Epidemiologic Disparities in Colon Cancer Screening and Adherence during the COVID-19 Pandemic: A Retrospective Cohort Analysis

Background: Colorectal cancer (CRC) is the second-leading cause of death in the US. Despite the National Colorectal Roundtable goal of achieving 80% adherence, CRC screening remains underutilized, especially in the underinsured populations. Screening programs have been heavily disrupted during the COVID-19 pandemic. Aim: This research was performed to explore the impact of the pandemic on the existing ethnic and gender disparities prevalent in CRC screening. Methods: Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020, as the inflection point. For each year, the primary inclusion criterion was an ordered colonoscopy. The outcome of interest was a colonoscopy performed. Differences by year and race were assessed using Chi-square analysis. A cohort of 1413 patients between age 45 and 75 for whom a colonoscopy was ordered was selected from EHR at a single large institution. 897 patients were in the pre-COVID group, and 516 were in the post-COVID group. Results: There was a 51% reduction in screening colonoscopies performed. White patients had a decrease of 49%, and African Americans had a 55% reduction. Stool testing increased from 47% prior to the pandemic to 94% during the pandemic representing a greater than 100% increase in stool testing uptake. Conclusion: The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to the widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our retrospective analysis over the last two years points to the drastic reduction of screening for all races, and especially for African Americans. As life gradually returns to normal, it would be interesting to see how the past year has impacted the incidence and prevalence of CRC.

Usability and Acceptability of Oral Fluid Hepatitis C Self-testing Among People Who Inject Drugs in Coastal Kenya: a Cross-sectional Pilot Study

Background: People who inject drugs (PWID) are disproportionally affected by hepatitis C virus (HCV) infection and many remain undiagnosed. HCV self-testing (HCVST) may be an effective approach to increase testing uptake, but has rarely been used among PWID. We assessed the usability and acceptability of HCVST among PWID in Kenya. Methods: We conducted a cross-sectional study nested within a cohort study between August and December 2020 on Kenya’s North Coast region. Participants were handed a prototype oral fluid HCVST kit and asked to conduct the test relying on the instructions for use. Usability was assessed by documenting errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. Results: Among 150 participants, 19% were female and 65.3% had primary level education or lower. 71.3% made at least one error, 56.7% experienced some difficulty during at least one step, and the majority of participants (78%) required assistance during at least one step of the procedure. Most common errors occurred when placing the tube into the stand (18%), collecting the oral fluid sample (24%) and timing of reading results (53%). There was a strong association between presence of symptoms of opiate withdrawals and observed errors (94% vs 62%; p=0.016) in a sub-group of 74 participants assessed. Inter-reader and inter-operator concordance were 97.7% (kappa: 0.92) and 99.2% (kappa: 0.95), respectively. Acceptability assessed by asking whether participants would choose to use HCVST prior to and after conducting HCVST was 98% and 95%, respectively. Conclusions: We found a high acceptability of oral fluid HCVST among PWID. User errors were common and were associated with the presence of withdrawal symptoms among users. Despite errors, most participants were able to obtain and interpret results correctly. These findings suggest that this group of users may benefit from greater messaging and education including options to receive direct assistance when self-testing for HCV.

Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China

Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China.Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education.Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01–1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03–1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03–1.25).Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.

Acute respiratory infection symptoms and COVID-19 testing behaviour: results based on South Australian health surveys

Background Effective syndromic surveillance alongside COVID-19 testing behaviours in the population including in higher risk and hard to reach subgroups is vital to detect re-emergence of COVID-19 transmission in the community. The aim of this paper was to identify the prevalence of acute respiratory infection symptoms and coronavirus testing behaviour among South Australians using data from a population based survey. Methods We used cross-sectional data from the 2020 state-wide population level health survey on 6857 respondents aged 18 years and above. Descriptive statistics were used to explore the risk factors and multivariable logistic regression models were used to assess the factors associated with the acute respiratory infection symptoms and coronavirus testing behaviour after adjusting for gender, age, household size, household income, Aboriginal and/or Torres Strait Islander status, SEIFA, Country of birth, number of chronic diseases, wellbeing, psychological distress, and mental health. Results We found that 19.3% of respondents reported having symptoms of acute respiratory infection and the most commonly reported symptoms were a runny nose (11.2%), coughing (9.9%) and sore throat (6.2%). Fever and cough were reported by 0.8% of participants. Of the symptomatic respondents, 32.6% reported seeking health advice from a nurse, doctor or healthcare provider. Around 18% (n = 130) of symptomatic respondents had sought testing and a further 4.3% (n = 31) reported they intended to get tested. The regression results suggest that older age, larger household size, a higher number of chronic disease, mental health condition, poor wellbeing, and psychological distress were associated with higher odds of ARI symptoms. Higher household income was associated with lower odds of being tested or intending to be tested for coronavirus after adjusting for other explanatory variables. Conclusions There were relatively high rates of self-reported acute respiratory infection during a period of very low COVID-19 prevalence and low rate of coronavirus testing among symptomatic respondents. Ongoing monitoring of testing uptake, including in higher-risk groups, and possible interventions to improve testing uptake is key to early detection of disease.

Impacts of vaccination and asymptomatic testing on SARS-CoV-2 transmission dynamics in a university setting

We investigate the impact of vaccination and asymptomatic testing uptake on SARS-CoV-2 transmission in a university student population using a stochastic compartmental model. We find that the magnitude and timing of outbreaks is highly variable under different vaccine uptake levels. With low level interventions (no asymptomatic testing, 30% vaccinated), 53-71% of students become infected during the first term; with high interventions (90% using asymptomatic testing, 90% vaccinated) cumulative incidence is 7-9%, with around 80% of these cases estimated to be asymptomatic. Asymptomatic testing is most useful when vaccine uptake is low: when 30% of students are vaccinated, 90% uptake of asymptomatic testing leads to almost half the case numbers. Under high levels of vaccine uptake (70-90%), case numbers in the student population are largely driven by community importation. Our findings suggest that vaccination is critical for controlling SARS-CoV-2 transmission in university settings with asymptomatic testing being a useful supporting measure.

Determinants of Recent HIV Self-Testing Uptake Among Men Who Have Sex With Men in Jiangsu Province, China: An Online Cross-Sectional Survey

Background: To help inform regarding HIV self-testing (HIVST) upscale, we assessed the determinants of recent HIVST uptake among men who have sex with men (MSM) in Jiangsu province, China.Methods: We conducted a convenience online survey from March to April, 2020 among men aged ≥16 years, who had ever had sex with other men. Statistical analysis included Pearson's chi-square test, bivariate correlation, and multivariable logistic regression. p < 0.05 was considered statistically significant.Results: Of the total 692 participants, 69.5% (481) were aged between 18 and 40 years, and 65.9% (456) had reportedly ever self-tested. Using HIVST for first HIV test (aOR = 1.98, 95% CI: 1.21–3.26), perceiving HIVST as more private (aOR = 1.41, 95% CI: 0.85–2.35), and users not needing to go to a health facility (aOR = 1.68, 95% CI: 1.20–2.34) were associated with recent HIVST as facilitating factors.Conclusion: HIVST uptake rate has increased among Jiangsu MSM and can be further promoted by healthcare workers routinely recommending HIVST to their clients.

Effectiveness of Health Interventions towards HIV/AIDS in Developing Countries: A Systematic Review

Background: Plentiful development has been achieved in interventions for the prevention of HIV. Although, progression of prevention programs based on evidence – informed methods that interpret the effectiveness of these approaches in population is still a challenge. In developing countries, not many interventions are implemented for reduction of HIV burden. The single most important identified problem is lack of demand, supply, and adherence approaches. In current systemic review, recent evidence for the prevention of HIV in a cascade manner is described to see status of current interventions and further needs for improvements. Methodology: Systemic reviews regarding effectiveness on interventions of HIV prevention were searched. Primary studies were identified from eligible review that evaluated one of following factors: prevalence of HIV, incidence of HIV, testing uptake of HIV and use of condom. Interventions were categorized that pursued demand for prevention of HIV, improvement in supply for preventive approaches, support related to preventive behaviors or prevent HIV directly. A rating was assigned for each intervention based on evidence strength or randomized controlled trials. Results: Out of 91 eligible reviews, 264 primary studies were included in this review. Primary studies related to direct mechanisms of prevention that showed strong data for circumcision and effectiveness of pre – exposure prophylaxis. Evidence implies that interventions related to increased supply of preventive methods including clean needles or condoms can be operative. Interventions related to demand – side and adherence approaches were less clear with some studies showing effectiveness. Quality evidence was assessed among various categories. Various interventions showed supportive outcomes and results. In our findings, it was observed that difference between behavioral and structural has not evidently distinguished the interventions. Conclusion: Growing data is present for the support of effectiveness of products, behaviors, and procedures for prevention of HIV. In developing countries, negligible data is present for implementation of such approaches on community level. Interventions will be required for transforming this evidence to produce impact on population. It will empower the demand for prevention of HIV, supply of preventive technologies and utilization of preventive approaches against HIV. The findings can be eye opener to see actual burden of HIV and their implanted interventions and can be useful to design further intervention programs in future.

Assessing the feasibility, acceptability and impacts of an education program on hepatitis B testing uptake among ethnic Chinese in Australia: results of a randomised controlled pilot study

Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care. Conclusion A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection.