Singh B, Risanger S, Morton D, Pignone M, and Meyers LA
Medical decision making : an international journal of the Society for Medical Decision Making [Med Decis Making] 2021 Jan; Vol. 41 (1), pp. 3-8. Date of Electronic Publication: 2020 Oct 30.
COVID-19 diagnosis, Health Services Accessibility, Humans, Rural Population, SARS-CoV-2, United States, COVID-19 Testing, and Postal Service organization administration
Widespread, convenient access to COVID-19 testing has been challenging in the United States. We make a case for provisioning COVID-19 tests through the United States Postal Service (USPS) facilities and demonstrate a simple method for selecting locations to improve access. We provide quantitative evidence that even a subset of USPS facilities could provide broad access, particularly in remote and at-risk communities with limited access to health care. Based on daily travel surveys, census data, locations of USPS facilities, and an established care-seeking model, we estimate that more than 94% of the US population would be willing to travel to an existing USPS facility if warranted. For half of the US population, this would require traveling less than 2.5 miles from home; for 90%, the distance would be less than 7 miles. In Georgia, Illinois, and Minnesota, we estimate that testing at USPS facilities would provide access to an additional 4.1, 3.1, and 1.3 million people and reduce the median travel distance by 3.0, 0.8, and 1.2 miles, respectively, compared with existing testing sites per 28 July 2020. We also discuss the option of distributing test-at-home kits via USPS instead of private carriers. Finally, our proposal provides USPS an opportunity to increase revenues and expand its mission, thus improving its future prospects and relevance.
Takano M, Iwahashi K, Satoh I, Araki J, Kinami T, Ikushima Y, Fukuhara T, Obinata H, Nakayama Y, Kikuchi Y, and Oka S
BMC infectious diseases [BMC Infect Dis] 2018 Dec 05; Vol. 18 (1), pp. 627. Date of Electronic Publication: 2018 Dec 05.
Adult, HIV, HIV Infections blood, Humans, Japan epidemiology, Male, Mass Screening methods, Middle Aged, Prevalence, Reagent Kits, Diagnostic, Self Care methods, Sexual and Gender Minorities statistics numerical data, Tokyo epidemiology, Young Adult, Blood Specimen Collection methods, Dried Blood Spot Testing standards, Dried Blood Spot Testing statistics numerical data, HIV Infections diagnosis, HIV Infections epidemiology, Homosexuality, Male statistics numerical data, Postal Service, and Transportation methods
Background: Men who have sex with men (MSM) are at high risk of HIV infection. However, there are only few data on HIV prevalence in MSM in Japan. The objective of this study was to explore the HIV prevalence in MSM at Shinjuku 2-chome, a well known gay quarter in Tokyo. Methods: MSM directly collected the dried blood spot (DBS) self-collection HIV test kit from a drop-in center in Shinjuku 2-chome between August 2015 and December 2016. The participants collected their own blood by finger-prick and anonymously posted the kit to the laboratory. The participants accessed the study website and checked the results of their tests using unique ID and password. DBS was soaked in phosphate buffered saline overnight and the eluted sample was examined by the fourth generation HIV Ag/Ab test of LUMIPULSE (FUJIREBIO INC.), and followed by HISCL (Sysmex Corp.) when the first assay was positive. The result was defined provisionally positive if both were positive. Results: A total of 1702 HIV test kits were distributed and 1403 DBS were returned (return rate: 82.4%). Since 20.2% of participants collected the test kit more than once, the estimated number of actual test kit users was 1120. Based on the results of the test kit, 34 cases were provisionally diagnosed with HIV. The estimated prevalence was 3.04% (95% confidence interval: 2.03-4.04). Of these 34, 24 (70.6%) were later confirmed to be HIV-positive in the hospital, while the remaining 10 were lost to follow-up. Among the participants, 34.5% received HIV test for the first time. Especially in those aged 20-29, 46.0% were first time HIV testers. Conclusions: The prevalence of HIV infection in the study population was 3.04%. The high collection suggested a demand for this type of testing in MSM. The test should be expanded further to difficult-to-reach or hidden populations. Trial Registration: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry in August 20th, 2015 (Registry number: UMIN000018699 ).