thomas DL. Public health clinic-based hepatitis C testing and linkage to care in Baltimore. J Viral Hepat 2016; 23:366-74. [PMID: 26840570 PMCID: PMC4836954 DOI: 10.1111/jvh.12507] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022]
Abstract
Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross-sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA-positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1-0.9] and OR 0.4 [95% CI 0.1-0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV-infected patients linked to off-site specialist care.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, Baltimore, MD,Baltimore City Health Department, Baltimore, MD
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alex Niculescu
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cristi O’Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Patrick Chaulk
- Baltimore City Health Department, Baltimore, MD,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Khalil Ghanem
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, MD,Baltimore City Health Department, Baltimore, MD
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Vutien P, Hoang J, Brooks L, Nguyen NH, Nguyen MH. Racial Disparities in Treatment Rates for Chronic Hepatitis C: Analysis of a Population-Based Cohort of 73,665 Patients in the United States. Medicine (Baltimore) 2016; 95:e3719. [PMID: 27258498 PMCID: PMC4900706 DOI: 10.1097/md.0000000000003719] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic hepatitis C (CHC) disproportionately affects racial minorities in the United States (US). Although prior studies have reported lower treatment rates in Blacks than in Caucasians, the rates of other minorities remain understudied. We aimed to examine antiviral treatment rates by race and to evaluate the effect of other demographic, medical, and psychiatric factors on treatment rates. We performed a population-based study of adult CHC patients identified via ICD-9CM query from OptumInsight's Data Mart from January 2009 to December 2013. Antiviral treatment was defined by pharmaceutical claims for interferon and/or pegylated-interferon. A total of 73,665 insured patients were included: 51,282 Caucasians, 10,493 Blacks, 8679 Hispanics, and 3211 Asians. Caucasians had the highest treatment rate (10.7%) followed by Blacks (8.8%), Hispanics (8.8%), and Asians (7.9%, P < .001). Hispanics had the highest cirrhosis rates compared with Caucasians, Blacks, and Asians (20.7% vs 18.3%, 17.1%, and 14.3%, respectively). Caucasians were the most likely to have a psychiatric comorbidity (20.1%) and Blacks the most likely to have a medical comorbidity (44%). Asians were the least likely to have a psychiatric (6.4%) or medical comorbidity (26.9%). On multivariate analysis, racial minority was a significant predictor of nontreatment with odds ratios of 0.82 [confidence interval (CI): 0.74-0.90] for Blacks, 0.87 (CI: 0.78-0.96) for Hispanics, and 0.73 (CI: 0.62-0.86) for Asians versus Caucasians. Racial minorities had lower treatment rates than Caucasians. Despite fewer medical and psychiatric comorbidities and higher incomes and educational levels, Asians had the lowest treatment rates. Hispanics also had lower treatment rates than Caucasians despite having higher rates of cirrhosis. Future studies should aim to identify underlying racial-related barriers to hepatitis C virus treatment besides socioeconomic status and medical or psychiatric comorbidities.
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Affiliation(s)
- Philip Vutien
- From the Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA (PV, JH, MHN), Department of Medicine, Rush University Medical Center, Chicago, IL (PV), Optum Insight, Eden Prairie, MN (LBJ), and University of California San Diego Medical Center, San Diego, CA (NHN)
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40
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Deming P, Martin MT, Chan J, Dilworth TJ, El-Lababidi R, Love BL, Mohammad RA, Nguyen A, Spooner LM, Wortman SB. Therapeutic Advances in HCV Genotype 1 Infection: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2016; 36:203-17. [PMID: 26846728 DOI: 10.1002/phar.1700] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatitis C virus (HCV) is the most common blood-borne infection in the United States. The high morbidity and mortality due to untreated infection have prompted updated screening recommendations that now include one-time HCV screening for all patients born between 1945 and 1965, in addition to risk factor-based screening. Current guidelines recommend treatment for all patients with chronic HCV. Treatment for HCV genotype 1 has evolved dramatically since the approval of the direct-acting antivirals. The approval of ledipasvir-sofosbuvir, ombitasvir-paritaprevir-ritonavir and dasabuvir, and simeprevir with sofosbuvir has dramatically altered the treatment landscape. High sustained virologic response (SVR) rates favor treatment, yet access to care poses a challenge for patients and providers. Current and emerging data with new therapies indicate high SVR rates in treatment-naïve and treatment-experienced patients, including patients with cirrhosis and in other special populations. Additional data suggest the addition of ribavirin can decrease treatment duration without compromising SVR rates. Resistance is an increasing area of interest in HCV, with baseline mutations identified and the potential for the development of resistance-associate variants in patients undergoing treatment. Due to the rapid evolution of HCV treatment, pharmacists should address challenges and play an integral role in agent selection, dosing, drug interaction screening, adverse effect monitoring, and the coordination of treatment. Clinical application of the latest information will reduce patient risk and improve outcomes.
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Affiliation(s)
- Paulina Deming
- Department of Pharmacy Practice, University of New Mexico College of Pharmacy, Albuquerque, New Mexico
| | - Michelle T Martin
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Juliana Chan
- Colleges of Pharmacy and Medicine, University of Illinois at Chicago, Chicago, Illinois.,Gastroenterology/Hepatology, Illinois Department of Corrections Hepatology Telemedicine, Sections of Hepatology, Digestive Diseases and Nutrition, University of Illinois Hospital & Health Sciences Center, Chicago, Illinois
| | - Thomas J Dilworth
- Department of Pharmacy, Wheaton Franciscan Healthcare - St. Francis, Milwaukee, Wisconsin.,Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rania El-Lababidi
- Pharmacy Education and Training, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Bryan L Love
- Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Columbia, South Carolina
| | - Rima A Mohammad
- Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan.,University of Michigan Health System, Ann Arbor, Michigan
| | - Amy Nguyen
- Gallup Indian Medical Center, Gallup, New Mexico
| | - Linda M Spooner
- Pharmacy Practice, School of Pharmacy Worcester/Manchester, MCPHS University, Worcester, Massachusetts.,Infectious Diseases, Saint Vincent Hospital, Worcester, Massachusetts
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Hernández D, Feaster DJ, Gooden L, Douaihy A, Mandler R, Erickson SJ, Kyle T, Haynes L, Schwartz R, Das M, Metsch L. Self-Reported HIV and HCV Screening Rates and Serostatus Among Substance Abuse Treatment Patients. AIDS Behav 2016; 20:204-14. [PMID: 25952768 PMCID: PMC4637257 DOI: 10.1007/s10461-015-1074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.
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Affiliation(s)
- Diana Hernández
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA.
| | | | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
| | - Antoine Douaihy
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raul Mandler
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Tiffany Kyle
- The Center for Drug Free Living, Orlando, FL, USA
| | - Louise Haynes
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Moupali Das
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
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42
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Turner BJ, Taylor BS, Hanson JT, Perez ME, Hernandez L, Villarreal R, Veerapaneni P, Fiebelkorn K. Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: Strategies, results, and costs. J Hosp Med 2015; 10:510-6. [PMID: 26033458 DOI: 10.1002/jhm.2376] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/10/2015] [Accepted: 04/19/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVE The US Preventive Services Task Force recommends 1-time hepatitis C virus (HCV) screening of all baby boomers (born 1945-1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs. DESIGN/PATIENTS Prospective cohort of 6140 baby boomers admitted to a safety-net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014. PROCEDURES/MEASUREMENTS The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt-out consent, anti-HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti-HCV antibody-positive and HCV RNA-positive results. RESULTS Of 3168 eligible patients, 240 (7.6%) were anti-HCV positive, which was more likely (P < 0.05) for younger age, men, and uninsured. Of 214 (89.2%) patients tested for HCV RNA, 134 (4.2% of all screened) were positive (chronic HCV). Among patients with chronic HCV, 129 (96.3%) were counseled, 108 (80.6%) received follow-up primary care, and 52 (38.8%) received hepatology care. Five patients initiated anti-HCV therapy. Total costs for start-up and implementation for 14 months were $286,482. CONCLUSIONS This inpatient HCV screening program diagnosed chronic HCV infection in 4.2% of tested patients and linked >80% to follow-up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Barbara S Taylor
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joshua T Hanson
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary Elizabeth Perez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Poornachand Veerapaneni
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristin Fiebelkorn
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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43
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Trooskin SB, Poceta J, Towey CM, Yolken A, Rose JS, Luqman NL, Preston TWL, Chan PA, Beckwith C, Feller SC, Lee H, Nunn AS. Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program. J Gen Intern Med 2015; 30:950-7. [PMID: 25680353 PMCID: PMC4471023 DOI: 10.1007/s11606-015-3209-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/27/2014] [Accepted: 01/16/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care. OBJECTIVE We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting. DESIGN We developed a comprehensive, community-based HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure. PATIENTS Philadelphia residents were recruited through street outreach. MAIN MEASURES We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients. KEY RESULTS We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8% of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64% of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment. CONCLUSIONS Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.
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Affiliation(s)
- Stacey B. Trooskin
- />Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, PA USA
| | - Joanna Poceta
- />Division of Infectious Diseases, Miriam Hospital, Providence, RI USA
- />Rhode Island Public Health Institute, Providence, RI USA
| | - Caitlin M. Towey
- />Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI 02912 USA
- />Rhode Island Public Health Institute, Providence, RI USA
| | - Annajane Yolken
- />Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI 02912 USA
- />Rhode Island Public Health Institute, Providence, RI USA
| | - Jennifer S. Rose
- />Department of Psychology, Wesleyan University, Middletown, CT USA
| | | | | | - Philip A. Chan
- />Division of Infectious Diseases, Miriam Hospital, Providence, RI USA
- />Brown University Warren Alpert Medical School, Providence, RI USA
| | - Curt Beckwith
- />Division of Infectious Diseases, Miriam Hospital, Providence, RI USA
- />Brown University Warren Alpert Medical School, Providence, RI USA
| | - Sophie C. Feller
- />Division of Infectious Diseases, Jefferson Medical College, Philadelphia, PA USA
| | - Hwajin Lee
- />Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI 02912 USA
- />Rhode Island Public Health Institute, Providence, RI USA
| | - Amy S. Nunn
- />Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI 02912 USA
- />Rhode Island Public Health Institute, Providence, RI USA
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Abstract
Hepatitis C virus (HCV) is the most common blood-borne infection in the USA, though seroprevalence is elevated in certain high-risk groups such as inmates. Correctional facility screening protocols vary from universal testing to opt-in risk-based testing. This project assessed the success of a risk-based HCV screening strategy in the Philadelphia Prison System (PPS) by comparing results from current testing practices during 2011-2012 (Risk-Based Screening Group) to a September 2012 blinded seroprevalence study (Philadelphia Department of Public Health (PDPH) Study Cohort). PPS processed 51,562 inmates in 2011-2012; 2,727 were identified as high-risk and screened for HCV, of whom 57 % tested HCV antibody positive. Twelve percent (n = 154) of the 1,289 inmates in the PDPH Study Cohort were anti-HCV positive. Inmates ≥30 years of age had higher rates of seropositivity in both groups. Since only 5.3 % of the prison population was included in the Risk-Based Screening Group, an additional 4,877 HCV-positive inmates are projected to have not been identified in 2011-2012. Gaps in case identification exist when risk-based testing is utilized by PPS. A more comprehensive screening model such as opt-out universal testing should be considered to identify HCV-positive inmates. Identification of these individuals is an important opportunity to aid underserved high-risk populations and to provide medical care and secondary prevention.
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Coughlin SS. "Test, Listen, Cure" (TLC) Hepatitis C Community Awareness Campaign. JMIR Res Protoc 2015; 4:e13. [PMID: 25677459 PMCID: PMC4342624 DOI: 10.2196/resprot.3822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Improved drugs have been approved for the treatment of hepatitis C virus (HCV), but many people are unaware of improved therapies that are now available to cure the illness in a high percentage of patients. OBJECTIVE The objectives of the Test, Listen, Cure (TLC) Hepatitis C Community Awareness Campaign include the development and implementation of a health education and promotion campaign in Memphis, Tennessee, and surrounding areas of western Tennessee, eastern Arkansas, and northern Mississippi, to increase community awareness about HCV, and to provide up-to-date provider education on HCV screening and treatment. The health education and promotion campaign, which will be conducted in collaboration with area hospitals, clinics, and nonprofit organizations, will provide information about how HCV infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease. A second objective will be to provide continuing professional education on HCV screening and treatment to a minimum of 200 area health care providers, including primary care and internal medicine physicians and residents, physician assistants, nurse practitioners, providers who care for homeless persons, and dialysis unit nurses. METHODS Health education materials will be developed for this community awareness campaign that is culturally appropriate for African Americans and suitable for people with lower health literacy and educational attainment. Information will be compiled and disseminated about area providers who provide screening services and treatment for persons with HCV in order to facilitate linkages to care. Four focus groups of 8-10, African American adults aged 40-64, will be conducted to test the health education materials. The provider education on HCV will also address patient-physician communication and cultural competency. The National Medical Association regional chapters and expert physician consultants will provide assistance with delivering the education program. RESULTS Results from this one year project will be available in early 2016. CONCLUSIONS Depending on the availability of funding and successful implementation of the project, the TLC campaign will be extended to similar cities in the United States.
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Schackman BR, Leff JA, Barter DM, DiLorenzo MA, Feaster DJ, Metsch LR, Freedberg KA, Linas BP. Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction 2015; 110:129-43. [PMID: 25291977 PMCID: PMC4270906 DOI: 10.1111/add.12754] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/11/2014] [Accepted: 09/29/2014] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. DESIGN We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody-positive and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV [Hepatitis C Cost-Effectiveness (HEP-CE)] and HIV [Cost-Effectiveness of Preventing AIDS Complications (CEPAC)]. SETTING AND PARTICIPANTS Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States. MEASUREMENTS Lifetime costs (2011 US$) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs). FINDINGS On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one- and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in 91% of probabilistic sensitivity analyses. CONCLUSIONS On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/quality-adjusted life year threshold.
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Affiliation(s)
- Bruce R. Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Jared A. Leff
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Devra M. Barter
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Madeline A. DiLorenzo
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- The Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lisa R. Metsch
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kenneth A. Freedberg
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- The Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin P. Linas
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Hepatitis C in African Americans. Am J Gastroenterol 2014; 109:1576-84; quiz 1575, 1585. [PMID: 25178700 DOI: 10.1038/ajg.2014.243] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 12/11/2022]
Abstract
The care of hepatitis C virus (HCV) in African Americans represents an opportunity to address a major health disparity in medicine. In all facets of HCV infection, African Americans are inexplicably affected, including in the prevalence of the virus, which is higher among them compared with most of the racial and ethnic groups. Ironically, although fibrosis rates may be slow, hepatocellular carcinoma and mortality rates appear to be higher among African Americans. Sustained viral response (SVR) rates have historically significantly trailed behind Caucasians. The reasons for this gap in SVR are related to both viral and host factors. Moreover, low enrollment rates in clinical trials hamper the study of the efficacy of anti-viral therapy. Nevertheless, the gap in SVR between African Americans and Caucasians may be narrowing with the use of direct-acting agents. Gastroenterologists, hepatologists, primary care physicians, and other health-care providers need to address modifiable risk factors that affect the natural history, as well as treatment outcomes, for HCV among African Americans. Efforts need to be made to improve awareness among health-care providers to address the differences in screening and referral patterns for African Americans.
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Abstract
In the USA, infectious diseases continue to exact a substantial toll on health and health-care resources. Endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of individuals and widen health disparities. Additional concerns include health-care-associated and foodborne infections--both of which have been targets of broad prevention efforts, with success in some areas, yet major challenges remain. Although substantial progress in reduction of the burden of vaccine-preventable diseases has been made, continued cases and outbreaks of these diseases persist, driven by various contributing factors. Worldwide, emerging and reemerging infections continue to challenge prevention and control strategies while the growing problem of antimicrobial resistance needs urgent action. An important priority for control of infectious disease is to ensure that scientific and technological advances in molecular diagnostics and bioinformatics are well integrated into public health. Broad and diverse partnerships across governments, health care, academia, and industry, and with the public, are essential to effectively reduce the burden of infectious diseases.
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Affiliation(s)
- Rima F Khabbaz
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Robin R Moseley
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Riley J Steiner
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra M Levitt
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beth P Bell
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
PURPOSE OF REVIEW This article examines recent health services and policy research studies in hepatology and liver transplantation. RECENT FINDINGS Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. SUMMARY Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.
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Khalil MO, Morton LM, Devesa SS, Check DP, Curtis RE, Weisenburger DD, Dores GM. Incidence of marginal zone lymphoma in the United States, 2001-2009 with a focus on primary anatomic site. Br J Haematol 2014; 165:67-77. [PMID: 24417667 DOI: 10.1111/bjh.12730] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/06/2013] [Indexed: 12/31/2022]
Abstract
The aetiology of marginal zone lymphoma (MZL) is purported to differ by anatomic site. While this is supported by clinical series of single MZL sites, no population-based study has comprehensively assessed incidence patterns across sites. To gain insight into disease aetiology, we assessed MZL incidence by site using data from 18 U.S. Surveillance, Epidemiology and End Results (SEER) Program population-based registries. We calculated age-adjusted incidence rates (IRs) by sex, race, and calendar year. During 2001-2009, 4,081 (IR = 5·7/1,000,000 person-years) and 8,821 (IR = 12·3) individuals were diagnosed with nodal MZL and extranodal MZL, respectively. The most common extranodal sites were stomach (IR = 3·8), spleen (IR = 1·6), eye/adnexa (IR = 1·4), and lung, skin, and salivary glands (IRs = 0·9-1·0). We observed distinct age-specific patterns by MZL site, with IRs increasing steeply at younger ages and less prominently after mid-life at several sites, except skin. Gender and racial/ethnic disparities were also apparent across sites. Between 2001-2005 and 2006-2009, MZL IRs decreased significantly for gastric (-15%) and soft tissue (-28%) sites, whereas IRs increased significantly for lung (18%), skin (43%), and kidney/renal pelvis (116%). In combination, our findings support the contention that MZL is characterized by aetiological heterogeneity across sites and susceptibility is probably influenced by intrinsic characteristics and environmental exposures.
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Affiliation(s)
- Mohammad O Khalil
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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