bluuebunny/crossref_metadata_2025 huggingface dataset:
O2-S2.03 Feasibility of giving HSV serological test results by mail and phone
Authors: Hayley M , Chikovani T , Rompalo A
Published: July 2011

Background

Accurate serological tests for the herpes simplex virus have been commercially available since 1999. Despite this availability, they are offered infrequently. Concerns about the resources required for testing including time spent on counselling and follow-up are among the barriers to testing. The purpose of this study was to determine the feasibility of using letters and phone calls to give HSV-1 and HSV-2 serological test results and to document the resources used to deliver results and respond to subjects' concerns.

Methods

Subjects were recruited from an urban STD clinic and tested for HSV-1 and HSV-2 as part of a multi-site study of HSV serological test performance (N=612). Subjects were offered the option of having an investigator mail or call with test results. Result letters included a one page hand-out on HSV-1 and HSV-2 and the phone number of an investigator who could address concerns. Number of phone calls received, time spent on the phone, level of subject distress, and request for referrals were documented. Descriptive statistics were calculated for all variables and data was examined for bivariate relationships using SPSS.

Results

Sixty-seven per cent of the subjects requested that their results be mailed (n=410) and 33% requested that their results be given by phone (n=202). Approximately 6% of the subjects who received letters called for additional information. Seventy-one per cent of the calls took less than 5 min and only 2% required more than 10 min. A total of approximately 6.4 h were spent on the phone to give results and respond to questions. <1% of the subjects required multiple phone calls and less than 1% requested a referral to a clinician. Investigators rated 55% of subjects spoken to on the phone as not at all distressed, 31% as somewhat distressed, and 12% as very distressed. Distress was significantly associated with longer time on the phone, but not with testing positive for HSV-2 vs HSV-1.

Conclusions

Delivery of HSV serological test results by phone or mail is feasible and requires minimum time on the part of providers.
O2-S2.04 Targeting HIV prevention efforts on HIV-infected men using conditional cash transfer (CCT): does it work?
Authors: Khan A , Qazi R , Nazim N , Khan A A
Published: July 2011

Background

Preventing HIV infections in female spouses of HIV-infected men is limited by low HIV testing rates among these women who are at an increasingly high risk for HIV acquisition. We explored the effect of conditional cash transfer (CCT) on HIV-infected men for spouse testing and HIV status disclosure to their spouses.

Methods

Using medical charts we identified all eligible HIV-infected married men receiving care at the PIMS HIV clinic, Islamabad. Selection criteria for CCT were sexually active married men receiving care >6 months including at least two counselling sessions whose spouses had never been tested for HIV (HIV status unknown). CCT was cash given to cover travel/accommodation (US$14 for out-town and US$ 5 for in-town) costs for bringing the spouse to the HIV clinic for testing. All study participants underwent a brief study questionnaire looking at patient demographics, visit history, factors influencing spouse testing, barriers to care and self-disclosure. The CCT acceptance rate was 90% among HIV-infected men. Outcome of interest was spouse testing and status disclosure to spouse at 6 months post CCT.

Results

Of the 230 married men, 138 men (60%) had spouses’ never tested/unknown status. Baseline disclosure of HIV status to wife was 29%, and median duration of receiving care was 14.3 months. From these 138 men we were able to contact and enrol 94 (68%) men for CCT; 53 (56%) brought their spouses for HIV testing within 4 months; 19 (20%) self-reported getting their wives tested elsewhere, and only 22 (24%) did not comply with the CCT conditionality. CCT improved disclosure of HIV status from baseline 29% to 62% (p <0.05). Factors associated with spouse testing were men <50 years, high ART compliance score, and prior self-disclosure of status to one family member (p <0.05).

Conclusions

Even within the context of a socially conservative society CCT can significantly improve HIV testing rates for female spouses and self-disclosure of HIV status by HIV-infected men. Using CCT for timely prevention of HIV infection in wives and children of HIV positive men reduces risk and can be an effective strategy to overcome socio-cultural and financial barriers. Further studies are needed to explore cost-effectiveness of this approach in preventing new infections.
O2-S2.05 Start with the social determinants of health to tailor sexual health promotion for First Nations, Inuit and Métis youth in Canada
Authors: Seto J , Asfaw T , Folz K , Clark W , Deleary M , Sheikh A
Published: July 2011

Background

Sexual health promotion and approaches for the prevention of sexually transmitted and blood-borne infections (STBBI) should be tailored to the needs and realities of youth. Engaging youth and building their capacity is an important step in health promotion and has proven to be critical in the development of a promising initiative aimed at engaging First Nations, Inuit and Métis youth in Canada.

Methods

Community consultative processes were used to engage First Nations, Inuit and Métis (FN/I/M) youth in the development of sexual health promotion and STBBI prevention approaches. Engagement began in 2008 through the establishment of a steering committee, which included FN/I/M youth stakeholders, with representatives from governmental and non-governmental agencies. The steering committee aimed to make effective use of relevant technologies and social media to reach and engage FN/I/M youth in Canada. In 2009, a workshop was held to enhance the involvement of youth to identify priorities for STBBI messaging and explore the best mediums to reach youth. The outcomes of this consultation process informed the development of capacity building social media pilot projects to reach FN/I/M youth.

Results

FN/I/M youth identified the importance of taking a holistic approach by viewing sexual health through the lens of social determinants. Youth highlighted poverty, social support networks and education as major influences on sexual health outcomes for their peers. Key challenges youth noted included the lack of sexual health education and the need to strengthen social support networks. By tying in these determinants into promotion, youth identified themes such as addressing homophobia, and raising the importance of cultural relevancy to de-stigmatise sexual health within FN/I/M communities and to help youth to relate closer to messages. Youth also indicated that peer-to-peer social media methods were an ideal mechanism to convey messages. Many youth from across Canada were engaged in developing their own STBBI messages.

Conclusions

Engaging FN/I/M youth as partners from concept onwards has led to an informed approach to the development of sexual health promotion and STBBI prevention messaging. Public health practitioners learnt youth need to be involved to gain credibility within this population, youth capacity building is important and taking a holistic social determinants approach in conceptualising messages is critical when reaching FN/I/M youth.
O2-S2.06 Reducing sexual risk behaviour among youth: the development and effect evaluation of an interactive online intervention for individuals and their sexual network
Authors: Davidovich U , Uhr-Dall H
Published: July 2011

Background

This study presents an intervention and its evaluation of an innovative approach to counteract barriers to safe sex and STI testing of youth aged 16–24.

Methods

The intervention—http://www.vrijlekker.nl/—has been developed based on over 200 qualitative interviews with youth investigating barriers to safe sex and STI testing. Based on these interviews, training modules were developed which participants could follow online. These modules aimed at counteracting the individual barriers for safe sex and STI testing as well as removing impeding elements in the social and sexual network. The Information-, Motivation and Behavioural Skills (IMB) model (Fisher & Fisher) was used as the theoretical basis of the intervention. The training included filmed coaches that guided users throughout the intervention, thematic films, interactive text with personal feedback and sexual network tools. The modules were offered on a tailored basis to match each user's own cognitive & behavioural risk profile. This profile was established via an automated online intake. An evaluation was conducted comparing a demographically matched control group recruited prior to the launch of the intervention and an intervention group. Behavioural outcomes were compared at 6 month follow-up.

Results

The evaluation included 2944 participants of whom 1553 completed the follow-up (mean age 19, SD 2.4). The intervention group used condoms significantly more often with their most recent casual partner [OR=1.82 95% CI 1.08% to 3.04%] and/or with their steady partner [OR=2.17 95% CI 1.48% to 3.18%] than the control group at 6 months follow-up. Over 170 000 unique persons used the intervention already during its first year, and more than 100 new users continue to do so every day. Some schools in the Netherlands have adopted the site as part of their routine sexual education program.

Conclusions

This study has shown than offering youth an empirically and theoretically sound intervention that is interactive and which adapts itself to the individual needs of each user and its sexual network, results in a desired behavioural change and high uptake, even among the challenging target group of youth.
O2-S3.02 Assessing the validity of sexual behaviour reports in a whole population survey in rural Malawi
Authors: Glynn J , Kayuni N , Banda E , Parrott F , Floyd S , Tanton C , Hemmings J , Molesworth A , Crampin A , French N
Published: July 2011

Background

Sexual behaviour surveys are widely used, but under-reporting of particular risk behaviours is common, especially by women. Surveys in whole populations provide an unusual opportunity to understand the extent and nature of such under-reporting.

Methods

All consenting individuals aged between 15 and 59 within a demographic surveillance site in northern Malawi were interviewed about their sexual behaviour. Validity of responses was assessed by analysis of probing questions; by comparison of results with in-depth interviews and with Herpes simplex type-2 (HSV-2) seropositivity; by comparing reports to same sex and opposite sex interviewers; and by quantifying the partnerships within the local community reported by men and by women, adjusted for response rates.

Results

6796 women and 5253 men (83% and 72% of those eligible) consented and took part in sexual behaviour interviews. Probing questions and HSV-2 antibody tests in those who denied sexual activity identified under-reporting for both men and women. Reports varied little by sex or age of the interviewer. The number of marital partnerships reported was comparable for men and women, but men reported about four times as many non-marital partnerships. The discrepancy in reporting of non-marital partnerships was most marked for married women (men reported about seven times as many non-marital partnerships with married women, as were reported by married women themselves), but was only apparent in younger married women see Abstract O2-S3.02 figure 1.

Abstract O2-S3.02 Figure 1

Ratio of non-marital partners reported by men compared to women, by characteristics of the women and partnership

Conclusions

We have shown that the under-reporting of non-marital partnerships by women was strongly age-dependent. The extent of under-reporting of sexual activity by young men was surprisingly high. The results emphasise the importance of triangulation, including biomarkers, and the advantages of considering a whole population.
O2-S3.03 Duration of recent sexual partnerships in sexually active men and women
Authors: Leichliter Jami , Aral Sevgi
Published: July 2011

Background

The duration of partnerships and partner change rates contribute to STI transmission. Additionally, concurrent partnerships and short gaps between partnerships may be associated with STI spread. Few studies have examined the duration of sexual partnerships at the national level. We examined the duration of recent sexual partnerships reported by sexually active men and women in the US.

Methods

Data were from a national survey of reproductive age men and women in the US 7470 men and women reported having an opposite-sex partner in the past year and reported on their recent sex partners (up to three). Duration of partnerships was measured in months; partnerships where respondents reported only having sex once were coded as 1-month in duration. Respondents indicated whether or not the partner was a current sex partner. Bivariate analyses examined duration of partnerships (mean) by demographics. Data were analysed separately for men and women. A subset of unmarried respondents was also examined.

Results

Findings were similar for the entire sample and for those who were unmarried. Duration of most recent partnership was longer for women as compared to men, but men reported longer 2nd and 3rd most recent partnerships than women. Adolescents had the shortest duration for all three partnerships and were least likely to report that the partner was a current sex partner. There was no difference in duration of partnerships by race with the exception of black men having a shorter duration most recent partnership than other men. More black men but fewer black women reported that their most recent partner was a current partner as compared to other groups. However, black and Hispanic men were more likely to indicate that their second recent partnership was also current. For most recent and 2nd recent partnerships, married men and women reported the longest duration. For most recent partnership, unmarried men and all women with less than a high school education had a longer duration than their counterparts. There were no differences in whether the partner was current by education.

Conclusions

Adolescents and black men had the shortest partnerships. Black women did not differ from white or Hispanic women in the duration of their partnerships. Men and women with short partnerships, overlapping and non-overlapping, may play a key role in the transmission of STIs.
O2-S3.04 Web-based sex diaries and young men who have sex with men: assessing feasibility, reactivity, and data agreement
Authors: Glick S , Winer R , Golden M
Published: July 2011

Background

Web-based diaries are a promising means for collecting detailed sexual behaviour and substance use data. Few studies have evaluated the feasibility and reliability of collecting these data among men who have sex with men (MSM). We compared quantitative diary data with retrospective survey data collected over 1-year in a cohort of young MSM in Seattle, WA.

Methods

Ninety-five MSM, age 16–30, completed web-based surveys every 3 months and were randomised to 1 of 4 diary submission schedules: every 2 weeks, once a week, twice a week, or never. The diaries asked questions about daily sexual behaviour and substance use. We assessed the agreement between diary and survey data using κ statistics for dichotomous variables and concordance correlation coefficients (CCC) for continuous variables. We used generalised estimating equations to assess for differences in survey data over time between those assigned an active diary schedule to those assigned no diary.

Results

During the first 6 months, 78% of participants assigned to an active diary schedule completed at least 80% of their diary days, and the 2-week schedule had the highest and most consistent completion rate. Completion rates dropped to <60% during the second 6 months. Among participants with active diary schedules, most measures had strong agreement between the diary and survey data (ie, κ or CCC≥0.8). The exceptions to this were numbers of overall and unprotected anal sex acts during the first 3 months (CCC=0.53 and 0.57, respectively) and alcohol use during the first 6 months (κ=0.57–0.59). We observed some reactivity, or a difference in reported behaviour associated with diary completion. For example, participants assigned no diary reported an average increase of 5.2 more unprotected anal sex acts over consecutive 3-month periods than those assigned an active diary schedule (p<0.01).

Conclusions

This study suggests that sexual behaviour and substance use data collected from young MSM during 3-month retrospective surveys—an interval commonly used in sexual behaviour research—are largely adequate. Web-based diaries can be used for up to 6 months to gather detailed behavioural data, and may be more appropriate than retrospective surveys for counts of anal sex acts. Furthermore, our finding that diaries may be associated with lower levels of reported sexual behaviour suggests that web-based diaries may be useful as a behavioural intervention to prevent HIV/STI among young MSM.
O2-S3.05 STIs and neighbourhood drug markets: first a foray into measurement
Authors: Jennings J , Taylor R , Furr-Holden D , Ellen J
Published: July 2011

Background

Neighbourhoods with drug markets (as compared to those without) may be more likely to have a greater concentration of STI infected sex partners. The objectives of this study were to assess the reliability and validity of three measures of neighbourhood drug markets.

Methods

Data were collected from a cross-sectional household study of English-speaking, sexually-active persons, 15–24 years of age (n=568) residing in selected neighbourhoods (n=63). Participants responded via ACASI to “In your neighbourhood, are there any places like a street corner, block, house, club, bar, or other place where drug activity, like people selling or buying drugs, happens?” Survey reports were aggregated to the neighbourhood level and coded to > (vs <) 50% of residents reporting yes. To supplement this measure, information was obtained from systematic social observations (SSOs) using a multi-item assessment tool. Multiple rater information on a block was aggregated to the greater value to generate one value for a block unit. Ratings were summed to create one continuous measure at the neighbourhood level. Additionally drug arrest data on drug manufacturing, distribution, or intent to distribute was measured as a count per neighbourhood. We conducted reliability analyses using intraclass correlations and inter rater reliabilities and convergent validity testing using Poisson and linear regression.

Results

Within-neighbourhood respondent agreement on survey-reports of neighbourhood drug markets had a reliability 0.50 and an intra class correlation of 0.10 (p<0.001). Neighbourhood survey-reports were significantly associated with gonorrhoea counts (IRR) 3.05, 95 CI% 2.07 to 4.51, p<0.001) and socioeconomic status (SES) (ß −1.74, 95 CI% −2.54 to −0.93, p<0.001). The SSO drug market inter rater reliability was significant and moderate at the block level (0.57, p<0.05) with a reliability of 0.88. The SSO measure was not associated with gonorrhoea counts (IRR 1.18, 95 CI % 0.94 to 1.49, p=0.15) and was significantly associated with SES (ß −0.65, 95 CI% −0.99 to −0.31, p<0.000). Drug arrest counts were significantly associated with gonorrhoea counts (IRR 1.01, 95 CI% 1.00 to 1.01, p=0.002) and SES (ß −0.01, 95 CI% −0.02 to −0.01, p<0.001).

Conclusions

The results suggest that neighbourhood drug markets can be measured through the use of household survey-reports and drug arrest data; the use of SSOs was less clear. The mismatch of the drug market measures may have been due to differences between the measures in sensitivity and specificity.
O2-S4.01 Efficiency vs equity in screening: considerations in the scale-up of rapid syphilis testing in rural Tanzania
Authors: Sweeney S , Mosha J , Terris-Prestholt F , Changalucha J , Peeling R
Published: July 2011

Background

The burden of congenital syphilis remains high in many low-income countries, despite the availability of preventive therapy. Rapid syphilis tests (RSTs) could improve access to and cost-effectiveness of syphilis screening programs in low resource settings. The objective of this study was to inform programs how best to use RSTs based on relative efficiency, cost-effectiveness and access considerations.

Methods

Incremental costs for RST screening in existing antenatal care settings in Tanzania were collected from nine health facilities varying in size, remoteness, and scope of services provided. The number of DALYs averted was modelled from project outputs. Economic costs per: woman tested, treated, and DALY were calculated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty.

Results

In surveyed facilities a total 6362 women were tested with RSTs over a costing period of 9 months, as compared with just 224 tested with RPR over a similar time period the previous year. Total economic costs for RST screening ranged from $1758 to $6375. Unit costs ranged from $1.90 to $6.06 per woman screened, $17.76–$63.19 per woman treated, and $1.20–$4.26 per DALY. Larger facilities had lower unit costs, suggesting that economies of scale exist in screening services. Results were sensitive to assumptions regarding supply wastage, frequency of supervision, and program duration.

Conclusion

RST screening costs fall well below the WHO threshold for ‘highly attractive’ cost-effectiveness. Although RST costs are slightly higher than those for RPR, the number of women reached by screening services was increased under RSTs. Results suggest that RSTs can overcome critical barriers to antenatal syphilis testing and treatment. Through removal of supply chain barriers, RSTs enable the realisation of economies of scale in screening services. This suggests that larger facilities will benefit from implementation of RSTs. RSTs further allow for screening where a lack of infrastructure prevents consistent RPR testing. Therefore, in the effort to increase equity in access to screening, roll-out is also recommended in facilities not able to provide RPR screening. RSTs are currently being expanded throughout the country in the effort to increase access to syphilis screening in antenatal care. This could facilitate control of congenital syphilis and prevent countless unnecessary fetal and infant deaths.
O2-S4.02 Cost-effectiveness of screening forChlamydia trachomatisin Dutch pregnant women
Authors: Rours G I J G , Verkooijen R P , Verbrugh H A , Postma M J
Published: July 2011

Background

Chlamydia trachomatisinfections may have serious consequences for women, their offspring and pregnancy outcomes, but are largely asymptomatic. Prevention is therefore based on screening. Screening for Chlamydial infections during pregnancy is not part of routine antenatal care in many countries, as in the Netherlands.

Objective

Cost-effectiveness analysis ofC trachomatisscreening during pregnancy.

Methods

A health-economic decision analysis model was designed, which included not only potential health outcomes ofC trachomatisinfection for women, partners and infants, but included also premature delivery. The cost-effectiveness was estimated from a societal perspective using recent prevalence data from a population-based prospective cohort study among pregnant women in the Netherlands. The prevented costs were calculated by linking health outcomes with health care costs and productivity losses. Cost-effectiveness was expressed as net costs per major outcome prevented and was estimated in a base-case analysis as well as a sensitivity- and scenario analysis.

Results

In the base-case analysis (current base-case test cost €12), the costs to detect 1000 pregnant women withC trachomatiswere estimated at €378 300. Cost savings on complications were estimated at €924 600 resulting in net cost savings. Sensitivity analysis showed that net cost savings remained for a broad range of variation in underlying assumptions such as test costs (up to €32), proportion of complications that can be averted (between 25% and 75%), risk for PID (0.4% to 40%), and any other parameter within plausible ranges (between + to −25%). Cost savings were most sensitive to preterm delivery, but remained when preterm delivery was excluded (making the model comparable to other cost-effectiveness analyses). Scenario analysis showed even more cost savings with targeted screening for women's age (≥20 years, 26–30 years, and <30 years) or pregnancy rate (first pregnancies only). At base-case costs, screening appeared cost-saving in populations with a chlamydial prevalence beyond 1.7%. At the extremes, with test costs as low as €5 cost savings would already occur beyond a prevalence of 0.6% and with test costs as high as €40 cost savings would occur beyond a prevalence of 4.7% see Abstract O2-S4.02 figure 1.

Abstract O2-S4.02 Figure 1

Costs per QALY gained by prevalence when using different test costs forChlamydia trachomatisscreening in pregnant women.

Conclusions

C trachomatisscreening of pregnant women in the Netherlands is cost-saving.
O2-S4.04 The cost of expedited partner therapy compared to the cost of standard partner referral for the treatment of chlamydia or gonorrhoea
Authors: Gift T , Kissinger P , Mohammed H , Leichliter J , Hogben M , Golden M
Published: July 2011

Background

Partner treatment is an important component of sexually transmitted disease (STD) control. Several randomised controlled trials (RCTs) have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, and some found that EPT significantly lowered re-infection rates in index patients.

Methods

We collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient re-infection rates from two RCTs examining EPT and SR for patients diagnosed with chlamydia or gonorrhoea. Additional elements were estimated or drawn from the literature, such as the likelihood of progression to and QALY impact of sequelae. We used a Monte Carlo simulation (10 000 iterations) to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal. Sensitivity analyses assessed the impact of varying settings in which EPT might be employed, such as one in which no patient counselling or data entry costs were incurred when employing either EPT or SR.

Results

From a health care system or societal perspective, EPT was less costly and treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥ 40%–45% of male index patients’ female partners or ≥38% of female index patients’ male partners received care from the same payer. The Abstract O2-S4.04 figure 1 shows the Monte Carlo results for New Orleans and depicts the relationship between the cost difference between EPT and SR and the proportion of partners of the index patient who receive care from the same payer as the index. Negative values in the figure indicate EPT is less costly per patient. In sensitivity analyses, EPT was less costly than SR from all payer perspectives when counselling and data entry costs were eliminated; when counselling costs were applied to EPT alone, the payer-perspective cost of EPT was greater than SR for index women, but the additional cost was less than $2600 per QALY gained over SR.

Abstract O2-S4.04 Figure 1

Payer-perspective cost difference per index patient: Expected partner therapy (EPT)-standard referal (SR).

Conclusions

EPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients’ partners receive care from the same payer.
O2-S4.05 Serosorting behaviours and beliefs among MSM at an urban LGBT health center
Authors: Hotton A , Gratzer B , Pohl D , Mehta S D
Published: July 2011

Background

Serosorting, preferentially engaging in unprotected anal intercourse (UAI) with partners of the same HIV status, is practiced by some MSM as a risk reduction strategy.

Methods

May through November 2010, we assessed serosorting practices and beliefs among MSM seeking STI testing at an urban LGBT health center. We compared serosorting practices and beliefs by HIV status and partner characteristics with Pearson χ2tests. Sexual behaviours, partner characteristics, and HIV status were based on self-report.

Results

705 HIV-negative and 88 HIV-positive MSM completed the assessment. Median time since last HIV test was 7.5 months; nearly a third had not been tested in the last year. Overall, 53% reported no UAI, 27% reported seroconcordant UAI, and 18% reported serodiscordant UAI with last sex partner. UAI was more common with seroconcordant partners than with serodiscordant partners (55% vs 37%, p<0.001); 23% of HIV-positive and 17% of HIV-negative men reported serodiscordant UAI. 81% of men with seroconcordant partners said they knew their partner's status by getting tested together or talking with them; 5% determined partners' status indirectly and 14% did not report how they determined their partner's status. Seroconcordant UAI was more common among HIV-positive than HIV-negative men (53% vs 24%, p<0.001). Among 288 HIV-negative men reporting UAI: seroconcordant UAI was more common with main vs casual partners (76% vs 41%, p<0.001) and within monogamous vs non-monogamous relationships (69% vs 51%, p=0.003); serodiscordant UAI was more common among men with ≥3 recent sex partners vs <3 partners (50% vs 33%, p=0.005) and those who reported any anonymous sex partners vs none (53% vs 28%, p<0.001). Among men who said that they could not be talked out of safer sex with a seroconcordant partner, 10% of HIV-negative men and 16% of HIV-positive men reported serodiscordant UAI. 19% of HIV-negative men who endorsed seroconcordant partnerships reported serodiscordant UAI.

Conclusions

Discrepancies between serosorting endorsement and practice underscore the importance of assessing cognitions related to risk-taking and behaviour. High rates of partner concurrency, infrequent testing, and indirect assessment of partner serostatus may limit the effectiveness of serosorting as a risk reduction strategy, even with main partners. The contribution of serosorting to HIV transmission within primary relationships warrants further research.
O2-S5.05 Are MSM looking for lesions? Examining self and partners for syphilis
Authors: Surie D , Koumans E , Furness B , Perkins R , Brewer T , Turner D , Hernandez-Kline P , Gamerdinger K , Workowski K , Markowitz L
Published: July 2011

Background

Syphilis rates among men who have sex with men (MSM) in the US are rising. In 2009, 62% of reported primary and secondary syphilis cases in the U.S. were among MSM. Self- and partner-examination for primary syphilis (painless chancre) might increase early detection and treatment and reduce transmission. As the first step in a study to increase syphilis lesion awareness, we collected baseline data on rates of self- and partner-examination.

Methods

Data were collected from five MSM STD or infectious disease clinics in the US before and after introduction of brochures with pictures and information about syphilis signs, transmission, and prevention. Surveys included questions about demographics, sexual behaviours, syphilis knowledge and self- and partner-examination. Data were analysed using SAS V.9.2.

Results

From September 2009 to January 2011, 586 sexually active men completed a survey; 124 (21%) from Arizona, 128 (22%) from the District of Columbia, 202 (34%) from Florida and 132 (22%) from Georgia; 542 (92.5%) reported having sex with men only and 44 (7.5%) reported having sex with men and women. Most participants (334, 57%) were aged 18–39 years, 240 (41%) were 40–59 years and 12 (2%) were older than 60 years; 222 (38%) reported one partner, 180 (31%) 2–3 partners, 133 (23%) 4–10 partners, and 51 (9%) >10 partners in the last 3 months or since their last clinic visit. Most participants correctly identified oral (510, 87%), anal (529, 90%) and oral-anal sex (487, 83%) as ways to transmit syphilis. Few recognised frottage that is, rubbing against someone (112, 19%) and kissing (196, 34%) as other modes of transmission. Over 50% reported self-examination of mouth, penis and skin at least once a week, whereas less than half reported partner-examination of these areas (Abstract O2-S5.05 table 1). Less than 50% reported self- or partner-examination of anus at least once a week. Rates of self-examination did not vary by number of partners or age; whereas, examining partner's mouth, penis and skin was less frequent (p<0.05) among MSM with >3 partners.

Abstract O2-S5.05 Table 1

Proportion of MSM reporting self- and partner-examination of mouth, anus, penis and skin, n=586)

Body partsFrequency of examinationNever (%)Once a month (%)At least once a week (%)SelfMouth17.114.568.4Anus26.424.948.7Penis6.27.686.3Skin8.39.781.9PartnerMouth76.67.715.6Anus62.111.526.5Penis47.111.641.4Skin47.29.843.0

Conclusions

The majority of MSM reported examining themselves at least once a week, but did not examine their partners as frequently. MSM with >3 partners were less likely to examine their partners' bodies than those with fewer partners. Analysis of surveys from men after brochure introduction will determine whether education materials increase rates of self- and partner-examination.
O2-S6.02 Occupational and intimate partner violence and inconsistent condom use with clients among female sex workers in southern India
Authors: Deering K , Bhattacharjee P , Mohan H L , Bradley J , Shannon K , Boily M C , Ramesh B M , Isac S , Moses S , Blanchard J
Published: July 2011

Background

Global reports suggest that interpersonal violence experienced by female sex workers (FSWs), including occupational violence (eg, by clients, CLViol) and intimate partner violence (IPViol) may be important structural determinants of vulnerability to HIV and sexually transmitted infections (STIs). This study characterised the type and frequency of CLViol and IPViol experienced by FSWs in southern India and examined the relationship between client violence and inconsistent condom use (ICU) with clients.

Methods

Data were analysed from cross-sectional surveys of FSWs in three districts in Karnataka state (2007). ICU was defined as condom use frequency reported as 'never/sometimes/often' vs ‘always’, by repeat and occasional clients. CLViol and IPViol measures included having experienced physical violence in the past 6 months (ie, hurt, hit, kicked, punched, choked, burned) or sexual violence in the past year (ie, beaten or otherwise physically forced to have sexual intercourse).

Results

Of our sample of 1245 FSWs, ICU was 13.0% with occasional and 20.2% with repeat clients. Overall, 13.1% of women reported physical violence from any perpetrator (CLViol: 5.5%; IPViol: 4.6%) and 9.7% reported sexual violence (CLViol: 5.2%; IPViol: 4.4%). In multivariable logistic regression analysis, the odds of ICU with occasional clients were significantly higher for women who had experienced physical CLViol (adjusted OR (AOR): 2.4, 95% CI: 1.2% to 4.8%) or sexual CLViol (AOR: 2.7, 95%CI: 1.3% to 5.5%). Similar results were found with repeat clients: AOR: 2.5, 95% CI: 1.4% to 4.6% and AOR 2.3, 95% CI: 1.3% to 4.2%, for physical and sexual violence respectively. A dose-response relationship between the number of times experiencing CLViol and increased ICU with both types of clients was also observed (p<0.001) (Abstract O2-S6.02 figure 1). IPViol was not significantly associated with ICU with clients. Experiencing CLViol was not associated with experiencing IPViol (p=0.321).

Abstract O2-S6.02 Figure 1

Proportion of female sex workers who used condoms inconsistently with occasional or repeat clients according to the number of times they experienced physical violence by clients in the last 6 months (did not experience, experienced one time, experienced 2-5 times, experienced 6+ times).

Discussion

A strong independent relationship between experiencing client violence and inconsistent condom use with clients among FSWs in southern India was observed, highlighting FSWs' vulnerability to HIV/STI infection. Occupational violence against FSWs should be addressed within HIV/STI prevention programming. Structural-legal reforms to current sex work laws and safer-environment interventions should be developed to reduce violence and HIV/STI vulnerability among FSWs.
O2-S6.03 Heterogeneity of HIV risk: female sex worker clients and their non-commercial sexual partners in south India
Authors: Shaw S , Deering K , Isac S , Ramesh B , Washington R , Moses S , Blanchard J
Published: July 2011

Introduction

Clients of female sex workers (FSWs) are an important bridging population for the further transmission of HIV and other sexually transmitted infections (STIs). However, the extent of risk to non-commercial partners (NCP) of clients has rarely been quantified. This study sought to characterise the risk behaviours of clients with both non-commercial and commercial partners.

Methods

Data were collected from a cross-sectional integrated behavioural and biological survey of FSW clients from five districts in Karnataka state, southern India. Clients were classified into three groups: married (and thus with an NCP); unmarried with at least one NCP; and unmarried without an NCP. Bivariate and multivariable logistic regression models were constructed to examine the association between group membership and condom use patterns with regular and casual FSWs, and where applicable, non-commercial partners. Associations between the prevalences of HIV, HSV-2, syphilis, gonorrhoeal and chlamydial infections and group membership were examined in multivariable models. Normalised weights were used to account for a complex sampling design.

Results

The total sample size was 2328. Most respondents (61%) were married, 9% were unmarried with an NCP, and 30% were unmarried without an NCP. Married clients were, on average 9 years older (34 vs 24.8 years), and had been visiting FSWs for an average of 12 years, vs 4 years in the other two marital categories. Compared to respondents without an NCP, married clients were at higher odds of reporting never using condoms with both casual (AOR: 1.8; 95% CI:1.3% to 2.4%, p<0.0001) and regular (AOR:1.8; 95% CI 1.2% to 2.7%, p=0.009) FSWs. Among the two groups reporting an NCP, 91% of married respondents reported never using condoms with their NCP, compared to 62% of unmarried clients (AOR: 5.2; 95% CI 3.3% to 8.1%, p<0.0001). HIV prevalence was 6 %, 5% and 8% among those that were married, those unmarried without an NCP, and those unmarried with an NCP, respectively (p=0.384). For the same groups, HSV-2 prevalence was 37%, 16% and 19% (p<0.0001). In adjusted analyses, married respondents remained at highest odds of being infected with HSV-2 (AOR: 1.5; 95% CI 1.1% to 2.1%, p=0.006).

Conclusion

Married respondents were least likely to use condoms with both commercial and non-commercial sexual partners, while also having the highest prevalence of HSV-2. These findings illustrate the high risk posed to both commercial and non-commercial partners of married clients of FSWs.
LBO-1.1 Acyclovir achieves lower concentration in African HIV−, HSV-2+ women compared to non-African populations, possibly explaining lower herpes suppression
Authors: Lu Y , Hendrix C , Celum C , Baeten J , Cowan F , Delany-Moretlwe S , Reid S , Hughes J , Wald A , Corey L
Published: July 2011

Background

Two trials of acyclovir (ACV) 400 mg twice daily as daily suppressive therapy against herpes simplex virus type 2 (HSV-2) proved ineffective for prevention of HIV acquisition. Explanations for this lack of efficacy are unclear. In one of these trials, HPTN 039, ACV was modestly effective in reducing genital ulcers due to HSV-2; however, there was less reduction in the frequency of genital ulcers and higher HSV-2 DNA quantity in breakthrough lesions in women from African sites than in men from US sites. Pharmacokinetic differences of ACV have been proposed as one explanatory variable for these findings.

Methods

Sixty-eight HIV-negative, HSV-2 seropositive women participated in a pharmacokinetic study of ACV after completion of HPTN 039 (a phase III, randomised clinical trial of daily acyclovir 400 mg p.o. twice daily). Following a single oral dose of 400 mg of acyclovir, blood was collected over an 8 h period. An LC/MS/MS-based assay determined ACV concentrations. PK parameters were estimated using non-compartmental methods.

Results

Sixty-six African women had complete PK data for evaluation. Mean (range) age was 36 (21–54) years and weight was 70 (40–129) kg. The geometric mean (95% CI) for PK parameter estimates were: Cmax 0.31 ug/ml (0.28, 0.34), AUC0-inf 1.59 ug*hr/ml (1.43, 1.76), Tmax 1.56 h (1.40, 1.80), and half-life 2.8 h (2.5, 3.0). This Cmax was lower than 8 comparable single dose ACV PK studies in non-African populations, mean 46% lower (range 28%–59% lower, all p values <0.006). Similarly, AUC was lower than all other studies, mean 38% lower (range 26%–62%, all p values <0.001). In some studies, Tmax was earlier and the half-life was shorter. Subject weight did not explain the differences.

Conclusion

Acyclovir exposure in black African women was lower than in comparable ACV studies of non-African populations. These statistically significant differences in drug exposure (Cmax and AUC) may be clinically significant and partly explain the modest effects of ACV on HSV-2 recurrence in these African women.
LBP-1.05 Challenges and barriers for conducting STI/HIV prevention projects targeting female sex workers within national programs in Benin and Niger
Authors: Batona G , Michel A , René K , Marie G , Évelyne A , Clément A , Kamaye I M , Hassane D
Published: July 2011

Context

In West Africa, HIV/STIs prevention activities targeting female sex workers (FSW) and their partners were developed and supported financially through a bilateral cooperation project. After the end of the project in Benin (2006) and Niger (2007), the national HIV/STI programs took over these interventions.

Objectives

(i) to identify the challenges and barriers for FSW program interventions within national programs; (ii) to assess the capacity of FSW dedicated services to treat and prevent STI efficiently.

Methods

A triangulation of methods and sources of data collection were used within an evaluative approach centered on the use of the results, such as individual and collective interviews, review of data records from health centers and field observations. Quantitative data from clinical attendance were crossed with qualitative data. A conceptual framework was developed to explain the exploratory and analytical elements. The main findings were validated with the stakeholders.

Results

There are several constraints and major challenges facing STI/HIV prevention under the responsibility of national programs, namely: (i) the deficit of synergies between two major components (communication for behavioural change and medical follow-ups), (ii) the lack of coordination and actions in the field, (iii) the abandonment of structural activities, (iv) low resource allocation for activities targeting FSW. Since the integration of the activities into the national programs, the capacity to provide prevention services to the FSW population, both in terms of coverage and of the package and the quality of services provided, has significantly declined, even if the strengthening of staff capacity in this domain remains an encouraging achievement.

Conclusions

The national programs of Benin and Niger do not yet cover sufficiently the most exposed groups (FSW and their partners) who are at the centre of the HIV epidemic. Thus, the study proposes reflection and action to improve coverage of this clientele in order better control of STIs and HIV.
LBP-1.08 Preliminary report on experience with point of care syphilis and HIV testing in hard-to-reach populations in outreach settings in Edmonton, Canada
Authors: Bergman J , Plitt S , Gratrix J , Conroy P , Li J , Rocco K , Fenton J , Archibald C , Wong T , Singh A
Published: July 2011

Background

Edmonton is in the midst of a syphilis outbreak occurring largely in high risk and hard-to-reach populations. Point of care (POC) testing for syphilis and HIV offers the opportunity for immediate and rapid access to testing, and in the case of syphilis, immediate treatment. POC syphilis tests have not been previously evaluated in clinical settings in Canada.

Methods

Since 14 February 2011, treponemal syphilis (Bioline Syphilis 3.0) and HIV (INSTI HIV-1/HIV-2 Antibody Test) POC testing, using whole blood from a finger prick specimen, has been offered to outreach clients in Edmonton. POC results were compared to standard testing from simultaneously collected serum specimens. Baseline demographics, sexual and drug use risk behaviour information were collected. Age and gender were collected on individuals who refused POC testing. A descriptive analysis was performed on the characteristics and outcomes of participants and those who refused.

Results

As of 15 April 2011, 146 individuals had been offered POC testing; 85.6% (n=125) consented. Among participants, 59.2% (74) were male [vs 66.7% (14) of non-participants, p=0.5)] and the median age was 29 yrs (IQR 24–36 yrs) [vs non-participants median age 29 yrs (IQR 25–45 yrs), p=0.2)]. The majority of participants (83.2%; 104) were heterosexual, 59.2% (69) were Aboriginal, and 30.4% (38) reported injection drug use. Among females, 62.7% (32) reported sex trade involvement, while among males, 21.6% (16) reported sex with a sex trade worker. Of 121 syphilis treponemal POC tests, 5 (4.1%) were positive, all in old treated cases of syphilis that were asymptomatic for infectious syphilis at the time of testing. Two syphilis POC (1.7%) tests were falsely negative when compared to the standard screening test (Architect Syphilis TP Microparticles, Abbott Laboratories, Illinois, USA); both were in individuals previously treated for syphilis. Of 123 HIV POC tests, 2 (1.6%) were reactive, both newly diagnosed cases as confirmed by GS HIV-1 Western Blot (BioRad Laboratories, California, USA); both were negative by syphilis POC tests.

Conclusion

Preliminary results from Edmonton suggest that POC testing for syphilis and HIV is well accepted among high-risk populations in outreach settings in Edmonton. This ongoing study will assess the utility of these tests in mitigating the further spread of both syphilis and HIV through POC testing, and in the case of syphilis, POC treatment.