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A US-Based Multi-Site Pilot to Screen Hepatitis B Surface Antigen-Positive Patients for Hepatitis D

Li, Maggie; Hunt, Bijou; Balani, Bindu; Ogedegbe, Chinwe; Gordon, Peter; Hayden, Joshua; Glick, Nancy; Chang, Anita; Wang, Su; Caponi, Mitchell; Yarber-Cambron, Lisa; Bhat, Sandeep; Ward, Tyshea; Suryadevara, Madhu
Hepatitis D (HDV) is a severe infection with well-recognised clinical ramifications that remains relatively neglected and underdiagnosed; consequently, the epidemiology of HDV is poorly characterised, both in the United States and globally. In 2022, a pilot project involving eight healthcare institutions was undertaken to ascertain the prevalence of HDV in healthcare institutions with an HBV seropositivity of at least 1%, describe the characteristics of patients testing positive for HDV, and evaluate diagnostic and laboratory processes of HDV screening. From August 2022 to April 2024, a total of 106,693 patients were tested for HBsAg, of whom 65,341 (61.2%) were female and 40,863 (38.3%) were male, with a mean age of 47 years. The overall HBsAg positivity rate was 1.04% (n = 1112). Among the HBsAg+ samples, 645 (58.0%) underwent HDV Ab testing. The HDV Ab positivity rate was 0.81% (n = 9), with 2 cases of HDV RNA positivity (0.18%). The incomplete testing reflects several challenges associated with screening for both HBV and HDV. Further research is necessary to better understand the epidemiology and burden of HDV in the United States and considerations for implementation.
PMCID:11638661
PMID: 39668640
ISSN: 1365-2893
CID: 5763072

Limited Evidence of Shared Decision Making for Prostate Cancer Screening in Audio-Recorded Primary Care Visits Among Black Men and their Healthcare Providers

Stevens, Elizabeth R; Thomas, Jerry; Martinez-Lopez, Natalia; Fagerlin, Angela; Ciprut, Shannon; Shedlin, Michele; Gold, Heather T; Li, Huilin; Davis, J Kelly; Campagna, Ada; Bhat, Sandeep; Warren, Rueben; Ubel, Peter; Ravenell, Joseph E; Makarov, Danil V
Prostate-specific antigen (PSA)-based prostate cancer screening is a preference-sensitive decision for which experts recommend a shared decision making (SDM) approach. This study aimed to examine PSA screening SDM in primary care. Methods included qualitative analysis of audio-recorded patient-provider interactions supplemented by quantitative description. Participants included 5 clinic providers and 13 patients who were: (1) 40-69 years old, (2) Black, (3) male, and (4) attending clinic for routine primary care. Main measures were SDM element themes and "observing patient involvement in decision making" (OPTION) scoring. Some discussions addressed advantages, disadvantages, and/or scientific uncertainty of screening, however, few patients received all SDM elements. Nearly all providers recommended screening, however, only 3 patients were directly asked about screening preferences. Few patients were asked about prostate cancer knowledge (2), urological symptoms (3), or family history (6). Most providers discussed disadvantages (80%) and advantages (80%) of PSA screening. Average OPTION score was 25/100 (range 0-67) per provider. Our study found limited SDM during PSA screening consultations. The counseling that did take place utilized components of SDM but inconsistently and incompletely. We must improve SDM for PSA screening for diverse patient populations to promote health equity. This study highlights the need to improve SDM for PSA screening.
PMID: 38822923
ISSN: 1557-1920
CID: 5662852

Clinical Trial Protocol for a Randomized Trial of Community Health Worker-led Decision Coaching to Promote Shared Decision-making on Prostate Cancer Screening Among Black Male Patients and Their Providers

Makarov, Danil V; Ciprut, Shannon; Martinez-Lopez, Natalia; Fagerlin, Angela; Thomas, Jerry; Shedlin, Michele; Gold, Heather T; Li, Huilin; Bhat, Sandeep; Warren, Rueben; Ubel, Peter; Ravenell, Joseph E
We propose a randomized controlled trial to evaluate the effectiveness of a community health worker-led decision-coaching program to facilitate shared decision-making for prostate cancer screening decisions by Black men at a primary care federally qualified health center.
PMID: 34426097
ISSN: 2405-4569
CID: 5061072

Comparison of automated and expert human grading of diabetic retinopathy using smartphone-based retinal photography

Kim, Tyson N; Aaberg, Michael T; Li, Patrick; Davila, Jose R; Bhaskaranand, Malavika; Bhat, Sandeep; Ramachandra, Chaithanya; Solanki, Kaushal; Myers, Frankie; Reber, Clay; Jalalizadeh, Rohan; Margolis, Todd P; Fletcher, Daniel; Paulus, Yannis M
PURPOSE:The aim of this study is to investigate the efficacy of a mobile platform that combines smartphone-based retinal imaging with automated grading for determining the presence of referral-warranted diabetic retinopathy (RWDR). METHODS:A smartphone-based camera (RetinaScope) was used by non-ophthalmic personnel to image the retina of patients with diabetes. Images were analyzed with the Eyenuk EyeArt® system, which generated referral recommendations based on presence of diabetic retinopathy (DR) and/or markers for clinically significant macular oedema. Images were independently evaluated by two masked readers and categorized as refer/no refer. The accuracies of the graders and automated interpretation were determined by comparing results to gold standard clinical diagnoses. RESULTS:A total of 119 eyes from 69 patients were included. RWDR was present in 88 eyes (73.9%) and in 54 patients (78.3%). At the patient-level, automated interpretation had a sensitivity of 87.0% and specificity of 78.6%; grader 1 had a sensitivity of 96.3% and specificity of 42.9%; grader 2 had a sensitivity of 92.5% and specificity of 50.0%. At the eye-level, automated interpretation had a sensitivity of 77.8% and specificity of 71.5%; grader 1 had a sensitivity of 94.0% and specificity of 52.2%; grader 2 had a sensitivity of 89.5% and specificity of 66.9%. DISCUSSION:Retinal photography with RetinaScope combined with automated interpretation by EyeArt achieved a lower sensitivity but higher specificity than trained expert graders. Feasibility testing was performed using non-ophthalmic personnel in a retina clinic with high disease burden. Additional studies are needed to assess efficacy of screening diabetic patients from general population.
PMCID:7852658
PMID: 32341536
ISSN: 1476-5454
CID: 5326792

Tele health for prep initiation: A pilot program to expand access to hiv prevention services [Meeting Abstract]

Schubert, F; Bhat, S; Keneipp, K; Dapkins, I
STATEMENT OF PROBLEMOR QUESTION (ONE SENTENCE): To determine the feasibility and acceptability of using a virtual-only model for initiating and maintaining patients on PrEP (pre-exposure prophylaxis) for HIV prevention. LEARNING OBJECTIVES 1: Participants will be able to identify 3 key considerations in developing a clinical workflow for virtual PrEP initiation. LEARNING OBJECTIVES 2: Participants will be able to discuss 3-5 challenges associated with virtual PrEP initiation, and identify strategies to address these challenges. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Family Health Centers at NYU Langone (FHC) is a federally qualified health center network with 8 clinical sites in Brooklyn, NY, primarily serving a low-income, immigrant community. Since 2016, FHC has operated a focused outreach program to promote PrEP to high-risk individuals, using targeted strategies to engage those not currently in PrEP care. Our intervention sought to expand on our successful outreach model by using tele health to remove geographic barriers to participation. We developed clinical and patient navigation workflows to enable patients to initiate and continue PrEP through virtual visits. For necessary labs, patients were supported in identifying a lab collection site convenient to their home. Patient navigation staff played a key role in risk reduction education, benefits navigation, and facilitating compliance with labs and virtual care. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVEMETRICSWHICHWILL BEUSEDTOEVALUATE PROGRAM/INTERVENTION): The key measure of success is PrEP uptake and continuation among the virtual visits cohort. Additional evaluation measures include the referral source of patients for virtual PrEP initiation, patient demographics, and HIV risk-these measures will enable us to assess whether we are reaching a more diverse or higher risk population through this program. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The pilot project launched in October 2020. In the three months since project launch, 8 patients were served through this program. Six of the patients (75%) had been initially engaged with the FHC through the HIV prevention program, while two were existing FHC patients-one of whom had previously been in standard PrEP care, but struggled to make the in-person visits. Six patients were cisgender men who have sex with men, while two were transgender women. Virtual PrEP provided an opportunity to link patients to other needed healthcare services, including vaccination and STI treatment. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY): The tele health PrEP pilot program enabled us to reach a diverse group of high-risk patients, a majority of whom had not previously been engaged in care within our health system, and we anticipate continued growth this program as we expand our outreach to additional geographic areas. Navigation staff were key in overcoming some of the barriers associated with the virtual model by building relationships with the patients and serving as a reliable source of support for patients encountering logistical barriers. PrEP initiation by tele health must account for additional logistical considerations-most notably, ensuring patient compliance with labs-but it is a feasible approach for engaging high-risk patients in HIV prevention services
EMBASE:635797094
ISSN: 1525-1497
CID: 4984852

Disparities in HIV testing rates: Does predominant clinic racial/ethnic population play a role? [Meeting Abstract]

Twito, V; Schubert, F D; Bhat, S; Dapkins, I
BACKGROUND: Race, ethnicity, and language have been identified as factors impacting uptake of HIV testing. This project sought to compare testing rates between predominant and non-predominant ethnic, racial, or language populations within neighborhood FQHCs.
METHOD(S): We identified Family Health Center network locations at which more than 50% of patients served identified as the same race, and/ or had the same preferred language, and focused our analysis on these sites. We used Excel and SPSS to compare HIV testing rates between predominant and non-predominant population groups at each clinic.
RESULT(S): At 2 of 5 sites with a predominant non-English preferred language, speakers of the predominant language were more likely to receive an HIV test than speakers of other languages (p<0.001 for both sites). The other sites showed no difference by language. Of 2 clinics with a predominant racial population, there was no difference between predominant and non-predominant populations in terms of HIV testing. At all included sites, with one exception, Hispanic ethnicity was associated with a significantly higher rate of HIV testing.
CONCLUSION(S): Predominant/non-predominant race did not affect HIV testing rates, but language and ethnicity did. One mechanism for this may be increased trust associated with patient-provider language concordance, resulting in greater uptake of tests. There is a need for future research to further explore the factors associated with these findings
EMBASE:633956015
ISSN: 1525-1497
CID: 4805312

Deep neural network and human evaluation of referral-warranted diabetic retinopathy using smartphone-based retinal photographs [Meeting Abstract]

Aaberg, Michael; Kim, Tyson; Li, Patrick; Niziol, Leslie; Bhaskaranand, Malavika; Bhat, Sandeep; Ramachandra, Chaithanya; Solanki, Kaushal; Davila, Jose; Myers, Frankie; Reber, Clay; Musch, David C.; Margolis, Todd; Fletcher, Daniel; Paulus, Yannis Mantas
ISI:000488628103218
ISSN: 0146-0404
CID: 5326842

Comparison of automated and expert human grading of diabetic retinopathy using smartphone-based retinal photography [Meeting Abstract]

Kim, Tyson; Li, Patrick; Niziol, Leslie M.; Bhaskaranand, Malavika; Bhat, Sandeep; Ramachandra, Chaithanya; Solanki, Kaushal; Davila, Jose R.; Myers, Frankie; Reber, Clay; Musch, David C.; Margolis, Todd P.; Fletcher, Daniel; Woodward, Maria A.; Paulus, Yannis Mantas
ISI:000432170301260
ISSN: 0146-0404
CID: 5326852