Objective Hepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago. Methods Sinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients’ knowledge of infection. Results Of 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment. Conclusion Patient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.

Women account for 25% of all people living with HIV and 19% of new diagnoses in the United States. African American (AA) women are disproportionately affected. Yet, differences in the care continuum entry are not well understood between patient populations and healthcare sites. We aim to examine gender differences in diagnosis and linkage to care (LTC) in the Expanded HIV Testing and Linkage to Care (X-TLC) program within healthcare settings. Data were collected from 14 sites on the South and West sides of Chicago. Multivariate logistic regression analysis was used to determine the differences in HIV diagnoses and LTC by gender and HIV status. From 2011 to 2016, X-TLC performed 281,017 HIV tests; 63.7% of those tested were women. Overall HIV seroprevalence was 0.57%, and nearly one third (29.4%) of HIV-positive patients identified were cisgender women. Of newly diagnosed HIV-positive women, 89% were AA. 58.5% of new diagnoses in women were made at acute care hospitals, with the remainder at community health centers. Women who were newly diagnosed had a higher baseline CD4 count at diagnosis compared with men. Overall, women had lower odds of LTC compared with men (adjusted odds ratio=0.58, 95% confidence interval 0.44-0.78) when controlling for patient demographics and newly versus previously diagnosed HIV status. Thus, interventions that focus on optimizing entry into the care continuum for AA women need to be explored.

Nonalcoholic fatty liver disease (NAFLD) is characterized by the presence of hepatic steatosis in individuals who consume little or no alcohol and can lead to nonalcoholic steatohepatitis. Patients with nonalcoholic steatohepatitis, and in particular those with advanced fibrosis, are at significant risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma. 1,2 Recently, magnetic resonance elastography (MRE), a magnetic resonance-based imaging technique, has been shown to accurately diagnose fibrosis in patients with NAFLD.Weight loss remains the mainstay of treatment for NAFLD and nonalcoholic steatohepatitis; however, there are limited data regarding the effect of weight loss on liver fibrosis. In addition, whether MRE-estimated liver stiffness decreases with weight loss has not been previously assessed. In this study, we aim to determine the quantitative effect of weight loss on MRE-estimated liver stiffness in patients with NAFLD.

BACKGROUND & AIMS: Magnetic resonance imaging (MRI) techniques and ultrasound-based transient elastography (TE) can be used in noninvasive diagnosis of fibrosis and steatosis in patients with nonalcoholic fatty liver disease (NAFLD). We performed a prospective study to compare the performance of magnetic resonance elastography (MRE) vs TE for diagnosis of fibrosis, and MRI-based proton density fat fraction (MRI-PDFF) analysis vs TE-based controlled attenuation parameter (CAP) for diagnosis of steatosis in patients undergoing biopsy to assess NAFLD. METHODS: We performed a cross-sectional study of 104 consecutive adults (56.7% female) who underwent MRE, TE, and liver biopsy analysis (using the histologic scoring system for NAFLD from the Nonalcoholic Steatohepatitis Clinical Research Network Scoring System) from October 2011 through May 2016 at a tertiary medical center. All patients received a standard clinical evaluation, including collection of history, anthropometric examination, and biochemical tests. The primary outcomes were fibrosis and steatosis. Secondary outcomes included dichotomized stages of fibrosis and nonalcoholic steatohepatitis vs no nonalcoholic steatohepatitis. Receiver operating characteristic curve analyses were used to compare performances of MRE vs TE in diagnosis of fibrosis (stages 1-4 vs 0) and MRI-PDFF vs CAP for diagnosis of steatosis (grades 1-3 vs 0) with respect to findings from biopsy analysis. RESULTS: MRE detected any fibrosis (stage 1 or more) with an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% confidence interval [CI], 0.74-0.91), which was significantly higher than that of TE (AUROC, 0.67; 95% CI, 0.56 +/- 0.78). MRI-PDFF detected any steatosis with an AUROC of 0.99 (95% CI, 0.98 +/- 1.00), which was significantly higher than that of CAP (AUROC, 0.85; 95% CI, 0.75 +/- 0.96). MRE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.89 (95% CI, 0.83 +/- 0.96), 0.87 (95% CI, 0.78 +/- 0.96), and 0.87 (95% CI, 0.71 +/- 1.00); TE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.86 (95% CI, 0.77 +/- 0.95), 0.80 (95% CI, 0.67-0.93), and 0.69 (95% CI, 0.45-0.94). MRI-PDFF identified steatosis of grades 2 or 3 with AUROC values of 0.90 (95% CI, 0.82 +/- 0.97) and 0.92 (95% CI, 0.84 +/- 0.99); CAP identified steatosis of grades 2 or 3 with AUROC values of 0.70 (95% CI, 0.58 +/- 0.82) and 0.73 (95% CI, 0.58 +/- 0.89). CONCLUSIONS: In a prospective, cross-sectional study of more than 100 patients, we found MRE to be more accurate than TE in identification of liver fibrosis (stage 1 or more), using biopsy analysis as the standard. MRI-PDFF is more accurate than CAP in detecting all grades of steatosis in patients with NAFLD.

From 1960 to 1962, more than 14,000 unaccompanied minors took flight from Cuba to the United States, establishing the largest recorded exodus in the Western Hemisphere. The displaced children and the country they left behind are often metaphorized using a popular Latin American nursery rhyme, “The Lost Apple.” Now, more than four decades later, Operation Pedro Pan persists through a revealing body of performance by and about a nation’s exiled children. The Lost Apple Plays investigates how memory, identity formation, nationhood, citizenship, and migration have been dramatized through these performances. Pulitzer Prize-winning playwright Nilo Cruz, director/actor/playwright Mario Ernesto Sánchez, singers Willy Chirino and Lissette, performance artist Ana Mendieta, sculptor María Brito, prolific dramatist Eduardo Machado, and new playwright Melinda López compose a Cuba that can be neither lost nor recovered for Pedro Pans, but remains an impenetrable illusion like the restless, liminal condition of lifelong exile.