Preventive Services Task Force Research Articles

Effectiveness and Cost-Effectiveness of Expanded Targeted Testing and Treatment of Latent Tuberculosis Infection Among the Medicare Population in 2022.

In the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB). To estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population. Model-based cost-effectiveness analysis. Nationally representative surveys and published evidence. Medicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations. Lifetime. Societal. One-time offer of LTBI testing and treatment versus no intervention. Lifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs). In 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval [UI], 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% [95% UI, 13.9% to 19.1%]) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively. The ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare. Health benefits from averted post-TB sequelae were not estimated. Medicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare. Centers for Disease Control and Prevention.

Cost-effectiveness of blood-based colorectal cancer screening – a simulation model incorporating real-world longitudinal adherence

ABSTRACT Objectives Although U.S. Preventive Services Task Force (USPSTF) recommended CRC screenings are effective; patient reluctance reduces adherence. Most cost-effectiveness models assume perfect adherence, yet one-third of eligible individuals aren’t current with CRC screening. Our study assesses the cost-effectiveness of Shield, an FDA-approved blood-based CRC screening test, using real-world adherence. Methods The CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model, a validated discrete-event simulation, evaluated clinical and economic outcomes of CRC screening under real-world adherence scenarios. We compared the Shield blood-based test administered every 3 years to no screening, considering it cost-effective if the incremental cost-effectiveness ratio (ICER) was under $100,000 per quality-adjusted life-year (QALY) gained. Results Shield increased QALYs by 154 and raised costs by $7.5 million per 1,000 individuals, with an ICER of $48,662 per QALY, meeting the $100,000/QALY threshold. Shield remained cost-effective up to a unit cost of $3,241 (at $100,000/QALY) and $4,942 (at $150,000/QALY). Sensitivity analyses confirmed cost-effectiveness with lower adherence to diagnostic colonoscopy (56.1%) and annual screenings. Conclusion The CAN-SCREEN model shows that Shield is cost-effective compared to no screening. Including real-world adherence improves accuracy in assessing screening strategies. Shield’s noninvasive approach offers a promising, cost-effective way to increase adherence and reduce CRC mortality.

Socioeconomic and Geographic Differences in Mammography Trends Following the 2009 USPSTF Policy Update

In 2024, the US Preventive Services Task Force (USPSTF) reversed a 2009 policy recommending only females aged 50 to 74 years complete a biennial mammogram. Understanding whether females facing heterogeneous breast cancer risks responded to the 2009 guidance may illuminate how they may respond to the latest policy update. To evaluate whether the 2009 policy was associated with changes in mammography screening in females no longer recommended to complete a biennial mammogram and whether these changes varied by factors associated with breast cancer risk. The difference-in-differences design compared biennial mammogram trends in the exposed groups (aged 40-49 and ≥75 years) with trends of the unexposed groups (aged 50-64 and 65-74 years), before and after the 2009 update. Population-based, repeated cross-sectional survey data came from the Behavioral Risk Factor Surveillance System (BRFSS) biennial cancer screening module (2000-2018). The sample was restricted to females between ages 40 and 84 years. Data were analyzed from March 1 to June 30, 2024. The outcome was a binary variable indicating whether the respondent reported a mammogram in the past 2 years (biennial). After 2009, females aged 40 to 49 and 75 or older years were exposed to the policy update, as a complete biennial mammogram was recommended. Subgroup analyses included race and ethnicity, educational level, household income, smoking history, current binge drinking status, and state of residence. The sample included 1 594 834 females; 75% reported a biennial mammogram. In those aged 40 to 49 years, the USPSTF update was associated with a 1.1 percentage-point (95% CI, -1.8% to -0.3 percentage points) decrease in the probability of a biennial mammogram, with the largest decreases in the non-Hispanic Black population (-3.0 percentage points; 95% CI, -5.5% to -0.5 percentage points). In the aged 75 years or older group, the USPSTF update was associated with a 4.8 percentage-point decrease (95% CI, -6.3% to -3.5 percentage points) in the probability of a biennial mammogram, with significant heterogeneity by race and ethnicity, binge drinking status, and state residence. In this study, socioeconomic factors were associated with differences in how females responded to the 2009 USPSTF mammography recommendation. Whether the 2024 update considered such differences is unclear. These findings suggest that including risk assessment into future USPSTF policy updates may improve adoption of risk-reducing interventions and shorten the time to diagnosis and treatment for high-risk patients.

Evaluation of the effects of smoking on the clinical and histological characteristics and levels of growth factors in autologous fibrin membranes.

Considering the increase in regenerative dental treatments, autologous fibrin membranes (ARMs) have been widely used in tissue engineering, favoring the regeneration of hard and soft tissues, accelerating angiogenesis and promoting cell differentiation and migration. This study proposed evaluate the differences in clinical characteristics and levels of the growth factors BMP-2, IGF, PDGF and VEGF between smokers and nonsmokers were evaluated according to the guidelines of the US Preventive Service Task Force (USPSTF). Fourteen smokers and 14 nonsmokers were selected. After processing, the samples were allowed to rest in tubes for 5min for the organization of the matrix and completion of the fibrin clot. Only the yellow portion and the buffy coat were removed and stored. Four clots were obtained from each donor and used to quantify the release of the growth factors BMP2, PDGF, IGF and VEGF. In addition, histological analyses were performed, and clinical characteristics were evaluated. The data were tabulated and subjected to statistical analysis with a significance level of 5%. In both groups, the membranes remained intact throughout the analysis period, indicating similar structural behavior. Histological evaluation of the membranes obtained from the participants revealed the presence of more homogeneous fibrin membranes in the nonsmoker group and many leukocytes bordering the entire fibrin clot. In the smoker group, heterogeneous fibrin clots, sometimes malformed, and fewer leukocytes in the region of the buffy coat and bordering the entire fibrin were observed. Smokers had significantly lower levels of VEGF, PDGF and BMP-2 (pg/ml in 1µg total protein) than smokers did (p < 0.05), and there was no significant difference in IGF levels (p > 0.05) between the groups. There was also no statistically significant difference in membrane size between smokers and nonsmokers (mm, p > 0.05). Smoking may interfere with the formation of the fibrin mesh and consequently affects the quality and regenerative capacity in in smoking patients.

Cost-effectiveness of blood-based colorectal cancer screening: A simulation model incorporating real-world longitudinal adherence.

93 Background: Colorectal cancer (CRC) is a predominant cause of cancer-related mortality worldwide. Regular screening improves outcomes. However, despite there being many U.S. Preventive Services Task Force (USPSTF) recommended CRC screening options, many people elect not to use any of them. Most cost-effectiveness models assume perfect (100%) adherence initially and over time (longitudinally), which is implausible as approximately one-third of eligible individuals are not up to date with CRC screening. Our study evaluates the cost-effectiveness of Shield, an FDA-approved blood-based CRC test, while incorporating real-world adherence. Methods: The CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model is a validated, discrete-event simulation model designed to evaluate the clinical and economic outcomes of CRC screening strategies under real-world adherence scenarios. We simulated individual lifetime outcomes for a cohort of 10,000 people beginning screening at age 45, running 4,000 trials per cohort. We conducted a cost-effectiveness analysis using the CAN-SCREEN model, and compared the Shield blood-based test administered every three years to no screening. Costs were calculated from a healthcare perspective and adjusted to 2023 US dollars. Shield was considered cost-effective if the incremental cost-effectiveness ratio (ICER) was below $100,000 per quality-adjusted life-year (QALY) gained. The analysis also assessed the maximum price Shield could maintain while remaining cost-effective. Results: Compared to no screening, Shield increased the number of QALYs by 154 per 1,000 individuals and raised costs by $7.5 million per 1,000 individuals at its commercial test cost. With an incremental cost of $48,662 per QALY gained, Shield was found to be cost-effective relative to no screening at $100,000 cost per QALY willingness-to-pay threshold. Furthermore, the unit cost of Shield can be as high as $3,241 and $4,942 to be considered cost-effective at $100,000 and $150,000 per QALY gained, respectively. Conclusions: This study used the CAN-SCREEN model to compare Shield, an FDA-approved blood-based CRC screening test, against no screening, finding that Shield is cost-effective. With about one-third of the U.S. population not up to date on CRC screening, Shield's noninvasive approach offers a promising, cost-effective solution to increase adherence and reduce CRC mortality. Economic outcomes of Shield against no screening using CAN-SCREEN model. Intervention Test Unit Cost QALYs/Person Cost ($)/Person Cost ($)/QALY Gained vs No screening No Intervention - 15.269 $6,312.18 - Shield $1,495 15.423 $13,786.72 $48,662 Shield $3,241 15.423 $21,672.34 $100,000.00 Shield $4,942 15.423 $29,352.42 $150,000.00

Multi-target stool DNA test adherence among average-risk 45- to 49-year-old patients from 2017-2023.

102 Background: Colorectal cancer (CRC) is the third most common cancer in the United States and the second most common cause of cancer-related mortality. In 2021, the US Preventive Services Task Force (USPSTF) lowered the age of initial CRC screening from 50 to 45 years of age for average risk individuals. At that time, only 20% of adults aged 45-49 years were up-to-date with CRC screening. With its at-home use, accessibility, and patient navigation, the multi-target stool DNA test (mt-sDNA) could help support screening uptake in this population. Here, we analyzed national claims data to investigate mt-sDNA adherence rates among average-risk adults aged 45-50 years. Methods: Using a national claims database of over 165 million individuals linked with Exact Sciences Laboratories data, mt-sDNA orders for AA patients were retrospectively identified from 2017 to 2023. Average CRC risk individuals aged ≥45 years, and new to mt-sDNA, were included in this analysis. Primary outcome of interest was adherence, defined as mt-sDNA kit return rate within 365-days from shipment. Test return time was examined as the secondary outcome. Demographics were age, sex, ordering provider, residential geography, payor, and outreach preference. Covariates on adherence were examined using logistic regression. Results: A total of 607,388 mt-sDNA orders were prescribed during the study period, with an overall 365-day return rate of 65.4%. Average time to test return was 30.4 days. Women outnumbered men in the cohort (58.6%), and most mt-sDNA orders were prescribed by primary care providers (59.4%). The majority of individuals preferred ‘Digital SMS’ communication (62%), and nearly 90% of the cohort was Commercially insured (87.6%). Among those in the cohort participants’ self-reported race/ethnicity was: White (37.3%), Hispanic or Latino (10.1%), Black or African American (8.8%), unknown (8.8%), Asian or pacific islander (4.6%), and other (3.7%). Adherences for the four identified races/ethnicities were all near, or above 60%. Men demonstrated higher adherence than women (66.7% vs 64.5%; p&lt;0.0001). Time to test return was shortest in men (28.9 days) and African American persons (28.5 days). Tests ordered by gastroenterologists yielded the quickest adherence times amongst providers (26 days). After controlling for race, gender, payor class, setting (urban/rural classification), and preferred language, digital outreach and provider type were significantly associated with increased mt-sDNA adherence. Conclusions: This large, national analysis reports a substantially higher rate of adherence among individuals ages 45-49 with the mt-sDNA test than the current nationally reported rates. At-home testing, along with standard and preference-based navigation may have contributed to high mt-sDNA completion rates. More research is warranted to explore screening behaviors and the benefits of screening within this younger population.

Utilization of Radical Prostatectomy Versus Radiation Therapy for Gleason Grade Group 5 Prostate Cancer Before and After USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening in 2012.

The 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening has resulted in a shift to higher-stage prostate cancer (PC) at diagnosis. We evaluate the utilization of radical prostatectomy (RP) versus radiation therapy (RT) in the US for Gleason grade group 5 (GG5) prostate cancer before and after 2012. We identified 34,011 men with localized GG5 PC undergoing primary therapy with (1) RP or (2) RT + androgen deprivation therapy (ADT) between 2004 and 2017 from the National Cancer Database. The chi-square test was used to compare the relative use of RP and RT before versus after 2012. Annual use of RP versus RT from 2004 to 2017 was compared using Cochran-Armitage test for trend. We modeled the effect of treatment year on the use of RP using multivariable logistic regression. Across all centers, the use of RP increased from 31% to 41% (p for trend < 0.001). 2012 was associated with significant inflection for increase in RP use in all centers. There was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28-1.40, p < 0.001). Utilization of RP for GG5 PC has significantly increased in the United States over the past decade. It remains unknown if outcomes may be compromised in this group of high-risk men, many of whom require post-prostatectomy RT and/or ADT. Prospective comparison of RP versus RT + ADT for GG5 PC are needed to determine optimal treatment for these patients.

The "Mammograms Available Due to Resources and Education" (MADRE) Study: Rationale and Design.

Latinas suffer disproportionately from breast cancer, partially due to lower uptake of guideline-concordant breast cancer screening. We describe the design of a study to compare two approaches addressing this important public health problem. We are conducting a 5-year randomized controlled trial. From a federally qualified health center network and through community outreach, we are recruiting 400 Latinas from Chicago who are non-adherent with United States Preventive Services Task Force breast cancer screening guidelines. Participants are randomized at a 1:1 ratio to receive one of two phone-based interventions (empowerment, education) administered across 3 weekly sessions. Both interventions provide information about breast cancer early detection. The empowerment intervention additionally teaches participants to share information about breast cancer screening with family and friends, while the education intervention educates patients about breast cancer prevention. Non-adherent Latina participants recruit family and friends eligible for breast cancer screening to take part in the study as network members. Network members do not participate in the intervention. Primary outcomes are initial (any mammogram post-enrollment) and repeat (measured at two-year intervals after enrollment) breast cancer screening among intervention participants and network members. Additionally, we will use multi-level structural equation models to assess potential mediators of the impact of the interventions. This study will inform the development of empowerment approaches to increase participation in breast cancers screening among Latinas and reduce health disparities. NCT05841355.

Randomized study to assess colonic microbiome changes in response to energy drink consumption (ROSANNA Trial).

TPS325 Background: Colorectal cancer (CRC), the second leading cause of cancer deaths in the US, is increasingly diagnosed in individuals under 50. This rise in early-onset CRC (eoCRC) led the U.S. Preventative Services Task Force to recommend a reduction in the age to begin colorectal cancer screening in average-risk persons, from 50 to 45. The etiology of eoCRC is multifaceted, with one postulated theory pointing to alterations in the young adult colonic microbiome. Hydrogen sulfide (H 2 S) producing bacteria, like Bilophila wadsworthia , Fusobacterium nucleatum and Atopobium parvulum , are typically minor gut microbiota components but are overrepresented in CRC cases, linked to inflammation, and may promote a pro-carcinogenic environment. These bacteria preferentially use taurine, an essential amino acid, as a primary energy source. Energy drinks represent one of the largest dietary sources (6-16x normal daily intake) of taurine in contemporary diets. Our hypothesis is that high taurine levels in energy drinks could exacerbate CRC risk by promoting preferential growth and metabolic activities of already present H 2 S-producing bacteria, contributing to the rise of eoCRC. Methods: This randomized open-label trial is actively enrolling up to 60 young adults (18-40 years) without personal or family history of CRC, other major GI disease/distress, and baseline infrequent energy drink consumption. Group 1 (Arm A; n=30), will consist of subjects consuming at least one of two protocol-specified energy drinks daily for 4 weeks. Group 2 (Arm B; n=30), will consist of usual dietary intake. Enrollments are randomized 1:1 and stratified, by gender, age (18-25 vs. 26-40), and baseline energy drink consumption (rare/none vs. 1-2 per week). Every subject will complete: 1) a daily dietary and fitness log, 2) a weekly wellness log, 3) collection of stool/saliva/skin/urine at 3 sequential time points (baseline, after 2 weeks, after 4 weeks), and 4) blood collection at the same time points. The primary endpoint is the change in H 2 S-metabolizing bacterial communities between baseline and 1 month of energy drink exposure within Arm A and also compared to those in Arm B using microbiome analysis (diversity, taxonomy, sulfur-enriched gene pathways). Several secondary and exploratory assessments include changes related to subject demographic and dietary differences, concordance of microbiome changes with dietary logs and in other biospecimens beyond stool, H 2 S-production measurements, and analyses of subject metabolic and immune function. Trial opened in February 2024 with active enrollment ongoing. Updated data on trial status and any amendment modifications will be presented at the meeting. Clinical trial information: NCT06137248 .

Assessing the Adherence of ChatGPT Chatbots to Public Health Guidelines for Smoking Cessation: Content Analysis.

Large language model (LLM) artificial intelligence chatbots using generative language can offer smoking cessation information and advice. However, little is known about the reliability of the information provided to users. This study aims to examine whether 3 ChatGPT chatbots-the World Health Organization's Sarah, BeFreeGPT, and BasicGPT-provide reliable information on how to quit smoking. A list of quit smoking queries was generated from frequent quit smoking searches on Google related to "how to quit smoking" (n=12). Each query was given to each chatbot, and responses were analyzed for their adherence to an index developed from the US Preventive Services Task Force public health guidelines for quitting smoking and counseling principles. Responses were independently coded by 2 reviewers, and differences were resolved by a third coder. Across chatbots and queries, on average, chatbot responses were rated as being adherent to 57.1% of the items on the adherence index. Sarah's adherence (72.2%) was significantly higher than BeFreeGPT (50%) and BasicGPT (47.8%; P<.001). The majority of chatbot responses had clear language (97.3%) and included a recommendation to seek out professional counseling (80.3%). About half of the responses included the recommendation to consider using nicotine replacement therapy (52.7%), the recommendation to seek out social support from friends and family (55.6%), and information on how to deal with cravings when quitting smoking (44.4%). The least common was information about considering the use of non-nicotine replacement therapy prescription drugs (14.1%). Finally, some types of misinformation were present in 22% of responses. Specific queries that were most challenging for the chatbots included queries on "how to quit smoking cold turkey," "...with vapes," "...with gummies," "...with a necklace," and "...with hypnosis." All chatbots showed resilience to adversarial attacks that were intended to derail the conversation. LLM chatbots varied in their adherence to quit-smoking guidelines and counseling principles. While chatbots reliably provided some types of information, they omitted other types, as well as occasionally provided misinformation, especially for queries about less evidence-based methods of quitting. LLM chatbot instructions can be revised to compensate for these weaknesses.

Transportation Insecurity, Social Support, and Adherence to Cancer Screening.

Transportation insecurity and lack of social support are 2 understudied social determinants of health that contribute to excess morbidity, mortality, and acute health care utilization. However, whether and how these social determinants of health are associated with cancer screening has not been determined and has implications for preventive care. To determine whether transportation insecurity or social support are associated with screening adherence for colorectal, breast, and cervical cancer. This cohort study used data from the publicly available 2018 in-person National Health Interview Survey (NHIS) comprising a noninstitutionalized, civilian adult population of the United States. Participants included adults eligible for colorectal, breast, or cervical cancer screening who participated in the in-depth NHIS interview (1 selected per household). Data were acquired in December 2023 and analyzed through July 31, 2024. Transportation insecurity, represented dichotomously as adults who reported that they have or have not delayed medical care in the past year due to transportation difficulties, and neighborhood social support, represented as factor scores derived from 4 Likert-type questions. The primary outcome was adherence to the US Preventive Services Task Force screening recommendations in place during 2018 for colorectal, breast, and cervical cancer. In 2018, of 25 417 NHIS respondents (55% female), 660 (3%) reported delaying medical care because they did not have transportation. In fully adjusted models, transportation insecurity was associated with adherence to breast cancer screening (odds ratio [OR], 0.59 [95% CI, 0.40-0.86]) but not to colorectal (OR, 0.87 [95% CI, 0.65-1.15]) or cervical (OR, 0.73 [95% CI, 0.46-1.13) cancer screening. Social support was associated with colorectal (OR, 1.12 [95% CI, 1.06-1.17]) and breast (OR, 1.13 [95% CI, 1.05-1.22]) cancer screening but not with cervical cancer screening (OR, 1.01 [95% CI, 0.93-1.10]). There were no significant interactions between transportation insecurity and social support for any cancer screening. The presence of transportation insecurity was associated with a 41% reduction in the odds of breast cancer screening. Clinicians should consider screening for transportation needs at the time of mammography referral, as patients may be eligible for programs that can assist with medical transportation needs.

P-504. Disparities in PrEP Coverage by Sex Among Individuals Diagnosed with Bacterial STIs in a Large Municipal Healthcare System

Abstract Background Nationally almost 20% of new HIV diagnosis are in females. Females carry 53% of sexually transmitted infection (STI) disease burden in the US, yet nationally represent only 10% of individuals on Pre-Exposure Prophylaxis (PrEP). The US Preventive Services Task Force and CDC include females diagnosed with bacterial STIs as one of the populations to be considered for PrEP. However, females are often not the focus of HIV PrEP campaigns, resulting in knowledge gaps, bias and stigma that further challenge PrEP access for women. As part of efforts to improve sexual health services and access within NYC's municipal healthcare system, we designed a sexual health dashboard (SHD) that included a “PrEP Eligible” metric focused on federal PrEP guidelines related to bacterial STIs. Methods All alive patients aged 13-75 years old with a primary care or women’s health clinic visit within a NYC Health and Hospitals facility during April 2023-March 2024 were included in the SHD. The SHD displays testing and positivity rates for Chlamydia, Gonorrhea, and Syphilis, in addition to PrEP eligibility and PrEP active status. PrEP eligibility is based on high frequency of HIV or STI tests (3+ in 1 year), an abnormal STI lab or STI diagnosis and ‘PrEP Active’ is defined as an active prescription for PrEP within the preceding 6-months. Results Females represented 82% of PrEP eligible patients but only 13.2% (162) of PrEP Active patients (1,223). Among all people with Chlamydia, 0.2% of females were PrEP Active compared to 16% of males. For Gonorrhea, 2.6% of females were PrEP Active compared to 44.3% of males. For Syphilis, 1.9% of females were PrEP Active compared to 18.6% of males (Figure 1). Conclusion According to the CDC, 6% of sexually acquired HIV can be attributed to bacterial STIs, however PrEP usage remains low among eligible females within a municipal healthcare system in NYC. Dedicated efforts are being made within NYC Health and Hospitals to expand PrEP to primary care and women’s health, with the hopes that diversifying care settings for PrEP will reach populations not currently accessing PrEP services. Lack of recognition of the connection between HIV risk and STIs may disproportionately impact females and contribute to underutilization of PrEP. Disclosures Emma Kaplan-Lewis, MD, Gilead Pharmaceuticals: Grant/Research Support

P-480. Improving HIV Screening Rates among US Veterans: A Quality Improvement Project

Abstract Background Fifteen percent of the 1.2 million people living with human immunodeficiency virus (HIV) in the United States are unaware of their infection, which increases risk of onward transmission and negative sequalae from untreated HIV. To improve early detection of HIV infection, the US Preventive Services Task Force recommends one-time HIV testing for all adults aged 15 to 65. The goal of this quality improvement project is to understand the rate of HIV testing in US Veterans (USV) who seek care at the Northport Veterans Affairs Medical Center (NVAMC) primary care setting and assess the efficacy of a quality improvement strategy to improve HIV screening rates.Table 1:HIV, HCV, and STI screening rates, and demographic variables identified in Veterans at NVAMC primary care setting.NVAMC, Northport Veterans Affairs Medical Center; HIV, Human Immunodeficiency Virus; HCV, Hepatitis C Virus; STI, Sexually Transmitted Infections; USV, United States Veterans Methods We conducted a prospective study of USV aged 15 to 65 from three Primary Care provider panels at NVAMC. Demographics, sexual history, injection drug use (IDU), prior hepatitis C virus (HCV), and sexually transmitted infection (STI) testing rates were obtained from chart review. USV without prior HIV screening were telephoned to obtain informed HIV testing consent and testing was ordered for USV who agreed. Results We identified 368 USV, with mean age of 60 years. The majority of this cohort were male (n=366, 99.4%) and White (n=262, 72.3%). Seventy-five (20.4%) USV did not have sexual orientation screening charted, no USV were identified as men who have sex with men (MSM), and 4 (1.1%) USV were identified with IDU history. Two hundred twenty (59.8%) USV had received prior HIV testing. Sixty-eight (18.5%) USV with no prior testing gave consent to obtain an HIV test, 29 (42.6%) USV underwent testing and 29 (100%) tested negative for HIV. Prior HCV testing was common (n=262, 71.2%); 2 (0.8%) USV had prior HCV infection and were treated. Sixty-two (16.8%) USV received testing for gonorrhea, 63 (17.1%) for chlamydia, and 138 (37.5%) for syphilis; one USV was identified with chlamydia infection history. We identified patient barriers to HIV testing (refusal, provider outside VA system) and provider factors (testing not offered). Conclusion Implementation of a telephone strategy improved HIV testing rates at NVAMC. HIV screening is cost effective as early identification improves survival due to linkage to care and access to treatment. Consequently, this may prevent forward transmission of HIV. Disclosures All Authors: No reported disclosures

P-2195. Hepatitis C Virus Screening Guidelines Rates Among a National Sample

Abstract Background Objective: Evaluate US hepatitis C virus (HCV) screening rates after the 2013 and 2020 US Preventive Services Task Force HCV screening recommendations. Design/Participants: A retrospective observational study utilizing TriNetX, an electronic health record (EHR) aggregation platform among 100 million patients.Table 1.Percentages of Patients Screened for Hepatitis C Based on Sample Methods We identified patients eligible for HCV screening based on their age (58-78 for 2013 guidelines and 18-79 for 2020 guidelines) and having a preventative care visit, based on common procedure terminology (CPT) codes. Successful screening encompassed a HCV antibody test result. High risk patients: encounter diagnosis ICD codes for HIV or renal dialysis or a CPT code for hemodialysis. We examined age distribution, gender, race, and ethnicity for possible screening disparities.Figure 1.Overview of Cohorts. Results In 2021, the first year after 2020 guidelines, 13.65% (219,333/1,607,333) of patients were screened. In 2022 and 2023, 15.25% (450,236/2,952,850) and 16.38% (638,335/3,896,376) were screened. In 2023, ten years after the 2013 guidelines, 22.66% (416,139/1,836,061) of eligible patients were screened. Among high-risk patients 10-year after the 2013 guidelines, 24.70% (62,332/252,402) with HIV and 25.80% (107,937/418,292) on dialysis were screened. In our disparities analysis, we found that the percentage of unknown ethnicity or race, Asian, or other races was significantly less (p-value &amp;lt; .001) among screened eligible patients compared to eligible patients based on the 2020 and 2013 guidelines. Over time screening disparities generally decreased so that people eligible based on the 2013 guidelines had fewer disparities in 2023 than those eligible based on the 2020 guidelines, except for gender where disparities increased between the two sets of guidelines with men being screened ∼3% more than women based on the 2013 guidelines.Figure 2.Total Eligible Patients and Eligible Patients Screened for HCV. Conclusion The current percentage of eligible patients screened for hepatitis C (&amp;lt; 20%) based on current guidelines is low and is only increasing slowly (1-2% per year). Even high-risk patients were only screened ∼25% of the time.Figure 3.Percentage of Eligible Patients Screened for HCV. Disclosures David C. Kaelber, MD, PhD, MPH, FAAP, FACP, FACMI, FAMIA, Dynavax Technologies Corporation: Advisor/Consultant

Are AI chatbots concordant with evidence-based cancer screening recommendations?

This study aimed to assess whether information from AI chatbots on benefits and harms of breast and prostate cancer screening were concordant with evidence-based cancer screening recommendations. Seven unique prompts (four breast cancer; three prostate cancer) were presented to ChatGPT in March 2024. A total of 60 criteria (30 breast; 30 prostate) were used to assess the concordance of information. Concordance was scored between 0 and 2 against the United States Preventive Services Task Force (USPSTF) breast and prostate cancer screening recommendations independently by international cancer screening experts. 43 of 60 (71.7 %) criteria were completely concordant, 3 (5 %) were moderately concordant and 14 (23.3 %) were not concordant or not present, with most of the non-concordant criteria (9 of 14, 64.3 %) being from prompts for the oldest age groups. ChatGPT hallucinations (i.e., completely made up, non-sensical or irrelevant information) were found in 9 of 60 criteria (15 %). ChatGPT provided information mostly concordant with USPSTF breast and prostate cancer screening recommendations, however, important gaps exist. These findings provide insights into the role of AI to communicate cancer screening benefits and harms and hold increased relevance for periods of guideline change. AI generated information on cancer screening should be taken in conjunction with official screening recommendations and/or information from clinicians.

What does cancer screening have to do with tomato growing?

Cancer screening is considered to be a major strategy for combatting cancer. The United States Preventive Services Task Force (USPSTF) recommends screening for five cancers, but the strength of evidence about the effectiveness of screening is limited. To gain insights into the efficacy of early detection requires prospective, blinded, placebo-controlled clinical trials with decades of follow-up and inclusion of millions of participants. Recently, Bretthauer etal. estimated lifetime gained with cancer screening tests by using a meta-analysis of 18 large randomized clinical trials which included more than two million subjects. They asked if cancer screening tests are saving lives and how much life is extended due to commonly used cancer screening tests. Colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110days, while fecal testing and mammography screening did not prolong life. A modest extension of 37days was noted for prostate cancer screening with prostate-specific antigen testing and 107days with lung cancer screening using computed tomography, but these estimates were not statistically significant. The authors concluded that current cancer screening strategies do not significantly prolong life. Based on these data, and the known biological behavior of some cancers, we hypothesized that the current strategies of treating cancer, after detection, could be modified to avoid the side effects of screening, which is a major determinant of the patient's overall survival.

Derivation and Validation of D-RISK: An Electronic Health Record-Driven Risk Score to Detect Undiagnosed Dysglycemia in Clinical Practice.

We derive and validate D-RISK, an electronic health record (EHR)-driven risk score to optimize and facilitate screening for undiagnosed dysglycemia (prediabetes + diabetes) in clinical practice. We used retrospective EHR data (derivation sample) and a prospective diabetes screening study (validation sample) to develop D-RISK. Logistic regression with backward selection was used to predict dysglycemia (HbA1c ≥5.7%) using diabetes risk factors consistently captured in structured EHR data. Model coefficients were converted to a points-based risk score. We report discrimination, sensitivity, and specificity and compare D-RISK to the American Diabetes Association (ADA) risk test and the ADA and United States Preventive Services Task Force (USPSTF) screening guidelines. The derivation cohort included 11,387 patients (mean age 48 years; 65% female; 42% Hispanic; 32% non-Hispanic Black; mean BMI 32; 29% with hypertension). D-RISK included age, race, BMI, hypertension, and random glucose. The area under curve (AUC) for the risk score was 0.75 (95% CI 0.74-0.76). In the validation screening study (n = 519), the AUC was 0.71 (95% CI 0.66-0.75) which was better than the ADA and USPSTF diabetes screening guidelines (AUC = 0.52 and AUC = 0.58, respectively; P < 0.001 for both). Discrimination was similar to the ADA risk test (AUC = 0.67) using patient-reported data to supplement EHR data, although D-RISK was more sensitive (75% vs. 61%) at the recommended screening thresholds. Designed for use in EHR, D-RISK performs better than commonly used screening guidelines and risk scores and may help detect undiagnosed cases of dysglycemia in clinical practice.

ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine

BackgroundTo provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.MethodsFollowing board approval, in 2020 the American...

Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities : An Ecological Study.

The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria. To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility. Cross-sectional ecological study. U.S. census tracts. 71 691 census tracts. The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality. Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts. Analyses did not account for travel time or cost. Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality. Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.

Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression.

Mental health screening is recommended by the US Preventive Services Task Force for all patients in areas where treatment options are available. Still, it is estimated that only 4% of primary care patients are screened for depression. The goal of this study was to evaluate the efficacy of machine learning technology (Kintsugi Voice, v1, Kintsugi Mindful Wellness, Inc) to detect and analyze voice biomarkers consistent with moderate to severe depression, potentially allowing for greater compliance with this critical primary care public health need. We performed a cross-sectional study from February 1, 2021 to July 31, 2022 to examine ≥25 seconds of free-form speech content from English-speaking samples captured from 14,898 unique adults in the United States and Canada. Participants were recruited via social media, provided informed consent, and their voice biomarker results were compared with a self-reported Patient Health Questionnaire-9 (PHQ-9) at a cut-off score of 10 (moderate to severe depression). From as few as 25 seconds of free-form speech, machine learning technology was able to detect vocal characteristics consistent with an increased PHQ-9 ≥10, with a sensitivity of 71.3 (95% CI, 69.0-73.5) and a specificity of 73.5 (95% CI, 71.5-75.5). Machine learning has potential utility in helping clinicians screen patients for moderate to severe depression. Further research is needed to measure the effectiveness of machine learning vocal detection and analysis technology in clinical deployment.