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Background: People who inject drugs (PWID) are vulnerable to SARS-CoV-2 and severe disease but have low rates of COVID-19 testing and vaccination due to multilevel barriers. We partnered with a mobile syringe service program (SSP) in San Diego County, CA, to develop the theory-informed LinkUP intervention to increase COVID-19 testing and vaccination among PWID. Method(s): From March-June 2022, we conducted a pilot randomized controlled trial (RCT;ClinicalTrials.gov #NCT05181657) to assess efficacy of LinkUP vs. a didactic attention-matched control condition in increasing COVID-19 testing uptake and acceptance of vaccination referrals. Based on Social Cognitive Theory, trained, SSP-hired peer counsellors delivered tailored education, motivational interviewing, and problem-solving and planning to the active LinkUP intervention arm. We referred eligible participants (PWID, >=18 years old, San Diego County residents without recent voluntary COVID-19 testing or fully vaccinated status) to mobile SSP sites that had been randomized by week to offer LinkUP or the control condition;all participants were then offered on-site rapid COVID-19 antigen testing and vaccination referrals. Our intent-to-treat analysis used Chi-square tests to compare intervention groups' outcomes and log-binomial regression to estimate preliminary intervention efficacy and explore potential moderation. Result(s): Among 150 participants, median age was 41 years, 33% identified as Latinx and 65% as male, 73% were experiencing homelessness, and 45% had prior mandatory COVID-19 testing. Overall, we only detected one SARS-CoV-2 case. However, more active intervention vs. control participants agreed to COVID-19 testing (77.3% vs. 22.7%;p< .001) and vaccine referrals (32.4% vs. 13.3%;p=0.006). Homelessness moderated intervention effects: LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.64;95% CI: 1.27-2.12) than those not experiencing homelessness (aRR: 1.25;95% CI: 0.99-1.56). Conclusion(s): Findings from this RCT support the efficacy of LinkUP in increasing COVID-19 testing and acceptance of vaccination referrals among PWID presenting at mobile SSP sites, particularly for those experiencing homelessness. This research underscores the significance of communityacademic partnerships when working with PWID and identifies a promising model that could be adapted to increase access to other underutilized vaccines in this vulnerable population.
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INTRODUCTION: In the United States, cancer screening rates declined in spring 2020 due to the COVID-19 pandemic. Stay-athome orders and social distancing mandates created a new barrier to health care while further exposing the pre-pandemic health care disparities. METHODS: Using fully de-identified electronic health record data from the University of Mississippi Medical Center's (UMMC) Patient Cohort Explorer, we assessed changes in cervical cancer screening before and during the COVID-19 pandemic. The number of women screened with cervical cytology and human papillomavirus (HPV) testing in the pre-COVID months of September 2019 and January 2020 were compared with the same months of the following year during the pandemic (September 2020;January 2021). RESULTS: Data showed a pre-pandemic baseline of 319 and 340 women screened via cervical cytology during September 2019 and January 2020, respectively. Compared to pre-pandemic baseline, cervical cytology screening remained consistent throughout the pandemic with 302 and 311 women screened in September 2020 and January 2021, respectively. Similarly, HPV testing in the pre- COVID months resulted in 229 and 226 women screened as compared to 211 and 170 women screened during the pandemic. CONCLUSION: Cervical cancer screening did not significantly decline during the COVID-19 pandemic in Mississippi as compared to the 80% decline in cervical screening noted in California. The lack of change could be attributed to the low number of women screened both before and during the pandemic. Low cancer screening in women demonstrates various health care disparities affecting the UMMC patient population and the need to increase patient awareness and education regarding the importance of routine cancer screening.
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IntroductionSince the publication of the ARUBA trial, interventional management of cerebral arteriovenous malformations has become an area of debate. Treatment practices may have changed based on data from this recent trial which suggested that the risk of AVM treatment is greater than medical management in unruptured AVMs. To assess the ‘real world’ experience with interventional AVM outcomes, we compared outcomes of ARUBA eligible patients from the NVQI-QOD registry database to the ARUBA trial results.MethodsIn an IRB approved study, the NVQI-QOD AVM registry database was queried for treated patients between 2017 to present with the following inclusion criteria: age > 18 years, baseline mRS> 1, unruptured AVMs. 174/364 patients were ARUBA eligible and were included in the analysis. Patients were divided into embolization alone, microsurgery with or without embolization, and gamma knife radiation therapy with or without embolization. Primary outcomes of ischemic/hemorrhagic stroke or death were analyzed with a mean follow up time of 5.8 months (range 1 to 128 months).ResultsA total of 14 (8.0%) of patients that underwent any type of intervention suffered stroke or mortality. The risk of stroke or death was 6.8% (5 of 74) for microsurgery, 5.4% (2 of 37) for gamma knife, and 10.9% (7 of 64) for embolization alone. Annual stroke or death rates for all treatments were 7.5% (13 of 174) at one year and 0.57% (1 of 174) at 2 years.ConclusionARUBA eligible patients from the NVQI-QOD registry demonstrate a significantly lower risk of stroke or death with intervention of 8.0% (N=174) compared to the 30.7% (N=114) ARUBA trial interventional risk, and is nearly equivalent to the ARUBA trial medical management risk of 10.1% (N=109) over 33 months.DisclosuresN. Moore: 1;C;SNIS Joe Niekro Research Grant. R. Abdalla: None. T. Patterson: None. Y. Moazeni: None. P. Rasmussen: 2;C;Blockade Medical, Covidien/Medtronic, Stryker Neurovascular, Perflow Medical. 4;C;Perflow Medical. G. Toth: None. M. Bain: 2;C;Stryker Neurovascular. S. Ansari: None. S. Hussain: 2;C;Pulsar Inc.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the ongoing global COVID-19 pandemic that began in late December 2019. The rapid spread of SARS-CoV-2 is primarily due to person-to-person transmission. To understand the epidemiological traits of SARS-CoV-2 transmission, we conducted phylogenetic analysis on genome sequences from >54K SARS-CoV-2 cases obtained from two public databases. Hierarchical clustering analysis on geographic patterns in the resulting phylogenetic trees revealed a co-expansion tendency of the virus among neighboring countries with diverse sources and transmission routes for SARS-CoV-2. Pairwise sequence similarity analysis demonstrated that SARS-CoV-2 is transmitted locally and evolves during transmission. However, no significant differences were seen among SARS-CoV-2 genomes grouped by host age or sex. Here, our identified epidemiological traits provide information to better prevent transmission of SARS-CoV-2 and to facilitate the development of effective vaccines and therapeutics against the virus.
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BACKGROUND: Throughout the United Kingdom, there have been sweeping changes to the practice of medicine due to the COVID-19 pandemic. For the surgical speciality, there have been changes to both elective and emergency practice. Concern regarding potential aerosolisation during invasive procedures have been raised - including the use of pneumoperitoneum to facilitate laparoscopy. The aim of this study is to systematically review the data available to date regarding the potential risk posed to theatre staff by laparoscopy. METHOD: A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only publications in peer-reviewed journals were considered. PubMed, Ovid Embase, SCOPUS, and Cochrane Library were searched. The search period was between 1st January 1980 and 27th April 2020. Bias was assessed using the ROBINS-I tool. RESULTS: 4209 records were identified, resulting in 9 unique studies being selected. The included studies examined viral DNA aerosoliation generated by electrosurgery and CO2 laser ablation, with one study examining viral DNA aerosolisation following laparoscopy. Each of these demonstrated that viral DNA (Hepatitis B Virus and Human Papilloma Virus) was detectable in the surgical smoke plume. CONCLUSION: The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to assess risk towards healthcare staff. It was constrained by heterogeneity of reporting for several outcomes and lack of comparable studies. There is currently insufficient data to recommend open or a minimally invasive surgical approach with regard to theatre team safety in the COVID-19 era.