Persons who inject drugs (PWID) commonly experience venous degradation as a complication of prolonged injection, which makes routine phlebotomy difficult. Clients may decline care due to the ...perceived lack of skilled phlebotomy services, and this contributes to significant delays in infectious disease screening and treatment. In this study, we investigated ultrasound-guided phlebotomy in clients with difficult venous access receiving care at two low-threshold buprenorphine clinics. Our objectives were to increase the accuracy of vascular access, expedite infectious disease treatment for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), and increase client satisfaction with phlebotomy services.
PWID who declined routine phlebotomy at two clinic sites were offered ultrasound-guided vascular access by a trained clinician. Participants completed a survey to collect data regarding acceptability of the intervention.
Throughout a 14-month period, 17 participants were enrolled. Of the total 30 procedures, 41.2% of clients returned for more than one phlebotomy visit, and 88.2% of clients achieved vascular access within 1 attempt. Of participating clients, 52.9% described themselves as having difficult venous access and at conclusion of the study, 58.8% expressed more willingness to have phlebotomy performed with an ultrasound device.
Offering ultrasound-guided phlebotomy for PWID with difficult venous access resulted in decreased access attempts, increased patient satisfaction, and expedited screening and treatment for HIV and HCV point-of-care ultrasound technology is an effective approach to improving care for persons who inject drugs.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential for rapid transmission in congregate settings. We describe the multidisciplinary response to an outbreak of coronavirus ...disease (COVID-19) in a large homeless shelter in Chicago, Illinois, USA. The response to the outbreak included 4 rounds of mass PCR testing of all staff and residents and subsequent isolation of persons who tested positive for SARS-CoV-2. We further describe the dynamics of the shelter outbreak by fitting a modified susceptible-exposed-infectious-recovered compartmental model incorporating the widespread SARS-CoV-2 testing and isolation measures implemented in this shelter. Our model demonstrates that rapid transmission of COVID-19 in the shelter occurred before the outbreak was detected; rates of transmission declined after widespread testing and isolation measures were put in place. Overall, we demonstrate the feasibility of mass PCR testing and isolation in congregate settings and suggest the necessity of prompt response to suspected COVID-19 outbreaks in homeless shelters.
During January-August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and ...nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons >2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.
The pharmacokinetic profile of ceftaroline has not been well characterized in obese adults. The purpose of this study was to evaluate the pharmacokinetics of ceftaroline in 32 healthy adult ...volunteers aged 18 to 50 years in the normal, overweight, and obese body size ranges. Subjects were evenly assigned to 1 of 4 groups based on their body mass index (BMI) and total body weight (TBW) (ranges, 22.1 to 63.5 kg/m(2) and 50.1 to 179.5 kg, respectively). Subjects in the lower-TBW groups were matched by age, sex, race/ethnicity, and serum creatinine to the upper-BMI groups. Serial plasma and urine samples were collected over 12 h after the start of the infusion, and the concentrations of ceftaroline fosamil (prodrug), ceftaroline, and ceftaroline M-1 (inactive metabolite) were assayed. Noncompartmental and population pharmacokinetic analyses were used to evaluate the data. The mean plasma ceftaroline maximum concentration and area under the curve were ca. 30% lower in subjects with a BMI of ≥40 kg/m(2) compared to those <30 kg/m(2). A five-compartment pharmacokinetic model with zero-order infusion and first-order elimination optimally described the plasma concentration-time profiles of the prodrug and ceftaroline. Estimated creatinine clearance (eCLCR) and TBW best explained ceftaroline clearance and volume of distribution, respectively. Although lower ceftaroline plasma concentrations were observed in obese subjects, Monte Carlo simulations suggest the probability of target attainment is ≥90% when the MIC is ≤1 μg/ml irrespective of TBW or eCLCR. No dosage adjustment for ceftaroline appears to be necessary based on TBW alone in adults with comparable eCLCR. Confirmation of these findings in infected obese patients is necessary to validate these findings in healthy volunteers. (This study has been registered at ClinicalTrials.gov under registration no. NCT01648127.).
METHODS During October 2018 to August 2019, the University of Illinois at Chicago College of Nursing, College of Medicine and School of Public Health screened for injection practices among clients ...receiving wound care in once weekly half‐day medical clinic co‐located within a syringe exchange program. While the practice has been previously mentioned in case studies, wider inquiry among PWID in wound‐related studies is generally missing. ...we included it among our universal screening criteria to assess prevalence. Clients' disclosure of intrawound injection was often reluctant. ...we recommend that all PWID be screened for this practice and that screening is done sensitively and tactfully.
A 71-year-old woman presented with painful vision loss in the right eye followed by ophthalmoplegia. Magnetic resonance imaging demonstrated optic nerve sheath enlargement and enhancement. Biopsy of ...the optic nerve sheath revealed purulent and necrotic material that was positive for methicillin-sensitive Staphylococcus aureus. The patient underwent enucleation of the right eye and was treated with systemic antibiotics with clinical stabilization. Imaging, pathological and treatment aspects of optic nerve sheath abscess are discussed.
People who inject drugs (PWID) are at increased risk for developing wounds in addition to skin and soft tissue infections. The University of Illinois at Chicago College of Nursing, College of ...Medicine, and School of Public Health collaborated to establish a medical clinic serving PWID attending a Chicago syringe exchange program. A wound care program was implemented to improve clinicians’ competence. During October 2018 to August 2019, 24% of all encounters were related to wound complaints.
Abstract
Background
People with substance use disorders (SUD) are at elevated risk of infectious diseases (ID) but have low uptake of preventive and primary care (PC) due to structural, social, and ...behavioral barriers to care. Syringe service programs (SSP) are established, trusted sources of care; expanding health care provided through these programs may result in improved health for this population. We aimed to assess uptake of services from a pilot program in Chicago that offered PC, ID consultation, and harm reduction services.
Methods
PC and ID providers were embedded in the SSP to provide routine PC and preventive health services to patients seeking harm reduction services referred by outreach workers with lived SUD experiences. For this analysis, we reviewed all clinical encounters occurring from 10/19/2018-12/31/2021. We assessed patient demographics and visit types and determined the number of encounters for those with and without SUD. We compared characteristics of encounters for individuals with and without SUD using Chi-squared tests and Wilcoxon rank sum tests.
Results
During the study period, a total of 552 patients had 1720 clinical encounters (median 1 per patient, range 1-44). Overall, 390 (70.7%) patients were male, median age was 43 years (IQR 19-71), and 415 (75.2%) had public insurance (Table 1). A higher proportion of those who had a visit for SUD had public insurance compared to those without SUD (79.6% vs 67.2%, p=0.003).
Of the 1720 encounters, 1227 (71.3%) included care for active SUD, of which 402 (23.4%) addressed infections often associated with SUD (Table 2). Encounters for HIV and hepatitis C virus made up 20% of all encounters. PC services were rendered at 910 (52.9%) encounters and 625 (36.3%) encounters included services for both SUD and PC. Those without active SUD were more likely to have encounters for PC (61.7% vs 49.4%, p< 0.001) and infections (50.7% vs 27.1%, p< 0.001) than those with active SUD.
Conclusion
Incorporating ID and PC services in an established SSP was effective for engaging vulnerable populations in Chicago, including people with SUD, with nearly half of all encounters among people with SUD including PC services. Integration of ID and PC within SSPs should be scaled-up to improve access to care, especially given the burden of infections in this population.
Disclosures
All Authors: No reported disclosures
During January-August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and ...nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons >2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.
Abstract
Background
Although chlamydia (CT) and gonorrhea (GC) infections are increasing in the United States, there are limited data on their incidence, testing rates, and associated risk factors ...among persons living with HIV (PLWH), including by anatomic site among men who have sex with men (MSM).
Methods
We analyzed 2007–2017 medical records data from Human Immunodeficiency Virus (HIV) Outpatient Study (HOPS) participants in care at 9 HIV clinics. We calculated CT (and GC) incidence and testing rates and assessed associations with sociodemographic and clinical factors using log-linear regression.
Results
Among 4727 PLWH, 397 had 881 CT infections and 331 had 861 GC infections, with an incidence of 2.95 and 2.88 per 100 person-years, respectively. From 2007 to 2017, incidence and testing rates increased by approximately 3.0- and 1.9-fold for CT and GC, respectively. Multivariable factors associated with incident CT (GC) included younger age, MSM, and prior diagnoses of sexually transmitted diseases (STDs). Among 1159 MSM, 583 (50.3%) had 844 CT and 843 GC tests during 2016–2017, and 26.6% of tests were 3-site (urethra, rectum, and pharynx), yielding the highest rates of CT (GC) detection. Multivariable factors associated with CT (GC) testing included younger age, non-Hispanic/Latino black race, and having prior STDs.
Conclusions
Recent CT and GC incidence and testing increased among PLWH; however, only half of MSM were tested for CT or GC during 2016–2017 and less than a third of tests were 3-site. To promote sexual health and STD prevention among PLWH who are MSM, research regarding the added value of CT and GC testing across 3 anatomic sites is needed.
Only half of Human Immunodeficiency Virus-positive men who have sex with men were tested for chlamydia (CT) or gonorrhea (GC), and less than a third of tests were 3-site. The added value of CT and GC testing across 3 anatomic sites warrants additional research.
PDF
