Abstract
A comparative effectiveness study of two nontargeted human immunodeficiency virus and hepatitis c virus screening algorithms in an urban emergency department
Douglas White, MD, Tamara Todorovic, BS, MPH, Mae Petti, BA, Kaitlin Ellis, BS and Erik Anderson, MD
Alameda Health System - Highland Hospital, Oakland, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
We compare the effectiveness of 2 nontargeted human immunodeficiency virus (HIV) and hepatitis C virus (HCV) screening protocols integrated consecutively into care in an urban emergency department (ED): a nurse order HIV/HCV screening algorithm (NOHA) followed by an automated laboratory order HIV/HCV screening algorithm (ALOHA) programmed into the electronic health record (EHR).
Methods:
This was a before-after comparative effectiveness cohort study. All patients ages 18-75 years who received treatment during 5-month time periods were eligible for participation. The main outcome measures were the number of patients screened and the number newly diagnosed with HIV and HCV infection.
Results:
Of the eligible patients, 6,736 (33.9%) completed HIV screening during ALOHA while 4,121 (19.6%) completed HIV screening during NOHA (difference 14.3%; 95% confidence interval [CI] 13.4% to 15.1%); and 6,972 (35.1%) completed HCV screening during ALOHA while 2,968 (14.2%) completed HCV screening during NOHA (difference 20.9%; 95% CI 20.1% to 21.7%). More patients were newly diagnosed with HIV (23 vs. 17) and HCV infection (101 vs. 29) during ALOHA than NOHA. Results were more often available before discharge (HIV: 87.2% vs. 65.1%; HCV: 90.0% vs. 65.4%) and fewer patients underwent repeat screening (HIV: 1.6% vs. 5.8%; HCV: 1.3% vs. 4.5%) during ALOHA than NOHA.
Conclusion:
An EHR algorithm which automatically links HIV/HCV screening to laboratory ordering for adult patients is more effective than a nurse-driven protocol. With widespread use of EHR systems, this model can be easily replicated and should be considered the standard for future programs.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Protection of the public in relation to communicable diseases including prevention or control Provision of health care to the public
Abstract
Remaining need for human contact to make ehealth programs successful
DeAnne Turner, PhD, MPH1, Elizabeth Lockhart, PhD1, M. Margaret Dolcini, PhD2, Robert Glueckauf, PhD3, Wei Wang, PhD1, Celia M. Lescano, PhD1, Julie Baldwin, PhD4 and Stephanie Marhefka, PhD5
(1)University of South Florida, Tampa, FL, (2)Oregon State University, Corvallis, OR, (3)Florida State University College of Medicine, Tallahassee, FL, (4)Northern Arizona University, Flagstaff, AZ, (5)University of South Florida, College of Public Health, Tampa, FL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: ehealth programs for people living with HIV (PLH) have emerged in both research and practice. An advantage of ehealth programs is the ability to reach a large number of people within a broad geographic range at a low cost; to do this, wide-spread systems for dissemination and implementation are needed.
Methods: In-depth semi-structured interviews were conducted with 24 PLH in the southeastern US. Via structural codes and thematic analysis, key considerations for dissemination and preferred modes of ehealth program dissemination were identified.
Results: When asked about potential avenues for learning about ehealth programs for PLH, most suggested referral from non-technology-based sources (e.g. care team member, group meetings, flyers). Care team staff referrals were the preferred way of learning about ehealth programs – resulting in statements such as “[If my doctor referred me to an ehealth program] I definitely would like it 'cuz she never have told me nothing wrong.“ Although recruitment via social media was considered acceptable, several participants noted that if they saw a flyer or advertisement they would need to confirm its authenticity with a care team member (“Because they put anything [legitimate or not] on Facebook”).
Conclusions: Despite many ehealth programs being conducted online, internet-based advertisement often raised skepticism–leading many participants to confirm programs’ legitimacy through a trusted source. Healthcare staff were deemed reliable referral/confirmation sources regarding ehealth programs, and programs recommended by these professionals were considered likely to be helpful. Dissemination and implementation strategies for care team referral to ehealth programs should be tested.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning Public health or related education Public health or related research Social and behavioral sciences
Abstract
More than just reminders: Improving HIV outcomes for young men who have sex with men (YMSM) through text messaging
Donald Gerke, MSW, PhD1, Maria Freshman, MA2, Jeff Glotfelty, MPH2, Stacey Slovacek, MSW2, Julia Schlueter, MPH2 and Katie Plax, MD2
(1)University of Denver, Denver, CO, (2)Washington University School of Medicine in St. Louis, Saint Louis, MO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Young men of color who have sex with men (YMSM) experience disproportionately high rates of HIV infection. Additionally, once diagnosed, youth fare worse across the HIV care continuum. However, high rates of smartphone access among youth creates opportunities for technology-based interventions for YMSM. Accordingly, we implemented a two-way text-messaging intervention to increase engagement in the care continuum and improve viral suppression (VLS) rates in this high-risk population. The intervention design and preliminary outcomes are reported.
Methods: We recruited HIV positive youth who received care in our program, had access to a private mobile device with texting, and met one additional criteria: newly diagnosed; not linked to care; out of care for at least six months; viral load greater than 200 copies/mL. The texting intervention introduced an automated two-way text message system that included HIV-specific medication and appointment reminders, housing/utilities needs assessment, and mood checks. Any report of client challenges via response to automated texts triggered action alerts to case managers, who were provided smart phones to respond to alerts and maintain monthly communication with client.
Results: 68 youth enrolled and 54 completed 6-month follow-ups. Most participants were male (91%), Black (96%), and YMSM (83%), with an average age of 22.33 (SD=2.08). Approximately 19% (N=10) of participants newly achieved VLS and 35% (N=19) maintained VLS during the first 6 months.
Conclusions: Texting interventions may help improve outcomes, especially VLS, across the HIV care continuum for high-risk youth. Future research should examine intervention effectiveness over time and across diverse settings.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Translating theory into social media practice through the weCare intervention to promote health for young MSM and transgender women with HIV
Amanda Tanner, PhD, MPH1, Eunyoung Y. Song, PhD2, Lilli Mann-Jackson, MPH2, Jorge Alonzo, JD2, Katherine Schafer, MD2, Elias Arellano Hall2, Manuel Garcia2, Jonathan Bell2, Scott Rhodes, PhD, MPH2 and Samuella Ware, MPH, CHES1
(1)University of North Carolina Greensboro, Greensboro, NC, (2)Wake Forest School of Medicine, Winston-Salem, NC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Young racial/ethnic minority men who have sex with men (MSM) and transgender women with HIV often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we implemented weCare, a social media intervention utilizing Facebook, texting, and GPS-based mobile applications (e.g., Adam4Adam/Radar, badoo, Jack’d, SCRUFF, and Grindr) to improve HIV-related care retention and health outcomes.
Methods: We compared viral load suppression and missed clinic appointment attendance among 92 participants during the 12-month period prior to and following weCare implementation. McNemar's chi-square test analyses were conducted comparing the pre- and post-intervention difference using paired data.
Results: Since February 2016, intervention staff and 92 intervention participants (78% African-American, 13% Latino, mean age=25) had 3,694 days of conversation (average: 40.2 days per participant) including 13,606 messages related to: appointment reminders (“saw missed appt-everything ok? call ###-###-#### to reschedule. make sure to ask for a day/time that works for U”), reinforcing positive health behaviors (“great that U took all your meds this week!”), and reducing barriers (“i can connect U to somebody to help with transportation”). There were significant increases in viral load suppression (60.5% vs. 88.9%, p<0.0001) and reductions in missed HIV care appointments (67.1% vs. 52.6%, p=0.04) post-implementation.
Conclusions: Our results highlight the initial success of weCare in improving care engagement and viral suppression. Social media is an important tool, especially for young MSM and transgender women, to support individual- (e.g., viral suppression) and community- (e.g., reduced transmission efficiency) level health.
Implementation of health education strategies, interventions and programs