Viral Hepatitis and Human Immunodeficiency Virus Testing and Linkage to Care for Individuals Enrolled in an Opioid Treatment Program.

BACKGROUND: In the United States, many opioid treatment programs (OTPs) do not offer viral hepatitis (VH) or human immunodeficiency virus (HIV) testing despite high prevalence among OTP clients. We initiated an opt-out VH and HIV testing and linkage-to-care program within our OTP. METHODS: All OTP intakes are screened for VH and HIV and evaluated for rescreening annually. A patient navigator reviews laboratory results and provides counseling in the OTP clinic. The medical record is queried to identify individuals with previously diagnosed, untreated VH or HIV. Navigation support is provided for linkage or relinkage to VH or HIV care. RESULTS: Between March 2018 and Februrary 2019, 532 individuals were screened for hepatitis C virus (HCV), 180 tested HCV antibody positive (34%), and 108 were HCV-ribonucleic acid (RNA) positive (20%). Sixty individuals were identified with previously diagnosed, untreated HCV. Of all HCV RNA+, 49% reported current injection drug use (82 of 168). Ninety-five individuals were seen by an HCV specialist (57% of HCV RNA+), 72 started treatment (43%), and 69 (41%) completed treatment. Individuals with primary care providers were most likely to start treatment. Four individuals were diagnosed with hepatitis B; 0 were diagnosed with HIV. CONCLUSIONS: The implementation of an OTP-based screening and navigation protocol has enabled significant gains in the identification and treatment of VH in this high prevalence setting.

Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana.

OBJECTIVES: Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. METHODS: We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. RESULTS: Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. CONCLUSIONS: Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

Methods to assess youth engagement in a text messaging supplement to an effective teen pregnancy program.

Youth are prolific users of cell phone minutes and text messaging. Numerous programs using short message service text messaging (SMS) have been employed to help improve health behaviors and health outcomes. However, we lack information on whether and what type of interaction or engagement with SMS program content is required to realize any benefit. We explored youth engagement with an automated SMS program designed to supplement a 25-session youth development program with demonstrated efficacy for reductions in teen pregnancy. Using two years of program data, we report on youth participation in design of message content and response frequency to messages among youth enrolled in the intervention arm of a randomized controlled trial (RCT) as one indicator of engagement. There were 221 youth between the ages of 14-18 enrolled over two years in the intervention arm of the RCT. Just over half (51%) were female; 56% were Hispanic; and 27% African American. Youth were sent 40,006 messages of which 16,501 were considered bi-directional where youth were asked to text a response. Four-fifths (82%) responded at least once to a text. We found variations in response frequency by gender, age, and ethnicity. The most popular types of messages youth responded to include questions and quizzes. The first two months of the program in each year had the highest response frequency. An important next step is to assess whether higher response to SMS results in greater efficacy. This future work can facilitate greater attention to message design and content to ensure messages are engaging for the intended audience.