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1. Characteristics of and Deaths among 333 Persons with Tuberculosis and COVID-19 in Cross-Sectional Sample from 25 Jurisdictions, United States

Author

Scott A. Nabity, Suzanne M. Marks, Neela D. Goswami, Shona R. Smith, Evan Timme, Sandy F. Price, Lon Gross, Julie L. Self, Katelynne Gardner Toren, Masahiro Narita, Donna H. Wegener, and Shu-Hua Wang

Subjects
COVID-19, tuberculosis and other mycobacteria, coronavirus disease, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, viruses, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB–COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 [95% CI 0.8‒1.4]). Among TB–COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB–COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.

Published
2023
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2. Implementation of the Arizona Pain and Addiction Curriculum: Findings and Implications From a Statewide Evaluation

Author

Lisa Villarroel, Aram S. Mardian, Evan Timme, Shakaib Rehman, and Cara M. Christ

Subjects
public health, pain, addiction, curriculum, evaluation, didactic dissonance, Public aspects of medicine, RA1-1270
Abstract

Purpose: The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education programs collaboratively created the evidence-based, comprehensive Arizona Pain and Addiction Curriculum which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state.Materials and Methods: Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities.Results: Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives.Conclusion: In < 1 year after creation of the Arizona Pain and Addiction Curriculum, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.

Published
2021
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3. Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

Author

Heather Venkat, Manisha Patel, Ken Komatsu, Ahmed M. Kassem, Chia-ping Su, Diana Elson, Paul A. Gastañaduy, Paul A. Rota, Shane Brady, Graham Briggs, Carole J. Hickman, Susan Robinson, Kathryn Fitzpatrick, Evan Timme, Clancey Hill, Sara Mercader, Eugene Livar, Jabette Franco, Sun Bae Sowers, and Jessica Leung

Subjects
0301 basic medicine, Microbiology (medical), Adult, Male, medicine.medical_specialty, 030106 microbiology, Attack rate, Measles, History, 21st Century, Polymerase Chain Reaction, Article, Herd immunity, Disease Outbreaks, Immunoenzyme Techniques, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Epidemiology, medicine, Humans, Avidity, Public Health Surveillance, Serologic Tests, 030212 general & internal medicine, business.industry, Arizona, Outbreak, Middle Aged, medicine.disease, Rash, Vaccination, Infectious Diseases, Immunoglobulin M, Immunoglobulin G, Prisons, Female, medicine.symptom, business, Demography
Abstract

Background We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. Methods Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. Results We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. Conclusions Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Published
2019

4. 2263. HIV-TB Co-Infection in Arizona From 1993 to 2016

Author

Heather Venkat, Mitchell Keener, Rick DeStephens, Evan Timme, and Gregory L. Damhorst

Subjects
Tuberculosis, business.industry, Human immunodeficiency virus (HIV), virus diseases, medicine.disease, medicine.disease_cause, Hiv seropositivity, Virology, Comorbidity, Abstracts, Infectious Diseases, Oncology, B. Poster Abstracts, Coinfection, Medicine, business, Co infection
Abstract

Background Key risk factors for tuberculosis (TB) in the United States include HIV-positive status, birth outside of the United States, incarceration and homelessness. Despite advances in antiretroviral therapy (ART) and declining HIV-TB comorbidity, TB remains an important opportunistic infection for all people living with HIV. Few studies exist which characterize HIV-TB co-infection in geographic populations within the United States In this study, we cross-reference the HIV and TB registries in Arizona from 1993 through 2016 and compare features of HIV-TB co-infected individuals with HIV-negative TB cases and the broader population living with HIV. Methods Case records were identified by cross-referencing two separate databases maintained by the Arizona Department of Health Services, the Report of Verified Case of Tuberculosis (RVCT) and the Enhanced HIV/AIDS Reporting System (eHARS). Data were organized and analyzed in SAS and comparisons evaluated with Pearson chi-square test. Results A total of 361 unique cases of HIV-TB co-infection in Arizona were identified during the study period. Annual TB diagnoses in people living with HIV range from 25 (1995) to 7 (2008 and 2016). Significant differences in birth sex and age were observed in HIV-TB co-infections compared with HIV-negative TB cases. Homelessness was more common among people living with HIV (22.6% vs. 9.0%, χ2 = 70.22, P < 0.001). TB disease manifestations differed (χ2 = 159.7604, P < 0.001) and HIV-positive individuals more frequently had concurrent pulmonary and extrapulmonary TB disease. Outcomes of TB treatment were less favorable among individuals living with HIV (χ2 = 45.33, P < 0.001) as more HIV-positive patients failed to complete the full course of TB therapy or died before therapy completion. Finally, among all people living with HIV, our study revealed significant differences in race (χ2 = 243.53, P < 0.001), country of birth (χ2 = 441.88, P < 0.001), HIV transmission risk factors (χ2 = 125.19, P < 0.001), and correctional status (χ2 = 347.90, P < 0.001) for those who had a TB diagnosis. Conclusion Our study reveals important trends in HIV-TB comorbidity in Arizona and may inform public health strategies for addressing TB and its burden among people living with HIV. Disclosures All authors: No reported disclosures.

Published
2018

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