Sustained virologic response from hepatitis C from an emergency department screening & linkage program: A retrospective review.

INTRODUCTION: The role of the Emergency Department (ED) as a vital constituent in Hepatitis C (HCV) screening has become increasingly evident. A key component of the ED's role in HCV screening is the ability to effectively link HCV-RNA positive patients to definitive, HCV-specific care, to include direct-acting antiviral (DAA) medication with resultant sustained virologic response (SVR). We sought to consider the rate of HCV-specific linkage, DAA initiation, and SVR obtained in HCV patients identified from an ED screening program. METHODS: A retrospective chart review was conducted in February of 2022 of all individuals who participated in an opt-out ED-based HCV screening program between January 2018 and December 2019. Data was disaggregated by race, gender, age/birth cohort, insurance status, and achievement of sustained virologic response (SVR). Bivariate analysis using Pearson's chi-square was utilized to compare outcomes based on insurance status, race, sex, and birth cohort. RESULTS: Of 66,634 individuals screened for HCV during the study period, 885 (1.33%) patients were RNA-positive. Of those individuals, 121 (13.67%) were linked to HCV-specific care. Of those linked, the majority (66.9%) were male, white (66.1%; 33.1% Black), baby boomers or older (53.7%) and publicly insured (57.9%; private insurance 23.1%, self-pay 19%). Among linked patients, 88 (72.7%) started DAA medication. Mirroring linked demographics, majority were male (64.8%), white (64.8%), baby boomers or older (52.3%), and publicly insured (57.6%). White patients initiated on DAA were more likely to obtain SVR (64.9% versus 41.9% Black; p = .04) and uninsured patients were more likely to obtain SVR (82.4% versus 50.7% insured; p = .02). Bivariate consideration of SVR-patients specifically demonstrates that Black patients tended to be older, with significant overrepresentation of Baby boomers (77.5%) as compared to whites (37.5%; p < .0001). Black patients were also more likely to be publicly insured (82.5%) while white patients were more likely to have private insurance (28.8%) or be uninsured (26.3%) than their Black counterparts (12.5% and 5% respectively; p < .05). CONCLUSION: An ED-based HCV screening program can result in successful HCV-specific linkage and care, to include DAA initiation and ultimately, SVR. Among linked patients, specific cohort considerations may demonstrate differences in age and insurance status which may have implications on DAA application and adherence, and therefore, individual ability to achieve SVR.

Eastern oysters Crassostrea virginica settle near inlets in a lagoonal estuary: spatial and temporal distribution of recruitment in Mid-Atlantic Coastal Bays (Maryland, USA).

Background: Declines of the Eastern oyster, Crassostrea virginica, and its numerous ecological benefits have spurred oyster restoration initiatives. Successful restoration of a self-sustaining oyster population requires evaluating the temporal and spatial patterns of recruitment (settlement and survival) of oyster larvae in the target waterbody. Restoration of the Eastern oyster population in the Maryland Coastal Bays (MCBs), USA, a shallow lagoonal estuary, is of interest to federal, state, and non-governmental, but the location and timing of natural recruitment is not known. Methods: We assessed the spatial and temporal variation in oyster larval recruitment throughout the MCBs using horizontal ceramic tiles and PVC plates. Newly settled oyster larvae (recruits) were monitored biweekly from June to September 2019 and 2020 at 12 sites in the MCBs and a comparison site in Wachapreague, Virginia. Water quality measurements collected included temperature, salinity, dissolved oxygen, pH, and turbidity. The objectives of this study were to determine (1) the most effective substrate and design for monitoring oyster recruitment, (2) the spatial and temporal distribution of oyster larval recruitment in the MCBs, and (3) patterns in oyster larval recruitment that would be applicable to other lagoonal estuaries. Results: (1) Ceramic tiles were more effective than PVC plates for recruiting oyster larvae. (2) Peak settlement began during the period from late June through July, and oyster recruitment was greatest at sites closest to the Ocean City and Chincoteague inlets. (3) Areas near broodstock that have slow flushing rates to retain larvae may provide the best environments for recruitment of oysters to lagoonal estuaries. Discussion: As the first study on oyster larval recruitment in the MCBs, our results provide insight into their spatial and temporal distribution, methods that can serve as a foundation for future recruitment studies in other lagoonal estuaries, and baseline data that can be used to inform stakeholders and evaluate the success of oyster restoration projects in MCBs.