Postpartum Hepatitis C Linkage to Care Program in a Co-located Substance Use Disorders Treatment Model.

PURPOSE: Hepatitis C virus (HCV) is increasingly prevalent in pregnancy and among people with substance use disorders (SUD). Highly effective treatments are now available for chronic HCV. Qualifying for HCV treatment often requires preauthorization and several clinical criteria, including laboratory assessment of liver function and other infectious diseases and liver imaging to assess for fibrosis. Linkage to care (LTC) models have been shown to assist with obtaining the necessary clinical information (laboratory assessment/liver imaging) and improving HCV treatment rates in non-pregnant individuals. DESCRIPTION: Beginning in December 2020, a specialized LTC team identified patients with HCV viremia who were interested in postpartum treatment. The LTC team assisted patients with completing the necessary clinical criteria (laboratory assessment and liver imaging) for HCV treatment. Patients were then linked to infectious disease specialists who prescribed treatment to patients via telemedicine. Most patients identified with HCV were enrolled in our institution's co-located obstetric and SUD program, which provides continued care until 1 year postpartum. ASSESSMENT: In 2019, an internal review identified that none of the 26 pregnant patients with HCV viremia in our co-located obstetric and SUD program were prescribed direct-acting antiviral (DAA) treatment within 12 months postpartum. Between December 2020 and July 2022, our HCV LTC team identified 34 patients with HCV who were eligible for treatment. Of these patients, 55% (19/34) obtained all necessary laboratory and liver imaging requirements and 79% (15/19) were prescribed DAA treatment after a telehealth visit with an infectious disease specialist. All fifteen patients who were prescribed treatment participated in the co-located obstetric and SUD program. The largest barrier to obtaining treatment was completing the necessary laboratory and liver imaging requirements for prescribing DAA. Only one patient who did not receive care in our co-located obstetric and SUD program had completed the necessary laboratory and liver imaging requirements to proceed with treatment but did not follow up with the infectious disease specialist for DAA treatment. CONCLUSION: Our HCV LTC program was successful in treating postpartum patients for HCV if they participated in the co-located obstetric and SUD program at our institution. Creating a partnership with an infectious disease specialist and utilizing telemedicine were beneficial strategies to connect patients to treatment for HCV during the postpartum period.

Hepatitis C virus (HCV) is increasingly prevalent in the pregnant population and among individuals with SUD. Highly effective HCV treatments are available postpartum, however LTC is underutilized during prenatal and postpartum care. A LTC model involving a co-located obstetric and SUD program, partnership with a referral department, and telemedicine was effective at improving HCV treatment rates at our institution.

Neuropeptide VGF Promotes Maturation of Hippocampal Dendrites That Is Reduced by Single Nucleotide Polymorphisms.

The neuropeptide VGF (non-acronymic) is induced by brain-derived neurotrophic factor and promotes hippocampal neurogenesis, as well as synaptic activity. However, morphological changes induced by VGF have not been elucidated. Developing hippocampal neurons were exposed to VGF through bath application or virus-mediated expression in vitro. VGF-derived peptide, TLQP-62, enhanced dendritic branching, and outgrowth. Furthermore, VGF increased dendritic spine density and the proportion of immature spines. Spine formation was associated with increased synaptic protein expression and co-localization of pre- and postsynaptic markers. Three non-synonymous single nucleotide polymorphisms (SNPs) were selected in human VGF gene. Transfection of N2a cells with plasmids containing these SNPs revealed no relative change in protein expression levels and normal protein size, except for a truncated protein from the premature stop codon, E525X. All three SNPs resulted in a lower proportion of N2a cells bearing neurites relative to wild-type VGF. Furthermore, all three mutations reduced the total length of dendrites in developing hippocampal neurons. Taken together, our results suggest VGF enhances dendritic maturation and that these effects can be altered by common mutations in the VGF gene. The findings may have implications for people suffering from psychiatric disease or other conditions who may have altered VGF levels.

Association of Pregnancy and HIV Status With Molecular-Bacterial Vaginosis in Indian Women.

BACKGROUND: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbiota. Molecular-BV may put women at increased risk for adverse reproductive and obstetric outcomes. We investigated the association of HIV and pregnancy on the vaginal microbiota and associations with molecular-BV in women of reproductive age from Pune, India. SETTING: We studied vaginal samples from N = 170 women, including N = 44 nonpregnant HIV seronegative, N = 56 pregnant seronegative, N = 47 nonpregnant women with HIV (WWH), and N = 23 pregnant WWH, and collected data on clinical, behavioral, and demographic factors. METHODS: We used 16S rRNA gene amplicon sequencing to characterize the composition of the vaginal microbiota. We classified the vaginal microbiota of these women into community state types based on bacterial composition and relative abundance and further categorized them into molecular-BV versus Lactobacillus -dominated states. To determine associations between pregnancy and HIV status with outcome of molecular-BV, logistic regression models were used. RESULTS: There was a high prevalence of molecular-BV (30%) in this cohort. We found that pregnancy was associated with decreased odds of molecular-BV (adjusted OR = 0.35, 95% CI: 0.14 to 0.87), while HIV was associated with increased odds of molecular-BV (adjusted OR = 2.76, 95% CI: 1.33 to 5.73), even when controlling for multiple relevant factors such as age, number of sexual partners, condom use, and douching. CONCLUSION: Larger and longitudinal studies are needed to further characterize molecular-BV and the vaginal microbiota in pregnant women and WWH and relate these factors to infectious, reproductive, and obstetric outcomes. In the long term, these studies may lead to novel microbiota-based therapeutics to improve women's reproductive and obstetric health.

An exploratory survey regarding the Maryland Contraceptive Equity Act: clinician awareness and impact on contraception provision.

OBJECTIVE: The Maryland Contraceptive Equity Act took effect in January 2018 with the goal of reducing insurance barriers to contraception. We sought to assess the Act's impact on contraceptive provision. STUDY DESIGN: From March-August 2019, we emailed an exploratory survey to clinicians providing contraception in Maryland that queried awareness of the Act and changing practices. RESULTS: The survey had a 13% response rate (164/1256 clinicians). Fifty (31%) were aware of the Act. Clinicians rated the Act was somewhat likely to change prescribing practices (3.5/5 point Likert Scale, SD 1.3). CONCLUSION: The majority of clinicians providing contraception in Maryland are not aware of the Act. If aware of the Act, clinicians may change their contraceptive prescribing practices.

Contraception Policies in U.S. Jails, Prisons, and Juvenile Detention Systems: A National Survey.

Contraception is an important health care service for incarcerated women, yet its availability in U.S. prisons, jails, and juvenile detention systems is unknown. We surveyed 6 jails, 22 state prisons, and 3 juvenile detention systems (N = 31 sites) on their contraception policies in 2016. Twenty (65%) sites had formal written contraception policies. All sites allowed people to continue a preincarceration contraceptive method with restrictions on the type of contraception and reason for use. Two sites (6%) did not allow continuation of oral contraceptive pills, 3 sites (10%) did not allow continuation of contraceptive injection, 21 sites (68%) did not allow continuation of contraceptive ring, and 23 sites (74%) did not allow continuation of contraceptive patch. Twenty-eight (90%) sites allowed people to initiate a contraceptive method in custody. Contraception policies in incarceration settings in the United States are varied and may restrict women's ability to continue or initiate the contraception of their choice.

Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011-2017.

OBJECTIVES: The effects of the comprehensiveness of sex education on sexual health measures have not been well-studied. We compared trends in comprehensive sex education and its relation to contraceptive use at first intercourse and current contraceptive use for women ages 15-24 in the United States between 2011 and 2017. STUDY DESIGN: Analyses included females ages 15-24 from the 2011-2017 National Survey of Family Growth. We defined comprehensive sex education as including 6 topics queried in the NSFG (how to say no to sex, birth control methods, where to get birth control, how to use condoms, sexually transmitted infections, HIV/AIDS), and non-comprehensive sex education as including less than 6 topics. Multivariable regression models investigated associations with contraceptive indicators. RESULTS: Among 5445 respondents, percentages of women receiving comprehensive sex education in 2011-2013, 2013-2015, and 2015-2017 were 35%, 40%, and 34%. Across all periods, respondents reporting comprehensive sex education before first sex were less likely to report first sexual intercourse before age 15 (aOR 0.55; 95% CI: 0.40-0.74) and non-volitional first intercourse (aOR 0.42, 95% CI: 0.26-0.72) compared to those with non-comprehensive sex education. At first intercourse, those with comprehensive sex education were more likely to have used any (aOR = 1.63; 95% CI: 1.18-2.25) and very effective (aOR = 1.35; 95% CI: 1.04-1.75) contraception. Comprehensive sex education was unrelated to current contraceptive use (aOR = 0.87; 95% CI: 0.63-1.21). CONCLUSIONS: Comprehensive sex education was associated with increased odds of contraceptive use at first intercourse, but not current contraceptive use. IMPLICATIONS: Programs that promote comprehensive sex education may have a positive impact on preventive behaviors at sexual debut.

Public Health Clinic-Based Hepatitis C Treatment.

INTRODUCTION: The availability of safe, effective treatments for hepatitis C virus infection has led to a call for the elimination of hepatitis C, but barriers to care persist. METHODS: In July 2015, the Baltimore City Health Department sexual health clinics began on-site hepatitis C virus treatment. Investigators conducted a retrospective evaluation of the first 2.5 years of this program. Data were extracted from the medical record through June 2019, and data analysis was completed in September 2019. RESULTS: Between July 2015 and December 2017, a total of 560 patients infected with hepatitis C virus accessed care at the Baltimore City Health Department sexual health clinics. Of these patients, 423 (75.5%) were scheduled for hepatitis C virus evaluation at the clinics, 347 (62.0%) attended their evaluation appointment, 266 (47.5%) were prescribed treatment, 227 (40.5%) initiated treatment, and 199 (35.5%) achieved sustained virologic response. Older age was independently associated with hepatitis C virus evaluation appointment attendance (aged 40-59 years: AOR=3.64, 95% CI=1.88, 7.06; aged ≥60 years: AOR=5.61, 95% CI=2.58, 12.21) compared with those aged 20-39 years. Among those who attended hepatitis C virus evaluation appointments, advanced liver disease was independently and positively associated with treatment initiation (AOR=11.89, 95% CI=6.35, 22.25). Conversely, illicit substance use in the past 12 months was negatively associated with hepatitis C virus treatment initiation (AOR=0.49, 95% CI=0.25, 0.96). CONCLUSIONS: The integration of hepatitis C virus testing and on-site treatment in public sexual health clinics is an innovative approach to improve access to hepatitis C virus treatment for medically underserved populations.