ABSTRACT
Background: Early surveillance of COVID-19 in Scotland included routine monitoring of positive test rates and COVID-19-related NHS 24 calls. The COVID Symptom Study (CSS) provides another surveillance source, collating self-reported symptoms in the general population and predictions of likely infection. Aim(s): To capture spatial patterns of COVID-19 infection using Spatio-temporal (ST) analyses on three data streams: positive test rates, NHS24 calls, and CSS predicted cases. These were compared to assess which was best for early disease surveillance. Method(s): Data streams recorded weekly counts of activity by postcode district (PCD) during the first wave of the pandemic. ST analyses assessed the relationship between COVID-19 testing, NHS 24 COVID-19 calls, and CSS predicted COVID-19 cases, applying a Leroux conditional auto-regression (CAR) spatial GLM, adjusting for spatial covariates. Result(s): Positive test rates were associated with the proportion of NHS 24 calls related to COVID-19 per PCD (OR=1.038, 95% credible interval, 1.024-1.052) and the proportion of CSS app users predicted as cases, (OR=1.014, 0.974-1.056). A temporal effect was seen between all streams, after adjusting for spatial covariates. Using both NHS24 and the CSS to model COVID-19 positive test rates accounted for more ST variability than with the separate models, implying that combining sources may improve surveillance accuracy. Conclusion(s): NHS 24 and the CSS can identify similar trends/clusters of COVID-19 and gold-standard testing data, particularly when used in parallel. In the early stages of a pandemic, when widespread testing might not be available, alternative sources of data may be used to inform outbreak management.
ABSTRACT
Introduction: Medication assisted treatment (MAT) utilizes medications such as buprenorphine/naloxone (BUP/NLX) in conjunction with behavioral therapies to treat opioid use disorder. Studies suggesting increased treatment adherence with higher doses of BUP/NLX. Routine urine drug screens (UDS) assist in monitoring MAT adherence via measurement of excreted BUP and its metabolite, norbuprenorphine (NBP). The clinical significance of BUP/NBP levels and ratios outside of assessing adherence and detecting urine adulteration is unknown. Furthermore, the impact of COVID-19 on the MAT population has yet to be fully explored. Research Question or Hypothesis: (1) Does total daily BUP doses affect treatment adherence and substance use? (2) Is there a relationship between BUP/NBP levels/ratios and MAT adherence and substance use? (3) How has COVID-19 impacted MAT treatment population? Study Design: Single-center, retrospective chart review. Methods: Data was collected on 195 clients age ≥18-years enrolled in a local MAT program from August 1, 2017 to February 28, 2021. Demographic variables, BUP doses, prescription fill history, and UDS results were collected. Participants were divided into two groups based on MAT adherence (<80% vs ≥80%) in addition to pre-and post-COVID-19 cohorts. Results: Median total daily dose of BUP ≥16mg (n=126) vs <16mg (n=68) was not correlated with MAT adherence (p=0.107) or incidence of illicit drug use (p=0.117). Median BUP and NBP urinary concentrations were significantly correlated with MAT adherence (p<0.0001) and reduced percentage of positive UDS for opioids (p=0.0004 and p<0.0001, respectively) but not their ratios. For clients enrolled both pre-and post-COVID, a significantly higher incidence of UDS positive for opiates (p=0.049) and alcohol (p=0.035) were observed post-COVID. Conclusion: Higher concentrations of urinary BUP and NBP were correlated with increased MAT treatment adherence and reduced incidence of opioid-positive UDS independent of the dose of BUP prescribed. An increase in opioid-and alcohol-positive UDS were observed during the COVID-19 pandemic.