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Deng H, Gross AE, Trotter AB, Touchette DR. Cost evaluation of a nurse coordinated outpatient parenteral antimicrobial therapy (OPAT) program. Antimicrob Steward Healthc Epidemiol 2024; 3:e252. [PMID: 38178876 PMCID: PMC10762635 DOI: 10.1017/ash.2023.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
A structured, nurse-driven outpatient parenteral antimicrobial therapy (OPAT) program within an academic healthcare system was associated with reduced odds of 60-day unplanned OPAT readmissions and costs after hospital discharge. These findings may facilitate justifying additional resources for OPAT programs to improve care while decreasing costs.
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Affiliation(s)
- Huiwen Deng
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Alan E. Gross
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Andrew B. Trotter
- Division of Infectious Disease, Department of Medicine, University of Illinois Chicago College of Medicine, Chicago, IL, USA
| | - Daniel R. Touchette
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
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2
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Agnihotri G, Gross AE, Seok M, Yen CY, Khan F, Ebbitt LM, Gay C, Bleasdale SC, Sikka MK, Trotter AB. Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program. Antimicrob Steward Healthc Epidemiol 2023; 3:e33. [PMID: 36865701 PMCID: PMC9972539 DOI: 10.1017/ash.2022.330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine whether a structured OPAT program supervised by an infectious disease physician and led by an OPAT nurse decreased hospital readmission rates and OPAT-related complications and whether it affected clinical cure. We also evaluated predictors of readmission while receiving OPAT. PATIENTS A convenience sample of 428 patients admitted to a tertiary-care hospital in Chicago, Illinois, with infections requiring intravenous antibiotic therapy after hospital discharge. METHODS In this retrospective, quasi-experimental study, we compared patients discharged on intravenous antimicrobials from an OPAT program before and after implementation of a structured ID physician and nurse-led OPAT program. The preintervention group consisted of patients discharged on OPAT managed by individual physicians without central program oversight or nurse care coordination. All-cause and OPAT-related readmissions were compared using the χ2 test. Factors associated with readmission for OPAT-related problems at a significance level of P < .10 in univariate analysis were eligible for testing in a forward, stepwise, multinomial, logistic regression to identify independent predictors of readmission. RESULTS In total, 428 patients were included in the study. Unplanned OPAT-related hospital readmissions decreased significantly after implementation of the structured OPAT program (17.8% vs 7%; P = .003). OPAT-related readmission reasons included infection recurrence or progression (53%), adverse drug reaction (26%), or line-associated issues (21%). Independent predictors of hospital readmission due to OPAT-related events included vancomycin administration and longer length of outpatient therapy. Clinical cure increased from 69.8% before the intervention to 94.9% after the intervention (P < .001). CONCLUSION A structured ID physician and nurse-led OPAT program was associated with a decrease in OPAT-related readmissions and improved clinical cure.
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Affiliation(s)
- Gaurav Agnihotri
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alan E. Gross
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Minji Seok
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Cheng Yu Yen
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Farah Khan
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Laura M. Ebbitt
- College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Cassandra Gay
- Division of Infectious Disease, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Susan C. Bleasdale
- Division of Infectious Disease, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Monica K. Sikka
- Division of Infectious Disease, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Andrew B. Trotter
- Division of Infectious Disease, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Copen CE, Rushmore J, De Voux A, Kirkcaldy RD, Fakile YF, Tilchin C, Duchen J, Jennings JM, Spahnie M, Norris Turner A, Miller WC, Novak RM, Schneider JA, Trotter AB, Bernstein KT. Factors Associated with Syphilis Transmission and Acquisition Among Men Who Have Sex with Men (MSM): Protocol for a Multi-Site Egocentric Network Study (Preprint). JMIR Res Protoc 2022; 11:e40095. [PMID: 36331528 PMCID: PMC9675014 DOI: 10.2196/40095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months. OBJECTIVE The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM. METHODS The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail. RESULTS The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5%) of the participants were non-Hispanic Black, 29.8% (217/727) were non-Hispanic White, and 8.8% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only). CONCLUSIONS Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/40095.
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Affiliation(s)
- Casey E Copen
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julie Rushmore
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alex De Voux
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Yetunde F Fakile
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carla Tilchin
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jessica Duchen
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jacky M Jennings
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Morgan Spahnie
- Division of Epidemiology, The Ohio State University, Columbus, OH, United States
| | | | - William C Miller
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Richard M Novak
- Division of Infectious Disease, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, United States
| | - John A Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, United States
- Howard Brown Health, Chicago, IL, United States
| | - Andrew B Trotter
- Division of Infectious Disease, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, United States
| | - Kyle T Bernstein
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Acharya R, Kafle S, Kandinata N, Slipman B, Ghimire M, Trotter AB. A Retrospective Cross-Sectional Study of Severe Breakthrough SARS-CoV-2 Infection in the General Population Requiring Hospitalization Within a Single Health System. J Clin Med Res 2022; 14:45-52. [PMID: 35211216 PMCID: PMC8827223 DOI: 10.14740/jocmr4662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite coronavirus disease 2019 (COVID-19) vaccination efforts, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in vaccinated individuals ("breakthrough SARS-CoV-2 infections") have emerged. Our understanding of breakthrough SARS-CoV-2 infections continues to evolve, and there is a paucity of information describing severe breakthrough SARS-CoV-2 infections. We conducted this study with the aim of describing breakthrough SARS-CoV-2 infections requiring hospitalization and exploring factors associated with severe breakthrough infection. METHODS The study included patients within our health network who received at least one dose of a messenger RNA (mRNA) COVID-19 vaccine and required hospitalization due to breakthrough SARS-CoV-2 infection from January 1 to August 15, 2021. We performed a descriptive analysis of vaccinated patients requiring hospitalization. Multivariable logistic regression (LR) analysis was performed to explore factors associated with severe breakthrough infection. RESULTS Out of 67,223 vaccinated individuals, 78 (0.12%) patients were hospitalized with breakthrough SARS-CoV-2 infection, of which 25 individuals (0.04% of those vaccinated, and 32% of all hospitalized) developed severe infection. The mean age of those with breakthrough infection was 72 years, the majority were White (60%), and dyspnea was the most common reason for hospital admission (53%), with bimodal peaks of hospitalization in January-February (40%) and July-August (34%). In LR analysis, male patients had 4.03 times the odds of developing severe SARS-CoV-2 infection than female patients (adjusted odds ratio (aOR): 4.03, 95% confidence interval (CI): 1.21 - 13.40), and an immunocompromising condition had 6.32 times the odds of developing severe COVID-19 disease (aOR: 6.32, 95% CI: 1.48 - 26.18). CONCLUSIONS The rate of severe breakthrough SARS-CoV-2 infection was very low, and male sex and immunocompromising conditions were associated with severe breakthrough infection. Clinicians and health systems should continue to campaign for COVID-19 vaccination aggressively.
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Affiliation(s)
- Roshan Acharya
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA
| | - Smita Kafle
- Fayetteville State University School of Nursing, Fayetteville, NC 28301, USA
| | - Natalie Kandinata
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA
| | - Brian Slipman
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA
| | - Meera Ghimire
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA
| | - Andrew B. Trotter
- Division of Infectious Disease, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
Immunization information systems (IISs) play a central role in coordinating distribution, administration, documentation, and monitoring of COVID-19 vaccination. In this commentary, the authors provide an introduction to IISs and discuss how clinicians can help maximize their utility in the COVID-19 pandemic.
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Affiliation(s)
| | - Elizabeth K Abbott
- American Immunization Registry Association, Washington, DC (E.K.A., R.C.)
| | - Rebecca Coyle
- American Immunization Registry Association, Washington, DC (E.K.A., R.C.)
| | - Angela K Shen
- and American Immunization Registry Association, Washington, DC, and Immunization Action Coalition, St. Paul, Minnesota (A.K.S.)
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Agnihotri G, Gross AE, Seok M, Yen CY, Khan F, Ebbitt LM, Bleasdale SC, Sikka MK, Trotter AB. 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program. Open Forum Infect Dis 2020. [PMCID: PMC7776203 DOI: 10.1093/ofid/ofaa439.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention ![]()
Table 2. Factors independently associated with hospital readmission in OPAT patients ![]()
Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Gaurav Agnihotri
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - Minji Seok
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Cheng Yu Yen
- University of Illinois at Chicago College of Pharmacy, Missouri City, Texas
| | - Farah Khan
- University of Illinois at Chicago College of Pharmacy, Missouri City, Texas
| | | | | | | | - Andrew B Trotter
- University of Illinois College of Medicine/UI Health, Chicago, IL
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7
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KC S, Murphy H, Dixit S, Rai A, Pradhan B, Lagrange-Xelot M, Karki N, Dureault A, Karmacharya U, Panthi S, Tulachan N, KC P, KC A, Rajbhandari R, Trotter AB, Gölz J, Pradat P, Trépo C, Creac'H P. Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. PLoS Negl Trop Dis 2020; 14:e0008931. [PMID: 33326423 PMCID: PMC7773414 DOI: 10.1371/journal.pntd.0008931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/30/2020] [Accepted: 10/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Despite direct-acting antivirals (DAA), aims to “eradicate” viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting. Methodology/Principal findings In 2015, we established a network of hepatologists, laboratory experts, and community-based leaders at 6 Opioid Substitution Treatment (OST) sites from 4 cities in Nepal screening 838 patients for a treatment cohort of 600 individuals with HCV infection and past or current drug use. During phase 1, patients were treated with interferon-based regimens (n = 46). During phase 2, 135 patients with optimal predictors (HIV controlled, without cirrhosis, low baseline HCV viral load) were treated with DAA-based regimens. During phase 3, IFN-free DAA treatment was expanded, regardless of HCV disease severity, HIV viremia or drug use. Sustained virologic response (SVR) was assessed at 12 weeks. Median age was 37 years and 95.5% were males. HCV genotype was 3 (53.2%) or 1a (40.7%) and 32% had cirrhosis; 42.5% were HIV-HCV coinfected. The intention-to-treat (ITT) SVR rates in phase 2 and 3 were 97% and 81%, respectively. The overall per-protocol and ITT SVR rates were 97% and 85%, respectively. By multivariable analysis, treatment at the Kathmandu site was protective and substance use, treatment during phase 3 were associated with failure to achieve SVR. Conclusions/Significance Very high SVR rates may be achieved in a difficult-to-treat, low-income population whatever the patient’s profile and disease severity. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal. Despite very effective antiviral therapies, Hepatitis C virus (HCV) eradication remains a major challenge, especially in resource-limited countries. In Nepal, which ranks among the poorest countries in the world an expert consortium was established to treat HCV patients in six centers throughout the country. A cohort of 600 individuals with HCV infection and past or current drug use were treated using different treatment strategies over time. Very high treatment response rates were achieved in a difficult-to-treat, low-income population whatever the patient’s profile and disease severity and despite the severe 2015 earthquakes in Nepal. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal.
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Affiliation(s)
- Sudhamshu KC
- National Academy of Medical Sciences, Kathmandu, Nepal
| | - Holly Murphy
- Saint Joseph Mercy Ann Arbor Hospital, Ann Arbor, Michigan, United States of America
| | - Sameer Dixit
- Centre for Molecular Dynamics Nepal (CMDN), Kathmandu, Nepal
| | - Apurva Rai
- Society of Positive Atmosphere and Related Support for HIV and AIDS, (SPARSHA-Nepal), Kathmandu, Nepal
| | | | | | - Niyanta Karki
- National Academy of Medical Sciences, Kathmandu, Nepal
| | | | - Ujjwal Karmacharya
- Society of Positive Atmosphere and Related Support for HIV and AIDS, (SPARSHA-Nepal), Kathmandu, Nepal
| | - Santosh Panthi
- Centre for Molecular Dynamics Nepal (CMDN), Kathmandu, Nepal
| | | | - Prawchan KC
- Society of Positive Atmosphere and Related Support for HIV and AIDS, (SPARSHA-Nepal), Kathmandu, Nepal
| | - Anjay KC
- Society of Positive Atmosphere and Related Support for HIV and AIDS, (SPARSHA-Nepal), Kathmandu, Nepal
| | | | - Andrew B. Trotter
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America
| | - Jörg Gölz
- Praxiszentrum Kaiserdamm, Berlin, Germany
| | - Pierre Pradat
- Centre for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- * E-mail:
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Trotter AB, Maheswaran A, Kate Mannion M, Baghikar S, Lin J. 1299. Cluster of False-Positive “Fifth-Generation” HIV Test Results During Implementation of a Routine HIV Screening Program in an Emergency Department. Open Forum Infect Dis 2019. [PMCID: PMC6808978 DOI: 10.1093/ofid/ofz360.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In November 2014, the University of Illinois Hospital (UI Health) introduced an electronic medical record (EMR)-driven HIV screening program in the emergency department (ED). In October 2016, our hospital laboratory introduced “Fifth-generation” HIV testing using the Bio-Rad BioPlex 2200 HIV Antigen/Antibody diagnostic assay. Fifth-generation HIV testing has the advantage of separately detecting and reporting HIV antibody and HIV-1 p24 antigen. Although the literature and manufacturer report high sensitivity and specificity of this test, we encountered higher than expected rates of false-positive tests during the introduction of this test.
Methods
We retrospectively reviewed the results of our ED HIV screening program from October 2016 to March 2019 to describe the outcomes of HIV testing, determine the rates of false-positive HIV tests and determine if false-positive rates were temporally clustered. We also investigated various potential causes of higher than expected false positives including pre-analytical and analytical error. We defined a false-positive test as a repeatedly reactive initial HIV antigen and/or HIV-1 antibody result with a subsequent negative or indeterminate HIV-1/2 antibody differentiation immunoassay and negative HIV-1 nucleic amplification test.
Results
During the review period, out of a total of 17,385 HIV tests which were performed, 85 tests were confirmed positive and 27 were false positives. This represents an HIV prevalence of 0.5%. Eighteen of the 27 false positives occurred during an 8 month period between October 2016 and April 2017 (see Figure 1). During our investigation of potential causes of the false-positive tests, we discovered that a reagent lot for the test was changed in June 2017 which resulted in a significant decrease in the false-positive rate (0.33% to 0.07%).
Conclusion
We provide data which suggests that a reagent lot may have been the cause of higher than expected false-positive tests for HIV testing. Monitoring of testing outcomes during implementation of a routine HIV testing program can help identify potential root causes of false-positive tests.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Andrew B Trotter
- University of Illinois College of Medicine/UI Health, Chicago, Illinois
| | | | | | - Sara Baghikar
- University of Illinois at Chicago, Chicago, Illinois
| | - Janet Lin
- University of Illinois at Chicago, Chicago, Illinois
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Pandit K, Khanal S, Bhatta S, Trotter AB. Anorectal tuberculosis as a chronic rectal mass mimicking rectal prolapse in a child-a case report. Ann Med Surg (Lond) 2018; 36:264-266. [PMID: 30568795 PMCID: PMC6287574 DOI: 10.1016/j.amsu.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/09/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis of the colon commonly involves the ascending,transverse, or sigmoid colon while rectal involvement in tuberculosis is uncommon and poorly characterized. We report a six-year-old male from Nepal who presented with abdominal pain and difficulty passing stool for two years. On per rectal examination, palpation revealed a circumferential rectal mass. On further evaluation, CT scan showed mural thickening and luminal narrowing in the ano-rectum. Colonoscopy with biopsy showed caseating granuloma and positive acid fast bacilli culture consistent with tuberculosis. After starting anti-tubercular therapy, the patient's abdominal pain resolved and the patient was able to pass stool normally within two weeks. Colonoscopy three months after starting treatment showed complete resolution of the mass. Gastrointestinal tuberculosis should be considered in cases of children from endemic areas who present with a rectal mass. Anorectal tuberculosis is a rare entity which can present as a chronic rectal mass. A high index of suspicion for tuberculosis is necessary in all pediatric patients from TB endemic areas with nonspecific abdominal signs and symptoms. When diagnosed early, with 6–12 months of therapy ano-rectal tuberculosis shows very good prognosis.
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Affiliation(s)
| | | | - Andrew B. Trotter
- *Address correspondence to Andrew B. Trotter, Department of Internal Medicine, Tribhuvan University Teaching Hospital, C/O Dean's Office, Institute of Medicine, P.O. Box 1524, Maharajgunj, Kathmandu, Nepal. E-mail:
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Trotter AB, Hong SY, Srikantiah P, Abeyewickreme I, Bertagnolio S, Jordan MR. Systematic review of HIV drug resistance in Southeast Asia. AIDS Rev 2013; 15:162-170. [PMID: 24002200 PMCID: PMC3955359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In 2010, 3.5 million people were living with HIV in the World Health Organization Southeast Asia Region (SEAR), giving this region the greatest burden of HIV after Africa. Scale-up of antiretroviral therapy has resulted in over 717,000 benefitting from it by the end of 2010. A systematic review of studies of HIV drug resistance in the SEAR published between 2000 and 2011 was performed. Of 10 studies of transmitted HIV drug resistance in recently infected patients, all but two reported low levels (< 5%) of transmitted resistance. Of 23 studies of HIV drug resistance in pretreatment populations initiating antiretroviral therapy, three reported moderate levels (5-15%) of HIV drug resistance and 20 reported low levels. Amongst 17 studies of acquired HIV drug resistance, levels of nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor resistance ranged from 52 to 92% and 43 to 100%, respectively, amongst those with virological failure. Overall, data included in this review suggest that currently recommended first- and second-line regimens are appropriate for the cohorts studied. However, data were only available from two of 11 Southeast Asia Region countries and studies largely examined urban populations. Results are unlikely to be representative of the region. Studies lacked standardized methods, which greatly limits comparability of data and their use for public health and antiretroviral therapy program planning. Routine, standardized, and nationally representative HIV drug resistance surveillance should be strongly encouraged in the Southeast Asia Region countries to best characterize population-level HIV drug resistance. National-level HIV drug resistance surveillance data may be used to optimize delivery of HIV care and treatment and minimize emergence of population-level HIV drug resistance, thus promoting the long-term efficacy and durability of available first- and second-line antiretroviral therapy regimens.
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Affiliation(s)
- Andrew B Trotter
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, USA.
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Hong SY, Jerger L, Jonas A, Badi A, Cohen S, Nachega JB, Parienti JJ, Tang AM, Wanke C, Terrin N, Pereko D, Blom A, Trotter AB, Jordan MR. Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia. PLoS One 2013; 8:e56307. [PMID: 23509605 PMCID: PMC3585291 DOI: 10.1371/journal.pone.0056307] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/09/2013] [Indexed: 11/18/2022] Open
Abstract
The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation. We conducted a cross-sectional survey in HIV-infected adults receiving ART for 6-12 months prior to the adherence assessment. Adherence measures included 30-day VAS, 30-day Likert item, self-reported treatment interruptions, PIT, and MPR. Association of adherence measures with 6-month HIV-1 RNA level was assessed using two thresholds (1000 copies/mL and 5000 copies/mL). Adherence was assessed in 236 patients, mean age 37.3 years, 54% female. Mean adherence was 98.1% by 30-day VAS, 84.7% by 30-day Likert item, 97.0% by self-reported treatment interruptions, 90.6% by PIT, and 98.8% by MPR. Agreement between adherence measures was poor using kappa statistic. 76% had HIV-1 RNA <1000 copies/ml, and 88% had HIV-1 RNA <5000 copies/ml. MPR (continuous) was associated with viral suppression <5000 copies/ml (p = 0.036). MPR <75% was associated with virologic failure at ≥5000 copies/ml with OR 3.89 (1.24, 12.21), p = 0.013. Adherence was high with all measures. Only MPR, was associated with short-term virologic response, suggesting its cross-culturally utility for early identification of patients at high risk for virologic failure.
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Affiliation(s)
- Steven Y. Hong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
| | - Logan Jerger
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Anna Jonas
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Alfons Badi
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Steven Cohen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Jean B. Nachega
- Center for Global Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Centre for Infectious Diseases, Stellenbosch University Faculty of Health Sciences, Cape Town, South Africa
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, University Hospital Center, Caen, France
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Dawn Pereko
- Strengthening Health Outcomes through the Private Sector, Abt Associates Incorporated, Windhoek, Namibia
| | - Abraham Blom
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Andrew B. Trotter
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
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Haese JB, Trotter AB, Flynn RT. Attitudes of stroke patients toward rehabilitation and recovery. Am J Occup Ther 1970; 24:285-9. [PMID: 4315904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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