Riley Hill, Wake County, North Carolina : an action-oriented community diagnosis including secondary data and qualitative data collection

The following is a document describing the qualitative results of an Action Oriented Community Diagnosis (AOCD) in the Riley Hill community of Wake County, North Carolina. Riley Hill is a traditionally rural and African American community bordering the towns of Wendell and Zebulon. The community diagnosis was performed by a graduate student team from the School of Public Health at the University of North Carolina at Chapel Hill from November 2001 to May 2002. The students were assisted with entry into the community by their assigned preceptor, Kimberlee Clifton R.H.Ed., CHES, Teen-Link Program Coordinator for Lincoln Health Community Center Inc. and Riley Hill community member. Qualitative information regarding community strengths and limitations was obtained through interviews and focus groups from service providers and community members conducted in the Riley Hill community. The collected data was then analyzed based upon community perspective, and is presented in the appropriate sections of this document. Following the completion of the AOCD process, the data was presented to a planning committee composed of community members and service providers who assisted in the development of a Community Forum. The Riley Hill community forum was centered on the utilization and initiation of services at the Riley Hill Family Life Center (RHFLC). The Family Life Center is the only resource/recreation center located within the community. The center is currently in the process of addressing many of the issues identified by local residents and service providers. The planning committee, based upon qualitative data obtained from the AOCD process, and input from FLC program directors, decided to focus on the how areas of Education, Recreation, Health, and Job Skill training were addressed by the FLC. The Community Forum took place on May 13th, 2002 at the Riley Hill Family Life Center. The forum contained an initial presentation by the students presenting the AOCD process and the explaining the themes, which would be discussed during the forum. Following this presentation, participants were broken into self-selected groups on the chosen topics. A small group member facilitated each of the small group sessioins. Following the SHOWED method, these groups were intended to elicit information and promote dialogue between community members and service providers regarding the FLC’s role in the community and the application of the chosen themes to currently available or needed services within the Riley Hill community. After completion of the Community Forum, information gathered from participants was assembled and presented to FLC board members and program directors. The results will be used to formulate action steps for the initiation or revitalization of FLC programs, specifically programs addressing the issues identified by forum participants and qualitative AOCD information. In addition to describing the results of the AOCD process, this document details the findings of the Riley Hill community forum and includes several implications resulting from findings from the AOCD process in general, and the interactions between the students and the Riley Hill community.Master of Public Healt

Evaluation of the cost and effectiveness of diverse recruitment methods for a genetic screening study

Purpose: Recruitment of participants from diverse backgrounds is crucial to the generalizability of genetic research, but has proven challenging. We retrospectively evaluated recruitment methods used for a study on return of genetic results. Methods: The costs of study design, development, and participant enrollment were calculated, and the characteristics of the participants enrolled through the seven recruitment methods were examined. Results: A total of 1118 participants provided consent, a blood sample, and questionnaire data. The estimated cost across recruitment methods ranged from $579 to$1666 per participant and required a large recruitment team. Recruitment methods using flyers and staff networks were the most cost-efficient and resulted in the highest completion rate. Targeted sampling that emphasized the importance of Latino/a participation, utilization of translated materials, and in-person recruitments contributed to enrolling a demographically diverse sample. Conclusions: Although all methods were deployed in the same hospital or neighborhood and shared the same staff, each recruitment method was different in terms of cost and characteristics of the enrolled participants, suggesting the importance of carefully choosing the recruitment methods based on the desired composition of the final study sample. This analysis provides information about the effectiveness and cost of different methods to recruit adults for genetic research

Implementation of Birth-Cohort Testing for Hepatitis C Virus

Hepatitis C virus infection affects approximately 2.2 to 3.2 million Americans. In 2012, the Centers for Disease Control and Prevention recommended a one-time antibody test of all persons belonging to the 1945-1965 birth cohort. Efforts to implement this recommendation in clinical settings are in their infancy; this case study report therefore seeks to share the experiences of three sites that implemented interventions to increase birth-cohort testing through participation in the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C. At each site, project managers completed standardized questionnaires about their implementation experiences, and a qualitative analysis was conducted of the responses. The testing interventions used in-person recruitment, mail recruitment, and an electronic health record prompt. Sites reported that early efforts to obtain stakeholder buy-in were critical to effectively implement and sustain interventions and that the intervention required additional staffing resources beyond those being used for risk-based testing. In each case, administrative barriers were more extensive than anticipated. For the electronic health record-based intervention, technological support was critical in achieving study goals. Despite these barriers, interventions in all sites were successful in increasing rates of testing and case identification, although future studies will need to evaluate the relative costs and benefits of each intervention

HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care

INTRODUCTION: Receipt of hepatitis C virus (HCV) RNA testing following a positive HCV antibody (anti-HCV+) test result to establish current infection is a quality indicator for HCV-related care. This study examines HIV infection status as a predictor of HCV RNA test receipt after an anti-HCV+ result in the primary care setting. METHODS: Electronic medical records of anti-HCV+ patients from a multisite retrospective study of patients aged ≥18 years who utilized one or more primary care outpatient services during 2005-2010 were analyzed in 2014. A multivariable logistic regression model examined the independent relationships between patient characteristics and receipt of HCV RNA testing. RESULTS: Among 1,115 anti-HCV+ patients, 133 (11.9%) were also HIV-positive. Of these, 77.4% (n=103) underwent HCV RNA testing to determine current infection status. By contrast, 66.7% (n=654/980) of anti-HCV+ patients who were HIV-negative received HCV RNA testing. Following multivariable adjustment, the odds of receiving HCV RNA testing were higher among anti-HCV+ patients who were also HIV-positive (AOR=1.9, 95% CI=1.2, 3.0), compared with their HIV-negative counterparts. Elevated alanine aminotransferase level was also associated with receipt of HCV RNA testing (AOR=1.9, 95% CI=1.4, 2.4). Black race was associated with decreased odds of receiving HCV RNA testing (AOR=0.7, 95% CI=0.5, 1.0). CONCLUSIONS: HIV infection status is independently associated with the likelihood of receiving HCV RNA testing following an anti-HCV+ result. One quarter of anti-HCV+ patients who were also HIV-positive and one third of their HIV-negative counterparts, respectively, did not receive testing to establish active HCV infection, which is imperative for appropriate care and treatment

Healthy Schools Initiative Paula Hudson Collins, MHDL, R.H.Ed., Senior Advisory for Healthy Schools Contributing Authors

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Characteristics of patients tested for hepatitis C and intervention costs in the best-C study

Given that 80% of Hepatitis C virus (HCV)-infected Americans were born during the years 1945-1965, the Centers for Dis-ease Control and Prevention (CDC) and the U.S Preventive Services Task Force recommended a one-time HCV antibody test for adults born in the 1945-1965 birth cohort (BC). CDC’s Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C was designed to assess the impact of testing interventions on the probability of HCV testing in primary care (PC) among BC patients as compared to usual care and the incremental costs per person tested and per case identified at each site. From December 2012-March 2014, 3 health systems implemented independent testing interventions using randomized designs to compare intervention testing and identification rates to usual care. Site 1 mailed paid lab test orders and repeated reminders to a randomly selected list of active patients compared to a second list who received no mailings. Site 2 created an electronic health record best practice alert (BPA) implemented or not implemented based on cluster randomized design. Site 3 directly solicited patients following a scheduled PC visit and used a cluster randomized crossover design. Multilevel multivariable regression was used to estimate the risk ratio for HCV testing; activity-based costing was used to estimate costs. HCV testing was significantly more common for all interventions compared to controls; adjusted risk ratio (aRR) 19.2, (95% CI, 9.7–38.2), 13.2 (95% CI, 3.6–48.6), and 32.9 (95% CI 19.3–56.1) for sites 1, 2, and 3, respectively. The BPA intervention had the lowest incremental cost per person tested ($25 with fixed startup costs,$3 without startup costs). The incremental cost per new case identified under usual care ranged from $3,771-$6207 across sites. All interventions increased HCV testing among the BC compared to usual care, but also increased the costs. The cost per case identified excluding startup costs was lowest for the BPA intervention ($1,691), suggesting that integrating BC testing into usual care is likely to be more cost-effective than instituting an intervention in addition to usual care, e.g., repeated-mailings and patient-solicitation

Hepatitis C virus testing for case identification in persons born during 1945-1965: Results from three randomized controlled trials

The Centers for Disease Control and Prevention and US Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born during 1945-1965 (birth cohort). However, few studies estimate the effect of birth cohort (BC) testing implementation on HCV diagnoses in primary care settings. We aimed to determine the probability of identifying HCV infections in primary care using targeted BC testing compared with usual care at three academic medical centers. From December 2012 to March 2014, each center compared one of three distinct interventions with usual care using an independently designed randomized controlled trial. Across centers, BC patients with no clinical documentation of previous HCV testing or diagnosis were randomly assigned to receive a one-time offering of HCV antibody (anti-HCV) testing via one of three independent implementation strategies (repeated-mailing outreach, electronic medical record-integrated provider best practice alert [BPA], and direct patient solicitation) or assigned to receive usual care. We estimated model-adjusted risk ratios (aRR) of anti-HCV-positive (anti-HCV+) identification using BC testing versus usual care. In the repeated mailing trial, 8992 patients (intervention, n = 2993; control, n = 5999) were included in the analysis. The intervention was eight times as likely to identify anti-HCV+ patients compared with controls (aRR, 8.0; 95% confidence interval [CI], 2.8-23.0; adjusted probabilities: intervention, 0.27%; control, 0.03%). In the BPA trial, data from 14,475 patients (BC, n = 8928; control, n = 5,547) were analyzed. The intervention was 2.6 times as likely to identify anti-HCV+ patients versus controls (aRR, 2.6; 95% CI, 1.1-6.4; adjusted probabilities: intervention, 0.29%; control, 0.11%). In the patient-solicitation trial, 8873 patients (BC, n = 4307; control, n = 4566) were analyzed. The intervention was five times as likely to identify anti-HCV+ patients compared with controls (aRR, 5.3; 95% CI, 2.3-12.3; adjusted probabilities: intervention, 0.68%; control, 0.11%). Conclusion: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. (Hepatology 2018;67:524-533)

Hepatitis C virus testing for case identification in persons born during 1945-1965: Results from three randomized controlled trials

The Centers for Disease Control and Prevention and US Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born during 1945-1965 (birth cohort). However, few studies estimate the effect of birth cohort (BC) testing implementation on HCV diagnoses in primary care settings. We aimed to determine the probability of identifying HCV infections in primary care using targeted BC testing compared with usual care at three academic medical centers. From December 2012 to March 2014, each center compared one of three distinct interventions with usual care using an independently designed randomized controlled trial. Across centers, BC patients with no clinical documentation of previous HCV testing or diagnosis were randomly assigned to receive a one-time offering of HCV antibody (anti-HCV) testing via one of three independent implementation strategies (repeated-mailing outreach, electronic medical record-integrated provider best practice alert [BPA], and direct patient solicitation) or assigned to receive usual care. We estimated model-adjusted risk ratios (aRR) of anti-HCV-positive (anti-HCV+) identification using BC testing versus usual care. In the repeated mailing trial, 8992 patients (intervention, n = 2993; control, n = 5999) were included in the analysis. The intervention was eight times as likely to identify anti-HCV+ patients compared with controls (aRR, 8.0; 95% confidence interval [CI], 2.8-23.0; adjusted probabilities: intervention, 0.27%; control, 0.03%). In the BPA trial, data from 14,475 patients (BC, n = 8928; control, n = 5,547) were analyzed. The intervention was 2.6 times as likely to identify anti-HCV+ patients versus controls (aRR, 2.6; 95% CI, 1.1-6.4; adjusted probabilities: intervention, 0.29%; control, 0.11%). In the patient-solicitation trial, 8873 patients (BC, n = 4307; control, n = 4566) were analyzed. The intervention was five times as likely to identify anti-HCV+ patients compared with controls (aRR, 5.3; 95% CI, 2.3-12.3; adjusted probabilities: intervention, 0.68%; control, 0.11%). CONCLUSION: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. (Hepatology 2017)

Stellaria media (L.) Vill. (BR0000010100424)

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Hepatitis C care cascade among persons born 1945-1965: 3 medical centers

OBJECTIVES: Effective screening, diagnosis, and treatment are needed to reduce chronic hepatitis C virus (HCV) infection-associated morbidity and mortality. In order to successfully increase HCV treatment, it is necessary to identify and understand gaps in linkage of antibody-positive patients with newly identified HCV to subsequent HCV RNA testing, clinical evaluation, and treatment. STUDY DESIGN: To estimate attainment of HCV care cascade steps among antibody-positive patients with newly identified HCV, we conducted chart reviews of patients with a new positive HCV antibody test at 3 academic medical centers participating in the Birth-Cohort Evaluation to Advance Screening and Testing of Hepatitis C (BEST-C) study. METHODS: We tracked receipt of RNA testing, clinical evaluation, treatment initiation, and treatment completion among individuals born between 1945 and 1965 who were newly diagnosed as HCV antibody-positive between December 2012 and October 2015 at 3 BEST-C centers, predominantly from the participating medical centers\u27 primary care practices and emergency departments. RESULTS: Of the 130 HCV-seropositive individuals identified, 118 (91%) had an RNA or genotype test, 75 (58%) were RNA-positive, 73 (56%) were linked to care, 22 (17% overall; 29% among RNA-positive) started treatment, and 21 (16%; 28% among RNA-positive) completed treatment. CONCLUSIONS: This analysis showed that although linkage to care was largely successful in the target birth cohort, the largest gap in the HCV care cascade was seen in initiating treatment. Greater emphasis on linking patients to clinical evaluation and treatment is necessary in order to achieve the public health benefits promised by birth-cohort testing