Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

Adolescent vaccination: The important role of GPs

GPs have an important role in supporting adolescent vaccination, including ensuring vaccinations are up to date and in promoting health literacy among parents and adolescents. With the recently approved COIVD-19 vaccines and boosters for adolescents, it is timely for GPs to consider missed doses and catch-up vaccination as part of standard preventive health activity for the adolescent patient in general practice.

Process improvement for emergent ECMO cannulation of critically ill COVID-19 and MIS-C pediatric patients

Introduction: Children diagnosed with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C) can have rapid clinical deterioration and may require emergent hemodynamic and respiratory support with Extracorporeal Membrane Oxygenation (ECMO). Wolfson Children's Hospital (WCH) is the only free standing children's hospital in Northeast Florida. The 20 bed Pediatric Intensive Care Unit (PICU) averages 1100 admissions per year and is a level 1 trauma center. During the most recent wave of COVID, our hospital saw significantly increased numbers of children with COVID-19 and MIS-C requiring hospitalization and medical treatment in the PICU. The ECMO team at WCH was consulted for initiation of ECMO on several critically ill children with COVID-19 and MIS-C. Some children required extracorporeal cardiopulmonary resuscitation (ECPR). Many of these patients had significant obesity and other co-morbidities complicating patient management including emergent cannulation for ECMO. Cannulating a patient for ECMO during active CPR has poor outcomes that can be further impacted by obesity and an inability to generate adequate blood flow through smaller vessels in obese children. Therefore, our center sought to evaluate patients earlier for ECMO and attempt to avoid ECPR or emergent cannulation. A daily rounding checklist for COVID-19 and MIS-C patients was developed and implemented with a goal of preventing delayed care and enhancing efficient communication among all members of the healthcare team. Purpose: The ECMO team and physician leadership developed a daily rounding checklist to enhance communication with the interdisciplinary team for all COVID-19 and MIS-C patients admitted to the PICU. The checklist is completed by the ECMO Coordinator upon admission for children requiring respiratory and hemodynamic support with daily updates by the ECMO team coordinators, pediatric intensivist, and pediatric surgeon. The checklist ensures that each patient admitted to the PICU with COVID-19 or MIS-C has the following patient information, laboratory and imaging studies documented in the event the patient rapidly deteriorates and requires emergent cannulation for ECMO. Checklist information includes: patient weight, BMI, co-morbidities, cardiac echocardiogram to evaluate cardiac function, ultrasound of neck and femoral vessels to determine cannula size, head ultrasound (if applicable), patient's current condition (improving, unchanged, or deteriorating), type and cross, and candidacy for ECMO. The checklist allows all members of the healthcare team to have pertinent patient information readily available allowing expedited initiation of ECMO if needed. Implementation: The ECMO Coordinator consults with the attending pediatric intensivist and pediatric surgeon daily. Once the rounding checklist is completed, it is updated daily. If any items have not been completed, the ECMO coordinator recommends completion of missing testing or laboratory studies to the ICU team. Information gained from the ECMO Coordinator rounds is then added to the checklist and distributed to physician leadership, the PICU attending, ECMO medical directors, and the pediatric surgical team. If candidacy of a patient for ECMO is questionable, discussion occurs with the pediatric intensivist, pediatric surgeon, and ECMO medical directors to determine ECMO suitability. For high-risk patients, a primed circuit and catheters are available at the bedside with the ECMO team on standby. Outcomes: The implementation and utilization of this checklist has streamlined the process to determine suitability of children with COVID-19 and MIS-C that may require ECMO support at WCH. The process has enhanced patient care allowing a primed circuit, appropriate sized catheters, and discussion with the cardiovascular team in the event that thoracic cannulation may be required. This checklist is now being utilized for all patients that may require ECMO support allowing improved communication and collaboration between the pediatric intensivists, surgical group, and ECMO team.

Usability, acceptability, and feasibility of a High-Density Microarray Patch (HD-MAP) applicator as a delivery method for vaccination in clinical settings.

BACKGROUND: High-density microarray patch (HD-MAP) vaccines may increase vaccine acceptance and use. We aimed to ascertain whether professional immunizers (PIs) and other healthcare workers (HCWs) in Australia, a High-Income Country (HIC), found the HD-MAP applicator usable and acceptable for vaccine delivery. METHODS: This feasibility study recruited PIs and HCWs to administer/receive simulated HD-MAP administration, including via self-administration. We assessed usability against essential and desirable criteria. Participants completed a survey, rating their agreement to statements about HD-MAP administration. A subset also participated in an interview or focus group. Survey data were analyzed using descriptive statistics, and interviews were transcribed and subject to thematic analysis. RESULTS: We recruited 61 participants: 23 PIs and 38 HCWs. Findings indicated high usability and acceptability of HD-MAP use across both groups by a healthcare professional or trained user and for self-administration with safety measures in place. Most administrations met essential criteria, but PIs, on average, applied the HD-MAP for slightly less time than the required 10-seconds, which the HCWs achieved. PIs perceived safety concerns about home administration but found layperson self-administration acceptable in an emergency, pandemic, and rural or remote settings. CONCLUSIONS: Participants found HD-MAP administration usable and acceptable. Usability and acceptability are likely to be improved through end-user education and training.

Professional immunizers and healthcare workers found high-density microarray patch devices highly usable and acceptable to administer vaccines.HD-MAPs may have advantages over intramuscular injections in clinical settings and in pandemics.Vaccination with HD-MAP may improve acceptance for those with needle-related anxiety.

Adolescent vaccination The important role of GPs

The article offers information on the General Practitioners (GP) having an important role in supporting adolescent vaccination, including ensuring vaccinations are up to date and in promoting health literacy among parents and adolescents. It highlights that they can opportunistically prioritise vaccination during routine consultations and ensure the adolescent is up to date with the vaccination schedule recommended in the National Immunisation Program.