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Did the 2011 AAP recommendations on youth HIV testing change practice? Trends from a large urban adolescent program.

ABSTRACT: The purpose of this study was to determine whether there is adherence to the October 2011 American Academy of Pediatrics (AAP) recommendations for HIV screening in a large urban adolescent program with availability of a publicly funded program providing free, confidential, sexually transmitted infection (STI) and HIV counseling and testing (then rapid or third generation HIV testing), nested in the same adolescent clinic.We conducted a retrospective chart review of HIV screening trends among 13- to 24-year-old patients tested for HIV during periods of January 2010 to June 2011 (18 months pre-AAP recommendations period) and July 2011 to December 2012 (18-month period, which included 15 months after the AAP recommendations).During the period of January 2010 to June 2011, there were 22 tests/1,000 medical visits (N = 824 of 37,520 medical visits), and during the period of July 2011 to December 2012, there were 27 tests/1,000 medical visits (N = 1,068 of 38,763 medical visits) (p < 0.0001, odds ratio [OR] 1.26). The number of 13- to 18-year-old patients screened in the pre-AAP period was 150, compared to 297 in the second 18-month period (X 2 = 43.3, df = 1, p < 0.0001). A summative risk profile score of 0-9 was created in the form of a continuous variable, with a risk score of 0 for those with no risk factor identified and 1 point for each risk behavior identified. The proportion of HIV test clients with zero-specified risk (a risk score of "0") increased from 2010 to 2012.Release of the 2011 AAP HIV testing guidelines was associated with a modest increase in HIV screening and a shift toward testing younger people and away from risk-based screening.

SUBMITTER: Seetharaman S

PROVIDER: S-EPMC5490436 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:ImportanceThe Medicare Advantage (MA) program is rapidly growing. While previous work has found that beneficiaries with substantial health needs disenroll from plans at higher rates, the long-term frequency of disenrollment is not well understood.ObjectiveTo compare cumulative disenrollment trends in the MA program by beneficiary and plan characteristics.Design, setting, and participantsThis retrospective, serial cross-sectional study included beneficiaries with any MA enrollment from January 1, 2011, to December 31, 2020. Data analysis took place from September 2022 to March 2023.ExposuresBeneficiary characteristics, including race and ethnicity, length of Medicare enrollment, dual eligibility, and comorbidity burden, and contract characteristics, including vertical integration status, premium, and MA star rating.Main outcomes and measuresThe main outcome was disenrollment from an MA contract within 5 years. Rates of cumulative disenrollment by beneficiary and contract characteristics were compared. Pearson correlation coefficients were calculated to assess the correlation between a contract's 1-year disenrollment and the contract's disenrollment over a longer period.ResultsThe sample included 82 377 917 beneficiaries (524 442 225 beneficiary-year observations; 56.7% female; mean [SD] age, 71.9 [10.3] years). After 1 year, 13.2% of nondually enrolled and 15.9% of dually enrolled beneficiaries had left their contract, increasing to 48.3% and 53.4%, respectively, after 5 years. Black enrollees disenrolled at the highest rates among race and ethnicity categories, with 14.8% disenrolling after 1 year and 52.6% disenrolling after 5 years. Contracts had a median disenrollment rate of 9.8% (IQR, 4.5%-19.0%) after 1 year and 56.1% (IQR, 23.1%-79.0%) after 5 years. Contracts rated 5 stars had substantially lower 5-year disenrollment rates (23.0% after 5 years compared with 41.2% for 4- to 4.5-star contracts and 67.2% for 3- to 3.5-star contracts). Disenrollment from a contract after 1 year was not well correlated with disenrollment after 5 years (r, 0.46).Conclusions and relevanceThis cross-sectional study found substantial cumulative rates of disenrollment from MA plans within 5 years between 2011 and 2020, with wide variation in 5-year disenrollment by contract. The findings suggest that evaluating long-term disenrollment rates in MA performance measures may capture different outcomes than single-year disenrollment alone.

Project description:AIMS:The mental health of youth is continually changing and requires reliable monitoring to ensure that adequate social and economic resources are allocated. This study assessed trends in mental health among Canadian youth, 12-24 years old. Specifically, we examined the prevalence of poor/fair perceived mental health, diagnosis of mood and anxiety disorders, suicidality, perceived stress and sleep problems, substance use, and mental health consultations. METHODS:Data were collected from eight cycles of the annual Canadian Community Health Survey (2011-2018). Prevalence of mental health outcomes was calculated from each survey, and meta-regression was used to assess trends over time. In the absence of a significant trend over time, the eight cycles were pooled together using meta-analysis techniques to gain precision. Trends in prevalence were assessed for the overall sample of youth (12-24 years) and separately for male and female adolescents (12-18 years) and young adults (19-24 years). RESULTS:The prevalence of poor/fair perceived mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased from 2011 to 2018, most strongly among young adult females. Past-year suicidality increased among young adult females but did not change for other age and sex groups. Notably, the prevalence of binge drinking decreased by 2.4% per year for young adult males, 1.0% for young adult females and 0.7% per year for adolescent males, while staying relatively stable for adolescent females. Prevalence of cannabis use declined among adolescents before legalisation (2011-2017); however, this trend did not persist in 2018. Instead, the 2018 prevalence was 5.6% higher than the 2017 prevalence (16.3 v. 10.7%). The combined prevalence of other illicit drug use was stable at 4.6%; however, cocaine use and hallucinogens increased by approximately 0.2% per year. CONCLUSIONS:Our findings highlight a growing need for youth mental health services, as indicated by a rise in the prevalence of diagnosed mood and anxiety disorders and past-year mental health consultations. The reason for these observed increases is less apparent - it may represent a true rise in the prevalence of mental illness, or be an artefact of change in diagnostic practices, mental health literacy or diminishing stigma. Nonetheless, the findings indicate a need for the health care system to respond to the rising demand for mental health services among youth.

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Did the 2011 AAP recommendations on youth HIV testing change practice? Trends from a large urban adolescent program.

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