In Canada, inactivated hepatitis A vaccines are targeted selectively at those at increased risk for infection or its complications. In order to evaluate the need for routine hepatitis A vaccination programs in Vancouver for street youth, injection drug users (IDUs) and men who have sex with men (MSM), we determined the prevalence of antibodies against hepatitis A virus (HAV) and risk factors for HAV in these groups.
The frequency of past HAV infection was measured in a sample of Vancouver street youth, IDUs and MSM attending outreach and STD clinics and needle exchange facilities by testing their saliva for anti-HAV immunoglobulin G. A self-administered, structured questionnaire was used to gather sociodemographic data. Stepwise logistic regression was used to evaluate the association between presumed risk factors and groups and past HAV infection.
Of 494 study participants, 235 self-reported injection drug use, 51 were self-identified as MSM and 111 met street youth criteria. Positive test results for anti-HAV were found in 6.3% of street youth (95% confidence interval [CI] 2.6%-12.6%), 42.6% (95% CI 36.2%-48.9%) of IDUs and 14.7% (95% CI 10.4%-19.1%) of individuals who denied injection drug use. Among men who denied injection drug use, the prevalence was 26.3% (10/38) for MSM and 12% (21/175) for heterosexuals. Logistic regression showed that past HAV infection was associated with increased age and birth in a country with high rates of hepatitis infection. Injection drug use among young adults (25-34 years old) was a significant risk factor for a positive anti-HAV test (p = 0.009). MSM were also at higher risk for past HAV infection, although this association was nominally significant (p = 0.07).
Low rates of past HAV infection among Vancouver street youth indicate a low rate of virus circulation in this population, which is vulnerable to hepatitis A outbreaks. An increased risk for HAV infection in IDUs and MSM supports the need to develop routine vaccination programs for these groups also.
Cites: Ann Intern Med. 1989 May 15;110(10):838-92712463
Cites: Am J Public Health. 1989 Apr;79(4):463-62929804
Cites: Rev Soc Bras Med Trop. 1995 Jul-Sep;28(3):199-2037480913
The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-effectiveness of such screening.
The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs.
Over 1995 and 1996, 135,681 women were pregnant and 92,645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between November 1995 and November 1996. On the basis of seroprevalence studies, an estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identified mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, there were 10 terminations, 1 spontaneous abortion and 14 cases in which the woman elected to carry the pregnancy to term with antiretroviral therapy. There was one stillbirth. One instance of maternal-fetal HIV transmission occurred among the 13 live births. The net savings attributable to prevented infections among babies carried to term were $165,586, with a saving per prevented case of $75,266.
A routine offer of pregnancy screening for HIV in a low-prevalence setting reduces the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectiveness.
Cites: JAMA. 1996 May 15;275(19):1483-88622222
Cites: AIDS. 1996 Dec;10(14):1683-78970689
Cites: JAMA. 1996 Jul 10;276(2):132-88656505
Cites: Public Health Rep. 1996 Jul-Aug;111(4):335-418711101
The medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). We sought to determine if predicted support for these activities was related to equity of income as perceived by physicians. The study design was a cross-sectional study of all 1462 physicians actively practising in Saskatchewan during 1991/1992. The data were originally collected by Lepnurm and Henderson during the summer of 1992. ANOVA tests were conducted between predicted support for wellness activities and income equity to determine if there were significant interactions. Predicted support for wellness activities was measured by four items: preventive medicine counselling activities during office visits, clinical work with other health professionals, teaching and research, and, institutional medical administrative duties. The first income equity construct was based on: satisfaction with income, fairness of fee-for-service between general practitioners and specialists, fairness of fee-for-service between cognitive and procedural/technical specialists, and the current method of payment reflected factors important to physicians. To increase sample size a second equity construct was created by dropping fairness of fee-for-service between cognitive and procedural/technical specialists. The main effect and significant interactions with control variables were subjected to further analysis using Tukey's test. Significant relationships were found between changes in wellness activities under fee-for-service and income equity (p = 0.001 and p = 0.033) and between changes in wellness activities under salary and income equity (p = 0.002 and p = 0.037). No significant relationships (p = 0.858 and p = 0.610) were found between support for wellness activities under capitation and income equity. The findings of this study demonstrate a relationships between perceived equity of income and predicted support for wellness activities. The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.