Impact of Behavioral Health Consultation on Hepatitis C Treatment Outcomes at a Federally Qualified Health Center; Philadelphia, PA

Hepatitis C virus (HCV) infection is a public health issue that claims the lives of 350,000 individuals globally every year. Primary care providers are increasingly prescribing HCV medications with more modern, simplified administrations. Individuals with HCV are disproportionately affected by behavioral health challenges and substance use disorders. Integrated behavioral health providers can work in concert with their patients' primary care teams to provide innovative treatment programs to help support the needs of HCV care. We used simple and multivariable logistic regression to determine the association between receipt of behavioral health consultation and two outcomes on the care continuum: insurance approval for treatment and initiated HCV treatment regimen. These models were fitted using theoretically hypothesized variables and multivariable regression models included age, sex, and race/ethnicity as potential confounders. From January 2015 to May 2017, 189 patients at health centers were referred for onsite HCV primary care treatment. Of these, 142 were approved for participation, and 132 started treatment. Simple regression revealed a significant association between behavioral health consultation and treatment approval; however, behavioral health consultation was non-significant in the multivariable model for treatment approval. For initiating HCV treatment, onsite behavioral health consultation was significantly associated in both the unadjusted and adjusted regression models. Integrating behavioral health services for patients seeking HCV treatment may improve movement across the care continuum, optimizing patient's HCV health outcomes. Behavioral health consultation in primary care settings should be studied further to improve HCV treatment outcomes for patients with behavioral health and substance use disorders

Integration of Hepatitis C Treatment in a Primary care Federally Qualified Health Center; Philadelphia, Pennsylvania, 2015-2017

Hepatitis C virus (HCV) infection remains a pressing public health issue. Identification of long term infection in primary care settings and community health centers can facilitate patients’ access to appropriate care. Given the increase in HCV prevalence in the United States, improving the HCV care continuum and expanding medication access to disproportionately affected populations can help reduce disease burden, health care system costs, and transmission. Innovative treatment programs developed in the primary care setting are needed to deliver quality care to meet the demand of those engaging in treatment. This article describes an HCV treatment program developed within a primary care federally qualified health center (FQHC) using physician assistants (PAs) and nurse practitioners (NPs) to address the high number of HCV positive patients identified at the clinic. An interdisciplinary care team was established to optimize patient experience around HCV care and treatment, using on-site primary care behavioral health consultants, an HCV treatment coordinator, and a 340B contracted specialty pharmacy. From January 2015 to April 2017, the Public Health Management Corporation (PHMC) Care Clinic medical providers referred 189 patients for HCV treatment. Of those referred, 102 patients successfully obtained a sustained virologic response (SVR), representing a 53.7% success rate from referral to cure. This treatment program successfully integrated HCV treatment in a patient population heavily affected by substance use and mental illness. Support and adoption of similar programs in primary care community health centers testing for HCV can help meet the clinical/behavioral needs of these marginalized populations

Racial Disparities in Mortality Among American Film Celebrities: A Wikipedia-Based Retrospective Cohort Study

In the United States, well-documented racial disparities in health outcomes are frequently attributed to racial bias and socioeconomic inequalities. However, it remains unknown whether racial disparities in mortality persist among those with higher socioeconomic status (SES) and occupational prestige. As the celebrity population is generally characterized by high levels of SES and occupational prestige, this study aimed to examine survival differences between black and white film celebrities. Using a Web-based, open-source encyclopedia (ie, Wikipedia), data for 5829 entries of randomly selected American film actors and actresses born between 1900 and 2000 were extracted. A Kaplan-Meier survival curve was conducted using 4356 entries to compare the difference in survival by race. A Cox semiparametric regression analysis examined whether adjusting for year of birth, gender, and cause of death influenced differences in survival by race. Most celebrities were non-Hispanic white (3847/4352, 88.4%), male (3565/4352, 81.9%), and born in the United States (4187/4352, 96.2%). Mean age at death for black celebrities (64.1; 95% CI 60.6-67.5 years) was 6.4 years shorter than that for white celebrities (70.5; 95% CI 69.6-71.4 years; P<.001). Black celebrities had a faster all-cause mortality rate using Kaplan-Meier survival function estimates and a log-rank test. However, in a Cox semiparametric regression, there was no longer a significant difference in survival times between black and white celebrities (hazard ratio 1.07; 95% CI 0.87-1.31). There is some evidence that racial disparities in all-cause mortality may persist at higher levels of SES, but this association was no longer significant in adjusted analyses. Further research is needed to examine if racial disparities in mortality are diminished at higher levels of SES among more representative populations

Psychosocial Correlates of Monocyte Activation and HIV persistence in Methamphetamine Users

This cross-sectional study investigated the associations of psychosocial factors relevant to recovery from substance use disorders with monocyte activation and HIV persistence in a sample of 84 HIV-positive, methamphetamine-using sexual minority men with undetectable HIV viral load (<40 copies/mL). We examined if psychosocial factors were associated with decreased soluble CD14 (sCD14) and lower proviral HIV DNA. Multiple linear regression models adjusted for age, anti-retroviral therapy regimen, and CD4+ T-cell count. Time on ART was also included in models examining proviral HIV DNA. Greater self-efficacy for managing methamphetamine triggers and higher social support for abstinence were independently associated with lower sCD14. Greater social support for abstinence was also independently associated with lower proviral HIV DNA. Psychosocial factors relevant to recovery from substance use disorders are associated with lower monocyte activation and decreased proviral HIV DNA. Findings underscore the need for longitudinal research to identify plausible mechanisms linking psychosocial factors and substance use with biological processes relevant to HIV pathogenesis