bluuebunny/crossref_metadata_2025 huggingface dataset:
P5-S7.06 Chlamydia screening implementation in the Netherlands is not cost-effective
Authors: Schmid B , Over E , van den Broek I , de Coul E O , van Bergen J , Group CSI , Kretzschmar M , de Wit A
Published: July 2011

Background

Chlamydia trachomatisis the most common sexually transmitted infection in western countries. Most infections are asymptomatic and may cause severe complications. In the Netherlands, 3 years of Chlamydia screening implementation (CSI) have been performed. Here, we model its cost-effectiveness after 10 years.

Methods

A cost-effectiveness analysis compares the relative costs and effects of two or more scenarios, and is usually expressed as the incremental cost-effectiveness ratio (ICER). The costs of the CSI program included those for hospital care, antibiotics, testing, and productivity loss. We measured the effects as either Major Outcomes Averted (MOA) or Quality Adjusted Life Years (QALY) gained. In the Chlamydia literature, MOAs usually consist of symptomatic pelvic inflammatory disease, chronic pelvic pain (CPP), ectopic pregnancy, infertility, and neonatal pneumonia. We calculated the ICER, the ratio of the above-mentioned costs and effects, for four scenarios: the default screening scenario (annual invitation of all 16–29 year olds), screening for women 16–29 only, for all 16–24 year olds, and biennial screening of all aged 16–29. To account for uncertainty in model parameters, we conducted a probabilistic sensitivity analysis (PSA).

Results

If we compare the results of the four different scenarios presented in the abstract P5-S7.06 table 1, the default scenario has the most favourable ICER. This is probably due to the fact that the total number of invitations (and thus people tested) per year is the largest in the default scenario, implying that the fixed annual program costs are spread over more tests (and outcomes), which improves the ICER. The cost per QALY of all four scenarios seems acceptable if we include CPP in our QALY estimate. However, the evidence base for CPP forming nearly 90% of all QALYs lost is extremely weak. Therefore, we prefer the cost-per-QALY estimate excluding CPP, which is 30 000–70 000. Considering previous decisions on population screening programs, this ratio is relatively high and cannot be regarded as cost-effective. However, these results should be interpreted with caution due to the weak evidence base for the disease progression model. Because of this, the PSA showed variability of the four ICERs of up to 50%.

Abstract P5-S7.06 Table 1

Results from the economic CSI model

Scenario:Total costs (M EUR)MOAs avertedQALYs gainedQALYs gained [w/o CPP]Costs/MOA (k EUR)Costs/QALY (k EUR)Costs/QALY [w/o CPP] (k EUR)Default6.9120016002105.64.332Women only6.26709001309.26.94916-246.666086092107.672Biennial6.482011001407.96.047

Conclusions

We conclude that the evidence base for cost-effectiveness of Chlamydia screening is less strong than appeared from previous Dutch and foreign research, because of the much higher costs per MOA.
P5-S7.07 Chlamydia screening in Cornwall: How often do young people get retested?
Authors: Turner K , Trela-Larsen L , Gates P , May M , Horner P
Published: July 2011

Aim

To analyse the uptake of screening and rescreening in Cornwall, UK within the National Chlamydia Screening Programme (NCSP).

Methods

We tested for any association between gender, age, test result and the probability of retesting. The time between tests was estimated using a Cox proportional hazards model and we tested whether the result of first test or gender influenced whether or not individuals were retested.

Results

Between 2003–2009, 66 513 tests in 46 950 individuals were analysed. Most people were tested once. During this period the number of tests increased dramatically and the positivity declined (shown in Abstract P5-S7.07 table 1). Compared with those negative at the first test, positive cases were more likely to be retested and were retested sooner. Abstract P5-S7.07 table 1 Positivity among those tested in Cornwall 2003–2009.

Abstract P5-S7.07 Table 12003–20042004–20052005–20062006–20072007–20082008–2009TotalTests4794615311 15812 86414 44317 10166 513Positive5898051086110312139935789Positivity0.12870.13760.10190.09010.08740.06040.0910

Discussion

We found that even in an area which has achieved high screening coverage, few people were re-screened. However, positive cases are more likely to be retested than negatives. This detailed county level analysis will provide information to policy makers to develop a long-term, sustainable and effective screening strategy.
P5-S7.09 Is abandoning urethral smear microscopy for the detection of non-gonococcal non-chlamydial urethritis in asymptomatic men a cost effective strategy?
Authors: Caffrey O , Saunders J , Estcourt C , Birger R , White P , Roberts T
Published: July 2011

Background

Asymptomatic non-gonococcal non-chlamydial urethritis (NCNGU) is common and can only be diagnosed by urethral smear microscopy. UK guidelines no longer recommend urethral smear microscopy in asymptomatic men, leaving men with this condition and their sexual partners untreated. The clinical and economic significance of this is unclear. We do not know if the costs of microscopy screening for asymptomatic NCNGU outweigh any future health benefits. We performed a model based economic evaluation to compare a screening strategy which includes microscopy to one which omits microscopy in asymptomatic men.

Methods

The economic model was from the perspective of the UK health service and so only direct medical costs and outcomes are included. A hypothetical cohort of asymptomatic men who present at sexual health clinics, or at primary care is assumed to haveChlamydia trachomatis,Neisseria gonorrhoeaeor NCNGU. In the economic model, untreated infections were taken into account for patients and their partners (pelvic inflammatory disease and tubal factor infertility in female partners). Probabilities and frequencies of these health events were informed by the outputs of a mathematical transmission model which used data from literature and national databases. A bottom-up costing estimated the cost for microscopy screening, while other cost inputs were sourced from published literature and online reference manuals for the economic evaluation. Appropriate sensitivity analyses were conducted to test the baseline results.

Results

Currently, there are no robust quality-adjusted-life-year (QALY) data to value STI outcomes. Consequently, results will be presented as cost per major outcome avoided and cost per infection avoided, where major outcome averted refers to PID, infertility and tubal factor infertility. Incremental cost-effective ratios will be interpreted based on accepted precedents.

Conclusions

The UK's current financial restraint has increased the importance of allocating resources based on need and value-for-money. This in turn, requires the UK health service to eliminate ineffective and inefficient services to create additional source of funding. Results from this study will indicate whether microscopy testing for asymptomatic men is good use of public money and whether funding for the service should be maintained.
P5-S7.10 Chlamydia screening coverage among American Indian and Alaska native women in the USA
Authors: Tulloch S , Taylor M
Published: July 2011

Background

Racial and ethnic minorities are often disproportionately affected by health disparities. In 2009, American Indian and Alaska Natives (AI/AN) had the 2nd highest rates of chlamydia in the USA. In an effort to eliminate health inequities and reduce the burden of disease, the US Centers for Disease Control and Prevention (CDC) recommends annual chlamydia screening for all sexually active women <25 while reducing screening among older less at-risk individuals. We sought to assess and describe geographic regional differences in how recommendations have been adopted across Indian Country to identify what opportunities exist for improving care within the Indian Health Service (IHS) National STD Program's Stop Chlamydia Project, a screening program that partners with IHS/Tribal/Urban Indian health centers (I/T/U) to enhance and expand chlamydia screening among AI/AN.

Methods

We calculated chlamydia screening coverage rates and associated per cent positivity for women <25 and >26 years of age screened through sites participating in the Stop Chlamydia Project by geographic region. Screening coverage was calculated using the 2009 Indian Health Services facility-level user population estimates as denominator values.

Results

Screening coverage among AI/AN women tested in Stop CT Project sites varied across geographic regions. Among women <25, rates ranged from 50.8% (Alaska) to 6.8% (California). Chlamydia positivity among this population also demonstrated variance across geographic regions ranging from 13.2% (Aberdeen) to 4.6% (California). Among >26-year-old women, similar levels of screening were seen ranging from 34.4% (Alaska) and 5.7% (Bemidji); however, significantly less positivity was identified (1.4%–5.6%) (Abstract P5-S7.10 table 1).

Abstract P5-S7.10 Table 1

Chlamydia screening coverage among AI/AN women (≤25 & ≥26) by geographic regions, Stop Chlamydia Project—2009

Geographic Regions# of Tests≤25% Positive≥26% PositiveAberdeen (IA, NE, NS, SD)859031.70%13.20%19.00%3.80%Alaska (AK)12 18550.80%8.60%34.40%2.50%Bemidji (MI, MN, WI)19010.90%5.00%5.70%5.60%Billings (MT, WY)263028.70%9.20%18.70%1.40%California (CA)1736.80%4.60%6.10%1.90%Oklahoma (KS, OK)221114.70%11.60%10.90%2.80%Portland (ID, OR, WA)206328.80%9.20%23.80%2.40%Southwest (AZ, CO, NM, NV, TX, UT)15 50629.30%9.40%27.70%4.00%Nashville (AL, AR, CT, DE, FL, GA, IL, IN, KY, LA, MA, MD, ME, MO, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WV)No participating sitesOverall Total43 54831.50%10.00%23.80%3.30%

Conclusions

This is the first time screening coverage for American Indian/Alaska Native women has been evaluated by geographic regions. These data can help inform program improvement activities to maximise screening outcomes by expanding testing among women <25 years old and limiting routine screening efforts in older women (>26 years old) in order to better utilise testing resources to expand coverage among those at greatest risk for chlamydia (<25 years old).
P5-S7.12 STD testing in emergency department: a novel method to provide test results
Authors: Arno J , Messina F , Perkins A , Allen A
Published: July 2011

Background

Realising the potential of broad based STD testing depends on treatment of those with positive results. Because emergency department (ED) physicians expressed reluctance to test for STD's because they had no mechanism for giving test results, we devised a system to provide results to patients tested for STD's at the county's public hospital by calling Bell Flower, the health department's STD program, to determine whether patients tested for STD's in the ED would call for their results.

Methods

An electronically generated individually modified referral note with instructions for calling Bell Flower for STD test results was given to all patients tested for STD's including gonorrhoea (GC), Chlamydia (CT) or syphilis, in the Wishard Hospital Emergency Department. The Bell Flower results clerk was given access to the hospital's electronic medical record system containing laboratory results. The clerk's access to a specific patient's results was recorded electronically by the system. Patient records accessed by the clerk were extracted and matched to patients given the discharge note. A patient was judged to have called if the clerk accessed that patient's test results. Continuous variables were compared using student t tests and proportions compared using χ2analysis. Because Hispanic patients used a different call mechanism, their data were excluded.

Results

From 1 January 2010 to 30 April 2010, 503 patients were given the STD referral note. Of these, 447 were >14 years old, not Hispanic and had complete medical record information. Of the 447 patients with analysable data, 146 (32.7%) called for test results. Age, race, sex, Chlamydia results or treatment and high risk zip codes were unrelated to whether or not a patient called for results. Of 65 patients infected with CT 33 (52.3%) were not treated in the ED of which 10 called. Of 45 patients with GC, 6 (13.3%) were not treated for it in the ED, of which 2 called. Patients infected with GC, were less likely to call for their results than those not infected (p=0.019), particularly those who were adequately treated in the ED (p=0.039).

Conclusions

Roughly one third of patients in one public hospital ED instructed to call for STD results called for them. Most of those infected with GC but not CT were treated appropriately with empiric antibiotics while in the ED. Infected patients calling in for test results could facilitate prompt treatment.
P5-S7.13 Royal Perth Hospital emergency department screening project forChlamydia trachomatis
Authors: Dykstra C , Fatvich D , Flexman J , Phillips M , McCloskey J
Published: July 2011

Background

Western Australian (WA) rates of Chlamydia are consistently higher than the national average and continue to rise. Chlamydia screening programs often miss hard-to-reach populations, including young men, indigenous peoples, and the homeless. The objective of this pilot study was to determine if screening patients for genital Chlamydia in the Emergency Department (ED) of a large metropolitan hospital is: feasible, able to access the hard-to-reach populations, and follow-up for treatment is possible Methodology Urinary screening for Chlamydia was offered to asymptomatic people aged 18–25 years who attended the Royal Perth Hospital (RPH) including visitors. Recruitment via a nurse-led strategy was compared to a patient self-initiated strategy. A resource package (including brochure and DVD) was designed to facilitate recruitment and screening, as well as to provide information on Chlamydia to those choosing not to participate. Options for notifying patients of their results have been evaluated (including text messaging and e-mail). Statistical analysis was performed using SAS.

Results

823 people (male 532, female 291, aboriginal 58) were recruited. Of these 10% were homeless and 35% had moved residences in the last 3 months. The indigenous population of 7.1% was greater than that of the State (1.9% 2006 Census). The recruited asymptomatic population had a Chlamydia prevalence of 5.4%. When the nurse-led vs patient self-initiated strategies were compared there was a 23.8 to 1 ratio of recruitment.

Conclusions

This study was able to access the hard-to-reach population. The nurse-led recruitment was the most successful strategy to gain access to this group. This cohort engaged in many risk taking behaviours including higher than expected rates of current smoking (45.7%), binge drinking (72.1% male and 42.8% female), never using condoms (26.3%) and recreational drug use (62.4% ever). Most people preferred to get their results by mobile phone (54.1%). This was a feasible ED screening method with respect to notification success. Less than 7% of this hard-to-reach population with Chlamydia could not be informed of their infection. A quarter of the cases of Chlamydia required augmented efforts to notify them of their infection. The analysis of the data indicates that for every day there is a delay in attempting contact there is a 7.7 times increased chance of not having a successful contact.
P5-S7.14 High Chlamydia and gonorrhoea incidence, reinfection and HIV infection among workers in the adult film industry: time to regulate and protect workers
Authors: Rodriguez-Hart C , Goldstein B , Aynalem G , Kerndt P
Published: July 2011

Background

Adult film industry (AFI) workers engage in prolonged and repeated unprotected oral, vaginal, and anal sex with multiple partners over short periods of time, creating ideal conditions for acquisition and transmission of sexually transmitted infection (STIs). Workers are often required to perform without condoms to maintain employment. Our objective was to estimate the annual cumulative incidence rate of chlamydia (CT) and gonorrhoea (GC), assess the rate of reinfection with CT and GC and describe past HIV outbreaks in the AFI.

Methods

CT and GC cases in AFI workers reported to the Los Angeles, California health department surveillance registry between 2004 and 2008 were retrieved. Using 2008 data, CT and GC annual cumulative incidence rates were calculated based on estimates of the worker population. For cases reported between 2004 and 2007, the CT and/or GC reinfection rates within 1 year were determined; all reported HIV cases from 2004 to 2010 were investigated.

Results

From 2004 to 2008, 2633 cases were reported among 1849 AFI workers. Lower bounds for the annual cumulative incidence rate of CT and GC among AFI workers were estimated to be 14 300 and 5100 per 100 000 workers, respectively. Reinfection within 1 year was 26%. Female workers were 27% more likely to be reinfected than males (Prevalence Ratio=1.27, 95% CI 1.09 to 1.48). Between 2004 and 2010, 10 HIV cases were reported. In April 2004, 3/14 female workers were infected (attack rate 23%) as a result of workplace exposure. In October of 2010, an acute HIV infection was diagnosed in a male who worked over an 8-week period with 14 performers, including two later found to be HIV infected.

Conclusions

CT and GC infection rates among AFI workers are high and repeat infection is common. Transmission of HIV in the workplace has been documented. This industry is not sufficiently regulated to protect workers from serious health risks.
P1-S2.06 HIV, sexually transmitted infections, and risk behaviours among clients of sex workers in Guatemala - are they a bridge in HIV transmission?
Authors: Sabidó M , Lahuerta M , Hernández G , Montoliu A , Gonzalez V , Giardina F , Monzón J E , Pedroza M I , Casabona J , Guevara R
Published: July 2011

Background

Clients of female sex workers (FSW) are an important target group for HIV/STI prevention. This study aimed to estimate the prevalence of HIV and other sexually transmitted infections (STI) prevalence in clients examine their risk behaviours and evaluate their role as a bridge population in the spread of HIV/STI.

Methods

Cross-sectional study conducted between 2008 and 2009 among 553 clients recruited through a two-stage convenient sample in commercial sex sites in the province of Escuintla, Guatemala. They were interviewed and tested for HIV and other STI. Bridge clients were defined as those who engaged in sex with both regular partners and FSWs but reported inconsistent condom use with FSWs whereas potential bridge as those reported consistent condom use with FSWs. Non-bridge clients engaged in sex with only FSWs. Multinomial and multivariable logistic regression models were used to identify risk factors associated with the bridge category and with having ≥1 STI/HIV, respectively.

Results

Half of the clients approached refused participation. Median age was 28.9 years; 57.7% had a regular partner, of whom 10.1% had concurrent non-commercial partnerships. Consistent condom use with FSW and regular partners was 72.5% and 17.1%, respectively. The main reason for not using condoms was trust (49.5%). Approximately 18% formed a bridge, and 40.0% a potential bridge. Among those who provided samples (70.5% a blood sample and 89.7% urine sample), prevalence of HIV, syphilis, gonorrhoea, chlamydia, and herpes simplex virus 2 was 1.5%, 1.0%, 0.8%, 5.5%, and 3.4%, respectively. Unprotected sex with FSWs and drug use just before sex were risk factors for having any STI (9.8% of participants). Bridge clients were significantly less educated, more employed, paid lower prices to the FSW just visited, and had a previous STI.

Conclusions

Clients showed high-risk sexual behaviour, a relatively high prevalence of HIV in clients compared to national estimates and a substantial proportion of them act as a bridge for HIV/STI transmission between FSW and the general population in Escuintla. Given that this is fuelling the current HIV epidemic, preventive interventions addressing this hard-to-reach group are urgently required. A significant challenge is to overcome the difficulty of reaching clients as well as to address the variety of high-risk behaviours among clients by partner type in this setting and take into account traditional concepts of masculinity.
P1-S2.08 Geography, mobility, work venue, and sexually transmitted infections among 4100 female sex workers in 20 cities in Peru
Authors: Mejia C , Campos P , Carcamo C , Garcia P , Hughes J , Martin D , Garnett G , Holmes K
Published: July 2011

Objectives

To estimate and compare prevalences of five STIChlamydia trachomatis(CT)Neisseria gonorrhoeae(NG),Trichomonas vaginalis(TV),T pallidum(syphilis), and HIV infection for female sex workers (FSW) according to home geographic region and mobility, and to identify other STI risk factors.

Methods

Data on geographic region, internal mobility (defined as having engaged in sex work in >2 Peruvian cities in the previous 12 months or was working away from their home city at enrolment), sex work characteristics, sociodemographics and, behaviours, were collected together with vaginal and blood specimens from 4100 FSW in 20 Peruvian cities. Multivariate analysis identified factors associated being infected with any of the five STI.

Results

FSW from the jungle region had higher prevalences of CT, NG, TV, syphilis, and HIV than FSW from the coastal or highlands regions. In univariate analysis, having worked in >2 more cities or working away from home were significantly negatively associated with having any STI. In multivariate analyses the mobility status variable showed a trend towards protective associations; neither remained significant. Risk of any STI was significantly and independently associated with bar/nightclub or street work, being from the jungle region, and not completing high school.

Conclusion

Findings suggest that internal mobility does not increase risk among Peruvian FSW. Preventive interventions should focus on FSW from the jungle region, those working in bars/nightclubs or on the street and those lacking secondary education to halt the spread of STI among FSW and, presumably, to the general population.
P1-S2.09 Who is at higher risk of STIs and HIV—brothel-based or street-based female sex workers? Evidence from two rounds of bio-behavioural surveys
Authors: Gautam A , Adhikary R , Ramanathan S , Goswami P , Khobragade S , Deshpande S M , Khazi S , Mainkar M M , Paranjape R S
Published: July 2011

Background

Female sex workers (FSWs) are considered a high-risk group for HIV and other STIs. Sex work practices of FSWs in Maharashtra are diverse and vary according to the sex work milieu (eg, street-, brothel- and bar-based). We examined changes in HIV and STI prevalence, associated risk behaviours and socio-economic variables among street-based (SB) and brothel-based (BB) FSWs in Maharashtra.

Methods

Two rounds of cross-sectional surveys were conducted in 2005 (R1) and 2009 (R2) in selected districts of Maharashtra. Probability sampling methods, such as conventional and time-location cluster sampling, were used to sample 2257 (1212 BB and 1045 SB) FSWs in R1 and 2228 (1182 BB and 1046 SB) FSWs in R2. Sexual behaviours were assessed, blood and urine samples were collected to measure the prevalence of HIV,Neisseria gonorrhoeae(NG),Chlamydia trachomatis(CT) and syphilis. Changes were analysed using bivariate and multivariate methods.

Results

HIV prevalence increased significantly among SB FSWs from 17.2% in R1 to 24.3% in R2 (OR 1.54, p=0.04), whereas among BB FSWs, there was no significant change (28.4 in R1 to 28.9 in R2, OR 1.03, p=0.88). Prevalence of active syphilis (TPHA and RPR positive at any titre) declined among BB FSWs from 15.4% (R1) to 11.0% (R2) (OR 0.67, p=0.05), while the decline among SB FSW was not significant (R1—13.6% to R2—10.6%; OR 0.75, p=0.22). NG prevalence fell from 7.7% (R1) to 3.9% (R2) (OR 0.48, p=0.006) for BB FSWs, whereas for SB FSWs, it declined from 7.2% in R1 to 4.2% in R2 (OR 0.56, p=0.07). No significant change was observed in the prevalence of CT in either group. Self-perceived risk of HIV among BB FSWs increased from 52.5% (R1) to 62.5% (R2), (OR 1.5, p=0.02); whereas among SB FSWs, it was unchanged (49.8% in R1 to 50.3% in R2; OR 1.02, p=0.23). The proportion of illiterate BB FSWs decreased from 80.1% (R1) to 74.3% (R2), (OR 0.72, p=0.02) while for SB FSWs, illiteracy increased significantly from 64.4% (R1) to 77.1% (R2), (OR 1.86, p<0.001). The proportion of FSWs having more than 10 clients per week was same over both rounds for BB FSWs but for SB FSWs, it increased significantly to 49.9% (R2) from 32.8% (R1) (OR 2.04, p<0.001).

Conclusion

SB FSWs are at higher risk of contracting HIV and other STIs and are more vulnerable compared to BB FSWs. Prevention interventions must account for differences in profiles, risk behaviours and sex work typology to customise strategies for these groups for maximum impact.
P1-S2.11 High prevalence of HIV, other sexually transmitted infections and risk profile in male commercial sex workers who have sex with men in the Netherlands
Authors: Cuypers W J , Niekamp A M , Keesmekers R , Spauwen L , Hollman D , Telg D , Dukers-Muijrers N , Hoebe C
Published: July 2011

Background

Little is known about the epidemiology and burden of sexually transmitted infections (STI) in male commercial sex workers who have sex with men (MSM-CSWs) in the Netherlands and other Western countries. MSM-CSWs are often hard to reach for prevention and STI testing. This feasibility study aimed to reach MSM-CSWs, assess their socio-demographics and prevalence of HIV and other STI, and their risk profile.

Methods

Retrospective, cross sectional study. Demographic and STI diagnosis data were retrieved from standardised medical records of MSM-CSWs consulted during outreach activities by a public health service in Southern Limburg, The Netherlands (2009 and 2010).Chlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) were diagnosed by NAAT and serology was performed for HIV (HIV-Ag/Ab), syphilis (TPPA, FTA-ABS, VDRL) and hepatitis B (anti-HBc and HBsAg).

Results

In 2009 and 2010 139 consultations by 99 MSM-CSW were performed. Their median age was 23.6 years; 56% of participants were of Romanian nationality, 20% of other (East) European nationality, 16% of South American nationality and 8% of Dutch nationality. Of participants, 50% self identified as homosexual, 33% as bisexual and 17% as heterosexual. All MSM-CSWs were tested for STI. Resultsof testing at first time consultation revealed that 45.5% was diagnosed with at least one STI—infection with CT was most prevalent (18.2%), followed by infection with NG (12.1%) and HIV (11.1%). Of participants, 24.2% had evidence of exposure toTreponema pallidum; half was infectious at time of diagnosis. Of participants, 28.3% had evidence of previous exposure to hepatitis B virus (anti-HBc positive); 8.1% was infectious at time of diagnosis (HBsAg positive). 24.2% was fully vaccinated against hepatitis B.

Conclusions

Identification and recruitment for STI testing and prevention of this population at high risk for HIV and STI is shown to be feasible. Follow-up and retention appears to be a challenge. MSM-CSWs who have sex with men pose a serious STI acquisition and transmission risk regarding MSM-CSWs users. Further research is urgently required to address the needs of MSM-CSWs and explore prevention strategies. Furthermore, targeted health education to encourage safer sex is needed.
P1-S2.12 Improving access to STI care among female sex workers by strengthening service provider networks in Bangalore, South India
Authors: Shetti B , Sunil P , Bhattacharjee P , Moses S , Prakash K H , Vidyacharan M
Published: July 2011

Background

The Karnataka Health Promotion Trust, in partnership with non-governmental and community-based organisations, has been implementing a focused HIV prevention project among female sex workers (FSWs) in Bangalore since 2005. Over 25 000 distinct female sex workers have been contacted to date, and approximately 10 000 distinct FSWs are regularly contacted each month. The majority of FSWs are street-based and home-based, and are dispersed throughout the city. In the first 3 years of the project, STI services were provided through eight program-linked clinics located in program drop-in-centres, and 20 external referral doctors. Discussions with FSWs indicated that distance and inconvenient timings of the clinics were major barriers to accessing STI services. A strategy was therefore developed in 2008 to expand the network of referral doctors. Referral doctor networks were established at sites based on recommendations made by FSWs, both in government facilities and in private clinics. A total of 70 referral doctors (preferred providers) were identified and trained to provide quality STI services. We evaluated the outcome of this changed strategy.

Methods

Indicators related to STI services provided and their accessibility were extracted from the program's computerised management information system (CMIS).

Results

Following the change in strategy, average monthly clinic visits by FSWs increased from 16% to 28% of the total available population. Quarterly clinic visits increased from 41% in 2008 to 63% in 2010. Administration of presumptive STI treatment for newly identified FSWs increased from 35% in 2008 to 58% in 2010. Focus group discussions with FSWs indicated that they are more comfortable in accessing clinic services, as the preferred providers are closer to where they live and work, and are available at more convenient times, especially in the evenings. This resulted in the higher levels of service coverage. The sex workers also indicated that, although services currently are provided at no charge to them, they would continue to access them from the preferred providers if the project ended, even if they had to pay for the services.

Conclusions

Establishing a network of referral doctors who have been identified and sanctioned by the FSW community has complemented program-linked STI clinic services in the context of a large-scale HIV prevention program in the city of Bangalore, and has made STI services more accessible.
P1-S1.07 Multiple bacterial sexually transmitted infections in Ontario, Canada
Authors: Lee C , Whelan M , Achonu C , Bhanich-Supapol W , Christian J
Published: July 2011

Background

In 2009, there were 33 000 reported cases of chlamydia, gonorrhoea and infectious syphilis in Ontario. These reportable bacterial sexually transmitted infections (STIs) represented approximately 48% of all reportable disease cases reported in Ontario that year. A significant amount of resources is expended on public health case and contact management of bacterial STIs. The objective of our study was to use routine surveillance data from Ontario to quantify the incidence of persons with reported multiple bacterial STIs in Ontario from 2006 to 2009 in order to inform future public health interventions.

Methods

All bacterial STI records from 2006 to 2009 were extracted from Ontario's integrated Public Health Information System (iPHIS). Multiple STIs were defined as repeat bacterial STIs or infection with a different bacterial STI in the same individual. Repeat STIs were defined as diagnoses of chlamydia or gonorrhoea more than 28 days after the previous infection. The data were analysed using PASW 18 for Windows (SPSS Inc.).

Results

There were almost 100 000 unique clients with at least one bacterial STI from 2006 to 2009 representing 113 097 STI cases. Approximately 24% of STI cases reported from 2006 to 2009 occurred in individuals with multiple STIs during the same timeframe. However, clients with multiple STIs accounted for only 12% of the total number of clients reporting at least one STI in this 4-year time period and clients with three or more STIs only accounted for 2.4% of all clients. The majority of clients (∼60%) with multiple STIs were infected within one year of their first STI. On average clients with multiple STIs had more sexual contacts recorded for their first STI than those clients who only had one STI (1.44 contacts vs 1.33 contacts, p<0.001). There was no difference in the number of clients lost to follow-up when comparing clients with only one STI to those with multiple STIs (p>0.9).

Conclusions

Public health resources may be well spent in case and contact management because almost 90% of individuals only have one STI reported. However, individuals who have multiple STIs account for a substantial proportion of reported bacterial STI cases in Ontario. Further work to identify additional characteristics of individuals at risk for multiple STIs would aid in informing future public health interventions aimed at these high-risk individuals.
P1-S2.13 The impact of the 2010 Winter Olympic Games on sex work patterns, safety and sex worker vulnerability to HIV and sexually transmitted infections
Authors: Deering K , Chettiar J , Chan K , Taylor M , Montaner J , Shannon K
Published: July 2011

Background

Large-scale international sports events such as the 2010 Winter Olympics Games in Vancouver, Canada can have significant impacts on the vulnerability of sex workers (SWs) to HIV and sexually transmitted infections (STIs). SWs in Vancouver continue to face extreme vulnerabilities to violence and HIV/STIs. Despite significant focus on the social legacy of large-scale sports events, there is surprisingly limited research evaluating the impact of such events on sex work. This study therefore examined the impact of the 2010 Olympic time period on sex work patterns, safety and HIV/STI vulnerability of SWs in Vancouver.

Methods

Data were used from a screening questionnaire for a longitudinal cohort study of 230 SWs from January to July 2010. Bivariate and multivariable logistic regression was used to examine the impact of time period (pre/during-Olympics vs post-Olympics) on sex work patterns, safety and HIV/STI vulnerability in the last 30 days.

Results

Overall, the median age of respondents was 33 years (IQR—28–40), and 106 (51.2%) SWs were non-Caucasian. In multivariable analysis (after adjusting for social and environmental factors) in the pre/during-Olympics period compared to post-Olympics, we found significantly higher odds of respondents reporting more police stopping SWs without arrest (adjusted ORs[AOR]—3.95, 95% CIs 1.92 to 8.14), reporting a decrease in the numbers of clients available (AOR—1.97, 95% CI 1.11 to 3.48), reporting difficulty hooking up with clients due to road closures/construction (AOR 7.68, 95% CI 2.46 to 23.98) and a decrease in the numbers of clients available (AOR 3.59, 95% CI 1.79 to 7.19). We found no significantly increased odds in new/trafficked SWs in the Olympic time period.

Conclusions

There were significant changes in sex work patterns, safety and HIV/STI vulnerability of SWs immediately before and during the 2010 Winter Olympics compared to post-Olympics. Fears over an influx of new SWs or human trafficking appear to be unfounded. Displacement of SWs away from main streets/commercial areas has significant public health implications, since this previously has been shown to promote violence and coercive unprotected sex, and increase risk for HIV/STIs. Safer sex work spaces such as indoor brothels and policy reforms should be considered both in Canada and by other host countries of large-scale events to reduce the vulnerability of SWs to HIV from displacement and disruption.
P1-S2.14 Neisseria gonorrhoeaandChlamydia trachomatisRe-infection and associated risk factors among cohort of female sex workers in India
Authors: Risbud A R , Deshpande G R , Narayanan P , Parimi P , Das Anjana
Published: July 2011

Background

Neisseria gonorrhoea(NG) andChlamydia trachomatis(CT) infections can be completely cured by appropriate medication. Syndromic STI management often fails to cover asymomatic NG/CT infections. Additionally, Female sex workers (FSWs), due to their risky behaviour are vulnerable to repeated infections. Frequency of repeated infections with these pathogens was studied in a cohort of FSWs.

Methods

In 6 months prospective cohort study, FSWs aged 18–40 years were recruited from three STI clinics in two states in India as a part of Bill & Melinda Gates Foundation funded operational research. Vaginal swab specimens were collected in all visits and were tested for NG/CT by Gen-Probe APTIMA Combo II assay. Presumptive treatment for gonorrhoea and chlamydia at the baseline visit and syndromic STI management at all subsequent visits was provided during the study period. Re-infection was defined as a laboratory confirmed NG/CT infection occurring after 30 days from an initial confirmed positive test result.

Results

Of 417 FSWs recruited during 2008–2009, 360 made at least 1-monthly follow-up visit. At baseline and during follow-up, 184 were NG infected and 210 were CT infected see Abstract P1-S2.14 Table 1. A total of 39 (11.8%) NG re-infections and 30 (8.3%) CT re-infections were identified at follow-up visits. Among the factors studied, alcohol consumption (OR=2.4, p=0.01); relatively new to commercial sex work (within 3 years) (OR=2.16, p=0.03); had STIs in the past (OR=3.85, p=0.00) were significantly associated with the NG, CT re-infection.

Abstract P1-S2.14 Table 1

Re-infection frequency among female sex workers Cohort in India

NG-Re-infectionVisit 1Visit 2Visit 3Visit 4Visit 5TotalNo re-infection/Negatives4173432882441751467Re-infected (31–330 days)0017461239Total4173602922501871506CT-Re-infectionNo re-infection/ Negatives4173462822501811476Re-infected (30–291 days)0014100630Total4173602922501871506

Conclusion

High frequency of NG and CT re-infection among FSWs highlights the need for regular screening for etiological diagnosis for effective treatment. New sex workers and those consuming alcohol need special attention in STI management.
P1-S2.15 Prevalence of condyloma acuminatum and certain sexually transmitted diseases among female sex workers (FSWs) in a cohort study at sexually transmitted diseases dispensary (DIST) in Cotonou, BÉnin
Authors: Nassirou N , Diabate S , Akakpo J , Tremblay C , Alary M
Published: July 2011

Background

Condyloma acuminatum usually diagnosed among FSWs, represents an entrance for HIV infection. This study aimed to determine the prevalence of condyloma acuminatum and factors associated with its appearance among FSWs who attended this STI dispensary.

Methods

From September 2008 to March 2010, each FSWs of the cohort at recruitment was probed with a questionnaire on her sexual behaviours, social and demographic characteristics, to provide a blood sample for HIV screening, vaginal and cervix samples for gonorrhoea and Chlamydia screening. Prevalence of condyloma acuminatum, HIV, gonorrhoea and Chlamydia were performed. Analysis unites and multivariates in logistic regression have been performed to estimate the influence of these factors in the appearance of condyloma acuminatum among FSWs in DIST.

Results

Among the 403 FSWs enrolled, the prevalence of condyloma acuminatum was 5.2%. The one of HIV infection was 37%. Prevalence of gonorrhoea and Chlamydia were nil. This remark certifies the high level of condom use (87.3%) among FSWs. HIV infection was significantly associated with appearance of condyloma acuminatum in the cohort of FSWs attending the STI dispensary with an adjusted OR of 2.4 (95% CI= 0.90 to 6.43).

Conclusion

Condyloma acuminatum remains a way in HIV infection transmission. A meticulous check and treatment contributes to reduce HIV/AIDS risk.
P1-S2.17 Modelling the impact of rapid test syphilis screening among female sex workers in China
Authors: Mitchell Kate , Cox Andrew
Published: July 2011

Background

In China, female sex workers (FSWs) are hard to reach for public health interventions. STIs and syphilis (Tp) in particular, are now a major public health concern in China. Currently, diagnosis of active Tp requires laboratory tests, which have high sensitivity, are capable of diagnosing active Tp infection, but involve delays between testing and treatment. Such delays lead to a low proportion of FSWs returning for treatment. In contrast, rapid Tp tests can provide instant results, thereby offering the possibility of immediate treatment, but are generally lower sensitivity and cannot differentiate between active and previous Tp infection. In this study, we estimate the impact of using rapid tests to screen FSWs for Tp in a Chinese setting and compare the performance with lab-based diagnosis.

Methods

A deterministic model of Tp transmission among FSWs and clients was parameterised and fitted to data from the medium prevalence setting (Kaiyuan City). Random sampling of parameter uncertainty ranges was used to find multiple fits. Model fits were used to explore the epidemiological impact of providing rapid Tp testing and treatment for FSW at different annual coverage levels for 3 years, in comparison to using a high sensitivity lab-based test. Because of evidence for Tp rebounding following treatment, the impact of the intervention after it has ended was evaluated.

Results

The model projected the 3-year impact of annually screening 40% or 80% of FSWs with a rapid Tp test (sensitivity 87%) would result in a 46% (43–54%) or 69% (66–77%) relative reduction in Tp prevalence in this setting, respectively. The corresponding decrease in Tp prevalence among clients was estimated to be 2 to 3-fold less but more infections were averted among them. The Asbtract P1-S2.17 figure 1 shows that for a lab-based testing strategy to achieve the same impact as using a rapid test with 87% sensitivity would require a return rate of 92% or 98% if the delay in treatment was 1 or 2 weeks, respectively. After screening ceases, the model projects the percentage of infections averted would continue increasing for a number of years in this setting.Asbtract P1-S2.17 Figure 1

Required return rate for lab-based gold standard test to have same impact as a rapid test for different delays in treatment. Different lines are for different delay periods between testing and treatment for the lab test - thick line, 0 weeks; dashed line, 1 week; dotted line, 2 weeks; narrow line, 4 weeks.

Conclusions

In a moderate Tp prevalence setting, a rapid test point of care intervention could have considerable impact on Tp transmission. Unless there is very low sensitivity for the rapid test and a very high return rate for the lab-based method of screening, the rapid test intervention will provide a greater relative reduction in Tp prevalence.
P1-S2.18 Syphilis prevalence and related risk factors among female workers at social venues in Liuzhou, China
Authors: Li J , Chen X S , Gandhi A , Suchindran C , Weir S
Published: July 2011

Background

In the context of rapid urbanisation and economic growth in China, places where social mixing intersects with commercial activities could play an important role in the formation of new partnerships and spread of sexually transmitted infections (STIs) including HIV. People who work at such venues may be at higher risk of STIs. A study was conducted from October 2009 through February 2010 in Liuzhou, China to estimate the prevalence of syphilis and related risk factors among females working at places where people go to meet new sexual partners.

Methods

Using a two-stage venue-based sampling method called PLACE, data were collected through interviews with 656 females nested within 36 venues with a minimum of five females per venue. A venue was classified as a “sex venue” if the manager or at least one of the females reported solicitation of commercial sex at the venue in the past 4 weeks. All respondents were screened for syphilis onsite using a rapid treponemal-specific test which represents lifetime syphilis infection acquired at anytime. Multi-level regression modelling was used to examine individual and venue correlates of syphilis infection and to account for clustering.

Results

23 of the 36 venues were classified as sex venues. Among all females, those working at sex venues and at venues with no report of sex work, the weighted lifetime syphilis prevalence was 5.8%, 16.3%, 0.5% respectively and the reported average number of new sexual partners in the past 4 weeks was 1.5, 4.4, 0.1 respectively. After adjusting for other individual characteristics and clustering, two venue-level factors, that is working at sex venues (AOR 24.0, 95% CI 2.5 to 227.6), working in venues located in rural counties (AOR 3.6, 95% CI 1.2 to 10.9), and two individual correlates, ie, self-report of sex work (AOR 2.3, 95% CI 1.0 to 5.3) and being in elder age groups (AOR 7.0, 95% CI 1.5 to 32.2) were significantly associated with risk of lifetime syphilis infection.

Conclusions

Females working at social venues had a high rate of new sexual partner acquisition and a high prevalence of lifetime syphilis infection. Females working at sex venues or venues located in rural counties were at relatively high risk of syphilis infection, despite whether they reported engaging in sex work. An intervention strategy focused on the places where social mixing occurs rather than risk group status may contribute to the prevention and control of HIV/STIs in China.
P1-S2.19 Unprotected fellatio and pharyngeal gonorrhoea in Sydney sex workers
Authors: Read P J , Wand H , Guy R , McNulty A , Donovan B
Published: July 2011

Background

Sex workers are a priority population in the WHO sexually transmitted infection (STI) global strategy. In Australia, condom use for vaginal sex has remained high over the past decade rates in sex workers with corresponding low rates of STIs. In recent years, there have been anecdotal reports of Sydney sex workers increasingly reporting unprotected fellatio with clients which has coincided with an increase in cases of pharyngeal gonorrhoea in these women. The aim of this study was to investigate the extent and predictors of inconsistent condom use for fellatio at work, and rates of pharyngeal gonorrhoea among sex workers attending a large sexual health clinic.

Methods

All female sex workers reporting fellatio at work seen at the Sydney Sexual Health Centre from May 2009 to January 2011 were included. Demographic data, risk behaviours and STI diagnoses were extracted from the clinic database. Pharyngeal gonorrhoea cultures were collected routinely. Multivariate logistic regression analysis was used to determine predictors of inconsistent condom use for fellatio at work.

Results

There were 1539 sex workers seen during the study period—most (n=1142, 74%) worked in brothels and 24% reported inconsistent condom use for fellatio at work. Significant independent predictors of reporting inconsistent condom use for fellatio at work were being a new client at our clinic (compared to an existing client) (adjusted (AOR) 2.66, 95% CI 2.08 to 3.44), speaking a Mandarin or Cantonese language (AOR 3.01, 95% CI 1.67 to 5.42), inconsistent condom use for vaginal sex at work (AOR 12.54, 95% CI 7.32 to 21.48), and being older than 40 years (AOR 2.85, 95% CI 1.91 to 4.25). Thai language speakers were less likely to report inconsistent condom use for fellatio (AOR 0.44, 95% CI 0.23 to 0.83). No significant association was demonstrated for injection drug use or sexual practice outside of work. During the study period 17 of the 1539 sex workers (1.1%, 95% CI 0.6 to 1.8) were diagnosed with pharyngeal gonorrhoea.

Conclusions

These finding suggest interventions to promote condoms for fellatio by sex workers are needed. We could not determine if inconsistent condom use for fellatio at work was directly associated with pharyngeal gonorrhoea due to the low sample size of cases. Further research into the determinants of this behaviour, particularly among different language groups is warranted.