An Innovative Model to Ensure Access to Hcv Treatment among Vulnerable Inner City Residents in Covidworld

Background: Due to public health regulations, many outreach programs aimed at identifying and treating disengaged populations at high risk of HCV infection were suspended. This led to a significant decrease in treatment starts and, quite likely, an increase in disease incidence among this group of core transmitters. There is an urgent need to design and evaluate novel approaches to ensure that this unmet need is addressed in concert with COVID-related programs to mitigate disease transmission, optimize COVID vaccination rates as well as timely diagnosis and treatment of COVID cases in this unique environment. Method(s): We designed a program of intervention based in single room occupancy residences in the inner city of Vancouver, Canada. Events were held in common areas and conformed to all social distancing/personal protective equipment regulations. Only residents of the building were allowed to participate, to minimize social mixing. Point of care testing for HCV was offered by finger stick rather than oral swab, to allow constant masking. Education was offered about COVID transmission, the importance of vaccination and the availability of treatment. Access to COVID rapid tests at the time of the event and beyond was facilitated, along with (more recently) an offer of antiviral treatment if eligible. In all cases, an offer of broader engagement in multidisciplinary care was made, to address HCV infection and other essential needs. Result(s): Since July 2020, 80 events have been held. We have reached 1193 individuals (71.1% male, 23.8% Aboriginal). HCV antibody positivity rate was 36.3%. Viremia testing was completed in 358 individuals, with 173 (48.3%) being positive. Of these, 97 have initiated treatment, 64 have completed treatment, with SVR12 rate of 53/54 (98.1%), and 31 patients remain in care, awaiting HCV treatment initiation. Data on COVID vaccination and disease transmission rates are being analyzed. Conclusion(s): It is still possible to design programs of intervention for inner city residents while respecting COVID regulations. Such events (conducted within a population where 1/3 are infected with HCV), conducted within the context of an offer of broader care, are highly successful and will contribute significantly towards an increase in HCV treatment starts in a group that has been particularly disadvantaged in the pandemic era.

Cook and Move for Your Life: A pilot study of an online intervention to improve diet and physical activity among breast cancer survivors

Purpose: The Cook & Move for Your Life randomized pilot study assessed the feasibility and relative efficacy of two dose levels of a remotely-delivered diet and physical activity (PA) intervention for breast cancer (BC) survivors. Methods: Women with a history of stage 0-III BC who were >60 days post-treatment, ate <5 servings per day of fruits/vegetables or engaged in <150 minutes per week of moderate to vigorous physical activity (MVPA), and had smartphone or computer access were enrolled. Participants were randomized to receive one of two doses of an online diet and PA didactic and experiential program, with outcomes measured at 6 months. The low-dose arm received a single 2-hour Zoom session delivered by a dietitian, a chef, a culinary educator, and an exercise physiologist;the high-dose arm received 12 2-hour Zoom sessions over 6 months. All participants received weekly motivational text messages, a Fitbit to self-monitor PA, and study website access. The primary objective was to evaluate overall feasibility based on accrual, adherence, and retention. Prespecified feasibility endpoints were 75% retention at 6 months and 60% of high-dose arm participants attending at least 8 of the 12 sessions. Secondary objectives were to compare high vs. low dose intervention effects on 6-month changes in fruit/vegetable servings per day (24-hour dietary recall), MVPA minutes per week (accelerometry), and blood and stool biomarkers.Results: From December 2019 to January 2021, 74 women were accrued. On average, women were 57.9 years old, 4.8 years post-diagnosis, with body mass index of 29.1 kg/m2 . Most were nonHispanic white (89.2%), 51.4% were diagnosed at stage I, and 40.5% were on endocrine therapy. Questionnaire and biospecimen data collection at 6-months were completed for 93.2% and 83.8% of the sample, respectively. In the low-dose arm (n=36), 94.4% of participants attended the single class, while in the high-dose arm (n=38) 84.2% of participants attended at least 8 of the 12 sessions live or via video archived on the website (mean 9.4 sessions). On average over the 6-month intervention period, participants responded to 71.5% of the text messages, 73.0% wore their Fitbit device ≥50% of the time, and 77.0% accessed the study website. Mean vegetable intake increased by 1 serving per day among women in the high-dose arm and decreased slightly among women in the low-dose arm (P=0.03). Changes in fruit/vegetable intake and MVPA varied little by arm. Blood and stool biomarker analyses are ongoing. Conclusion: We successfully conducted a remotely-delivered diet and PA intervention for BC survivors with high accrual, adherence, and retention during the COVID-19 pandemic. Women in the high-dose arm increased vegetable intake relative to the low-dose arm. Future research will refine and test the intervention in a larger and more diverse study population.

Predictors of objectively-measured sedentary time during the COVID-19 pandemic among breast cancer survivors participating in a diet and physical activity intervention

Purpose of the study: The purpose of this study was to investigate the predictors of objectively-measured sedentary time (ST) among breast cancer (BC) survivors who were 60 days post-treatment and were initiating participation in an intervention to improve diet and physical activity (PA) during the early phase of the COVID-19 pandemic. Methods: Cook and Move for Your Life (CMFYL) was a pilot and feasibility study of stage 0-III BC survivors testing the effects of a remotely-delivered and remotely-assessed nutrition and PA intervention. Women were ≥60 days post-treatment (current endocrine therapy allowed), consumed <5 servings of fruits/vegetables per day and/or engaged in <150 minutes/week of moderate to vigorous physical activity (MVPA). Hip-worn Actigraph GT3X accelerometers measured ST for 7 consecutive days at baseline. ST was defined as minutes/day (continuous) based on the Troiano cutpoint (<100 counts/minute), during awake (6am-11pm) wear time, and non-wear was identified using the Choi algorithm on the vector magnitude counts/minute. Multivariable linear regression models adjusting for wear time (average minutes/day) and minutes of MVPA/day were used to examine whether the following factors were predictors of ST at baseline: self-reported demographics, psychosocial factors (assessed via PROMIS Physical Function and PROMIS Anxiety forms), diet quality (Healthy Eating Index 2015 score), caloric intake (calories/day), and fruit and vegetable intake (servings/day). Results: Among the 84 women included in this analysis who had actigraphy measurements at baseline, the average ST/day was 684±79 minutes. On average, women were 58±10 years in age and most self-identified as non-Hispanic white (87%). The average time since diagnosis at time of enrollment was 4.5 years and 59% of women were receiving endocrine therapy at baseline. Adjusted models show that participants with a college degree had 24.7 (95%CI 2.0, 47.4) more minutes of ST than those with less than a college degree, and for every 1-point increase in PROMIS Physical Function scores participants had 2.5 (95%CI -4.9, -0.2) fewer minutes of ST. Conclusion: In a sample of BC survivors enrolled in a diet and PA intervention, higher level of education and poorer physical function were associated with higher ST during the early phase of the COVID-19 pandemic. These findings provide preliminary insight into factors associated with ST. Future work will investigate how these factors influence change in ST after participation in the CMFYL intervention.

Rapid antigen test during a COVID-19 outbreak in a private hospital in Hong Kong.

INTRODUCTION: In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS: Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS: In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION: The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.

Hepatitis c treatment for vulnerable inner-city populations: impact on treatment initiation during COVID-19 era

Background: To achieve the World Health Organization's goal to eliminate hepatitis C (HCV) as a public health concern by 2030, treatment starts will have to be maintained, especially among vulnerable inner-city populations With the advent of the SARS-CoV-2 pandemic, treatment starts were reduced due to diversion of resources away from HCV programs The inner-city population was further marginalized by essential public health measures designed to control the pandemic It is important to document the impact on HCV programs and the measures that may have already been taken to address them in the context of the evolving measures to address the SARS-CoV-2 pandemic Methods: Within our multidisciplinary program of care to address HCV among vulnerable populations (most of whom reside in the inner city), we calculated our usual rate of monthly treatment starts from 01/19 to 02/20 We then calculated treatment starts in 03/20 to 05/20, when programs to identify HCV-infected patients and engage them in care were suspended This was further compared to starts from 06/1/20 to 07/15/20 when outreach programs were slowly re-initiated in conjunction with TeleHealth initiatives to provide enhanced support to patients Results: In the 14 months from 01/19 - 02/20, there was an average of 10 treatment starts/month at our centre Key demographics of the treated population were mean age 50 (25-76) years, 79% male, 93% drug users, 89% on opioid substitution therapy (OST), 27% homeless, and 38% with psychiatric co-morbidities From 03/1/20 - 07/15/20 there were 23 treatment starts: mean age 47 (22-75) years, 83% male, 70% drug users, 65% on OST, 22% with psychiatric co-morbidities, and 17% homeless In the 3 months from 03/20 - 05/20, there were only 9 starts and in 06/20, there were 6 starts. In the first half of 07/20, there were 8 starts. This represents a 60% increase in treatment starts/month compared to our long-term average, and likely represents a partial 'warehouse' effect Conclusion: Among established programs such as ours, the advent of the SARS-CoV-2 pandemic led to a virtual suspension of HCV treatment starts for a period of 3 months As the pandemic came under control in our jurisdiction, we were able to resume our programming in a way that is consistent with the public health measures needed to control the pandemic while still optimizing HCV care delivery In order to stay on track to achieve HCV elimination goals, we must control SARS-CoV-2 transmission to allow treatment programs to resume optimal function within the framework of the 'better normal' of the evolving pandemic response.