The Effect of Student-Run Vision Screenings on Ophthalmic Education and Recognition of Visual Impairment

Objective: For many in the United States, standard health insurance does not cover eyecare, leading to lapses in care and exacerbations of pre-existing conditions. Touro College of Osteopathic Medicine (TouroCOM) recognizes the importance of ocular health and offers the opportunity to engage the community through student-run vision screenings. This study aims to assess the effect of medical student-run vision screenings in supplementing pre-clinical education and to review health fair data on common vision pathologies seen in Harlem, New York.Methods: Pre- and post-surveys were administered to medical student volunteers to assess their comfort in performing a basic vision screening. Training was given in regards to screening protocols and applied at health fairs.Results: 90% of medical students (n=20) indicated discomfort in performing a basic vision screening when solely relying on their preclinical coursework. In comparison, after a training session and use during a health fair, 100% (n=20) indicated that they were comfortable with performing a vision screening.  60% of health fair participants (n=193) met referral criteria in requiring further testing or follow-up care. 100% of participants had some degree of refractive error, with 6% (n=7) having concomitant color vision abnormality and 9% (n=11) with macular abnormalities.Conclusion: Osteopathic medical students are better equipped to perform basic vision screenings and recognize visual disease with additional training and practice at health fairs. This engagement allows for early clinical experience, osteopathic outreach, and interprofessionalism. Furthermore, this provides an opportunity for community members to receive information that may guide future health decisions

Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

International audienceBackgroundSafety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.ObjectivesTo describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.MethodsIn the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.ResultsAmong 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.ConclusionsIn virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes