bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S6.20 Perinatal Screening for STIs in the USA: adherence to preventive screening recommendations for HIV and syphilis among the commercially insured (2008)
Authors: Janes G , Beard A , Tao G , Hoover K , Kent C
Published: July 2011

Background

Perinatal transmission of sexually transmitted infections is a preventable source of morbidity. In the USA, the incidence of congenital syphilis has increased by 23% since 2005 and, in 2008, 141 infants were infected with HIV, despite the fact that the CDC recommends routine prenatal syphilis and HIV screening. To encourage compliance with guidelines, many payers rely on claims data to track utilisation. In this study, the percentage of women screened for syphilis or HIV during their pregnancy was estimated using MarketScan claims data, as a measure of compliance and of the feasibility of using these data for assessment of prenatal screening.

Methods

We analysed data from the MarketScan database, that allows linkage of de-identified patient and utilisation data from varying sites of care. The analysis was restricted to women who delivered a live birth in 2008, and who were continuously enrolled in one health plan for at least 293 days prior to delivery. The eligible population was identified using the coding algorithm for a live birth defined by HEDIS.

Results

Among the 220 571 women with a live birth in 2008, 87.0% received a syphilis test during their pregnancy, 74.1% received an HIV test and 73.3% received both. The test rate for syphilis was highest for those 31–35 yrs (88.2%) and lowest for those 15–20 yrs (78.3%). The test rate for HIV was highest among those 21–25 yrs (75.2%) and lowest among those 15–20 yrs (70%). Both prenatal syphilis and HIV test rates were highest among those insured by a preferred provider plan. Regionally, testing rates were highest in the South (89.8% for syphilis and 82.1% for HIV) and lowest in the Northeast for syphilis (82.8%) and in the West for HIV (62.9%).

Conclusions

The results suggest fairly good compliance with guidelines for prenatal HIV and syphilis screening, although utilisation still varies by age, insurance type and geographic region. The MarketScan database represents individuals covered by employment-based health plans, which is how most Americans are insured. These data provide a unique opportunity to assess utilisation among the insured, at a time when the USA is poised to move a larger proportion of the population into this group. Tracking of year-to-year changes could help public health and healthcare organizations partner to improve care and target interventions to ensure equal access to these critical services.
P1-S6.21 Chlamydia trachomatisscreening initiative among female US army soldiers deployed to Korea
Authors: Jordan N , Clemmons N , Gaydos J , Fishman J , Jacobsmuhlen T , Lee H Choon , Meyers M , Klein T
Published: July 2011

Objectives

To determine the prevalence ofChlamydia trachomatis(Ct) infections among female US Army soldiers deployed to the Republic of Korea; to identify high-risk groups; and to develop data to inform Army leaders and public health decision makers regarding the program's impact.

Methods

All females reporting (in-processing) to the Eighth US Army, Republic of Korea, between 1 November 2007 and 31 December 2009 received an educational STI brief and a questionnaire, and were requested to provide a urine sample for Ct and gonorrhoea testing using the Aptima Combo 2 Assay. Contact tracing was conducted for all identified cases. Descriptive analyses of the population of interest and data collected during calendar years 2008–2009 were performed. A logistic regression model was generated to identify statistically significant risk factors.

Results

Women deployed to Korea differed somewhat demographically when compared to the overall female Army population; a higher proportion of known high risk groups was observed (eg, women under 25 years of age). A total of 3761 women were screened during the 2 calendar years, with an overall positive rate of 5.7%. Ct rates were as high as 11.4% among women under 20 years, and decreased with increasing age. Rates varied considerably by race, with the highest rates observed among American Indians/Alaskan natives (9.3%), followed by Black females (6.5%). The Eighth US Army screening program was associated with diagnosis of infections at an earlier age (22.1 years on average during the screening program, as compared to 26.1 years on average before the program was initiated). Statistically significant differences were observed, with higher rates found among Black women and women <25 years of age.

Conclusion

A high prevalence of infection was observed, highlighting the need for a continued Eighth US Army screening program. Furthermore, the program demonstrated that universal screening during Army in-processing was feasible and resulted in detection of Ct at earlier ages, which likely reduces disease transmission, medical complications, and associated costs with treatment. These findings have implications not only for the continuation of the program in the Republic of Korea, but also for the expansion of such programs during in-processing activities among other military high risk populations (eg, Army recruits).
P1-S6.22 Characteristics of chlamydia testing by a large commercial laboratory corporation, USA, 2008–2010
Authors: Kent C , Tao G , Hoover K , Body B , Nye M
Published: July 2011

Background

US guidelines recommend chlamydia screening for all sexually active young women, HIV-infected persons, and men who have sex with men (MSM). Several types of chlamydia tests are available, including nucleic amplification tests (NAATs), DNA probe, and culture. Different assays have different sensitivity and specificity, and sensitivity and specificity also varies by specimen type. Because reported chlamydia trends could be impacted by shifts in the proportion of tests and specimen types used by providers and laboratories, it is important to monitor changes in test usage to help interpret reported trends in morbidity. We examined chlamydia testing data from one of the two largest commercial laboratories in the USA

Methods

Among chlamydia tests performed from June 2008—to July 2010 by this laboratory, we assessed the frequency of test types used by year, sex, specimen type, and positivity of these tests.

Results

During these 2 years, 2.9 million specimens were tested for chlamydia. Among those tested, 86% were women. Tests performed were: 77% NAATs, 23% DNA probes, and 0.3% cultures. Between year 1 and 2, NAATs increased from 73% to 80% of all tests, and DNA probes decreased from 27% to 19%. Test type varied by sex; 88% of tests among men were NAATs compared to 75% among women. The top specimen types among women tested by NAAT were: 45% cervical, 35% urine and 18% vaginal. Chlamydia positivity varied by test type: 5.1% NAAT, 1.4% DNA probe, and 2.3% culture.

Conclusions

NAATs were the most frequently used chlamydia test and their use increased over the evaluation period, creating a smaller market for other tests. Although vaginal swabs are the most sensitive specimen for testing women by NAAT, currently they are the least common specimen type used for testing. This may reflect the delayed introduction (FDA clearance) of the vaginal swab compared to other collection devices. Stocking the wide assortment of collection devices required for testing different specimens in different populations might also be a barrier for providers. Because these data are from one of the largest U.S. laboratories, with representation by insurance type and geography of the U.S. population, they can be useful for monitoring testing trends. Laboratory testing data also might be a valuable adjunct for national surveillance of chlamydia positivity trends that would not be dependent on provider or health department reporting nor small sample size from national surveys.
P1-S6.24 Estimation of prenatal screening rates for chlamydia, syphilis, and HIV among low-income women, California, 2007
Authors: Chow J , Wright G , Bolan G
Published: July 2011

Background

Prenatal screening for chlamydia (CT), syphilis, and HIV infection is recommended to diagnose and treat infection that might otherwise be transmitted to the neonate and result in perinatal complications. Assessment of screening is important for programs serving low-income women who may be more likely to initiate care late in pregnancy and may be at higher risk for adverse perinatal outcomes.

Methods

We analysed Medi-Cal program claims to identify low-income California female clients who delivered an infant in 2007 with ≥9 months Medi-Cal eligibility, ≥1 prenatal and family planning claim in the 42 weeks before delivery. Test claims in Medi-Cal and family planning claims during this period for CT, syphilis (including obstetric panels), and HIV were identified based on Common Procedural Terminology-4 codes. We estimated the percent of women screened for CT, syphilis, and HIV, and stratified by trimester screened, age (≤25 years; >25 years), and race/ethnicity. Results of 181 390 Medi-Cal clients who delivered in 2007, the percent with ≥1 prenatal test for all 3 STDs was 62% and for CT, syphilis, and HIV was 73%, 77%, and 62%, respectively, with little variation by age and race/ethnicity. Among 125 444 women who initiated care in the first trimester the percent tested for CT, syphilis, and HIV was 78%, 83%, and 68%, respectively. Among 11 802 women who initiated care in the third trimester the percent tested for CT, syphilis, and HIV of was lower at 43%, 48%, and 31%. Among women who were tested in the first trimester, the percent re-tested in the third trimester for CT, syphilis and HIV was 21%, 30%, and 5%, respectively.

Conclusions

These lower than expected STD prenatal screening rates should be considered minimum estimates. Estimates have not included testing from all other healthcare programs accessed by women prior to delivery in the Medi-Cal program and have not been validated against medical records. Nevertheless, the lower rates of testing among women with late prenatal care initiation and the relatively low rates of HIV testing as compared with syphilis testing despite legislative mandate are concerning and further studies are needed to understand reasons for these differential rates.
P1-S1.25 Trend of sexually transmitted diseases diagnosed by syndromic approach in an institute setting
Authors: Kanwar A
Published: July 2011

Background

The paradigm of research in sexually transmitted diseases (STD) has recently shifted to HIV/AIDS. Recent trend of sexually transmitted diseases in India is lacking.

Objective

To determine the trend in the syndromic diagnosis of sexually transmitted infections (STI).

Methods

Data of patients attending our STD clinic between 2008 and 2010 was retrieved. Aetiological diagnosis of individual patients as practiced in our clinic were fit into any of the following syndromic diagnoses—vaginal/cervical discharge, non-herpetic genital ulcer, herpetic ulcer, lower abdominal pain, urethral discharge, ano- rectal discharge, inguinal bubo, scrotal swelling, genital warts, and other STIs that could not be characterised into above syndromes. The syndromic approach as suggested by National AIDS Control Organization of India was followed. Trend of syndromic diagnosis of STIs was determined.

Results

In 2008, majority (51.1%) of the new patients registered to the clinic (36, 26.66% herpetic genital ulcer, 33, 24.44% genital warts) had one or the other viral STI. In 2009, 43.68% patients had viral STIs (21.35% herpetic GUD, 22.33% genital warts). In 2010, there was a significant increase in the incidence of viral STIs; 72.6% patients (36.94% herpetic GUD and 35.66% genital warts) had one or the other viral syndromic diagnosis.

Conclusion

In concurrence to observations worldwide, proportion of viral STIs have increased significantly recently due to widespread use of broad spectrum antibiotics. One more reason could be recurrent or persistent nature of these viral STIs. In our setting, incidences of herpetic GUD and genital warts were almost similar.
P1-S6.26 Modelling the impact of rapid treponemal tests on syphilis prevalence among female sex workers in India
Authors: Mishra S , Moses S , Pickles M , Ramesh B M , Isac S , Washington R , Becker M , Blanchard J , Boily M C
Published: July 2011

Background

Rapid treponemal tests performed at point-of-care (POC) are being used to scale up syphilis (Tp) screening in high-prevalence resource-limited settings. However, their advantage over offsite rapid plasma reagin (RPR) may be offset by variable sensitivity when used as POC, and the potential for resurgence in infectious cases due to enhanced treatment of latent Tp and loss of acquired immunity. We compare the change in prevalence of infectious Tp using different screening methods within a community of female sex workers (FSWs) in Karnataka, India.

Methods

We developed a deterministic model of heterosexual Tp transmission between FSWs and their clients. Test sensitivities were estimated against a reference laboratory RPR with a confirmatory test. Main outcomes included predicted changes in FSW and client infectious Tp prevalence at 30 years, and post-intervention rebound in infectious Tp.

Results

Reductions in infectious Tp prevalence achieved by screening were highest in areas with low initial treponemal test positivity, and were relatively insensitive to variations in parameter assumptions. At least once a year screening with a 100% sensitive POC test reduced infectious prevalence to an equal or greater extent as compared to a 100% sensitive offsite RPR test. A paradoxical rebound in infectious prevalence was observed after start of POC or RPR screening in approximately half of scenarios but resurgence above pre-intervention levels was rare (<5% of scenarios). Rebound was most likely in high-prevalence regions (treponemal test positivity 35–45%), where it manifested after 3.5 to 8.6 years, depending on assumptions on duration of immunity and sex-work turnover, and could be prevented with screening every 3 months. The ability to detect resurgence depended on frequency of monitoring and size of the surveyed population. POC screening of variable sensitivity was equally or more effective at reducing Tp prevalence than offsite RPR (sensitivity 100%) when follow-up was less than 50% (POC sensitivity 70%) and 70% (POC sensitivity 95%).

Conclusions

Rapid treponemal POC tests have the potential to be as or more useful than offsite RPR tests within a high-risk population, when offsite RPR is unfeasible or return visits are low, irrespective of the sensitivity of available POC tests. In high-prevalence settings, sufficient coverage and screening frequency must be maintained to avert an increase in infectious syphilis prevalence.
P1-S6.27 Could a peer driven intervention increase uptake of chlamydia screening? Proof of principle
Authors: Horner P , Loaring J , Matthew H , Oliver I , Campbell R , Trotter C , Macleod J , Pye K
Published: July 2011

Background

Uptake of the opportunistic National Chlamydia Screening Programme in England is low and below model estimates of the optimal level to reduce Chlamydia incidence. Peer led approaches may increase screening uptake but their feasibility and acceptability to young people is not known.

Methods

Focus groups and interviews with young women and men. All participants had expressed an interest in undergoing Chlamydia screening or had already been screened. The focus group and interviews were audio taped and transcribed verbatim for analysis. Thematic analysis of the data was conducted to identify, compare and report patterns in the data. Following interview, Chlamydia postal kits were introduced to participants and their opinions on giving these out to their peers sought. Participants were asked for their views and experiences of discussing Chlamydia screening and distributing kits to their friends four to eight weeks after the focus group/interview. All kits returned over a 9-month period to the laboratory were recorded.

Results

Six men (mean age 19 years) and 6 women (mean age 20 years) were recruited. In total 45 kits were distributed, 33 (73%) to female participants. 26 (79%) and 3 (25%) of kits given to females and males respectively were given to peers. Of those tests distributed to peers there is a high return rate 34% (10/29) all of which had been given out by females. On average, 1.7 kits were returned for each female participant. Participants generally felt positive about the idea of peer-driven screening using postal kits. However, embarrassment was a key theme, particularly among men. Generally women but not men were able to discuss Peer Driven Screening among their close friends. Both sexes felt Peer Driven Screening would be easier if kits were readily available in multiple sites, and Chlamydia screening was more widely promoted.

Conclusion

Female Peer Driven Screening but not male Peer Driven Screening was successful in recruiting peers to participate in Chlamydia screening. A peer driven intervention may increase uptake of Chlamydia screening.
P1-S6.29 Longitudinal trends in HIV testing and prevalence among STI clinic patients in Lilongwe, Malawi: 2006–2010
Authors: Powers K , Kamanga G , Mapanje C , Malava J K , Chindebvu M , Kamzati H , Martinson F , Miller W , Cohen M , Hoffman I
Published: July 2011

Background

To understand longitudinal trends in HIV status awareness, HIV test acceptance, and HIV prevalence among patients of a sexually transmitted infections (STI) clinic in Lilongwe, Malawi, we conducted descriptive analyses of these endpoints over the last 5 years.

Methods

Using data collected routinely at all STI clinic visits since March 2006, we calculated the proportion of visits in each of the last five calendar years (2006, 2007, 2008, 2009, and 2010) during which patients reported a previous HIV test, and among those, the proportions reporting positive and negative results. We also calculated the proportion accepting HIV tests at the clinic, and among those who received HIV tests at their visits, the proportion who had positive results. We conducted log-binomial regression with generalised estimating equations to analyse trends in each endpoint over time.

Results

An average of 8944 clinic visits occurred each year, approximately 60% by females and 40% by males. The proportion of visits at which patients reported a previous HIV test increased from 57% in 2006 to 86% in 2010 (p<0.0001) (Abstract P1-S6.29 figure 1). Among those reporting a previous test, the proportions reporting negative or positive results remained relatively constant, at approximately 70% and 30%, respectively (results not shown). At visits where patients did not report a prior positive HIV test, the proportion accepting HIV antibody tests increased from 50% to 78% (p<0.0001). Among all those who received HIV antibody tests at a visit, the proportion who were found to be HIV-positive decreased from 31% to 17% (p<0.0001), with a decrease from 13% to 10% among those reporting a previous negative test (p<0.0001) (Abstract P1-S6.29 figure 1).

Abstract P1-S6.29 Figure 1

Longitudinal Trends in HIV Testing and HIV Prevalence, Kamuzu Central Hospital STI Clinic, Lilongwe, Malawi, 2006–2010.

Conclusions

Over the last 5 years, the proportion of STI clinic visits at which patients reported awareness of their HIV status has increased, including an increase in known positives to 25% of all patients. At visits where patients did not report a previous positive result, the proportion who accepted rapid antibody tests has also increased. Among those receiving HIV tests at their clinic visits, the proportion testing HIV-positive has decreased substantially, although 10% of those with a previous negative result tested positive. These findings raise great concern about ongoing HIV acquisition and transmission in patients becoming aware of their serostatus through expanded HIV testing. Novel and better HIV prevention strategies for these patients are urgently needed.
P1-S6.30 HIV testing of patients receiving an STD Evaluation in a North Carolina Community Health Center
Authors: Klein P , Bishop A , Leone P
Published: July 2011

Background

The CDC has recommended HIV testing for persons with a suspected STD since 1987 and for all patients in clinical settings since 2006. However, HIV testing of suspected STD patients in emergency medical sites is inadequate, despite the high risk of HIV acquisition in this population. Community health centers may have better adherence to HIV testing recommendations due to a more personal relationship with their clientele and heightened awareness of state disease trends.

Methods

Robeson Healthcare Corporation is a federally-qualified health center with 4 sites located in a county in the top 10% of HIV case rates and top 33% of syphilis case rates in North Carolina. A routine HIV testing program was started in June 2009. Patients receiving an STD evaluation 1 June 2009 through 31 January 2011 were examined for concurrent HIV testing. The association between age and HIV testing among STD testers was assessed with multivariate logistic regression with a robust variance estimator to account for patients with multiple clinic visits.

Results

Of the 6588 clinic visits that included an STD evaluation, 2324 also included an HIV test (35.3%, 95% CI 32.1 to 36.4%). Over 70% of patients tested for syphilis also received an HIV test (n=1531/2111, 72.5%, 95% CI 70.6 to 74.4%). Less than 30% of patients screened for gonorrhoea and Chlamydial infections were also tested for HIV (n=1545/5442, 28.4%, 95% CI 27.2 to 29.6%). During a statewide syphilis outbreak in 2009 with high HIV-syphilis coinfection rates, HIV testing of suspected syphilis patients reached 84.0% (95% CI 80.9 to 87.0%). Patients of older ages were less likely to be tested for HIV during their STD evaluation than patients of younger ages (Abstract P1-S6.30 table 1).

Abstract P1-S6.30 Table 1

HIV Testing of patients receiving an STD Evaluation by Patient Age, June 2009–January 2011

OR (95% CI)OR (95% CI)OR (95% CI)Patient age (years) 13–241.001.001.00 25–340.76 (0.59 to 0.98)0.81 (0.71 to 0.91)0.45 (0.21 to 1.00) 35–440.31 (0.23 to 0.42)0.48 (0.40 to 0.58)0.55 (0.22 to 1.37) 45–540.16 (0.11 to 0.24)0.29 (0.22 to 0.40)0.23 (0.07 to 0.72) 55–640.10 (0.06 to 0.20)0.28 (0.17 to 0.44)0.39 (0.09 to 1.75) 65+0.05 (0.02 to 0.11)0.14 (0.03 to 0.59)0.39 (0.03 to 4.61)Age (10-year interval)0.51 (0.47 to 0.57)0.68 (0.63 to 0.72)0.75 (0.58 to 0.98)

Conclusions

In this community health center population, over 70% of patient visits with a syphilis evaluation included a concurrent HIV test order. This represents an improvement from an emergency department setting, in which less than 30% of syphilis testers were also tested for HIV. However, HIV testing among patients screened for gonorrhoea and Chlamydial infection was still low; the inclusion of HIV testing in the standard order panel for patients receiving an STD evaluation may increase HIV testing in this high-risk population.
P1-S6.33 Monitoring chlamydia testing and positivity in the USA using data from a large commercial laboratory corporation, 2008–2010
Authors: Hoover K , Tao G , Nye M , Body B , Kent C
Published: July 2011

Background

Guidelines recommend chlamydia screening of sexually active young women. Screening rates have increased over the past 10 years, but remain low. Current data used to monitor chlamydia testing trends and positivity rates have limitations, for example, national surveys provide representative data but are cross sectional and use small sample sizes, so longitudinal and subgroup analyses are not possible. To monitor trends more effectively, we solicited chlamydia testing data from commercial laboratories to obtain a representative sample of the US market.

Methods

Demographic characteristics of persons tested, their geographic location, assay types, specimen sources, and test positivity by sex, age, and insurance type were assessed for all chlamydia testing performed by this laboratory corporation during June 2008–July 2010.

Results

The dataset contained 3.26 million specimen records. Among those tested, 86.2% were women, 41.0% were aged 15–24 years, 73.5% had commercial insurance, 21.8% had Medicaid insurance, and 56.6% resided in the South. The most frequently used type of chlamydia test was a nucleic acid amplification test (77.5%). Among women, 59.7% of specimens were cervical, 21.1% vaginal, and 18.8% urine. Overall, 4.0% of tests were positive. Positivity rates were highest in persons aged 15–19 years, and higher in men than women for all age groups. Rates also were higher in women with Medicaid insurance than women with private insurance.

Conclusions

Systematically collected laboratory data can fill a critical gap in monitoring US chlamydia testing and positivity trends. These data are more representative of the US population by geographic distribution and insurance type than other data sources. The analysis of laboratory testing data might be useful for national surveillance that would not be dependent on provider or health department reporting. Our findings underscore the importance of screening young women for chlamydia, especially adolescents in whom screening rates are low. Men had higher positivity rates probably because they sought treatment for symptoms or were referred by an infected partner. Further analysis is needed to assess if testing of persons older than 25 years was according to guidelines, such as pregnant women, at-risk persons, or symptomatic persons.
P1-S6.34 Evaluation of risk-score algorithms for the detection of HIV infection and syphilis in North Carolina county jails
Authors: Sampson L A , Miller W C , Leone P A
Published: July 2011

Background

In North Carolina, the funding environment for jail screening has shifted from a syphilis-centred model to one based on integrating HIV and STI testing. We developed and evaluated risk score algorithms for HIV screening with and without the addition of syphilis screening in North Carolina county jails.

Methods

This study included 3610 inmates screened for both syphilis and HIV in two North Carolina jails, 2002–2005. We verified reactive syphilis tests against surveillance records to identify new syphilis cases. We created logistic regression models to predict two different outcomes: HIV only and HIV or syphilis. We created risk scores by rounding the β coefficients from the final models. Cut-offs were chosen based on testing 50% of the available inmate population. We calculated the sensitivity and specificity for each of the risk scores for three outcomes: HIV only, syphilis only, HIV or syphilis. Analyses were conducted using Stata.

Results

The final model for the HIV-only outcome included sex, age, ever tested for HIV, and race/ethnicity. The lowest scoring individual type would be a heterosexual man, age 18–24, never tested for HIV, with a race/ethnicity in the referent group (total score=0). The highest scoring individual would be MSM, age 25 or older, previously tested for HIV, and of Hispanic or Black non-Hispanic race/ethnicity (total score=6). A risk score cutoff of three or above will lead to screening <50% of the available inmate population. The weighted risk scores from the HIV-only outcome model had better sensitivity for the detection of HIV (82.6, 95% CI 71.2—to 94.0) than the combined-outcome model (65.2 95% CI 50.9—to 79.5). If inmates are selected for screening based on the HIV model, the sensitivity for detection of new syphilis cases is also good (73.3, 95% CI 56.5—to 90.1) and is only slightly inferior to the HIV or syphilis model (80.0 95% CI 64.8—to 95.2).

Conclusions

We believe that the screening algorithm will perform well in the county from which the sample was drawn. Generalisation to other communities in the Southern USA with similar demographics and rates of HIV and syphilis is also possible. More generally, we recommend targeting HIV jail screening efforts based on HIV data. In communities with incident syphilis infections, we recommend adding syphilis screening to the HIV protocol.
P1-S6.37 Can rapid syphilis tests be implemented and improve screening for maternal syphilis in a third level hospital?
Authors: La Rosa Roca S , Garcia P
Published: July 2011

Background

Syphilis continues to be one of the most important causes of maternal and child morbi-mortality, frequently being more common than HIV. Ideal diagnostic test should provide rapid and accurate results to provide timely diagnosis and treatment. Rapid syphilis testing is an excellent option. The objective of this study is to determine the feasibility of the implementation of Rapid Syphilis Testing (RST, Syphilis 3.0 BioLine) and the impact on maternal screening for syphilis at a third level hospital in Peru: the National Maternal and Perinatal Institute (INMP).

Methods

Between February and December of 2010, RST was implemented in the Antenatal care (ANC), labour and miscarriage services. The National guidelines recommended screening for syphilis in all those services with RPR. Health workers (midwives, nurses and laboratory technicians, depending on the service) were properly trained on the use of RST and their performance was monitored throughout the study.

Results

RST was performed on 15 116 women, with a prevalence of syphilis (RPR reactive, TPPA positive) of 1% for ANC, 0.7% for miscarriage services and 0.8% at labour. The coverage of screening for syphilis improved from 82% with RPR to 99% with RST at the ANC services; from 0% to 91% at the miscarriage services and from 79% to 94% at labour. At baseline, at the ANC visit, the results of the RPR were only available 15 days after the visit, resulting in a low coverage for treatment when the test was positive, 39%. With the implementation of the RST, the results and treatment were given immediately at the same visit, resulting on treatment coverage of 95%. The RST was very well accepted by the providers and patients.

Conclusions

This study shows the feasibility, acceptability and improvements on screening associated to the implementation of RST in a third level hospital. In addition of improving coverage and treatment, our results triggered changes in the institutional policies for syphilis control.
P1-S6.38 Interpretation of routine data from a youth friendly clinic in region F, Johannesburg
Authors: Lalla-Edward S T
Published: July 2011

Background

The Wits Institute for Sexual and Reproductive Health, HIV and Related Diseases (WrHI)'s Youth Friendly Programme aims to engage with young people and make reproductive healthcare accessible and non-threatening. The team educates and informs young people about HIV and has specially sensitised nurses and counsellors for HIV and STI testing who are skilled in working with youth. This abstract discusses the HIV and STI outputs of the Youth Friendly clinic based on the quantitative reported data.

Methods

Routine programme data submitted for the period October 2007–January 2011 was reviewed. Data was collated for the purposes of graphing, and calculating percentage difference and percentage change.

Results

The target age for service delivery fluctuated in line with WHO and is currently 15–24 years. There was inconsistent reporting of headcounts for the review period. In 2007 the clinic saw 15–19 year olds (ration of 1 male: 2 female). From 2008 this changed to a ratio of 30% male: 70% female. The age threshold moved to 24 years and clinic population became 35% of 15–19 year olds: 65% of 20–24 year olds. Total number of HIV tests conducted was 10 132 (3515 males and 6617 females). 10% tested HIV positive. 77% (n=764) had blood draws for CD4 count testing. 722 results were received from the laboratory, of which 571 (79%) were collected by patients. 414 results were <200 cells/mm3see Abstract P1-S6.38 Figure 1. All eligible patients were worked up for ARVs and referred to the initiation facilities. 5176 clients accessed STI services. In 2007 50% males and 50% females were treated for STIs. During the review period this changed to 44% males and 56% females. Both HIV testing and STI services were lowest from October 2007 to February 2008 and peaked from May 2009—to July 2009 and again from September 2009 to November 2009. The reported data did not distinguish between new and repeat clients for HIV testing and STI treatment.

Abstract P1-S6.38 Figure 1

Cascade of HIV service bundling for October 2007–January 2011.

Conclusion

The increase in target population age led to more services being accessed by 20–24 year olds. Over time there was an increase in the number of people accessing HIV and STI testing and treatment. There was an increase in males accessing the clinic and a decrease in STI services required by males. Lab reporting of CD4 counts and CD4 results collection needs to be strengthened. Routing data needs to be collected on new and repeat clients as a means of addressing casual factors for STI acquisition.
P1-S6.40 VCT sites in MSM from Mexico City: an opportunity to action
Authors: Magis-Rodríguez C , González-Rodríguez A , Bravo-García E , Juárez-Figuroa L , Rodríguez-Nolasco E , De Azcárraga Urteaga C
Published: July 2011

Background

Mexico has a concentrated HIV epidemic (15% HIV prevalence among Male Sex Workers; 11% in MSM; 5% in IDU; and 2% in FSW). Voluntary counselling and testing (VCT) for HIV is a strategy for case detection and deliver prevention messages. This study analyses the HIV prevalence in MSM in two different settings, in order to identify potential opportunities for HIV prevention.

Methods

We realised a comparative study between the men that received VCT inside the clinic, and the men reached with VCT in a mobile unit. Both services were offered by the Clinica Condesa in Mexico City (January, 2010). We described and analysed the population demographics, HIV prevalence, condom use, and sexual practices. All data were considered to identify the MSM and the factors associated with their HIV prevalence.

Results

956 men were HIV tested in January 2010 (401 in VCT site, and 555 in mobile unit). The percentage of MSM was 57.9 vs 47.9%, respectively; however, the HIV prevalence in MSM from the VCT site (27.6%), was seven times great than HIV prevalence in MSM from mobile unit (3.8%).

Conclusions

Results suggest that the MSM attending the VCT site are different than the one attending the mobile unit. MSM tested in VCT site have the self-selection bias. However, due to higher HIV prevalence, the VCT site is an excellent place to develop intensive prevention programs in MSM.
P1-S6.41 Determinants of human papilloma virus vaccination (HPVV) among Quebec (Canada) teenagers
Authors: Guay M , Clément P , Hamid A , Dubé E , Sauvageau C , Boulianne N , Landry M , Lemaire J
Published: July 2011

Background

In 2010, 76% of Quebec female students aged 14 and 15 received complete HPVV through a publicly funded school-based program where teenagers can elect to be vaccinated (parental consent not mandatory). Quebec's free HPVV program also targeted female teenagers up to age 18 in various settings (mostly public clinics and schools). A study was conducted to identify the determinants of HPVV among Quebec teenagers targeted by the program.

Methods

A mailed and electronic survey was conducted in 2010 of a random sample of 3000 females (aged 14 to 18) listed in the public health insurance data registry. The survey questionnaire was based on a model elaborated following an extensive literature review and upon an adaptation of the Health Belief Model and the Walsh and McPhee model. The model developed takes into account the mutual influence of teenagers and their parents, as well as interactions with health professionals, on the vaccination decision. Prior to the survey, two focus groups were conducted with vaccinated and non-vaccinated teenagers to improve the model, and the questionnaire reliability was tested on 110 students aged 14 and 15. The final questionnaire had 38 Likert scale and multiple-choice questions. Bivariate and multivariate analyses were done.

Results

The response rate was 46%. Generally, teenagers have a good knowledge of HPVV and the virus transmission. However, 68% thought that men cannot catch the virus. The HPVV coverage for one dose decreases with age: from 94% for teenagers aged 14 to 68% for those aged 17–18 (p<0.001). HPVV was significantly associated with better knowledge, HPVV perceived benefits, vaccination habits, encouragement from the school nurse or a teacher, relatives? Encouragement and parental approval (adjusted OR: 1.1–4.3). Not having HPVV was significantly associated with concern about HPVV side effects, family discouragement, and media promotion of HPVV (adjusted OR: 0.27–0.50).

Conclusions

School-based HPVV is more effective in reaching high vaccine uptake. Information on the virus transmission has to be improved; by targeting girls, the program suggests that only females can be infected. Even if their consent is not mandatory for teenager HPVV, parents play a major role in their daughter's vaccination decision. The media influence on unvaccinated teenagers must be deepened as it has a paradoxical impact.
P1-S6.43 HPV vaccine coverage among high-risk women: racial and socioeconomic disparities and barriers
Authors: Niccola L , Mehta N , Julian P , Bilinski A , Sosa L , Meek J , Hariri S , Markowitz L , Hadler J
Published: July 2011

Background

Human papillomavirus (HPV) is a necessary cause of cervical cancer and two vaccines are recommended for routine use among females ages 11–12 years with catch-up through age 26. Reducing disparities in cervical cancer will depend on achieving adequate vaccine coverage among racial and ethnic minorities and low-income women. The purpose of this analysis was to describe racial, ethnic, and socioeconomic differences in HPV vaccine coverage and identify barriers to catch-up vaccination.

Methods

Telephone interviews were conducted among women diagnosed with precancerous cervical lesions and reported to the CT Department of Public Health for routine surveillance during 2008–2010. The sample consisted of 269 women ages 18–27 years (age-eligible for catch-up vaccination after licensure) including 77% white, 15% black, and 17% Hispanic; median age was 23 years.

Results

Overall, 43% of women reported having received ≥1 dose of HPV vaccine (mean age at vaccination 22 years). Publicly insured and uninsured women were significantly less likely than privately insured women to have received vaccine (23% and 15% vs 52%, p<0.05 for both), and black women were marginally less likely to receive vaccine compared to white women (31% vs 48%, p=0.06). There was no significant difference for ethnicity. The most common self-reported barrier to vaccination was lack of provider recommendation (25%). Other common self-reported reasons were previous HPV diagnosis (20%) and being too old (15%). Women who did not discuss HPV vaccine with a provider were more likely to have not received vaccine compared to women who discussed vaccine (95% vs 44%, p<0.001) see Abstract P1-S6.43 Figure 1.

Abstract P1-S6.43 Figure 1

Self-reported barriers to hpv vaccination among women with precancerous cervical lesions (n=152).

Conclusions

Provider interventions may be necessary to assure catch-up vaccine is offered to eligible women. A common reported barrier was being too old, yet all women in this sample were age-eligible for vaccination. Previous HPV infection was another common barrier, yet this is not a contraindication for vaccination to protect against infection from other HPV types. In particular, greater efforts are required to administer catch-up vaccine to low-income and black women. Providing vaccine for underinsured women in this age group will be a challenge because they are not eligible for some state or federal vaccination programs (eg, Vaccines For Children).
P1-S6.44 HIV vaccine clinical trial adherence and retention: high-risk drug-using women
Authors: Becher J , Chhatre S , Eisenberg M , Fiore D , Dominique T , Dunbar D , Frank I , Metzger D
Published: July 2011

Background

Clinical trial protocol adherence and retention are often considered challenges that are especially difficult to achieve among certain high-risk populations. The HIV infection rate among heterosexual African-American women is increasing, making their participation in clinical trials of HIV behavioural and biomedical prevention interventions more important. We identify drug use and sex risk factors associated with adherence to protocol and study retention among this population during the course of an HIV vaccine trial.

Methods

Data from participants at the Philadelphia, PA site for the HIV Vaccine Trials Network (HVTN) 502 study testing the Merck Adenovirus 5 gag-pol-nef HIV vaccine were used to examine factors associated with adherence (receipt of three vaccines) and retention (present for 12-month appointment). Enrollees included 123 HIV-negative women 18–45 years of age reporting regular use of crack cocaine and frequent unprotected sex, who were randomly assigned to receive three injections of either the study vaccine or a placebo vaccine.

Results

Study participants had a mean age of 37 years and 91% were African–American. Overall adherence to study protocol was 89% and study retention at one year was 93.5%. Analyses found no association between drug use and high-risk sex behaviours and poorer rates of adherence and retention. In fact, participants who used recreational drugs at baseline were more likely than those who did not to adhere to study protocol (92% vs 75%, p<0.10). Participants who reported use of injectable contraceptives at baseline were less likely than those who did not to be retained in the study at 1 year (57% vs 96%, p<0.01). Other measures of drug use (whether injected recreational drugs, and used crack cocaine, speed and other drugs) and sex risk (whether had a STI, exchanged vaginal, oral or anal sex for money, drugs or services, used different methods of birth control, the number of male sex partners, whether aware of partner's HIV status and whether had protective and unprotected vaginal, anal or oral sex with them) were not associated with adherence and retention.

Conclusions

Factors commonly assumed to interfere with trial participation were not associated with adherence to study protocol or retention. These findings suggest that drug use and sexual risk behaviours do not impede completion of vaccinations and protocol required visits in clinical trials of experimental HIV vaccines.
P1-S6.45 Impact of a community level, diffusion based HIV/STI intervention on heterosexually-identified, socially marginalised men in urban, coastal Peru
Authors: Konda K , Lescano A , Celentano D , Maiorana A , Salazar X , Rosasco A M , Montano S , Kochel T , Hall E , Coates T , Caceres C , Kegeles S ,   NIMH Collaborative HIV/STD Prevention Trial Group
Published: July 2011

Objectives

The NIMH Collaborative HIV/STD Intervention Trial implemented a 2-year intervention based on the theory of diffusion of innovations to decrease unprotected sex with non-primary partners among high-risk populations including heterosexually-identified, socially marginalised men in urban, coastal Peru.

Methods

20 communities in 3 cities were randomised to the intervention or comparison arm. In intervention communities, 15% of the target population was trained as Community Popular Opinion Leaders (CPOLs) to deliver HIV prevention messages to their peers. In all communities, yearly assessments of the study cohort, independent of the intervention, gathered information on sexual behaviour, provided pre-test counselling, and testing for HIV/STIs at baseline, 1 year, and 2 years after randomisation. This analysis included the 2146 heterosexually-identified men who fulfilled the trial's inclusion criteria (frequented community social venues, were aged 18 to 40, and had sex in the past 6 months).

Results

Unprotected sex with a non-primary partner decreased by 10% in both study arms among heterosexually identified men. Almost half of the participants, in both the intervention and in the comparison arms, reported unprotected intercourse with a non-primary partner at the final follow-up (47.6% vs 48.7%, p=0.694) and there was no difference after controlling for baseline behaviour, OR 1.04, (95% CI 0.79—to 1.38). STI incidence was also did not differ by randomisation condition, IRR 1.14 (95% CI 0.77—to 1.68) comparing incidence in intervention vs control communities.

Discussion

We speculate that the lack of effect of the intervention among the heterosexually-identified men may be attributable to 1) an insufficiently strong intervention approach, 2) this group of men did not feel vulnerable to HIV or STI, or 3) the repeated biomedical testing and ancillary required counselling were as potent as the CPOL intervention. Future HIV prevention trials with this population should try to tailor the intervention to this group's risk perceptions and behaviours.
P1-S6.47 Description and evaluation of a regional condom access program for community organizations
Authors: Petit G , Bigras A , Dubé C , Malo F C , Surprenant M C , Salvail M , Gagnon M
Published: July 2011

Background

As observed in the rest of Quebec province, the number of STD declared to public health authorities in Estrie have been increasing in the last years. It has also been evaluated that condom use in this region is not as high as expected, particularly by young people. The Estrie region began a program in 2008 to favour free access to condoms for community organizations in contact with groups known as vulnerable to STDs. Purpose Describe and evaluate the implementation of the program after a period of 3 years. The regional program aim is to provide free condoms to vulnerable groups through distribution by community organizations in contact with these groups. This program is conducted among others to increase use of condoms and reduce STDs in Estrie. Recommendations resulting from evaluation will be use to improve the program.

Methods

The process evaluation was conducted in two parts: 1. First part was conducted by analysing all relevant documents available at the public health department in charge. 2. Second part was conducted by interviewing all community organizations which participated in the program. Information was collected orally by two interviewers, using a standardised questionnaire.

Results

The regional program is based on five components: 1) Annual launch (November) with a letter sent to all community organizations known to work with vulnerable groups. 2) Project submission by community organizations using a standardised form. 3) Distribution of condoms to community organizations. 4) Distribution of condoms to vulnerable groups by community organizations. 5) Annual report of activity by participating community organizations. Eleven community organizations had received condoms within the three years of the program. More than 100 000 condoms have been distributed in various projects. The regional budget allowed to the program has been able to covert the cost of all requested condoms, except for 1 year, where all projects were accepted, but with a somewhat reduced number of condoms per project. Participants were generally satisfied with the program. They confirmed its usefulness but proposed some modifications to it. Thirteen recommendations were made following evaluation. Some of them were about: 1) Favoured methods to approach community organizations. 2) Use more marketing so that more organizations know about the program. 3) Use of reminder for project submission and annual activity report. 3) Offering more kinds of condoms (especially large and without latex). 5) Offer education material to use in organizations along with condoms.

Conclusion

Overall, the regional condom access program is considered useful and satisfying by the participating organizations. The recommendations resulting from evaluation will be useful to optimise the implementation of program in the future, adapt it to the needs and therefore increase its efficacy to reach its STDs reduction goals.