Piper Duarte

Extragenital Testing for Neisseria gonorrhoeae and Chlamydia trachomatis in a Large HIV Clinic in the US South: Implementation and Epidemiology

Sexually Transmitted Diseases, Jan 11, 2021

BACKGROUND Rectal and oral N. gonorrhoeae (GC) and C. trachomatis (CT) infections are common amon... more BACKGROUND Rectal and oral N. gonorrhoeae (GC) and C. trachomatis (CT) infections are common among people with HIV, especially men who have sex with men (MSM), however, GC/CT testing rates remain low in many HIV clinics. We evaluated the real-world implementation and results of extra-genital nucleic acid amplification testing (NAAT) for GC/CT in an urban HIV clinic. METHODS Electronic health records were reviewed for all patients ≥18 years old with ≥ 1 outpatient visit to an HIV clinic in Dallas, TX from February 2016 to May 2019. Extra-genital NAAT testing became available in February 2017, which was followed by active interventions to increase testing. RESULTS Overall, 5,564 individual patients were included in the pre-intervention period (2/2016-1/2017), 5,067 in the intervention period (2/2017-8/2017) and 7,030 in the post-intervention period (9/2017-5/2018). Tailored education was provided to patients, nursing and medical providers and a self-collection protocol implemented beginning in spring 2017. A sustained increase in extra-genital GC/CT testing among MSM patients, from 70% to 87% (p < 0.1), was observed. Among MSM, overall GC positivity increased from 3.2% to 8.5% and CT positivity increased from 3.9% to 8.3%. GC/CT infections were highest among young (<35) MSM and approximately 50% of GC/CT infections diagnosed were detected by oral and rectal tests. CONCLUSIONS Clinic-wide education and self-collection of extra-genital specimens was associated with increased GC/CT testing and detection in a large HIV clinic.

Extragenital Testing for Neisseria gonorrhoeae and Chlamydia trachomatis in a Large HIV Clinic in the US South: Implementation and Epidemiology

Sexually Transmitted Diseases, 2021

BACKGROUND Rectal and oral N. gonorrhoeae (GC) and C. trachomatis (CT) infections are common amon... more BACKGROUND Rectal and oral N. gonorrhoeae (GC) and C. trachomatis (CT) infections are common among people with HIV, especially men who have sex with men (MSM), however, GC/CT testing rates remain low in many HIV clinics. We evaluated the real-world implementation and results of extra-genital nucleic acid amplification testing (NAAT) for GC/CT in an urban HIV clinic. METHODS Electronic health records were reviewed for all patients ≥18 years old with ≥ 1 outpatient visit to an HIV clinic in Dallas, TX from February 2016 to May 2019. Extra-genital NAAT testing became available in February 2017, which was followed by active interventions to increase testing. RESULTS Overall, 5,564 individual patients were included in the pre-intervention period (2/2016-1/2017), 5,067 in the intervention period (2/2017-8/2017) and 7,030 in the post-intervention period (9/2017-5/2018). Tailored education was provided to patients, nursing and medical providers and a self-collection protocol implemented beginning in spring 2017. A sustained increase in extra-genital GC/CT testing among MSM patients, from 70% to 87% (p < 0.1), was observed. Among MSM, overall GC positivity increased from 3.2% to 8.5% and CT positivity increased from 3.9% to 8.3%. GC/CT infections were highest among young (<35) MSM and approximately 50% of GC/CT infections diagnosed were detected by oral and rectal tests. CONCLUSIONS Clinic-wide education and self-collection of extra-genital specimens was associated with increased GC/CT testing and detection in a large HIV clinic.

Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

AIDS Patient Care and STDs, 2015

Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected indiv... more Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4-14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population.

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The risk of depression among racially diverse people living with HIV: the impact of HIV viral suppression

AIDS Care, 2020

ABSTRACT Understanding the correlates of depression in HIV patients can help identify groups whos... more ABSTRACT Understanding the correlates of depression in HIV patients can help identify groups whose members are at increased risk for depression. We conducted a cross-sectional retrospective study among racially diverse, indigent patients living with HIV (PLWH) who were obtaining care in an urban safety-net hospital system and had completed a Patient Health Questionnaire-9 (PHQ-9) in 2014 or 2015. We collected demographics, HIV risk factors, HIV viral loads, CD4 counts, missed visits, and emergency department (ED) visits. Data from the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) were abstracted. Missing data on substance use and CD4 cell counts were imputed to examine the odds of depression (PHQ-9 ≥ 10) by multivariable analysis for a complete case and sensitivity analysis. Stratified analysis by HIV viral suppression (VS) was used to determine the odds of depression among subgroups. Of the 5126 HIV patients (70.8% male,56.3% Black, 44.6% MSM, 6.0% IDU), 1271 (24.8%) experienced depression (PHQ ≥ 10). In a multivariable logistic model female gender, White race, injection drug use (IDU) or men who have sex with men (MSM) as an HIV risk factor, making ≥1 ED visit, having missed any HIV visit, having AIDS, and having a positive drug screen by SAMISS increased the odds for depression. Those who had achieved HIV VS or received efavirenz had lower odds of depression. Even among those with AIDS, those failing to achieve VS were at increased odds for depression, whereas those achieving VS were not. Moderate to severe depression is prevalent among PLWH. Among those with AIDS, HIV VS modifies the odds of depression.

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