Leveling of Tuberculosis Incidence — United States, 2013–2015

After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013–2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S. cases...

As they did during the previous 7 years, four states (California, Florida, New York, and Texas) reported >500 cases each in 2015 (Table 1). Together, these four states accounted for 4,839 TB cases, or approximately half (50.6%) of all reported cases. State-specific incidence ranged from 0.5 cases per 100,000 persons (West Virginia) to 9.1 TB cases per 100,000 persons (Alaska) (median state incidence = 2.0). By census division, the highest TB incidence was reported in the Middle Atlantic, West South Central, and Pacific divisions. The largest increases in TB incidence from 2014 to 2015 occurred in the East North Central, New England, Mountain, and West South Central divisions.

Among the 9,563 TB cases reported during 2015, 3,201 (33.5%) occurred among U.S.-born persons, corresponding to an annual TB incidence of 1.2 per 100,000 persons. The 6,335 TB cases among foreign-born persons in the United States (66.2% of the total U.S. cases) corresponded to an annual TB incidence of 15.1 per 100,000 persons (Table 2). Overall national TB incidence remained approximately 3.0 cases per 100,000 persons during 2013–2015 (Figure).

In 2015, most U.S.-born persons reported with TB were either non-Hispanic blacks (1,144 cases) or non-Hispanic whites (991 cases) (Table 2). Among U.S.-born non-Hispanic blacks, TB incidence was at an all-time low (3.3 cases per 100,000 persons). Incidence among U.S.-born non-Hispanic whites remained the lowest (0.5 cases per 100,000). Although U.S.-born Hispanics had the third highest case count (661 cases), they had the second lowest incidence (1.8 cases per 100,000). U.S.-born Native Hawaiians/other Pacific Islanders had the highest incidence (12.7 cases per 100,000), followed by U.S.-born American Indians/Alaska Natives (6.8 cases per 100,000). A total of 344 TB cases occurred among U.S.-born persons aged <15 years (0.6 cases per 100,000), representing 10.7% of all U.S.-born persons reported as having incident TB in 2015.

In 2015, among foreign-born persons with reported TB in the United States, Asians had both the highest case count (3,007 cases) and highest incidence (28.2 cases per 100,000 persons). The top five countries of origin for foreign-born persons with TB were Mexico (n = 1,250; 19.7%), the Philippines (n = 819; 12.9%), India (n = 578; 9.1%), Vietnam (n = 513; 8.1%), and China (n = 424; 6.7%). Together, these countries represent 45.2% of the foreign-born population in the United States (4), but accounted for 56.6% (3,584 cases) of all TB cases among foreign-born persons. Although Mexico-born persons accounted for the largest proportion of foreign-born persons reported with TB, their TB incidence in the United States (10.4 cases per 100,000) was lower than that among persons born in China (24.9 cases per 100,000), India (23.9 cases per 100,000), the Philippines (46.9 cases per 100,000), and Vietnam (47.8 cases per 100,000). From 2014 to 2015, the number of TB cases among Philippines-born persons grew from 755 to 819 (8.5% increase), and the number of TB cases among India-born persons grew from 479 to 578 (20.7% increase). The Philippines-born population in the United States grew from 1,639,286 to 1,747,287 (population growth of 6.6%), and the India-born population grew from 2,166,930 to 2,421,795 (population growth of 11.8%) (4). Ninety-six TB cases occurred among foreign-born persons aged <15 years (6.0 cases per 100,000), representing 1.5% of all foreign-born persons reported as having incident TB in the United States in 2015.

Below:  Tuberculosis (TB) incidence overall and among U.S.- and foreign-born persons, by year — United States, 2000–2015

Full article at:   http://goo.gl/yA6tZc

By:  Jorge L. Salinas, MD^1,2; Godwin Mindra, MBChB^1,2; Maryam B. Haddad, MSN²; Robert Pratt²; Sandy F. Price²; Adam J. Langer, DVM²

¹Epidemic Intelligence Service, CDC; ²Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

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Ten Sites, 10 Years, 10 Lessons: Scale-up of Routine HIV Testing at Community Health Centers in the Bronx, New York

OBJECTIVE:

In response to the current CDC recommendations for routine HIV testing in clinical settings, the Adolescent AIDS Program at Montefiore Medical Center in the Bronx, New York, developed the Advise, Consent, Test, Support routine HIV testing model (ACTS) in 2003. ACTS was piloted in 10 community health centers operated by Montefiore because they serve populations most at risk for HIV/AIDS.

METHODS:

ACTS streamlined and codified the counseling and testing process, provided a routine HIV testing practice change plan, and provided training and communication materials that promoted routine HIV testing. To determine program success, we measured the number of patients seen at the clinics, the number of HIV test-eligible patients (those aged 13-64 years and not pregnant), the number and percent of patients receiving HIV testing, HIV test results, and the number of patients linked to care.

RESULTS:

HIV testing in the 10 sites increased nearly threefold during the pilot period (2003-2007), from 3,944 of 49,125 eligible patients (8%) tested in 2003 to 11,212 of 55,629 eligible patients (20%) tested in 2007. With little ongoing support, the sites continued or maintained improvements: 13,226 of 56,686 eligible patients (23%) were tested in 2008, 15,965 of 57,025 eligible patients (28%) were tested in 2011, 17,483 of 60,514 eligible patients (29%) were tested in 2012, and 17,971 of 63,172 eligible patients (28%) were tested in 2013. Sites identified 433 HIV-positive patients from 2006 to 2013 (0.2%-0.6% annual seropositivity), and 96% of them were linked to care within 90 days of HIV diagnoses (range: 92% to 98% annually).

CONCLUSION:

ACTS demonstrated that substantial and sustained increases in routine HIV testing can be achieved in health-care settings, not by adding personnel or financial resources, but by using the model's practice change plan and streamlined HIV testing approach.

Full PDF article at:  http://goo.gl/YLO4Zp

By:  Futterman D1, Stafford S1, Meissner P2, Lyle-Gassama M1, Blank A3, DuBois L1, Swartz J4.

• 1Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
• 2Montefiore Medical Center, Office of Research Program Development, Bronx, NY.
• 3Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY.
• 4Montefiore Medical Center, Department of Family and Social Medicine, Bronx, NY. 
• Public Health Rep. 2016 Jan-Feb;131 Suppl 1:53-62.

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Like Parent Like Child? The Role of Delayed Childrearing in Breaking the Link Between Parent's Offending and Their Children's Antisocial Behavior

This paper investigates the impact of parents' history of violent offending, their age at first birth, and the interaction of the two on their adolescent children's violent behavior. We employ intergenerational longitudinal data from the Rochester Youth Development Study to estimate parental trajectories of offending from their early adolescence through early adulthood. We show that the particular shape of the parents' propensity of offending over time can interact with their age at first birth to protect their children from delinquency. We investigate these relationships for children at 6 and 10 years of age. We find that for some groups delaying childrearing can insulate children from their parents' offending.

Below: Three Hypothetical Paths of Offending

Below:  Violence Prevalence Trajectory Groups, Waves 1 – 10

Below:  Interquartile Ranges of Age at First Birth By Trajectory Group

...The more important research question is whether among those parents who put their children at risk by having participated in delinquent behavior, are there some relatively distal behaviors that can offset the effects of parental delinquency? That is, can even those parents who are in the high delinquent trajectory groups behave in ways that serve to protect their children from problematic behavior? Specifically, the question posed was whether having children later rather than earlier would serve to offset the effects of high parental involvement in delinquency.

The results answer the question affirmatively for those 10-year-old children of parents who were in the most delinquent trajectory group, the chronic group (group 5). The age of first birth is a protective factor for all three measures of problematic behavior for our 10-year-olds. Moreover, the impact of having parents who are in the group 5 is no longer significant once the interaction between age of first birth and group 5 membership is entered into the equation. It is important to note that this was not the case for the declining group (group 4). Their main effects of group membership on problematic behaviors were reduced to insignificance for two of the three outcomes when the interaction terms were entered into the equations. However, the interaction terms measuring the protective efficacy of delaying childbirth were not statistically significant. So, there is no protective effect of delaying childbirth. Although both group 4 and group 5 were similarly high in their offending patterns initially, the trajectory for group 4 sloped down while group 5 remained relatively high. In contrast, for group 4 (but not group 5) we found some evidence of a supportive effect for the protective role of age of first birth for the 6 year olds. The only significant impact of parental delinquency on the child’s problematic behavior was for the relationship between having parents in group 4 and the Achenbach delinquency scale. The interaction between age of first birth and parental membership in group 4 was significant as well, indicating that delaying having children protects children of relatively high risk parents even at the age of 6. The differences between 6- and 10-years-olds pose interesting questions about how mediators and protective factors might operate at different ages but we leave this for future research...

Full article at:   http://goo.gl/olPNYa

By:  Lizotte AJ1, Phillips MD1, Krohn MD2, Thornberry TP3, Bushway SD1, Schmidt NM4.

• 1School of Criminal Justice, University at Albany, Albany NY.
• 2Department of Sociology and Criminology & Law, University of Florida, Gainesville FL.
• 3Department of Criminology and Criminal Justice, University of Maryland, College Park MD.
• 4Institute on Urban Health Research, Northeastern University, Boston MA. 
• Justice Q. 2015;32(3):410-444.

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When HIV Treatment Goals Conflict with Guideline-Based Opioid Prescribing: A Qualitative Study of HIV Providers

BACKGROUND:

HIV-infected patients have high prevalence of chronic pain and opioid use, making HIV care a critical setting for improving the safety of opioid prescribing. Little is known about HIV treatment providers' perspectives about opioid prescribing to patients with chronic pain.

METHODS:

We administered a questionnaire and conducted semi-structured telephone interviews with 18 HIV treatment providers (infectious disease specialists, general internists, family medicine physicians, nurse practitioners, and physician assistants) in Bronx, NY. Open-ended interview questions focused on providers' experiences, beliefs, and attitudes about opioid prescribing and about use of guideline-based opioid prescribing practices (conservative prescribing, and monitoring for and responding to misuse). Transcripts were thematically analyzed using a modified grounded theory approach.

RESULTS:

Eighteen HIV treatment providers included 13 physicians, 4 nurse practitioners, and 3 physician assistants. They were 62% female, 56% white, and practiced as HIV providers for a mean of 14.6 years. Most reported always or almost always using opioid treatment agreements (56%) and urine drug testing (61%) with their patients on long-term opioid therapy. HIV treatment providers tended to view opioid prescribing for chronic pain within the "HIV paradigm," a set of priorities and principles defined by three key themes: 1) primacy of HIV goals, 2) familiarity with substance use, and 3) the clinician as ally. The HIV paradigm sometimes supported, and sometimes conflicted with guideline-based opioid prescribing practices. For HIV treatment providers, perceived alignment with the HIV paradigm determined whether and how guideline-based opioid prescribing practices were adopted. For example, the primacy of HIV goals superseded conservative opioid prescribing when providers prescribed opioids with the goal of retaining patients in HIV care.

CONCLUSION:

Our findings highlight unique factors in HIV care that influence adoption of guideline-based opioid prescribing practices. These factors should be considered in future research and initiatives to address opioid prescribing in HIV care.

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By:  Starrels JL1, Peyser D2, Haughton L1, Fox A1, Merlin JS3, Arnsten JH1, Cunningham CO1.

• 1 Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
• 2 Center for Alcohol Studies, Rutgers University , New York , NY , USA.
• 3 University of Alabama at Birmingham , Birmingham , AL , USA. 
• Subst Abus. 2016 Feb 9:0. 

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High Tuberculosis Strain Diversity among New York City Public Housing Residents

OBJECTIVES:

We sought to better understand tuberculosis (TB) epidemiology among New York City Housing Authority (NYCHA) residents, after a recent TB investigation identified patients who had the same TB strain.

METHODS:

The study population included all New York City patients with TB confirmed during 2001 through 2009. Patient address at diagnosis determined NYCHA residence. We calculated TB incidence, reviewed TB strain data, and identified factors associated with TB clustering.

RESULTS:

During 2001 to 2009, of 8953 individuals in New York City with TB, 512 (6%) had a NYCHA address. Among the US-born, TB incidence among NYCHA residents (6.0/100 000 persons) was twice that among non-NYCHA residents (3.0/100 000 persons). Patients in NYCHA had high TB strain diversity. US birth, younger age, and substance use were associated with TB clustering among NYCHA individuals with TB.

CONCLUSIONS:

High TB strain diversity among residents of NYCHA with TB does not suggest transmission among residents. These findings illustrate that NYCHA's higher TB incidence is likely attributable to its higher concentration of individuals with known TB risk factors.

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By:  Dawson P1, Perri BR1, Ahuja SD1.

• 1All authors are with the New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control, Queens, NY. Patrick Dawson is also with Columbia University Mailman School of Public Health Department of Epidemiology, New York, NY. 
• Am J Public Health. 2016 Mar;106(3):563-8. doi: 10.2105/AJPH.2015.302910. Epub 2015 Dec 21.

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The Impact of Comprehensive Case Management on HIV Client Outcomes

In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM), for people dealing with multiple comorbid conditions, including HIV. 

The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. 

The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment). Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. 

Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500). When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. 

Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of HIV.

Full article at:   http://goo.gl/Lz1c6Z

By:  Brennan-Ing M1,2, Seidel L1,3, Rodgers L4, Ernst J1,5, Wirth D5, Tietz D6, Morretti A7, Karpiak SE1,2.

• 1Center on HIV and Aging, ACRIA, New York, New York, United States of America.
• 2College of Nursing, New York University, New York, New York, United States of America.
• 3Graduate School of Social Service, Fordham University, New York, New York, United States of America.
• 4BOOM! Health, Bronx, New York, United States of America.
• 5Amida Care, Inc., New York, New York, United States of America.
• 6Human Resources Administration, City of New York, New York, New York, United States of America.
• 7Columbia University, New York, New York, United States of America. 
• PLoS One. 2016 Feb 5;11(2):e0148865. doi: 10.1371/journal.pone.0148865.

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Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study

To improve HIV screening rates, New York State in 2010 mandated that all persons 13-64 years receiving health care services, including care in emergency departments (EDs), be offered HIV testing. Little attention has been paid to the effect of screening on patient flow. 

Time-stamped ED visit data from patients eligible for HIV screening, 7,844 of whom were seen by providers and 767 who left before being seen by providers, were retrieved from electronic health records in one adult ED. During day shifts, 10% of patients left without being seen, and during evening shifts, 5% left without being seen. All patients seen by providers were offered testing, and 6% were tested for HIV. 

Queuing models were developed to evaluate the effect of HIV screening on ED length of stay, patient waiting time, and rate of leaving without being seen. Base case analysis was conducted using actual testing rates, and sensitivity analyses were conducted to evaluate the impact of increasing the testing rate. 

Length of ED stay of patients who received HIV tests was 24 minutes longer on day shifts and 104 minutes longer on evening shifts than for patients not tested for HIV. Increases in HIV testing rate were estimated to increase waiting time for all patients, including those who left without being seen. 

Our simulation suggested that incorporating HIV testing into ED patient visits not only adds to practitioner workload but also increases patient waiting time significantly during busy shifts, which may increase the rate of leaving without being seen. 

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By:  Liu N1, Stone PW2, Schnall R3.

• 1Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY.
• 2School of Nursing, Columbia University, New York, NY.
• 3School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032. 
• Res Nurs Health. 2016 Feb 1. doi: 10.1002/nur.21710.

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Do Sexual Networks of Men Who Have Sex with Men in New York City Differ by Race/Ethnicity?

The United States HIV epidemic disproportionately affects Black and Hispanic men who have sex with men (MSM). This disparity might be partially explained by differences in social and sexual network structure and composition. 

A total of 1267 MSM in New York City completed an ACASI survey and egocentric social and sexual network inventory about their sex partners in the past 3 months, and underwent HIV testing. Social and sexual network structure and composition were compared by race/ethnicity of the egos: black, non-Hispanic (N = 365 egos), white, non-Hispanic (N = 466), and Hispanic (N = 436). 21.1% were HIV-positive by HIV testing; 17.2% reported serodiscordant and serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last 3 months. Black MSM were more likely than white and Hispanic MSM to report exclusively having partners of same race/ethnicity. Black and Hispanic MSM had more HIV-positive and unknown status partners than white MSM. White men were more likely to report overlap of social and sex partners than black and Hispanic men. No significant differences by race/ethnicity were found for network size, density, having concurrent partners, or having partners with ≥10 years age difference. 

Specific network composition characteristics may explain racial/ethnic disparities in HIV infection rates among MSM, including HIV status of sex partners in networks and lack of social support within sexual networks. Network structural characteristics such as size and density do not appear to have such an impact. 

These data add to our understanding of the complexity of social factors affecting black MSM and Hispanic MSM in the U.S.

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By:  Hong-Van Tieu, MD, MS,¹ Vijay Nandi, MPH,² Donald R. Hoover, PhD,³ Debbie Lucy, MS,¹ Kiwan Stewart,BPS,¹ Victoria Frye, DrPH,⁴ Magdalena Cerda, DrPH,⁵ Danielle Ompad, PhD,⁶ Carl Latkin, PhD,⁷ and Beryl A. Koblin, PhD,¹ on behalf of the NYC M2M Study Team

¹Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York.

²Laboratory of Analytical Sciences, New York Blood Center, New York City, New York.

³Department of Biostatistics, Rutgers University, New Brunswick, New Jersey.

⁴Laboratory of Behavioral and Social Sciences, New York Blood Center, New York City, New York.

⁵Department of Emergency Medicine, University of California, Davis, California.

⁶New York University Steinhardt School of Culture, Education, and Human Development, New York City, New York.

⁷Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Address correspondence to:

Hong Van Tieu, MD, MS

Laboratory of Infectious Disease Prevention

Lindsley F. Kimball Research Institute

New York Blood Center

310 E. 67^th Street Suite 3-110

New York, NY 10065

E-mail: htieu@nybloodcenter.org

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Sexual Risk and HIV Infection among Drug Users in New York City

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study’s limitations are noted.

...The drug users recruited for this study would appear to be the ideal target of a sexual health intervention. Among the 102 drug users recruited in the first stage, 62% were eligible for the intervention; i.e., they reported recent unprotected sex with more than one partner. In this second-stage sample, 66% of NIDUs and 33% of IDUs were HIV positive, and only 64% of HIV positives were aware of their status. In addition, 75% had antibody to HSV-2, and only 12% had ever been told they had genital herpes. Thus, this method of recruitment led to a set of individuals who may greatly benefit from an intervention that seeks to reduce both HIV acquisition and transmission to uninfected partners and among whom efforts to address HSV-2 facilitation of HIV acquisition and transmission may be particularly important. The high prevalence of HSV-2 in this population is very similar to the rate (60%) observed in another New York City study of drug users and to the rates reported in other studies of crack users (Des Jarlais, Hagan, et al., 2007; Jones et al., 1998;Ross, Hwang, Leonard, Teng, & Duncan, 1999). Although it is understood that HSV-2 facilitates HIV transmission, it is unclear at this stage how to manage HSV-2 infection to reduce this risk (Celum et al., 2010).

The high prevalence of HIV in this sample was unexpected, as it was substantially higher than rates observed in other New York City studies of opiate users of 15%–20% (Des Jarlais, Arasteh, et al., 2007). The sample was also unique in the degree to which injectors, former injectors, noninjectors, and sexual minorities overlapped. Gay, lesbian, and bisexual participants were more likely to be crack users than were heterosexuals, and bisexuals were more likely to be involved in sex trade. As noted by Des Jarlais et al. in this issue, many injectors in New York City have stopped injecting and returned to smoking or inhaling drugs. This transition to noninjection drug use may have led to new social and sexual linkages between former injectors with high HIV prevalence and lower-prevalence noninjection users. Crack use, along with the buying and using of other drugs, may create linkages between sexual minorities and heterosexuals in New York. Crack use, in particular, appears to identify very high-risk subsets of drug users in New York City. This finding of great overlap between gay, lesbian, bisexual, and heterosexual injection and noninjection users of heroin and cocaine has several implications for the development of interventions, including that strategies should use social, sexual, and drug-use-related linkages to locate and intervene with persons at high risk of HIV acquisition and transmission. In addition, interventions should address multiple sources of risk for HIV exposure in a linked population...

Below:  Diagram showing relative overlap among drug injection, crack cocaine use, and gay or bisexual orientation among heroin and cocaine users, New York City

Full article at:   http://goo.gl/9zI5A0

By:   Holly Hagan,1 David C. Perlman,2 and Don C. Des Jarlais3

¹College of Nursing, New York University, New York, New York, USA

²Department of Medicine, Beth Israel Medical Center, New York, New York, USA

³Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA

Address correspondence to Dr. Holly Hagan, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003; Email:ude.uyn@05hh

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Cervical Cancer Screening among Homeless Women of New York City Shelters

Introduction

Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US.

Methods

We enrolled 297 homeless women 21-65 years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test).

Results

Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9 % were smokers and 41.7 % were homeless more than a year. Despite a 76.5 % proportion of self-reported Pap test within the past 3 years, 65 % of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p < 0.01) and relationship between HPV and an abnormal Pap test (p < 0.01).

Conclusions

Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.

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By:  Asgary R1,2, Alcabes A3, Feldman R4, Garland V3, Naderi R5, Ogedegbe G6, Sckell B3.

• 1Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA. ramin.asgary@caa.columbia.edu.
• 2Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA. ramin.asgary@caa.columbia.edu.
• 3Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA.
• 4Department of OBGYN, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
• 5New York University School of Medicine, 227 E30th Street, New York, NY, 10016, USA.
• 6Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA.
• Matern Child Health J. 2015 Dec 9.  

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