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Irvin R, McAdams-Mahmoud A, Hickman D, Wilson J, Fenwick W, Chen I, Irvin N, Falade-Nwulia O, Sulkowski M, Chaisson R, Thomas DL, Mehta SH. Building a Community - Academic Partnership to Enhance Hepatitis C Virus Screening. J Community Med Health Educ 2016; 6:431. [PMID: 27525192 PMCID: PMC4982512 DOI: 10.4172/2161-0711.1000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND An estimated 3.5 million Americans are chronically infected with hepatitis C virus (HCV). However, the majority are unaware of their HCV diagnosis and few are treated. New models are required to diagnose and link HCV infected patients to HCV care. This paper describes an innovative partnership between Sisters Together and Reaching (STAR), Inc., a community organization, and Johns Hopkins University (JHU), an academic institution, for the identification of HCV cases. METHODS STAR and JHU identified a mutual interest in increasing hepatitis C screening efforts and launched an HCV screening program which was designed to enhance STAR's existing HIV efforts. STAR and JHU used the Bergen Model of Collaborative Functioning as theoretical framework for the partnership. We used descriptive statistics to characterize the study population and correlates of HCV antibody positivity were reported in univariable/multivariable logistic regression. RESULTS From July 2014 to June 2015, 325 rapid HCV antibody tests were performed in community settings with 49 (15%) positive HCV antibody tests. 33 of the 49 HCV antibody positive individuals answered questions about their HCV testing history and 42% reported a prior positive result but were not engaged in care and 58% reported that they were unaware of their HCV status. In multivariable analysis, factors that were significantly associated with screening HCV antibody positive were increasing age (AOR: 1.06, 95% CI 1.02-1.10), male sex (AOR: 5.56, 95% CI 1.92-14.29), and history of injection drug use (AOR: 39.3, 95% CI 15.20-101.49). CONCLUSIONS The community-academic partnership was successful in identifying individuals with hepatitis C infection through a synergistic collaboration. The program data suggests that community screening may improve the hepatitis C care continuum by identifying individuals unaware of their HCV status or aware of their HCV status but not engaged in care and linking them to care.
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Affiliation(s)
- R Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A McAdams-Mahmoud
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Hickman
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - J Wilson
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - W Fenwick
- Sisters Together and Reaching, Incorporated, Baltimore, MD, USA
| | - I Chen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Irvin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Chaisson
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - DL Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - SH Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Salvo F, Dorjee K, Dierberg K, Cronin W, Sadutshang TD, Migliori GB, Rodrigues C, Trentini F, Di Serio C, Chaisson R, Cirillo DM. Survey of tuberculosis drug resistance among Tibetan refugees in India. Int J Tuberc Lung Dis 2015; 18:655-62. [PMID: 24903934 DOI: 10.5588/ijtld.13.0516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking. OBJECTIVE To determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients. DESIGN In a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates. RESULTS Of 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB. CONCLUSIONS MDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both.
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Affiliation(s)
- F Salvo
- Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - K Dorjee
- Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
| | - K Dierberg
- Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W Cronin
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - T D Sadutshang
- Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
| | - G B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy
| | - C Rodrigues
- Department of Microbiology, Parmanand Deepchand Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - F Trentini
- University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - C Di Serio
- University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - R Chaisson
- Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D M Cirillo
- Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
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Aguiar F, Vieira MA, Staviack A, Buarque C, Marsico A, Fonseca L, Chaisson R, Kristski A, Werneck G, Mello F. Prevalence of anti-tuberculosis drug resistance in an HIV/AIDS reference hospital in Rio de Janeiro, Brazil. Int J Tuberc Lung Dis 2009; 13:54-61. [PMID: 19105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING A reference hospital for tuberculosis (TB) and human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) with a TB control programme in Rio de Janeiro, Brazil. OBJECTIVE To estimate the prevalence of resistance to anti-tuberculosis drugs and to identify associated factors. DESIGN In a cross-sectional study, clinical and laboratory data were collected retrospectively from 2001 to 2005. Patients with isolation of Mycobacterium tuberculosis and available drug susceptibility tests were considered eligible. Data on demographic characteristics, risk factors for resistance, HIV serology and past TB history were collected and analysed by chi(2) Mann-Whitney test and Poisson regression. RESULTS We analysed 350 treatments, of which 62 were for patients with previous TB. HIV status was positive in 31.2% of cases. Resistance was found in 15.7% and multidrug resistance (MDR) in 4.3% of cases. Previous treatment (P < 0.001) and relapse within 2 years were associated with resistance (P < 0.03). Pulmonary cavities were associated with MDR (P < 0.001). Homelessness was associated with any resistance in newly diagnosed patients (P < 0.01). Working in a hospital was not associated with resistance. CONCLUSION Suspicion of drug-resistant disease is necessary in patients with a history of previous TB in hospitals in Rio de Janeiro. The implementation of an effective hospital TB control programme can prevent transmission even in high TB prevalence settings.
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Affiliation(s)
- F Aguiar
- Instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho Hospital (CFFH), Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
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Miller AC, Soares E, Fonseca Z, Cavalcante S, Durovni B, Moulton L, Chaisson R, Golub J. Care-Seeking Behavior for Respiratory Symptoms in a Brazilian Favela (SLUM). Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s35-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wilson D, Nachega J, Morroni C, Chaisson R, Maartens G. Diagnosing smear-negative tuberculosis using case definitions and treatment response in HIV-infected adults. Int J Tuberc Lung Dis 2006; 10:31-8. [PMID: 16466034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To assess the diagnostic utility of expanded case definitions for HIV-associated smear-negative pulmonary tuberculosis (PTB) and extra-pulmonary TB (EPTB), and to derive objective criteria for response to anti-tuberculosis treatment. DESIGN A prospective cohort study of HIV-infected adults who met expanded clinical case definitions for smear-negative PTB and EPTB. METHODS All participants were started on rifampicin-based anti-tuberculosis treatment after mycobacterial cultures from multiple sites. At weeks 2, 4 and 8, response to treatment (RTT) was assessed by measuring changes in weight, haemoglobin, C-reactive protein, Karnofsky performance score and symptom count ratio. RESULTS Of 147 participants enrolled, 105 (71%) were diagnosed with definite (culture-positive) or probable (histological features) TB and 25 (17%) with possible TB (treatment response). The positive predictive value for the most common case definitions ranged from 89% to 96%. Significant improvements in all the RTT parameters occurred in the subjects with confirmed TB (P < 0.001). Clinically relevant RTT criteria were derived, two or more of which were met at week 8 in 97.5% of subjects with confirmed TB, 91.3% of subjects with possible TB and none of the subjects without TB. CONCLUSION Expanded case definitions could enhance the diagnosis of PTB and EPTB in HIV-infected adults in resource-limited settings. Using objective criteria, RTT can be assessed within 8 weeks of initiating anti-tuberculosis treatment.
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Affiliation(s)
- D Wilson
- Department of Medicine, Division of Infectious Diseases, University of Cape Town, Cape Town, South Africa
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Nuermberger E, Yoshimatsu T, Tyagi S, Chaisson R, Bishai W, Grosset J. 288 Extrême efficacité du traitement de la tuberculose murine par la moxifloxacine (M). Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Halsey NA, Coberly J, Chaisson R. Prevention of tuberculosis in HIV-1. Lancet 1998; 352:742. [PMID: 9729026 DOI: 10.1016/s0140-6736(05)60866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- A C Gielen
- Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
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Chaisson R. Clarithromycin is effective against M. avium complex in AIDS. Am Fam Physician 1992; 46:1784. [PMID: 1456199] [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: 12/27/2022]
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Galai N, Graham N, Chaisson R, Nelson KE, Vlahov D, Lewis J. Multidrug-resistant tuberculosis. N Engl J Med 1992; 327:1172-3; author reply 1174. [PMID: 1528219] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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O'Campo P, de Boer MA, Faden RR, Gielen AC, Kass N, Chaisson R. Discrepancies between women's personal interview data and medical record documentation of illicit drug use, sexually transmitted diseases, and HIV infection. Med Care 1992; 30:965-71. [PMID: 1405802 DOI: 10.1097/00005650-199210000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- P O'Campo
- Department of Maternal and Child Health, John Hopkins School of Hygiene and Public Health, Baltimore, MD
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Feigal E, Murphy E, Vranizan K, Bacchetti P, Chaisson R, Drummond JE, Blattner W, McGrath M, Greenspan J, Moss A. Human T cell lymphotropic virus types I and II in intravenous drug users in San Francisco: risk factors associated with seropositivity. J Infect Dis 1991; 164:36-42. [PMID: 2056217 DOI: 10.1093/infdis/164.1.36] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Serologic assays for human T cell lymphotropic virus types I and II (HTLV I/II) infection were done in 676 intravenous drug users (IVDUs) in San Francisco between 1985 and 1987: 150 in 1985, 44 in 1986, and 482 in 1987. All sera were tested by Western blot, ELISA, and p24 RIA. A total of 111 participants were seropositive in a minimum of two assays. Duration of intravenous heroin use was strongly associated with the risk of HTLV I/II seropositivity: greater than or equal to 21 years odds ratio, 6.1 (95% confidence interval [CI], 2.2-17.5), compared with less than 10 years of heroin use. Additional independent risk factors included black or Hispanic race, female sex, and the use of drugs in a shooting gallery. Coinfection of HTLV I/II and human immunodeficiency virus was less frequent than expected by chance (P less than .02). Longitudinal specimens were available in 154 participants. The age- and race-adjusted seroconversion rate was 3.4% (95% CI, 1.3-8.9) per person per year. Of the 349 homosexual men tested, none were HTLV I/II-seropositive.
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Affiliation(s)
- E Feigal
- Department of Internal Medicine, University of California, San Diego 92103
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