bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S2.21 Integrating public health into the sex worker community in Indianapolis
Authors: Roth A M , Rosenberger J G , Waters J , Arno J , Van Der Pol B
Published: July 2011

Background

Syphilis is a significant disease from a public health perspective both historically and as a result of the serious consequences of infection. While studies have explored the epidemiology of syphilis among at-risk populations, limited information exists regarding women's preferences for STD testing and treatment services. The purpose of this study was to explore sex workers preferences for receiving sexual health services.

Methods

A total of six groups of 4–7 sex workers each were recruited from local community-based organisations. The semi-structured interview guide included questions based on the Health Belief Model such as—1) cues to action—“Think back to the last time you received a female wellness exam or got tested for STD. What prompted you to schedule that appointment?” 2) Perceived susceptibility—“Describe what worries you most when you think about your health and how it's affected by being on the streets.” and 3) perceived barriers—“What are some of the reasons why women who are working the streets don't get tested for STD?” Focus groups lasted 1 h, were audio recorded, and transcribed. Preliminary codes were selected, applied to the transcripts, and key concepts that spanned groups were identified.

Results

In general, most women used utilised health protective behaviours to mitigate health risks associated with sex work. However, these behaviours were context and partner specific. Participants were interested in having increased access to sexual health services. Primary themes regarding program development included—experiences with healthcare providers, types of services that would encourage uptake, mechanisms for service delivery and the importance of collaborating with law enforcement and other service providers. The participant's recommendations were organised into a model program with specific service delivery mechanisms for each key concept.

Conclusions

These data suggest potential pathways STD control programs to intervene with hard-to-reach populations, like commercial sex workers. In this project, a participant-informed approach was utilised that should result in increased uptake and utilisation of sexual health services because participants provided key insights into the programmatic considerations necessary for STD prevention efforts to be most effective.
P1-S1.08 Prevalence ofNeisseria gonorrhoeaeandChlamydia trachomatisinfection in men attending STD clinics in Brazil
Authors: Barbosa M , Pinto V M , Moherdaui F , Ribeiro D , Espinosa A
Published: July 2011

Introduction

The study aimed to assess the prevalence ofNeisseria gonorrhoeaeandChlamydia trachomatisinfections and identify demographic, behavioural and clinical factors correlated with such infections in men attending six sexually transmitted disease clinics in Brazil.

Methods

Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing forN gonorrhoeaeandC trachomatisby DNA-PCR.

Results

A total of 767 (92.9%) men were included in the study. The mean age was 26.5 (SD 8.3) years old. Prevalence of Chlamydia infection was 13.1% (95% CI 10.7% to 15.5%) and gonorrhoea was 18.4% (95% CI 15.7% to 21.1%). Coinfection prevalence was 4.4% (95% CI 2.95% to 5.85%) in men who sought attendance in STI clinics. Factors identified as associated withC trachomatiswere younger age (15–24) (OR=1.4 (95% CI 1.01 to 1.91)), present urethral discharge (OR=4.8 (95% CI 1.52 to 15.05)), genital warts (OR=3.0 (95% CI 1.49 to 5.92)) and previous history of urethral discharge (OR=2.4 (95% CI 1.11-5.18)]. Variables associated with gonorrhoea were younger age (15 to 24) [OR=1.5 (95% CI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95% CI 5.53-17.79)], genital warts [OR=18.3 (95% CI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95% CI 1.06-22.73)]. Conclusions—These findings have important implications for education and prevention actions directed towards men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.
P1-S2.29 Risky sexual practices among youth in Quebec Care Centers
Authors: Lambert Gilles , Haley Nancy , Jean Sandrine , Tremblay Claude , Frappier Jean-Yves , Otis Joanne , Roy Elise
Published: July 2011

Background

Adolescents in Youth Protection facilities are a vulnerable population, with difficult life trajectories; many of their behaviours are health compromising.

Method

Youth aged 14–17, living in semi-urban and urban youth centers in Quebec were recruited on a volunteer basis to participate in the study. Socio-demographic, drug use, sexual behaviours and health service utilisation data were obtained using a structured, face-to-face interview. A urine sample was collected to test for chlamydia and gonorrhoea.

Results

Between July 2008 and May 2009, 578 youth were interviewed—(♂—58 %); median age—♂—16; ♀—15. The majority of youth were sexually active (89%); two thirds experienced voluntary coitarche before 14 years of age. Median number of lifetime partners was 6 (♂—8, ♀—5). Over a third (41%) reported group sexual activities. A large proportion of youth experienced 50% or more of their sexual activities under the influence of alcohol—18%, cannabis—37%, other drugs—18%. Lifetime history of “never or rarely” using condoms was 24.7% for vaginal relations and 42.1% for anal relations (♂—33%, ♀—55%). Protection used during last vaginal activity was—double protection (condom and another contraceptive method)—25%; condom only—32%; contraceptive method without condom—20%; no protection—24%. A quarter of girls (28%) and boys (27%) reported an unplanned pregnancy (lifetime). Prevalence of chlamydia was—girls 9%, boys 1.9%. No cases of gonorrhoea were documented.

Conclusions

Youth in Quebec care centers report many risky sexual behaviours, often associated with drug and alcohol use. Only a quarter of youth used protection to prevention both STIs and pregnancy during their last sexual activity. Their sejour in residential care is an opportune moment to screen these youth for risk behaviours that may compromise their future health and to provide them with personalised prevention education and health services adapted to their reality.
P1-S2.39 Characteristics of Lymphogranuloma Venereum (LGV) infection among homosexual men in Melbourne.
Authors: Bissessor M
Published: July 2011

Background

Lymphogranuloma venereum (LGV) has re-emerged among men who have sex with men (MSM) internationally. Previous cases among MSM in Australia have been reported. We aimed to characterise a series of LGV cases seen at the Melbourne Sexual Health Centre.

Methods

We reviewed all cases of LGV seen at the Melbourne Sexual Health Centre between 2005 and 2010. During this period MSM who were diagnosed with rectal chlamydia using strand displacement assay were routinely questioned about symptoms of proctitis using a symptom check list. Those with symptoms of proctitis had specimens forwarded forChlamydia trachomatisomp1 genotyping. Genotyping of chlamydia-positive first void urine and penile ulcers in MSM was undertaken on selected MSM based on clinical presentation.

Results

During the study period, of 292 chlamydia positive ano-rectal specimens that were genotyped, 21 (7.2%) tested positive for LGV. Of the eight chlamydia positive urine or penile specimens genotyped, four were positive for LGV. There was also one case of an inguinal bubo that tested LGV positive from aspirated pus. In all cases L2 or L2b type was isolated. Of the 25 cases of LGV, 18 (72%) were in HIV positive men. Of the 21 men who had ano-rectal LGV, all had ano-rectal symptoms, namely—ano-rectal pain (71%), anal discharge (62%) and/or rectal bleeding (52%). All but one of the LGV infected men received at least a 3-week course of doxycycline 100 mg twice daily. Two men with ano-rectal LGV remained LGV positive on follow-up when tested 3 months later. Both these patients were noted to have had unprotected sex following initial treatment, hence, it is unclear whether this was due to treatment failure or reinfection.

Conclusions

LGV continues to be seen among MSM in Melbourne presenting with proctitis. Genotyping of anal chlamydia infections has been useful in distinguishing LGV from the more common non-LGV chlamydial infections, therefore ensuring appropriate antibiotic therapy and follow-up are instigated.
O3-S1.01 British Ocular Syphilis Study (BOSS): National Surveillance Study of intraocular inflammation secondary to infectious syphilis
Authors: Goh B , Matthew R , Simms I , Westcott M
Published: July 2011

Background

Syphilis poses a significant public health problem. There has been a 1032% increase in the incidence of syphilis between 1999 and 2008 in the UK. There are currently no epidemiological studies looking at the incidence of ocular syphilis in the light of the outbreak. Ocular syphilis is a rare, but treatable if recognised early. The purpose of this study is to ascertain the incidence of intraocular syphilis in the UK and to characterise the clinical presentation patterns of ocular syphilis.

Methods

A prospective study was conducted in the UK and Republic of Ireland, where cases of ocular syphilis were reported through the national reporting system (British Ocular Surveillance Unit) over an 18-month period from May 2009. Case definition was any adult patient who presented with intraocular inflammation and early infectious syphilis as evidenced by positive syphilis serology with (1) high titre RPR of >1:8 or (2) signs of secondary syphilis.

Results

35 new cases of ocular syphilis were reported (annual incidence 0.46 per million) with a mean age of 51.5 years (range 22–75 years). 86% were males; 88% were caucasians and 12% were Afro-Caribbean. The mean duration of symptoms was 1.0 month prior to presentation (range 2 days to 4 months). 46% of patients had bilateral involvement and the mean presenting logMAR visual acuity was 0.48 (20/60 Snellen; range −0.1–1.86). 54% had visual acuities of 20/40 Snellen or better at initial consultation. Presenting acuity was not influenced by duration of visual symptoms. Intraocular pressure on presentation was elevated in only one patient (27 mm Hg). Although 68.4% had an anterior uveitis (AU), isolated AU was rare (1 case). 63% had vitritis; 61% had a form of posterior uveitis, (60% retinitis, 56% vasculitis, 50% macular oedema, 28% choroiditis). 32% of cases had optic nerve involvement. Of males whose sexual orientation was ascertained 85% were MSM. Of patients whose HIV status was known, 71% were HIV positive.

Conclusions

This study is the largest prospective series of ocular syphilis in the post-penicillin era providing up to date Western European incidence, demographic and clinical data. Syphilitic uveitis affects mainly adult males of all ages; majority were MSM or HIV positive. The uveitis is normotensive, posterior uveitis is common, and AU rarely presents in isolation. Clinician and public health awareness of ocular syphilis remains important.
O3-S2.01 Long-term efficacy of human papillomavirus vaccination against CIN3 and invasive cervical carcinoma: a registry based Passive follow-up of the phase III trial (PATRICIA)
Authors: Paavonen J , Lehtinen M , Rana M , Apter D , Luostarinen T , Pukkala E
Published: July 2011

Background

While phase 3 trials have shown that vaccination against human papillomavirus (HPV) types 16 and 18 prevents persistent HPV type 16 and 18 infections and most high-risk HPV type positive cervical intraepithelial neoplasia (CIN) grade 2+ lesions, long-term follow-up of the phase 3 cohorts is needed to demonstrate that HPV16/18 vaccination prevents CIN3 and invasive cervical carcinoma (CIN3+).

Methods

We used data from the Finnish Cancer Registry for passive follow-up of cluster (age-cohort) and individually randomised cohorts of women born in 1984–1989 to assess incidence rates of CIN3+ in HPV16/18 vaccinated Finnish cohort of the bivalent HPV 16/18 vaccine PATRICIA trial participants (N=2404) and a reference cohort (N=7049) enrolled from the same communities. Six months after the Phase III trial was closed in 2009 the cohorts were linked with the Finnish Cancer Registry.

Results and Conclusions

A pilot study in 2009 showed that the baseline incidence of CIN3+ was 41 per 100 000 women years in the reference cohort. Knowing that CIN3+ incidence rapidly increases as the cohorts age, the baseline incidence yields 80% power to show 70% vaccine efficacy against CIN3+ in just 5 years. The phase 3 trial included intensive clinical follow-up and thorough health education and counselling which may have modified subsequent risk of cervical neoplasia in all study participants, the incidence rates of CIN3+ need to be validated in a cohort not exposed to any clinical intervention. Preliminary data from such comparison of the incidence rates during passive follow-up the PATRICIA study participants (comprising 50 000 women years) and the reference cohort will be reported.
O3-S4.04 Time to cure chlamydia: prospective study on detection of anorectal and cervicovaginal chlamydia after directly observed treatment with azithromycin
Authors: Dukers-Muijrers N , Werner M , Brouwers E , Speksnijder A , Spauwen L , Bruisten S , van den Broek I , van der Sande M , Morré S , Hoebe C
Published: July 2011

Background

When a person, diagnosed withChlamydia trachomatis(Ct), is being treated for Ct, STI Centres generally advise a short period of sexual abstinence; in most cases no test of cure is performed. These are considered best practices to cure Ct and prevent further spread, assuming high antibiotic efficacy. However, in about 5% of treated patients symptoms persist and among those retested 6–12 months later, 10% is Ct positive (again). Moreover, the efficacy of Azithromycin treatment for anorectal Ct is debated. The current study aims to increase understanding Ct treatment efficacy and to estimate time to cure cervicovaginal and anorectal Ct, using repeated measurements of laboratory, medical, and exposure parameters.

Methods

Prospective study among 49 persons with cervicovaginal Ct (45 women) and/or anorectal Ct (four men, three women). After directly observed treatment with 1000 mg Azithromycin, each participant provided during 2 months 18 time-sequential self-taken samples for testing for rRNA (TMA), Ct bacterial load (quantitative PCR; Ct plasmid DNA), and type Ct (serovar), and three time-sequential questionnaires on potential exposure (behaviour) and symptoms. Steady partners were treated as well. Here, we report on the 905 rRNA tests in 49 patients.

Results

Of all women with cervicovaginal Ct, the proportion rRNA positive was 100% at treatment, 54% at day 7, 11% at day 12 and 17% 2 months after treatment. For anorectal Ct, these rates were 100%, 57%, 29%, and 50%. In total 45% of persons with cervicovaginal Ct and 57% with anorectal Ct had at least one positive rRNA sample in the period between 2 weeks and 2 months after treatment. Three cases of anorectal Ct (negative Lymfogranuloma venerum (LGV) PCR) remained rRNA positive during 2 months and tested Ct negative after administration of doxycycline (testing 2 months later).

Conclusions

The proportion of Ct rRNA positivity during follow-up was much higher than expected in the light of assumed high effectiveness of Azithromycin treatment. Time to cure depends on the extent rRNA indicates clinically relevant or persistent Ct infection; this will be determined considering other markers (eg, Ct DNA) and symptoms as well (research ongoing). The persistent anorectal Ct cases that resolved after doxycycline treatment, contribute to the notion that this might be better treatment in anorectal Ct, after exclusion of LGV. Current study contributes to evidence based patient management and Ct transmission reduction.
O1-S03.02 Cephalosporin susceptibility ofNeisseria gonorrhoeaeisolates in the USA, 2000–2010
Authors: Kirkcaldy R , Murray E , Del Rio C , Hall G , Hook E , Whittington W , Papp J , Weinstock H
Published: July 2011

Background

Cephalosporins are recommended by CDC for first-line gonorrhoea treatment. Declining cephalosporin susceptibility and clinical cefixime treatment failure have been reported from Asia, Europe and other regions. We report cephalosporin susceptibility trends among USN gonorrhoeaeisolates.

Methods

The Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system that monitors antimicrobial susceptibility among isolates collected from men with urethritis. Minimum inhibitory concentrations (MICs) are determined by agar dilution. The proportion of isolates with elevated MICs to cefixime (≥0.25 μg/ml) and ceftriaxone (≥0.125 μg/ml) from 2000 through the first half of 2010 were tested for trends using the Cochran-Armitage trend test. Susceptibility tests for cefixime were not performed during 2007–2008.

Results

61 559 isolates were tested during 2000–June 2010 (annual mean=5845). Overall, 37% of isolates were from men in the northeastern or southern regions of the US, 25% were from the Midwest, and 38% were from the West; 21% were from men who have sex with men (MSM). The proportion of isolates with elevated MICs remained stable for cefixime (CFX) from 2000 to 2006 (0.2% to 0.1%; CFX susceptibility not tested 2007 and 2008) and for ceftriaxone (CRO) from 2000 to 2008 (0.1% to 0.1%); the proportions increased in 2009 and 2010 (CFX: 0.8% and 1.9% [n=53], p<0.001; CRO: 0.3% and 0.4% [n=11], p<0.001). In 2010, most isolates with elevated MICs to cephalosporins were from the West (CFX: n=48 [91%]; CRO: n=7 [64%]) and from MSM (CFX: n=46 [87%]; CRO; n=9 [82%]).

Conclusions

The proportion of gonococcal isolates with elevated MICs to cefixime and ceftriaxone recently increased in the US. Most of the isolates with elevated MICs were from men in the West and MSM. This is worrisome given trends elsewhere in the world and the history of fluoroquinolone-resistance in the US, which, early in the epidemic, was most often detected in the western US and among MSM. Cephalosporins remain effective for gonorrhoea treatment in the US, yet increasing MICs suggest that resistance may emerge. If cephalosporin resistance does emerge, alternative antibiotic treatment options will be needed.
O1-S03.03 Clonally relatedNeisseria gonorrhoeaeisolates with decreased susceptibility to extended-spectrum cephalosporins in Amsterdam, the Netherlands
Authors: Heymans R , Bruisten S , Golparian D , Unemo M , de Vries H , van Dam A
Published: July 2011

Background

Between 2006 and 2008, the prevalence ofNeisseria gonorrhoeae(NG) isolates with decreased susceptibility (0.125<MIC<0.5 μg/ml) to the extended-spectrum cephalosporin (ESC) cefotaxime (CTX) among visitors of the STI clinic in Amsterdam, the Netherlands increased from 4.8 to 12.1%. The transmission patterns, clonality, phenotypic and genotypic characteristics of the NG isolates transmitted within this high-risk group were examined.

Methods

From 2006 to 2008, 74 NG isolates with a CTX MIC of >0.125 μg/ml (group A), 54 with a CTX MIC of 0.125 μg/ml (group B), and a control group of 74 with a CTX MIC of <0.125 μg/ml (group C), were included. All isolates were characterised using antibiograms, conventional penA mosaic gene PCR, and genotyping by NG-multi-locus variable-number tandem repeat analysis (MLVA). PenA mosaic positive isolates and a strict selection of the remaining isolates were further characterised by NG-multilocus sequence typing (MAST) and sequencing of ESC resistance determinants (penA, mtrR, and porB1b).

Results

The majority of the isolates in group A (n=47; 64%) but only 11% (n=6) of the isolates in group B contained a penA mosaic allele. No penA mosaic-containing isolate was identified in group C (see Abstract O1-S03.03 figure 1). All the 53 penA mosaic isolates had an identical penA sequence (type XXXIV) and were assigned to the same MLVA cluster, which additionally included three isolates that were susceptible to CTX (MIC<0.125 μg/ml). Within this MLVA cluster, 46 (87%) of the penA mosaic isolates were assigned NG-MAST ST1407, and the remaining 7 isolates had closely related STs. All these penA mosaic isolates contained a mtrR promoter deletion and in 52/53 isolates the porB1b alterations G101K and A102N were found. Decreased susceptibility to cefixime and ceftriaxone (MIC≥0.016 μg/ml) was found in 50/53 and 44/53 isolates, respectively. The mosaic penA MLVA cluster, containing ST1407 (87%) and closely related STs (13%), represented Dutch homosexual men (66%), patients with frequent chlamydia co-infection (32%), and commercial sex workers (7%).

Abstract O1-S03.03 Figure 1

GGD.

Conclusions

A strong correlation was found between the decreased ESC susceptibility and a NG penA mosaic strain (ST1407) that was highly prevalent among visitors of the STI clinic Amsterdam. This strain was identified in many other countries. The rapid spread of this NG strain might be facilitated by high-risk sexual behaviour and should be monitored closely to identify potential treatment failure.
O1-S03.05 Community-acquired methicillin-resistant and susceptibleStaphylococcus aureusamong men who have sex with men
Authors: De Vries H , Joore I , van Rooijen M , Schim van der Loeff M , van Dam A , De Vries H
Published: July 2011

Background

Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) has been found more often among men who have sex with men (MSM) in some studies (USA). This study assesses the prevalence and sexual risk factors for CA-MRSA and methicillin susceptibleStaphylococcus aureus(MSSA) colonisation and infection among MSM in Amsterdam, the Netherlands.

Methods

MSM attending the sexually transmitted infections outpatient clinic in Amsterdam were invited to participate in this study and divided in two groups: (1) MSM with clinical signs of a skin/soft tissue infection (symptomatic group) and (2) MSM without clinical signs of such infections (asymptomatic group). Demographic characteristics, medical history, sexual behaviour, history of sexual contacts and known risk factors for colonisation withS aureuswere collected through a self-completed questionnaire. Swabs were collected from the anterior nasal cavity, throat, perineum, penile glans and, if present, from infected skin lesions. Culture forS aureuswas done on blood agar plates and for MRSA broth on selective chromagar plates after enrichment in broth. If MRSA was found, the sex partners of the index patient were invited for screening for MRSA.

Results

Between October 2008 and April 2010 a total of 214 MSM were included in the study: 76 into the symptomatic group and 138 MSM into the asymptomatic group. The prevalence of MSSA in the nose was 36% (78/214) and in skin lesions 36% (27/76). The prevalence of MRSA was 0.9% (2/214). Both MRSA cases, one asymptomatic and one symptomatic, were HIV positive. The asymptomatic MRSA carrier had been hospitalised the previous year. None of the four sexual contacts that could be traced were colonised by MRSA. The symptomatic MRSA case had a soft tissue infection in the genital area; in this case also the nasal cavity, perineum and glans penis were positive for MRSA. No sexual contacts could be traced. There were no significant differences in age, sexual risk behaviour, drug use, history or diagnoses of sexual transmitted diseases, circumcision status or hygiene behaviour between those with and without a genitalS aureusinfection, but those infected withS aureuswere significantly more often HIV infected (55% vs 34%; p<0.01).

Conclusion

CA-MRSA among MSM STI outpatient clinic visitors in Amsterdam is rare. There were no indications for sexual transmission of MRSA or MSSA in this population.
O1-S05.05 Association betweenTrichomonas vaginalisand vaginal bacterial community composition among asymptomatic reproductive-age women in the USA
Authors: Brotman R , Jones L L , Sakamoto J , Gajer P , Ault K , Peralta L , Forney L , Abdo Z , Ravel J
Published: July 2011

Background

Vaginal bacterial communities are thought to prevent infection by sexually transmitted organisms. Prior work demonstrated that the vaginal microbiota of reproductive-age women in the US cluster into five groups of bacterial communities; four dominated byLactobacillus spp. (L iners, L crispatus, L gasseri, L jensenii), and one lacking significant numbers of lactobacilli and characterised by higher proportions of strictly anaerobic organisms (termed group IV). We sought to compare the vaginal microbiota ofT vaginalis-positive andT vaginalis-negative women using cultivation-independent methods. To our knowledge, this is the first analysis of the relationship betweenT vaginalisand vaginal bacterial communities characterised by molecular methodologies.

Methods

Self-collected vaginal swabs were obtained cross-sectionally from 396 asymptomatic US women equally representing four ethnic/racial groups. Screening for the presence ofT vaginaliswas performed using PCR targeting the 18S rRNA and ß-tubulin genes. Vaginal bacterial composition was characterised by pyrosequencing of barcoded 16S rRNA genes. The relationship between vaginal microbiota andT vaginaliswas evaluated by Fisher's exact testing and logistic regression.

Results

Of the 11T vaginalis-positive cases, 8 (72%) were classified to the low-Lactobacillus group IV, 2 (18%) and 1 (9%) with communities dominated byL inersandL crispatus, respectively (p value: 0.056). Group IV was associated with an eightfold increased odds of detectingT vaginaliscompared to women with communities dominated byL crispatus(OR: 8.26, 95% CI: 1.07% to 372.65%, p value: 0.04). Other than the major bacteria dominating each cluster, none of the other observed taxa showed significant association withT vaginalis-positivity although this may reflect few observed cases rather than lack of a true association. Ten (91%) of theT vaginaliscases self-reported Black ethnicity and 1 (9%) reported Asian, (p value: 0.00002).

Conclusion

Molecular analyses revealed that vaginal microbiota with low proportions of lactobacilli were significantly associated with presence ofT vaginalis. Longitudinal studies are needed to identify the causal nature of the relationship between vaginal bacterial communities and STI risk.
O1-S06.03 Pre-exposure prophylaxis for HIV prevention
Authors: Cremin I , Hallett T , Dybul M , Piot P , Garnett G
Published: July 2011

Background

Two randomised controlled trials have recently provided evidence for the efficacy of Pre-Exposure Prophylaxis (PrEP), whereby uninfected individuals use antiretrovirals—either orally or topically—for the prevention of sexual acquisition of HIV. However, the potential population-level impact of a PrEP intervention remains uncertain.

Methods

A population-based deterministic mathematical model was developed to investigate the impact of a PrEP intervention in Cotonou, Benin (1.7% adult prevalence in 2006) and Kisumu, Kenya (13.9% adult prevalence in 2008). It was assumed that PrEP has high intrinsic efficacy (90% reduction in acquisition per PrEP protected sex act) but its effectiveness is reduced by imperfect adherence (75% of sex acts are protected for good adherers (40% of PrEP users) and 30% of sex acts are protected for poor adherers (60% of PrEP users)). The impact of prioritising a fixed amount of PrEP with respect to behavioural risk was investigated, whereby 10% of the population received PrEP in each scenario.

Results

In the absence of prioritisation of PrEP, an estimated 2.12% and 5.44% of infections would be averted over 10 years in Cotonou and Kisumu, respectively. However, the population-level epidemiological impact of a PrEP intervention can be substantially increased by prioritising to key populations most at risk of infection (Abstract O1-S06.03 figure 1). Percentage of infections averted over 10 years with respect to different levels of prioritisation by behavioural risk, in Cotonou, Benin and Kisumu, Kenya. The efficiency of increased prioritisation by behavioural risk is greater in Cotonou, as the HIV epidemic is more focussed within identifiable at-risk groups. However, the overall epidemiological impact of the PrEP intervention is greater in Kisumu, which has higher HIV incidence than Cotonou. Assuming an estimated cost range for PrEP of $160–$240 per-person per-year, the estimated cost per infection averted in Kisumu, Kenya, ranges from $13,578 to $20,368, if 50% of high risk individuals receive PrEP and the remaining PrEP is distributed among low and medium risk individuals. These costs should be considered in light of future averted costs of ART provision.

Abstract O1-S06.03 Figure 1

Percentage of infections averted over 10 years with respect to different levels of prioritisation by behavioural risk, in Cotonou, Benin and Kisumu, Kenya.

Conclusions

An effective PrEP intervention could reduce the incidence of HIV transmission in generalised HIV epidemics. Considerable gains in impact, and therefore cost-effectiveness, can be achieved if PrEP is prioritised for those at highest risk of acquisition. Epidemiological context plays an important role in influencing the potential population-level impact of a PrEP intervention.
O1-S01.04 Suboptimal repeat testing of women with positive chlamydia tests in the USA, 2008–2010
Authors: Hoover K , Tao G , Body B , Nye M , Kent C
Published: July 2011

Background

Women treated for chlamydia have a high prevalence of infection several months later, likely caused by reinfection from an untreated or new infected sex partner. To prevent potential adverse outcomes of chlamydia, US guidelines recommend repeat testing 3 months after treatment, regardless of partner treatment. If retesting at 3 months is not possible, women should be retested at their next clinical encounter within 12 months. A chlamydia test-of-cure is also recommended for all infected pregnant women 3–4 weeks after treatment. We assessed adherence to retesting guidelines using data from a US laboratory corporation that has a large share of the US market.

Methods

Among tests performed from June 2008 to May 2010, we estimated the percentage of women who were retested ≥3 weeks later by test result, age and pregnancy status. We also estimated the positivity rate among repeat chlamydia tests and the mean time between an initial test and the first repeat test. We assumed that for each woman in the database all chlamydia tests during the study period were performed by this laboratory corporation.

Results

Among 2.90 million chlamydia tests performed in 1.77 million women, 4.0% (114 963) were positive. Among the 1.77 million women with tests, 1.34 million (75.7%) had only a single test and 0.43 million (24.3%) had at least one repeat test. If an initial test was positive, 48.6% were retested compared to 23.5% if the initial test was negative (p<0.01); a repeat test was more likely to be positive in women with an initial positive test (13.3%) than a negative one (3.3%) (p<0.01). The mean time interval between the initial and repeat test was shorter if the initial test was positive (117 days) than negative (149 days). Women aged 15–24 years with a positive test had a lower retesting rate than those aged 25–34 years (46.8% vs 53.3%). The percentage of women with a positive test who were retested differed significantly by pregnancy status (60.0% pregnant vs 44.2% nonpregnant), and pregnant women had a repeat test within 93 days compared to 125 days in nonpregnant women.

Conclusions

These data from a large laboratory corporation provide insight into chlamydia testing practices among women in the USA, and suggest suboptimal adherence to retesting recommendations for both pregnant and nonpregnant women. These data can be useful to monitor the effectiveness of interventions to improve follow-up testing of women with chlamydia.
O1-S08.05 Recent trends in STIs and HIV among female sex workers and their clients in India: results from repeated cross-sectional surveys
Authors: Adhikary R , Ramanathan S , Gautam A , Goswami P , Ramakrishnan L , Kallam S , Mainkar M M , Brahmam G N V , Subramanaian T , Paranjape R S
Published: July 2011

Background

HIV transmission in India is concentrated among high-risk groups. Female sex workers (FSWs) and Clients of FSWs are the most vulnerable groups at risk for HIV. This paper presents the prevalence of sexually transmitted infections (STIs) and HIV among FSWs and their clients in the states of Andhra Pradesh (AP), Tamil Nadu (TN) and Maharashtra (MH) from repeated, cross-sectional, bio-behavioural surveys.

Methods

Data from two rounds of Integrated Behavioural and Biological Assessments conducted in 2005 (R1) and 2009 (R2) among 15 632 FSWs (R1-7828, R2-7804) and 9624 clients of FSWs (R1-4821, R2-4803) were analysed to observe the changes in STI and HIV prevalence among each group. Respondents' behaviour was assessed and blood and urine samples were collected to test for STIs [Chlamydia trachomatis(CT),Neisseria gonorrhoeae(NG), syphilis and HIV]. Analysis at both the aggregate and state level was done. Adjusted ORs were obtained by including all socio-demographic variables associated with rounds of survey in multivariate models.

Results

At the aggregate level, among FSWs, prevalence of syphilis declined from 10.8% in R1 to 5.0% in R2 (AOR 0.39, p=0.001) and no significant change was observed in prevalence of HIV, NG or CT. Among FSW clients, STI prevalence was low in R1 (syphilis 4.7%, NG 0.4% and CT 2.4%) and no significant change was observed in R2. The state-wide trend shows that for FSWs in AP, a significant decline occurred in prevalence of both HIV (AOR 0.68, p<0.01) and syphilis (AOR 0.39, p<0.001) whereas in TN, only syphilis prevalence declined (AOR 0.20, p<0.001). The trend in MH differs from the other two states. In MH, prevalence of bacterial STIs (syphilis, NG and CT) declined significantly whereas HIV prevalence increased significantly (AOR 1.29, p=0.04). Among FSW clients, STI prevalence was low in MH (syphilis 4.3%, NG 0.7%, and CT 4.2%) and TN (syphilis 4.1%, NG 0.0%, and CT 0.8%) in R1 and remained unchanged in R2. However, a significant decline occurred in HIV prevalence in both states [MH: AOR-0.25, p=0.002; TN: AOR-2.3, p<0.05]. In AP, only prevalence of syphilis (AOR 0.18, p<0.001) declined and no change was observed in other STIs.

Conclusion

The prevalence of syphilis declined among both FSWs and their clients in all three states whereas no change was seen in other bacterial STI prevalence (NG or CT). Among FSW clients in MH and TN, STI prevalence remained unaltered. Tailored and sustained programmatic efforts are needed to address the disparity in prevalence of STIs and HIV in the three states.
O1-S02.01 Epidemiology of, and behavioural risk factors for, sexually transmitted human papilloma virus infection in a sample of the British Population
Authors: Mercer C H , Johnson A M , de Silva N , Beddows S , Desai S , Howell-Jones R , Carder C , Sonnenberg P , Lowndes C M , Soldan K
Published: July 2011

Background

Persistent infection with high-risk sexually transmitted human papilloma viruses (HR-HPV) can lead to development of cervical and other cancers while low-risk types (LR-HPV) may cause genital warts, the most commonly-diagnosed viral STI in the UK. An HPV immunisation programme, using the bivalent vaccine protecting against types 16 and 18, was introduced in the UK in 2008. The frequency of HPV types is important baseline information against which to monitor the direct and indirect effects of vaccination. Here we examine the proportion of the population with detectable infection with HPV in urine collected in 1999–2001 for the National Survey of Sexual Attitudes and Lifestyles (Natsal-2) and the relationship with demographic and behavioural variables.

Methods

Natsal-2 was a probability sample survey of men and women aged 16–44 resident in Britain involving computer-assisted personal interviewing. Half of all sexually-experienced respondents aged 18–44 were invited to provide a urine sample. 3436 samples were tested using an in-house Luminex-based HPV genotyping system.

Results

HPV DNA was detected in 29.0% (95% CI 26.7% to 31.3%) of samples from women and 17.4% (95% CI 15.1% to 19.8%) from men. Any of 13 HR-HPV types was detected in 15.9% (95% CI 14.1% to 17.8%) of women's samples and 9.6% (95% CI 8.0% to 11.6%) of men's. Vaccine preventable types 16 and/or 18 were found in 5.5% (95% CI 4.5% to 6.8%) of women and 3.0% (95% CI 2.1% to 4.3%) of men; and types 6 and/or 11 in 4.7% (95% CI 1.8% to 3.3%) of women and 2.2% (95% CI 1.5% to 3.1%) of men. 4.1% (95% CI 3.1% to 5.2%) of women had HPV 16 and/or 18 without any other HR-HPV. In multivariate analysis, HR-HPV was associated with number of new partners, in women with younger age, single status, and partner concurrency, and in men with number of unprotected partnerships and age at first intercourse.

Conclusion

This is the first population-based probability sample study of the distribution of sexually transmissible HPV types in Britain. It is also the first to undertake a detailed analysis of relationships with demographic and behavioural variables and to include men. HPV DNA was detectable in urine of a high proportion of the sexually active British population; the lower prevalence in males reflected lower detection sensitivity for HPV in urine from males. In both genders HPV was strongly associated with sexual risk behaviour.
O2-S3.01 Feasibility and acceptability of self-sampling for rectal sexually transmitted infections (STI) among bisexual men in the USA
Authors: Dodge B , Van Der Pol B , Reece M , Malebranche D , Fortenberry D
Published: July 2011

Introduction

Rectal sexually transmitted infections (STI) are a common health concern for men who have sex with men (MSM). Studies have not yet determined the relevance of these pathogens among men who have sex with both men and women (MSMW). Screening for rectal STI is not currently a widespread option for bisexual men in the USA.

Methods

Qualitative data and self-obtained rectal specimens were collected from a diverse sample of bisexual men. Upon completion of the rectal self-sampling, each participant provided information regarding their overall experience with the process.

Results

From a total sample of 75 bisexual men, 58 participants provided self-obtained rectal samples. While most men did not test positive, a prevalence (10.3%) of C. trachomoatis infection was found in this sample. Men who collected samples reported overall acceptability and comfort with self-sampling for rectal STI. Privacy was a primary concern for men regarding self-sampling. Of the men who did not provide a rectal self-sample, the most common reason was having been tested in the recent past. Discussion: Self-sampling is a feasible and acceptable option when offered to bisexual men. Research and interventions are needed to ascertain which combinations of STI testing (including self-sampling) and treatment methods are most appropriate for diverse groups of bisexual men.
LBP-1.12 HIV and Hepatitis C prevalence in individuals leaving prison and entering drug and alcohol services in the area of highest HIV prevalence in the UK
Authors: Williams H , Axten D , Makia F , Teague A , Fox J
Published: July 2011

Background

Intravenous drug users, particularly those in prison, are at high risk of acquiring HIV and Hepatitis C (HCV) and commonly do not access mainstream medical care. Missed opportunities for HIV and Hepatitis C testing in Intravenous drug users attending prisons are therefore common. By using oral swabs difficulties of venous access can be avoided. Lambeth has the highest prevalence of HIV in the UK and it is estimated that 15–20% of inmates at HMP Brixton are HIV positive.

Methods

Staff delivered 26 walk-in clinics at a drug rehabilitation unit in Brixton over 5 months. The testing service was developed in close liaison with the drug and alcohol team and publicised using posters and education of reception staff. Oral swab testing for HIV and HCV was offered. A simple questionnaire was completed by attendees covering testing history and risk practice.

Results

35 individuals tested for HIV and HCV and were 80% male, 74.3% UK born, 48.6% white and 77.1% heterosexual. 37.1% were IVDU, median age was 36 (range 22–74). 57.1% individuals had previously tested for HIV, median time since last test was 4 years (range <1–15 years). 54.3% individuals had previously tested for HCV, median time since last test was 3 years (range <1–11 years). Median length of time in prison was 3 months (range <1–48 months). 48.6% and 51.4% had never been offered an HIV or HCV test in prison respectively. Only two individuals had tested for HIV and HCV in Prison. 14.3% individuals were already known to be HCV positive. 5.7% (N=2) individuals were newly diagnosed HCV positive but none tested HIV positive. 82.9% felt HIV/HCV testing should be offered in Prison. 71.1% felt this should be done using a mouth swab. 35% had no concerns regarding HIV/HCV testing but in those who did, dislike of needles, receiving a positive result and concerns regarding confidentiality were the commonest barriers to testing.

Conclusions

Prevalence of previously undiagnosed HCV was high in this group but HIV prevalence was zero. Uptake of HIV/HCV testing was very low despite good publicity and support from the drug services. This suggests that this method is not a cost effective approach to HIV testing despite oral swabs representing an acceptable mode of testing. Half of attendees had not been offered an HIV or HCV test in prison which needs to be increased. Testing in drug rehabilitation services does not result in high uptake of testing or detection of undiagnosed HIV.
LBO-1.2 The potential impact of pre-exposure prophylaxis for HIV prevention among Men who Have Sex with Men (MSM) in Lima, Peru
Authors: Borquez A , Gomez G B , Caceres C F , Segura E R , Grant R M , Garnett G P , Hallett T B
Published: July 2011

Background

HIV Pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by those HIV uninfected individuals to prevent HIV infection, recently demonstrated effectiveness in preventing acquisition in a high risk population of men who have sex with men (MSM). There is a need to understand if and how PrEP can be used cost-effectively. This study examines the programmatic implications of the iPrEX study: the only randomised controlled trial of PrEP among men who have sex with men (MSM) published last December in the New England Journal of Medicine.

Methods

We developed a mathematical model representing the HIV epidemic among Men who Have Sex with Men (MSM) and transgender people in Lima, Peru as a test-case. It considers differential infectiousness by stage, including the impact of antiretroviral treatment and different sexual practices, such as partnerships type and sexual positioning. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios, and to develop possible strategies by which PrEP could be implemented.

Results

The epidemiological impact of PrEP is largely driven by programme characteristics—coverage, prioritisation strategy and time to scale up—as well as individual's adherence behaviour. If PrEP is prioritised to key groups, it could be a cost-effective way to avert infection and save lives (up to 8% less new infections with 5% coverage). Across all our scenarios the estimated highest cost per DALY gained (US$$2755) is below the WHO recommended threshold for cost-effective interventions for the region (<US$$4608/DALY gained) see Abstract LBO-1.2 Figure 1. The impact of PrEP is reduced if those on PrEP decrease condom use, especially if the program has low coverage; but only extreme behaviour changes and a low PrEP efficacy would adversely impact the epidemic overall. However, PrEP will not arrest HIV transmission in isolation, due to its incomplete effectiveness, dependence on adherence, and the high total cost of programmes limiting attainable coverage levels.

Abstract LBO-1.2 Figure 1

Conclusions

This study quantifies the epidemic and financial implications of different programmatic scenarios. While the implementation of a strategic PrEP intervention has potentially important financial implications (a substantial expenditure would likely be required to generate significant reductions in incidence), PrEP among vulnerable populations could be a cost-effective option comparable to currently available interventions for Men who Have Sex with Men (MSM) populations.
LBP-1.15 An evaluation of the long-term effectiveness, immunogenicity, and safety of Gardasil in previously vaccinated women
Authors: Saah A
Published: July 2011

Background

The GARDASIL long-term follow-up (LTFU) study is an ongoing extension of a pivotal randomised, placebo-controlled, double-blind, 4-year study to investigate the safety, immunogenicity, and effectiveness of quadrivalent Human Papillomavirus vaccine (qHPV) on the incidence of HPV 16/18-related cervical intraepithelial neoplasia (CIN) 2 or worse in 16–23-year-old women (Protocol 015).

Methods

Follow-up of subjects will be accomplished in two ways: (1) registry-based follow-up for effectiveness data as well as safety data including but not limited to deaths, cancer, and hospitalisations; (2) active follow-up for blood collection for immunogenicity assessments at years 5 and 10 of the LTFU study. Effectiveness and safety analyses will occur approximately 2 years following completion of Protocol 015 and approximately every 2 years thereafter for 10 years. The current report represents the first of these efficacy and safety analyses. Cohort 1 included approximately 2700 subjects who received qHPV vaccine at the start of Protocol 015. Cohort 2 consists of approximately 2100 subjects who received placebo at the start of Protocol 015 and qHPV vaccine prior to entry into the LTFU. Vaccine effectiveness against HPV 16/18-related CIN 2 or worse was estimated by calculating the expected incidence of CIN 2/3 or worse in an unvaccinated (placebo) cohort using historical registry data. The primary analysis approach was per-protocol.

Results

There were 1080 subjects that contributed to the follow-up period out of a total of 2195 eligible subjects in the per-protocol population in Cohort 1. In these subjects there were no cases of HPV 16/18-related CIN 2 or worse observed. There were also no cases of HPV 6/11/16/18-related CIN, vulvar cancer, and vaginal cancer observed. However, the follow-up time in person-years is insufficient to make a definitive statement about the effectiveness of the qHPV vaccine for the current time period.

Conclusions

The qHPV vaccine shows a trend of continued protection in women who were vaccinated up to 7 years previously, although there is as yet insufficient data to confirm that protection is maintained. The qHPV vaccine continues to be generally safe and well tolerated up to 6 years following vaccination.