Using surveillance data to monitor entry into care of newly diagnosed HIV-infected persons: San Francisco, 2006–2007

<p>Abstract</p> <p>Background</p> <p>Linkage to care after HIV diagnosis is associated with both clinical and public health benefits. However, ensuring and monitoring linkage to care by public health departments has proved to be a difficult task. Here, we report the usefulness of routine monitoring of CD4 T cell counts and plasma HIV viral load as measures of entry into care after HIV diagnosis.</p> <p>Methods</p> <p>Since July 1, 2006, the San Francisco Department of Public Health (SFDPH) incorporated monitoring initial primary care visit into standard HIV public health investigation for newly diagnosed HIV-infected patients in select clinics. Entry into care was defined as having at least one visit to a primary HIV care provider after the initial diagnosis of HIV infection. Investigators collected reports from patients, medical providers, laboratories and reviewed medical records to determine the date of the initial health care visit after HIV diagnosis. We identified factors associated with increased likelihood of entering care after HIV diagnosis.</p> <p>Results</p> <p>One -hundred and sixty new HIV-infected cases were diagnosed between July 1, 2006 and June 30, 2007. Routine surveillance methods found that 101 of those cases entered HIV medical care and monitoring of CD4 T cell counts and plasma HIV viral load confirmed entry to care of 25 more cases, representing a 25% increase over routine data collection methods. We found that being interviewed by a public health investigator was associated with higher odds of entry into care after HIV diagnosis (OR 18.86 [1.83–194.80], p = .001) compared to cases not interviewed. Also, HIV diagnosis at the San Francisco county hospital versus diagnosis at the county municipal STD clinic was associated with higher odds of entry into care (OR 101.71 [5.29–1952.05], p < .001).</p> <p>Conclusion</p> <p>The time from HIV diagnosis to initial CD4 T cell count, CD4 T cell value and HIV viral load testing may be appropriate surveillance measures for evaluating entry into care, as well as performance outcomes for local public health departments' HIV testing programs. Case investigation performed by the public health department or case management by clinic staff was associated with increased and shorter time to entry into HIV medical care.</p

Bodyweight Perceptions among Texas Women: The Effects of Religion, Race/Ethnicity, and Citizenship Status

Despite previous work exploring linkages between religious participation and health, little research has looked at the role of religion in affecting bodyweight perceptions. Using the theoretical model developed by Levin et al. (Sociol Q 36(1):157–173, 1995) on the multidimensionality of religious participation, we develop several hypotheses and test them by using data from the 2004 Survey of Texas Adults. We estimate multinomial logistic regression models to determine the relative risk of women perceiving themselves as overweight. Results indicate that religious attendance lowers risk of women perceiving themselves as very overweight. Citizenship status was an important factor for Latinas, with noncitizens being less likely to see themselves as overweight. We also test interaction effects between religion and race. Religious attendance and prayer have a moderating effect among Latina non-citizens so that among these women, attendance and prayer intensify perceptions of feeling less overweight when compared to their white counterparts. Among African American women, the effect of increased church attendance leads to perceptions of being overweight. Prayer is also a correlate of overweight perceptions but only among African American women. We close with a discussion that highlights key implications from our findings, note study limitations, and several promising avenues for future research

HIV Partner Notification Outcomes for HIV-infected Patients by Duration of Infection, San Francisco, 2004 to 2006

Background: The San Francisco Department of Public Health conducts HIV third-party partner notification in the following populations based on standard Centers for Disease Control and Prevention (CDC) guidelines: (1) persons with acute and nonacute incident HIV infection tested at the municipal sexually transmitted disease (STD) clinic and the county hospital and (2) all county residents with early syphilis and long-standing HIV infection. Methods: We reviewed routinely collected demographic and partner notification outcome data among acute and nonacute cases between 2004 and 2006 and among long-standing cases between July 2005 and December 2006. Outcomes were examined among the 3 case types. Results: Most acute (n = 30), nonacute (n = 398), and long-standing cases (n = 335) occurred in gay/bisexual men (89%), and most case-patients were interviewed (80%). In acute and nonacute cases, 13% of partners tested for HIV were newly identified as HIV-infected. The number of patients interviewed per new HIV infection identified was 25 for acute cases, 21 for nonacute cases, and 39 for long-standing cases; however, half of recent new HIV infections were identified among partners of long-standing patients. Few patients or partners refused partner notification services. Conclusions: Partner notification was acceptable and successfully identified new HIV infections. Other jurisdictions should consider implementing or expanding partner notification for HIV infection. More evaluation is needed of the effectiveness of partner notification among HIV-infected persons with other STDs

The Oxford Royal College of General Practitioners clinical informatics digital hub: Protocol to develop extended COVID-19 surveillance and trial platforms

Background: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects with the anticipation they could be used to support rapid, lower cost clinical trials. Much larger numbers of general practices are required to deliver effective surveillance and in-pandemic trials, given the partial national lockdown has resulted in falling community disease incidence. Objective: To describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital (ORCHID) Hub, and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform will be a streamlined clinical trials platform integrated into routine primary care practice. Methods: We will apply the FAIR (Findable, Accessible, Interoperable and Reusable) metadata principles to a new, unique, integrated digital health hub, combining routinely collected electronic health date from UK general practice. The hub will be findable through membership of Health Data Research UK and European metadata repositories. Accessibility through an online application system will allow study-ready datasets to be accessed or custom datasets developed. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymised data. All semantic descriptors (i.e. ontologies) and code used for analysis will be made shareable, to accelerate analyses. We will also make data available using common data models starting with the FDA Sentinel and OMOP approaches to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorised through agreements between Oxford, the Royal College of General Practitioners and by Public Health England. All studies using the Trials Platform will have gone through appropriate ethical and other regulatory approval. Results: The hub will be a bottom-up, professionally led network ensuring benefits for member practices, our health service and the population served. Data will only be used for SQuIRE (surveillance, quality improvement, research and education) purposes. There has already been a positive response from practices and the number in the network has doubled since February to over 1,150. COVID-19 Surveillance has delivered a trebling of virology sites to 293 (target 300), helping collect the largest ever weekly total of surveillance swabs in the UK as well as over 3,000 SARS-CoV-2 serology samples. Practices are recruiting to the PRINCIPLE trial and follow-up of these participants will take place through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national, digital health hub. Conclusions: ORCHID will deliver equitable and innovative use of big data, through a professionally-led national primary care network and the application of FAIR principles. The unique and secure data hub will host routinely collected general practice data linked to other key healthcare repositories. ORCHID will support rapid data extraction, analysis and dissemination with the aim of improving future research and development in general practice to positively impact upon patient care