A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services.

BACKGROUND: The intersecting epidemics of opioid misuse, injection drug use, and HIV/HCV have resulted in record overdose deaths and sustained high levels of HIV/HCV transmissions. Literature on social networks suggests opportunities to connect people who use drugs (PWUD) and their peers to HIV/HCV and opioid overdose prevention services. However, little evidence exists on how to design such peer referral interventions in emergency department (ED) settings. METHODS: A mixed-method study was conducted to assess the feasibility of an mHealth-facilitated 'patient to peer social network referral program' for PWUD. In-depth interviews (IDIs) and quantitative surveys were conducted with urban ED patients (n = 15), along with 3 focus group discussions (FGDs) (n = 19). RESULTS: Overall, 34 participants were enrolled (71 % males, 53 % Black). 13/15 IDI participants reported a history of opioid overdose; all had witnessed overdose events; all received HIV/HCV testing. From survey responses, most would invite their peers for HIV/HCV testing and naloxone training; and anticipated peers to accept referrals (HIV: 60 %, HCV: 73 %, naloxone: 93 %). Qualitative data showed PWUD shared health-related information with each other but preferred word of mouth rather than text messages. Participants used smartphones regularly and suggested using Internet advertising for prevention services. Participants expressed enthusiasm for ED-based peer mHealth referral platform to prevention services, as well as referring their peers to proposed services, with monetary incentives. CONCLUSION: ED-based peer referral intervention to HIV/HCV testing and naloxone training was viewed favorably by PWUD. Frequent smartphone use among PWUD suggests that the medium could be a promising mode for peer referral.

Freehand Transperineal Prostate Biopsy with Three-Dimensional Ultrasound Organ-Based Tracking.

Transperineal prostate biopsy carries a significantly lower risk of infectious complications compared with the transrectal approach. We provide a step-by-step description of our current procedural technique for performing transperineal prostate biopsy under local anesthesia. A key component of our technique is the use of a disposable, probe-mounted needle guide that minimizes the number punctures to the perineal skin and allows for continuous needle visualization throughout the procedure. We have paired this device with a novel fusion biopsy platform that utilizes three-dimensional transrectal ultrasound to enable targeting of suspicious lesions found prebiopsy MRI as well as allows for mapping of biopsy core locations for postprocedure review and use at the time of subsequent prostate biopsy or ablation procedures.