bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S2.65 Crack/cocaine use among MSM in Latin America: a multilevel analysis of RDS studies to identify drug use patterns and associated factors across cities
Authors: Jacobson J O , Alonso-Gonzalez M , Ramachandran D , Morales-Miranda S , Carballo-Dieguez A , Medrano J , Solano T , Rosales-Perez M D
Published: July 2011

Background

In Latin America (LA), men who have sex with men (MSM) are the population most affected by HIV, crack/cocaine production and trafficking routes are well-established, and local consumption has risen sharply in recent years. Yet, drug use and associations with sexual risk behaviours among MSM remain largely unexamined LA despite being recognised as important drivers of HIV transmission in the USA. Variation in crack/cocaine consumption within LA is also unknown.

Methods

Data from participants self-identifying as MSM and aged 18 years and older in recent (2006−2009) respondent-driven sampling (RDS) studies using similar survey methodologies in nine high-population cities in Argentina, Bolivia, Costa Rica, El Salvador and Honduras (N=2081) were pooled and analysed in a multilevel statistical framework to increase statistical power to evaluate past 12-month crack/cocaine consumption (CC). CC prevalence was estimated by study site, adjusting for sampling weights incorporating personal network and population sizes. Logistic, multilevel models identified correlates of CC, adjusted for intraclass correlation within levels defined by study site and recruitment chain, and partitioned variance in CC among levels.

Results

CC prevalence was 21.7% (95% CI 17.4 to 26.7) in the pooled sample and varied significantly across cities from 0.1% in Cochabamba, Bolivia to 44.5% in Ceiba, Honduras. In multivariate analysis, daily alcohol consumption (adjusted OR [AOR]=4.0), sexual debut of ≤ 12 (AOR=3.1) and 13−17 (AOR=1.9) years old, self-identifying as transexual/transgender/transvestite (TTT) (AOR=2.2), age 18−22 (vs >40) years (AOR=2.0), having a stable female partner (AOR=1.8) and ever purchasing sex (AOR=1.6) were associated with CC (p<0.05). Significant city-level random effects expressed as AOR were 5.4 (SE=1.3) and 2.7 (SE=1.3) in Ceiba and San Pedro Sula, Honduras, respectively and 3.4 (SE=1.2) in Buenos Aires, Argentina. Of the total variance in CC, 29.3% was associated with unobserved differences among cities. Associations between CC and condom use at last sex, and recruitment chain, were non-significant (p>0.1).

Conclusions

CC prevalence among MSM, and variation among cities in LA, are considerable. Associations with frequent drinking and sexual risk Behaviours likely compound HIV transmission risk among MSM and to female partners. Substance abuse prevention and treatment for MSM are needed, particularly among TTT, and in Honduras and Argentina.
P1-S2.72 Predictors of HSV-2 seroprevalence and willingness to accept a prescription for suppressive therapy among recently incarcerated women
Authors: Roth A , Van Der Pol B , Reece M , Dodge B , Zimet G
Published: July 2011

Background

HSV-2 seropositivity has direct links with one's increased risk for HIV acquisition. Given that increases in HIV incidence are highest among women of colour in the USA, they may benefit from HSV-2 control efforts. We evaluated the acceptability of a community-based HSV-2 screening program for women in the justice system and assessed factors related to HSV-2 positivity and willingness to accept a prescription for suppressive therapy.

Methods

As part of a larger randomised controlled trial, recently arrested women were recruited from a community court handling lower-level misdemeanour cases, including prostitution, in a large Midwestern city. Individuals completed an interviewer administered survey assessing factors related to HSV-2 screening intentions and were offered no-cost of point-of-care HSV-2 testing. Individuals screening positive were offered low-cost ($4) suppressive therapy.

Results

Participants included 136 women, 18−62 years old (median=31) with reported ethnicities of White (51%), Black (43%) and other (6%). Most (51%) had less than a high school education, were unemployed (68%) and 28% were currently facing prostitution charges. The majority (64%) of participants accepted testing and 60% tested HSV-2 seropositive. Factors associated with an infection included age (OR=1.09; 95% CI 1.03 to 1.16), Black race (OR=50.06; 95% CI1.1.70 to 1472.14), lower educational attainment (OR=5.86; 95% CI 1.13 to 30.37), current genital symptoms (OR=6.5; 95% CI 1.25 to 34.17), and lifetime number of sexual partners (OR=102.33; 95% CI 6.62 to 1581.73). Being recently arrested for prostitution was not associated with an HSV-2 diagnosis. The majority of women testing positive (84.6%) accepted a prescription for suppressive therapy.

Conclusion

We detected very high rates of HSV-2 among recently incarcerated women, especially among Black women. Nearly all women who tested positive accepted a prescription for Acyclovir, indicating they were interested in suppressive therapy which could provide some benefit in preventing HIV acquisition. These results highlight how non-traditional public health partnerships, like academic-judicial system collaborations, provide an opportunity for STD control programs to intervene with high-risk individuals.
P1-S2.73 Exploring the relationship between Rural-to-Urban circular migration and HIV: a qualitative study of migrants and persons living with HIV in North India
Authors: Rai T , Lambert H , Piot P , Agarwal K , Ward H
Published: July 2011

Background

Migrant workers may be at increased risk of acquiring HIV and have been described as a potential bridge between high- and low-prevalence geographic areas and groups. The National AIDS Control Organisation of India has prioritised interventions for migrant workers with the aim of curbing the spread of HIV from high to low prevalence parts of the country. We describe links between migration and HIV and explore variations in risk between migrants.

Methods

A qualitative study in Allahabad district, Uttar Pradesh, India. Interviews, focus groups and observations were carried out in two rural villages with high temporary out-migration of men, and in an HIV treatment centre in Allahabad. For this study we defined migrants as those who leave and return to their place of origin once or more in a year. Participants included key informants (14), rural migrant men (20), and men and women living with HIV/AIDS (PLHAs) (30).

Results

PLHA and migrant men described a range of ways in which migration could lead to an increase in the potential or actual risk of acquiring HIV. These included separation from wives and opportunities for other relationships, exposure to sexual abuse in destination workplaces, sex between men, and exposure to unregulated injections. These risks varied according to destination, with less opportunity for sexual risk-taking in factories where men were housed in closely-supervised factory accommodation. HIV in turn affected migration with a particular impact on the ability to make money and care for families. For some men illness or the fear of becoming unwell limited further migration, and thus reduced income; others increased migrant labour in order to plan for an uncertain future for their dependents. An HIV diagnosis meant some lucrative international destinations became inaccessible, so they moved elsewhere for work.

Conclusions

Labour migration can increase vulnerability to infection for migrants and their families. However, this relationship appears to be more complex than is often assumed. Unprotected heterosexual intercourse may not be the only way in which migration increases HIV risk as there are numerous other risky encounters that migrant workers may have due to their circumstances. Planned programmes to increase HIV awareness and promote condom use at destination and source locations have to be combined with a systematic examination of the effect of social and sexual networks and power relationships in the labour market.
P1-S2.74 How patterns of migration may influence heterosexual HIV transmission
Authors: van Veen M , Xiridou M , Prins M , Coutinho R
Published: July 2011

Background

Ethnic minorities originating from countries with high HIV prevalence account for a large number of heterosexually acquired HIV infections in Western European countries. These groups may be infected before migrating and they may engage in unsafe sexual practices both in the country of residence and in their country of origin. We investigate how patterns of migration may affect the heterosexual HIV epidemic in the Netherlands.

Methods

A mathematical model was used that describes the transmission of HIV infection in heterosexual partnerships between African migrants, Caribbean migrants, and the local Dutch population. Acquiring HIV infection before migrating to the Netherlands or during trips to the country of origin was also accounted for in the model.

Results

The estimated HIV incidence among adult heterosexuals in 2010 was 1.50 new infections per 100 000 individuals per year. If the number of migrants entering the country increases, then the incidence of HIV will increase, although the change among the local Dutch will be negligible. Moreover, if HIV prevalence among those migrating to the Netherlands (at the time of entry to the country) is higher, then the incidence in the respective ethnic groups will increase; among the other ethnic groups, the increase will be very small.

Conclusions

Changes in patterns of migration can have a considerable impact on HIV transmission within ethnic minority communities in the Netherlands, but they hardly have any impact on transmission in the local population. Therefore, limiting migration and introducing travel restrictions would likely have no effect on HIV incidence in countries with low HIV prevalence among heterosexuals. Policy making should focus on targeted interventions, to reduce the burden of HIV disease in migrant communities.
P1-S2.75 Are sex/drug risk behaviours in sending countries predictive of sex/drug risk behaviours in receiving countries? The case of Latino migrant men in New Orleans
Authors: Kissinger P , Mills J , Schmidt N , Salinas O , Hembling J , Aran A , Shedlin M
Published: July 2011

Background

Migration and mobility have been associated with higher drug and sex risk behaviour. Whether this increased risk is a result of the characteristics of mobile persons or environmental influences in a receiving community has not been well elucidated. The purpose of this analysis was to determine if risk behaviour was a continuation of sending country practices or if it was adopted in the new receiving environment (ie, New Orleans).

Methods

A cohort of Latino migrant men (n=93) were interviewed at baseline, 3 and 6-month visits and asked about past month behaviour. At a subsequent visit, they were also asked about behaviours in their sending country. All interviews were conducted in Spanish by trained staff. Four behaviours were examined: patronage of a female sex worker (FSW), sex with a man (MSM), binge drinking, and crack cocaine use. Cross-tabulations and McNemar tests were performed.

Results

At baseline, the men were mostly Honduran (71.0%), migrated directly to New Orleans from their country of origin (62.0%), were single (50.5%) with a median age of 28 (range 18−50) and a median of 6 years of schooling. The percentage of men reporting patronage of FSW, MSM and crack cocaine use was significantly higher in New Orleans than in the sending country, and high proportion of those reporting the behaviours in New Orleans, did not practice these behaviours in the sending country. When comparing sending country to New Orleans behaviour in order to examine discrepancies for behaviours, all but binge drinking were significantly different (p<0.04) with adoption of the behaviour in New Orleans accounting for >85% of the discrepancy see Abstract P1-S2.75 Table 1.

Abstract P1-S2.75 Table 1

Behaviours in sending country and in New Orleans (N=93)

BehavioursPatronage of FSWMSMBinge*Crack cocaineReported in sending country16/93 (17.2%)3/93 (3.2%)39/91 (42.9%)2/93 (2.2%)Reported in New Orleans60/93 (64.5%)10/93 (10.8%)35/91 (38.5%)12/93 (12.9%)Not reported in sending country (of those reported in New Orleans)50/60 (83.3%)8/10 (80.0%)15/35 (42.9%)12/12 (100.0%)*

2 men had missing information.

Conclusion

Rates of these four risky behaviours were high and, with the exception of binge drinking, were largely behaviours adopted in the USA Newly arrived migrant men are a group at high risk for sex and drug related STI/HIV. Interventions to prevent transmission in this vulnerable, difficult-to-access and highly mobile population are greatly needed.
P1-S2.76 Sexual concurrency among Latino migrant men in New Orleans
Authors: Kissinger P , Anderson-Smits C , Kovacs S , Salinas O ,   J H, Schmidt N
Published: July 2011

Background

Sexual concurrency and migration have both been implicated in the spread of HIV/STI. Migrant men are highly mobile, but their level of sexual concurrency has not been well studied. The purpose of this study was to examine the prevalence of and factors associated with sexual concurrency and to examine condom use within concurrent relationships among a group of newly arrived Latino migrant men (LMM) in New Orleans.

Methods

LMM enrolled in an ongoing cohort study, who had at least one female sexual partner during follow-up were interviewed a three time points over 6 months. Concurrency was calculated by asking start and stop date of each sexual relationship as well as intention to continue. Partnerships that had overlapping dates were considered concurrent. The association between selected individual and environmental factors and sexual concurrency was examined using generalised estimated equations (GEE).

Results

At baseline, LMM (n=90) were mostly Honduran (77.9%), employed (80.0%), worked in construction (55.6%), were uncircumcised (88.9%), were living with family (51.1%) and did not have a main sex partner (74.4%). Their mean age was 35.4 (SD 10.6) and they had been in New Orleans for average of 4.70 years (SD 0.89). During follow-up, 30 (33.3%) had at least one concurrent relationships, 10 (11.1%) had only concurrent relationships, and 59 (65.6%) had no concurrent relationships. In 239 observations, sexual partnering and consistent condom use was: concurrent (18.0%/53.5%), multiple but non-concurrent partners (5.9%/78.6%), and monogamous (50.6%/30.8%), while 25.5% were abstinent. Factors associated with sexual concurrency included: younger age, drug use, and living in crowed housing while belonging to organizations or sport team was protective. Of these 43 concurrent events, 21.0% included a risky partner (ie, female sex worker or casual partner) and main partner and 65.2% had at least one non-Latina partner. Of the 29 concurrent relationships that included a FSW, 5 (17.2%) did not use a condom with the sex worker.

Conclusion

This sample of LMM exhibited high rates of concurrency with a potential for bridging. Drug prevention and interventions that promote social connectedness are needed to reduce concurrency among this mobile group.
P1-S3.01 Trends in the incidence of hospitalisation for chlamydia-related sequelae among women
Authors: Liu B , Donovan B , Wand H , Guy R , Hocking J , Kaldor J
Published: July 2011

Background

Chlamydia infection is thought to increase the risk of infertility and ectopic pregnancy. Over the last 10 years in Australia, chlamydia testing and notifications have increased dramatically, particularly in young women. As it is unclear how much increasing notifications reflect a true increase in chlamydia incidence, we sought to investigate rates of hospitalisation for the chlamydia-related sequelae, infertility and ectopic pregnancy in New South Wales (NSW), Australia's largest state with a population of 7 million.

Methods

Routine data on hospitalisations for infertility and ectopic pregnancy, perinatal data, and population census data from 2001 to 2008 were used to estimate annual age-specific hospitalisation rates for infertility and ectopic pregnancy in women aged 15 to 44 years for the entire state of New South Wales. Hospital separations occuring within each year belonging to the same woman were linked using probabilistic linkage of identifiers so that multiple admissions by one woman were only counted once.

Results

From 2001 to 2008 the number of women hospitalised for infertility increased from 7050 to 9978. The greatest increase was seen in women aged 35 to 44 years, from 6.4 [95% CI 6.2 to 6.6] to 11.2 [10.9 to 11.5] per 1000 population (p trend<0.001). There was no significant change among women aged 15 to 24 years (ptrend=0.3); see Abstract P1-S3.01 figure 1A. For women with ectopic pregnancy overall the number of women hospitalised decreased from 1204 to 1192, a decrease in annual rates from 14.3 [13.5 to 15.1] to 12.6 [11.9 to 13.3] per 1000 births (p trend<0.001) but this decrease was mostly in women aged between 25 to 44 years. There was no appreciable fall in hospitalisations for ectopic pregnancy in women aged 15 to 24 years (13.1 [11.5 to 15.0] to 13.1 [11.4 to 15.0] per 1000 births; ptrend=0.9; see Abstract P1-S3.01 figure 1B).

Abstract P1-S3.01 Figure 1

Women hospitalised for A) infertility and B) ectopic pregnancy in NSW, 2001 to 2008.

Conclusions

Among women aged 25 to 44 years decreases in hospitalisations for ectopic pregnancy and increases in hospitalisations for infertility were observed. The relationships between chlamydia prevalence, testing and notifications do not appear to be straightforward.
P1-S3.02 The economic burden of chlamydia and gonorrhoea in Canada
Authors: Smylie L , Lau P , Lerch R , Kennedy C , Bennett R , Clarke B , Diener A
Published: July 2011

Background

The latest estimate of the economic burden of chlamydia and gonorrhoea in Canada was modelled with data from 1990 and was published in 1992 by Ron Goeree and Paul Gully. Given the changes that have occurred since in diagnostic testing technology, the availability of new data sources and increasing rates of the two infections, a new model using updated data from 2000 is called for.

Methods

Diagnostic test costs were estimated using provincial laboratory data on the number of diagnostic tests performed forChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC) for the year 2000. Direct costs of CT and GC from drugs, hospitals, and physician billings were estimated using the Economic Burden of Illness in Canada (EBIC) data. Direct costs of associated sequelae of each infectious disease were also included in the model. Indirect costs estimated in the model included production losses from both infectious diseases and their associated sequelae. Sensitivity analyses were conducted to provide upper, base and lower-bound estimates of the total cost.

Results

The preliminary combined estimate for both direct and indirect costs of CT and GC (in 2000 dollars) ranges from approximately $31.5 to $178.4 million (CAD).

Conclusions

Further work is required to improve data access and estimates of the burden of infection in Canada. A top priority should be to improve the data infrastructure by expanding data linkages within and among provinces around laboratory tests. The majority of costs related to CT and GC are attributable to drug, hospital and physician costs, suggesting that much of the burden of these two infections can be reduced through implementation of effective prevention programs. The number of CT infections has increased exponentially since 2000, warranting further modelling considering current incidence rates and inflation costs.
P1-S3.04 Death in the era of HAART: not all about AIDS
Authors: Smith R , Kall M , Delpech V
Published: July 2011

Background

Mortality from AIDS has dramatically reduced since the introduction of effective antiretroviral therapy, Nevertheless, HIV infected individuals remain at higher risk of early death. We investigate all causes of deaths among HIV diagnosed adults reported nationally in the HAART era.

Methods

Analyses of data from national HIV surveillance linked to the Office National Statistics. Deaths among all adults (≥15) diagnosed between 1997 and 2008 in England and Wales (E&W) were reviewed and grouped by cause of death (COD) and risk information. Death rates were calculated using a census of all persons accessing HIV care in 2008 (SOPHID).

Results

The crude mortality rate among HIV-infected individuals (15−59 yrs) fell from 21.8 to 8.2 per 1000 persons living with diagnosed HIV in 2008. A total of 3640 (5.6%) persons diagnosed over the 12-year period were reported to have died [3544 had a cause of death]. The overall median age at death was 41 yearss [IQR: 35−50 years]. AIDS related mortality accounted for 56% of all deaths: 51% among MSM, 61% among heterosexuals and 34% among IDUs. AIDS-related respiratory infection (including PCP) was the most common COD in MSM and heterosexuals whereas external causes were the most common COD among IDUs. Non AIDS mortality increased sixfold since 1997 (36−226), with particular increases in cardio/cerebrovascular disease, non-AIDS defining malignancies and external causes. Infectious diseases (mostly respiratory) was the most common underlying cause of non AIDS deaths for MSM and heterosexuals aged 15−59: (38% and 36% respectively) and also high among IDUs (35%). External causes (mostly due to overdose and suicide) was the most common COD among IDUs (36%) and high among MSM (19%). Cardio/cerebrovascular disease and non AIDS malignancies accounted for 16% and 11% of non-AIDS deaths (15−59 years) respectively. Three quarters (76%) of all AIDS deaths and 47% of non AIDS deaths occurred within a year of diagnosis.

Conclusion

Overall mortality rates in HIV positive persons have substantially declined in the HAART era but remain high compared to the general population. Clinical AIDS associated with late presentation continues to account for the majority of deaths. Our analyses also reveal that a disproportionate number of deaths are due to infectious diseases, overdose and suicide occur in this population, many of which may be preventable. Surveillance of non-AIDS causes of death is critical in the HAART era.
P1-S1.14 Is HIV prevalence declining in Southern India? Evidence from two rounds of general population surveys in Bagalkot District, Karnataka
Authors: Rajaram S P , Bradley J E , Ramesh B M , Isac S , Washington R G , Moses S , Blanchard J F , Becker M , Alary M
Published: July 2011

Background

As a part of the evaluation of Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation, a cross-sectional survey was undertaken in the general population of Bagalkot district, Karnataka state, South India, in 2009. This replicated an earlier survey in 2003 that had examined HIV prevalence and risk behaviours.

Methods

The repeat survey in 2009 was conducted in the same rural and urban areas as the 2003 study. The study covered 10 rural villages and 20 urban blocks of three of the six talukas (sub-district units) in the district. In both surveys, a target sample of 6600 adult males and females was selected. Urine and blood samples were collected from all consenting participants for HIV and STI testing. An individual was deemed HIV positive, if positive on two different tests. We compared HIV and STI prevalence in 2003 and 2009. We also examined the age-specific distribution of HIV prevalence among rural and urban males and females at both time points. These analyses used logistic regression that considers survey design to adjust for characteristics of the population that may have changed between the two rounds.

Results

Overall, HIV prevalence in the district declined from 3.16% in 2003 to 2.58% in 2009, although this decline was not statistically significant (OR=0.82, p=0.278). The prevalence of active syphilis was <1% and was similar in both periods. A slight decline in the prevalence of HSV-2 was observed over the period, but the difference was not statistically significant. There was a significant decline observed in HIV prevalence among persons aged 15–24, among persons below 30 years in urban areas, and among all women younger than 20 years of age (Abstract P1-S1.14 table 1). Among rural males aged 40 and above, we observed a significant increase in HIV prevalence from 0.71 to 5.33 (Abstract P1-S1.14 table 1), a level similar to that found in the younger age group in 2003.

Abstract P1-S1.14 Table 1

HIV prevalence and adjusted OR among selected population groups

Sub-groupRound 1, 2003 (%)Round 2, 2009 (%)Adjusted OR, 2009 vs 2003 (95% CI)p ValueOverall3.162.580.82 (0.57 to 1.18)0.278Age 15–242.41.260.54 (0.30 to 0.96)0.038Age 15–29, urban2.040.770.36 (0.20 to 0.63)0.001Age 15–19, female2.250.490.15 (0.04 to 0.61)0.009Age 40+, rural males0.715.3313.80 (2.59 to 73.45)0.006

Conclusion

We observed a downward overall trend in HIV prevalence in Bagalkot district over the period examined, and a significant decline in HIV prevalence among younger age groups, where HIV prevalence more closely reflects incidence. The increase in HIV prevalence among older rural males may have been due to a cohort effect, as they aged over time. This may also have in part reflected increased survival in those age groups, as a result of the scaling-up of antiretroviral treatment programs throughout the state.
P1-S3.08 Pelvic inflammatory disease (PID) in adolescents after treatment for cervicitis
Authors: Risser W , Risser J
Published: July 2011

Background

We did a prospective study of incarcerated adolescents who had been treated for gonorrhoeal and/or chlamydial cervicitis to determine what proportion subsequently developed PID.

Methods

We performed the study at the Harris County Juvenile Detention Center, Texas, where PID is relatively common. At the time of their mandated medical assessment, all incarcerated women submitted first-catch urine samples for chlamydia and gonorrhoea testing. We used Gen-Probe NAAT assays. At the time of treatment among those infected, we performed bimanual pelvic examinations to determine if they had PID. We used the PID diagnostic criteria of the US Centers for Disease Control and Prevention: the presence of adnexal or cervical motion or uterine tenderness. The bimanual examinations were performed by one of three experienced practitioners. We treated infected patients with no evidence of PID for chlamydial and gonococcal cervicitis with 1 gm of azithromycin and 400 mg of cefixime, even if they were positive for only one of the two organisms. We treated for both organisms in case that one test was falsely negative. Treatment was observed by clinic staff; if the medicine was vomited, treatment was repeated following the administration of an anti-emetic. We followed all treated women for 30 days or until released, to determine if they developed PID after treatment for cervicitis. During incarceration, they had no opportunity for sexual intercourse.

Results

We evaluated 61 adolescents with no evidence of PID, who were treated for chlamydia and gonorrhoea between 29 March 2010 and 27 December 2010. Their mean age was 15.6 (SD 1.2) years; 45% were black, 31% Hispanic, and 24% white. Duration of follow-up after treatment ranged from 6 to 30 days. During follow-up, 8 of 62 (13%) developed lower abdominal pain and had bimanual pelvic examination findings that supported the diagnosis of PID. All but one patient developed PID at least 10 days after cervicitis treatment (range 3−30 days).

Conclusion

In incarcerated adolescents treated for gonorrhoeal and/or chlamydial cervicitis, 13% met the criteria for PID in the month subsequent to treatment, even though their therapy was directly observed, and they were not re-exposed to these organisms. Our data suggest that appropriate treatment for cervicitis does not rule out the possibility of subsequent PID even without exposure to gonorrhoea or chlamydia.
P1-S3.10 The role of Chlamydia trachomatis in the development of symptomatic pelvic inflammatory disease: a multi-parameter synthesis
Authors: Price M , Ades T , Welton N , Macleod J , Soldan K , De Angelis D , Simms I , Turner K , Horner P
Published: July 2011

Background

Chlamydia trachomatis(CT) is an important risk factor for the development of Pelvic Inflammatory Disease (PID), but despite much study the extent of its causal role remains unclear. Knowledge of the role of Chlamydia is critical for assessing the cost-effectiveness of screening programmes.

Methods

We perform a Bayesian multi-parameter synthesis of evidence from a range of prospective, retrospective, and routine data sources. These were; randomised trials following screened and unscreened women to PID; retrospective studies of Chlamydia in PID cases and controls, from which an etiologic fraction can be estimated; routine data on the number of PID cases diagnosed in England in 1 year; survey data on the probability of diagnosis of PID. We also used information on the incidence and prevalence of CT in England and the clearance rate of asymptomatic infection.

Results

We found that the different data sources provided consistent estimates of the critical parameters. We estimate the probability an episode of Chlamydia causes an episode of PID to be 0.09 (0.04 to 0.16) and that the Excess fraction of PID cases due to Chlamydia to be 0.20 (0.09 to 0.35). We estimate that prior to the start of the current screening program in the UK the annual population incidence of PID in women in England was 0.022 (0.016 to 0.028) in women aged 16−24 and 0.013 (0.009 to 0.019) in women aged 25−44 and that 42% (31% to 54%) of these cases were diagnosed.

Conclusions

In the absence of direct data, it is possible to statistically combine evidence from different types of data, to check the consistency of the data sources, and to estimate the relation between CT and PID. In considering the effect on PID risk of treating women who screen positive for Chlamydia, it is important to note that this is a survivor population who acquired CT an unknown time previously and who have not developed PID.
P1-S4.01 HIV/STD Coinfection in Arizona, 2000−2008: identifying opportunities for integrated surveillance and partner services
Authors: Taylor M , Winscott M , Skinner J , Ereth R , Kenney K , Bailey R
Published: July 2011

Background

Persons with HIV who acquire STDs such as chlamydia, gonorrhoea, and syphilis likely represent high-risk sources of HIV and STD transmission. Some state and local STD and HIV programs do not allow data sharing that would identify these individuals due to concerns with data security and confidentiality.

Objective

To identify the number of STD cases that were known to have HIV prior to the time of the STD diagnosis.

Methods

A probabilistic matching method was used to merge the HIV and STD surveillance databases at the Arizona Department of Health Services (ADHS). Partial matches were reviewed by hand to avoid misclassification. The person and diagnosis events from the HIV-STD merge were limited to gonorrhoea (GC), chlamydia (CT), primary and secondary syphilis (PS) and early latent syphilis (EL) diagnosed during 2000−2008. Persons diagnosed with GC, CT, PS or EL diagnosis were considered to be co-infected with HIV if the HIV diagnosis date was more than 60 days before the STD diagnosis date.

Results

During 2000−2008, 1494 reported STD cases occurred among persons with previously diagnosed HIV. These cases included 14% (271/1960) of the PS, 9% (173/2043) of the EL, 2% (725/39 779) of the gonorrhoea, and 0.2% (325/171 010) of the CT cases reported to ADHS. HIV coinfection among syphilis cases was highest among males ages 35−39 (PS 25%, EL 19%), 40−44 (PS 27%, EL 24%) and 45−49 (PS 22%, EL 34%). Among male GC cases the age group with the greatest percentage of HIV coinfection was 40−44 at 9%. HIV coinfection among females reported with syphilis was highest in the age group 25−29 for PS (4%, 3 cases) and 40―44 for EL (2.4%, 2 cases). Among syphilis cases, white males had the greatest percentage of HIV co-infection (PS 31%, EL 32%). Similarly among GC and CT cases, white males had the highest percentages of HIV coinfection at 7% and 1% respectively. HIV coinfection was less than 1% among women in all age groups with CT and GC. A dramatic increase in the overall percent of HIV coinfection for syphilis was seen during the study period ranging from 0.5% in 2000 to 24% in 2008 for PS and 2% to 21% during the same time interval for EL. A similar but smaller increase in the overall percent of HIV co-infection for gonorrhoea was seen during the study period ranging from 0.7% in 2000 to 2.6% in 2008.

Conclusion

Retrospective data integration identified many coinfected HIV/STD cases. Timely integrated HIV and STD surveillance would allow rapid identification of these persons who could be reached for more intensive counselling and partner services. Public STD and HIV programs should address comorbidity using methods that facilitate public health intervention.
P1-S4.02 Ethnicity based on the country of birth is better to identify the young population at high risk for Chlamydia infection than self-defined ethnicity
Authors: Haasnoot A , Koedijk F D H , Op de Coul E L M , van der Sande M A B , Götz H M , Fennema J F A , van den Broek I V F ,   on behalf of the CSI group
Published: July 2011

Background

Chlamydia infections are frequently found in young persons and ethnic minorities. Ethnicity can be defined in different ways. In this study, ethnic disparities inChlamydia trachomatispositivity in the Netherlands were assessed comparing two definitions of ethnicity. The study objective was to determine which definition is most useful to discriminate persons at risk for Chlamydia infection.

Methods

Chlamydia positivity rates in persons aged 16−29 years, were investigated using data from the first round of the Chlamydia Screening Implementation (CSI, 2008−2009) and surveillance data from specialised at STI centres in the Netherlands (2009), comparing self-defined ethnicity and ethnicity based on the country of birth of a person and his parents (first and second generation immigrants). The relation between ethnicity and Chlamydia positivity rates were evaluated using logistic regression, adjusting for age, sex and SES, in both data sets.

Results

Overall, the Chlamydia positivity rate was 13 % in the STI centres, and 5% in CSI. Being a young (first or second generation) immigrant was associated with Chlamydia positivity in both CSI (adjusted OR 2.3 [95% CI 2.0 to 2.6]) and the STI centres (adjusted OR 1.4 [95% CI 1.3 to 1.5]). Classifying the population by self-defined ethnicity resulted in a considerable group labelling themselves as Dutch (57% of the immigrants in CSI and 60% of those in the STI centres), especially second generation immigrants (72% in CSI and 80% in the STI centres). Self-defined non-Dutch ethnicity showed similar associations with testing positive in CSI (OR 2.4 [95% CI 2.1 to 2.7]) and the STI centres (OR 1.2 [95% CI 1.0 to 1.3]), but the model basing ethnicity on country of birth of a person and his parents had a better fit (higher likelihood). Self-defined ethnicity may allow for more personal input, this however also makes it a dynamic variable: in the second round of CSI, 15% of the immigrants identified themselves by a different ethnicity than in the first round see Abstract P1-S4.02 Figure 1.

Abstract P1-S4.02 Figure 1

Chlamydia positivity rate by region of origin, by self-defined ethnicity, in young persons in the Chlamydia Screening Implementation (CSI) and the Dutch STI centres.

Conclusions

Both self-defined ethnicity and ethnicity based on the country of birth of a person and his parents, can be used to detect young persons at a higher risk of Chlamydia infection. However the definition of ethnicity based on the country of birth explains variation in the Chlamydia data better and is objective and constant, whereas self-defined ethnicity would disregard a large part of the young population at higher risk for Chlamydia infection.
P1-S4.03 Using organism load ofChlamydia trachomatisandNeisseria gonorrhoeaein clinical specimens as an epidemiologic tool
Authors: Van Der Pol B , Pantone A , Williams J
Published: July 2011

Background

The Abbott Realtime m2000 system (m2000) is a qualitative real-time PCR assay for the detection of CT and NG that has the capability to provide a relative measure of target DNA. Results from the m2000 were used to determine CT and NG organism load by comparing the delta cycle (DC) value of each specimen to a set of lab developed standards containing known concentrations of each organism.

Methods

Vaginal swabs and male urine specimens were evaluated. Six standards of each organism were prepared by inoculating collection tubes with lab strains in concentrations ranging from 0 to 4×105 organisms. The log10 organism load for each positive specimen was determined by comparing the DC value to the calibration curve. Self-reported symptoms were available for each patient.

Results

A total of 99 vaginal and 284 urine specimens were available for analysis. There was no statistical difference in DC value of mean organism load by gender. Neither was there a difference based on the presence or absence of symptoms in people infected with CT. For NG, there was a significant difference in mean DC value and organism load by gender (p<0.001 for both DC and organism load) with men having higher loads. In NG positive men the mean DC was 15.2 [95% CI 14.7 to 15.8] and 11.4 [95% CI 9.0 to 13.7] for men with and without symptoms (p=0.003). This translated in mean log10 organism loads of 6.5 [95% CI 6.3 to 6.6] and 5.4 [95% CI 4.7 to 6.1] for men with and without symptoms (p=0.005). In NG positive women there was no difference in organism load based on presence or absence of symptoms (p=0.220).

Conclusions

Advantages to using this methodology include being able to quantify organism load from specimens obtained for routine diagnostic testing, using standardised test reagents that can be purchased commercially, and using an automated platform. Even in those settings that do not have the capacity for calibration, the DC values may provide useful relative loads. This exploratory study demonstrated the feasibility of using this method to obtain relative quantitation measures. Application of this tool to epidemiologic questions using larger data sets may prove useful.
P1-S1.15 The status of the HIV epidemic in Lebanon—systematic review and synthesis
Authors: Mumtaz G , Hilmi N , Abu-Raddad L
Published: July 2011

Background

The Middle East and North Africa (MENA) continues to be perceived as a region with limited HIV epidemiological data. The objective of this work was to review and synthesise for the first time all available data related to HIV in Lebanon, in order to assess the status of the epidemic in this country and provide the basis for future interventions, prevention, and research needs.

Methods

A comprehensive systematic review of HIV and risk behaviour studies in Lebanon was undertaken. Sources of data included (1) PubMed using a strategy with both free text and MeSH headings, (2) country-level reports and databases including governmental and non-governmental organisations publications, and (3) international organisations reports and databases.

Results

Available data indicate that HIV prevalence among the high risk groups ranged between 0 and 3.6% among men who have sex with men (MSM), 0 and 3.9% among injecting drug users (IDUs), and 0%–0.3% among female sex workers (FSWs). HIV prevalence in the general population was very limited (∼0%). Analysis of HIV notified cases indicated a substantial recent increase in the contribution of male same-sex sex, whereby 52% of notified cases in 2008 were due to MSM transmission compared to 13% in the cumulative period until 2008. Substantial levels of risk behaviour were reported by the three high-risk groups. MSM reported an average of 9.5 sexual partners in the last year and up to 36% engaged in male sex work. Seventeen to 65% of IDUs shared needles/syringes, 33%–47% had sex with FSWs, 17%–33% engaged in sex work, and 24.7% reported male same-sex sex. FSWs reported an average of 11.7 sexual partners per week. Despite relatively high levels of risk behaviour, condom use in Lebanon was high and among the highest in the MENA region, so were the levels of knowledge of HIV/AIDS and of its modes of transmission. Molecular epidemiology evidence indicated a diverse HIV subtype distribution suggesting multiple exogenous introductions of the virus.

Conclusions

The evidence gathered in this review indicates that HIV endemic transmission appears to be still limited in Lebanon with most diagnosed cases representing exogenous exposures. There are however few indications suggesting an emerging epidemic among MSM. HIV surveillance of high-risk groups needs to be actively expanded in Lebanon to track such potential emerging epidemics and prevent further HIV transmission among population groups at high risk of HIV infection.
P1-S4.07 The use of the Arizona Department of Health Services surveillance database to identify discordant syphilis treponemal laboratory results, Arizona
Authors: Winscott M , Betancourt A , Ereth R
Published: July 2011

Background

In March of 2010 a large commercial lab performing STD testing in Arizona implemented the reverse algorithm for syphilis testing with the use of the syphilis treponemal enzyme immunoassay (EIA).

Methods

Per the Arizona Department of Health Services (ADHS) Sexually Transmitted Disease Control Program protocol, manual review of positive syphilis lab results is performed by one epidemiologist. During May through October 2010, this epidemiologist recorded negative syphilis EIA results identified among reported syphilis cases with a prior history of positive treponemal tests (TP-PA, FTA-ABS).

Results

From 6 May 2010 to 29 October 2010 78 syphilis EIA tests were reported as negative in individuals with a previously positive treponemal test. Fifty of these tests were completed among males and 28 among females. This discrepancy was brought to the attention of the reporting lab in May and again in October 2010. In November, a coordinated investigation between the reporting laboratory, the ADHS public health lab, and the ADHS Sexually Transmitted Disease Control Program (ADHS STDCP) was undertaken. This investigation resulted in the identification and correction in a specimen transfer procedure at the local laboratory level. All providers of patients with possible incorrect lab results completed during this time period were notified of the problem and advised to retest their patients, if indicated. The ADHS STDCP continues to monitor syphilis lab results for this particular error and has not identified any further discordant results since the corrections were implemented in November 2010.

Conclusions

Discrepancies in syphilis EIA results have been reported from other regions. The detailed manual review of all reported syphilis lab results by an epidemiologist at the ADHS STDCP aided in the detection of this particular issue. Upon implementation of electronic lab reporting, this program and others, should continue routine, manual quality assurance checks of syphilis laboratory results. Such practices are imperative to ensure that these errors do not go undetected and that syphilis patients do not go undiagnosed.
P1-S4.15 Revisiting HIV epidemic appraisals for assisting in the design of effective HIV prevention programs
Authors: Mishra S , Sgaier S K , Thompson L , Moses S , Ramesh B M , Alary M , Blanchard J F
Published: July 2011

Background

There is substantial heterogeneity in the size and trajectory of HIV, driven largely by differences in the population sexual structure, which determines overall HIV transmission dynamics. Two standard methods have been developed to appraise epidemics and guide prevention strategies. The numerical proxy method classifies epidemics based on HIV prevalence thresholds. The Modes of Transmission (MOT) model estimates the distribution of incidence over 1 year among subgroups. Neither approach explicitly captures the drivers of the epidemic and can therefore lead to misguided prevention priorities. Using data from India, we explored the limitations of current methods and propose an alternative approach.

Methods

We compared outputs of the traditional methods in five countries with published results, and applied the numeric and MOT model to India, and to six districts within India. We developed an alternative approach based on a qualitative understanding of local epidemic drivers, the Transmission Dynamics Epidemic Classification (TDEC) scheme, and demonstrated its application. Where data permitted, we calculated the population attributable fraction of paid sex for HIV infection among males to assist in TDEC classification.

Results

Country and district level analysis illustrated three main limitations of the numeric and MOT methods: (1) their results misinterpreted underlying transmission dynamics and were inconsistent; (2) they were difficult to apply to local epidemics with heterogeneity across districts ; and (3) the MOT model was highly sensitive to input parameters, many of which required extraction from non-regional sources. The TDEC method offered a logical algorithm to characterise local sexual structures that likely sustain onward HIV transmission; it required minimal but key input data.

Conclusion

Traditional appraisals of HIV epidemics can misdirect prevention programming if the goal is long-term HIV control. By characterising local transmission dynamics, the TDEC approach provides a potentially more effective tool with which policy makers can design intervention programs.
P1-S4.16 The UNAIDS modes of transmission model: a useful tool for decision making?
Authors: Foss A , Prudden H , Mehl A , Zimmerman C , Ashburn K , Trasi R , Kiess M , Bantebya-Kyomuhendo G , Fritz K , Watts C
Published: July 2011

Background

The UNAIDS Modes of Transmission (UNAIDSMoT) model is increasingly being used to inform national-level HIV priority setting. Although the model is simple to use, important factors may be omitted. Using the UNAIDSMoT model, with Uganda and Cambodia as case studies, we explored the influence of the incorporation of additional factors.

Methods

A detailed review of the UNAIDSMoT model was conducted, including reviewing the model structure, data requirements, parameters and assumptions. Country-specific literature reviews were undertaken, along with field visits involving key-informant interviews, to identify the main features of the HIV epidemic in each setting. Adaptations were made to the UNAIDSMoT model to explore the sensitivity of the model projections to these revisions.

Results

A key limitation of the original UNAIDSMoT model is that it does not allow an individual's multiple sources of risk to be considered. The model was adapted to incorporate important multiple risk sources (including injecting drug use), and the effects of the 2008 change in Cambodian law on human trafficking which led to brothel closures, the migration of many sex workers into entertainment venues, and the discontinuation of numerous outreach and condom distribution programmes. As illustrated in Abstract P1-S4.16 figure 1, the revised model projects lower percentages of new HIV infections occurring among sex workers (2% vs 5%) and the regular female partners of men who buy sex (5% vs 48%) than the original model, primarily replaced with new infections occurring in the new groups: entertainment workers who sell sex (38%), and injecting drug users and their sexual partners (5%). In Uganda, the high prevalence of HIV infection among women means that the static model predicts men are more at risk of infection from their female partners than women are from their male partners. This fails to reflect the dynamic chain of HIV transmission.

Abstract P1-S4.16 Figure 1

Distribution of HIV incidence in original and revised UNAIDSMoT models.

Conclusions

Our analysis highlights the limitations of the UNAIDSMoT model, and the potential dangers of over-interpretation of a relatively simplistic and static reflection of a dynamic HIV epidemic (and prevention priorities) at a particular time-point. It is important to regularly re-structure and re-parameterise models according to new data and changes in patterns of risk behaviours. Further research to test the validity, sensitivity and robustness of the UNAIDSMoT model projections in different epidemic settings is needed.