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Objectives: During the COVID-19 pandemic, telehealth was rapidly implemented to mitigate disruptions in HIV care services. However, participation in and benefits from telehealth were not distributed equally among people living with HIV (PWH). The acceptability of alternative telehealth options in HIV care remains understudied. This study aims to assess the relative importance of telehealth features among HIV care providers and PWH. Method(s): We compiled a comprehensive list of 21 telehealth features from the literature and formative research. Telehealth features were grouped into four domains with 4-6 features each: administrative (5), technology (6), visit-related (6), and other (4) features. 22 purposively selected participants (10 HIV care providers, 12 PWH) from South Carolina were asked to rank these features within domains and the domains themselves according to their perceived relative importance. Ranking data was analyzed through count analysis. Result(s): Domain rankings indicated that visit-related features such as a prior relationship with the provider and multidisciplinary virtual visits were most important. Administrative features such as scheduling modalities (e.g., virtual walk-in options) and the waiting time for an appointment were second most important, followed by technological features such as the type of provider (artificial intelligence vs. human provider) and type of telehealth (video, voice-only, or email). Other features such as the availability of technical support and the location where telehealth visits take place were least important to our participants. Across telehealth features, the relationship to the provider was most often ranked first (14 out of 22 participants) followed by out-of-pocket cost (9 out of 22 participants). Conclusion(s): Our findings highlight the importance of visit-related and administrative features of telehealth. A pre-existing relationship with the telehealth provider was particularly important to many providers and patient participants. Findings may inform telehealth HIV care options to meet the needs of PWH and HIV care providers.Copyright © 2023
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Objectives: Social distancing requirements and lockdowns due to COVID-19 resulted in a rapid integration of telehealth into HIV care. To maximize patient retention and ensure quality of care, it is vital to understand patient perspectives and preferences for various attributes of telehealth. This study aims to identify preference-relevant features of telehealth. Method(s): A review of PubMed and Embase was conducted in September 2022. Search terms describing telehealth (e.g., telehealth, telemedicine) and its features (e.g., attribute, characteristic) were combined for the search. Duplicate and non-English records, as well as irrelevant records, were removed. Literature was analyzed and synthesized using meta-synthesis and thematic synthesis methodology. Result(s): 10 records were included in the review (5 qualitative studies, 1 mixed-methods study, 4 discrete choice experiments). No HIV-specific studies were identified that described preference-relevant telehealth features. Studies primarily reported telehealth features in primary care, oncology, and rheumatology settings. Data synthesis revealed four domains of preference-relevant telehealth features: administration, technology, visit-related, and other features. Administrative features included waiting time for and during an appointment, scheduling flexibility, and out-of-pocket costs. Technology features included hardware and software used for telehealth visits, extent of privacy, and type of telehealth (e.g., video or voice-only). Visit-related features included relationship to the provider, consultation purpose, and severity of the patient's health concern. Other features included technological support options, convenience, and ease of telehealth use. Continuity of care with a patient's regular provider was the most often reported feature of telehealth within the identified literature. Conclusion(s): While there is no HIV-specific literature, preference-relevant administrative, technology, visit-related, and other features were identified in non-HIV-related literature. Future research needs to assess the importance of identified features to people living with HIV and which tradeoffs they are willing to make. This will inform tailored telehealth options addressing patients' needs and preferences for optimal utilization and care.Copyright © 2023
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Background: Coronavirus disease 2019 (COVID-19) had been a stronger hit in Deep South compared with other developed regions in the United States, and vaccination remains a top priority for all eligible individuals. However, there are limited data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age group, which is of critical importance for future vaccine planning. Racial/ethnic disparities were found in the COVID-19 vaccination, but the vast majority of evidence was generated from studies at the individual level. There is an urgent need for evidence at the population level to reveal and evaluate the booster coverage in racial/ethnic minority communities, which could identify vulnerable communities and inform future healthcare policymaking and resource allocation. We evaluated county-level COVID-19 booster coverage by age group in the Deep South and examined its relationship with residential segregation. Method(s): We conducted an ecological study at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of five Deep South states from December 15, 2021 to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster coverage by age group (e.g., 12 to 17 years old, 18 to 64 years old, and at least 65 years old) by the end of the study period. We examined the longitudinal relationships between residential segregation, interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson mixed model. Result(s): As of October 19, 2022, among the 418 counties, the median percentage of booster coverage was 40% (interquartile range [IQR]: 37.8-43.0%). Compared with elders, youth and adults had lower percentages of booster uptake. There was geospatial heterogeneity in the COVID-19 booster coverage. Results of the Poisson mixed model found that as time increased, higher segregated counties had lower percentages of booster coverage. Such relationships were consistent across the age groups. Conclusion(s): The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccine planning should focus on youth and adults. Healthcare facilities and resources are needed in racial/ethnic minority communities. Residential segregation and COVID-19 booster coverage by age group in the 418 counties across the five Deep South states from December 15, 2021 to October 19, 2022.
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Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s): Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s): We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR: 3.45, 95% CI (2.98, 3.99)], hypertension [OR: 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR: 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR: 1.51, 95% CI (1.22, 1.86)], and diabetes [OR: 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s): This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.
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INTRODUCTION: Existing studies examining the impact of the pandemic on engagement in HIV care often capture cross-sectional status, while lacking longitudinal evaluations. This study examined the impact of the pandemic on the longitudinal dynamic change of retention in care and viral suppression status. METHOD(S): The electronic health record (EHR) data of this population-level cohort study were retrieved from the statewide electronic HIV/AIDS reporting system in South Carolina (SC). The study population was people with HIV (PWH) who had at least one year's symmetric follow up observation record before and after the pandemic. Multivariable generalized linear mixed regression models were employed to analyze the impact of the pandemic on these outcomes, adjusting for socio-demographic characteristics and preexisting comorbidities. RESULT(S): In the adjusted models, PWH had a lower likelihood of retention in care (adjusted odds ratio [aOR]: 0.806, 95%CI: 0.769, 0.844) and a higher probability of virological failure (aOR: 1.240, 95%CI: 1.169, 1.316) during the peri-pandemic period than pre-pandemic period. Results from interaction effect analysis from each cohort revealed that the negative effect of the pandemic on retention in care was more severe among PWH with high comorbidity burden than those without any comorbidity;meanwhile, a more striking virological failure was observed among PWH who reside in urban areas than in rural areas. CONCLUSION(S): The COVID-19 pandemic has a negative impact on retention in care and viral suppression among PWH in South Carolina, particularly for individuals with comorbidities and residing in urban areas. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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Background: HIV infection might accelerate aging process and people living with HIV (PLWH) have been observed to have a higher risk of severe COVID-19 outcomes. However, it is unclear whether the worse COVID-19 outcomes can be attributed to the accelerated aging process. This study aimed to examine: 1) the causal effect of HIV infection on severe COVID-19 outcomes;and 2) the threshold of age difference at which PLWH and non-HIV patients will have comparable COVID-19 outcomes. Methods: We identified COVID-19 positive adults between Jan 1, 2020, and Oct 18, 2021, from the U.S. National COVID Cohort Collaborative (N3C), a nationally-sampled electronic medical record repository. We identified PLWH by clinical diagnosis, drug exposure, and laboratory results. Among COVID-19 cases, PLWH were matched 1:1 to non-HIV persons using exact matching (by gender, race, and ethnicity) and propensity score matching (PSM) (by age, gender, race, ethnicity, and pre-COVID comorbidities). To determine age threshold, PLWH were matched to older non-HIV patients with an age differences between 1 to 15 years. We used conditional logistic regression for exact matched data and standard logistic regression for PSM data. Subgroup analyses stratified by CD4 counts (≥200 or CD4<200 cells/mm) were also conducted. Results: Among a total of 2,422,870 COVID-19 positive adults, we identified 15,188 PLWH. Among PLWH with CD4 data, 872 (14.03%) had CD4<200. Using exact match, PLWH had a significantly higher odds of COVID-19-associated hospitalization [OR: 1.95, 95%CI:(1.88,2.02)] or death [OR: 2.05, 95%CI:(1.90,2.22)] compared to non-HIV persons. By repeating PSM modeling with incrementally increasing ages, PLWH persistently had a higher risk of death compared to non-HIV persons until the age difference reached 6 years, while the threshold of age difference for the comparable hospitalization outcome extended to 14 years. Furthermore, when matching PLWH with CD4<200 with non-HIV persons, the threshold of age difference increased to 10 years for similar odds of mortality and at least 15 years for similar odds of hospitalization. PLWH with CD4≥200 more likely to be hospitalized, though had similar outcomes for death, than non-HIV persons. Conclusion: We find that the worse COVID-19 outcomes, among PWH may be potentially related to aging in HIV. Further investigation of the biological mechanisms at the intersections of HIV infection itself (eg, lower CD4 counts) and accelerated aging in HIV causing worse COVID-19 outcomes is needed.
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Introduction Both clinicians and inflammatory bowel disease (IBD) patients remain concernedthat either their disease or medications—namely biologics, may increase the risk ofsevere adverse outcomes from coronavirus disease-2019 (COVID-19). We performed a systematic review and meta-analysis of the available literature to assess the safety of biologicsin COVID-19 patients with IBD.Methods We performed a systematic review of the databases PubMed/Medline, Embase,Cochrane, Web of Science, LitCOVID-NIH, and WHO COVID-19 from January 1-November3, 2020, to identify relevant articles reporting outcomes in IBD patients with COVID-19.Studies were excluded if they did not report the outcomes of interest (intensive care unit(ICU) admission, mechanical ventilation, and mortality) or excluded data on IBD medications(biologics). Pooled analysis was performed using a random-effects model and multivariateregression was applied.Results The initial search yielded a total of 81 articles, of which a total of 12 studies with2,681 patients were finally included. We found the overall prevalence of outcomes for allIBD patients as: need for mechanical ventilation: 5.1% (95% CI: 3.5%–7.4%, I2 = 52.1%),need for ICU admission: 6.1%, (95% CI: 4.2%-8.8%, I2 = 54.8%), and overall mortality:4.5% (95% CI: 2.8%-7.1%, I2 = 68.0) (Figure 1). Use of biologics did not show a moderatingeffect on the need for mechanical ventilation (coefficient: -0.01, 95% CI -0.08 – 0.05, p =0.68), ICU admission (coefficient: 0.03, 95% CI: -0.02 – 0.08, p = 0.27), or mortality(coefficient: 0.03, 95% CI -0.01 – 0.07, p = 0.20) (Figure 2).Discussion We found the overall prevalence of “severe” COVID-19—mechanical ventilation,ICU admission, and mortality, for all IBD patients with COVID-19 to be 5.1%, 6.1%, and4.5%, respectively. This appears to be fairly low given the impact IBD and its medicationsmay have on the immune-system. We also found that the use of biologics did not predict“severe” COVID-19—as shown upon multivariable analysis from our meta-regression model.This finding is important as it advocates for the ongoing and continued IBD therapy (biologics)in patients during the COVID-19 pandemic. The incidence, severity, and outcomes relatedto COVID-19 in IBD patients needs to be reassessed as data continues to emerge from thepandemic. Additional outcomes data will be required to understand how all classes ofbiologics and/or the use of concomitant immunosuppressants effect COVID-19 outcomesin IBD patients.(Figure Presented)Figure 1. Forrest plot demonstrating the overall prevalence of outcomes—(A) need for mechanical ventilation, (B) need for ICU admission, and (C) overall mortality—in COVID-19 infected inflammatory bowel disease (IBD) patients.(Figure Presented)Figure 2. Scatter plots demonstrating the impact of biologics on outcomes;(A) need for mechanical ventilation, (B) need for ICU admission, and (C) overall mortality.
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Background: Coronavirus disease 2019 (COVID-19) has infected over 62 million people worldwide as of November 28, 2020. Emerging studies have revealed a high prevalence of gastrointestinal (GI) symptoms among patients with COVID-19, and coronavirus particles have been found in their stool. However, there are minimal data regarding the impact of COVID-19 severity on the GI system. In this study, we evaluated GI and hepatobiliary manifestations in a large number of hospitalized patients across the United States (US) with COVID-19 based on admission to the intensive care unit (ICU), a surrogate for COVID-19 severity. Methods: Seven US academic centers ed data from patients who had a positive COVID-19 test and were hospitalized. Demographics, presenting symptoms, clinical, and laboratory data were ed, as were hospitalization outcomes. Patients were stratified According to admission to the ICU (yes/no) during their hospital course. GI and hepatobiliary manifestations and outcomes were compared using the Chi-square test, and parametric laboratory values were compared using Student’s t test. Results: Of a total of 1,896 COVID-19 positive patients, 730 patients (38.5%) were admitted to the ICU (Table 1). ICU admissions were more likely to be male (64.2% vs. 52.1%;p<0.01). The most common presenting symptom was dyspnea in ICU patients (57.8%) versus cough in non-ICU patients (47.9%).The prevalence of patients reporting GI symptoms was similar between ICU and non-ICU patients (20.4% vs 21.1%;p=0.14). Compared with non-ICU patients, ICU patients had a higher prevalence of abnormal serum aspartate aminotransferase (AST) values (16.0% vs. 6.7%;p<0.01) and total bilirubin > 3 mg/dL (3.1% vs. 0.8%;p<0.01) (Table 2). There was not a significant difference in prevalence of abnormal alanine aminotransferase (ALT) values between the two groups (9.6% vs. 7.1%;p=0.13). The peak values of AST, ALT, and total bilirubin among all patients in the cohort were 3384 U/L, 1274 U/L, and 54 mg/dL, respectively. Conclusions: In a large US-based cohort of hospitalized patients with COVID-19, GI symptoms did not differ between ICU and non-ICU patients despite their high prevalence. ICU patients were more likely to have serum liver test abnormalities. In this context, further investigation is needed to clarify whether hepatobiliary dysfunction stems from direct injury from COVID-19 or an indirect effect of ICU-related multi-organ dysfunc-tion. Such insight would help guide future management to reduce the risk of and mitigate hepatic injury in these patients (Table Presented) (Table Presented)
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Background: Coronavirus disease 2019 (COVID-19) has infected over 14 million people in the United States (US) as of December 1, 2020. Recent data have shown that COVID-19 strains appear to demonstrate geographic variation, such as Asian strains predominating in the Western US and European strains predominating in the Eastern US. However, the clinical significance of this variation remains unclear. In this large, multi-center cohort study, we evaluated gastrointestinal (GI) manifestations of COVID-19 regionally and throughout the US. Methods: Patients hospitalized with a positive COVID-19 test were identified at seven US academic centers. As a surrogate for differing COVID-19 strains, patients were stratified into regions (West, Midwest, or Northeast) depending on hospital location. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were ed. Statistical comparisons were performed with Chi-square and ANOVA tests, as appropriate. Results: A total of 1896 patients were identified (Table 1). Most patients were male (56.8%), and the most prevalent race was Caucasian (40.5%). The mean age was 58.1 years (±19.1), and the mean body mass index (BMI) was 29.9 (±8.4). A third (29.2%) of patients had a known COVID-19 exposure. The mean presenting temperature was 37.3 °C, and dyspnea was the most common presenting symptom (48.2%). GI symptoms were present in 20.3% of the overall cohort (Table 2);diarrhea was most common (12.4%), followed by nausea and/or vomiting (10.3%) and abdominal pain (6.0%). Geographically, GI symptoms were significantly less common in the Western cohort (17.8%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. GI complications (GI hemorrhage and pancreatitis) were also significantly less common in the Western cohort (1.5%, 0.2%) than the Northeastern (6.9%, 1.5%) and Midwestern (3.3%, 1.7%) cohorts. The Midwestern cohort had a higher prevalence of moderately elevated serum aspartate aminotransferase (AST;23.5% vs 8.5% in Western and 10.5% in Northeastern cohorts;p<0.01). Compared to the Northeastern and Midwestern cohorts, the Western cohort had a higher prevalence of mildly elevated serum alanine aminotransferase (ALT;20.9% and 20.9% vs 28.5%;p=0.01) and total bilirubin (6.7% and 7.0% vs 11.4%;p=0.03). The presence of GI symptoms was not associated with increased mortality (p=0.15). Conclusions: Although GI manifestations were common among patients hospitalized with COVID-19, there is significant variability in prevalence across the US. GI symptoms and complications were less common in the West than the Northeast or Midwest. Our study highlights notable geographic variations in GI manifestations of COVID-19, prompting the need for further investigation into the mechanisms of these differences. Such insight could identify strategies that mitigate GI complications of COVID-19 infection.(Table presented) Demographic and Clinical Data of Patients with COVID-19 by Geographic Region. (Table presented) Gastrointestinal Manifestations of COVID-19 in Patients by Geographic Region.
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Background. Convalescent plasma (CP) may be obtained from patients who have recovered from the novel coronavirus disease, COVID-19, caused by the virus SARS-CoV-2. Although not FDA approved, preliminary data suggests patients who receive convalescent plasma from recovered donors may have shortened recovery time and symptom reduction. The purpose of the study is to detail learner recruitment of convalescent plasma donation (CPD) for treating hospitalized COVID-19 patients. Methods. Prisma Health Midlands formed a multidisciplinary CP donation team, consisting of seven COVID-19-certified pharmacy learner volunteers, two pharmacists, and two providers. Primary eligibility criteria were SARS-CoV-2 polymerase chain reaction (PCR) positivity at least 28 days prior to donation and asymptomatic for a minimum of 14 days. Donors were excluded based on FDA guidelines for CPD, limiting ineligible contact. Team learners were trained on call techniques and subsequently contacted, educated, and requested candidates donate through this program. Willing donors were then linked to The Blood Connection to circulate CP back into the Prisma Health System, creating a self-sustaining and closed-loop donation cycle. Results. In total, 253 recovered adult patients with positive SARS-CoV-2 PCR test results were evaluated. 195 patients met baseline inclusion criteria for contact. This pre-screen reduced call and travel time for ineligible candidates. 108 patients were successfully reached. Of the 108, n=79 (73.14%) accepted referral to The Blood Connection, and n=29 (26.85%) were no longer candidates primarily due to patient communicated new exclusionary factors, such as active COVID-19 symptoms. The program allowed for rapid, internal access to CP for patients hospitalized with COVID-19 at Prisma Health Midlands. Conclusion. Interest and awareness in COVID-19 CPD was successfully increased upon direct communication from the team and was felt to represent a personnel intense but successful model for recruiting potential CP donors. This program educated and utilized learners during this pandemic to enhance Prisma Health's ability to obtain CP for hospitalized patients using a closed system.