bluuebunny/crossref_metadata_2025 huggingface dataset:
P5-S5.06 Population-based partner services for men who have sex with men (MSM) with gonorrhoea or chlamydial infection: a missed HIV prevention opportunity
Authors: Golden M , Stenger M , Kerani R , Dombrowski J , Stekler J
Published: July 2011

Background

Few US health departments provide partner service (PS) to persons with gonorrhoea (GC) or chlamydia (CT). We sought to define the potential utility of providing PS to MSM with GC or CT as an HIV prevention intervention.

Methods

We analysed public health reporting and PS data from WA State, USA, 2007–2010 to evaluate whether provider initiated case reports could identify MSM with GC or CT, to assess engagement in HIV care among MSM with STIs previously diagnosed with HIV, and to determine how often MSM HIV test when diagnosed with GC or CT. Estimates of previously diagnosed HIV, engagement with care, and HIV testing were derived from a random sample of cases weighted to reflect cases' residence and receipt of care in the King County STD clinic. We linked STI and HIV reporting data to estimate the risk of subsequent HIV diagnoses among MSM reported with GC or CT.

Results

Medical providers recorded the gender of cases' sex partners on 19 000 (68%) of 27 762 case reports on men with GC or CT, 4281 (22%) of which indicated that the case had sex with men. Case report and PS interview data on cases' sexual orientation agreed in 6711 (96%) of 6999 cases for which both data sources were available (κ=0.90). Agreement was higher for STD clinic cases (κ=0.98) than for other King County cases (κ=0.86) or among men outside of King County (κ=0.68). Among a random sample of 1103 cases identified as MSM in both case report and PS data, 25% were previously diagnosed with HIV, of whom 87% were in care and 63% were on antiretrovirals. Among MSM without a prior HIV diagnosis, 55% reported that they HIV tested when diagnosed with GC or CT. The proportion of MSM who HIV tested was higher STD clinic cases (82%) than among other King County MSM (57%) or MSM outside of King County (41%) (p<0.0001). Nineteen (3.3%) of 583 tested MSM were newly diagnosed with HIV. Among MSM without a prior HIV diagnosis who were not diagnosed with HIV at time of their GC or CT diagnosis, the subsequent rate of new HIV diagnosis was 2.5/100 person years. Among 1421 MSM diagnosed with HIV in WA State 2007–2010, 6.3%, 9.6%, and 11.9% had been reported with GC or CT in the 1, 2, and 3 years prior to HIV diagnosis, respectively.

Conclusions

MSM with GC and CT are an identifiable and accessible population at high risk for HIV acquisition and transmission who might benefit from efforts to increase HIV testing frequency and linkage to HIV care. Expanding PS for bacterial STI should be evaluated as a means to achieve these goals.
P5-S6.07 The management of syphilis and gonococcal infections among men who have sex with men (MSM) in a community medical center named “Centre Oasis, Ouagadougou, Burkina Faso”
Authors: Dah T T Elias
Published: July 2011

Background

“Centre Oasis” is a community medical center of an NGO named “Association African Soildarité” (AAS). It provides to MSM a framework for management and prevention of STIs and HIV/AIDS. The review of the NGO activities in the first half of 2010 showed high rates of syphilis and gonococcal infections, 21% and 17%. A special care of these infections has been established with the help of international and national partners in order to face this problem.

Methods

An active search for cases of syphilis and gonorrhoea among MSM who come in the center have made after obtaining their consent. They also answered a questionnaire. The search for gonococcie was by electron microscope on urethral and/or anal and/or buccal swabs. The syphilis infection was diagnosed by two tests recommended by WHO (VDRL and TPHA). The MSM who were positive for syphilis received antibiotics based Benzathine Penicillin (2.4 million IU intramuscular) and those who were positive for gonorrhoea received 400 mg of Cefixime. Doxycycline (100 mg×2 daily orally for 14 days) was given as an adjuvant therapy to treat a possible Chlamydia infection. The partner (s) of the positive subjects were also treated.

Results

Five months after the implementation of the program, we found prevalences of 12.2% for syphilis and 9.8% for gonorrhoea for a total of 316 consultations. In 71.1% of case the MSM had several sexual partners, 57% had used condoms during their last intercourse, 42% used lubricants (gels). 67.1% of MSM were bisexuals. All screened patients had received antibiotic treatment according to the protocols described above. 78% of identified partners had also benefited from antibiotic treatments in the medical center.

Conclusion

The MSM community in Ouagadougou is highly vulnerable given the high rates of syphilis and gonorrhoea. Such programs help to fight against STDs and HIV/AIDS but are not sufficient when we know the condition of the homosexual in African countries. It is time for national health policies to fight against STIs and HIV to take more account of the population of MSM.
P5-S6.11 HIV prevention with positives provider training in a resource-constrained setting: the US Virgin Islands
Authors: Canete A , Nagendra G , Chun E , Olans R , Ciprian T , Dreisbach S
Published: July 2011

Background

To describe HIV Prevention with Positives training for healthcare providers in the USA Virgin Islands (USVI).

Methods

The Caribbean region has the world's second highest adult HIV prevalence after Africa. In 2007, the prevalence rate of HIV among adults and adolescents in the USVI was 641.3 per 100 000 population. In the USVI, HIV clinical care is provided by three physicians at the USVI Department of Health or at community health centers. Due to a shortage of trained clinicians, non-clinical providers play a crucial role in the delivery of comprehensive HIV care. Ask Screen Intervene (ASI), a training curriculum, was developed by the National Network of STD/HIV Prevention Training Centers and the AIDS Education and Training Centers with support from Centers of Disease Control and Prevention. ASI was designed for clinical HIV providers and discusses risk assessment, STD screening, prevention messages and partner services for HIV+ patients. In June 2010, the Region II STD/HIV Prevention Training Center offered ASI in the USVI, in St. Croix and St. Thomas. ASI was targeted to clinical and non-clinical providers to encompass the range of providers caring for HIV+ patients. Participants completed an evaluation rating the training and a retrospective self-assessment of their confidence to perform learning objectives on a 5 point Likert Scale; 1=not at all confident and 5=very confident.

Results

A total of 37 providers attended training in St. Croix and 42 in St. Thomas. Non-clinical providers represented a significant proportion of attendees; 62.2% in St. Croix, (23/37) and 40.5% in St. Thomas (17/42). Among all participants, course satisfaction ratings ranged from 4.28 to 4.59 (1=strongly disagree; 5=strongly agree), with high ratings for relevance of learning objectives and appropriateness of content. Participants reported post-training gains in confidence ranging from +0.69 to +1.24 Likert scale interval per each learning objective, including increased knowledge of STD screening and prevention counselling for HIV+ patients. The most frequently reported intended practice changes included asking more detailed questions routinely about sex practices and taking a more thorough sexual history.

Discussion

ASI training reached the intended target audience and resulted in gains in provider confidence and intention to change practice, and can be expected to positively impact patient outcomes. Further dissemination of ASI training appears warranted.
P5-S6.13 Objective assessment of patient satisfaction with their HIV care
Authors: Land L , Ross J
Published: July 2011

Background

Patient engagement with HIV services is essential since early diagnosis and care has a direct impact on patient survival and also provides public health benefits associated with reduced infectivity. Positive physician/patient relationships have been linked to higher levels of treatment adherence. Determining and measuring patient priorities in the delivery of HIV services can therefore have a direct impact on perceived satisfaction with services and also improve clinical outcomes.

Methods

A systematic review was undertaken to identify existing approaches to identifying patient derived key themes in the delivery of their care. These themes were then examined and expanded using 4 focus groups discussions with HIV services users.

Results

A search of 12 bibliographic databases, a hand search of journal bibliographies and a wider internet search yielded 1474 titles from which 150 study abstracts were appraised. 32 articles were retrieved and reviewed using a quality appraisal checklist. A data extraction form was used by two reviewers to extract relevant information for thematic analysis. The review identified key themes of principal importance to patients attending for HIV care—medical staffs' perceived knowledge about HIV, attitude of clinic staff, maintenance of patient dignity, patient autonomy, confidentiality and an appropriate care environment. Three specific survey tools were identified for measuring satisfaction with HIV services but none had wide geographical validity or else failed to reflected current clinical management of HIV disease. The subsequent focus groups supported the findings of the literature review but following the introduction of HAART issues of staff knowledge about HIV were given less prominence.

Conclusions

Existing survey tools to measure patient satisfaction with HIV services lack validity or generalisability. The themes identified from this literature review and patient focus groups should be incorporated in the development of future assessment tools.
P5-S6.15 Social work services at New York City Health Department STD clinics
Authors: Ciprian T , Lifflander A , Sobin S , Kosovrasti M , Muzacz A
Published: July 2011

Objective

To describe the introduction of social work services in New York City Department of Health & Mental Hygiene Bureau of STD Control (NYC DOH) clinics.

Background

Each year the NYC DOH STD clinics serve over 120 000 patients. Services include free and confidential testing for HIV and other STDs, STD treatment, emergency contraception and the hepatitis vaccine. Social work services were introduced at the STD clinics in 2008 to address mental health and social service needs that often drive high risk sexual behaviour, such as substance abuse, domestic violence and untreated mental illness. Social work services include short-term counselling and referrals to outside agencies.

Methods

Patients are routinely screened for social work and mental health needs during interviews with physicians or disease intervention specialists (DIS), and are referred to a social worker or mental health counsellor assigned to the clinic. As appropriate, patients are provided with behavioural interventions utilising motivational interviewing techniques and short term counselling. Patients are also referred to local resources for additional services.

Results

Since July 2009, 471 patients were referred to the on-site social worker or mental health counsellor and 460 (97%) were evaluated. 40/460 patients (9%) received short-term counselling at a NYC DOH STD clinic. 200/460 patients (43%) were referred to local agencies specialising in domestic violence/sexual assault, public health benefits/health insurance to legal and housing services. 100/460 patients (22%) were referred to a health clinic and 120/460 (26%) patients were connected to mental health agencies. All 40 patients who received short term counselling at a DOH STD clinic returned for follow-up social work visits, independent of STD care.

Conclusion

In a busy STD clinic, social work services can be introduced and utilised by patients, allowing physicians and DIS to focus on clinical patient issues. Offering more comprehensive care may be expected to improve patient outcomes and care. Follow-up data are required to measure the long-term impact of these services on sexual risk-taking and on rates of STDs and HIV.
P5-S6.21 Acyclovir for managing genital ulcer disease in South Africa: experiences of guideline introduction, implementation and uptake
Authors: Emge D , Delany-Moretlwe S , Mayaud P
Published: July 2011

Background

Herpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer disease (GUD) worldwide. Treatment with acyclovir has been shown to shorten GUD duration, decrease plasma and genital HIV RNA levels and slow HIV disease progression in several trials. In South Africa, STI management guidelines were revised in 2008 to include acyclovir as first-line GUD therapy. However, acyclovir access appeared to be unequal across various settings. This study attempted to understand acyclovir access in South Africa from both a supply and demand perspective.

Methods

The study was cross-sectional and primarily qualitative. Three groups of participants were recruited to reflect acyclovir access and use: policymaker key informants, healthcare providers at public primary healthcare facilities and ART initiation sites in greater Johannesburg, and former HSV-2 treatment trial participants (both genders, HIV-positive and -negative). Information was collected following the WHO/Health Action International two-stage cluster random selection of health units through standardised questionnaires, complemented by in-depth interviews with selected stakeholders.

Results

Acyclovir was documented to be widely available. Challenges to access included the initial policy development and implementation process, staff training, accessibility and availability. The updated guidelines appeared to have been introduced with little high-level co-ordination and minimal staff training, although policymakers and staff thought that HSV-2 treatment was both efficacious and useful. Clinics did not experience drug stock outs. The demand for acyclovir appeared to be poor and influenced by limited knowledge of HSV-2 by the general public, negative perceptions associated with HSV-2 infection, adverse logistical factors like long waiting times at clinics and negative experiences with staff at clinics.

Conclusions

The South African guidelines were supported by local research evidence in line with WHO recommendations. Although little attention was paid to how the new guidelines had to be introduced, implemented and monitored, both the supply and prescribers' awareness improved rapidly. Access to acyclovir was undermined by poor demand from patients. Individuals possibly did not see herpes as enough of a problem to seek treatment. To ensure the success of new treatment approaches, it is essential to consider user and well as provider issues.
P5-S6.24 Comprehensive, competent and compassionate care for people living with HIV in coastal Andhra Pradesh
Authors: Washington R , Babu R
Published: July 2011

Background

Districts in coastal Andhra Pradesh, south India have the highest burden of HIV in both rural and urban areas. A comprehensive care program focused on improving clinical care and community outreach, complemented by a computerised management information system (CMIS), was implemented under the USAID supported Samastha project.

Methods

Four community care centres covering 19 mandals were chosen as project sites. A mandal covers about 25 villages. Doctors, nurses and other members of the care teams were trained using the adapted “Integrated Management of Adult Illness” package and followed up with clinical mentorship visits every quarter. All on-site staffs were trained on infection prevention procedures. At the community level, people living with HIV (PLHIV) were involved in community outreach focused on treatment adherence, accompanied referrals for management of opportunistic infections and social linkages for livelihood options and basic nutrition. Small support groups of 10–12 individuals were formed at village or cluster level. Minor ailments and illnesses were treated at the local primary healthcare centers. Each community outreach worker maintained individual line-lists and prioritised outreach and follow-up for an average of 125 PLHIV, including children infected or affected by HIV. 6–8 outreach workers were supervised by a counsellor.

Results

By the fourth year of implementation, 3257 PLHIV were registered with the project, of whom 1269 (38.9%) were initiated on Government supplied free ART. 2845 (87.3%) received nutrition support through education, supplementation and government schemes. 2085 (64%) were linked to social schemes such as widow pensions, bank loans or alternative livelihood options. Psychosocial support was provided to 2964 (91%) of the individuals registered. Loss to follow-up among those on ART reduced from 17% to <1% and annual death rates among those registered decreased from 21% to 4%. Success stories document the increased quality of life and ability to cope with stigma and discrimination.

Conclusions

People living with HIV can be engaged in effective outreach when they function as spokes from the hub of a community care centre. Community outreach complements facility based clinical care and a comprehensive approach that includes both a bio-medical and social focus can improve quality of life and minimise death.
P5-S6.25 Integrating HIV/AIDS, family planning, and reproductive health service into Nigerian communities
Authors: Traffina C I
Published: July 2011

Background

In response to the rapid and complex HIV/AIDS epidemic, EPIC/DOD- Nigeria expanded its focus on family planning and reproductive health (FP/RH) to integrate HIV/AIDS prevention and care activities in 2008. Approaches include the establishment of work place programmes. Whereby peer promoters are selected from among the personnel. The peer promoters undergo a 2-week training that enables them to provide FP/RH and HIV/AIDS- related information and services to their co-workers.

Methods

The objective of the assessment was to identify the benefits of the workplace Programme as perceived by workplace organisations, peer promoters, and workers. The assessment was designed to obtain qualitative information through focus group discussions and reviews of client registration books.

Results

Peer promoters educate workers during tea and lunch breaks. They also provide pills and condoms and refer to nearby clinics for injectables and other services. From 2008 to 2009, they served 2215 new family planning users in two sites mainly in the medical centers of Mogadishu cantonment- Asokoro - Abuja. Uptake of condoms is high-for dual protection against unintended pregnancy and STI/HIV/AIDS. Condoms are also available in workplace restrooms for soldiers and their families, especially at the Defence Health Club (DHC). Peer promoters are more than satisfied to provide this service, and say that since their involvement in the project, they know more about HIV/AIDS and other health issues. The management also acknowledges benefits of the Programme, both financially and in terms of workers health.

Conclusion

Many people working in military units and establishments in Nigeria have reproductive health and HIV/AIDS needs. Due to the characteristics and timing of their work, they have limited access to needed FP/RH and HIV/AIDS information and services. Workplace and Programme benefit managers, peer promoters and workers and others they should be expanded in other barracks and defence locations across the nation.
P5-S6.29 Intensive use of a clinical documentation audit tool to bring about sustained improvement in the standard of record-keeping in a busy genito-urinary medicine (GUM) clinic
Authors: Spice W , Whitby R , Bhaduri S
Published: July 2011

Introduction

Accuracy and consistency in clinical note-keeping is an essential element of clinical governance. In this busy GUM clinic, up to 12 different healthcare practitioners (both nurses and doctors) see patients for their history and examination, as well as taking tests, making microscopic diagnoses, giving treatment and notifying contacts. With this many staff of differing clinical backgrounds seeing patients autonomously, it is important that minimum standards of documentation are maintained. This study reports the use of an audit tool designed to provide clinic workers with regular feedback on their individual record-keeping performance compared to the clinic as a whole, thereby identifying areas where documentation standards can be improved.

Methods

The audit was started in January 2009 and carried out monthly for 12 months with three sets of clinical notes audited per clinician each month. Collective scores for the clinic were issued on a monthly basis, with individual clinicians also receiving their own scores confidentially every quarter. The audit was discontinued for a year, then repeated so as to evaluate the extent to which improvements made in the first year had been maintained. Clinicians were unaware that the re-audit was taking place. The audit was based on 31 separate criteria divided into administrative (7 criteria), clinical (20 criteria) and health adviser (4 criteria) sections. This report focuses on the outcome of the clinical section, which included criteria such as adequacy of history and examination records, choice of tests conducted, consistency of diagnoses with findings, and suitablility of treatments prescribed. The internal standard was set at 100% for each criterion.

Results

Overall scores for individual clinicians in the first month ranged from 72% to 96%, with median 82% and mean 83%. At month 12, the range was 87–100%, median 98%, mean 97%. The repeat audit conducted after a 12-month lapse revealed overall scores ranging from 89 to 100%, median 98%, mean 97%.

Conclusions

This study shows that it is possible to substantially improve standards of clinical record-keeping in a GUM clinic staffed by clinicians from a variety of backgrounds, through the intensive application of a wide-ranging audit tool and the use of individual feedback. The repeat audit conducted a year after the 12-month intensive phase shows that these improvements appear to be both sustainable and durable.
P5-S6.30 HPV catch-up vaccination among a community sample of young adult women
Authors: Manhart L , Burgess-Hull A , Fleming C , Bailey J , Haggerty K , Catalano R
Published: July 2011

Background

Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to catch-up vaccination exist.

Methods

A community sample of 428 women enrolled in a longitudinal study of social development were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22.

Results

19% of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (Adjusted Prevalence Ratio (APR) 2.5; 95% CI 1.7 to 3.8) and intention to vaccinate (APR 1.5; 1.2–1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4–0.9) or intention to vaccinate (APR 0.5; 0.4–0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.4–0.8) see Abstract P5-S6.30 table 4.

Abstract P5-S6.30 Table 4

Multivariable analyses of characteristics independently associated with vaccine initiation and intention to vaccinate among 428 young women who participated in the Raising Healthy Children (RHC) young adult survey during 2008 and 2009

Vaccine initiationIntention to vaccinateAPR (95% CI)*p ValueAPR (95% CI)*p ValueDaily smoker0.5 (0.30 to 0.90)0.02––Illegal drug use†0.3 (0.07 to 0.99)0.05––Pelvic exam in the past year2.3 (1.30 to 4.15)0.005Belief vaccine is <75% effective0.6 (0.39 to 0.95)0.030.5 (0.39 to 0.71)<0.001Peers strongly approve of vaccine2.1 (1.42 to 3.20)<0.0011.5 (1.15 to 1.91)0.002Currently attending school––1.3 (1.03 to 1.70)0.03>5 sex partners––1.3 (1.02 to 1.71)0.04Low perceived susceptibility to HPV––0.6 (0.43 to 0.80)0.001*

APR (95% CI) = adjusted prevalence ratio and 95% CI from Poisson regression with robust standard errors; adjusted for all characteristics listed in table. Further adjustment for the following characteristics made no appreciable difference in the estimates and were not included: race, education (self or parent), marital status, income, sexually active in the past 3 months, lifetime number of sex partners, condom use, history of HPV-related conditions, history of STD, religious preferences, physical health, mental health, binge drinking, and severity of or susceptibility to HPV infection.

†

Excluding marijuana use.

Conclusions

HPV catch-up vaccination uptake was low in this community sample. Increasing awareness of susceptibility to HPV and the high vaccine efficacy, along with peer interventions to increase acceptability, may be most effective.
P5-S6.33 HIV/AIDS impact mitigation in resource-poor settings: scaling-up a multi-sectoral response
Authors: Mwendwa A , Kyalo N , Kihara W , Mburu J , Mutua M
Published: July 2011

Background/issues

The HIV and AIDS epidemic constitutes not only the worst scourge and onslaught with which peoples in resource-limited places must contend; It also occurs in a context in which the effects of the epidemic and key issues which they engender are juxtaposed with a multiplicity of societal problems. Many high HIV/AIDS prevalence countries apparently remain unconvinced of the longer term impact of this epidemic, and have not yet developed strategies to cope with the obvious and incontrovertible impact of HIV and AIDS. Impact mitigation of HIV and AIDS is not high on the agenda of the many organisations which are involved in mounting a response to this epidemic. These organisations have assumed HIV/AIDS to be a public health issue and failed in many cases to recognise it for the socio-economic development challenge it more properly represents. Empirical research findings and Observations/In resource poor settings, greed and avarice of the political leadership overwhelms their responsibilities take urgent action to mitigate HIV/AIDS impact. There are small islands of dazzling abundance which exist side by side with a cheerless ocean of absolute poverty, dehumanising HIV/AIDS high prevalence rate and wide-scale social exclusion. Africa's famed traditional extended family system, exemplary at absorbing members under stress, is confronted with HIV and AIDS impact on every constituent part of its network and may reach breaking point without some assistance. This strain may have the effect of not only accelerating the reversal of development gains of the last decade but of fragmenting the very societal structure that has so far sustained marginal societies.

Conclusions/policy implications

There's the pressing moral, social, political and economic imperative to scale up the impact mitigation of HIV/AIDS among residents of poor areas. The immediate focus of managing the crisis of HIV and AIDS in resource-limited settings will impact every aspect of multi-sectoral, systemic functioning, response. The advent of a vastly improved prognosis of new classes of ARV drugs and their use in combination can dramatically improve rates of mortality and morbidity, prolonged lives, improved quality of life, revitalised communities and transformed perceptions of HIV/AIDS from a plague to a manageable, chronic illness in resource poor settings.
P1-S2.02 HIV prevalence in female sex workers in a focused HIV prevention project in Mumbai and Thane District, India
Authors: Bhardwaj S , Roy S , Gaikwad S , Ranebennur V
Published: July 2011

Background

Since 2004, FHI has been implementing Aastha, a Bill & Melinda Gates Foundation supported HIV/STI prevention project for 24 000 sex workers (SWs) in Mumbai and Thane. It provides STI services to approximately 11 000 SWs monthly. HIV counselling and testing services were strengthened from March 2009 and by October 2010, 13 669 individuals had been tested for HIV. This abstract discusses the prevalence of HIV in female sex workers (FSWs) registered with the project by age and typology. When the project commenced its intervention in 2004, the HIV prevalence in brothel-based FSWs according to the HIV Sentinel Survey 2004 was 44.76%.

Methods

From March 2009 to October 2010, 13 669 FSWs underwent voluntary counselling and testing for HIV. The results were analysed across age and typology. HIV tests were conducted and interpreted as per Indian national guidelines using three rapid tests.

Results

Of the 13 669 tested, 623 individuals tested HIV-positive for HIV (4.6%). Among the 623 HIV-positive individuals, 177 individuals (28.4%) were aged 18–24 years; 404 individuals (64.8%) were aged 25–36 years and 42 individuals (6.7%) were aged 37 years or older. By FSW typology, HIV prevalence was as follows—13.1% brothel-based; 3.3% bar-based; 4.7% street-based; 1.6% home-based; and 1.6% lodge-based. The difference in HIV prevalence is statistically highly significant across different typologies (p=0.0001). All the sex workers who tested HIV-positive and were willing to disclose their status were linked to care, support and treatment services.

Conclusions

In this study, overall HIV prevalence among sex workers was 4.6%. The highest HIV prevalence (13.1%) was observed in the brothel-based SWs. A change in the national policy for HIV testing for brothel-based sex workers from biannually to quarterly is recommended. Historically, in Maharashtra, it has been observed that brothel-based sex workers have high incidence and this has been corroborated even after scaling up testing in this group. Given this scenario and considering the duration of the window period in any high-risk group, we can inform policy-makers to increase the frequency of HIV testing. This will provide an opportunity for early testing and inclusion of newly identified HIV-positives for referral for care and treatment.

Abstract P1-S2.02 Figure 1

HIV prevalence by SW typology.
P5-S6.34 Provider characteristics associated with gonorrhoea treatment errors, Massachusetts, 2010
Authors: Swails J , Smock L , Tang Y , Hsu K
Published: July 2011

Background

Massachusetts experienced a 29% increase in gonorrhoea cases during 2010. In 4% of cases where treatment was known, treatment was inconsistent with public health guidelines. We examined healthcare provider characteristics associated with gonorrhoea treatment errors to help target future educational outreach strategies.

Methods

Case-control study where treatment error cases were defined as any patient 15–65 years of age, diagnosed with gonorrhoea in 2010, who did not receive ceftriaxone 125 mg or 250 mg IM or other approved cephalosporin regimen, or azithromycin 2 g PO. Two controls were randomly selected from patients who received correct treatment, matched to cases in regard to age, sex, and month of diagnosis. Data regarding exposures to various provider characteristics were collected from case report cards, provider licensing databases, and direct provider phone calls. Proportions of cases and controls were compared on the basis of provider training, years in practice, specialty, and practice type by χ2analysis or Fisher's exact test.

Results

76 cases were matched to 152 controls. In preliminary analysis, no differences were identified with respect to provider degree (MD/DO or NP/PA; p>0.25). More treatment errors occurred in private practice/health maintenance organisations compared to STD or family planning clinics (p<0.0001), emergency departments (p<0.0001), or community health centers/hospital clinics (p=0.0004). Among physicians, no differences were identified with respect to years since residency graduation (p>0.25). More treatment errors occurred with family medicine physicians compared to OB/GYN (p=0.0225) and emergency medicine physicians (p=0.0101), but not compared to paediatricians or internists see Abstract P5-S6.34 table 1.

Abstract P5-S6.34 Table 1

Analysis to date

Controls (n, %)Cases (n, %t)p ValueProvider degree NP/PA49 (45%)30 (41%)NS MD/DO59 (55%)43 (59%)Practice location Private practices/HMOs22 (18%)41 (56%)Reference STD clinics15 (13%)0<0.0001 Emergency departments40 (33%)11 (15%)<0.0001 Community health centers/hospital clinics43 (36%)21 (29%)0.0004Residency graduation year After 200027 (47%)15 (39%)NS 1990s16 (28%)13 (33%) Before 199014 (25%)11 (28%)Physician specialty Family Medicine5 (9%)11 (24%)Reference Paediatrics3 (5%)5 (11%)NS Internal Medicine10 (18%)10 (22%)NS OB/GYN18 (32%)7 (16%)0.0225 Emergency Medicine20 (36%)7 (16%)0.0101

Conclusions

Although gonorrhoea treatment errors were rare, specific practice locations and physician specialties were significantly associated with gonorrhoea treatment errors, suggesting important opportunities for educational intervention. Further studies may determine reasons for errors, relative importance of provider factors, and what systems support accurate treatment.
P5-S6.39 Integrating medication assisted therapy with buprenorphine and other harm reduction interventions into an urban public health department STD clinic in the Southwestern USA
Authors: Trigg B , Murphy M , Tsang A
Published: July 2011

Background

Public Health Department STD clinics often serve high risk populations that have limited access to treatment of opiate addiction using evidence-based medication assisted therapies (buprenorphine and methadone) and to other clinical preventive services. In Albuquerque, New Mexico, in the southwestern US, an urban STD clinic has developed an integrated buprenorphine induction program for injecting heroin users that prioritises those recently released from a county jail. Patients are also recruited directly from the STD clinic and from a co-located syringe exchange program.

Methods

Patients enrolled in the buprenorphine induction program who met specific screening criteria were tested for chlamydia, gonorrhoea, HIV, hepatitis C and syphilis. Patients who completed 2 months of buprenorphine were referred to primary care providers for continuation of treatment.

Results

In the first 2 years, a total of 291 patients received buprenorphine. 85 clients (29.2%) were referred to the program from public health programs including STD clinic, family planning and harm reduction. 67 (23.0%) were recently released from jail. Of the first 191 patients, 55 (28%) completed 2 months of buprenorphine treatment. 1 of 160 clients screened for syphilis were positive. 68 of 131 (51.9%) screened for hepatitis C were positive. 10 of 89 (11.2%) screened for gonorrhoea and chlamydia were positive for one or both infections. 194 were tested for HIV; none were positive.

Conclusion

An integrated STD clinic and opiate addiction treatment program can provide comprehensive services to a high risk population.
P5-S7.01 Exploring the acceptability of medical, educational and sport settings for STI screening: stratified random probability survey of young men in the UK
Authors: Estcourt C , Saunders J , Mercer C , Sutcliffe L , Hart G
Published: July 2011

Background

UK prevalence of STIs in young people is rising. Although a similar number of infections are diagnosed in men and women, men account for only 20% of National Chlamydia Screening Program tests. New strategies are required to increase uptake of STI screening in young men.

Methods

Stratified random probability survey of men (18–35 years) using computer-assisted personal- and self-interviews, including use of healthcare; sporting activity; acceptability of accessing urine/oral fluid self-taken tests for STIs and HIV in a variety of healthcare and non-healthcare settings.

Results

Data were collected from 411 (632 weighted) men median age 28 y; 39% aged <25 y. 29% and 20% of men had previously tested for STIs and HIV, respectively. Two-thirds of men <25 y had tested in the last year vs one-fifth of men >25 y (p<0.0001). 75% of men had seen their Family Physician within the last year. 91% of men would be willing to self-test for STI/ HIV. Primary Care settings (80%), sexual health clinics (67%) and pharmacies (65%) were the most acceptable test kit pick-up points. Further education settings were more popular than school settings as pick-up points (42% vs 28%) and the workplace was acceptable to 22% of men. Of the 391 (69%) men who reported playing sport in the last 4 weeks 18% found a sports club/centre acceptable. Among the 37% men who reported playing the most popular sport (soccer), 47% and 43% said they would be willing to pick-up STI and HIV test kits, respectively, from their club. This did not vary by whether they had previously tested for STI/ HIV.

Conclusions

Almost one-third of men under 25 have already tested for STI/ HIV. Most men have seen their Family Physician in the last year, which challenges the assumption that young men infrequently attend primary care. Primary care is a highly acceptable setting for STI/ HIV screening. Non-traditional settings such as soccer clubs are acceptable to some men but further research is needed to better understand the barriers and opportunities with this approach to testing.
P5-S7.03 Syphilis screening for high-risk groups in a large-scale HIV prevention program in India: uptake and trends
Authors: Parthasarathy M , Potty N , Gurung A , Das A , Parimi P
Published: July 2011

Background

Avahan, a large-scale HIV prevention program in India, provides syphilis screening as a part of its service package for high-risk groups (HRGs) including female sex workers, men who have sex with men (MSM) and injecting drug users through its targeted intervention clinics. The objective of this retrospective study was to understand the uptake and trends in reactivity patterns of syphilis screening tests at Avahan clinics from 2005 to 2009.

Methods

Syphilis screening was done with either Rapid Plasma Reagin (RPR test, provided on-site or through referrals to local laboratories) or a point-of-care immunochromatographic strip test (ICST) using whole blood. ICST was introduced to the program in 2007. The clinical records of the HRGs attending Avahan clinics in six high HIV prevalence states in India from January 2005 to December 2009 were collated in an “individual tracking sheet” database and analysed with STATA software version 10.

Results

The overall proportion of clinic attendees screened for syphilis increased consistently during the study period from 2.6% in 2005 to 21% in 2009. The increasing trend in uptake and actual proportions were similar in all risk groups. The use of ICST as a screening test increased from 8% in 2007 to 70% in 2009 thus becoming the predominant screening method. During this period, the uptake of syphilis screening also increased from 9% in 2007 to 21% in 2009 see Abstract P5-S7.03 table 1. A declining trend was found with the overall syphilis sero-reactivity rates (ICST and RPR), from 7% in 2006 to 4% in 2009 and this decreasing trend was found in all risk groups. The proportion of active high-titre syphilis (>1:8) to all reactive RPR tests (any titre) declined from 61% in 2005 to 30% in 2009.

Abstract P5-S7.03 Table 1

Uptake of syphilis screening by RPR and ICST

YearTotal individuals attending clinics# Screened for syphilis (%)Proportion screened with RPR (%)Proportion screened with ICST (%)200543 3941112 (2.6%)10002006108 8365700 (5.2%)10002007169 61215 179 (8.9%)91.88.22008220 87728 502 (12.9%)60.139.92009286 99160 412 (21.1%)30.869.2

Conclusions

The improved uptake of syphilis screening has lead to improved detection and appropriate management of cases of latent syphilis. The results show that introduction of rapid point-of-care tests likely contributed to the improved uptake of syphilis screening. Rapid tests may be considered for syphilis screening at other resource-constrained primary care sites in India such as targeted intervention and ante-natal clinics.
P5-S7.04 Who participates in the Dutch chlamydia screening? A study on demographic and behavioural correlates of (repeated) participation and positivity
Authors: de Coul E O , Götz H , Van Bergen J , Brouwers E , Fennema H , Hoebe C , Koekenbier R , van Ravesteijn S , Pars L , van den Broek I
Published: July 2011

Background

Achieving adequate levels of participation and capturing high risk groups are key stones for the effectiveness of large-scale Chlamydia screening programs. We examined the determinants of (repeated) participation and Chlamydia positivity to evaluate to what extent high risk groups were reached in a large scale Internet-based screening program in the Netherlands.

Methods

The Chlamydia Screening Implementation was initiated in three regions among people aged 16–29 years. Data from the first two screening rounds (2008–2010), in which approximately 280 000 persons were invited annually, were analysed. Socio-demographic and behavioural correlates of screening participation and positivity were studied in multilevel logistic regression models. Cluster was added as a second level of analysis, taking into account the effect of the neighbourhood-based invitations (to cover social or sexual networks).

Results

The same socio-demographic factors associated with lower screening uptake were also associated with higher Ct-positivity such as young age, non-Dutch origin, lower education, high community risk, low SES, in round 1 as well as 2. At the same time, behavioural risk factors such as having casual partners, ≥2 partners in <6 months, concurrent partners, and a history of STI, were associated with higher participation. A small cluster effect for screening uptake was observed, independent from community risk and individual risk factors. The model for repeated participation showed that men, Turkish/Moroccans and persons ≤20 years were less likely to participate twice, while people having a short-term relationship, a non-Dutch partner or concurrent partners were more likely to participate again. Ct-positives, who did not participate in the rescreening after 6 months, were also less likely to participate in the second screening round.

Conclusions

Socio-demographic factors associated with lower participation were also associated with higher Ct-positivity, showing that, high-risk demographic groups were more difficult to mobilise than low-risk groups. However, independent of this, higher behavioural risk levels were associated with higher participation rates (especially in the model for repeated participation), suggesting self-selection for screening based on the persons’ risk (perception) in both low and high community risk groups. Our study shows the complexity of the process—including individual as well as community factors and their interaction—as to whether or not be screened for chlamydia.
P1-S1.06 Rectal health: prevalence of rectal STIs and associations with clinical signs and self-reported symptoms
Authors: Gorbach P M , Javanbakht M , Fuchs E , Weiss R E , Hezerah M , Brown S , Voskanian A , Anton P , Cranston R
Published: July 2011

Background

Predictors of rectal health are needed for public health programs and planning rectal microbicide clinical trials.

Methods

From October 2006 to December 2008, 896 men and women in Los Angeles and Baltimore in a rectal health and behaviours study (UCLA IPCP U19 0606414) completed interviews and rectal sexually transmitted infections (STIs) testing including Gonorrhoea (GC), Chlamydia (CT) and high-risk human papilloma-virus (HR-HPV). Rectal signs detected by High Resolution Anoscopy (HRA) and self-reports of symptoms in the past month were analysed for associations with STIs (GC (n=7), CT (n=15) and HR-HPV (n=178)), demographics and receptive anal intercourse (RAI) in the past month. Those with active haemorrhoids were excluded (n=77) from analyses of STI predictors.

Results

SIGNS—Men reporting RAI (n=234) had a higher prevalence of swelling seen by HRA than men not reporting RAI (6.4% vs 1.9%; p value 0.02). Prevalence of erythema or haemorrhoids was lower among men reporting RAI (2.2% vs 6.8%; p value=0.02 and 18.3% vs 30.8%; p value<0.01 respectively). There were no differences in signs between women by RAI. More erythema and discharge were HRA detected among HIV-positive men; more HIV positive men and women than HIV negative had ulceration. SYMPTOMS—Significantly more RAI+ men reported symptoms (swelling, itching, burning and irritation) but there were no differences in reported symptoms among women by RAI. HIV positive men (n=218) and women (n=186) reported more symptoms (swelling, itching, discharge and burning) than HIV negative men and women; HIV positive men reported more pain and irritation than HIV negative men (n=227). STIs—No HRA detected signs were associated with rectal GC or CT. Bleeding (OR 5.06, 95% CI 1.09 to 23.45) and leukoplakia (OR 5.06 95% CI 1.22 to 25.66) were significantly associated with detection of HR-HPV. No symptoms were associated with GC or CT; discharge in the past month was associated with HR-HPV (OR 2.16, 95% CI 1.07 to 4.35).

Conclusions

Lack of association between signs or symptoms and prevalent rectal STI suggests syndromic approaches may be problematic requiring laboratory testing for detection of rectal STIs. Prevalence of signs varied little by RAI practice but there was a higher prevalence of self-reported symptoms among men reporting RAI. These findings can serve as a reference for expected rates to be found in clinical trials testing rectal microbicides and interpretation of adverse events.
P5-S7.05 Chlamydia screening in an international resort community: an outreach program to expand access
Authors: Collins M , Holehouse R , Kaczorowski J
Published: July 2011

Objective

To evaluate an event-based outreach Chlamydia (CT) screening program pilot developed to address barriers to access in a resort community with an international, transient and disproportionally large young adult population. A local sexual health clinic operates at capacity. There is no provincial or national outreach CT screening campaign.

Methods

Series of 15 outreach CT screening sessions, each 2–3 h duration, held in Whistler, BC, Canada in 2009 & 2010. Sessions were held at resort staff-housing dinners, staff-housing lounge, entertainment, educational and sport events. Men and women <30 years were offered free CT nucleic acid amplification tests on urine. Positive cases were notified, with treatment and partner notification per standard of care. Primary outcome measures were age, gender and infection rates of outreach participants compared to <30 age cohort tested for CT at the sexual health clinic during same calendar years. Anonymous, post-test survey queried interval since last CT test, intention to test, health insurance, and satisfaction with the outreach experience. Unpaired t test & χ2analysis.

Results

112 tests for CT were obtained through outreach; 87.5% response rate to post-test survey. Mean outreach age of 23.3 years was 14.4 months younger than comparison age cohort tested at clinic (p=0.0001). Males were tested at outreach in greater proportion than at clinic (57.1% vs 46.5%, p=0.04). Proportion of asymptomatic cases was greater at outreach than clinic (90% vs 46.6%, p=0.01), yet positive test rates at outreach (8.9%, 10/112) and clinic (8.5%, 58/686) were comparable (p=0.87). On survey, 43.9% had never previously tested for CT, 53.7% were not already considering a test, 61.7% would not have gone for a test within the next 2 months. Only 27.6% had Canadian health insurance. 93.9% were satisfied or very satisfied with CT screening in an outreach setting.

Conclusions

Intermittent, free, event-based outreach CT screening was operationally feasible, effective at increasing case detection, and highly acceptable to participants. Outreach attracted a younger age and more men than clinic. A large proportion of participants were first-time testers, over half were without prior intent to test or likelihood to test in near future, and most would have had to pay up-front for CT testing in a clinic setting. This study demonstrates both need and benefit of expanded CT screening efforts in the international resort setting.