Inadequate Screening Research Articles

Cross-national validity of the Beck Hopelessness Scale for children and adolescents: findings from the YouthSave-Impact Study Kenya

A sense of hopelessness is common but under-identified among poor children in sub-Saharan Africa (SSA). Given the concomitant inadequate screening, assessment, and a lack of culturally and developmentally appropriate measures in much of SSA, identifying reliable and valid measures of hopelessness is needed. One promising candidate, the Beck Hopelessness Scale (BHS), has undergone limited evaluation in the region and none with non-adult populations. The present study assesses the psychometric properties of the BHS using data from a diverse sample of 3965 school-going youth (M = 12.2, SD = 1.1) in Kenya. Given inconclusive results from model comparisons of previously established factor structures, we used parallel analysis, exploratory factor analysis, and confirmatory factor analysis to ascertain the factor structure of the BHS in this sample. We also evaluated measurement invariance of the scale across two key developmental ages (9–12 and 13–18), given distinct cognitive and emotional differences. Models supported a one-factor 20-item structure with partial invariance across child and adolescent samples. Concurrent criterion validity correlations were in the small to medium range. Findings provide evidence of the utility of the BHS as a psychometrically sound measure that possesses cultural relevance to Kenyan youth.

Does Medicaid Coverage Modify the Relationship between Glycemic Status and Teeth Present in Older Adults?

Understanding the relationships among diabetes, teeth present, and dental insurance is essential to improving primary and oral health care. Participants were older adults who attended senior centers in northern Manhattan (New York, N.Y.). Sociodemographic, health, and health care information were obtained via intake interviews, number of teeth present via clinical dental examinations, and glycemic status via measurement of glycosylated hemoglobin (HbA1c). Complete data on dental insurance coverage status for 785 participants were available for analysis (1,015 after multiple imputation). For participants with no dental insurance and any private/other dental insurance, number of teeth present is less for participants with diabetes than for participants without diabetes; however, for participants with Medicaid coverage only, the relationship is reversed. Potential explanations include the limited range of dental services covered under the Medicaid program, inadequate diabetes screening and monitoring of Medicaid recipients, and the poor oral and general health of Medicaid recipients.

A Breast Cancer Education Program for D/deaf Women.

Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population's inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from -baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.

Severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening.

With the aim of assessing the occurrence of severe intimate partner physical violence as a risk factor for inadequate screening of uterine cervical cancer, a case-control study was performed with a multidimensional questionnaire in a sample of 640 users of the Family Health Strategy in the Municipality of Nova Iguaçu, Rio de Janeiro State, Brazil. Cases were defined as women who had not had a cervical cytology test in the previous three years. The results showed that severe physical violence against the woman (adjustedOR = 2.2; 95%CI: 1.1-4.4) and co-occurrence of the event in the couple (adjustedOR = 3.8; 95%CI: 1.4-9.8) were risk factors for inadequate screening. Alcohol abuse by the woman was an effect modifier for not having the test among victims of violence (adjustedOR = 10.2; 95%CI: 1.8-56.4) and in cases of co-occurrence of violence (adjustedOR = 8.5; 95%CI: 1.4-50.7). In addition to known causal factors for intimate partner violence, the results point to a risk association between women's exposure to abuse and inadequate screening. The findings call for an expanded view of women's absenteeism from screening, since this indicator can represent unmet demands not readily detected by health teams.

Post-transplant diabetes: diagnosis and management.

Post-transplant diabetes mellitus (PTDM) is common after most types of solid organ transplantation, though the actual incidence is as yet unknown because of the use of different diagnostic criteria. PTDM is the result of individual risk factors as well as risk factors associated with the transplant itself, particularly immunosuppressants. Previously called New Onset Diabetes, in many cases inadequate screening for diabetes before transplant cannot assure that the diabetes is new after transplant. The most recent international consensus guidelines suggest diagnosis should be delayed until the patient is taking maintenance doses of immunosuppressants even if they require treatment in the immediate hospitalization. Criteria for diagnosis follow those of the American Diabetes Association and the World Health Organization, although hemoglobin A1C should not be used as the only screening test at least until one year after transplant because of its insensitivity for significant glucose intolerance in the transplant patient and setting. Management of PTDM is best done in a team setting, with an emphasis on glycemic control, dyslipidemia, and hypertension, and taking into consideration immunosuppressant regimens and potential drug side effects and interactions. While PTDM has been associated with changes in outcomes, these have and may continue to improve with improved diabetes care in and out of the hospital, and other changes in post-transplant care.

Therapeutic potential of an anti-angiogenic multimodal biomimetic peptide in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Due to inadequate screening methods and the common coexistence of limited functional liver reserves, curative treatment options are limited. Liver transplantation is the only curative treatment modality for early HCC. There are multidisciplinary treatment options like ablative treatments, radiation and systemic therapy available for more advanced patients or those that are inoperable. Treatment resistance and progression is inevitable for these HCC patients. Newer therapeutics need to be explored for better management of HCC. HCC is a hypervascular tumor and many pro-angiogenic proteins are found significantly overexpressed in HCC. Here we explored the therapeutic potential of the anti-angiogenic, anti-lymphangiogenic, and directly anti-tumorigenic biomimetic collagen IV-derived peptide developed by our group. Human HCC cell lines HuH7, Hep3b and HepG2 showed significant disruption of cell adhesion and migration upon treatment with the peptide. Consistent with previously described multimodal inhibitory properties, the peptide was found to inhibit both c-Met and IGF1R signaling in HepG2 cells and blocked HepG2 conditioned media stimulation of microvascular endothelial cell (MEC) tube formation. Furthermore, the peptide treatment of mouse HepG2 tumor xenografts significantly inhibited growth relative to untreated controls. The peptide was also found to improve the survival of autochthonous Myc-induced HCC in a transgenic mouse model. Mechanistically, we found that the peptide treatment reduced microvascular density in the autochthonous liver tumors with increased apoptosis. This study shows the promising therapeutic potential of our biomimetic peptide in the treatment of HCC.

Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy

Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy Stephen Hull, MHS, Seán Kelley, MD, MSc, and Janice L. Clarke, RN, BBA Editorial: Sexually Transmitted Infections-A Fixable Problem: David B. Nash, MD, MBA S-3 Introduction S-3 Rising Prevalence of Sexually Transmitted Diseases (STIs) S-4 Current Screening Rates for Chlamydia and Gonorrhea S-4 The Human Toll and Economic Burden of STI-Related Illness S-5 Current Screening Guidelines for Chlamydia and Gonorrhea S-5 Factors Contributing to Inadequate Screening, Diagnosis, and Treatment for STIs S-6 Methods Used to Improve Screening Rates S-7 Benefits of Opt-Out Screening Strategies for STIs S-8 Cost-Effectiveness of Screening for STIs S-8 Discussion S-9 Conclusion S-10.

Spheroid growth in ovarian cancer alters transcriptome responses for stress pathways and epigenetic responses.

Ovarian cancer is the most lethal gynecological cancer, with over 200,000 women diagnosed each year and over half of those cases leading to death. These poor statistics are related to a lack of early symptoms and inadequate screening techniques. This results in the cancer going undetected until later stages when the tumor has metastasized through a process that requires the epithelial to mesenchymal transition (EMT). In lieu of traditional monolayer cell culture, EMT and cancer progression in general is best characterized through the use of 3D spheroid models. In this study, we examine gene expression changes through microarray analysis in spheroid versus monolayer ovarian cancer cells treated with TGFβ to induce EMT. Transcripts that included Coiled-Coil Domain Containing 80 (CCDC80), Solute Carrier Family 6 (Neutral Amino Acid Transporter), Member 15 (SLC6A15), Semaphorin 3E (SEMA3E) and PIF1 5'-To-3' DNA Helicase (PIF1) were downregulated more than 10-fold in the 3D cells while Inhibitor Of DNA Binding 2, HLH Protein (ID2), Regulator Of Cell Cycle (RGCC), Protease, Serine 35 (PRSS35), and Aldo-Keto Reductase Family 1, Member C1 (AKR1C1) were increased more than 50-fold. Interestingly, EMT factors, stress responses and epigenetic processes were significantly affected by 3D growth. The heat shock response and the oxidative stress response were also identified as transcriptome responses that showed significant changes upon 3D growth. Subnetwork enrichment analysis revealed that DNA integrity (e.g. DNA damage, genetic instability, nucleotide excision repair, and the DNA damage checkpoint pathway) were altered in the 3D spheroid model. In addition, two epigenetic processes, DNA methylation and histone acetylation, were increased with 3D growth. These findings support the hypothesis that three dimensional ovarian cell culturing is physiologically different from its monolayer counterpart.

The Physical Health of Patients with Psychiatric Disorders: What Is the Role of the Psychiatrist?

People with chronic mental disorders, such as schizophrenia, experience excessive medical morbidity and mortality. This results from various patient, disease, and health-system factors. Among them is inadequate screening for and treatment of common medical conditions. There is a growing impetus for psychiatrists to play a larger role in the physical health of their patients. Clinical context, provider comfort and competence, and patient preference are all factors that must be considered. Psychiatrists' increasing involvement in managing the physical health issues of their patients is a key approach to reducing health disparities among people with chronic mental disorders. [ Psychiatr Ann . 2017;47(7):362–367.]

Screening for Syphilis and Other Sexually Transmitted Infections in Pregnant Women - Guam, 2014.

Prenatal screening and treatment for sexually transmitted infections (STIs) can prevent adverse perinatal outcomes. In Guam, the largest of the three U.S. territories in the Pacific, primary and secondary syphilis rates among women increased 473%, from 1.1 to 6.3 per 100,000 during 2009-2013 (1). In 2013, the first congenital syphilis case after no cases since 2008 was reported (1,2). Little is known about STI screening coverage and factors associated with inadequate screening among pregnant women in Guam. This study evaluated the prevalence of screening for syphilis, human immunodeficiency virus (HIV), chlamydia, and gonorrhea, and examined correlates of inadequate screening among pregnant women in Guam. Data came from the medical records of a randomly selected sample of mothers with live births in 2014 at a large public hospital. Bivariate analyses and multivariable models using Poisson regression were conducted to determine factors associated with inadequate screening for syphilis and other STIs. Although most (93.5%) women received syphilis screening during pregnancy, 26.8% were not screened sufficiently early to prevent adverse pregnancy outcomes. Many women were not screened for HIV infection (31.1%), chlamydia (25.3%), or gonorrhea (25.7%). Prenatal care and insurance were important factors affecting STI screening during pregnancy. Prenatal care providers play an important role in preventing congenital infections. Policies and programs increasing STI and HIV services for pregnant women and improved access to and use of prenatal care are essential for promoting healthy mothers and infants.

Assessing Marijuana Use During Pregnancy

Recreational and medicinal marijuana uses have become more prevalent in recent years. Women’s health nurses are increasingly likely to encounter pregnant women who use or have used marijuana. Research has found that inadequate screening for substance use, inadequate knowledge about the effects of marijuana use, and punitive counseling are barriers to women’s understanding of the importance of seeking treatment for substance use. Provision of evidence-based counseling, education, and resources support women and strengthen the patient–provider relationship. Women’s health nurses can gain a basic understanding of the effects of perinatal marijuana use and create a plan for women who have positive screening results. This article reviews two recent studies that examine marijuana use during pregnancy and suggest interventions that women’s health nurses can implement.

Abstract TMEM-034: THE HEAT SHOCK TRANSCRIPTION FACTOR HSF1 INDUCES OVARIAN CANCER EPITHELIAL-MESENCHYMAL TRANSITION IN A 3D SPHEROID GROWTH MODEL

Abstract Ovarian cancer is the most lethal gynecological cancer, with over 200,000 women diagnosed each year and over half of those cases leading to death. These poor statistics are related to a lack of early symptoms and inadequate screening techniques. This results in the cancer going undetected until later stages when the tumor has metastasized through a process that requires the epithelial to mesenchymal transition (EMT). In lieu of traditional monolayer cell culture, EMT and cancer progression in general is best characterized through the use of 3D spheroid models. Compared to other cancers, ovarian cancer has very limited treatment options to date, with cisplatin and paclitaxel being the most common and efficient. Recently, a significant increase in heat shock factor 1 (HSF1) expression has been found in highly malignant ovarian cancer. HSF1 is the regulator of the heat shock response (HSR) and promotes the transcription of heat shock proteins (HSPs). Previous studies have shown that HSF1-induced chaperone activity may act to stabilize multiple oncogenes within many different cancer types. This leads to cancer proliferation, reduced apoptosis, and metastasis. In this study, we examine gene expression changes through microarray analysis in spheroid versus monolayer ovarian cancer cells treated with TGFβ to induce EMT. Interestingly, EMT and stress response pathways, including the heat shock response, were all significantly affected by 3D growth. HSF1 knockdown was utilized in both 2D and 3D cultures to further study this response. HSF1 knockdown is shown to inhibit ovarian cancer progression in both monolayer and spheroid model cells. Moreover, HSF1 knockdown in spheroid cells has a significantly greater impact on EMT markers than it does in 2D cultures. This indicates HSF1 may be a utilized as a target for chemotherapeutics in ovarian cancer patients and could potentially have implications in other such hormonal cancers. Citation Format: Trillitye Paullin, Chase Powell, Chris Menzie, Robert Hill, Christopher Martyniuk, and Sandy D. Westerheide. THE HEAT SHOCK TRANSCRIPTION FACTOR HSF1 INDUCES OVARIAN CANCER EPITHELIAL-MESENCHYMAL TRANSITION IN A 3D SPHEROID GROWTH MODEL [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr TMEM-034.

Abstract 434: The Majority of Outpatients With Severe Hypercholesterolemia at an Academic Tertiary Centre Have Not Been Screened for FH

Background: National and International guidelines recommend, as a minimum, that individuals with LDL-C ≥190mg/dL are asked about a family history of ASCVD and hypercholesterolemia to screen for familial hypercholesterolemia (FH), a monogenic condition that carries considerable ASCVD risk. However, FH is grossly underdiagnosed and undertreated in the US. One reason for this may be failure to screen severely hypercholesterolemic individuals for FH. Hypothesis: We evaluated the hypothesis that poor identification of FH might be due to inadequate screening for FH among individuals with severe hypercholesterolemia. Methods: An EHR query was used to identify active adult patients in the University of Pennsylvania outpatient EHR database (N=310 802) with LDL-C≥220mg/dL, excluding secondary causes of hypercholesterolemia. The EHR was then systematically reviewed for structured notation of family history information. Result: The query identified 3,475 individuals with severely elevated LDL-C. Among them, only 47.9% (1666) had family history data relating to ASCVD (968), hypercholesterolemia (336) or both (362) in the EHR. The history was positive in 94.2% (1569) of these cases. Overall, patients with LDL-C ≥220mg/dL were more likely to be screened (OR 1.57; 95% CI 1.47-1.68) than those with LDL <220mg/dL. Within the former group, the odds of being screened were higher in Caucasians (OR 1.52; 95% CI 1.33-1.75), with more severe LDL-C elevation or a history of ASCVD (OR 1.36; 95% CI 1.10 - 1.67). Conversely, the presence of diabetes (OR 0.73; 95% CI 0.61-0.86) or hypertension (OR 0.82; 95% CI 0.72-0.94), made screening less likely to occur. Interestingly, the setting of clinical care was also important; individuals seen in secondary care (OR 1.68; 95% CI 1.41-2.26), general (OR 1.69, 95% CI 1.47-1.95) or preventative cardiology (OR 1.82; 95% CI 1.47-2.25) were more likely to be screened. Finally, statin prescription was more common in those screened (OR 1.39; 95% CI 1.16-1.88), but this did not affect LDL-C goal achievement. Conclusion: At a large academic centre, the majority of outpatients with severe hypercholesterolemia had no record of being screened for FH. This report sheds light on factors that might be relevant to the underdiagnosis of FH in the US.

Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.

Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.

Knowledge about cervical cancer, Pap test, and barriers to women's participation in screening in Belgrade, Serbia.

Cervical cancer (CC) is a serious public health concern in Serbia, due to opportunistic screening still being in force, which led to twice higher than the average incidence rate of cervical cancer in Europe. Despite the fact that early detection and treatment services of CC are available at no additional cost, majority of women use inadequate screening services in Serbia. This study aimed to examine the link between the knowledge about CC and Papanicolaou (Pap) test and perception of barriers to women's participation in CC screening. The study included 300 women aged 21 to 69, with a place of residence in the city of Belgrade (Serbia), who were attending for their medical examination to the University Clinic of Gynecology and Obstetrics - "Narodni front", from June through December 2014. A survey instrument to collect data was an adapted questionnaire for the assessment of knowledge about and barriers to CC and Pap test. Patients were divided into three groups: a study group consisted of women attending irregularly (over three years), women who never participated in screening, and a control group that included women regularly participating in screening. Women regularly participating in screening (52.7%) had adequate knowledge about CC and Pap test, while women who irregularly (79.4%) or never participated (71.9%) did not have any adequate knowledge. There was a significant statistical difference between the CC and Pap test awareness in a group of respondents who regularly participated in comparison to respondents who irregularly or never participated in screening (x²= 27.772, p = 0.000). Regarding knowledge about human papillomavirus (HPV), 80% of women did not know that Pap test cannot be used for detection of HPV, as well as that abnormal Pap test result may be due to HPV (61.7%). Majority of women (93.7%) had poor knowledge about Pap test role in CC early detection and considered Pap test to be used to diagnose CC. The authors found a significant statistical correlation between participation of women in screening and barriers. Women who were irregular or never participated, had barriers such as: lack of time (F = 9.51; p = 0,000), difficult access to Healthcare facilities (F = 11.29; p = 0.000), lack of knowledge about the Pap test procedure (F = 21.27,p = 0.000), discomfort (F = 9.36; p = 0.000), and anxiety of Pap test results (F = 3.35; p = 0.036). Women who regularly participated did not have prejudice when choosing a gynecologist, unlike the other two groups that preferred a female gynecologist (F = 3.61; p = 0.028). This study showed that the level of knowledge about CC and Pap test in women is an important factor associated with regular participation in screening. It is necessary to take educational measures in order to raise awareness of women regarding risk factors, as well as to overcome fear and shame, with the ultimate aim to reduce frequency and mortality rate caused by CC in Serbia.

Lymphedema: Improving Screening and Treatment Among At-Risk Breast Cancer Survivors.

Inadequate peripheral lymphedema screening is a persistent gap in the provision of quality survivorship care at many breast cancer centers. Lymphedema should be identified and treated during the subclinical stage, when it is more likely reversible. The purpose of this project was to integrate a screening process for patients with breast cancer at risk for lymphedema, using bioimpedance spectroscopy via the L-Dex®, in a breast cancer center. A protocol was developed that included specific criteria for early patient referral to physical therapy.

Abstract C65: Promoting colorectal cancer screening in rural Appalachian emergency department

Abstract Objective: To provide a conceptual description of an Emergency Department (ED) placed randomized controlled trial designed to reduce the disproportionate burden of colorectal cancer (CRC) among rural Appalachian residents. Background: Residents of rural Appalachia have a higher incidence and mortality rate from CRC than residents of any other region of the country. The Centers for Disease estimate that as many as 60% of CRC deaths could be prevented if everyone aged 50 and up were screened regularly. One of the primary barriers to CRC screening for rural Appalachian residents is limited access to the health care system resulting in infrequent recommendations for screening and inadequate screening education. Given the propensity of rural Appalachians to accept health related information from trusted community members we designed an intervention to be delivered by local community health workers in the ED while individuals waited for non urgent care or waited with a family member. The ED provides services to a segment of the population that is traditionally hard to reach and at high risk for underutilization of preventive services. ED visits may be the sole point of contact with the health care system for these vulnerable individuals and provides a venue and opportunity for CRC screening promotion and education. Methods: This ED-placed RCT, designed and implemented in collaboration with community members and health care providers in rural Eastern Kentucky, is one of the first to use the ED as a site to promote colorectal cancer screening using a community health worker trained to deliver a motivational interviewing intervention to persons waiting for non urgent care or with a family member, in the ED of rural Appalachian hospitals. Results: We provide a conceptual overview to key elements of the intervention, including intervention development and refinement, theoretical foundations, intervention approach and implementation and evaluation procedures. Conclusion: This RCT has recruited more than 150 persons from rural Appalachian EDs who have not been screened for CRC in accordance with guidelines. It provides promise that CRC screening promotion activities are appropriately placed in rural EDs and provides a solid platform from which researchers and providers may launch efforts to develop targeted preventative health interventions in innovative public health settings. Citation Format: Jennifer Hatcher, Arica Brandford, Adaeze Aroh, Adebola Adegboyega, Brenda Combs, Nancy Schoenberg. Promoting colorectal cancer screening in rural Appalachian emergency department. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C65.

Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal health care: A population-based study

AimsTo examine retinopathy screening and treatment rates for recent immigrants compared to non-immigrants in a universal health care system. MethodsLinked health care and immigration databases were used to identify all 771,564 adults diagnosed with diabetes between 1996 and 2007, in Ontario, Canada. The cohort was stratified by their immigration status and followed until 2013 for retinopathy screening and treatment visits. ResultsRetinopathy screening rates were low, and recent immigrants were considerably less likely to receive screening than long-term residents (≥1 examination within 1year: 37.5% vs. 50.5%, adjusted OR 0.76 [95% CI, 0.75–0.77]; ≥3 examinations within 6years: 46.6% vs. 61.9%, adjusted OR 0.77 [95% Cl, 0.76–0.79]). Immigrants were also less likely to receive surgical treatment for retinopathy, but adjustment for the frequency of screening attenuated these differences. ConclusionsDespite universal access to physician services, only half of all individuals with newly-diagnosed type 2 diabetes received retinopathy screening within the first year, and recent immigrants were markedly less likely to be screened. After adjusting for screening rates, gaps in surgical treatment for retinopathy were attenuated, suggesting that treatable retinopathy may be being missed among recent immigrants because of inadequate screening.

Integration of Tuberculosis (TB) Screening in The Ryan White Program in Arkansas

Background Globally, TB remains the most common cause of death among people with HIV (killing 1 in 4 patients). In the US, the conservative estimate of HIV-LTBI burden is 48,000. Population-based TB-HIV data are not available due to inadequate TB screening among the HIV-infected. In the previous study we found that recommendation for TB screening is missing in HIV guidelines in 36 out of 50 (72%) US states, and TB screening data are missing in half of the Ryan White Programs.Methods We aim to assess the current surveillance structure and prevalence of TB screening among Ryan White clients in Arkansas, and inform revisions of guidelines. We interviewed ADH staff (including Ryan White program manager, data specialist, Infectious Disease branch manager, and TB epidemiologist) to map out how TB screening is supposed to be reported in the Ryan White Program. We also assessed data availability and quality in both CAREWare and electronic client dossiers. After evaluation, we created a user-defined data field in CAREWare for pilot testing. Then we had meetings involving both the Ryan White Program and the TB Program for discussion.ResultsThe data flow is shown in Figures 1 and 2. We found no TB screening files in Ryan White client dossiers. The existing TB data structure in CAREWare is confusing, with duplicate variables (both active and inactivate) in multiple sub-tabs. We proposed a user-friendly data field for TB screening (date, type of tests, result, and interpretation). We made three policy changes at the ADH: a memorandum of understanding between the Ryan White Program and the TB Program to improve communications, a modified contract (effective March 2017) with Ryan White providers that mandates annual TB screening for all clients, and an official letter to all physicians in Arkansas addressing the importance of TB screening among HIV-infected people.Conclusion We believe that program collaboration and service integration between TB and HIV is the key in eliminating missed opportunities in TB-AIDS diagnoses. In our next steps, we want to evaluate the data captured in CAREWare between 2016 and 2017. We also want to question why individual level data, which should include TB screenings, are not reported to the HRSA.Figure 1.TB and HIV reporting system in the USA.Figure 2.Information flow in the Ryan White ProgramDisclosures All authors: No reported disclosures.

Inadequate Cancer Screening: Lack of Provider Continuity is a Greater Obstacle than Medical Mistrust.

Racial minorities and low-income individuals are generally less likely to have adequate cancer screening than Whites or higher-income individuals. To examine the roles of medical mistrust and lack of provider continuity in cancer screening in a low-income minority population. A total of 144 urban federally qualified health center patients completed a cross-sectional survey that included the Group Based Medical Mistrust Scale and questions on provider continuity and cancer-screening-history. Breast cancer screening was associated with continuity of care but not mistrust (respectively p = .002, p > .05); colon cancer screening was not significantly associated with either factor (p > .05). Findings suggest that among low-income minority adults continuity of care is more strongly associated with screening than medical mistrust. Shifting focus from medical mistrust-a patient-level issue-to establishing health care homes-a system-level issue-may be a more effective strategy for reducing racial and socioeconomic disparities in cancer screening.