Can Primary Care Drive Tuberculosis Elimination? Increasing Latent Tuberculosis Infection Testing and Treatment Initiation at a Community Health Center with a Large Non-U.S.-born Population.

Community health centers (CHC) play a key role in latent tuberculosis infection (LTBI) testing and treatment. We performed a retrospective analysis of LTBI testing and treatment among pediatric and adult patients at a CHC with a large non-U.S.-born (USB) population during a series of quality improvement (QI) interventions from 2010 to 2019. Among 124,695 patients with primary care visits, 40% of patients were tested for tuberculosis (TB) infection and among those tested, 20% tested positive, including 39% of adults aged 50-79 years. Compared to adults aged 18-49 years, children aged 6-17 had increased odds of LTBI testing and treatment initiation [odds ratio and 95% confidence interval 3.23 (3.10, 3.36) and 1.41 (1.12, 1.79), respectively], while age ≥ 65 was associated with lower odds of both testing and treatment initiation. Over the analysis period, coinciding with unfunded QI interventions intended to reduce barriers to LTBI care, there was a significant increase in the proportion of patients receiving LTBI testing for both adults (6% to 47%, p < 0.001) and children (23% to 80%, p < 0.001). During the analysis period, there was also a significant increase in the proportion of patients receiving prescriptions for LTBI treatment, as well as provider use of evidence-based strategies including rifamycin-based treatment. Our study suggests that primary care interventions can reduce barriers to LTBI treatment and drive TB elimination.

Hep B Moms: A cross-sectional study of mother-to-child transmission risk among pregnant Asian American women with chronic hepatitis B in New York City, 2007-2017.

Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B virus (HBV) infections worldwide. Despite timely HBV immunoprophylaxis of neonates, MTCT can occur in infants born to mothers with high levels of HBV viremia. We performed a retrospective cross-sectional analysis of Asian American women with chronic HBV evaluated with HBV DNA during prenatal care at two community health sites in New York City from 2007 to 2017. We described patient's demographic and clinical characteristics, categorized their HBV disease phase and analysed for variables associated with high MTCT risk (defined by HBV DNA level >200 000 IU/mL) using multivariable logistic regression. A total of 1298 pregnancies among 1012 mostly China-born (97.6%) women with chronic HBV were included in the study. Of the 1241 pregnancies among women not on antiviral treatment, 22.4% were considered high risk for MTCT and, of these, 255 (91.7%) were HBV e antigen (HBeAg)-positive and 19 (6.8%) were HBeAg-negative. HBeAg-positive status and ALT levels between 26 and 50 U/L were associated with higher likelihood for being high risk for MTCT. Only 0.8% of pregnancies low risk for MTCT were in the immune active phase while the majority (58.4%) were in the inactive chronic HBV phase of infection. Approximately one in five (22.4%) pregnancies among Asian American women with chronic HBV was considered high risk for MTCT and met criteria for antiviral therapy. Full assessment of HBV pregnant women and early coordinated care is needed to deliver interventions to prevent MTCT during critical windows of time.

Disparities in Hepatitis B Virus Infection and Immunity Among New York City Asian American Patients, 1997 to 2017.

OBJECTIVES: To measure disparities in hepatitis B virus (HBV) infection and immunity among a high-risk patient population at a community health center in New York City. METHODS: We performed a retrospective chart review of 25 565 adults with HBV surface antigen, surface antibody, and total core antibody tests from 1997 to 2017. We categorized HBV test results by infection and immunity status and analyzed by demographic characteristics with χ2 and logistic regression analysis. RESULTS: Of 25 565 adults, 13.4% were currently infected, 52.1% were ever infected, 33.4% were immune from vaccination, and 14.5% were susceptible. Significant factors associated with ever infection were age, male sex, being China-born, limited English proficiency, having Medicaid or no insurance, and family history of HBV (P < .01). CONCLUSIONS: Our study demonstrated a high burden of HBV infection among foreign-born Asian Americans seeking care at a community health center. Public Health Implications. It is important to test patients at high risk for HBV infection with all 3 tests to identify those with current infection, risk for reactivation, or need for vaccination, and to assess the effectiveness of public health interventions.

From admission to discharge: patterns of interpreter use among resident physicians caring for hospitalized patients with limited english proficiency.

Resident physicians' use of professional interpreters drives communication with hospitalized patients with limited English proficiency (LEP). We surveyed residents from three specialties across two hospitals affiliated with one academic medical institution about their communication with their last hospitalized LEP patient. Among 149 respondents (73% response rate), 71% reported using professional interpreters for fewer than 60% of hospital encounters. Most (91%) perceived their quality of communication with hospitalized LEP patients as worse than with English-speaking patients. Professional interpreter use varied substantially by resident and by hospital encounter, with more reporting use of ad hoc interpreters, their own language skills, or not talking to the patient due to time constraints during pre-rounds (39%), team rounds (49%), or check-ins (40%) than during procedural consents (9%) or family meetings (17%). The reported variation suggests targets for quality improvement efforts and the need for clear enforceable guidelines on resident communication with hospitalized LEP patients.

Electrophysiological, clinical and epidemiological study of Guillain-Barre Syndrome in Hong Kong Chinese.

The authors reviewed the clinical and electrophysiological features in 20 consecutive adult patients with Guillain-Barre Syndrome (GBS) admitted to a regional hospital in Hong Kong from 1993 to 1998. The majority of cases in this locality consists of the demyelinating form of GBS; epidemic, acute motor axonal neuropathy is not the predominant form. The incidence of GBS in this region of China was 0.44 per 100,000.

The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients.

OBJECTIVE: This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions. DESIGN AND METHODS: Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information. RESULTS: Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05). CONCLUSION: The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.

Assessment of HIV-related sexual risk behaviors among the general female population in Hong Kong.

This study examined sexual practices among the female population in Hong Kong. A total of 2,076 women between 18 and 50 years were interviewed by using a computerized telephone survey method. Sexually active women (59.3%) were classified into the "Husband Only Group" (HOG, n = 1,005), the "Steady Boyfriend Only Group" (SBG, n = 192), and the "Higher Risk Group" (HRG, n = 35). Over 60% of the HRG members did not perceive condom use as an efficacious means for HIV/AIDS prevention. Within the HOG and SBG, 30.0% and 41.1% reported that they always used condoms (25.7% in the HRG). Condom use was often suggested by both men and women of the SBG, but was often initiated by the women only in the HRG. "Trust" and "lack of necessity" were common reasons for not using condoms. About 85% of the respondents would ask their partners to use condoms if they suspected their partners having engaged in commercial sex; however, only 75% would have the final control. The HRG members seemed to be less able to insist on using condoms (55.6%, OR = 0.41, p < .05) and were more likely than the HOG to perceive some chance of contracting HIV (OR = 10.88, p < .01). The prevalence of high risk behaviors among women in Hong Kong was not high; however, those at risk were often inconsistent condom users and they had weak control over condom use. Women in Hong Kong had low awareness of HIV-related risk.