Program Collaboration and Service Integration in the Prevention and Control of HIV Infection, Viral Hepatitis, STDs, and Tuberculosis in the U.S.: Lessons Learned from the Field

Fenton, Kevin; Aquino, Gustavo A.; Dean, Hazel D.

doi:10.1177/00333549141291s101

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…The very high rates of coinfection demonstrated highlight the importance of service integration through combined testing and treatment pathways. 32 NICE now recommends that persons accessing targeted mobile radiology should be offered tests for BBV, 22 and our data provide the basis to estimate the cost-effectiveness of this approach. The recent national collaborative TB strategy 33 commits to new investment in a national outreach service in line with the proven F&T outreach model.…”

Section: Discussionmentioning

confidence: 86%

High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

Aldridge

Hayward²,

Hemming³

et al. 2018

Thorax

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IntroductionUrban homeless populations in the UK have been shown to have high rates of active tuberculosis, but less is known about the prevalence of latent tuberculosis infection (LTBI). This study aimed to estimate the prevalence of LTBI among individuals using homeless hostels in London.MethodsWe performed a cross-sectional survey with outcome follow-up in homeless hostels in London. Our primary outcome was prevalence of LTBI. Recruitment for the study took place between May 2011 and June 2013. To estimate an LTBI prevalence of 10% with 95% CIs between 8% and 13%, we required 500 participants.Results491/804 (61.1%) individuals agreed to be screened. The prevalence of LTBI was 16.5% (81/491; 95% CI 13.2 to 19.8). In UK-born individuals, a history of incarceration was associated with increased risk of LTBI (OR 3.49; 95% CI 1.10 to 11.04; P=0.018) after adjusting for age, length of time spent homeless and illicit drug use. Of the three subjects who met English treatment guidelines for LTBI at the time of the study, none engaged with services after referral for treatment. Prevalence of past hepatitis B infection was 10.4% (51/489; 95% CI 7.7 to 13.1), and 59.5% (291/489; 95% CI 55.1 to 63.9) of individuals were non-immune. Prevalence of current hepatitis C infection was 10.4% (51/489; 95% CI 7.8 to 13.1).ConclusionsThis study demonstrates the high prevalence of LTBI in homeless people in London and the associated poor engagement with care. There is a large unmet need for LTBI and hepatitis C infection treatment, and hepatitis B vaccination, in this group.

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Section: Discussionmentioning

confidence: 86%

High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

Aldridge

Hayward²,

Hemming³

et al. 2018

Thorax

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“…In recent years, the concept of healthcare service integration has received increasing attention as an essential element of primary care for many diseases, especially conditions with comorbidities [1][2][3]. For example, opioid addiction, as a chronic condition, requires long-term multi-pronged healthcare services, among which harm reduction services [e.g., methadone maintenance therapy (MMT)] and HIV treatment services [e.g., antiretroviral therapy (ART)] are 1 3 two most essential services needed by HIV-positive people who inject drugs (PWID) [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Using Social Media to Enhance Provider Network for HIV and Harm Reduction Service Integration in Vietnam

Li¹,

Lin²,

Feng³

et al. 2019

AIDS Behav

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Social media can potentially serve as a platform to coordinate medical care among fragmented health sectors. This paper describes procedures of using social media to enhance antiretroviral therapy (ART) and methadone maintenance treatment (MMT) providers' virtual network for integrated service for HIV-positive people who inject drugs (PWID) in Vietnam. A total of 88 ART and MMT treatment providers participated in person group sessions followed by online virtual support to improve service integration. In-person reunions were held to reinforce Facebook participation and network activities. Content analysis was used to identify keywords and topic categories of the online information exchange. Both MMT and ART providers were actively engaged in online communications. Referral and treatment adherence were the two most frequently discussed topic areas by both the MMT and ART providers. Frequent cross-agency connections were observed. Online provider networks and communities could be built and useful to support treatment providers to improve service integration. Keywords Social media • Treatment providers • Service integration • Network • Vietnam Resumen Los medios sociales pueden potencialmente servir una plataforma para coordinar atencion medica entre los sectores de salud fragmentados. Este documento describe los procedimentos de uso de las redes sociales para mejorar proveedores red virtual de proveedores de terapia antiretoriviral (TARV) y la tratamiento de mantenimiento con metadona (TMM) para el servicio integrado para personas VIH positivas que se inyectan drogas en Vietnam. Un total de 88 proveedores de tratamiento de TARV y TMM participación en sesiones grupales en persona siguiendo un ayuda virtual web para mejorar integracions de servicio. Se llevaron reuniones en persona para reforzar la participación en Facebook y en las actividades de la red. El método de análisis se utiliza para identificar palabras y categorías de intercambio de información en línea. Los proveedores de TMM y TARV participaron activamente en las comunicaciones en línea. La referencia y la adherencia al tratamiento fueron las dos áreas temáticas más discutidas por los proveedores de TMM y TARV. Observaron conexiones frecuentes entre agencias. Las redes y comunidades de proveedores en línea podrían ser construidas y útiles para apoyar a los proveedores de tratamiento para mejorar la integración del servicio. Palabra claves Medios sociales • Proveedores de tratamiento • Integración del servicio • La red • Vietnam

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“…High rates of co-infection highlight the importance of service integration through combined testing and treatment pathways. 31 NICE now recommends that persons accessing targeted mobile radiology should be offered tests for blood-borne viruses 11 and our data provide the basis to estimate the cost-effectiveness of this approach. The recent national collaborative tuberculosis strategy 32 commits to new investment in a national outreach service in line with the proven Find&Treat outreach model.…”

Section: Discussionmentioning

confidence: 89%

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

Story

Garber

Aldridge

et al. 2020

Programme Grants Appl Res

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Background Socially complex groups, including people experiencing homelessness, prisoners and drug users, have very high levels of tuberculosis, often complicated by late diagnosis and difficulty in adhering to treatment. Objective To assess a series of interventions to improve tuberculosis control in socially complex groups. Design A series of observational surveys, evaluations and trials of interventions. Setting The pan-London Find&Treat service, which supports tuberculosis screening and case management in socially complex groups across London. Participants Socially complex groups with tuberculosis or at risk of tuberculosis, including people experiencing homelessness, prisoners, drug users and those at high risk of poor adherence to tuberculosis treatment. Interventions and main outcome measures We screened 491 people in homeless hostels and 511 people in prison for latent tuberculosis infection, human immunodeficiency virus, hepatitis B and hepatitis C. We evaluated an NHS-led prison radiographic screening programme. We conducted a cluster randomised controlled trial (2348 eligible people experiencing homelessness in 46 hostels) of the effectiveness of peer educators (22 hostels) compared with NHS staff (24 hostels) at encouraging the uptake of mobile radiographic screening. We initiated a trial of the use of point-of-care polymerase chain reaction diagnostics to rapidly confirm tuberculosis alongside mobile radiographic screening. We undertook a randomised controlled trial to improve treatment adherence, comparing face-to-face, directly observed treatment with video-observed treatment using a smartphone application. The primary outcome was completion of ≥ 80% of scheduled treatment observations over the first 2 months following enrolment. We assessed the cost-effectiveness of latent tuberculosis screening alongside radiographic screening of people experiencing homelessness. The costs of video-observed treatment and directly observed treatment were compared. Results In the homeless hostels, 16.5% of people experiencing homelessness had latent tuberculosis infection, 1.4% had current hepatitis B infection, 10.4% had hepatitis C infection and 1.0% had human immunodeficiency virus infection. When a quality-adjusted life-year is valued at £30,000, the latent tuberculosis screening of people experiencing homelessness was cost-effective provided treatment uptake was ≥ 25% (for a £20,000 quality-adjusted life-year threshold, treatment uptake would need to be > 50%). In prison, 12.6% of prisoners had latent tuberculosis infection, 1.9% had current hepatitis B infection, 4.2% had hepatitis C infection and 0.0% had human immunodeficiency virus infection. In both settings, levels of latent tuberculosis infection and blood-borne viruses were higher among injecting drug users. A total of 1484 prisoners were screened using chest radiography over a total of 112 screening days (new prisoner screening coverage was 43%). Twenty-nine radiographs were reported as potentially indicating tuberculosis. One prisoner began, and completed, antituberculosis treatment in prison. In the cluster randomised controlled trial of peer educators to increase screening uptake, the median uptake was 45% in the control arm and 40% in the intervention arm (adjusted risk ratio 0.98, 95% confidence interval 0.80 to 1.20). A rapid diagnostic service was established on the mobile radiographic unit but the trial of rapid diagnostics was abandoned because of recruitment and follow-up difficulties. We randomly assigned 112 patients to video-observed treatment and 114 patients to directly observed treatment. Fifty-eight per cent of those recruited had a history of homelessness, addiction, imprisonment or severe mental health problems. Seventy-eight (70%) of 112 patients on video-observed treatment achieved the primary outcome, compared with 35 (31%) of 114 patients on directly observed treatment (adjusted odds ratio 5.48, 95% confidence interval 3.10 to 9.68; p < 0.0001). Video-observed treatment was superior to directly observed treatment in all demographic and social risk factor subgroups. The cost for 6 months of treatment observation was £1645 for daily video-observed treatment, £3420 for directly observed treatment three times per week and £5700 for directly observed treatment five times per week. Limitations Recruitment was lower than anticipated for most of the studies. The peer advocate study may have been contaminated by the fact that the service was already using peer educators to support its work. Conclusions There are very high levels of latent tuberculosis infection among prisoners, people experiencing homelessness and drug users. Screening for latent infection in people experiencing homelessness alongside mobile radiographic screening would be cost-effective, providing the uptake of treatment was 25–50%. Despite ring-fenced funding, the NHS was unable to establish static radiographic screening programmes. Although we found no evidence that peer educators were more effective than health-care workers in encouraging the uptake of mobile radiographic screening, there may be wider benefits of including peer educators as part of the Find&Treat team. Utilising polymerase chain reaction-based rapid diagnostic testing on a mobile radiographic unit is feasible. Smartphone-enabled video-observed treatment is more effective and cheaper than directly observed treatment for ensuring that treatment is observed. Future work Trials of video-observed treatment in high-incidence settings are needed. Trial registration Current Controlled Trials ISRCTN17270334 and ISRCTN26184967. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

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Program Collaboration and Service Integration in the Prevention and Control of HIV Infection, Viral Hepatitis, STDs, and Tuberculosis in the U.S.: Lessons Learned from the Field

Cited by 9 publications

References 17 publications

High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

Using Social Media to Enhance Provider Network for HIV and Harm Reduction Service Integration in Vietnam

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

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