RESUMEN
OBJECTIVE: CDC recommends that all people born between 1945 and 1965 be tested for hepatitis C virus (HCV). We hypothesized that HCV testing in a large, urban primary care clinic would reveal higher rates of HCV infection than previously published. METHODS: Through the Hepatitis Testing and Linkage to Care initiative, the primary care clinic at MedStar Washington Hospital Center in Washington, DC, provided HCV antibody (anti-HCV) testing and linkage to care from October 2012 through September 2013 for patients born between 1945 and 1965 without previously noted risk factors. We collected data on age, race/ethnicity, sex, anti-HCV and HCV ribonucleic acid (RNA) results, risk factors in those who tested anti-HCV positive, and health insurance type and made comparisons using c(2) and Student's t-tests. RESULTS: Of 1,123 patients tested, the mean age was 57 years, 742 (66.1%) were women, 969 (86.3%) were black/African American, and 654 (58.2%) had public health insurance. Of the 99 (8.8%) patients who tested anti-HCV positive, the mean age was 58 years, 54 were men, and 93 were black/African American; 41 of 74 anti-HCV-positive patients were intravenous drug users. Of 82 anti-HCV-positive patients, 51 were HCV RNA positive. Of the black/African American patients tested, 49 of 317 men (15.5%) and 44 of 652 women (6.7%) were anti-HCV positive (p,0.001). The HCV prevalence rate in the birth cohort (8.8%) was significantly higher than the U.S. (3.3%) and DC (2.5%) rates (p,0.001), and the HCV prevalence rate among black/African American men in DC (15.5%) was substantially higher than the prevalence rate reported by CDC (8.1%). CONCLUSION: Testing initiatives in primary care settings need to be more rigorously upheld, and internal champions are needed to advocate for increased screening to ensure linkage to care and engagement in the HCV care cascade.
Asunto(s)
Hepatitis C/epidemiología , Tamizaje Masivo/estadística & datos numéricos , Atención Primaria de Salud , Servicios Urbanos de Salud , Negro o Afroamericano , Anciano , District of Columbia/epidemiología , Femenino , Hepacivirus/aislamiento & purificación , Anticuerpos contra la Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post-Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6-3.6), previously screened (OR = 2.13, CI 1.07-4.26), have Internet access (OR = 3.66, CI 1.15-11.58), and to report daily Internet use (OR = 2.58, CI 1.47-4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.