The evaluation of patients with hepatitis C living in rural California via telemedicine.

Patients with hepatitis C who live in rural and low socioeconomic communities often lack access to specialty care. Over the past 7 years, we have provided telemedicine consultations at the Peach Tree Clinic, located in rural northern California. We performed a retrospective analysis of our experience. During this time period we provided consultations for 103 patients with hepatitis C; 37% had cirrhosis, and 64% had never undergone therapy with interferon and ribavirin. Twenty-three percent of the patients were candidates for therapy. The most common contraindication to therapy was the severity of their disease and the risk of decompensation. Fifteen patients were evaluated for liver transplant; 2 were listed but none survived long enough to receive a liver transplant. Our data suggest that there is a large number of patients with hepatitis C and advanced liver disease living in rural communities, some of whom may need treatment or liver transplant. Telemedicine is an effective tool for identifying and treating patients with hepatitis C who live in rural communities.

Performance characteristics of a quantitative TaqMan hepatitis C virus RNA analyte-specific reagent.

We determined the dynamic range, reproducibility, accuracy, genotype bias, and sensitivity of the TaqMan hepatitis C virus (HCV) analyte-specific reagent (ASR). Serum samples were processed using the MagNA Pure LC instrument and run on the COBAS TaqMan 48 analyzer. The performance characteristics of the ASR were also compared with those of the qualitative AMPLICOR and quantitative AMPLICOR MONITOR HCV tests. The ASR exhibited a >/=6-log(10) linear dynamic range and excellent reproducibility, with a mean coefficient of variation of 14%. HCV RNA concentration measured with the ASR agreed within an average of 0.42 log(10) (2.6-fold) of the labeled concentration with members of a standard reference panel. HCV genotypes 1 to 4 were amplified with similar efficiencies with the ASR. The ASR and AMPLICOR MONITOR viral load results were significantly correlated (r = 0.8898; P < 0.01), but the agreement was poor (mean difference, 0.45 +/- 0.35 log(10)) for 72 HCV RNA-positive clinical samples. However, 98.9% agreement between the ASR and qualitative AMPLICOR test results was found with 60 positive and 29 negative samples. Limiting-dilution experiments demonstrated that the limits of detection for ASR and AMPLICOR tests were 84 and 26 IU/ml, respectively. The performance characteristics of the TaqMan HCV ASR are appropriate for all clinical applications of HCV RNA testing.

Exploring risk in early adolescent African American youth.

Two studies were conducted to explore the degree to which single- and multiple-risk profiles were evident in samples of African American early adolescents in low-income inner-city, rural, and suburban schools. Study 1 examined early adolescent risk status (i.e., single, multiple) in relation to later adjustment in a representative sample (70% European American, 30% African American). Youth who experienced a single risk in early adolescence had moderately increased levels of school dropout and criminal arrests, whereas youth with multiple risks (i.e., combination of 2 or more risks) had significantly increased levels of school dropout, criminal arrests, and teen parenthood. Study 2 examined the extent to which single- and multiple-risk profiles were evident in cross-sectional samples of African American youth from low-income inner-city and rural areas. About one fourth of both the inner-city and rural samples of African American youth were composed of youth in the single-risk category. A significantly greater proportion of boys in the inner-city sample (20%) than boys in the rural sample (13%) experienced multiple risks. Girls across the rural and inner-city samples did not differ in terms of risk. Overall, more than 60% of African American youth in these two low-income samples did not evidence risk for later adjustment problems. Implications for research and intervention are discussed.