bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S1.52 Incidence of Anal HPV and HPV-related sequelae in HIV-infected and uninfected US adolescents
Authors: Mullins T , Wilson C , Rudy B , Sucharew H , Kahn J
Published: July 2011

Background

Immunodeficiency related to HIV infection may place HIV-infected youth at increased risk of human papillomavirus (HPV) infection and anal dysplasia. Our objective was to determine incidence of anal HPV infection and related sequelae, and factors associated with these outcomes, among adolescents who are HIV-infected or -uninfected but at-risk.

Methods

We analysed data from the Reaching for Excellence in Adolescent Care and Health Project. Adolescents age 12–18 years who were behaviourally HIV-infected (n=319) or -uninfected but at risk (n=177) were recruited at 15 US sites from 1996 to 1999. Incidence rates for anal HPV, high risk anal HPV, anogenital warts, and anal dysplasia were calculated using Poisson modelling. Factors associated with these outcomes were explored using Cox proportional hazards modelling.

Results

Mean age at entry was 16.8 years, and mean follow-up time for detection of anal HPV infection was 22.4 months (SD 10.8). Most participants (76%) were female, and 70% were black non-Hispanic. HIV-infected women (vs -uninfected women) had higher incidence of anal HPV (30 vs 14 per 100 person-years; p=0.002), high risk anal HPV (12 vs 5.3 per 100 person-years; p=0.04), and anogenital warts (6.7 vs 1.6 per 100 person-years; p=0.002) but not anal dysplasia. Although incidence rates of these outcomes were consistently higher among HIV-infected vs -uninfected men, they did not achieve statistical significance. Factors associated with incident anal HPV, high risk anal HPV, anogenital warts, and anal dysplasia in women are shown in the Abstract P1-S1.52 table 1 below. No factors were associated with any outcome in men.

Abstract P1-S1.52 Table 1

Factors associated with incident anal HPV and HPV-related sequelae among women

OutcomeHIV-uninfectedHIV-infectedPredictorHR (95% CI)PredictorHR (95% CI)Anal HPVCervical HPV infection2.45 (1.01 to 5.92)NoneHigh risk anal HPVNoneSmoker3.46 (1.21 to 9.89)Late (vs early) CDC disease stage2.80 (1.18 to 6.67)Anogenital wartsNoneCervical HPV infection4.28 (1.29 to 14.19)HIV viral load1.55 (1.12 to 2.17)Anal dysplasiaNoneLate (vs early) CDC disease stage7.02 (2.18 to 22.59)Ever had high risk anal HPV infection3.72 (1.52 to 9.12)

Conclusions

HIV-infected women, when compared to HIV-uninfected women, had higher rates of HPV and related sequelae. Because HIV-infected youth are at increased risk of HPV and related disease, enhanced HPV prevention efforts, such as vaccination, are warranted for this group.
P4-S3.08 Development of a novel chimeric protein construct for improved diagnosis of syphilis
Authors: Smith B , Cameron C
Published: July 2011

Objectives

To develop a novel diagnostic protein in order to enhance early detection of syphilis infections and improve overall syphilis diagnosis.

Methods

Using pooled serum samples from patients infected with syphilis, immunoreactive regions of two previously identified diagnostic protein candidates, Tp0326 and Tp0453, were elucidated. Focusing on these regions, a chimeric protein construct was created for expression inEscherichia coliand expression conditions were optimised to produce soluble protein expression. This Tp0326/Tp0453 chimeric construct was screened against serum samples from; patients with primary, secondary, latent, and neurosyphilis and uninfected individuals. These results were directly compared to the rapid plasma regain (RPR) test, and the microhemagglutination assay forT pallidum(MHA-TP).

Results

Screening results show high degrees of sensitivity and specificity for the Tp0326/Tp0453 chimeric construct, identifying all stages of syphilis infection from early primary to late latent.

Conclusion

The Tp0326/Tp0453 chimera shows promise as a new diagnostic antigen for detecting all stages of syphilis infection and for development into point-of-care diagnostic test formats.
P4-S3.09 The prevalence ofTrichomonas vaginalisvirus (TVV) in globally distributedTrichomonas vaginalisisolates
Authors: Lezeau L , Conrad M , Gorman A , Carlton J
Published: July 2011

Objective

Trichomonas vaginalis, a highly prevalent non-viral sexually transmitted infection, has been shown to be infected by a double-stranded RNA virus known asT vaginalisvirus (TVV). The presence of this virus has been associated with increased trafficking of the immunogenic P270 to the surface of the parasite, and has therefore been hypothesised to be an important virulence factor in trichomoniasis. In the present study, we investigate the prevalence of TVV in globally distributedT vaginalisisolates and find an association between TVV infection and genetically distinctT vaginalispopulations.

Methods

150T vaginalisisolates from the USA, Mexico, Italy, Southern Africa, Papua New Guinea and Australia were screened for TVV infection by running total RNA extract on 1% agarose gels to detect the presence or absence of the diagnostic 4.5 kb dsRNA genome of the virus. The prevalence of TVV in genetically distinctT vaginalisphylotypes was compared using χ2tests.

Results

TVV was found to be present in 37% ofT vaginalisisolates. We find a difference in the prevalence of TVV infection between genetically distinct populations of parasites, with 3% of phylotype 1 isolates containing the virus vs 73% of phylotype 2 parasites (<0.001).

Conclusions

TVV prevalence varies betweenT vaginalisphylotypes 1 and 2. This finding has implications suggesting that TVV is transmitted vertically among parasites, as more closely relatedT vaginalisstrains are infected with TVV. Preliminary data also suggests that phylotype 2 parasites may show greater virulence, and further studies will be required in determining the role of TVV in this increased pathology.
P4-S4.01 Investigation of the bacterial diversity in urine of urethritis patients and healthy controls using 454 high-throughput-sequencing
Authors: Ahrens P , Frølund M , Al-Soud W A , Wikström A , Lidbrink P , Cullberg M , Sørensen S J , Jensen J S
Published: July 2011

Background

Non-gonococcal urethritis (NGU) is a common sexually transmitted disease in men but in 30–50% of NGU cases, no known organism is found. We have used 454 high throughput sequencing to analyse the micro flora in urine samples from cases of urethritis and from controls.

Methods

Urine samples from men, 10 patients with urethritis and >5 PMNL/hpf and 10 healthy controls with <5 PMNL/hpf, were collected. All samples were tested forNeisseria gonorrhoeae,Chlamydia trachomatis,Mycoplasma genitalium,Ureaplasma urealyticum,U parvum,Trichomonas vaginalis, Herpes Simplex Virus type 1 and 2 and Adenovirus using specific PCR assays. The V3 and V4 regions of the 16S rRNA gene were PCR amplified, tagged and sequenced using the Titanium kit and GS FLX pyrose-quencing system (Roche) according to manufacturer's instructions. Sequences were analysed using the RDP Pyrosequencing Pipeline and CLC Genomics Workbench.

Results

From each of the 20 samples, 8150 quality filtered sequences were randomly selected. Sequences were assigned to the genus level using the RDP Classifier. A total of 172 gen-era were identified, 133 in patients and 104 in controls. The median number of genera was 35.5 (19–49) in patients with urethritis compared to 25 (16–43) in the controls. No single genus was present in all samples. Members of the genera Pseudomonas and Sphingomonas were present in all the controls and in most of the patient samples. Also, representatives of the genera Brevundimonas, Micrococcus, Bradyrhizobium and Chry-seobacterium were present in 15–18 of the samples. Of the 172 genera, 77 were only found in a single sample and 33 were found in two different samples. Rarefaction analysis at the 5 % level (comparable to genus) suggested that all the controls and most urethritis samples harboured each between 31 and 125 different groups. Four of the urethritis samples apparently contained between 150 and 300 different groups.

Conclusions

Urine, even from healthy men, contains a very diverse micro-flora. Though not statistically significant, the total and median number of genera was found higher in patients with urethritis than in controls. Several widespread genera are likely to represent commensals and bacteria present in the environment.
P5-S1.02 Sexual risk behaviours and mental health concerns among HIV-infected MSM
Authors: Safran M , Guoyu T , Butler M , Hoover K
Published: July 2011

Background

Some HIV-infected MSM are at risk for acquisition and transmission of STDs because of ongoing high risk sexual behaviours. HIV-infected MSM also can experience psychosocial stressors and related mental health issues. We assessed the association between STD risk behaviours and the desire to discuss mental health issues, as reported by HIV-infected MSM currently receiving care in HIV clinics.

Methods

In 2007, 426 HIV-infected MSM receiving care in eight urban HIV clinics were randomly selected to complete a survey that queried them about risk behaviours and health concerns. We estimated the percentages who answered that they wanted to discuss their mental health with their clinicians, by sexual behaviour and substance use in the past year. Differences in percentages of patients were considered statistically significant if the two tailed p value was ≤0.05 using a χ2test.

Results

90% of patients had initiated care for their HIV infection more than a year ago. In the year preceding the survey, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had at least one HIV-uninfected partner, and 82% used illegal psychoactive drugs. Among those who reported anal intercourse, 39% did not use a condom during the most recent episode. Among patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not engage in unprotected receptive anal sex (80% vs 62%, p<0.01); those who engaged in unprotected insertive anal sex were also more likely to want a discussion (81% vs 63%, p<0.01).

Conclusions

Although the vast majority of these patients had been in treatment for more than a year, a large percentage of patients engaged in substance abuse and sexual behaviours that increase their risk of HIV transmission, and STD transmission and acquisition. Such patients were more likely to want to discuss their mental health concerns than those who did not engage in these behaviours. These findings underscore the importance of interventions to decrease risky sexual behaviour and to promote clinical assessment of mental health needs for this patient population. A mental health assessment can identify patients who might need greater psychosocial support or referral for treatment of substance abuse and underlying mental illness.
P5-S1.03 HIV status disclosure in family and determinants of stigmatisation in a conservative society
Authors: Rashid A , Adnan M
Published: July 2011

Background

National AIDS control of Pakistan and its development partner Canadian Government CIDA is seeking for effective AIDS surveillance. However, prevailing illiteracy and conservative societal norms are challenging factors in preventing HIV spread. Factors which lead to behavioural changes among people if they have been told of their HIV positive status are complicated and directly related to self-esteem and personal liberation.

Methods

We evaluated this complex phenomenon with an aim to identify factors that prevent a person to disclose his/her HIV status to family members. Effort was also made to characterise determinants of prevailing stigma at society level for HIV positive and PLHA. Self structured questionnaire with binary and multiple response items was used for data collection. Multivariate logistic regression was used to identify significant predictors of stigma at family and societal level.

Results

A total of 412 subjects (178 females and 234 males) were included in the study. Family level anticipated stigma items that were significantly associated with HIV test refusal were family perception, life partner perception, family break-up and neglect by family. Social indicators for prevalent stigmatisation were losing job and livelihood, bad treatment by the healthcare worker and difficulty in finding marital partner of choice (Abstract P5-S1.03 table 1).

Abstract P5-S1.03 Table 1

Association of HIV stigma with test refusal at personal level as predictors of family and social stigmatisation

Dependent variableAdjusted OR for HIV test refusal95% CIp ValueFamily level stigma indicators Life partner perception2.150.92 to 3.64<0.001 Family perception1.421.12 to 2.85<0.01 Family break-up1.161.02 to 2.88<0.05 Neglect by family1.831.32 to 2.41<0.01Social stigma indicators Losing job1.721.22 to 3.74<0.01 Livelihood loss1.050.29 to 0.65<0.001 Health worker treatment1.221.23 to 4.67<0.05 Marital life entry fallout2.410.39 to 2.16<0.05

Conclusions

The study concludes that prevailing stigma is the major hindrance for running effective AIDS surveillance program. Clinical programs to prevent HIV infection must be integrated with psychiatric care service as a policy to improve awareness and peoples' willingness for HIV testing.
P5-S2.01 Survey on knowledge, attitude and practices on male circumcision in Rwanda
Authors: Mbabazi J
Published: July 2011

Background

WHO/Joint United Nations Program on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyper endemic and AMC prevalence is low. The aim of this study was to provide evidences on knowledge and attitudes of non-circumcised men with regard to MC, and to determine the willingness to be circumcised among Rwandan men aged 15–59 years.

Methods

This cross sectional study was part of a large survey conducted in Rwanda in January 2010 by the Ministry of Health, to assess knowledge, attitudes and practices regarding MC in the general population (KAP). The data were collected independent of religions and participants were recruited from all of the five provinces of Rwanda and 29 out of 30 districts were covered The data were collected using quantitative technique and a structured questionnaire written in Kinyarwanda was administered and completed by 1098 men.

Findings

The study findings showed that the prevalence of circumcision is 16.5% (95% CI 14.3 to 18.7%) in the study population. This proportion is the highest in the City of Kigali (52.5%) and in the Western Province (25.9%). The district of Rusizi in the western Province has the highest rate of circumcised men in our study, compared to other districts (71%). Among 63.3% of circumcised men, the procedure was performed by a healthcare provider. An estimated 50.2% of uncircumcised men would consider being circumcised and 78.5% would support circumcision for their sons and uptake will steadily increase if services are provided. The main reason would be to prevent them to be infected with STIs (including HIV) and Hygiene. The major reasons preventing uncircumcised men to circumcise is being too old for that procedure, the fear of pain and not becoming sexually promiscuous.

Conclusion

This study demonstrates that male circumcision prevalence in Rwanda remains low although MC is a known and acceptable practice among the study participants. The major barriers to MC acceptability can be removed by effective interventions like education and social mobilisation. Interventions should also target women as they can play a key role in the decision making process about circumcision within their couples and families.
P5-S3.01 Developing a multi-pronged quality improvement (QI) strategy to increaseChlamydia trachomatis(CT) retesting rates: building a framework for success
Authors: Howard H , Barandas A , Creegan L , Bauer H , Chow J , Park I , Bolan G
Published: July 2011

Background

CT reinfection is common and linked with adverse reproductive sequelae. Despite strengthened national recommendations and clinician education efforts in California (CA), retesting rates remain low. Our objective was to use a systematic QI approach (assess, intervene, assure, evaluate) to build an effective, feasible, multi-pronged strategy for increasing CT retesting rates in the CA family planning (FP) setting.

Methods

We assessed underlying barriers to retesting using two data sources: (1) clinical encounter data from a CA FP program screening 1 million low-income women for CT annually was analysed to determine clinic return and retesting rates among female CT patients 1–6 months post-treatment; and (2) a survey of FP clinicians was used to identify retesting knowledge, attitudes, and practices. A pilot strategy designed from these findings was refined after iterative sessions with key clinic staff and evaluation of existing protocols and electronic systems at select sites.

Results

Claims data analyses revealed that while 60% of female CT patients returned to clinic 1–6 months post-treatment, only half were retested. Missed opportunities for retesting were associated with limited visits such as pregnancy tests and birth control refills. Clinician survey results showed that 79% did not prioritise CT retesting, only 33% utilised active retesting strategies, and 73% attributed low retesting rates to low patient return rates. A 4-pronged strategy was implemented: (1) to promote retesting as a high priority, medical directors were shown clinic data demonstrating high reinfection rates, high patient return rates, and low retesting rates; (2) clinic systems-level interventions were introduced (chart prompts, clinic practice tools, express STD screening visits); (3) all levels of clinic staff were trained to provide comprehensive counselling to CT-positive patients on reinfection, partner treatment, and practical ways to remember to retest; and (4) patient education materials were revised to improve readability and reinforce messaging. A detailed checklist was developed as a quality assurance tool to facilitate implementation of each intervention and ensure that any operational loopholes were closed. A plan for evaluating the strategy through future monitoring of retesting rates was developed.

Conclusions

By employing a systematic QI approach we were able to tailor specific interventions to address multiple underlying causes of low CT retesting rates.
P5-S3.03 Individual tracking among high risk groups for STI management in India: an analysis of 400 000 high risk groups followed from 2004 to 2009
Authors: Gurung A , Narayanan P , Mugundu P , Ranjan M , Kumar R , Prabhakar P , Das A
Published: July 2011

Background

Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation implemented a large HIV prevention program across six high HIV prevalence states among high risk groups (HRG) consisting of female sex workers (FSW), high risk men who have sex with men (HR-MSM), transgender (TG) and injecting drug users (IDU) in India.

Methods

The Avahan monitoring system included individual tracking data pertaining to registration, outreach and clinical services among HRG. All clinic visits were recorded using unique identification numbers, and visits by each clinic attendee were tracked from January 2004 to December 2009. Each clinic visit was recorded using a pre-defined clinical encounter form (CEF).

Results

A total of 439 000 individuals (including 331 616 FSW, 10 280 IDU, 82 246 H- MSM, and 7330 TG) visited the clinics with a total of 2 716 391 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of syndromes diagnosed among FSW decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of syndromes diagnosed among HR-MSM decreased from 11.6% to 3.5 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of HRG accessing clinics within 2 days of the onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly (p<0.001) see Abstract P5-S3.03 figure 1.

Conclusions

The project demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardised approaches. The paper presents the utilisation of these services, improved health seeking behaviour and reduced STI syndromes among the HRG.

Abstract P5-S3.03 Figure 1

Decreasing trends of STI syndromes in the Avahan clinics Jan 2005 to June 2009.
P5-S3.04 Continued decline in genital warts 3 years after introduction of quadrivalent Human papillomavirus (HPV) vaccination program
Authors: Read T , Hocking J , Gurrin L , Chen M , Donovan B , Bradshaw C , Fairley C
Published: July 2011

Background

Vaccination of girls and young women aged 12–26, for HPV genotypes 6, 11, 16 and 18, commenced in Australia in 2007. Vaccine uptake is estimated to be 70%.

Methods

Diagnoses for all new patients were recorded and the proportion of patients diagnosed with warts was calculated for exclusively homosexual (MSM) and heterosexual men (MSW) and, for women according to their eligibility for vaccination. Women aged ≥27 years in 2007 were too old for the vaccine program. Changes in these proportions are reported from 2004 to the end of 2010 (to be updated to 30 June 2011).

Results

53 088 new patients were seen from 2004 to the end of 2010 and 5191 were diagnosed with warts. The proportion of patients diagnosed with warts fell from 11.2% (95% CI 9.8 to 12.8%) in the third quarter of 2007 to 7.3% (95% CI 6.2 to 8.4%) in the final quarter of 2010. Women aged <27 years in 2007 experienced the greatest quarterly reduction (OR per quarter (OR) 0.93, p<0.001) to a proportion of 3.8% seen with warts in the 4th quarter of 2010. There was no significant change in women ≥27 years (OR 1.0, p=0.9) or in homosexual men (OR 0.99, p=0.54) and a small reduction in heterosexual men (OR 0.98, p=0.005). The proportion of younger women diagnosed with warts is continuing to fall, compared to other groups and to the proportions diagnosed with first episode genital herpes (Abstract P5-S3.04 figure 1).

Abstract P5-S3.04 Figure 1

Presentations with Warts Quarters 2004 to end 2010.

Conclusions

The substantial decline in genital warts continues in young Australian women, 3 years after the roll-out of the HPV vaccination program. Heterosexual men are experiencing a smaller, but significant decline.
P5-S4.01 TRACnet: sustaining mHealth at scale in Rwanda
Authors: Nyemazi J P
Published: July 2011

TRACnet is an mHealth system that has been supporting the national HIV/AIDS program of Rwanda since 2004 with funding and technical support from the US Centers for Disease Control. The longest continuously operating national mHealth system in Africa, TRACnet was built by Voxiva for and with the Government of Rwanda and the Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemic diseases (TRAC Plus). Today, more than 350 facilities offering ART, VCT and PMTCT submit monthly program indicators and receive lab results using the web or mobile phones. 91% of routine reports use mobile phones to report; the rest use the Internet. Using Rwanda's burgeoning mobile infrastructure, TRACnet has achieved 67 months of continuous nationwide routine reporting of data on ART care since 2004. In addition, more than 100 000 patients on care and treatment have been registered. The system includes >8000 reports submitted, >98% reporting rate, 1200 users, >100 000 patients registered The Ministry of Health and TRACPlus are also extending the system to incorporate integrated disease surveillance and response. Voxiva has an active partnership with MTN which is providing a national toll-free line to TRACnet, GPRS SIM cards and free access for users. Data collected by TRACnet is used for a variety of purposes, for example: to monitor program expansion and progress; drive performance-based incentive payments to health center; deliver lab results to facilitate early infant diagnosis; and provide donor reporting. Sustainability is a major focus of the TRACnet program. An innovative framework that addresses all components of operating and maintaining a national enterprise system guides capacity building efforts in collaboration with Rwanda's School of Public Health. This abstracts presents the experience of 6 years of continuous operation of an mHealth solution at national scale.
P5-S4.07 SMS reminders increase re-testing for repeat chlamydial infection in heterosexuals at a sexual health clinic
Authors: Guy R , Wand H , Read P , Kenigsberg A , Knight V , McNulty A
Published: July 2011

Background

Repeat infection withChlamydia trachomatisfollowing treatment is common. If left untreated it can lead to onward transmission and in females it increases the risk of pelvic inflammatory disease by fourfold. In late 2008, Sydney Sexual Health Centre implemented a reminder system using short message service (SMS) to improve re-testing rates following treatment of chlamydial infection. Clinicians were advised to set up SMS reminders to be sent out at 3 months after the visit.

Methods

We evaluated the impact of this system in its first year of operation using a controlled observation design. Using logistic regression we assessed the association between a SMS reminder and re-testing within 1–4 months of chlamydia infection in Jan–August 2009 among all heterosexuals. The comparison group was heterosexuals diagnosed with chlamydia who received a brief recommendation to re-test in the same time period.

Results

There were 230 heterosexuals diagnosed with chlamydial infection in the study period; 128 females (median age=24 years) and 112 males (median age=26 years). Of these, 47% were sent a SMS reminder (SMS group), and 53% received a brief recommendation (comparison group). The re-testing rate within 1–4 months of chlamydial infection was 58% in the SMS group, compared to 42% in the comparison group, OR=1.9, 95% CI 1.1 to 3.2, p=0=002. In females, the chlamydia re-testing rate within 1–4 months of chlamydial infection was 57% in the SMS group, compared to 40% in the comparison group, OR=2.0, 95% CI 1.0 to 4.0, p=0.05. In males, the chlamydia re-testing rate within 1–4 months of chlamydial infection was 59% in the SMS group, compared to 45% in the comparison group, OR=1.7, 95% CI 0.8 to 3.8, p=0.165.

Conclusion

This low cost system substantially increased re-testing rates after chlamydia infection in heterosexuals at a large sexual health clinic. The clinic now plans to implement electronic prompts to remind clinicians to offer SMS reminders to all patients diagnosed with chlamydia.
P1-S1.55 Higher seroprevalence is associated with HPV infections of mucosal epithelium and infections at multiple sites in men
Authors: Lu B , Viscidi R , Wu Y , Nyitray A , Villa L , Lazcano-Ponce E , Silva R J Carvalho , Baggio M L , Quiterio M , Salmerón J , Smith D , Abrahamsen M , Papenfuss M , Giuliano A
Published: July 2011

Background

Previously we observed elevated HPV seroprevalence in men who had sex with men (MSM) and men who had sex with men and women (MSMW) compared to men who had sex with women (MSW). We hypothesise that the higher seroprevalence is associated with HPV infection at multiple anatomic sites, and the presence of mucosal epithelium infection as opposed to keratinised epithelium infection. We assessed associations between HPV seropositivity and prevalent HPV infection at anal canal and external genitalia in men to test the hypothesis.

Methods

Enrolment data for 1663 men, including 1474 MSW, 83 MSM and 106 MSMW, were analysed. HPV L1 VLP-based ELISA was used for serum antibody testing and Linear Array for HPV DNA testing. Associations were estimated for HPV 6 and 16, respectively, using logistic regression. MSM and MSMW were combined to form the group MSM.

Results

Overall HPV 6 and 16 seroprevalence was 9.9% and 14.1%. HPV 6 and 16 DNA was present in 2.2% and 2.7% of anal samples, and 6.4% and 7.3% of genital samples. Seroprevalence of HPV 6 and 16 was significantly higher in MSM compared to MSW (32.8 vs 6.9%; 34.4 vs 11.5%). Similarly, HPV 6 and 16 DNA was more frequently detected in anal samples (9.5 vs 1.2%; 9.0 vs 1.8%) and genital samples (7.4 vs 6.2%; 9.0 vs 7.1%) of MSM than MSW. Men with simultaneous anal and genital HPV infection (AOR—9.20 and 6.79) or anal HPV infection alone (AOR—19.93 and 3.19) were significantly more likely to be HPV 6 and 16 seropositive. There was no association of seropositivity with prevalent genital HPV 6 or 16 infection. Strong positive associations were detected in MSW and MSM who were anal HPV 6 positive, regardless of coinfection with genital HPV 6. In contrast, no association was observed among MSW with anal HPV 16, with or without genital coinfection. However, significant associations were observed in MSM with anal HPV 16 (with coinfection—AOR, 10.94, 95% CI, 1.18 to 101.68; without—AOR, 4.96, 95% CI, 1.40 to 17.57).

Conclusion

We found type-specific associations of HPV 6 and 16 seropositivity with prevalent anal HPV infection, but not with prevalent genital HPV infection alone. Anal HPV 6 infection was associated with seropositivity in both MSW and MSM, while anal HPV 16 infection was only associated with seropositivity in MSM. Our data suggest that, in men, anal HPV infection may be more efficient than genital HPV infection in inducing immune responses. This may have relevance for protective immunity or the lack thereof, conferred by natural infection.
P5-S5.02 Outcomes following the introduction of HIV partner notification guidelines in Edmonton, Canada
Authors: Bergman J , Brandley J , Gratrix J , Ross K , Paradis K , Parker P , Anderson B , Houston S , Singh A
Published: July 2011

Background

In April 2010, the HIV Partner Notification Guidelines were implemented in Edmonton, Alberta, Canada. Prior to this, partner notification of newly diagnosed HIV cases was conducted inconsistently.

Methods

All individuals newly diagnosed with HIV in the Alberta Health Services- Edmonton zone were interviewed by a partner notification nurse (PNN) for sexual and needle sharing partners, and perinatal contacts under Alberta's Public Health Act. PNNs attempted to locate named contacts to ensure timely counselling, testing, and follow-up care. The number of contacts in the year preceding the diagnosis and information required to locate each contact was recorded for each case. Additional information included whether they were located, tested, and their test results; all information was entered into a Notifiable Disease Reporting database. A descriptive analysis was performed on the characteristics and outcomes of data collected between 5 April and 31 December 2010.

Results

There were 50 newly diagnosed HIV cases during this time period. The majority (n=33; 66%) of the cases were male and the overall median age was 39 years (IQR 32–48). Male cases were more likely to be Caucasian (n=21; 63.6%) while female cases were more likely to be Aboriginal (n=8; 47.1%, p=0.001). The primary mode of transmission among male cases was MSM (n=18; 54.5%) and among female cases was heterosexual transmission (n=10; 58.8%). A total of 92 contacts were provided by 36 (72%) of the HIV cases, with an average of 2.6 (range 1–14) contacts per case. The majority (97.8%; n=90) of contacts were exposed through sex with an additional 5 (5.4%) contacts being exposed through needle sharing during drug use. Of the 92 named contacts, 17.4% (n=16) were found to be previously positive for HIV, 16.3% (n=15) resided outside of Edmonton, and the remaining 66.3% (n=61) were followed up by local PNNs. At the time of analysis, 75.4% (n=45) of the contacts were located and of those located, 82.6% (n=38) were tested resulting in four new cases of HIV.

Conclusions

HIV partner notification efforts resulted in the majority of contacts being located and tested for HIV, with four new cases of HIV identified. Nearly one-quarter (n=20; 21.7%) of the total contacts were HIV positive, suggesting a need for ongoing prevention and risk reduction strategies for individuals living with HIV and their partners.
P5-S5.04 Provider and contract referral for bacterial STIs: two sides of the same coin?
Authors: Cassell J , Estcourt C , Symonds M , Richens J , Rait G , Lanza S , Dodds J , Smith H
Published: July 2011

Background

During the pilot of an RCT of provider, contract and patient referral, for a 66 practice RCT of partner notification in UK primary care, it emerged that there is uncertainty about real life clinical practice. Our objectives are to describe how health advisers negotiate provider, contract and patient partner notification in clinical practice. To determine the feasibility of comparing both provider and contract referral separately against patient referral.

Methods

We recruited 10 health advisers from contrasting settings to attend a 1-day workshop led by partner notification specialists and researchers. They participated in focus group discussions, observations of practice, role play with each other and with actors. They and the actors then contributed to further focus groups reflecting on their observations and experiences, and advising on feasible strategies for delivering standard partner notification interventions in the RCT context. All discussions were recorded for qualitative analysis.

Results

All health advisers practised provider referral, but the extent was variable. Contract referral as defined in the UK (a time period is explicitly agreed for the patient to notify, after which provider notification is initiated) is practised for HIV, other bloodborne viruses and sometimes syphilis. However for common bacterial STIs, a patient's choice of provider referral often emerges over multiple consultations, and provider referral is not a distinct intervention from contract referral. Health advisers saw their role as helping patients find solutions to partner notification, rather than applying specific interventions.

Conclusions

Provider and contract referral are not sufficiently distinct to be compared with each other in a trial setting for chlamydia and gonorrhoea. However contract referral does have an important role in management of partner notification for bloodborne viruses.
P5-S5.05 Partner notification uptake for sexually transmitted infections in China: a systematic review
Authors: Wang A , Peng R , Tucker J , Chen X S , Cohen M
Published: July 2011

Background

China's sexually transmitted HIV and resurgent syphilis epidemics require comprehensive control programs. Partner services are traditional pillars of sexually transmitted infection (STI) control but have not been widely implemented in China. This systematic review of English and Chinese literature examined the feasibility and uptake of partner notification (PN) in China.

Methods

Four English language and four Chinese language databases were searched from 1980 to 2010 to identify original articles on partner services in China. A systematic review was performed to assess: (1) willingness to notify via patient, provider, or contract notification; and (2) PN uptake, defined as the number of partners successfully notified, evaluated, and treated per index case. Approaches to partner services in China, perceived barriers, and implementation consequences were also abstracted. χ2tests were used to compare the proportions of index patients willing to notify partners using different PN methods.

Results

A total of 441 citations were identified, and 17 studies (3 English and 14 Chinese), published between 1997 and 2010, examined PN willingness and uptake. All three types of PN--patient, provider, and contract--were assessed. Overall willingness to notify was 67% (SD±25.0) in nine studies (n=2145). Six studies (n=1380 index cases) reported median STI PN uptakes of: 0.9 (IQR 0.5–1.2) notified, 0.7 (IQR 0.4–0.9) evaluated, and 0.3 (IQR 0.2–0.3) new infections detected. Partner services counselling was shown to reduce reinfection rates, and no adverse events were reported. Perceived patient barriers included social stigma, fear of relationship breakdown, right to confidentiality, and lack of partner contact information. Perceived infrastructure barriers included lack of available patient education, limited resources and trained staff, mistrust between patients and health providers, and lack of partner services regulations. All studies were in heterosexual populations; none examined partner services in men who have sex with men (MSM).

Conclusions

Although STI PN is not widespread in China, these limited studies suggest that more structured pilot programs could be feasible. More research on STI partner services, particularly among MSM and other high-risk groups, is an important public health priority.
P5-S6.02 Sexual education and citizenship construction: Colombia (2006–2008). What does this mean?
Authors: Estrada-Montoya J H
Published: July 2011

Background

Current Sexual education program in country wide Colombia has been analysed. Conceptual frame of pedagogical approaches used in the program was analysed as well. Other issues including context, background, gender and social class were the main aspects evaluated.

Methods

Qualitative research methods were performed for this pedagogical evaluation. Four phases were developed during the evaluation: Data collection (documentary analysis of official documents and 40 in-depth interviews with teachers and government employees) information organisation, analyse/critical evaluation and result dissemination.

Results

The results show that Program's main approach is competence-based education. Results of this research suggest that program intends to arrange and to conduct people's sexual life. Values underling program's approach are those of a society looking for order, stability and individual freedom. Narrow analyses of sex-gender duality predominate such as: permanent monogamy, mandatory heterosexuality and marriage keeping an eye on different options for sexual practice. Sexuality presented in the program reflects the moral values of the prevailing group. Current implemented program is clearly the expression of the Colombian government ideological perspective leaded by the elites. Controlling and oppressive approaches for the vast majority were identified as being an important axis of evaluated program.

Conclusions

New citizenship construction in a Latin American country implies abandon of existing racial, sexual, and class-based educational approaches. This requires the implementation of a wide approach underlying elimination of ideological and material conditions driving to different forms of oppression, subjugation or marginalisation. Design of educational programs must consider historical, social, economic and politic context in which people live. States should be able to guaranty human rights.
P1-S1.56 The incidence ofMycoplasma genitaliumin a cohort of young Australian women
Authors: Walker J , Fairley C , Bradshaw C , Tabrizi S , Chen M , Twin J , Taylor N , Donovan B , Kaldor J , Hocking J
Published: July 2011

Background

Mycoplasma genitalium(Mg) is an emerging sexually transmitted infection that has been associated with serious upper genital tract infections in women such as cervicitis, pelvic inflammatory disease and endometritis. The burden of disease for Mg in Australia is unknown as there are no current population prevalence or incidence data.

Methods

Women aged 16–25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and consented to participate in a 12-month study providing vaginal swabs through the mail. Women were tested at 6-monthly intervals for chlamydia and Mg.

Results

Overall, 1116 women were recruited from 29 clinics; with 79% of women retained at the conclusion of the study. The prevalence of Mg at recruitment was 2.4% (95% CI 1.5 to 3.3). Increased numbers of sexual partners was strongly associated with Mg (adjusted OR [AOR]=2.2; 95% CI 1.0 to 4.6), as was being recruited from SHC (AOR=3.4; 95% CI 1.5 to 5.3). Mg incidence was 1.2 per 100 women years (95% CI 0.7 to 2.1) and was associated with women recruited from SHC (HR=4.9; 95% CI 1.5 to 16.3) and having increased numbers of new sexual partners (HR=5.7; 95% CI 1.4 to 23.1). We found a median organism load of 1.4×103/5?L, which was 100 times less than that found in chlamydia positive samples. We also found an azithromycin failure rate of 15% (95% CI 3.2 to 37.9).

Conclusion

Mg is common in young Australian women, and consistent with international studies, Mg was less prevalent than chlamydia.
P5-S6.04 HIV testing of homosexual men: clinicians as part of the testing equation
Authors: Chen M , Petlo T , Fairley C , Whitton B
Published: July 2011

Introduction

High HIV testing coverage of men who have sex with men (MSM) attending clinical services has been advocated to improve early HIV detection. The proportion of MSM tested has been used as a measure of service quality. The aim of this study was to determine HIV testing rates and predictors of testing among MSM attending a sexual health service, including the impact of the treating clinician.

Methods

HIV testing rates among MSM attending the Melbourne Sexual Health Centre between 2003 and 2009 for the first time were calculated for individual treating clinicians. Factors independently associated with HIV testing were determined by logistic regression. Medical records were audited to ascertain the reasons why HIV tests were not performed.

Results

Overall, 78% of 4425 men were tested for HIV. Men reported a median of six male partners in the prior year with 51% reporting unprotected anal sex. Seventy six per cent of men reported a previous HIV test, performed a median of 12 months prior to their visit. HIV testing rates were higher for nurses (median 89%; range 77–95%) than doctors (median 73%; range 45–88%) with significant differences between doctors but not nurses (p<0.001). Men were less likely to be tested if they presented with symptoms of an STI (AOR 2.7, p<0.001) and if they saw a doctor vs a nurse (AOR 1.9, p<0.001) independent of recent sexual risk and duration since their last HIV test. Reasons for not testing included patient decline (28%) and recent testing (15%); however, no reason was documented in 39%.

Conclusions

While overall HIV testing rates were high, substantial differences in testing rates between clinicians were evident. Strategies geared at optimising HIV testing need to take into account the frequency with which clinicians offer testing.
P5-S6.06 Utilisation and cost of diagnostic methods for STD screening among insured American Youth, 2008
Authors: Owusu-Edusei K , Nguyen H , Gift T
Published: July 2011

Background

Information on the private sector utilisation and cost of sexually transmitted disease (STD) screening and diagnostic testing in the USA is limited. We present STD diagnostic method-specific utilisation and cost estimates for persons aged 15–25 years.

Methods

We used current procedural terminology (CPT) (or diagnostic methods) codes for seven major STDs (human papillomavirus (HPV), genital herpes simplex virus type 2 (HSV-2), hepatitis B virus (HBV), chlamydia (CT), gonorrhoea (GC), trichomoniasis (TV) and syphilis) to identify outpatient claims for persons aged 15–25 years in the MarketScan database for 2008, excluding codes for procedures that could be used to identify claims for non-STD-related tests. Utilisation was measured as the number of claims per 100 000 enrollees (ie, claims rate). We estimated CPT code-specific claims rates for each STD and average costs stratified by gender. Finally, we estimated the overall total cost of STD testing.

Results

We found 24 CPT codes for HPV; 2 for HSV-2; 11 for HBV; 9 for CT; 4 for GC; 2 for TV; and 5 for syphilis. The claims rate (all diagnostic methods included) for HPV was the highest (17 239/100 000, significantly higher (p<0.01) than all the STDs), while the claims rate (all testing methods included) for TV was the lowest (507/100 000, significantly lower (p<0.01) than all the STDs). Claims rates (for all STDs combined) for females were significantly (p<0.01) higher than for males for all the STDs. Estimated average costs (for diagnostic methods) were: HPV ($35), HSV-2 ($24), HBV ($32), CT ($46), GC ($45), TV ($30), and syphilis ($29). Average costs did not differ significantly between males and females. The estimated total cost of screening for all seven STDs was $90 million for the insured population aged 15–25 years.

Conclusions

The claims data provide an estimate of STD testing patterns among privately-insured persons. These can be compared to surveillance data and guidelines to assess testing vs disease prevalence and recommendations. The low utilisation rates we assessed for TV are likely attributable, at least in part, to our exclusion of claims that could be related to non-STD-related tests (such as wet mount). The low utilisation rates might also reflect the lack of attention to TV in STD prevention that has been reported in the literature.
P5-S6.08 STD surveillance and control: do STD and family planning clinics matter?
Authors: Doshi S , Owusu-Edusei K
Published: July 2011

Background

Information on the potential impact of the presence of an STD and/or family planning (FP) clinic on STD surveillance and control is scant. In the study, we examine the impact of STD and/or publicly funded Title V, X, and XX FP clinics on county-level surveillance and control of three reportable STDs (chlamydia (CT), gonorrhoea (GC) and primary and secondary syphilis (P&S)) in Texas during 2000 and 2007. Specifically, we examined the following two questions: (1) Are the counties with STD/FP clinics reporting relatively more cases of STDs? (2) Does having STD service(s) (the presence of an STD/FP clinic) in a county matter?

Methods

We used spatial regression to analyse the impact of STD/FP clinics on county-level STD morbidity using surveillance data on CT, GC, and P&S. the impact of STD/FP clinics on STD control was examined using a backward stepwise regression on the changes in incidence rates between 2000 and 2007. Dummy variables represented the presence of STD/FP clinic(s). Incidence rates were transformed into natural logs. County-level demographics for 2000 and 2007 were used as control variables.

Results

The coefficients on the dummy variables representing the presence of STD/FP clinics were: 0.11 (95% CI 0.05 to 0.16, p<0.01) in 2000 and 0.07 (CI 0.02 to 0.12, p<0.01) in 2007 for CT; 0.13 (CI 0.05 to 0.20, p<0.01) in 2000 and 0.06 (CI −0.002 to 0.12, p<0.01) in 2007 for GC and 0.18 (CI 0.12 to 0.23, p<0.01) in 2000 for P&S (2007 was not significant). This implies that the transformed GC and CT rates in the counties with STD/FP clinics increased by at least 6% in 2000 and 2007, while P&S increased by 18% in 2000. The coefficient for the changes in rates between 2000 and 2007 were: −0.04 (CI 0.01 to −0.09, p<0.10) for CT; −0.08 (CI −0.02 to −0.14, p<0.01) for GC and −0.09 (CI −0.03 to −0.15, p<0.01) for P&S. Thus, the transformed incidence rates of GC and P&S reduced by 8% and 9%, respectively, between 2000 and 2007 for those counties that had at least one STD/FP clinic.

Conclusion

The results from this ecological study are consistent with (but do not establish) a causal relationship between having an STD/FP clinic and improved surveillance and/or reduction in STDs at the county-level in Texas. However, the results suggest that STD/FP clinics play an important role in STD surveillance and control. Finer level analyses (such as census block or cities) may be able to establish a strong causal relationship.