Free Screening Research Articles

Salivary detection of COVID-19: clinical performance of oral sponge sampling for SARS-CoV-2 testing.

BackgroundThe current diagnostic standard for coronavirus disease 2019 (COVID-19) is reverse transcriptase-polymerase chain reaction (RT-PCR) testing with nasopharyngeal (NP) swabs. The invasiveness and need for trained personnel make the NP technique unsuited for repeated community-based mass screening. We developed a technique to collect saliva in a simple and easy way with the sponges that are usually used for tamponade of epistaxis. This study was carried out to validate the clinical performance of oral sponge (OS) sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.MethodsOver a period of 22 weeks, we collected prospectively 409 paired NP and OS samples from consecutive subjects presenting to a public community-based free screening centre. Subjects were referred by their attending physician because of recent COVID-19 symptoms (n = 147) or by the contact tracing staff of the French public health insurance because they were considered as close contacts of a laboratory-confirmed COVID-19 case (n = 262).ResultsIn symptomatic subjects, RT-PCR SARS-CoV-2 testing with OS showed a 96.5% (95% CI: 89.6–94.8) concordance with NP testing, and a 93.2% (95% CI: 89.1–97.3) sensitivity when using the IdyllaTM platform and a sensitivity of 76.3% (95% CI: 69.4–83.2) on the Synlab Barla laboratory platform. In close contacts the NP-OS concordance (93.8%, 95% CI: 90.9–96.7) and OS sensitivity (71.9%, 95% CI: 66.5–77.3) were slightly lower.ConclusionThese results strongly suggest that OS testing is a straightforward, low-cost and high-throughput sampling method that can be used for frequent RT-PCR testing of COVID-19 patients and mass screening of populations.

Frequency of chronic kidney disease among the population of Dalgopol municipality, Varna district – results from screening – campaing of the Clinic of Nephrology

Chronic kidney disease (CKD) is part of the modern pandemic of chronic, non-communicable diseases, which is one of the leading causes and causes of death among the world's population. CKD affects nearly 850 million people worldwide and is the 6th leading cause of death. In Bulgaria, the incidence is 12.8%, and 90% of the patients have advanced kidney disease. According to the summarized data of the National Statistical Institute (NSI) and the National Center for Public Health and Analysis at the Ministry of Health for 2018, urogenital diseases accounted for 1.4% of mortality in the country, and this percentage increased in 2019 by 1.7%. The reasons for this probably lie in the increasing frequency of risk factors among the population. In order to early detect the risk factors for CKD and the timely diagnosis of patients with hidden kidney disease and their further follow-up, in July 2020, the Clinic of Nephrology at the St. Marina University Hospital in Varna, supported by a project of the Medical University of Varna, conducted a free screening campaign for 147 people among the population of Dalgopol municipality. In addition, the campaign aimed to raise public awareness of CKD and renal replacement therapy methods (hemodialysis, peritoneal dialysis, and kidney transplantation). During the campaign, 58 participants (39%) were newly diagnosed with kidney disease. This indicates the lack of routine physical, imaging and laboratory tests and failure to diagnose kidney disease in its early stages. The financial burden that undiagnosed kidney problems, and subsequently end-stage renal disease, entail, puts even highly developed economies to a severe test. Screening and prevention can prevent chronic kidney disease, and where management strategies are in place, the incidence of end-stage renal disease is reduced.

Utilizing a Community Dance to Hold STD Testing for Chlamydia and Gonorrhea in High-Risk Adolescents.

Sexually transmitted diseases (STDs) in adolescents are a major public health concern, particularly in underserved communities. While STD screening is recommended by the United States Preventive Services Task Force, limited access remains one of a number of barriers. Community-based approaches may provide greater access and enhance screening rates. This study occured in a nationally recognized hot spot for STDs. We used a unique approach of hosting supervised dances at a community venue, during which free STD screening was offered at an attached health care clinic. A series of six Friday night dances was held at one community center sponsored by a nonprofit, girl-focused organization from 2018 to 2019. Dance participants could access an on-site health clinic for self-collected screening for chlamydia and gonorrhea. Treatment was provided for detected STDs. STD screening was also available to area youth at the on-site clinic during regular daytime clinic hours. A total of 118 adolescents were screened during the school year, and were predominantly female (88.13%) and African American (85.6%). More than half of the total STD screenings (51.7%) were administered during the dances, doubling the total number of STD screenings when compared to those administered during regular clinic hours. A significantly younger cohort were screened at the dances (mean age 14.8 years) compared to those screened at the regular clinic (mean age of 18.9 years). A youth-centric event utilizing community resources can be used to facilitate and enhance screening rates for STDs in youth in an underserved, high-risk community.

Prevalence of hypertension and diabetes in the population of Kosovo

Abstract Objectives To observe the prevalence of arterial pressure and glycemia in Kosovo and to provide free screening service through health promotion. Methods This prospective study was conducted over a 3-year period, during 2017–2019. All data were collected by AAB College staff in 11 Kosovo cities prior to a random sample with 7254 observations. Data included demographic information as well as blood pressure and glycemic level measurements. Results The overall prevalence of arterial pressure was registered at 27.6% and diabetes mellitus at 9.2%. Arterial pressure in females had a tendency to increase with age (r = 0.3552, P < 0.001), as well as the glycemic index (r = 0.1997, P < 0.001). Nevertheless, age had a stronger impact on males than in females, with regard to higher arterial pressure in the year 2017 (P < 0.001). In the following years, 2018 and 2019, the ratio had reversed. Glycemia had strong correlation with systolic arterial pressure value (P < 0.001). For a 1 mmol/L increase in glycemia, the diastolic value increased by 0.19 mmHg on average. Conclusions This study concluded that at younger ages the values of arterial pressure and glycemia remain within the commonly observed range, but over the years the probability for higher blood pressure or glicemia increases. Through continuous control of arterial pressure and glycemia at an early age, it is possible to identify abnormal diagnostics, in order to address them in time. Educational initiatives and screenings should take place in order to increase awareness of the citizens for checking themselves regularly.

Obese Subjects without Eating Disorders Experience Binge Episodes Also Independently of Emotional Eating and Personality Traits among University Students of Southern Italy.

It is widely acknowledged that obesity is a growing public clinical issue involving both physical and psychological well-being. Nevertheless, the relationship between psychological features and weight gain is still unclear. Although emotional eating (EE) and personality traits are considered significant predictors of eating disorders, their role in obesity without eating disorders (OB-wed) is far from proven. The present study aimed at investigating the cumulative effect of EE and personality traits on overeating behavior in a sample of 266 university students (169 female; mean age = 21.85, SD = 2.39) stratified based on their body mass index (BMI; normal weight, overweight, obese). They were enrolled during free screening days promoted by the Human Dietetic and Sport Service of a Southern Italian university. The results show a psychological pattern of increasing overeating behavior and lower Self-Directedness combined with higher Sadness and Anger. However, OB-wed subjects overate regardless of this emotional/personological configuration.

Diagnostic testing after positive results on cell free DNA screening: CVS or Amnio?

The positive predictive values of cell free DNA (cfDNA) and rates of confined placental mosaicism (CPM), imprinting and other factors vary by chromosome. We sought to review the literature for each of these features for each chromosome and provide recommendations on chorionic villus sampling (CVS) versus amniocentesis after an abnormal cfDNA result. For chromosomes with high rates of CPM (trisomy 13, monosomy X and rare autosomal trisomies [RATs]), an amniocentesis should be considered if the first trimester ultrasound is normal. For monosomy X on cfDNA with an unaffected fetus, maternal karyotyping should be considered after normal fetal diagnostic testing. In cfDNA cases with a trisomy involving a chromosome with imprinted genes (6, 7, 11, 14, 15 and 20), CVS should be considered, followed by amniocentesis if abnormal. If the fetus is unaffected, methylation studies should be considered given the risk of uniparental disomy. A third trimester growth ultrasound should be considered for patients with a positive cfDNA screen for a RAT and an unaffected fetus, especially in the case of trisomy 16. For patients with multiple aneuploidy results on cfDNA, a work-up for maternal malignancy should be considered. Clinicians should consider rates of CPM, imprinting, ultrasound findings and maternal factors when considering whether to recommend amniocentesis or CVS after an abnormal cfDNA result.

A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting.

Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and public health care. A CBPR study was conducted in one of the poorest districts in Wielkopolska region, Poland, among 122 beneficiaries of health education workshops. A self-developed questionnaire was used. The reported barriers to participation in cancer screening included: lack of time, lack of need, or feeling healthy (32.8%); long waiting times (17.2%); fear of costs (9%). Physicians seldom recommended screening to their patients. Only 7.4% of respondents had ever received dermatoscopy. Among women, 18.2% did not perform any breast exams and 25% had never had smear tests. Diagnostics was often financed out of pocket (thyroid ultrasound = 58.1%; smear test = 48.5%; breast ultrasound = 36.8%). The health system needs mentioned by participants included better access to physicians (65.6%), promotion of free screening tests (54.9%), and access to public health programmes (22.1%). There is an urgent need to translate national strategies into action. Health promotion and better access to care must become priorities in deprived areas, while primary care providers should become key figures in delivering these services.

Comparison of Medication Adherence Assessment Tools to Identify Glaucoma Medication Nonadherence

To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence. Prospective cohort study. Glaucoma patients (> 40 years old, >1 medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized glaucoma coaching program on medication adherence. Participants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of glaucoma medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence. Accuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence. Ninety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored medication adherence (r= 0.12; P= 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r= 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]). The single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify glaucoma patients at risk of poor medication adherence with reasonable accuracy.

A Mobile Health Breast Cancer Educational and Screening Intervention Tailored for Low-Income, Uninsured Latina Immigrants.

Objective: To investigate the efficacy of mobile health (mHealth) intervention strategies that delivered either personalized, culturally, and linguistically tailored cell phone voice messages or text messages related to breast cancer and prevention, compared to the control group, to determine which strategy is more likely to increase breast cancer knowledge and screening mammography among low-income Latina immigrants.Methods: This randomized controlled trial assigned 256 Latina immigrants 40 years of age or older to one of three groups: an automated cell phone voice message group, an automated text message group, or the control group (mail). The mHealth intervention employed a comprehensive approach that included breast cancer and prevention education and free mammography screening. Outcome measures included knowledge of breast cancer and breast cancer prevention, and adherence to screening mammography.Results: There was a general increase in breast cancer knowledge after the educational intervention for all the groups [p = 0.01, t(199) = 3.996]. Knowledge increase and mammography adherence did not differ based on group.Conclusion: More important than the actual method of communication is how breast cancer and prevention messages are constructed, who the messenger is, and the enabling factors that facilitate screening adherence. A breast cancer preventive intervention program that is personalized, culturally and linguistically tailored, and offers a free or low-cost mammogram holds promise to be an effective method in reaching an underserved Latina population with a high breast cancer burden.

Change in mammography screening attendance after removing the out-of-pocket fee: a population-based study in Sweden (2014\u20132018)

PurposeTo assess the change in mammography screening attendance in Sweden—overall and in sociodemographic groups at risk of low attendance—after removal of the out-of-pocket fee in 2016.MethodsIndividual-level data on all screening invitations and attendance between 2014 and 2018 were linked to sociodemographic data from Statistics Sweden. Odds ratios and 95% confidence intervals (CIs) for attendance by time period and sociodemographic factor were computed using mixed logistic regression to account for repeated measures within women. The study sample included 1.4 million women, aged 40–75, who had a mammography screening appointment in 2014–2015 and/or 2017–2018 in 14 of Sweden’s 21 health care regions.ResultsOverall screening attendance was 83.8% in 2014–2015 and 84.1% in 2017–2018 (+ 0.3 percentage points, 95% CI 0.2–0.4). The greatest increase in attendance was observed in non-Nordic women with the lowest income, where attendance rose from 62.9 to 65.8% (+ 2.9 points, 95% CI 2.3–3.6), and among women with four or more risk factors for low attendance, where attendance rose from 59.2 to 62.0% (+ 2.8 points, 95% CI 2.2–3.4).ConclusionScreening attendance did not undergo any important increase after implementing free screening, although attendance among some sociodemographic groups increased by almost three percentage points after the policy change.

Reaching the Hard to Reach: Mobile Development Screening Van to the Rescue

Currently more than 15% of children have an emotional, behavioral, or developmental concern. In spite of recommendations by the American Academy of Pediatrics and the Centers for Disease Control and Prevention to conduct universal developmental surveillance and screening with children at 9, 18, and 24 months of age, fewer than 30% of children under 6 years of age ever receive a developmental screening. Children in low-income and diverse communities are even less likely to be screened by a medical provider and/or referred for further diagnostic evaluation when predictive concerns are identified. As part of a cross-agency collaborative effort involving a family resource center, a child care resource and referral agency, a regional center for developmental disabilities, and a master's degree program in early childhood education, the Mobile Developmental Screening Van Project conducted outreach to provide free developmental screening with families of children 0-8 years of age in diverse and low-income communities within the greater Los Angeles County. Using the Parent Evaluation of Developmental Status (PEDS) screening tool, 94 children were screened over the course of 6 months, with 33% showing 2 or more predictive concerns that resulted in referrals for further diagnostic evaluation. The feasibility of reaching families in hard to reach communities using a mobile screening van, as well as study limitations and recommendations for next steps, are discussed.

Analysis of the reported data of National Cervical Cancer Screening Program in Rural Areas in China from 2009 to 2018

Objective: To analyze the effectiveness of the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in China. Methods: Data were collected in the form of quarterly statistical tables reported by NCCSPRA counties in 30 provinces (Hong Kong, Macao and Taiwan province of China were not included into the NCCSPRA, and Tibet Autonomous Region carried out the program but did not reported the data) from 2009 to 2018. The women aged 35-64 years with sexual behavior and the identity (Hukou) of rural area in these project counties were included into the NCCSPRA, and women receiving hysterectomy for non-cervical cancer or non-cervical lesions were excluded. The following indicators were analyzed: the positive rates of different screening methods, the abnormality rates of colposcopy and histopathology, the detection rate of precancerous lesions, the detection rate of cervical cancer and the rate of early diagnosis. Results: A total of 85 041 490 women aged 35-64 in rural areas received free cervical cancer screening and diagnosis if necessary. On the whole, the abnormality rate of cytology, HPV testing, VIA/VILI, colposcopy and histopathology was 3.71%(2 567 610), 9.91%(331 158), 10.10%(1 167 930), 28.85%(1 420 847), and 21.20%(303 068) respectively. The detection rate of cervical precancerous lesions was 153.88/100 000, and increased from 106.85/100 000 in 2012 to 223.89/100 000 in 2018 (P<0.001). Regionally, the east (207.37/100 000) reached higher rate than the middle (177.65/100 000), and the middle higher than the west (108.65/100 000) (P<0.001). The detection rate of invasive cervical cancer was 21.58/100 000, and increased from 18.02/100 000 in 2012 to 26.54/100 000 in 2018 (P<0.001). Regionally, the middle of China (25.46/100 000) reached the higher rate than the east (19.62/100 000) and the west (19.30/100 000) (P<0.001). The rate of early detection was 91.24%(136 140), which increased from 89.60% (11 883)in 2012 to 92.80%(26 962) in 2018 (P<0.001). Regionally, the east of China (94.02%, 37 600) reached the higher rate than the middle(91.06%, 56 488), and the middle higher than the west (89.12%, 42 052) (P<0.001). Conclusions: There are obvious difference in terms of the detection rate of cervical precancerous lesions and the rate of early diagnosis reflecting cervical cancer screening capacity among the eastern, middle and western regions,which showed service inequity among different areas indirectly. The middle and western regions, especially the western regions, are still the focus of future works.

Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study

BackgroundCervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention.MethodsEffectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women’s satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes.ResultsAfter a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women’s satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers’ workload.ConclusionFree HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence.

Clinical, serological and epidemiological features of hepatitis A in León, Nicaragua.

Background and ObjectivesTo monitor and document the endemicity and disease burden of acute hepatitis A in the area of an ongoing vaccine effectiveness study in León, Nicaragua.MethodsAt community health centres in León, all children, adolescents and young adults presenting with jaundice and/or other clinical signs of hepatitis were offered free serologic screening (hepatitis A, B and C) and blood tests for liver enzymes and bilirubin. Clinical and socioeconomic data were collected with a structured questionnaire. Diagnosis of acute hepatitis A was confirmed by anti-HAV IgM testing. Using logistic regression we compared the characteristics and living conditions of acute hepatitis A cases with those of non-cases.ResultsOf 557 eligible subjects enrolled between May 2006 and March 2010, 315 (56.6%) were diagnosed with hepatitis A, 80.6% of them ≤10 years and five >18 years of age. No severe cases were encountered. Apart from jaundice (95.6%) and other signs of hepatitis A (fever, pale stool, dark urine, nausea, vomiting, anorexia), two thirds of patients had moderately raised liver enzymes. Cases occurred throughout the year, with highest incidences from August to March. Poor sanitary conditions and crowding were the main risk factors.ConclusionsIn the study area, hepatitis A is still highly endemic in young and school age children living in low socioeconomic conditions. There are, however, first indications that the endemicity level is shifting from high to high-intermediate.

Group and Shuffle Convolutional Neural Networks with Pyramid Pooling Module for Automated Pterygium Segmentation.

Pterygium is an eye condition that is prevalent among workers that are frequently exposed to sunlight radiation. However, most of them are not aware of this condition, which motivates many volunteers to set up health awareness booths to give them free health screening. As a result, a screening tool that can be operated on various platforms is needed to support the automated pterygium assessment. One of the crucial functions of this assessment is to extract the infected regions, which directly correlates with the severity levels. Hence, Group-PPM-Net is proposed by integrating a spatial pyramid pooling module (PPM) and group convolution to the deep learning segmentation network. The system uses a standard mobile phone camera input, which is then fed to a modified encoder-decoder convolutional neural network, inspired by a Fully Convolutional Dense Network that consists of a total of 11 dense blocks. A PPM is integrated into the network because of its multi-scale capability, which is useful for multi-scale tissue extraction. The shape of the tissues remains relatively constant, but the size will differ according to the severity levels. Moreover, group and shuffle convolution modules are also integrated at the decoder side of Group-PPM-Net by placing them at the starting layer of each dense block. The addition of these modules allows better correlation among the filters in each group, while the shuffle process increases channel variation that the filters can learn from. The results show that the proposed method obtains mean accuracy, mean intersection over union, Hausdorff distance, and Jaccard index performances of 0.9330, 0.8640, 11.5474, and 0.7966, respectively.

Development and Validation of a Mobile Visual Acuity Examination App for Universal Use, Including Remote and Rural Regions

Background: Visual refractive errors are projected to rise in the coming decades worldwide, especially in remote and rural regions. To combat this, smartphone visual acuity testing apps may allow for the early detection of refractive errors thanks to their low cost and wide availability. Hence, we developed the OcularCheck app as a free mobile vision screening tool for public health use. Objective: We sought to determine whether OcularCheck accurately measures distance visual acuity (DVA) in comparison to a standard Snellen chart (Space Saving Chart SSC-350). Methods and Results: In January 2021, we measured DVA in n=56 eyes using the OcularCheck app and a standard Snellen chart. To minimize bias, we used two separate examiners who were blinded to each other’s measurements. To assess the similarity of measurement methods, we performed a two-tailed, paired t-test and Bland-Altman analysis using the R-Project software. The t-test showed that differences in DVA between testing methods were not significant (P=0.698). Bland-Altman analysis showed that the mean difference between measurement methods was 0.01 LogMAR (95% CI -0.03 to 0.04), and the standard deviation of differences (0.139 LogMAR) was below the test-retest variability of the Snellen chart. The main limitation of the study was that we were not able to measure DVA with non-English optotypes. Conclusion: OcularCheck provides accurate DVA measurements, and it harbors the potential to expand the accessibility of DVA screening to resource-scarce regions.

Development and Validation of a Mobile Visual Acuity Examination App for Universal Use, Including Remote and Rural Regions

Background: Visual refractive errors are projected to rise in the coming decades worldwide, especially in remote and rural regions. To combat this, smartphone visual acuity testing apps may allow for the early detection of refractive errors thanks to their low cost and wide availability. Hence, we developed the OcularCheck app as a free mobile vision screening tool for public health use. Objective: We sought to determine whether OcularCheck accurately measures distance visual acuity (DVA) in comparison to a standard Snellen chart (Space Saving Chart SSC-350). Methods and Results: In January 2021, we measured DVA in n=56 eyes using the OcularCheck app and a standard Snellen chart. To minimize bias, we used two separate examiners who were blinded to each other’s measurements. To assess the similarity of measurement methods, we performed a two-tailed, paired t-test and Bland-Altman analysis using the R-Project software. The t-test showed that differences in DVA between testing methods were not significant (P=0.698). Bland-Altman analysis showed that the mean difference between measurement methods was 0.01 LogMAR (95% CI -0.03 to 0.04), and the standard deviation of differences (0.139 LogMAR) was below the test-retest variability of the Snellen chart. The main limitation of the study was that we were not able to measure DVA with non-English optotypes. Conclusion: OcularCheck provides accurate DVA measurements, and it harbors the potential to expand the accessibility of DVA screening to resource-scarce regions.

A rapid near-patient RT-PCR test for suspected COVID-19: a study of the diagnostic accuracy.

BackgroundManagement of large numbers of reverse transcriptase-polymerase chain reactions (RT-PCR) for diagnosis of coronavirus 2019 disease (COVID-19) requires robust infrastructures, located in dedicated premises with a high standard of biosafety procedures, and well-trained personnel. The handling of a “run-of-river sample” to obtain rapid reporting of results is challenging.MethodsWe studied the clinical performance of the Idylla™ SARS-CoV-2 Test (index test) on a platform capable of fully automated nucleic acid testing including extraction, amplification, and detection in a single-use cartridge to establish the diagnosis of COVID-19. The study was conducted on a prospective cohort of 112 volunteers with recent symptoms and an unknown SARS-CoV-2 status who came to free screening centers of the Nice metropolitan area. All subjects underwent bilateral nasopharyngeal sampling. One sample was processed using the index test, the other using the standard of care RT-PCR. Samples were treated blind.ResultsMost of the participants (70%) were sampled within 4 days of symptom onset. Forty-five (40.2%) were positive for COVID-19. No clinical symptoms were distinguished between SARS-CoV-2 RT-PCR positive and negative subjects except anosmia and dysgeusia. Positive and negative agreement between the index and the standard of care test was 100%.ConclusionsThe Idylla™ SARS-CoV-2 Test is very sensitive, specific, rapid and easy to use in a near-patient RT-PCR approach to distinguish between symptomatic SARS-CoV-2 positive and negative patients in selected settings.

Novel mapping methods to describe utilization of free breast cancer screening from a state program

IntroductionThe National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a cancer screening program whose mission is to reduce cancer morbidities for uninsured and underinsured women. A primary activity is to connect women to breast cancer screening. The eligible population and utilization of NBCCEDP screening services have never been quantified at a sub-state level, which hampers effective program evaluation. Here, the Minnesota NBCCEDP, “Sage”, serves as a case study to demonstrate novel spatial analysis methods that depict variation of screening rates at the local level.MethodsWomen who received breast cancer screening through Sage between 2011 and 2015 were geocoded (N = 74,712 screenings); analysis occurred between 2017 and 2019. We determine an eligible population using a synthetic population dataset that provides geographic residence and demographic information. We introduce a novel spatial analysis technique, spatially adaptive filters (SAFs), to create a utilization map of Sage breast screening services by Minnesota women.ResultsBetween 2011 and 2015, an average of 36,979 women per year were eligible for NBCCEDP breast cancer screening services, representing 3% of the Minnesota female population 40 and older. For Minnesota NBCCEDP eligible women, the state average breast cancer screening utilization rate was 37.2%, but varied considerably by local regions within the state (range 0% to 131%, SD = 18.7%).ConclusionsThis geospatial model estimated screening service utilization at the local level and enables Minnesota’s Sage program to target specific areas they have yet to reach. Similar programs could employ this model to direct program activities.

Getting to Zero: A Demonstration Project of Partner HIV Testing in the Prenatal Setting in Chicago, Illinois.

Women who experience HIV seroconversion during pregnancy are missed during early routine pregnancy HIV screening and are at high risk of perinatal HIV transmission. Male partner HIV testing during routine prenatal care may be an effective primary prevention strategy by identifying women at risk of seroconversion and mitigating their risk. Our objective was to assess interest in and uptake of male partner HIV testing services offered during prenatal care. This demonstration project included all pregnant, English-speaking, HIV-negative women receiving publicly funded prenatal care in an urban hospital-based practice located in a high HIV prevalence area. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on social demographics, medical access characteristics, and HIV testing history. Women were invited to bring their partners to a prenatal visit where HIV testing was offered to their male partners. Factors associated with women's interest in testing and completion of partner testing were assessed using bivariable and multivariable analyses. Of 392 women approached, 70% (N = 274) completed study surveys. Although the majority (76%, N = 200 of 264 respondents) of women desired their partner undergo HIV testing, testing was underutilized as only 18 (7%) male partners completed testing. While neither maternal characteristics nor male social or attitudinal factors were associated with interest in or completion of partner HIV testing, sensitivity analyses, performed with multiple imputation, demonstrated some association between interest and completion of partner testing and partner medical care access and utilization. In conclusion, although the majority of low-income women in an urban prenatal clinic expressed interest in having their partners undergo HIV testing, uptake of free partner HIV testing services was uncommon. A focused assessment of implementation and uptake barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.