Digital Point Solutions for Extending Contact Tracing Capacity.

BACKGROUND: Initial COVID-19 surges in the United States created a need for technology to supplement human resources to increase efficiency and efficacy. METHODS: Resolve to Save Lives worked with jurisdictions to co-design four technology solutions-Epi Viaduct data pipeline, Epi Contacts contact elicitation webform, Epi Locator contact information search plugin, and Epi Viewpoint case management system (CMS)-to expand the capacity of case investigation and contact tracing (CI/CT) teams. We assessed impact on reducing CI/CT time intervals for COVID-19 using product data and user feedback. RESULTS: Epi Viaduct accelerated the transfer of approximately 7,400,000 records from an electronic laboratory reporting system in a single jurisdiction to the respective CMS from more than 2.5 hours to less than 1 minute and reduced time to remove duplicate laboratory results from multiple days to less than 6 hours. Epi Contacts focused on increasing the efficacy of contact elicitation, and during a single period, 10% of index cases (9,440 of 96,319) completed Epi Contacts for a total of approximately 18,700 contacts elicited. User interviews indicated the tool increased speed of CI/CT workflows. In total, 134,410 searches were run in Epi Locator by 7320 distinct users-75% of which returned 1 or more person matches. A simple CMS, Epi Viewpoint, was developed and completed, but not deployed. CONCLUSIONS: Systems to mount large-scale population-based contact tracing programs were developed and implemented during the COVID-19 pandemic and can be adapted for CI/CT programs aiming to control the spread of other communicable diseases such as sexually transmitted diseases.

Family characteristics of female-headed households in Pakistan in the context of health promotion.

Objective of this project is to describe characteristics of Pakistani women household heads and investigate effect differences with men in the context of health behavior. We used 2012 - 13 Pakistan Demographic and Health Survey data to conduct secondary data analysis of 10 868 households. In this article, methods that we described household head and household characteristics, and polio vaccination compliance as a proxy for health behavior. Univariate analysis was conducted to assess the relationship of household head gender with household characteristics and health behavior, first for the whole sample and then for currently married household heads. Significant relationships were entered in two multivariate logistic models. Results show that all demographic covariates were statistically significant (p < 0.05) except employment status. Adjusted associations were significant for age, marital status, wealth and ethnicity (p < 0.05). Polio compliance score was significantly higher for households headed by currently married men compared with currently married women, when adjusted for covariates and concluded certain household and head characteristic associations with gender suggest a greater likelihood of female-headed households, while male-headed households were associated with better polio vaccine compliance. Further research is needed with more complex health behavior composites to assess any relationship between gender and health behavior.

The influence of race and sex on gonorrhea and chlamydia treatment in the emergency department.

BACKGROUND: Emergency Departments (EDs) are a care source for patients with sexually transmitted diseases (STDs). St. Louis, MO reports among the highest rates of gonorrhea and chlamydia infection. We examined STD treatment in a high-volume urban ED, in St. Louis MO, to identify factors that may influence treatment. METHODS: A retrospective chart review and analysis was conducted on visits to a high volume, academic ED in St. Louis, MO where patients received a gonorrhea/chlamydia nucleic acid amplification test (NAAT) with a valid matching test result over two years. Using multiple logistic regression, we examined available predictors for under and overtreatment. RESULTS: NAATs were performed on 3.3% of all ED patients during the study period. Overall prevalence was 6.9% for gonorrhea (95% CI: 6.2, 7.7) and 11.6% for chlamydia (95% CI: 10.6, 12.5). Race was not a statistically significant predictor for undertreatment but Black patients were significantly more likely to be overtreated compared to White patients. (OR 1.83, 95% CI: 1.5, 2.2). Females were more likely to be undertreated when positive for infection compared to males (OR 7.34, 95% CI: 4.8, 11.2) and less likely to be overtreated when negative for infection (OR 0.27, 95% CI: 0.2, 0.3). CONCLUSION: The burden of STDs in a high-volume academic ED was significant and treatment varied across groups. Attention should be paid to particular groups, specifically women and patients reporting Black as their race, to ensure appropriate treatment is administered. Patients would benefit from targeted STD management protocols and training in the ED.

Single and Repeated Use of the Emergency Department for Chlamydia and Gonorrhea Care.

OBJECTIVE: Chlamydia and gonorrhea infection rates are rising in the United States, and the emergency department (ED) is increasingly a site where individuals seek care for these infections, sometimes more than once. This article investigates how individuals who use the ED more than once and receive chlamydia and gonorrhea care differ from individuals who are single users of the ED, as well as characteristics associated with being a repeat user of the ED. METHODS: We analyzed 46,964 visits made by individuals who attended 1 of 4 EDs from January 1, 2010, to May 31, 2016, and received a test for chlamydia and gonorrhea infection. We used negative binomial regression to test the ability of age, sex, race, infection status, and insurance status to predict number of visits. RESULTS: Individuals who used the ED more than once and received chlamydia and gonorrhea care were at their first visit more likely to be younger (incident rate ratio [IRR], 0.98; 95% confidence interval [CI], 0.97-0.98 per year) nonpregnant female (IRR, 1.23; 95% CI, 1.06-1.42), black (IRR, 1.27; 95% CI, 1.04-1.57), and have no or public insurance compared with single users of the ED. DISCUSSIONS: Individuals likely to make multiple visits to the ED and receive chlamydia and gonorrhea care may be identifiable on their first visit and potentially directed elsewhere during subsequent visits for more comprehensive and potentially less expensive sexually transmitted disease care.

Presenting to the Emergency Department Versus Clinic-Based Sexually Transmitted Disease Care Locations for Testing for Chlamydia and Gonorrhea: A Spatial Exploration.

BACKGROUND: Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area. METHODS: Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area. RESULTS: In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments. CONCLUSIONS: Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.

Importance of routine public health influenza surveillance: detection of an unusual W-shaped influenza morbidity curve.

Seasonal influenza causes excess morbidity and mortality at the extremes of age: It disproportionately affects the very young and the very old, typically resulting in "U"-shaped age-distributed curves. By means of a well-established public health department surveillance system using positive influenza tests submitted from sentinel sites, the authors generated annual influenza-specific morbidity curves over a 10-year period (1998-2008) for St. Louis County, Missouri. The authors detected an unusually high incidence of cases of medically attended test-positive influenza, particularly in young adults, during the 2007-2008 season, resulting in an unexpected "W"-shaped age-distributed morbidity curve that was distinctly unique in comparison with the prior 9 influenza seasons. Public health influenza surveillance programs are useful tools for detecting emerging epidemiologic trends that may have clinical importance.