• Analysis of Field Delivered Therapy for Chlamydia and Gonorrhea in Maricopa County

      Ebbing, Brittany; The University of Arizona College of Medicine - Phoenix; Taylor, Melanie (The University of Arizona, 2017-05-08)
      Chlamydia and gonorrhea are among the most frequently reported infectious diseases in the United States. These two diseases are easily treated with antibiotics; however, challenges exist in providing treatment to cases and their sexual partners. Maricopa County implemented a Field Delivered Therapy (FDT) protocol to treat chlamydia and gonorrhea cases and contacts in 2009. Ultimately, this project sought to inform other public health departments across the United States regarding the benefits of FDT program to treat gonorrhea and chlamydia and provide better insight on how to treat the two most commonly reported infectious diseases. Existing data was analyzed from April 1, 2011 to October 31, 2014 (42 months) for all patients that received FDT in Maricopa County utilizing pharmacy records and electronic health records (PRISM and eClinicalWorks). The following pieces of information were collected from these data sources: gender, age, race/ethnicity, diagnosis, number of partners, and time to treatment. The data were then divided into four FDT groups (FDT, expedited partner therapy via FDT, FDT attempted and FDT planned). There were 172 patients in this analysis; 140 diagnosed or in contact with chlamydia and 16 diagnosed or in contact with gonorrhea. There were 79 patients (45.9%) in the FDT group, 28 (16.3%) in the FDT EPT group, 28 (16.3%) in the FDT attempted and 37 (21.5%) in the FDT planned group. The median age of these patients was 23.8 (range 16.6‐31); 111 (64.5%) were female. The median time to treatment for these patients was 24.6 days (range 0‐64.5 days). Most patients (79.6%) lived outside of central Phoenix. The median number of sexual partners reported by these patients was 6.6 (range 1‐19.7 partners). A majority of the patients were <25 years old, except for in the FDT EPT group where 100% of patients were >25 years old. And the group with the largest <19‐year‐old population (32%) was in the FDT group. All the groups had a female majority, except in the FDT EPT group where 75% of the patients were male. Most patients in the FDT only group received testing at an outside hospital or outpatient clinic, while the FDT attempted and planned were more often tested at the STD clinic. Future Direction/Conclusion Many of the patients that received FDT are young women, some pregnant, that lived outside of Central Phoenix. However, a majority of the overall clients that received expedited partner therapy via FDT were male, a typically hard to reach population for treatment of potentially asymptomatic infections. This study demonstrates an effective method of delivering partner treatment to men. This study can be used to inform other public health departments about this novel practice and to help Maricopa County grow their FDT program to reach even more untreated patients.
    • Celiac Disease in the Hispanic Population at Maricopa Integrated Health System

      Massimo, Lauren; The University of Arizona College of Medicine - Phoenix; Chuang, Keng‐Yu (The University of Arizona., 2017-05-23)
      Celiac disease (CD) is an autoimmune gastrointestinal disorder that has been well studied amongst non‐Hispanic white populations. Data specifically describing the disease in the U.S. Hispanic population is limited and available studies that do report prevalence and incidence within this population reveal discrepancies. The aim of this study is to estimate the incidence of CD and to define common presenting symptoms in Hispanics in Phoenix, AZ. Data was collected via a retrospective chart review from Maricopa Integrated Health System (MIHS), an organization caring for a patient population that is >50% Hispanic, between 2004‐2013. The study population is both adult and pediatric patients that had received the ICD‐9 code 579.0. The total number of non‐repeat patients seen at MIHS each year between 2004‐2013 was also determined and broken down by race for incidence calculations. During this 10‐year period, 29 total patients were diagnosed with CD at MIHS. The overall yearly incidence increased from 1 in 44,011 patients in 2004 to 1 in 27,948 in 2013. Of the 29 diagnosed, 52% were Caucasian, 34% Hispanic, 7% Asian and 7% African American. The yearly incidence in Hispanic patients also increased from 0 in 2004 to 1 in 58,302 in 2007 to 1 in 25,826 in 2013. Although diagnosis was greater in females of both races, Hispanic patients were diagnosed at a younger age than Caucasians (22 vs. 31 y/o, respectively). The most common diagnostic approach was serological testing combined with duodenal biopsy. The 3 most common gastrointestinal presenting symptoms in Caucasians were diarrhea, abdominal pain and nausea/vomiting, while those in Hispanics were constipation, bloating/abdominal distention and diarrhea. At the time of diagnosis, at least 1/3rd of both Caucasian and Hispanic patients had presented with another autoimmune disorder. Other associated conditions were neurological symptoms and iron‐deficiency anemia. Data from this study suggests that CD in the Hispanic population may be more common in Phoenix than the overall population in the U.S. as described in the literature. It also suggests that Hispanic patients may have different presenting symptoms than do Caucasians. The reason behind the increase in CD incidence in Hispanics is unclear, although increased physician awareness and diagnosis may play a role. Further research and awareness of CD in the Hispanic population may be necessary to optimize diagnosis & treatment of the condition.
    • Comparing Transcutaneous to Serum Bilirubin after Phototherapy in the Outpatient Setting

      Makarova, Natasha; The University of Arizona College of Medicine - Phoenix; McMahon, Shawn (The University of Arizona., 2017-05-10)
      Currently few studies have investigated the accuracy of using transcutaneous bilirubinometry after phototherapy especially in the outpatient setting. The purpose of this study was to evaluate the accuracy of transcutaneous bilirubin measurements (TCB) after phototherapy for neonates with jaundice. At the Maricopa Integrated Health System, neonates who undergo phototherapy for hyperbilirubinemia come in for outpatient follow‐up at the Comprehensive Health Center following their discharge. For those neonates, current protocol calls for serum bilirubin (TSB) to be measured to properly monitor bilirubin levels, however transcutaneous measurements were made and recorded as well. In this study, we compared the values of total serum bilirubin and transcutaneous bilirubin in jaundiced neonates who underwent phototherapy. From October 2013‐April 2015, a total 67 healthy infants were seen in the Pediatric Clinic who had received phototherapy in our hospital, only 36 (54%) of those met minimum data criteria to be included in the study. The absolute difference between mean serum bilirubin and transcutaneous bilirubinometry in healthy outpatient newborns who received inpatient phototherapy was 0.4 and is clinically insignificant. The average time from hospital discharge to return to clinic was 47 hours. We conclude that for the outpatient physician, transcutaneous bilirubinometry can be used following phototherapy, which facilitates faster, more convenient, and painless follow‐up visits.
    • Evaluation of an Opt-Out HIV Screening Program in the Maricopa County Jails

      Nelson, Erin Da‐Hye; The University of Arizona College of Medicine - Phoenix; Taylor, Melanie; Mullany, Charles (The University of Arizona., 2017-05-12)
      Since inmates are a population disproportionately affected by HIV, correctional settings are important sites for delivering HIV services. The Maricopa county (Phoenix Area) jail system is the 4th largest in the nation. In 2011, the Maricopa County Correctional Health Service implemented an opt‐out HIV screening program for individuals booked into the Maricopa County Jails (MCJ). The aims of this study were to determine for the years 2012‐2014: • The number of inmates screened for HIV • The HIV positivity rate • The number of newly diagnosed patients • The clinical characteristics of the newly diagnosed HIV positive patients Five to seven days after booking, inmates are offered HIV screening. These laboratory records were used to determine the number of inmates tested and positivity. Prior history of previous HIV diagnosis was obtained from Maricopa public health records. Retrospective chart review of the MCJ health and case management records, including Ryan White forms, was performed to gather gender, age, race/ethnicity, sexual orientation, drug use, homelessness and co‐morbidities of newly HIV‐infected persons, such as Hepatitis C and prior STDs. Categorical factors were compared between groups with the Chi‐square test. Means were compared using a standard t test. P values ≤0.05 were considered significant. A total of 319,575 persons were booked and 46,346 were screened (14.5%) for HIV during the study period. The majority of booked inmates were male (76.9%) and Caucasian (50.8%). The mean age of inmates was 36 years. There were 70 newly HIV‐diagnosed patients. Chi squared and t tests comparing newly diagnosed individuals to the general jail population revealed statistical significance for male gender (p=0.02), African American race (p=0.04), and age (p=0.003). Undiagnosed HIV, including AIDS (CD4 counts <200), is an important issue among individuals booked into the MCJ. Compared to the general jail population, HIV is more likely to be diagnosed in males rather than females, younger patients, and African‐American patients. Additionally, IV drug use, polysubstance abuse, other STDs (particularly syphilis), high risk sexual activity, Hepatitis C and homelessness were common among HIV positive patients. Surveillance should be continued and include more patient education on the importance of screening. Furthermore, targeting high‐risk populations may result in even greater numbers of individuals being diagnosed and treated. Within the next year, all patients at the MCJ will also be offered screening for Hepatitis C, chlamydia, gonorrhea and syphilis. This may also result in more patients agreeing to be screened, and subsequently diagnosed with HIV.