Testing In High-risk Groups Research Articles

Celiac Disease–Related Conditions: Who to Test?

Celiac disease (CeD) is a chronic immune-mediated condition triggered by gluten consumption in genetically predisposed individuals. Approximately 1% of the general population is affected by the disorder. Disease presentation is heterogeneous and, despite growing awareness among physicians and the public, it continues to be underestimated. The most effective strategy for identifying undiagnosed CeD is proactive case finding through serologic testing in high-risk groups. We reviewed the most recent evidence on the association between CeD and more than 20 conditions. In light of this review, CeD screening is recommended in individuals with (1) autoimmune disease and accompanying symptoms suggestive of CeD; (2) diseases that may mimic CeD (eg, irritable bowel syndrome [IBS], inflammatory bowel disease [IBD], and microscopic colitis); and (3) among patients with conditions with a high CeD prevalence: first-degree relatives, idiopathic pancreatitis, unexplained liver enzyme abnormalities, autoimmune hepatitis, primary biliary cholangitis, hyposplenism or functional asplenia with severe bacterial infection, type 1 diabetes mellitus, Hashimoto's thyroiditis and Graves' disease, Sjögren's syndrome, dermatitis herpetiformis, recurrent aphthous syndrome and enamel defects, unexplained ataxia, peripheral neuropathy, delayed menarche or premature menopause, Down syndrome, Turner syndrome, Williams syndrome, chronic fatigue syndrome, IgA nephropathy, and IgA deficiency. CeD serology should be the initial step in the screening process. However, for patients with any of the aforementioned disorders who are undergoing upper endoscopy, biopsies should be performed to rule out CeD.

Diagnostics and treatment of ovarian cancer in the era of precision medicine - opportunities and challenges.

Due to predictions of increasing incidences and deaths from ovarian cancer, this neoplasm is a challenge for modern health care. The advent of NGS technology has made it possible to understand the molecular characteristics of many cancers, including ovarian cancer. The data obtained in research became the basis for the development of molecularly targeted therapies thus leading to the entry of NGS analysis into the diagnostic process of oncological patients. This review presents targeted therapies currently in preclinical or clinical trials, whose promising results offer hope for their use in clinical practice in the future. As more therapeutic options emerge, it will be necessary to modify molecular diagnostic regimens to select the best treatment for a given patient. New biomarkers are needed to predict the success of planned therapy. An important aspect of public health is molecular testing in women with a familial predisposition to ovarian cancer enabling patients to be included in prevention programs. NGS technology, despite its high throughput, poses many challenges, from the quality of the diagnostic material used for testing to the interpretation of results and classification of sequence variants. The article highlights the role of molecular testing in ongoing research and also its role in the diagnostic and therapeutic process in the era of personalized medicine. The spread of genetic testing in high-risk groups, the introduction of more targeted therapies and also the possibility of agnostic therapies could significantly improve the health situation for many women worldwide.

A systematic review of cost-utility analyses of screening methods in latent tuberculosis infection in high-risk populations

BackgroundThe World Health Organisation (WHO) recommends that testing and treatment for latent tuberculosis infection (LTBI) should be undertaken in high-risk groups using either interferon gamma release assays (IGRAs) or a tuberculin skin test (TST). As IGRAs are more expensive than TST, an assessment of the cost-effectiveness of IGRAs can guide decision makers on the most appropriate choice of test for different high-risk populations. This current review aimed to provide the most up to date evidence on the cost-effectiveness evidence on LTBI testing in high-risk groups—specifically evidence reporting the costs per QALY of different testing strategies.MethodsA comprehensive search of databases including MEDLINE, EMBASE and NHS-EED was undertaken from 2011 up to March 2021. Studies were screened and extracted by two independent reviewers. The study quality was assessed using the Bias in Economic Evaluation Checklist (ECOBIAS). A narrative synthesis of the included studies was undertaken.ResultsThirty-two studies reported in thirty-three documents were included in this review. Quality of included studies was generally high, although there was a weakness across all studies referencing sources correctly and/or justifying choices of parameter values chosen or assumptions where parameter values were not available. Inclusions of IGRAs in testing strategies was consistently found across studies to be cost-effective but this result was sensitive to underlying LTBI prevalence rates.ConclusionWhile some concerns remain about uncertainty in parameter values used across included studies, the evidence base since 2010 has grown with modelling approaches addressing the weakness pointed out in previous reviews but still reaching the same conclusion that IGRAs are likely to be cost-effective in high-income countries for high-risk populations. Evidence is also required on the cost-effectiveness of different strategies in low to middle income countries and countries with high TB burden.

Individualized Provider Feedback Increased HIV and HCV Screening and Identification in a New York City Emergency Department.

Efforts to end the HIV and hepatitis C virus (HCV) epidemics begin with ascertainment of a person's infection status through screening. Despite its importance as a site of testing, missed opportunities for screening in the Emergency Department (ED) are common. We describe the impact of implementing an individualized provider feedback intervention on HIV and HCV testing in a quaternary ED. We conducted an interrupted time series analysis to evaluate the impact of the intervention on weekly HIV and HCV screening in an observational cohort of patients seeking care in the ED. The intervention included a physician champion individualized feedback with peer comparisons to all providers in the ED and an existing HIV/HCV testing and response team. Data were abstracted from the electronic medical record (EMR) for 30 weeks before, during, and after implementing the intervention. We used Poisson regression analysis to estimate changes in the weekly counts and rates of HIV and HCV testing. The incidence rate ratios (IRRs) of HIV testing were 1.94 [95% confidence interval (CI) 1.85-2.04] and 1.38 (95% CI 1.31-1.45) times higher for the intervention and post-intervention period compared with the pre-intervention period. The IRRs of HCV testing was 6.96 (95% CI 6.40-7.58) and 4.70 (95% CI 4.31-5.13) for the intervention and post-intervention periods. There were no meaningful differences in demographic characteristics during the observation period. The intervention meaningfully increased HIV and HCV testing volume and positive case detection, including testing in high-risk groups like young adults and individuals without prior testing. Although diminished, the intervention effect sustained in the 30-week period following implementation.

An Informative Review on screening of COVID-19 (SARS-COVID-II)

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) is a highly transmissible and pathogenic coronavirus that emerged in late 2019 and has caused a pandemic of acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19), which threatens human health and public safety. The disease caused by SARS‐CoV‐2, coronavirus disease 2019 (COVID‐19), presents flu‐like symptoms which can become serious in high‐risk individuals. During the early phase of the coronavirus (COVID-19) pandemic, design, development, validation, verification and implementation of diagnostic tests were actively conveyed by a large number of diagnostic test manufacturers. In this Review, we give an outline of the crucial role of diagnostic tests during the first world-wide indication of COVID-19. The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) and its associated coronavirus (COVID-19) pandemic has demanded rapid up scaling of in-vitro diagnostic assays to enable mass screening and testing of high-risk groups. To encounter the exponential demand in testing, there has been an expedite development of both molecular and serological assays across a superfluity of manifestos. The adjacent review discusses the current information on these modalities, including nucleic acid amplification tests, direct viral antigen tests. In the analytic stage, real-time reverse transcription-PCR (RT-PCR) assays remain the molecular test of choice for the etiologic diagnosis of SARS-CoV-2.

Diagnostic strategies for SARS-CoV-2 infection

COVID-19 pandemic highlighted the importance of laboratory diagnostics to reduce the spread of SARSCoV-2 and to treat patients with severe coronaviral disease. The situation required a rapid development of molecular and serological tests to enable mass screening, testing of high-risk groups, and establishing epidemiological data. Knowledge of diagnostic methods is continuously evolving, so it is crucial to understand the nature of the tests and to be able to interpret their results. This review discusses the current literature on diagnostic methods, prognostic markers, diagnostic recommendations, choice of the appropriate test, type of biological material, and interpretation of results depending on test sensitivity and disease duration. Also, the percentage of positive results in the selected countries at two distant time points of the epidemic was analyzed. Further development of diagnostic techniques and incorporation of new technologies can provide more accurate and faster tools for control the epidemic.

History of Acquired Immune Deficiency Syndrome in Korea

The first human immunodeficiency virus (HIV) infection was reported in Korea in 1985. The number of HIV-infected persons domestically increased in the 1990s showing epidemic indigenousization. Since then, the number of new infections gradually increased every year, and recently more than 1,000 newly infected cases were reported per year. A total of 12,522 infected individuals have been reported up to 2015, of which 2,020 died. The male to female ratio was 15.4:1, and 34.2% of them were under 30 years old. The infection route was homosexual and bisexual contact in 60.1% of cases and heterosexual contact in 34.6% of cases. Candidiasis, Pneumocystis pneumonia, tuberculosis were common as a AIDS (acquired immune deficiency syndrome)-defining illness. But with the introduction of antiretroviral therapy in the late 1990s, non-AIDS defining illnesses such as metabolic complications, cardiovascular diseases, bone diseases, and neuropsychiatric disorders such as neurocognitive dysfunction, depression, and anxiety are emerging as new health problems. The management policy switched its focus from regulating and monitoring of HIV-infected persons to ensuring access to treatment and promotion of voluntary HIV testing in high-risk groups. Also as the age of the infected persons increases, a need for various supports such as social rehabilitation, life counseling, and welfare has emerged.

Genetic Testing in Ultra-Young Breast Cancer Patients: A Single Institution Analysis of Breast Cancer Patients ≤ 35 Years at Diagnosis

Since 1999, the NCCN guidelines have outlined criteria for genetic testing among high-risk patients with breast cancer. Nonetheless, fewer than 30% of eligible patients currently undergo genetic testing in the United States. Racial disparities in genetic testing rates have been demonstrated among breast cancer patients at the population level. Meanwhile, data is conflicting regarding radiation toxicity among patients with germline mutations involving DNA repair, potentially due to low rates of testing. We hypothesized that ultra-young patients with breast cancer (<35 years) from a single high-volume academic institution would have high rates of screening and fewer disparities in receipt of genetic testing, and therefore facilitate a prospective study of radiation toxicity among mutation carriers. After IRB approval, the medical records of 532 patients ages 35 and younger at time of breast cancer diagnosis between 1990 and 2010 at a single institution were reviewed. Demographic features including race, ethnicity, language, and highest education level were captured, in addition to family history, Ashkenazi Jewish ancestry, receipt of genetic counseling and genetic testing results. Statistical analysis included chi-square and linear-by-linear association tests. The overall rate of genetic testing was 55% (290/532) in this cohort. From 1990 to 1998, the annual rate of testing was roughly stable, with a mean of 42%; then following NCCN guidelines publication in 1999, the testing rate steadily increased to 89-100% by the end of the study period (years 2009 and 2010). Of 199 patients who saw a genetic counselor, 157 (79%) received genetic testing, and an additional 133 patients were tested without seeing a genetic counselor. Fifty-four patients (19%) had germline mutations in BRCA1 (n = 29), BRCA2 (n=17) or other (CHEK2=2, PTEN=2, p53=2, RAD51C=1, ATM=1). Receipt of genetic testing was correlated with higher levels of education (p=0.00084), race (p=0.047), Ashkenazi Jewish ancestry (p=0.024), and diagnosis after implementation of NCCN testing guidelines in 1999 (p=0.0002). Family history, ethnicity, language, and whether the patient had children were not correlated with receipt of genetic testing. Rates of genetic testing among ultra-young breast cancer patients were high, particularly in response to national guidelines published in 1999, after which it took 10 years to exceed 90% testing rate in this group. Disparities exist in receipt of genetic testing related to patient race and education level, even in the specialized setting, though is likely driven by early time points in this study. Future efforts will involve exploring barriers and facilitators to genetic testing that could be employed outside the tertiary care setting, and studying radiation toxicity among mutation carriers in a large center with over 90% rate of testing in high-risk groups.

Uptake of peer-led venue-based HIV testing sites in Sweden aimed at men who have sex with men (MSM) and trans persons: a cross-sectional survey

ObjectivesHIV testing among high-risk groups is a key intervention to diagnose persons living unknowingly with HIV to enable linkage to care and effective antiretroviral treatment. This study aimed to evaluate...

PG-2 Evidence of increased HIV cases in greater Kinshasa urban health zones: Democratic Republic of Congo (2017–2018)

PG-2 Evidence of increased HIV cases in greater Kinshasa urban health zones: Democratic Republic of Congo (2017–2018)

Optimising management of patients with hepatitis C virus in the age of direct-acting antivirals: results of a Delphi consensus.

To optimize the management of patients with chronic hepatitis Cvirus (HCV). We developed two questionnaires to determine Italian healthcare professionals' opinions on the overall management of HCV chronic liver disease and the use of direct-acting antivirals (DAAs) in the treatment of HCV. A Delphi consensus method using the RAND/UCLA appropriateness method was used to determine opinions of an expert panel (EP) of specialists. Overall 443 physicians from 167 Italian centres completed the two questionnaires. The EP confirmed the importance of collaboration with general practitioners (GPs) and HCV testing in high-risk groups, but did not agree on treating patients over 80 years of age with DAAs. Over 90% agreed that it was important to quantify HCV-RNA, determine genotype, and test for anti-HIV and HBsAg before starting DAAs. Transient elastography (FibroScan®) was used by >90% to evaluate the stage of liver fibrosis while serum biomarkers were used by <20%. Adherence to therapy, drug-drug interactions and the possibility of treating advanced liver disease were decisive factors in therapy choice. Monthly monitoring during therapy was considered appropriate and 80% were in favor of HCV-RNA testing 24 weeks after the end of the therapy to confirm sustained virological response (SVR). Over 80% agreed that it was necessary to continue follow-up of patients with advanced fibrosis/cirrhosis. Scientific organizations should review their guideline recommendations to facilitate access to DAAs.

Demographic and Other Characteristics, and Rates of Sexually Transmitted Infections among Adolescents Who Underwent Multiple Abortions in 1Year.

To examine characteristics of adolescent patients presenting for multiple terminations within 1year and evaluate sexually transmitted infection (STI) status at each visit. Cross-sectional retrospective chart review to identify women younger than age 20years who underwent multiple abortions during 1year at John H. Stroger, Jr Hospital of Cook County. None. Rates and results of STI testing at each abortion encounter. We identified 381 adolescent patients with 2 or more abortions in 1year. Of the 285 women who received STI testing at both clinical encounters, we identified 12 women with Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) coinfection. Among patients who were not coinfected, 47 of 273 (17.2%) and 4 of 273 (1.5%) tested positive for CT and GC at the initial visit, respectively. Among women who were STI negative at the time of their first abortion, 25 of 226 (11.1%) were positive for CT and 1 of 269 (0.37%) was positive for GC at the time of their second termination. Young women in our study had higher baseline rates of CT and GC than rates reported by the Centers for Disease Control and Prevention for an age-matched population. High rates of positivity at the second visit might indicate a need for increased health education and/or frequency of testing in high-risk groups. In the adolescent population for whom patient encounters can be limited, the abortion care visit provides an opportunity to provide education and mitigate risk.

Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study

BackgroundChlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous.MethodsLongitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test.ResultsIn total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3–5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test.ConclusionsRepeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.

P92 A comparison of blood and saliva sampling for home HIV testing

Background HIV home sampling offers an acceptable and convenient method for HIV testing and may provide a practical solution for increasing testing in high risk groups. However, we are unaware of any data comparing the effectiveness of different sampling methods. From August 2013 users of our online HIV testing service were offered an informed choice between blood and saliva HIV sampling. Method We interrogated the database of all HIV home sampling requests and analysed any differences in demographics and return rates for both blood and saliva samples. Results Between 15.8.13 and 31.11.14, 14312 home tests were requested. Blood tests were preferentially chosen (9532, 66.6% vs 4780, 33.4%). 7257 samples (50.7%) were returned, this encompassed 4758 blood samples and 2499 saliva samples (49.9% of requested blood samples vs 52.2% of requested saliva samples p = 0.01). The service is predominantly aimed at men who have sex with men and of the returned samples the majority were from men (6416, 84.7%) Men were significantly statistically more likely to request blood samples than women (67% vs 51%, p Discussion Despite being more invasive when given an informed choice, more people chose blood over saliva sampling. However saliva samples were more likely to be returned. Women were statistically more likely than men to choose saliva sampling. There was no difference in the length of time it took to return reactive and negative samples.

P3.034 General Practitioners in the Netherlands Miss Opportunities to Test For STI/HIV During STI-Related Consultations

BackgroundWhereas the majority of STI-related consultations in the Netherlands take place in general practise (GP), national surveillance of STI predominantly uses data from STI centres, focussing at trends in high-risk...

ANRS–COM'TEST: description of a community-based HIV testing intervention in non-medical settings for men who have sex with men

ObjectiveTo describe a community-based HIV testing programme.Design and settingAn intervention of HIV voluntary testing conducted in non-medical settings in four French cities.ParticipantsMen who have sex with men (MSM).InterventionCounselling and rapid...

Venous thromboembolism in women

The risk of venous thromboembolism (VTE) varies throughout a woman's life and is associated primarily with underlying hormonal exposure. Alteration in hemostatic mechanisms, including resistance to activated protein C, may explain this altered risk. Initially, development of VTE with the use of contraception in young adulthood may reveal inherited thrombophilia. Pregnancy, and particularly the post-partum period, likely confer the greatest risk of VTE, but the absolute risk is small. Guidelines for prevention of VTE during pregnancy are based on personal or family history of VTE, and known inherited thrombophilia. Use of hormone replacement therapy later in life is associated with increased risk of VTE, and may be safest if given as an estrogen-only preparation to young postmenopausal women for less than 5 years. Universal screening for thrombophilia prior to pregnancy or initiating hormonal therapy is not recommended; however, selected testing in high-risk groups may be warranted. The lack of firm recommendations for the prevention of VTE in women highlights the need for future investigation aimed at identifying high-risk groups and evaluating the efficacy of prophylactic measures.

EGFR

Reporting estimated glomerular filtration rate (eGFR) with serum creatinine simply provides the information for which the serum creatinine was ordered in the first place. Mass or universal screening is not the purpose of eGFR reporting. Furthermore, such mass screening does not seem justified. Rather, testing of high-risk groups with eGFR and urinary albumin is useful. Population estimates of the prevalence of chronic kidney disease in the United States that use the Kidney Disease Outcomes Quality Initiative staging system lead to disturbingly high estimates. Many of these people are elderly with marginally depressed GFRs and for whom there are no known therapeutic implications. However, an even more disturbing fraction of people with serious and progressive renal disease are not diagnosed, counseled, or treated. Reporting of eGFR is only one tool in attempting to rectify this latter problem. Nephrologists need to educate patients and their primary care colleagues in the use of this tool.

Private business: the uptake of confidential HIV testing in remote Aboriginal communities on the Ananau Pitiantiatiara Lands

Background and methodsDespite a concentration of risk factors for HIV transmission, many remote Aboriginal communities in central Australia have a low uptake of HIV testing. We studied, the uptake of HIV testing in six clinics in remote Aboriginal communities following the introduction of voluntary confidential testing to assess the impact of the intervention and to determine if the program was reaching people most at risk of HIV infection and transmission. SettingThe study was conducted by Nganampa Health Council, an Aboriginal-controlled health service on the Anangu Pitjantjatjara Lands in the far north-west of South Australia. ResultsSince the introduction of confidential coded testing in August 1994 the number of HIV tests provided through the remote clinics has increased from 83 tests/year to 592 tests/year. In the 12-month audit period (August 1, 1995, to July 31, 1996) 62.7% of women aged 20-24 years, 44.6% of people aged 12-40 years and 24% of the total population had an HIV test. Fifty per cent of tests were accounted for by the 15-25 year age groups and 60% of tests related to an STD consult. DiscussionThis study shows that a high uptake of HIV testing in high-risk groups can be achieved in remote Aboriginal communities where a high level of confidentiality is maintained.

Acceptance of HIV Testing by Substance‐Abusing Individuals

Routine HIV (human immunodeficiency virus) testing of high‐risk groups (i.e., substance‐abusing individuals) could help decrease the spread of AIDS (acquired immune deficiency syndrome). Such a policy, however, could deter individuals from entering treatment, paradoxically increasing the likelihood of the disease being spread. The authors examined the willingness of substance‐abusing individuals to consent to HIV testing by randomly assigning patients entering either a drug‐free outpatient program or a methadone maintenance program to one of three informed consent conditions differing in degree of perceived coerciveness. Overall, 69% of the patients agreed to testing. As hypothesized, the proportion of agreement was highest under the most coercive informed consent condition. Although the results tend to support continuation of voluntary testing programs, only 5.5% of patients asked indicated that mandatory testing would have deterred them from entering treatment.