Burden of Medically Attended Diarrhea and Outpatient Clostridioides difficile Infection Among Persons in 2 Large Integrated Healthcare Settings, 2016-2021.

Background: Identification of Clostridioides difficile infection (CDI) in the community setting is increasing. We describe testing for CDI among patients with medically attended diarrhea (MAD) in the outpatient setting, and the incidence of outpatient CDI. Methods: This was a retrospective cohort study among members ≥18 years of age from Kaiser Permanente Southern California and Kaiser Permanente Northwest from 1 January 2016 through 31 December 2021. MAD was identified by outpatient diarrheal International Classification of Diseases, Tenth Revision diagnosis codes, and CDI through positive laboratory results. Outpatient CDI was defined by no hospitalization ≤7 days after specimen collection. Incidence rates (IRs) of outpatient CDI were stratified by select demographic and clinical variables. Outpatient CDI burden 12 months following index date was measured by CDI-associated healthcare visits, and CDI testing and treatment. Results: We identified 777 533 MAD episodes; 12.1% (93 964/777 533) were tested for CDI. Of those tested, 10.8% (10 110/93 964) were positive. Outpatient CDI IR was 51.0 (95% confidence interval [CI], 49.8-52.2) per 100 000 person-years, decreasing from 58.2 (95% CI, 55.7-60.7) in 2016 to 45.7 (95% CI, 43.7-47.8) in 2021. Approximately 44% (n = 4200) received an antibiotic 30 days prior to index date and 84.1% (n = 8006) CDIs were "community-associated" (no hospitalizations 12 weeks prior to index date). Of outpatient CDIs, 6.7% (n = 526) had a CDI-associated hospitalization ≤12 months. Conclusions: There was a high incidence of outpatient CDI despite infrequent CDI testing among patients with MAD. The majority of those with outpatient CDI had no recent antibiotic use and no recent hospitalization. Further studies are needed to understand the source and management of medically attended outpatient CDI.

Trends in firearm injury in a southern California health care system from 2010 to 2020.

BACKGROUND: Firearm injury is a significant public health concern in the United States. METHODS: Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. RESULTS: There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p < .0001), primarily driven by non-self-inflicted firearm injuries (p < .0001). Self-inflicted injuries decreased during this time (p = .01). Injuries among youth showed no significant change. CONCLUSION: There was an increasing trend in firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system, primarily driven by non-self-inflicted firearm injuries; however, self-inflicted injuries decreased during this time. Injuries among youth showed no significant change.

Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care.

Nearly a decade after becoming formally available in the U.S., HIV pre-exposure prophylaxis (PrEP) remains underutilized by populations at risk for HIV acquisition. The next generation of PrEP research is pivoting toward implementation research in order to identify the most impactful avenues for scaling up PrEP uptake. Rapid identification of patients who may be at risk for HIV in primary care settings and the ability to provide brief consultation and prescription or referral for PrEP could help to increase PrEP uptake. The current study aimed to develop and pilot-test a PrEP screening instrument that could be integrated into the workflow of busy primary care clinics to help facilitate PrEP uptake among at-risk men. During the study, PrEP screening occurred for 12 months in two primary care clinics nested within a large integrated healthcare delivery system in Southern California. An interrupted time series analysis found a significant increase in PrEP referrals overall during the screening intervention period as compared to the preceding 12 months. Findings suggest that brief HIV risk screening in primary care is acceptable, feasible, and shows preliminary effects in increasing PrEP referral rates for Black and Hispanic/Latinx men.

RESUMEN: Casi una década después de estar disponible formalmente en los EE.UU., la profilaxis previa a la exposición al VIH (PrEP) sigue siendo subutilizada por las poblaciones en riesgo de contraer VIH. La próxima generación de investigación de PrEP está girando hacia la investigación de implementación con el fin de identificar las vías de mayor impacto para ampliar el consumo de PrEP. La identificación rápida de los pacientes que pueden estar en riesgo de contraer VIH en entornos de atención primaria y la capacidad de proporcionar una consulta breve y prescripción o referencia para PrEP podría ayudar a aumentar el consumo de PrEP. El estudio actual tuvo como objetivo desarrollar y probar un instrumento de detección de PrEP que podría integrarse en el flujo de trabajo de las clínicas de atención primarias concurridas para ayudar a facilitar el consumo de PrEP entre los hombres en riesgo. Durante el estudio, la detección de PrEP se realizó durante 12 meses en dos clínicas de atención primaria ubicadas dentro de un gran sistema integrado de prestación de atención médica en el sur de California. Un análisis de series de tiempo interrumpido encontró un aumento significativo en las referencias de PrEP en general durante el periodo de intervención de detección en comparación con los 12 meses anteriores. Los hallazgos sugieren que la detección breve del riesgo de VIH en la atención primara es aceptable, factible y muestra efectos preliminares en el aumento de las tasas de referencia de PrEP para hombres negros e hispanos/latinos.

Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men.

Text-messaging interventions present a novel approach for targeting high-risk men who have sex with men (MSM) who may not respond to or may be difficult to reach for face-to-face or site-based interventions. Project Tech Support (N = 52) was an open label pilot study testing the feasibility and utility of a text-messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM. Participants in the two-week intervention received social support and health education text messages transmitted in real-time. At follow-up, there were significant decreases in frequency of methamphetamine use and unprotected sex while on methamphetamine (both p < 0.01), and a significant increase in self-reported abstinence from methamphetamine use (13.3 % vs. 48.9 %; p < 0.001). Additionally, participants reported reductions of unprotected anal intercourse with HIV-positive partners (p < 0.01); with HIV-negative partners, participants reported fewer insertive and receptive episodes (both p < 0.05). Findings demonstrate that text messaging is a promising intervention for reaching and potentially changing HIV high-risk behaviors among out-of-treatment, methamphetamine-using MSM.