bluuebunny/crossref_metadata_2025 huggingface dataset:
P5-S6.12 Control of sexually transmitted infections (STI) in Guyana: plan to integrate into existing programmes
Authors: Scotland S , Singh S , Hernandez R , Springer D , LaFleur C , Boyle K , Singh A
Published: July 2011

Background

Over the last decade, Guyana has developed and strengthened surveillance, prevention and care and treatment for HIV. These interventions have resulted in a decline in HIV prevalence in antenatal as well as most at risk populations (MARPs defined as female sex workers, men who have sex with men (MSM), in and out of school youth, military and police). For non-HIV STI, a structured programme did not exist prior to 2005. From 2007 to 2009, the reported cases of STI increased significantly. In addition to HIV, non HIV STI has been identified as a priority for prevention and control by the National AIDS Program Secretariat (NAPS), Guyana Ministry of Health (MOH).

Methods

In conjunction with the Pan American Health Organisation and other international and local stakeholders, NAPS/MOH worked with local and external consultants to develop a STI strategy. Consultation meetings were held in Guyana and relevant documents were reviewed.

Results

A STI strategy for 2011–2020 has been developed. The strategy outlines activities that will build on existing HIV, antenatal and visualisation under acetic acid (VIA) programmes. In addition, activities have been outlined to build on existing second generation HIV surveillance initiatives currently in place in MARPs. Strategies to ramp up the provision of care and treatment for STI in existing primary care settings have also been addressed. The strategy highlights activities under five priority areas: (1) Programme Management and Coordination, (2) Prevention, (3) Laboratory, (4) Care and Treatment and (5) Surveillance. Under each priority area, broad goals, guiding principles, specific objectives, performance milestones and activities have been developed. A Monitoring and Evaluation plan will be a key part of the document to monitor progress during the strategy. The strategy will coordinate the activities of international and local agencies including non governmental and faith based organisations as well as persons from MARPs.

Conclusions

Guyana has developed a comprehensive 10-year plan for the prevention and control of non HIV sexually transmitted infections which will build on existing programmes for HIV, antenatal and VIA programmes.
P1-S1.57 Epidemiology ofMycoplasma genitaliumand Genital HIV-1 RNA - a Longitudinal Study among HIV-infected Zimbabwean women
Authors: Mavedzenge S N , Müller E E , Lewis D A , Chipato T , Morrison C , Weiss H A
Published: July 2011

Background

Mycoplasma genitalium(MG) is an emerging STI associated with reproductive tract syndromes in men and women, and with HIV in cross-sectional studies. MG is common in HIV-infected women, but there have been no longitudinal studies of MG and genital HIV RNA among HIV-infected women.

Methods

The study is nested in a cohort of 131 HIV-infected, ART-naïve Zimbabwean women aged 19–37 years. Real-time PCR was used to test for presence and quantity of MG DNA in 420 stored cervical samples (1–4 visits per woman). Genital and plasma HIV viral load, CD4 count and presence of other STI and reproductive tract infections were collected at each visit, together with clinical and behavioural data. Logistic and linear random-effects models were used to analyse i) factors associated with detection of MG, and ii) the association of detection and quantity of MG with detection and quantity of genital HIV RNA.

Results

MG was detected at 44/420 (10.5%) visits, with a median bacterial load of 1497 copies/ml (range <300–3 240 000 copies/ml). MG was twice as prevalent asN gonorrhoeae(5.0%) orC trachomatis(4.8%). Of the 33 women with MG detected at least once, six were infected at ≥2 consecutive visits, persisting for up to 43 weeks. In multivariable analyses, MG was independently associated with bacterial vaginosis (OR=2.24, 95% CI 1.03 to 4.85), HSV2 (OR=8.56, 95% CI 0.99 to 74.24) and younger age (OR=2.92, 95% CI 1.10 to 7.76). Cleaning inside the vagina was protective against MG infection (OR=0.33, 95% CI 0.15 to 0.71). Genital HIV RNA was detected at 237/397 (59.7%) visits, with a mean viral load of 5.14 log10 copies/ml. MG was independently associated with detection of genital HIV RNA (OR=2.73, 95% CI to 1.02–7.33) after adjusting for confounders including plasma viral load, CD4 count, HSV2, andN gonorrhoeae. Higher MG bacterial load was weakly associated with detection of genital HIV RNA (OR=1.75, 95% CI 0.96 to 3.19) but there was little association with quantity of HIV RNA.

Conclusions

This cohort study confirms previous cross-sectional results showing an association of genital HIV DNA detection with MG infection. Further research is needed to explore factors mediating this association, as MG was not associated with plasma viral load or measured markers of inflammation. The growing evidence for an association of MG with HIV genital shedding, and the high prevalence and persistence of MG infection, suggests that screening and treatment of MG may be warranted among HIV-positive women.
P5-S6.14 Qualitative assessment of facilitators and barriers to HPV vaccination among providers serving a high-risk community
Authors: Javanbakht M , Stahlman S , Walker S , Gottlieb S , Markowitz L , Liddon N , Plant A , Guerry S
Published: July 2011

Background

Maximising HPV vaccine uptake among those at highest risk for cervical cancer is critical. We explored healthcare provider perspectives on factors influencing HPV vaccination among adolescent girls in a community with high cervical cancer rates.

Methods

From March to May 2009, we conducted in-depth interviews with 21 physicians and other staff providing care to adolescent girls at two clinics in Los Angeles, CA, serving a predominantly Hispanic population with high cervical cancer rates. The semi-structured interviews explored HPV vaccination processes and potential barriers to vaccination.

Results

Providers overwhelmingly focused on parental beliefs as barriers to HPV vaccination, though noted other factors including the lack of school requirements and barriers related to serving a low-income, immigrant clientele. Perceived parental misconceptions acting as barriers included the belief that adolescents do not need vaccinations and that no-cost vaccine programs like Vaccines for Children are only available for younger children. Perceived parental concerns that the vaccine will promote sexual activity were prevalent, especially for parents of 11–12-year-old girls, which prompted providers to frame HPV vaccine as a “routine,” “cervical cancer” vaccine. However, providers felt mothers with experience with abnormal Pap tests and those with a supportive friend or relative were more likely to request HPV vaccine. Providers noted that for Hispanic parents the “preferred” source of information is peers; if the “right people” in the community were supportive of HPV vaccine, parents were more willing to vaccinate. Most providers noted that because HPV vaccine is not “required” for school, it was difficult to get eligible girls into clinic and to reinforce to parents the need for the vaccine. Other barriers included lack of immunisation records among immigrant parents and a difficult-to-reach, mobile clientele.

Conclusions

Providers noted a number of barriers to HPV vaccination, including some perceived parental misconceptions that could be addressed with education about the need for adolescent vaccines and available free vaccine programs. Because community support appears particularly important to Hispanic parents, the use of promotoras—peer liaisons between health organisations and the community—may increase HPV vaccine uptake in this population. Future research should explore how well providers' perceptions align with parents' actual concerns.
P5-S6.16 Novel modular teaching of HIV patients in resource-limiting setting: effect of learning outcomes on adherence to highly active antiretroviral therapy (HAART)
Authors: Busari O , Busari O , Adeyemi A , Nakayima M
Published: July 2011

Background

Patient education is a crucial aspect of antiretroviral treatment of HIV patients and plays a significant role in adherence to HAART, development of OIs, hospitalisation and mortality. Unfortunately, in most resource-poor setting, this is not often done, and when it is done, often casually.

Objective

Objective was to compare a modular teaching method (MTM) with traditional patient education (TTM), and evaluate its effectiveness on adherence to HAART, development of OIs, hospitalisation and mortality.

Methods

420 HIV-positive patients on HAART, zidovudine, lamivudine and nevirapine, were recruited and randomly divided into subject and control groups. A pre-test and post-test time-series design was used to collect data using a 30-item knowledge and skills assessment schedule with items rated on a 5-point Linkert-type scale. The schedule was pre-tested on 50 patients with Cronbach's Score of 0.92 and a test-retest co-efficient of 0.89 at a 4-week interval. The MTM consist of 10 modules which address issues on adherence such as benefits of treatment, family and social support, adverse drug effects, psychological factors, substance abuse, patient-provider relationship, patient's self efficacy and effect of traditional/cultural values. MTM was used to educate subject group while the controls received the traditional teaching by nurses on the wards. Teaching was done throughout the period of hospitalisation. All the patients were followed for 8 months at 4-week intervals via outpatient clinic and home visits. χ2and t-tests were used; p<0.05 was considered significant.

Results

Mean age was 28.7±6.9 years. Mean adherence rate for the subjects was 98.9±1.0% and for controls, 87.6±2.4% (p<0.001). Frequency of OIs per patient per month was lower in subjects than in controls (0.51 vs 1.31, p=0.002). Mean number of readmissions per patient per month during the 8-month follow-up was 0.18±0.01 for subjects and 0.89±0.02 for controls (p=0.0012). Subject group had shorter hospital stay (6.2±2.6 days vs 15.7±4.8 days, p=0.002) and lower mortality (p=0.008) than the controls.

Conclusion

MTM has significant effect on adherence to HAART, development of OIs, readmission rate, hospital stay and mortality. MTM is recommended as a core aspect of adherence counselling and antiretroviral treatment programme.
P5-S6.17 Facilitating access to sexual health services for men who have sex with men (MSM) and transgender persons in Guatemala city
Authors: Boyce S , Barrington C , Bolanos J Herbert , Arandi C Galindo , Paz-Bailey G
Published: July 2011

Background

Men who have sex with men (MSM) and transgender persons are disproportionately affected by sexually transmitted infections (STIs), including HIV, in Guatemala. Access to integrated sexual health prevention and treatment services is limited. The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual, and non-gay identified MSM and male-to-female transgender persons in Guatemala City to inform the development of high quality and population-friendly services that are sensitive to the needs of this population.

Methods

Semi-structured in-depth interviews were conducted with 27 purposively sampled participants, including 7 transgender, 11 gay, 5 bisexual, and 4 non-gay-identified participants, in Guatemala City. Interview topics included experiences with sexual health services, perceived barriers to access, social and sexual network characteristics, and HIV risk behaviours. Topical codes were developed based on readings of interview transcripts and codes were applied to the data using the qualitative software Atlas.ti. Data were compared between study sub-groups using thematic matrices and analytic memos.

Results

Across all participants, public clinics were the most commonly used sexual health services due to their lower cost and greater accessibility, but many participants provided examples of discrimination, violation of confidentiality, and distrust in the quality of services offered. Transgender and gay participants preferred clinics where they felt a sense of belonging while non-gay identified participants preferred clinics that were not associated with the MSM community. The most prominent barriers to sexual health services described by participants included fear of discrimination related to sexual identity and/or behaviour, fear of having HIV and the associated stigmatisation, cost, and lack of social support.

Conclusions

Findings highlight the need to strengthen and expand existing public STI clinics to improve access to services among MSM and transgender populations in Guatemala City. These services must address the multiple layers of stigma and discrimination that MSM and transgender persons experience related to identity, behaviour, and STI/HIV. Insights from this study are currently being applied to the implementation of two public clinics in Guatemala City that seek to provide a discrete, non-judgemental environment where individuals can seek affordable services without fear.
P5-S6.18 Cost-effectiveness of introducing rapid syphilis testing in the Amazon Region, Brazil
Authors: Carvalho C H , Benzaken A , Peeling R , Santos A , Terris-Prestholt F
Published: July 2011

Background

This study aims to estimate the costs-effectiveness of introducing a universal syphilis screening and treatment package with an enhanced quality assurance system among isolated indigenous populations in the Amazon region of Brazil.

Methods

In three indigenous health units (Umariacu II, Vendaval and Betania), incremental financial and economic costs of the full programme were collected including start-up, training and quality assurance, supervision and implementation. These units were chosen because of their different geographic access levels (easy to very difficult) so that results can be extrapolated to other health districts of the Amazon state. Unit cost per person screened and treated was estimated as well as the cost-effectiveness per adverse outcome and DALY averted. This study also provides the first data on prevalence rates in this population.

Results

Using rapid syphilis tests, the prevalence of syphilis was 1.56% and 2.2% in the sexually active population and in pregnant women respectively at the three health units. The total financial cost of syphilis screening 4173 people was $277 853. The total economic cost was $285 995.67. The economic cost per person screened was US$68.53 and treated was US$4028.11. The cost per DALY saved was US$484.31 (including stillbirth). Personnel costs contributed the largest input category consisting of 87.5% of the total costs, due to the high cost of labour of FUNASA (National Health Foundation) personnel. Training costs are also high due to the frequency of staff turnover and thus the need for repeated trainings.

Conclusions

Although the cost per person screened and per person treated for syphilis could be considered high by international standards, the only alternative to screening in the health units for this population would be transporting people to the nearest larger town for screening in the nearest health facility with a laboratory. This would clearly exceed the costs of treating the cases locally by far. This therefore makes rapid syphilis testing the most cost-efficient alternative for testing these remotely located populations. Additionally, because of cultural behaviour of the indigenous populations and the fact that some of them are located near border regions of Brazil, the prevalence scenario can change quickly, increasing the number of syphilis and HIV cases in the absence of prompt identification and treatment.
P5-S6.19 Prevalence and incidence of sexually transmitted infections among female sex workers in two cities in India: implications for STI control strategies
Authors: Das A , Prabhakar P , Narayanan P , Neilsen G , Morineau G , Mehendale S , Risbud A
Published: July 2011

Background

India is a large country with marked heterogeneity in prevalence of sexually transmitted infections (STIs) which has implications for STI control strategies. The study objective was to measure the prevalence and incidence of common bacterial STIs in a cohort of female sex workers (FSWs) in known high STI prevalence cities in response to a package of standardised interventions under Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation.

Methods

FSWs attending clinics were followed up periodically over 6–9 months. At every visit, vaginal swabs were tested forNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) by Gen-Probe APTIMA Combo II. During the baseline and final visits, vaginal swabs were tested forTrichomonas vaginalis(TV) by PCR and blood was tested for syphilis using Rapid Plasma Reagin (RPR) with confirmatoryTreponema pallidumHaemagglutination Assay (TPHA). All participants received presumptive treatment for gonorrhoea and chlamydia at the baseline visit and syndromic STI management at all subsequent visits.

Results

A total of 417 FSWs were recruited, 360 returned for at least one follow-up visit, and 282 completed the final visit. The total follow-up period was 109.4 person years (median 0.18 years, maximum 1.07 years). Self-reported consistent condom use with commercial and regular partners was 70% and 17%, respectively. A substantial proportion of cervical and trichomonal infections were asymptomatic (see Abstract P5-S6.19 table 1). The incidence of GC/CT and TV was 1.0 and 2.0 per person year respectively. Three new cases of latent syphilis were detected at the final visit.

Abstract P5-S6.19 Table 1

Prevalence of STIs and asymptomatic infections (n=282)

PathogenBaseline visit1st follow-upFinal visitCervical infections (GC and/or CT)27.7% (asymptomatic 35.9%)16.7% (asymptomatic 60.5%)21.3% (asymptomatic 76.7%)TV29.9% (asymptomatic 27.2%)46.6% (asymptomatic 82.2%)Latent syphilis (RPR titre >1:8)6.8%2.5%

Conclusions

The incidence of GC, CT and TV and the considerable burden of asymptomatic infections indicate the need for periodic presumptive treatment at high STI prevalence sites in India. The current regime of bi-annual syphilis screening is justified. Consistent condom use and partner treatment, particularly for regular partners, need to be re-emphasised.
P5-S6.20 STIs and healthcare reform. Will it really improve America's sexual health?
Authors: Mettenbrink C , Cornelis R
Published: July 2011

Background

The implementation of healthcare reform in the U.S has led to a debate on whether publicly-funded STI clinics will continue to be necessary. A large proportion of STIs are reported from non-STI clinic providers and this proportion will grow with universal access to care. However, STI clinics serve vulnerable populations such as men who have sex with men (MSM) and racial/ethnic minorities who have no other access to STI care. In addition, many prefer the confidentiality and expertise of STI clinics. We studied characteristics of patients reported with gonorrhoea in the City and County of Denver and compared those reported from the Denver Metro Health (STI) clinic (DMHC) with those reported from elsewhere.

Methods

As part of the CDC-funded STD Surveillance Network (SSuN), DMHC and the Colorado Department of Public Health and Environment (CDPHE) collect additional risk information for gonorrhoea cases residing in the SSuN catchment area. Of all incident gonorrhoea cases within a given month, 40 are randomly selected for an interview by CDPHE staff to collect demographic, treatment, and risk information. All gonorrhoea cases diagnosed between 1 January 2008 and 31 October 2010 were examined.

Results

Of 2933 gonorrhoea cases for the 2-year period, 932 (32%) were diagnosed at DMHC. Cases diagnosed at DMHC were considerably more likely to be male (74% vs 38% p<0.0001), and tended to be slightly older (mean age 27.0 vs 24.9, p=<0.0001) than cases diagnosed elsewhere. CDPHE successfully contacted 41% of selected cases for interviews. A significantly higher proportion of cases diagnosed in the STI clinic were MSM compared to cases diagnosed elsewhere (34.7% vs 14.5%, p≤0.0001). No differences were found in terms of race/ethnicity, number of reported sex partners, education level, or previous gonorrhoea infection.

Conclusions

In the City and County of Denver, heterosexual men and MSM are more likely to be diagnosed with gonorrhoea in the STI clinic than women. The successful transition of STI services to non-STI healthcare systems in the context of healthcare reform, will not only depend on the STI expertise in those settings, but in large part on a shift in health seeking behaviours among men, many of whom may be considered core STI transmitters. The continued need for and utilisation of STI clinics in countries with long-standing universal access to care, should give us pause in abandoning our STI clinical system to soon.
P5-S6.22 Social-structural factors associated with supportive service use in a cohort of HIV-positive individuals on ARV therapy in British Columbia, Canada
Authors: O'Brien N , Palmer A K , Zhang W , Michelow W , Shen A , Roth E , Rhodes C L , Montaner J S G , Hogg R S
Published: July 2011

Introduction

Medical services are seldom the only assistance required for HIV-positive individuals to lead longer, healthier lives. The clinical complexities of HIV infection and the multiple needs of people living with HIV often require additional assistance to ensure optimal health outcomes. Supportive services (eg, housing, food, counselling, addiction treatment) are increasingly conceptualised as critical components of care. Our study investigates social and clinical correlates of supportive service use across differing levels of engagement. Abstract P5-S6.22 figure 1 presents the conceptual model of the study.

Abstract P5-S6.22 Figure 1

Conceptual model for factors associated with supportive service use.

Methods

The Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) is a cross-sectional cohort of HIV-positive persons on antiretroviral therapy in British Columbia, Canada. Interviewer-administered surveys collected information regarding sociodemographic factors, substance use, social support networks, and supportive services. Clinical variables were obtained through longitudinal linkages with the Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. Participants were stratified by level of service engagement (daily, weekly, and 1–3 months). Bivariate analysis and a logistic regression proportional odds model were used to identify variables significantly associated with supportive service use.

Results

Among 915 participants, 742 (81%) reported using supportive services, of which 344 were highly engaged, 280 moderately engaged, and 118 minimally engaged. Food programs, medication support, and counselling and social supports groups were services most accessed. Multivariate results demonstrated that those most engaged in supportive services were more likely to report poor social determinants of health such as low income [adjusted OR (AOR)=1.81]; not having completed high school (AOR=1.97); unstable housing (AOR=1.89); and current illicit drug use (AOR=1.60). After adjusting for social determinants, there were no significant differences in clinical measures across different levels of engagement with supportive services.

Conclusion

High service use by those demonstrating social and clinical vulnerabilities reaffirms the need for continued expansion of supportive services to facilitate a more equitable distribution of health among persons living with HIV.
P5-S6.23 Barriers to accessing hepatitis C treatment for individuals who have experience with injection drug use
Authors: Sinclair C , Kirkland S , Asbridge M , Martin F
Published: July 2011

In Canada, approximately 10 000 people are living with both hepatitis C and HIV; 20% of individuals living with HIV are co-infected with hepatitis C. Many individuals who inject drugs are at a higher risk for contracting both hepatitis C and HIV because they engage in high risk activities that increase their chances of being in contact with infected blood Individuals living with hepatitis C are at risk of contracting HIV. Being co-infected with both diseases complicates both hepatitis C and HIV; it is therefore critical to provide treatment for hepatitis C. Although those living with hepatitis C often report high interested in treatment, uptake remains low. The purpose of this research project is to identify the factors which influence decisions around hepatitis C treatment. A mixed methods approach was used; 60 individuals participated in a cross sectional questionnaire, while 6 engaged in in-depth interviews. All participants were currently accessing methadone maintenance treatment for opioid addiction and had experience with injection drug use. The questionnaires explored characteristics, knowledge, attitude and willingness to access hepatitis C treatment. Interviews delved deeper into the issues uncovered in the questionnaires and explored life experiences and their influence around treatment decisions. Results indicated that 70% of participants were interested in starting hepatitis C treatment within the next 6 months, while 30% were undecided or uninterested. Analysis of the questionnaire results have suggested that it may not be factual knowledge which influences individuals' decisions around treatment, but life conditions (ie, housing, employment) and experiences. The interviews supported this finding though a thematic analysis. The results of this study suggest that efforts to increase interest in treatment should focus on improving life conditions that support accessing treatment (eg, providing supportive housing). Future studies would include a larger sample size and a more refined questionnaire.
P1-S2.01 Prevalence of HIV and sexually transmitted infections among clients of female sex workers in Karnataka, South India
Authors: Shaw S , Deering K , Reza-Paul S , Isac S , Ramesh B , Washington R , Moses S , Blanchard J
Published: July 2011

Introduction

Several studies have demonstrated the importance of commercial sex work in the transmission of HIV and other sexually transmitted infections (STIs) in India. Clients of female sex workers (FSWs) are thought to be an important bridging population for HIV and STIs. However, there is little information on basic characteristics of sex work clients. This study sought to describe the prevalence of HIV and other STIs, as well as examine the determinants of these pathogens, among a sample of clients in south India.

Methods

Data were from a cross-sectional biological and behavioural survey of FSW clients from six districts in Karnataka State, India. The prevalence of HIV, syphilis, herpes simplex virus type 2 (HSV-2), chlamydia (CT) and gonorrhoea (GC) among clients was examined. Multivariable logistic regression models were used to analyse the socio-demographic, sexual behaviour and sex-work related characteristics related to the prevalence of each pathogen. Sampling weights and appropriate survey methods were utilised in regression models to account for a complex sampling design.

Results

The total sample size was 2745. The average age of clients was 30.4 years (SE—0.3). Across the total sample, the prevalences of HIV, HSV-2, syphilis and CT/GC were 5.6%, 28.4%, 3.6% and 2.2%, respectively. The prevalence of HIV/STIs varied substantially across districts, reaching statistical significance for HIV (p<0.0001) and CT/GC (p=0.005). In multivariable models, duration of paying for commercial sex was associated with increased risk for HIV and HSV-2 (both AORs—1.1; 95% CI 1.0 to 1.1, p<0.0001). Clients using brothels as a main FSW solicitation site were associated with increased risk of HIV (AOR—2.4; 95% CI 1.2 to 4.7, p=0.001), while those frequenting lodges were at increased risk for CT/GC (AOR—6.3; 95% CI 1.9 to 20.6, p=0.03). Clients with HSV-2 infection were at substantially higher risk of being HIV-positive (AOR—10.4; 95% CI 6.1 to 17.7, p<0.0001).

Conclusions

This study fills in important gaps in knowledge regarding clients of FSWs in Southern India. FSW clients clearly constitute an important bridging population between FSWs and their other sexual partners in the population. It is important to design and implement effective prevention and care programs for this well-hidden population.
P5-S6.26 Prevention with positives in Nigeria: what have we learnt?
Authors: Traffina C I
Published: July 2011

Background

The introduction of care and treatment at the service delivery points at the community and the clinical settings- hospital facilities for prevention with the positives have giving the HIV/AIDS, STIs, TB management high quality significant improvement in the first 8 months of implementation in Nigeria.

Methods

Association of positive youth in Nigeria is a national non-governmental organisation in Nigeria, involved in HIV prevention, care and support. APYIN started implementing HIV prevention strategies in 2009 with a focus on involving HIV—positive people in prevention. The strategies included; counselling on prevention of HIV to positive persons this involved discussion of behavioural intervention in medical and counselling visits. Promoting the use and provision of condoms to sexually active HIV—positive individuals, promoting adherence to antiretroviral drugs, by counselling, use of pills boxes, and medicine companions. Encouraging HIV-positive persons to disclose HIV status to sex partners either by self or counsellor mediated during home visits or at the nearest opportunity. Home base management, HIV counselling and testing targeting partners and children born to all people living with HIV/AIDS.

Results

Most of the persons living with HIV realise that they have a role to play in prevention of HIV. There is 8.5% increase in the uptake of condoms by HIV -positive person between the year 2008 and 2009. Antiretroviral therapy adherence levels of 92% of the clients on ART with adherence >95%. In the same period there is an increase of 50% of HIV -positive individuals disclosing HIV status to partners. Community awareness of HIV has increased in the area serviced by the organisation.

Conclusion

Increase collaboration between the clinical and community base interventions. Regular monitoring of the community response for improvement. The capacity building of for community staff. HIV-positive persons are very important partners in HIV prevention. Therefore their involvement should be prioritised.
P5-S6.27 New avenues to increase quality of STI-care in general practice
Authors: van Bergen J E A M
Published: July 2011

Background

The role of primary care in STI-control has long been neglected. Although national STI surveillance often thrives on data of STI-Clinics, recent research in the Netherlands shows that approximately 70% of all STI-related consultations are in General Practice (GP). More attention for sexual health in primary care is warranted.

Methods

In 2004 the Dutch College for Family Physicians (NHG) added a guideline about the “STI consultation” to their list of GP certified “standards of care”. The guideline describes care for patients with complaints of STI, for patients with questions about STI (test request), and also describes pro-active testing policies for persons visiting the health centre for a not-STI related reason. The guideline is currently being updated. Implementation of the guideline is facilitated by regional “expert” GP, united in the GP-advisory group on STD, HIV and Sexuality (the Expert group Sexual Health (SeksHAG). Such Expert Groups within the GP institutional body are relatively new and also exist, for example, diabetes and Asthma/COPD.

Results

Annually approximately 1500 GP receive a continuous education session on STI facilitated by the GP expert in their region. Previous research showed moderate impact on testing habits and case detection. Qualitative interviews describe insight in personal barriers as a positive gain in training sessions. Prescribing habits of GP for Gonococcal infections are legging behind, half of GP prescribing ciprofloxacin, for which resistance is well above 40%.

Discussion

A substantial but often hidden proportion of STI consultations take place in general practice. More interventions on STI-care in GP are recommended. An expert group within the national GP body can enhance attention for quality of care. The new emerging paradigm within primary care to focus not only on disease (pathogenesis) but also on health (salutogenesis) might open new avenues for sexual health counselling. New technology also has potential: continuous education sessions have limited impact on prescribing habits for infrequent conditions with fast changing resistance patterns like gonoccocal infections; learning GP to use more and better their electronic prescription expert-system based on patient ICPC code (Prescriptor) is a better option and now available in most GP operating systems in the Netherlands.
P5-S6.32 Using a contingent valuation method to understand consumer preferences for care of adolescents with pelvic inflammatory disease (PID)
Authors: Trent M , Qian Q , Frick K , Thompson C , Butz A , Ellen J , Lehmann H
Published: July 2011

Objective

Adolescent girls diagnosed with PID are at higher risk for subsequent sexually transmitted infection (STI), pregnancy, and long-term pelvic pain. Although the 72-h post-PID evaluation provides an opportunity for risk reduction counselling, few adolescents adhere. Use of public health nurses (PHN) for clinical follow-up may meet the needs of this vulnerable population. The objective of this study is to estimate consumers' willingness-to-pay (WTP) for follow-up PID services by physicians and PHNs, differences by consumer type, and the differences in health-provider predicted consumer WTP values and actual consumer WTP values.

Methods

A contingent valuation method was used to collect WTP data regarding co-payments to physicians or nurses for clinical service delivery from the consumers of adolescent PID services (parents (n=121) and adolescents (n=134)) and a national sample of health providers (n=102). Consumers were recruited from an academic paediatric practice and school-based health clinics in a large urban community with high STI prevalence. Participants completed a web-based survey with data uploaded to a secure server after obtaining online consent. Data were analysed using linear regression analyses.

Results

The mean WTP for physician services was $16 (SD $16.9) for clinicians, $81.9 ($34.0) for parents, and $72 (SD $ 39.1) for adolescents. The mean WTP for PHN services was $13.6 (SD $17.4) for physicians, $62.4 (SD $44.1) for parents, and $49.7 (SD $44) for adolescents. Using physician estimates for WTP as the reference group, adolescents were willing to pay $56 more (95% CI 48.6 to 63.4) for physician care and parents were willing to pay $66 more (95% CI 59.0 to 72.8) than physician's predicted controlling for informant employment status. Adolescents were willing to pay $36 more (95% CI 48.6 to 63.4) for community-based nursing care and parents were willing to pay $48 more (95% CI 59.0 to 72.8) than physician's predicted. Consumers' (adolescents' & parents') WTP for physician services were on average $18.50 higher than PHN services (p=0.01).

Conclusion

While adolescents and parents prefer physician follow-up for PID based on WTP, they are amenable to PHN follow-up visits. Our data suggest that health providers underestimate the value the consumers place on clinical service for PID. Given poor adherence to office-based follow-up and consumer interest in PHN visits, additional research evaluating the effectiveness of PHN visits for PID is warranted.
P5-S6.35 Effectiveness of mobilising medical facilities to participate in STD/HIV control activities
Authors: Liang G
Published: July 2011

Since 2000, the STD clinics were brought into intervention service aimed at high-risk population by some projects, such as Health Project, Comprehensive Demonstration Area Project and the Global Fund to Fight AIDS Project. The ability of providing standardisation service in STD clinics was improved through the project activities. The outreach service increased awareness of STD clinics and attracted or made referral patients seeking service at standard clinic, and that strengthened the role of medical sites in preventing STD/AIDS.

Method

Two jobs improved the intervention service aimed at STD/AIDS at clinics. 1. The intervention service aimed at outpatient. Including the following service: (1) setting heath education bulletin and publicity photographs at STD clinics to spread information about prevention STD/AIDS (2) providing Health education prescription about prevention STD/AIDS freely (3) the medical staff provided health education and consultation after diagnosis and treatment and extended the use of condom (4) to advise patient to inform their partner of examination at clinic (5) the medical staff mobilised outpatients to accept HIV-test forwardly 2. The medical staff provided field service aimed at high-risk population (CSW, MSM).

Result

Several projects evaluated prevention service effect at STD clinics. The rate of medical staff accepting training on STD standardisation service increased from 9.21 to 21.56% to 68.99–89.7%. The rate of object population knew information about STD/AIDS prevention increased from 31.02–45.52% to 72.4–87.86%. The rate of outpatients accepting HIV test increased from 3.45% to 44.25%. While STD clinic staff provided field service for high-risk population, they advised people who needed further service to seek help at STD clinic. From 2006 to 2009, the proportion of high-risk in outpatient was increasing yearly. The evaluation result from three STD clinics showed the proportion of MSM in outpatient was increasing from 0.97% to 8.15%, from 2006 to 2009. And the evaluation result from 7 STD clinics showed the proportion of CSW in outpatient was increasing from 1.57% to 9.74%, from 2006 to 2009. The outpatient at STD clinic is high-risk population for STD/AIDS infection and spread, and most male outpatient especially had high-risk act, but the intervention in China touched on that. The prevention service at STD clinic smoothed over routine prevention action and expanded the range that STD medical service covered, so this prevention controlled the spread of STD/AIDS furtherly.
P5-S6.37 A community led decentralised and integrated approach for personalised prevention and care services to PLHIV in Karnataka, South India
Authors: Kumar P Manish , Jayanna K
Published: July 2011

Background

Care and support for People living with HIV (PLHIV) is often limited to institutional settings with considerable time lag between diagnoses and access to care, and poor linkages with other social support services. The USAID supported Samastha project aimed to address the gaps through an innovative approach.

Method

Drop-in centres (DIC) were set up within the PLHIV networks as a hub of decentralised care and support. They offered psychosocial, outpatient medical care, positive prevention and nutritional services. To increase accessibility to general medical care, outreach clinics were clubbed with support group meetings and held in local government hospitals. The linkages to treatment, testing, screening for TB and institutional care were strengthened through referral systems, including accompaniment by outreach workers and coordination meetings at district level. All outreach workers were trained on government sponsored social entitlements and schemes for PLHIV and methods of assessing and addressing these needs.

Results

By the fourth year of the project, 45 009 PLHIVs (53% female) had availed services of which 52% received clinical care, 99% of clinical visits screened for TB and 4% of PLHIV were treated for TB. 51% received positive prevention services, including treatment adherence counselling while 39% received treatment for minor OI and general ailments. 85% are registered at ART center and 44% are on ART. 91% were provided with psychosocial support, 81% received nutritional support and 51% attended support group meetings. Nutrition and livelihood support were leveraged from other sources.

Lessons Learned

The Drop-in centre run by people living with HIV makes a continuum of care possible. In resource poor settings, DICs helps in early enrolment of PLHIVs into care, thereby resulting in timely initiation of treatment for HIV and TB and a qualitative improvement in the life of a PLHIV.
P5-S6.38 NICE guidance on prevention of sexually transmitted infections and under 18 conceptions; has it influenced service providers?
Authors: Robinson A , Dixon K , Forbes K , Wilkinson D , Foley E
Published: July 2011

Background

National Institute of Health and Clinical Excellence (NICE) Public Health guidance on the prevention of sexually transmitted infections and under 18s conception was produced in 2007 for implementation in sexual health services in England. We undertook to find out what impact these had on Genito-urinary Medicine (GUM) service providers across UK.

Methods

In December 2009 lead consultants of UK GUM clinics were identified using the British Association for Sexual Health and HIV website and sent a postal survey as part of a larger study. Responses were analysed using a SPSS database.

Results

Of 222 clinics, 152 responses were from UK clinics overall of which 136 were from England. 115 of 148 (78%) from UK clinics answered that they had read the guidelines, 80% (106/132) for England only. For England 39% (54/133) of respondents were aware of a local lead to implement the guidance of which 9 (16.7%) named the Director of Public Health, 17 (31.5%) GUM physician with a variety of other healthcare professionals for the remainder. Only 30% had compared current service activity to NICE recommendations and 20% (26/132) were aware of an action plan being developed by local strategic partners to implement the guidance; 8% (10/128) had developed a business plan. Only three clinics had formally audited their clinic practice against the guidelines. In total, only 18 of 131 (13.7%) had implemented the recommendations but 56 (42.6%) had partially or were doing so. The barriers to implementation were cost pressure, cost of staff skills training, lack of time and capacity to implement, lack of leadership.

Conclusion

NICE takes an evidence-based approach to guidance development but has no mechanism to review implementation. There are no routine outcome measures to judge the effectiveness of this NICE guidance. The process measures above have demonstrated variable implementation in GUM services in England. With present resources, as one example providing 15–20 min of one-to-one structured discussions based on behavioural change theories is not deliverable. Service commissioners should ensure that services are implementing guidance and using recognised standards for the management of sexually transmitted infections. Prevention of sexually transmitted infections should be targeted, informed by the sexual health profile of local populations with resources identified by commissioners for prevention activities as integral to service delivery.
P5-S7.02 Trends in screening females for Chlamydia in juvenile detention centers US 2005–2009
Authors: Newman D R , Peterman T A , Collins D E
Published: July 2011

Background

CDC began development of Performance Measures in 1999 and 58 Project Areas have continuously reported on the measures twice yearly since 2005. Two Performance Measures from Juvenile Detention Centers (screening in 2004 and positivity in 2009) were developed to capture the burden of chlamydia infection in this underserved population of adolescent females.

Objectives

To assess changes in performance of screening of females in juvenile detention centers (JDC's) from the US as reported through Performance Measures and to obtain a measure of the positivity detected.

Methods

50 US States, six US cities, Washington, DC and Puerto Rico are asked to report the percentage of females screened for chlamydia twice yearly from all juvenile detention centers that admit 500 or more adolescent females annually. Project Areas with no facilities that admit 500 or more are to report on one or more facilities of their choice. A chlamydia positivity measure was added in 2009. We collapsed the 2 half-yearly reports for each Project Area into yearly summaries from 2005 to 2009.

Results

The percentage of Project Areas that were able to report any chlamydia screening from their JDC's increased from 60% in 2005 to 84% in 2009. The mean percentage of Project Areas reporting any screening over the 5 years was 80%. Many Project Areas reported from multiple JDC's during 2005–2009 with California reporting from 12 facilities and Ohio reporting from 11 facilities. The reported percentage of juvenile females screened by year were 54, 63, 59, 60 and 51% from 2005 to 2009. The percentage screened ranged from 3% to 100%. The mean percentage of females screened over the 5 years was 57%. In 2009, the mean chlamydia positivity for all Project Areas was 13.8%. For facilities (n=69) that screened at least 100 females in 2009, the mean chlamydia positivity detected was 13.7%, with a median of 12.6% and positivity ranging from 6 to 31%. Almost half (48%) of the Project Areas reported from 49 facilities for all 10 reporting periods across the 5-year period. The percentage screened in these 49 facilities increased 59, 64, 66, 69 and 69% from 2005 to 2009. The mean per cent positivity for these facilities in 2009 was 12.5%.

Conclusions

Juvenile Detention Centers are excellent venues from which to detect chlamydia infections in adolescent females. Additional efforts are needed to increase the number of facilities that routinely offer screening and increase the proportion screened.
P1-S2.03 Determinants of condom breakage among female sex workers in Karnataka, India
Authors: Bradley J , Rajaram S , Alary M , Isac S , Moses S , Ramesh B M
Published: July 2011

Background

Condoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in the state of Karnataka in South India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions.

Methods

We explored determinants of reported condom breakage in the previous month among 1928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage controlling for several independent variables including the district and client load.

Results

Overall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (OR 3.43, p=0.005); if divorced/ separated/widowed (OR 1.52, p=0.012); if they were regular alcohol users (OR 1.63, p=0.005); if they mostly entertained clients in lodges/rented rooms (OR 2.99, p=0.029) or brothels (OR 4.77, p=0.003), compared to street based sex workers; if they had ever had anal sex (OR 2.03, p=0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (OR 1.90, p<0.001); if they were inconsistent condom users (OR 2.77, p<0.001); and if they had never seen a condom demonstration (OR 2.37, p<0.001).

Conclusions

The reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalised female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to provide information and skills on correct condom use. More research is also needed on what specific situational parameters might be important in predisposing to condom breakage.