Low Testing Rates Research Articles

Youth insights on a digital crowdsourcing intervention to reduce HIV stigma in Kazakhstan

Abstract Background In Kazakhstan, nearly a quarter of new HIV infections occur among adolescents and young adults (AYA). Testing can reduce the spread of HIV, yet AYA have low testing rates in Kazakhstan, due in part to HIV-related stigma. This qualitative paper explores participants’ perceptions of digital crowdsourcing content designed to reduce HIV stigma and promote HIV self-testing among AYA in Kazakhstan. Methods We conducted semi-structured interviews with 20 AYA who participated in a digital crowdsourcing intervention. Questions focused on AYA’s perceptions of the crowdsourced content they viewed for the intervention, namely their likes, dislikes, the perceived impact of the content, and areas for improvement. Qualitative data analysis was conducted using a thematic approach. Results Findings revealed a perceived need for more youth-developed digital interventions. AYA favored artistic, interactive content featuring health specialists, youth characters, or real-life stories. Short videos and images were AYA’s favorite content formats. Many AYA showed less interest in longer videos and text-heavy content, finding them hard to understand. Most participants reported improved knowledge of HIV, reduced stereotypes related to HIV, heightened interests in HIV topics, more willingness to get tested, and changes of attitudes towards people living with HIV. Recommendations for future interventions include tailoring content to different AYA age groups and creating more engaging and easily digestible content. Conclusions This study highlights the potential of crowdsourced digital interventions in promoting HIV knowledge and awareness of HIV-related stigma among AYA in Kazakhstan. AYA appreciated youth-developed, interactive content that included real-life stories and artistic visual presentations. Key messages • This study highlights the potential of crowdsourced digital interventions in promoting HIV knowledge and awareness of HIV-related stigma among AYA in Kazakhstan. • AYA appreciated youth-developed, interactive content that included real-life stories and artistic visual presentations.

Hepatitis Delta Virus Testing and Prevalence Among Chronic Hepatitis B Patients Across Three U.S. Safety-Net Health Systems

Background & AimsDespite a high prevalence of risk factors associated with hepatitis delta virus (HDV) infection among safety-net populations, data evaluating HDV testing and prevalence are limited. We aim to evaluate HDV testing practices and HDV prevalence among an ethnically diverse, multi-center cohort of safety-net patients with chronic hepatitis B (CHB). MethodsWe retrospectively evaluated 13,218 patients with CHB (54.2% male, 57.9% non-white minorities, 12.5% HIV, 23.0% HCV) across three U.S. safety-net health systems from 2010-2022 to evaluate proportion tested for HDV and proportion positive among those tested. Adjusted multivariate logistic regression models evaluated for predictors of HDV testing and predictors of anti-HDV positive. ResultsAnti-HDV testing was performed in 6.1% overall and in 4.9% that met AASLD criteria for HDV testing. Greater odds of testing was observed in men vs. women (OR 1.49, 95%CI 1.27–1.75), Asian individuals vs. white individuals (OR 2.18, 95%CI 1.74-2.72), black/African American individuals vs. white individuals (OR 1.29, 95%CI 1.07-1.56), and patients with Medicare or Medicaid. Among CHB patients tested for HDV, 15.7% were positive (22.9% among those meeting AASLD HDV testing criteria). Only 2 (1.6%) patients had follow-up HDV RNA testing. Greater proportion of anti-HDV positive was observed in patients with baseline cirrhosis (47.4% vs. 13.3%, p<0.001), and patients with Medicare or Medicaid vs. those with commercial insurance. ConclusionsAmong an ethnically diverse, multi-center safety-net cohort of CHB patients, low rates of HDV testing were observed, even among those with high-risk HDV risk factors. Among those tested, 15.7% were positive, only 2 had follow up RNA testing. This highlights the need for greater awareness, education, and advocacy to improve HDV testing rates.

Hepatitis Delta Virus Testing, Prevalence, and Liver-Related Outcomes Among U.S. Veterans with Chronic Hepatitis B

Background and AimsHepatitis delta virus (HDV) infection in patients with chronic hepatitis B (CHB) is associated with worse liver-related outcomes. We aim to comprehensively evaluate HDV testing, diagnosis, and liver-related outcomes among a national cohort of U.S. Veterans with CHB. MethodsU.S. Veterans with CHB from 2010 to 2023 were evaluated to determine trends in HDV testing (anti-HDV antibody, HDV RNA) and proportion positive among those tested. HDV positive patients were 1:2 propensity score matched to CHB patients who were HDV negative to evaluate incidence (per 100,000 person-years) of cirrhosis, hepatic decompensation, or hepatocellular carcinoma using competing risks Nelson-Aalen methods for estimating cumulative hazards. ResultsAmong 27,548 CHB patients identified, 16.1% completed HDV testing, among whom 3.25% (n=144) were positive. After excluding patients with cirrhosis or HCC at baseline, 71 patients with HDV (median follow-up 5.3 years, IQR 2.5-7.6) were propensity score matched to 140 CHB patients without HDV (median follow-up 4.5 years, IQR 2.6-8.1). Compared to CHB patients without HDV, those with concurrent HDV had significantly greater incidence of cirrhosis (4.39 vs. 1.30 per 100,000 person-years, p < 0.01) and hepatic decompensation (2.18 vs. 0.41 per 100,000 person-years, p=0.01). ConclusionAmong a national cohort of U.S. Veterans with CHB, low rates of HDV testing were observed. This is concerning given that patients with concurrent HDV infection had >3 times and >5 times greater risks of cirrhosis and hepatic decompensation, respectively, compared to CHB patients without HDV, highlighting the importance of timely HDV diagnosis and treatment.

Abstract A138: Decreasing disparities in inherited cancer syndrome identification through a systems approach, The At-Risk Cancer Genetic Syndrome Identification (ARCAGEN-ID) system

Abstract Three percent of cancers are due to inherited cancer-predisposing syndromes, the most common ones being Hereditary Breast and Ovarian cancer syndrome and Lynch syndrome. Surveillance and preventive measures among diagnosed individuals lead to early detection, prevention of future cancers, and appropriate treatment modalities ultimately resulting in lower cancer mortality. Thus, identifying these individuals through genetic testing is of most importance. While guidelines have been drafted to identify people who need to be ruled out based on personal and family history of cancer, less than 30% of qualifying individuals are currently tested and these numbers are much worse among underserved communities. Lack of awareness, largely due to guideline complexity, has been documented as a critical factor for the low testing rates while clinician’s unconscious bias contributes to disparities. The objective of this project was to increase the identification of individuals at risk, especially among the underserved groups. We hypothesized that this could be accomplished by establishing a mechanism of automatic identification of candidates leveraging the electronic health records (EHR), the ARCAGEN-ID (At-Risk Cancer Genetic Syndrome Identification) system. Methods: An inclusion logic was designed based on 218 rules that evaluate personal and family history of specific cancers and age at diagnosis, relevant to NCCN/ACMG guidelines for genetic testing. Structured data was pulled from discrete fields in the EHR. External data was accessed by enabling the standard interoperability exchange of information system. The system was applied to the wellness registry, a cohort of 1,357,337 patients with an active EHR in our healthcare system. Results: The ARCAGEN-ID system identified 57,628 individuals at-risk (4.25%). Of those, 45,646 (79.2%) had no evidence of prior genetic test, cancer genetics evaluation, or referral. A manual chart review of 559 cases showed an identification accuracy rate of 96.2%. The ARCAGEN-ID identified a lower proportion of self-reported African Americans, Hispanics and Medicaid insured patients than the overall wellness registry (likely reflecting less complete relevant information in the EHR). However, patients in those categories were significantly overrepresented among the ones who were not previously referred for genetic testing. Thus, ARCAGEN-ID significantly increased the identification of individuals from minority groups by 12.7 to 23% in each category. Regarding criteria for inclusion, individuals identified only through ARCAGEN-ID were more likely identified because of family history of cancer only, representing 80.69%. In conclusion, a fully automated system that leverages the EHR was able to multiply by 5 the number of individuals who need to be ruled out for an inherited cancer syndrome while addressing the bias against underserved communities seen under current routine care. Citation Format: Rosa Munoz Xicola, Vinit Singh, Thomas Rafter, Jing Liu, Quiana Brown, Nitu Kashyap, Xavier Llor. Decreasing disparities in inherited cancer syndrome identification through a systems approach, The At-Risk Cancer Genetic Syndrome Identification (ARCAGEN-ID) system [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A138.

Geographical Mapping of COVID-19 Testing Rates in St. Louis: Influence of the Socioeconomic Index and Race on Testing in the Early Phase and Peak of the COVID-19 Pandemic

Purpose: This study aimed to explore how race and the socioeconomic index (SES) of residential zip codes influenced COVID-19 testing rates in St. Louis during the early and peak phases of the pandemic. Method: An ecological study was conducted using COVID-19 testing data from March to November 2020 in St. Louis City, including 16,915 tests from 30 residential zip codes. Geographical mapping identified areas lacking testing, descriptive statistics characterized testing rates by race and SES, and robust linear regression modeled the association between testing rates and race, controlling for SES. Results: The overall testing rate was 303.97 per 10,000 population. Testing rates among Blacks, Whites, American Indians/Alaskan Natives, and Asians were 374.26, 247.77, 360.63, and 242.41 per 10,000, respectively. Higher rates were observed in low- and middle-SES zip codes compared with high-SES areas. Adjusted for SES, testing rates per 10,000 were higher by 125 (1.25%), 448 (4.48%), and 32 (0.32%) among Blacks, American Indians/Alaskan Natives, and Asians compared with Whites. Testing rates decreased by 56 (0.56%) per unit SES improvement. There was statistically significant SES finding and that of the difference between American Indians/Alaskan Natives and Whites. Geographical mapping showed higher rates in the inner core and lower rates in the periphery of St. Louis. Conclusions: Race and SES influence testing rates. Targeted interventions are needed in areas with low testing rates in St. Louis.

Very low rates of thyroid function testing in human studies evaluating basal metabolic rate

Very low rates of thyroid function testing in human studies evaluating basal metabolic rate

Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention.

HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Received an HIV test in the prior six months. There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001). The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. This trial is registered with clinicaltrials.gov (NCT02786615). National Institute on Drug Abuse (NIDA), grant number R01DA040513.

A Mixed Methods Approach to Understanding the Public Health Impact of a School-Based Citizen Science Program to Reduce Arsenic in Private Well Water.

Exposure to arsenic (As) in well water is a well-documented public health issue for Maine and New Hampshire, as well as for other states in the United States and abroad. Arsenic contamination of well water in these locations is primarily attributed to metasedimentary bedrock that leaches As into groundwater. However, As can also enter groundwater reserves from soils contaminated by the historical use of arsenical pesticides. Approximately half of the households in Maine and New Hampshire rely on private wells, many of which have elevated As. Arsenic exposure has been associated with an increased risk of cancer, cardiovascular disease, reduced infection resistance, and lower intelligence quotient in children. Despite these known health impacts, well water testing and treatment are not universal. We have approached the problem of low well water testing rates in Maine and New Hampshire communities by developing the All About Arsenic (AAA) project, which engages secondary school teachers and students as citizen scientists in collecting well water samples for analysis of As and other toxic metals and supports their outreach efforts to their communities. We assessed this project's public health impact by analyzing student data relative to existing well water quality datasets in both states. In addition, we surveyed private well owners who contributed well water samples to the project to determine the actions taken to mitigate As in well water. Students collected 3,070 drinking water samples for metals testing, and 752 exceeded New Hampshire's As standard of . The AAA data has more than doubled the amount of information available to public health agencies about well water quality in multiple municipalities across both states. Students also collected information about well types and treatment systems. Their data reveal that some homeowners did not know what type of wells they had or whether they had filtration systems. Those with filtration systems were often unaware of the type of system, what the system was filtering for, or whether the system was designed to remove As. Through interviews with pilot survey participants, we learned that some had begun mitigating their exposure to As and other toxic metals in response to test results from the AAA project. A school-based approach to collecting and analyzing private well water samples can successfully reach communities with low testing rates for toxic elements, such as As and other metals. Importantly, information generated through the program can impact household decision-making, and students can influence local and state policymaking by sharing information in their communities. https://doi.org/10.1289/EHP13421.

Identifying and Linking Patients At Risk for MASLD with Advanced Fibrosis to Care in Primary Care.

Severity of fibrosis is the driver of liver-related outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD), and non-invasive testing such as fibrosis-4 (FIB-4) score is utilized for risk stratification. We aimed to determine if primary care patients at risk for MASLD and advanced fibrosis were evaluated with subsequent testing. A secondary aim was to determine if at-risk patients with normal aminotransferases had advanced fibrosis. Primary care patients at increased risk for MASLD with advanced fibrosis (n = 91,914) were identified using previously established criteria. Patients with known alternative/concomitant etiology of liver disease or cirrhosis were excluded. The study cohort included patients with calculated FIB-4 score in 2020 (n = 52,006), and stratified into low, indeterminate, and high likelihood of advanced fibrosis. Among those at indeterminate/high risk, rates of subsequent testing were measured. Risk stratification with FIB-4 characterized 77% (n = 40,026) as low risk, 17% (n = 8847) as indeterminate, and 6% (n = 3133) as high risk. Among indeterminate/high-risk patients (n = 11,980), 78.7% (n = 9433) had aminotransferases within normal limits, 0.95% (n = 114) had elastography, and 8.2% (n = 984) were referred for subspecialty evaluation. In this cohort of primary care patients at risk for MASLD with fibrosis, the FIB-4 score identified a substantial proportion of indeterminate/high-risk patients, the majority of which had normal aminotransferase levels. Low rates of subsequent testing were observed. These data suggest that a majority of patients at increased risk for liver-related outcomes remain unrecognized and highlight opportunities to facilitate their identification.

Low testing rates and high BRCA prevalence: Poly (ADP-ribose) polymerase inhibitor use in Middle East BRCA/homologous recombination deficiency-positive cancer patients.

Poly (ADP-ribose) polymerase inhibitors (PARPis) are approved as first-line therapies for breast cancer gene (BRCA)-positive, human epidermal growth factor receptor 2-negative locally advanced or metastatic breast cancer. They are also effective for new and recurrent ovarian cancers that are BRCA- or homologous recombination deficiency (HRD)-positive. However, data on these mutations and PARPi use in the Middle East are limited. To assess BRCA/HRD prevalence and PARPi use in patients in the Middle East with breast/ovarian cancer. This was a single-center retrospective study of 57 of 472 breast cancer patients tested for BRCA mutations, and 25 of 65 ovarian cancer patients tested for HRD. These adult patients participated in at least four visits to the oncology service at our center between August 2021 and May 2023. Data were summarized using descriptive statistics and compared using counts and percentages. Response to treatment was assessed using Response Evaluation Criteria in Solid Tumors criteria. Among the 472 breast cancer patients, 12.1% underwent BRCA testing, and 38.5% of 65 ovarian cancer patients received HRD testing. Pathogenic mutations were found in 25.6% of the tested patients: 26.3% breast cancers had germline BRCA (gBRCA) mutations and 24.0% ovarian cancers showed HRD. Notably, 40.0% of gBRCA-positive breast cancers and 66.0% of HRD-positive ovarian cancers were Middle Eastern and Asian patients, respectively. PARPi treatment was used in 5 (33.3%) gBRCA-positive breast cancer patients as first-line therapy (n = 1; 7-months progression-free), for maintenance (n = 2; > 15-months progression-free), or at later stages due to compliance issues (n = 2). Four patients (66.6%) with HRD-positive ovarian cancer received PARPi and all remained progression-free. Lower testing rates but higher BRCA mutations in breast cancer were found. Ethnicity reflected United Arab Emirates demographics, with breast cancer in Middle Eastern and ovarian cancer in Asian patients.

Impact on biomarker documentation in community oncology by optimizing clinical decision support.

11182 Background: Timing of biomarker results is critical to informing the selection of appropriate precision medicine-based treatment options for patients. Prior studies have demonstrated that low rates of biomarker testing may be driven by poor documentation. Our clinical decision support (CDS) tool aims to provide community oncology clinicians with a clear picture of the ever-growing available treatments. Evaluation of CDS data revealed an excess of biomarker results documented as “unknown” thought to be related to results availability. Methods: During treatment selection in the CDS tool, providers answer various prompts related to the patient’s disease, staging, treatment intent, and biomarker results. Prompts are aligned with NCCN guidelines for the respective cancer type. Changes were implemented to ease providers’ documentation of biomarker results. For adjuvant (adjNSCLC) and metastatic NSCLC (mNSCLC), prompts were relocated to align with when biomarker results were likely to be available. For metastatic castrate resistant prostate cancer (mCRPC), some biomarkers are only needed after a patient has received prior docetaxel and hormone therapy, thus prompts were moved to that scenario. Re-prompting of biomarker status for subsequent therapy was also implemented if the initial response was “unknown.” We report changes in percentage of known biomarkers specifically in adjNSCLC, mNSCLC, and mCRPC. Descriptive statistics were used to describe the rates of known biomarkers, and a chi-square test was used to analyze differences from pre and post changes. Results: In this evaluation, 85,493 biomarkers were documented. In adjNSCLC and mNSCLC, biomarker prompt changes increased documentation of known biomarkers from 69% to 78% and 59% to 79% pre- to post-implementation. In adjNSCLC, ALK and PD-L1 recording increased by ≥10% (P&lt;0.00001). For mNSCLC, documentation increased for all known biomarkers (P&lt;0.00001), including ≥15% increases for 8 of 10 biomarkers. In mCRPC, known biomarker documentation improved from 34% pre-implementation to 61% post-implementation. BRCA1/2, MSI, MMR, TMB, and PSMA biomarker recording increased by ≥20% (P&lt;0.00001) after prompt changes. Selected biomarkers are shown in the table. Conclusions: Adjusting prompts in a CDS tool to align with the availability of biomarkers in clinical practice increased the documentation of known biomarker results for adjNSCLC, mNSCLC, and mCRPC. Based on these findings, similar changes are being implemented for other cancer types in the CDS tool. [Table: see text]

Differences in baseline characteristics and healthcare costs among insured patients with advanced cancer with vs without clinical trial participation.

11154 Background: Despite concerted efforts to improve clinical trial participation (CTP), enrollment remains low. Perceived additional costs to the patient or health plan may be barriers to CTP; low biomarker testing rates may be another. This study assessed differences in characteristics of patients with CTP versus patients without CTP in an insured population with advanced cancer. Methods: A retrospective analysis was conducted using de-identified administrative claims data from commercially insured and Medicare Advantage (MA) enrollees in the Optum Labs Data Warehouse. Patients ≥18y with claims evidence of advanced cancer and systemic therapy between 01/01/2018 and 02/28/2022 were stratified into 2 groups: 1) with CTP: ≥1 claim with a CTP diagnosis (ICD10 Z00.6) and ≥1 claim with a Q modifier on or within 90 days after index date; and 2) without CTP: no claims with a CTP diagnosis or Q modifier. Patients with &gt;1 primary cancer, T-cell therapy, or &lt;360 days baseline or follow-up (unless death) enrollment were excluded. Biomarker testing, targeted therapy use, and healthcare costs per patient per month (PPPM) were assessed in the baseline period. Results: Of 61,490 patients identified, 1753 (3%) had CTP and 59,737 (97%) did not have CTP; 4% of commercial and 3% of MA patients had CTP. Most common tumor types were breast (27%; 2% had CTP), lung (16%; 3% had CTP), digestive tract (15%; 2% had CTP), and prostate (15%; 3% had CTP). Patients with CTP were younger and more frequently had documented biomarker test use in the baseline period than patients without CTP (Table). In unadjusted analyses, the CTP group had higher healthcare costs in the baseline period prior to CTP regardless of insurance type, driven by 51% higher systemic cancer therapy costs and 35% higher ambulatory visit costs. An ongoing propensity score matched analysis will evaluate the impact of CTP on cost of care in the follow-up period. Conclusions: Consistent with prior studies, the overall CTP rate among patients with advanced cancers was low (3%). Baseline costs (prior to CTP) were higher for patients that later enrolled in clinical trials than for patients without CTP. Further research is ongoing to assess differences in follow-up healthcare costs for patients with vs without CTP adjusting for baseline characteristics. [Table: see text]

Ethnic disparities in biomarker testing of patients with metastatic NSCLC in the United States: A real-world analysis.

e20617 Background: National Comprehensive Cancer Network guidelines recommend biomarker testing prior to intervention in metastatic non-small cell lung cancer (mNSCLC). However, biomarker testing remains low, particularly in minorities, especially when targeted therapy against actionable driver mutations improves outcomes and quality of life significantly. We sought to determine testing rates and assess disparities between Hispanic and non-Hispanic Whites. Methods: A retrospective cohort study was conducted in accordance with "strengthening the reporting of observational studies in epidemiology" (STROBE) guidelines. All Hispanic and non-Hispanic White patients across a US oncology-focused hospital consortium (Guardian Research Network) were identified from 01/2018 to 01/2023. Socio-demographic details, clinical profiles, and details related to biomarker testing, treatment, and clinical outcomes were extracted. We also ascertained the area deprivation index (ADI) based on zip code as a surrogate for socio-economic stratification. We grouped patients into validated quintiles of ADI. We extracted testing details of the most common driver mutations – EGFR, ALK, KRASG12C, and PDL1. Data were analyzed using descriptive and inferential statistics. Results: Out of 4898 eligible patients with mNSCLC, 9.89% (n = 484/4898) were Hispanic, and 90.11% (n = 4414/4898) were non-Hispanic Whites. Overall testing rates for EGFR, ALK, KRASG12C and PD-L1 were 36.07% (n = 1767/4898), 33.60% (n = 1646/4898), 3.76% n = 184/4898) and 48.42% (n = 2372/4898). EGFR and ALK testing revealed significant differences showing reduced testing in the non-Hispanic White population (Table 1.) Multivariate logistic regression revealed no significant association between ADI, ethnicity and biomarker testing. Four hundred and eighty-three individuals underwent biomarker testing but did not receive treatment. Forty-three percent (n = 205/483) were alive at the time of data extraction, with 5.18% (n = 25/483) identified as Hispanic. Conclusions: Our analysis reveals that biomarker testing remains low in patients with mNSCLC, showing decreased testing rates of EGFR and ALK in non-Hispanic Whites when compared to Hispanic Whites. Purposeful strategies such as education and testing awareness campaigns are warranted to overcome low testing rates in patients diagnosed with mNSCLC.[Table: see text]

Abstract PO1-08-07: Utilization Management: The Impact of Laboratory Genetic Counseling Oversight on BRCA1 and BRCA2 Targeted Analysis Orders

Abstract INTRODUCTION: While multigene hereditary cancer testing has become a common order for individuals with personal and/or family histories of cancer, targeted genetic testing (TGT) remains a cost-effective test option for cascade testing of individuals with a known gene mutation in the family. In order to proceed with TGT, the genetic testing laboratory must receive documentation of the specific variant. Intervention of a genetic counseling team (GCT), which includes laboratory genetic counselors and genetic counseling assistants, can play a major role in utilization management for genetic testing companies, including obtaining and reviewing mutation reports and offering clinically appropriate and cost-effective test options. Given previously reported low rates of cascade testing for family members of mutation carriers and the potential barriers of ordering TGT testing, we sought to review the success of providers ordering BRCA1 and BRCA2 TGT testing and the GCT role in management of these orders. METHODS: Per standard operating procedure at Labcorp, the GCT reviews all hereditary cancer genetic test orders before they begin processing through prior authorization and laboratory analysis. When societal guidelines dictate, GCT intervention may occur to request genetic testing reports and offer to update testing appropriately. A retrospective review of GCT notes on TGT orders was conducted, with review of all BRCA1 and BRCA2 TGT orders accessioned between January 1 and February 28, 2023. Orders that were updated or cancelled before GCT review were excluded from analysis. All other TGT orders were coded into one of seven categories: (1) ordered for TGT, mutation report provided, proceed without GCT intervention; (2) ordered for TGT, mutation report obtained after GCT intervention, proceed with TGT; (3) ordered for TGT, no report obtained, updated to BRCA1 and BRCA2 comprehensive sequencing and deletion/duplication analysis with or without other hereditary cancer genes (COMP) with authorization from ordering provider via GCT intervention; (4) ordered for TGT, report obtained, updated to COMP via GCT intervention; (5) ordered for TGT, no report or authorization to update testing obtained during GCT intervention, testing cancelled; (6) ordered for TGT and COMP, no report, TGT cancelled; and (7) ordered for COMP, mutation report obtained, updated to TGT with authorization from ordering provider after GCT intervention. Time between accessioning and initial GCT resolution was also collected. RESULTS: A total of 198 TGT orders and associated GCT notes were reviewed. 24 orders (12.1%) proceeded with TGT without GCT intervention (category 1) with an average turn-around-time of 1 day. GCT intervention was required for 158 (79.8%) of TGT orders with an average turn-around-time of 5 days. After GCT review and/or intervention, 60 (30.3%) orders proceeded with TGT analysis (categories 1, 2, and 7); 23 (11.6%) of these were originally ordered for COMP, then updated when a mutation report was obtained (category 7). Testing was updated from TGT to COMP because no mutation report was obtained in 78 (39.3%) cases (category 3). In 7 (3.5%) TGT orders, testing was updated to COMP even though a mutation report was obtained (category 4). CONCLUSION: TGT analysis is beneficial for cascade testing, but access to a mutation report as a requirement to proceed can be a barrier. More strategies are needed to provide education for ordering providers and patients on the benefit of sharing familial mutation reports for cascade testing. Efficiency of testing increases when patients and providers have access to records and provide this information to laboratories up-front. Laboratory GCTs are invaluable resources in reviewing nuanced genetic test orders, educating providers in the strengths and limitations of different genetic test options, and working to ensure patients receive clinically appropriate and cost-effective testing. Citation Format: Rebecca Vanderwall, Dagny Noeth, Angelica Goulbourne, Katherine Goode, Teresa Ruegg, Melissa Hayden, W. Christine Spence. Utilization Management: The Impact of Laboratory Genetic Counseling Oversight on BRCA1 and BRCA2 Targeted Analysis Orders [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-07.

Trends in RSV testing patterns among infants presenting with bronchiolitis: Results from four United States health systems, 2015-2023

BackgroundBronchiolitis due to respiratory syncytial virus (RSV) is the leading cause of hospitalization among American infants. The overall burden of RSV among infants has been historically under-estimated due to variable testing practices, particularly in the outpatient setting. Universal masking and social distancing implemented during the coronavirus disease 2019 (COVID-19) pandemic altered RSV seasonality, however potential consequences on RSV testing practices across different healthcare settings and sociodemographic groups have not been described. Variable testing practices could also affect accurate assessment of the effects of two recently approved RSV preventative agents targeting infants. MethodsUtilizing real-time clinical and viral surveillance, we examined RSV testing practices among infants with bronchiolitis within four United States healthcare systems across different healthcare settings and sociodemographic groups pre- and post-COVID-19. ResultsRSV testing among infants with bronchiolitis increased since 2015 within each healthcare system across all healthcare settings and sociodemographic groups, with a more dramatic increase since the COVID-19 pandemic. Outpatient testing remained disproportionately low compared to hospital-based testing, although there were no major differences in testing frequency among sociodemographic groups in either setting. ConclusionsAlthough RSV testing increased among infants with bronchiolitis, relatively low outpatient testing rates remain a key barrier to accurate RSV surveillance.

Cross-sectional study of personal protective equipment use, training and biosafety preparedness among healthcare workers during the first months of the SARS-CoV-2 pandemic in Brazil

ObjectivesBrazil has high rates of COVID-19 and tuberculosis among healthcare workers (HCWs). Personal protective equipment (PPE) is essential for their protection. We aimed to evaluate PPE use, training, and preparedness...

Prostate Cancer Screening Behaviors and Health Beliefs Regarding Prostate Cancer Screening of Individuals Over 50 Years of Age: A Descriptive, Cross-Sectional Study

Purpose: This descriptive cross-sectional study was conducted to assess the prostate cancer screening behaviors and health beliefs related to prostate cancer screening among individuals aged 50 and over. &#x0D; Material and Methods: The study sample consisted of 72 men aged 50 and over receiving treatment at the orthopedics and traumatology clinic of a university hospital. Data were collected using a "Personal Information Form" and the "Prostate Cancer Screening Health Belief Model Scale." &#x0D; Results: The mean age of the participants in the study was 61.59±8.51 years. It was found that 22.2% of the participants had undergone Prostate-Specific Antigen testing, 73.6% had no knowledge about prostate cancer, and 75% had no knowledge about early detection tests for prostate cancer. Furthermore, participants who had knowledge about prostate cancer and early detection, had a family history of prostate cancer, and considered undergoing prostate examination had a higher rate of undergoing Prostate-Specific Antigen testing. Those who had never undergone a prostate examination, had no knowledge about prostate cancer and early detection tests, and did not plan to undergo prostate examination within the next six months had higher scores on the barrier perception scale, while those who had undergone Prostate-Specific Antigen testing and planned to undergo prostate examination within the next six months had higher scores on the health motivation perception scale. &#x0D; Conclusion: The study revealed a low rate of Prostate-Specific Antigen testing for early detection of prostate cancer, and participants' knowledge and health beliefs and perceptions related to prostate cancer and early detection tests were identified as key factors influencing prostate cancer screening behaviors.

Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake

ObjectivesAlthough genetic testing (GT) is universally recommended for patients with epithelial ovarian cancer (EOC), rates are low (34%). In 1/2019, we implemented mainstreaming—GT in parallel with tumor testing via MSK-IMPACT within oncology clinics. We sought to determine GT rates pre/post-mainstreaming and patient characteristics associated with GT. MethodsPatients with newly diagnosed EOC seen at our institution from 7/1/2015–3/31/2022 were included. Clinical data were abstracted including social determinants of health (SDOH) variables, race/ethnicity, marital status, insurance, language, comorbidities, employment, and Yost index, a measure of socioeconomic status. GT rates were calculated overall and pre−/post-mainstreaming (1/2019). Logistic regression models were fit to identify variables associated with GT. ResultsOf 1742 patients with EOC, 1591 (91%) underwent GT. Rates of GT increased from 87% to 95% after mainstreaming (p < 0.001). Among 151 patients not undergoing GT, major reasons were lack of provider recommendation (n = 76, 50%) and logistical issues (n = 38, 25%) with few declining (n = 14, 9%) or having medical complications preventing GT (n = 7, 4.6%). High-grade serous histology, advanced stage (III/IV), and having a spouse/partner were associated with increased GT uptake (p < 0.01). Among SDOH variables, there were no differences by insurance, Yost score, language, comorbidities, employment, or race/ethnicity. In multivariable models, likelihood of GT increased with mainstreaming, even after adjustment for histology, stage, and marital status (OR 3.77; 95% CI: 2.56–5.66). ConclusionsMainstreaming increased the likelihood of GT in patients with EOC. We found lower testing rates in patients without partners/spouses, non–high-grade serous histology, and early-stage disease, representing potential areas for future interventions.

Have immigrant children been left behind in COVID-19 testing rates? - A quantitative study in the Lisbon metropolitan area between march 2020 and may 2023.

Immigrant children often encounter additional barriers in accessing health care than their peers. However, there is a lack of evidence globally regarding how migrant status may have affected access to COVID-19 testing during the pandemic. This study aimed to analyze migrant status as a determinant of COVID-19 testing rates among children in the Lisbon metropolitan area, Portugal. This cross-sequential study included 722 children aged 2-8 years (47% non-immigrants; 53% immigrants). We collected data from a national surveillance system on laboratory-confirmed COVID-19 tests conducted between March 2020 and May 2023 and assessed whether children were ever tested for COVID-19 and testing frequency. We employed robust and standard Poisson regression models to estimate Adjusted Prevalence Ratios and Relative Risks with 95% confidence intervals. A total of 637 tests were performed. Immigrant children had lower testing rates (53% vs. 48%) and fewer tests per child (median: 2 vs. 3). Moreover, they were 17% less likely to be ever tested (PR = 0.83, 95% CI: 0.76-0.89) and performed 26% fewer tests (RR = 0.74, 95% CI: 0.67-0.82) compared to non-immigrant children. Caregiver's age, education, employment status, child's birth weight, and perceived health status were associated factors. Our findings suggest that the COVID-19 pandemic has left immigrant children somewhat behind. We conclude that specific interventions targeting vulnerable populations, such as immigrant children, are needed in future health crises.

(149) Knowledge About HIV and Stigma Towards HIV-Positive People: A Study on the Italian Population

Abstract Introduction The literature shows that an adequate knowledge about HIV enables individuals to understand the risks associated with virus transmission and encourages the adoption of protective behaviors. Moreover, it reduces stigma and discrimination against people living with the virus, fostering an open and supportive environment for early diagnosis and treatment. Thus, HIV awareness plays a crucial role in preventing the spread of the virus, improving public health and enhancing the quality of life for those affected. Objective The objective of our study was to assess the level of knowledge about HIV, particularly concerning transmission, prevention, and testing. We also investigated participants' habits regarding risky behaviors and the use of protection during sexual intercourse. Additionally, we aimed to evaluate how participants' knowledge about HIV influenced their perceived stigma towards HIV-positive individuals. Our hypothesis was that HIV knowledge would be negatively correlated with perceived stigma towards HIV-positive individuals. Methods We recruited a sample of 5256 individuals aged between 14 and 69 (M = 23.99, SD = 6.71) who claimed being HIV-negative, as well as a 54-people sample of participants who reported being HIV-positive, aged between 21 and 70 (M = 43.85, SD = 12.49). Participants completed a questionnaire that assessed their knowledge of HIV, sexual habits related to risky behaviors and transmission prevention, and their level of perceived stigma towards HIV-positive individuals. Results Both groups displayed good overall knowledge about HIV, as 75% of the HIV-negative group gave 25 (78.1%) correct answers or more and 75% of the HIV-positives gave at least 28 (87.5%) correct answers. Nonetheless, results highlighted poor knowledge concerning the modalities of HIV transmission and risky behaviors, as well as a low use of condoms during sexual intercourse, as well as low rate of HIV testing. Significant but weak correlations were observed between HIV knowledge, age and perceived stigma. Conclusions Although our sample demonstrated good overall HIV knowledge, our findings highlighted specific areas that require attention and should be targeted in future awareness campaigns. Perceived stigma showed weak associations with HIV knowledge and participants' age, but further research is necessary to gain a deeper understanding of the factors influencing this construct. Disclosure No.