ABSTRACT
COVID-19 hospitalizations are a key indicator of the SARS-CoV-2 pandemic. The US Centers for Disease Prevention and Control describes oxygen supplementation as a measure of severe disease. SARS-CoV-2 PCR positive patients hospitalized without hypoxia or requiring oxygen may have been identified incidentally due to routine screening practices. We describe the application of a revised case definition for COVID-19 hospitalization based on the case-patient oxygen requirement on admission. Using data collected from consecutive SARS-CoV-2 PCR positive hospital admissions in December 2021 and January 2022 at a large safety net hospital in Los Angeles County, we highlight differences between patients hospitalized with COVID-19 (i.e., no oxygen requirement on admission or `incidental` infection) and those hospitalized for COVID-19 (i.e., oxygen requirement on admission). We conducted multivariable modeling to determine the effect of age as a positive predictor of COVID-19 hospitalization and vaccination or prior infection as a negative predictor. The revised case-definition resulted in a substantial decrease in the number of COVID-19 hospitalizations during the study period: 67.5% of SARS-CoV-2 PCR positive hospital admissions were not for COVID-19 but with COVID-19. A revised case-definition for COVID-19 hospitalization that includes the oxygen requirement on admission is needed to more accurately monitor the pandemic and inform public health policy.
ABSTRACT
BACKGROUND: HIV disproportionately affects men who have sex with men (MSM) in the USA, and new infections continue to increase, particularly among African American (AA) and Hispanic/Latino (H/L) MSM. Rates of HIV testing are particularly low among AA and H/L MSM, and innovative approaches to encourage testing may help address high incidence in these men. HIV self-testing (HST) may be an important tool for increasing rates and frequency of testing. HST may be particularly well-suited for AA and H/L MSM, given that stigma and mistrust of medical care contribute to low testing rates. Despite its promise, however, many are concerned that HST does not sufficiently connect users with critical post-testing resources, such as confirmatory testing and care among those who test positive, and that these limitations may result in delayed linkage to care. METHODS: We developed a mobile health platform (eTest) that monitors when HST users open their tests in real time, allowing us to provide timely, "active" follow-up counseling and referral over the phone. In this study, 900 high-risk MSM (with targets of 40% AA, 35% H/L) who have not tested in the last year will be recruited from social media and other gay-oriented websites in several major cities. Over 12 months, participants will be randomly assigned to receive (1) HST with post-test phone counseling and referral (eTest condition), (2) HST without active follow-up (standard condition), or (3) reminders to get tested for HIV at a local clinic (control) every 3 months. Primary outcomes include rates of HIV testing, receipt of additional HIV prevention services, and PrEP initiation verified by clinical medical records. DISCUSSION: This study tests whether providing more active counseling and referral after HST encourages more regular HIV testing and engagement with other prevention services among MSM, compared to more passive approaches or clinic-based testing alone. It will also explore the cost-effectiveness and emotional/behavioral effects of these two strategies. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03654690 . Registered on 31 August 2018.
