Access to Urgent Care Practices Improves Understanding and Management of Endemic Coccidioidomycosis: Maricopa County, Arizona, 2018-2023.

BACKGROUND: Coccidioidomycosis within endemic regions is often undiagnosed because appropriate testing is not performed. A dashboard was developed to provide information about the prevalence of coccidioidomycosis throughout the year. METHODS: Banner Urgent Care Service has many clinics within Maricopa County, Arizona, a highly endemic region for coccidioidomycosis. All clinic visits and subset analyses for patients with International Classification of Diseases, Tenth Revision codes for pneumonia (J18.*) or erythema nodosum (L52) during 2018-2024 were included. Tabulated were daily frequencies of visits, pneumonia and erythema nodosum coding, coccidioidal testing, and test results. Banner Urgent Care Services' counts of monthly coccidioidomycosis diagnoses were compared with those of confirmed coccidioidomycosis cases reported to Maricopa County Department of Public Health. RESULTS: Monthly frequencies of urgent care coccidioidomycosis diagnoses strongly correlated with public health coccidioidomycosis case counts (r = 0.86). Testing frequency for coccidioidomycosis correlated with overall pneumonia frequency (r = 0.52). The proportion of pneumonia due to coccidioidomycosis varied between <5% and >45% within and between years. Coccidioidomycosis was a common cause of erythema nodosum (65%; 95% confidence interval, 45%-67%) and independent of pneumonia. Over half of Banner Urgent Care Services' coccidioidomycosis diagnoses were coded for neither pneumonia nor erythema nodosum. CONCLUSION: Data provided by the coccidioidomycosis dashboard can assist urgent care practitioners in knowing when coccidioidomycosis is prevalent in the community. Patients with exposure to endemic coccidioidomycosis who develop erythema nodosum or pneumonia should routinely be tested for coccidioidomycosis. Data from private health care organizations can augment surveillance of diseases important to public health.

HIV survey in Mozambique: analysis with simultaneous model in contrast to separate hierarchical models.

BACKGROUND: The analysis of correlated responses obtained one at a time in survey data is not as informative or as useful as modeling them simultaneously. Simultaneous modeling allows for the opportunity to evaluate the system in a more pragmatic form rather than to allow for responses that assumedly originated in isolation. METHODS: This research uses the Mozambique National Survey data to demonstrate the benefits of simultaneous modeling on blood test results, knowledge of HIV/AIDS, and awareness of an HIV/AIDS campaign. This simultaneous modeling also addresses the correlation inherent due to the hierarchical structure in the data collection. RESULTS: Employment and self-perceived risk of HIV/AIDS have different impact on blood test, awareness of an HIV/AIDS campaign, and knowledge of HIV/AIDS when examined simultaneously as opposed to separate modeling. CONCLUSION: Simultaneous modeling of correlated responses improves the reliability of the estimates. More importantly, it provides an opportunity to engage in cost-saving decisions when designing future surveys and make better health policies.