Denver Public Health

Background and objective Although permanent surgical contraception via laparoscopic salpingectomy is commonly performed and associated with a substantial cancellation rate, the reasons for cancellation are poorly characterized. This study sought to examine patient-reported reasons for sterilization cancellation. Materials and methods Patients aged 18 to 50 who cancelled their laparoscopic salpingectomy at our academic county hospital and who were English- or Spanish-speaking were contacted for a qualitative interview. Inductive coding was used. Results Fifteen phone interviews were conducted between January 2023 and February 2024. Nine of the 15 participants (60%) were confident in their desire for permanent contraception, and eight of 15 (53.3%) continued to desire laparoscopic salpingectomy. The most common factor contributing to surgery cancellation among participants who desired permanent contraception was financial concerns, with insurance issues cited most frequently. Conclusions Some patients change their minds about undergoing salpingectomy. Financial concerns remain a barrier to receiving laparoscopic salpingectomy for permanent contraception, even with full insurance coverage or deeply discounted services.

Abstract Background People who inject drugs (PWID) are disproportionately affected by hepatitis C (HCV) but often do not receive treatment. HCV treatment in partnership with syringe service programs (SSPs) is one way to address this disparity. We implemented telehealth-based HCV treatment programs at 3 SSPs in Colorado and evaluated the effect of the programs on annual treatment rates for PWID with HCV in our safety net healthcare system.Figure 1.Hepatitis C Care Continuum for SSP-based Telehealth HCV Treatment Program Methods In November 2022, we began offering telehealth video consultations for SSP clients in Denver with self-reported HCV, along with on-site phlebotomy and medication storage. A pre-post analysis was completed to compare the proportion of individuals with evidence of HCV and injection drug use that received HCV treatment in our healthcare system in the year prior to the program (clinic-based treatment only) versus during the first year of the program (clinic-based plus SSP-based treatment). After the first year of program implementation, the program was expanded to 2 additional SSPs in Colorado (Boulder and Pueblo). Progression along the HCV care continuum was followed for all SSP program participants enrolled through April 2025. Results SSP-based telehealth for HCV treatment offered in addition to standard clinic-based treatment resulted in a higher proportion PWID treated for HCV throughout our healthcare system in the first year of program implementation compared to the year prior to implementation (30.1% [47/156] vs 20.1% [30/149], difference: 10.0%, 95% CI: 3.4% to 19.7%, p=0.04). To date, the SSP-based HCV telehealth program has been operating continuously for 30 months and has enrolled 117 individuals through April 2025. 64% of SSP HCV program participants (75/117) had HCV RNA detected, 88% (66/75) of those with +HCV RNA started treatment, 69% (52/75) completed treatment or were on treatment at the end of the study period, 43% (32/75) had evidence of sustained virologic response 4 weeks after the end of treatment (SVR4) (Figure). One individual experienced treatment failure and was retreated with a second-line regimen. Conclusion Telehealth-based HCV treatment at SSPs is a feasible approach to offering HCV treatment and may increase the proportion of PWID who receive HCV treatment in a safety net healthcare system. Disclosures All Authors: No reported disclosures

The National Network of STD Prevention Training Centers launched a 24 hours/7 days a week hotline pilot for consultations on syphilis during pregnancy and congenital syphilis. Most of the 28 urgent requests were from physicians (61%) in hospitals (54%), involving patients in their third trimester or recently born infants (82%).

The Centers for Disease Control and Prevention recommends test of cure (TOC) for persons with pharyngeal gonorrhea (GC) 7 to 14 days after treatment. We investigated the yield and feasibility of routine pharyngeal GC TOC to detect treatment failures. During May 2021-July 2022, 4 US sexually transmitted disease clinics implemented pharyngeal GC TOC. Sites collected demographic, clinical, and behavioral data on all treated pharyngeal GC and positive TOC cases. Cases were dispositioned with the suspected reason for positive TOC. To assess perceived feasibility, sites participated in qualitative interviews. During the study period, 1968 pharyngeal GC infections were diagnosed. Among 1829 treated cases, 97.3% (n = 1777) received ceftriaxone and 45.7% (n = 836) returned for TOC, varying by site (range, 35.5%-70.8%). Among those with TOC, 4.7% (n = 39) were positive by nucleic acid amplification test. Of these, 48.7% had culture attempted; 6 positive TOCs (15.4%) were also positive by culture. Most positive TOCs (66.7%) were attributed to reinfection (n = 13) or false-positive results (n = 13). Six (15.4%) were treatment failures. Four failed recommended treatment and had a positive culture: 2 were susceptible to ceftriaxone and 2 did not have antimicrobial susceptibility results. Seven positive TOC (17.9%) had insufficient data to disposition. Sites perceived TOC to be feasible, although substantial resources were required. Routine pharyngeal GC TOC yielded 5% positivity, although treatment failure was rare (<1%), and no cases of cephalosporin-resistant GC were identified. Low TOC return rates, limited culture collection, and limited culture yield highlight challenges to determining the cause of a positive TOC and the limitations of TOC in identifying cephalosporin resistance.