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Hepatitis C (HCV) infection is a major global health challenge, with particularly high prevalence among people who inject drugs (PWID) in the Eastern European and Central Asian region (EECA). While the country of Georgia has made major progress in reducing overall HCV prevalence, less is known about HCV reinfection rates and risk factors for reinfection among PWID. In this study, we aimed to: (1) estimate HCV reinfection rates and (2) identify risk factors associated with HCV reinfection among PWID. Data were from the 2022 Integrated Bio-Behavioral Surveillance Study (IBBS) of PWID in Georgia. For the present analysis, the sample was restricted to the 462 PWID who had previously received HCV treatment through the national elimination program. The survey included a behavioral component (face-to-face interviews using a standardized questionnaire covering injection-related risk behaviors), and a laboratory component (blood samples for HCV RNA testing). We conducted regression models based on bivariate analyses to identify risk factors associated with laboratory-confirmed HCV reinfection. Overall, the reinfection rate was 13% among PWID in our sample. We found that younger PWID had higher odds of HCV reinfection compared to older PWID. The highest reinfection rate was among participants aged 18–24, (33.3%), although this group comprised a small portion of the sample (n = 3). Those reporting public injecting, had an adjusted odds ratio AOR of 8.08 [95% CI: 2.13,30.98] of HCV reinfection. At the time of the study, continuous opioid injection every day during the last 12 months was also associated with reinfection with an AOR of 2.26 [95% CI: 1.06,5.01]. Reinfection presents a challenge to HCV elimination. We identified several key factors that may influence reinfection including age, injection environment, and duration of drug injection. These findings emphasize the necessity for an integrative approach to harm reduction that addresses both behavioral and environmental risk factors.

Linkage to and retention in care for US persons living with HIV (PLWH) after release from jail usually declines. We know of no rigorously evaluated behavioral interventions that can improve this. We hypothesized that a strengths-based case management intervention that we developed for PLWH leaving jail would increase linkage/retention in care (indicated by receipt of laboratory draws) and a suppressed HIV viral load (VL) in the year following release. We conducted a quasi-experimental feasibility study of our intervention for PLWH jailed in Atlanta. We recruited 113 PLWH in jail starting in 2014. \"SUCCESS\" (Sustained, Unbroken Connection to Care, Entry Services, and Suppression) began in jail and continued post-release. Subjects who started the intervention but subsequently began long-term incarcerations were excluded from further analysis. Persons who were retained in the intervention group were compared to contemporaneously incarcerated PLWH who did not receive the intervention. Identities were submitted to an enhanced HIV/AIDS reporting system (eHARS) at the state health department to capture all laboratories drawn. Both community engagement and care upon jail return were assessed equally. For 44 intervention participants released to Atlanta, 50% of care occurred on subsequent jail stays, as documented with EventFlow software. Forty-five receiving usual services only were recruited for comparison. By examining records of jail reentries, half of participants and 60% of controls recidivated (range: 1-8 returns). All but 6 participants in the intervention and 9 subjects in the comparison arm had ≥1 laboratory recorded in eHARS post-release. Among the intervention group, 52% were retained in care (i.e., had two laboratory studies, > = 3 months apart), versus 40% among the comparison group (OR = 1.60, 95% CI (0.71, 3.81)). Both arms showed improved viral load suppression. There was a trend towards increased retention for PLWH released from jail after SUCCESS, compared to usual services. Measuring linkage at all venues, including jail-based clinics, fully captured engagement for this frequently recidivating population. ClinicalTrials.gov NCT02185742.

The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners.

Hepatitis C (HCV) infection is a major global health challenge, with particularly high prevalence among people who inject drugs (PWID) in the Eastern European and Central Asian region (EECA). While the country of Georgia has made major progress in reducing overall HCV prevalence, less is known about HCV reinfection rates and risk factors for reinfection among PWID. In this study, we aimed to: (1) estimate HCV reinfection rates and (2) identify risk factors associated with HCV reinfection among PWID. Data were from the 2022 Integrated Bio-Behavioral Surveillance Study (IBBS) of PWID in Georgia. For the present analysis, the sample was restricted to the 462 PWID who had previously received HCV treatment through the national elimination program. The survey included a behavioral component (face-to-face interviews using a standardized questionnaire covering injection-related risk behaviors), and a laboratory component (blood samples for HCV RNA testing). We conducted regression models based on bivariate analyses to identify risk factors associated with laboratory-confirmed HCV reinfection. Overall, the reinfection rate was 13% among PWID in our sample. We found that younger PWID had higher odds of HCV reinfection compared to older PWID. The highest reinfection rate was among participants aged 18-24, (33.3%), although this group comprised a small portion of the sample (n = 3). Those reporting public injecting, had an adjusted odds ratio AOR of 8.08 [95% CI: 2.13,30.98] of HCV reinfection. At the time of the study, continuous opioid injection every day during the last 12 months was also associated with reinfection with an AOR of 2.26 [95% CI: 1.06,5.01]. Reinfection presents a challenge to HCV elimination. We identified several key factors that may influence reinfection including age, injection environment, and duration of drug injection. These findings emphasize the necessity for an integrative approach to harm reduction that addresses both behavioral and environmental risk factors.

Introduction The implementation of artificial intelligence (AI) in radiology as a medical decision support system has the potential to enhance diagnostic accuracy and improve patient outcomes. This retrospective study aimed to evaluate the diagnostic capabilities of GPT-4o in interpreting radiological imaging, specifically X-ray, CT, and MRI images, across various organ systems and disease types. Methods A total of 377 cases were collected and presented to GPT-4o with a standardized prompt and no clinical context. The responses were assessed by three independent raters using a five-point rating system. Results X-ray imaging exhibited a 2.21 times higher chance, on average, of being interpreted accurately compared to CT scans (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.33 - 3.69), while pelvic imaging had a 6.25 times lower chance, on average, of being interpreted accurately when compared to images of the abdomen (OR: 0.16; 95% CI: 0.02 - 0.56). Additionally, neoplastic conditions had a 2.7 times lower chance, on average, of being interpreted accurately compared to bleeding conditions (OR: 0.37; 95% CI: 0.16 - 0.84). Conclusion A bimodal distribution of median ratings highlights an overreliance on comparability to prior image encounters and emphasizes the need to develop a systematic approach to image analysis. Future research should prioritize eliminating hallucination, establishing standardized evaluation criteria, and exploring methods to integrate visual and text-based data in a balanced manner. Additionally, efforts should be directed towards enhancing dataset diversity to improve the model's overall accuracy and generalizability.

Abstract Background Hepatitis C disease (hepC) is unevenly distributed both by geography and subpopulation. Our 2013 US prisons survey led to an estimate of 17.4% anti-HCV prevalence in 2006. The 10M persons who pass through jails and prisons each year bear 30–50% of disease burden, but are excluded from traditional sources of surveillance data, such as NHANES. CDC estimates 50% of persons with hepC lack knowledge of infection in life, thus death data are also imperfect. Data for corrections would enrich understanding of geographic representation of hepC. Methods In 11/2016, we surveyed state prison medical directors, providers and testers, for data on non-targeted screening of prisoners between 2010 -2016. Non-responders were phoned for information. Sizes of state prison populations came from the Bureau of Justice Statistics. Via published reports, we obtained data on jail prevalence. Estimates of the contribution to the national hepC in prison epidemic came from weighting the size of the prison population of the states with prevalence data. Results As the map (Figure 1) shows, 50% of contiguous states performed non-targeted screening for anti-HCV prevalence in corrections. States with either jail or prison data held 65% of all state prisoners. Seroprevalence ranged from 7.5% to 39.7%. The 2015 prevalence in state prisoners nationwide, weighting by population size, was 18%. Prevalence in states has fluctuated substantially. (Figure 2) Conclusion Data from penitentiaries allow us to estimate an 18% prison anti-HCV prevalence nationwide, which varies by state and time. Better checks for uniformity in reporting in the future, such as how known positives are handled, would improve data quality. Correctional systems that routinely screen provide real-time data on new trends in hepC distribution, which will help ongoing efforts to treat and eliminate hepC. Such data could improve estimates based on NHANES and death data. Over 99% of persons entering jails and prisons leave, so the correctional epidemic closely influences the community epidemic. Adding hepC data from the Federal Bureau of Prisons, which tests persons entering from every state, will further inform our understanding of the changing geographic distribution of hepC, and, by proxy, the underlying opioid epidemic. Disclosures A. C. Spaulding, Gilead Science: Grant Investigator and Scientific Advisor, Consulting fee and Research grant.