bluuebunny/crossref_metadata_2025 huggingface dataset:
O11.3 Using HCV Incidence Trends to Disentangle the Likely Impact of HIV Anti-Retroviral Treatment on Decreasing HIV Incidence Amongst Injecting Drug Users: A Modelling Analysis
Authors: Chiyaka C , Martin N , Hickman M , Vickerman P
Published: July 2013

Background

Two epidemiological studies (Vancouver/Baltimore) have used ecological correlations between community measures of HIV viral load (CVL) and HIV incidence to postulate that scaled-up HIV anti-retroviral treatment (ART) has decreased HIV transmission amongst injecting drug users (IDUs). However, for both studies HCV incidence decreased concurrently with observed decreases in HIV incidence suggesting that reductions in injecting risks may also have played a role. We use modelling to estimate the likely importance of ART in producing the observed reductions in HIV incidence in Vancouver from 1997 to 2007.

Methods

A joint HIV and HCV transmission model, calibrated to the Vancouver IDU HIV epidemic (60% chronic HCV prevalence and 20% HIV prevalence) explored what combinations of ART recruitment and decreases in injecting risk could produce the observed relative reductions in HIV (> 66%) and HCV (> 50%) incidence for Vancouver. For each, the relative importance of ART was assessed. Sensitivity analyses considered the implications of behavioural uncertainty.

Results

Model projections suggest modest reductions in injecting risk (∼30%) result in large reductions in HIV (∼70%) and HCV (∼45%) incidence over 10 years, whereas ART scale-up (10% per year) only reduces HIV incidence (∼40%). If we assume that HIV and HCV incidence decreased by 83% and 50% in Vancouver, respectively, then projections suggest 31–45% of the HIV impact was possibly due to ART. However, the combined intervention’s impact is less than the sum of its parts, with the estimated HIV incidence decrease only reducing by < 15% with no ART. For smaller assumed reductions in HIV incidence and/or larger decreases in HCV incidence then projections suggest a smaller contribution due to ART.

Conclusions

Our analysis suggests ART may not have been too important for producing observed HIV incidence declines in Vancouver, and highlights the importance of considering HCV incidence trends in similar analyses.
O11.5 Risks For Sexually Transmitted Infections (STIs), HIV, and Pregnancy Among Women Working in Entertainment Establishments in Cambodia
Authors: Killam W P , Mun P , Mutuc J D , Chann N , Chan S , Shiraishi R W , Warren D , Vun M C
Published: July 2013

Background

Since the 1990s, Cambodia successfully reduced HIV and STI prevalence among female sex workers. In 2008, brothels were outlawed, and non-brothel Entertainment Establishments (EEs) increased. Some women working in EEs exchange sex for gifts or money. We examined associations between behavioural risks and STIs, HIV and pregnancy among Cambodian Female Entertainment Workers (FEWs).

Methods

In 2011, a stratified multi-stage cluster survey of 2,564 FEWs was conducted in karaoke establishments, beer halls, and former brothels. Participants consented to private interviews, blood collection, and self-administered vaginal swabs for gonorrhoea and chlamydia. Analyses were weighted and controlled for the complex design of the survey. Logistic regression models were used to examine potential risk factors of STIs, HIV and pregnancy.

Results

Transactional sex in the last year was reported by 41.1% of FEWs. Chlamydia (18.9%), gonorrhoea (5.3%), and active syphilis (0.4%) were associated with younger age (p < 0.0001). HIV (2.6%) and pregnancies (n = 1194) were more likely among older women (p < 0.0001). Heavy drinking was associated with gonorrhoea (odds ratio [OR] = 2.5, 95% CI 1.1–5.4), while drug use was associated with any STI (p = 0.0062) and HIV (p = 0.0005). Always using condoms varied by partner type (clients [74.0%], boyfriends [31.2%], and husbands [9.8%]) and was negatively associated with pregnancy only. Working in a former brothel (OR = 2.5, 95% CI 1.4–4.6) and having > 7 vs. ≤ 7 clients per week (OR = 3.8, 95% CI 1.8–7.7) was associated with HIV. Among FEWs, 36.8% had clients plus a husband and/or boyfriend. Those with both a boyfriend and client had the highest odds of any STI (OR = 3.8, 95% CI 2.2–6.7).

Conclusion

Cambodian FEWs are a heterogeneous group with varying risk behaviours. STIs and HIV appear to be concentrated in distinct subpopulations, but sexual partner relationships contribute to the complex transmission dynamics. Defining those most at risk will help focus national prevention and case-finding programmes.
O11.6 Migration and HIV Risk in Rakai Youth, 2000–2010
Authors: Edelstein Z R , Schulyer A C , Helleringer S , Wei Y , Sekasanvu J , Nalugoda F , Gray R H , Wawer M J , Serwadda D , Santelli J S
Published: July 2013

Background

Migration is common among youth in Africa and is connected to life transitions. Migration has also long been associated with increased risk of being HIV-infected. Although this association has been observed in multiple studies, the temporal order between infection and migration is often unclear. This investigation uses unique cohort data from Rakai, Uganda to test whether recent in-migration places youth at a higher risk of HIV acquisition.

Methods

We used data from the Rakai Community Cohort Study, 1999–2011. Respondents included were aged 15–24, sexually experienced and initially HIV negative (n = 9365). Migration and HIV status were assessed at each annual survey round. Poisson regression with robust standard errors was used to estimate age-adjusted incidence rate ratios (aIRR) of HIV acquisition among in-migrants versus non-migrants, by geographic origin and reason for migration. Additional adjustment for characteristics assessed at follow-up was explored.

Results

In young men, HIV incidence in recent in-migrants (14.3 per 1000 person-years (py)) was 2 times greater than non-migrants (6.6 per 1000 py) (aIRR = 2.04; 95% confidence interval (CI): 1.07–3.92). In young women, incidence among in-migrants (12.6 per 1000 py) was similar to non-migrants (11.5 per 1000 py) (aIRR = 1.07; CI: 0.74–1.55). Associations were not affected by geographic origin. Men who had migrated for marriage were at particularly high risk (141 per 1000 py) compared to non-migrants (aIRR = 17.16; CI: 3.15–93.35). However, this was uncommon (< 1% of py) and only in men aged > 19. Women who had migrated for work were at increased risk (30.3 per 1000 py) compared to non-migrants (aIRR = 2.59; CI: 1.41–4.76). IRRs were relatively unchanged with adjustment for marital status, number of partners in last 12 months or sexual concurrency.

Conclusion

Recent in-migration is associated with increased HIV risk in young Ugandan men. Among young women, the increase in HIV risk may be specific to migration for work.
O12.1 Using Social Determinants to PredictNeisseria GonorrhoeaeInfection Risk at the Census Tract-Level: Findings from the STD Surveillance Network (SSuN), United States
Authors: Stenger M , Samuel M , Weinstock H
Published: July 2013

Background

Associations between social factors and health outcomes have been established for many diseases, including gonorrhoea. Inequalities in gonorrhoea are particularly pronounced; the incidence for non-Hispanic Blacks is 17 times the incidence for non-Hispanic Whites. A gap exists in the literature on how social determinants for this population can be used to target STD interventions.

Methods

Health departments from 10 diverse states geocoded female gonorrhoea case reports from 2009–2011 to the census tract. We calculated three-year gonorrhoea incidence rates among females for 11,832 tracts in the study area. Tract-level social determinants were obtained from the American Community Survey. Female rates were used to preclude confounding by the unknown proportion of men-who-have-sex-with-men among male cases. Tracts were stratified as above or below the county-level mean proportion of non-Hispanic Black residents to minimise interactions between race and other factors, and subsequent analyses were limited to the stratum with a higher proportion of blacks (N = 4,345). Using hierarchical models and logistic regression, associations between female gonorrhoea incidence, household income, education and housing characteristics were examined. Factors found to be associated with gonorrhoea incidence were used to construct tract-level gonorrhoea risk indices.

Results

The mean tract-level female incidence rate was 194/100,000 (range, 0–2,836) in this stratum. Gonorrhea incidence was correlated with: proportion of households with annual income below $20,000 (β = 0.7089, P < 0.0001), housing vacancy rate (β = 0.5519, p < 0.0001) and proportion of population with less than high school education (β = 0.3206, p < 0.0001). Risk indices based on these factors correctly predicted 77.3% of tracts with incidence in the highest quartile in this stratum while excluding 58.9% of tracts with lowest incidence.

Conclusions

Area-based social factors provide more specific criteria than race alone and may be useful for better targeting disease prevention activities to areas at highest risk for gonorrhoea incidence, especially where street-level address information on reported cases is unavailable.
O12.2 Church Attendance in Men Who Have Sex with Men Diagnosed with HIV is Associated with Later Presentation
Authors: Wagoner N J Van , Mugavero M , Westfall A , Hollimon J , Slater L , Burkholder G , Raper J , Hook E W
Published: July 2013

Background

Tensions between religion/religious beliefs and personal behaviours may impact HIV-related health seeking for persons at risk for HIV. We evaluated the relationship between self-reported church attendance and sexual partner characteristics on CD4+ T lymphocyte count (CD4 count) and history of HIV screening among persons presenting for the first time to establish HIV care.

Methods

This was a secondary analysis of prospectively collected data at a University HIV Clinic in the U.S between April 2008 and June 2012. Socio-demographic and behavioural information, including church attendance, is collected and linked to laboratory data. Using logistic regression, we assessed for a 2-way interaction between church attendance and sexual behaviour on CD4 count at entry into care and on history of prior HIV testing in univariate and multivariable models.

Results

Of 508 participants, current church attendance was reported by 56%. There was a significant interaction between church attendance and sexual behaviour (p = 0.02) with CD4 count at the time of entry into care. MSM who reported church attendance were significantly more likely to present with a CD4 count < 200 cells/mm3(p = 0.013) than MSM who did not. No difference in CD4 count was observed for MSW or WSM when evaluated by report of church attendance. There was a significant interaction between church attendance and sexual behaviour (p = 0.012) on history of previous HIV testing. WSM who attended church were more likely to report previous HIV testing (p = 0.01). MSM who attended church were less likely to report previous HIV testing (unadj p = 0.041) but this difference did not maintain significance in adjusted models.

Discussion

These findings frame a potentially important interaction between church attendance and sexual behaviour on timing of HIV diagnosis and presentation into care with important implications for individual health outcomes and secondary HIV prevention.
O12.3 Evaluation of a Community-Based HIV Preventive Intervention For Female Sex Workers in Rural Areas of Karnataka State, South India
Authors: Washington R G , Nath A , Jawalkar P , Isac S , Moses S
Published: July 2013

Background

To examine changes in behavioural outcomes among rural female sex workers (FSWs) involved in a community-based HIV preventive intervention in south India.

Methods

14,284 rural FSWs from 1,253 villages that were selected through a process of rapid rural mapping were reached by community workers (called link workers) and FSW peer educators over a period of three years between 2009 and 2012. A community-based model for delivering outreach, medical and referral services was developed and employed. Socio-demographic profiles of the FSWs and programme outputs were captured using an individualised computerised management information system (CMIS). Changes in behaviour were assessed in an anonymised fashion using two rounds of polling booth surveys (PBS) conducted in 2009 and 2012.

Results

91% of FSWs were above the age of 25, and 85% had been involved in sex work for two or more years. During the three-year period, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. In 2012, 45% reported having been tested for HIV infection, at least once in the previous six months. The two rounds of PBS showed significant differences in behavioural outcomes. Condom use increased from 60% to 72%, and condom breakage reduced from 30. 2% to 8.4%. Utilization of HIV counselling and testing services increased from 64% to 92.4%, and the proportion of FSWs testing HIV positive declined from 2.3% to 0.17%.

Conclusions

This community-based model for delivering HIV prevention programmes and services among widely dispersed female sex workers in rural areas was effective. Community-based health workers provided the vital link between marginalised communities in need of services and the formal health system. This model for rural outreach and HIV care could also be applied to many other health problems.
O12.4 Design and Feasibility of Yo Puedo, a Combined Conditional Cash Transfer and Life Skills Sexual Health Intervention For Adolescents in San Francisco, California: Results of a Randomised Study
Authors: Minnis A M , Dommelen-Gonzalez E van , Luecke E , Cheng H , Dow W , Bautista-Arredondo S , Padian N S
Published: July 2013

Background

Innovative interventions to prevent persistently high rates of STIs and pregnancy among Latino youth in the U.S. are needed. We developedYo Puedo(“I can”), a sexual health intervention that combines conditional cash transfers (CCTs) and life skills, for youth in a high-risk, urban neighbourhood.

Methods

Yo Puedotargeted small social networks of youth aged 16 to 21 (both in-school and out-of-school). CCTs were tied to completion of educational goals and use of reproductive health clinical services. We conducted feasibility research through randomization of networks toYo Puedoor an observational control arm.

Results

72 social networks comprised of 162 youth enrolled inYo Puedo, with 92% follow-up over six months. At baseline, participants had a mean age of 17 years and one-third were foreign-born. 80% of males and 65% of females had ever had sex (p = 0.06), with males reporting a higher mean lifetime number of partners (5.8 vs. 3.1, p < 0.01). Half (58.2%) of participants had gang-affiliated close friends. Nearly all (94%) participants reported not wanting to become pregnant or get someone pregnant, yet one-third of sexually active youth reported unprotected sex in the past six months. Social networks clustered significantly (intraclass correlations ranged from 0.31–0.92) across sociodemographic and risk profile characteristics; analyses were adjusted for network clustering. 72% of youth randomised to the intervention participated: 53% received at least one CCT payment; 66% came to at least one life skills group. The median amount earned was $30 (range $0-$200). There was little evidence that cash payments financed illicit or high-risk behaviour. A higher proportion of youth who participated, compared to those who did not, had been to a reproductive health clinic at follow-up (p < 0.01).

Conclusions

Yo Puedoshowed promise as a sexual health intervention for high-risk, urban youth. Targeting youth’s social networks may yield sustained effects over time.
O12.5 Traditional Explanatory Models of Disease and Messaging Around HIV and STI Risk and Prevention: Findings from an Exploratory Study with Traditional Health Practitioners in South Africa
Authors: Pascoe S J S , Moolla A , Tabane R , Mbele-Khama S , Dlamini N , Darkoh E
Published: July 2013

Background

Research has shown that traditional medicine and Traditional Health Practitioners (THPs) represent the first line of healthcare for the majority in sub-Saharan Africa (SSA). In this context, understanding traditional beliefs is critical, if we are to design effective health messages and improve health outcomes. The aim of this study was to identify and understand how traditional knowledge and beliefs influence explanatory models of disease and patient actions to avoid risk of HIV and STI infection.

Methods

An exploratory qualitative study involving THPs and their patients was conducted in 2011 at five sites in provinces Gauteng and KwaZulu-Natal. THPs (n = 54) were recruited through local forums and patients (n = 48) recruited by their THP. Diviners, herbalists, traditional birth attendants and traditional surgeons were all represented. Data were analysed using NVivo 9.

Results

THPs provide a holistic ‘catch all’ service that would involve multiple providers within the allopathic sector. Whilst participants acknowledged allopathic risk factors and modes of transmission, beliefs around aetiology were generally located in the spiritual dimension with infection often blamed on lack of respect for/non-adherence to traditional practises resulting in ‘pollution’ and ‘dirt in the blood’. THPs demonstrated a willingness to refer patients to clinics for diagnosis and treatment, recognised benefits of circumcision, and encouraged patients on ARVs to continue treatment. However, protective and preventive properties of traditional medicines were frequently highlighted.

Conclusion

It was clear from this study that for many in South Africa traditional beliefs are often held alongside an acknowledgement of some aspects of germ theory. Given the pervasive traditional belief-based explanatory model of disease, health messaging and interactions that do not acknowledge this are likely to fail. It is critical that the allopathic/western system understands these core beliefs of patients accessing their services so as to optimise health messages, treatments, behaviours and clinical outcomes in SSA.
O12.6 Understanding Experiences and Impact of Domestic Violence and Abuse in Gay and Bisexual Men Attending a Sexual Health Service in the UK
Authors: Bacchus L J , Buller A , Sethi C , White J
Published: July 2013

Background

Domestic violence in men who have sex with men (MSM) is common and associated with adverse health consequences. This study aims to (i) explore the nature and impact of domestic abuse in gay and bisexual men attending a UK sexual health clinic and (ii) explore men’s views on routine enquiry for domestic abuse by health practitioners.

Methods

A self-completion survey was implemented in the waiting rooms of sexual health clinics at a UK hospital. Men aged 18 and over, attending alone, who could read and write English were invited to participate in a male patient survey on relationships and health. The 2-part survey examined potentially abusive behaviours and health outcome including: anxiety and depression; alcohol and drug abuse; use of services; and views on routine enquiry within a health context.

Results

1,135 men completed a survey, of which 523 (46.0%) identified themselves as either gay or bisexual, 501 (95.8%) answered all questions relating to domestic violence in Part 1 of the survey. 145 (28.9%) men reported experiencing at least one abusive behaviour from a current or former partner; 81 (16.2%) men reported carrying out at least one abusive behaviour towards a current or former partner; 55 (11.0%) men reported both experiencing and perpetrating at least one abusive behaviour towards a partner. The majority of men supported the idea of health practitioners asking about domestic abuse during consultations.

Conclusion

This study provides a greater understanding of domestic abuse in gay and bisexual men by including questions on impact as well as severity. The survey also examines the impact of these behaviours on men’s health and the role of sexual health practitioners in responding to gay and bisexual men affected by domestic abuse.
O13.2 Can the UNAIDS Modes of Transmission Model Be Improved? A Comparison of the Original and Revised Model Projections Using Data from Nigeria
Authors: Prudden H J , Watts C H , Vickerman P , Bobrova N , Heise L , Ogungbemi M K , Momah A , Blanchard J F , Foss A M
Published: July 2013

Mathematical modelling has increased our understanding of the HIV epidemic and played a key role in decision making. The UNAIDS Modes of Transmission (MoT) model has been used by 29 countries to analyse their HIV epidemics, with the results helping to guide and focus interventions. However, the simplistic compartmentalisation of the population within the model has raised concerns over its reliability.

We compared the MoT model projections for Cross River, Nigeria, with a revised MoT model that incorporates additional heterogeneity (including subgroups for sero-discordant partnerships and individuals engaging in transactional sex) and updated parameters. We categorised population subgroups into ‘high-risk’, representing core groups, their bridging partners and sero-discordant partnerships; ‘medium-risk’, who are regular partners of ‘high-risk’ individuals; and ‘general population’, who are not linked to ‘high-risk’ or ‘medium-risk’ groups. Sensitivity analyses were undertaken and model projections assessed which population categories generated the highest incidence of HIV.

The original MoT model projections suggest 73% of HIV infections occur in general population subgroups and 21% amongst ‘high-risk’ groups. Following revisions to the MoT, model projections estimate 76–94% (95%CrI) of new HIV infections are expected to occur in high-risk groups, who make up just 23% of the population, compared to 6–24% amongst general population subgroups. Changes in the distribution of infections result from the introduction of sero-discordant partnerships and ‘transactional sex’ groups (a relatively large subset of the population, often ignored in modelling analysis) in the model, which are classified as ‘high-risk’.

The UNAIDS MoT remains an accessible and potentially useful model that can help inform intervention priorities. However, our findings strongly suggest that the current model may produce misleading findings, especially in more concentrated HIV epidemic settings. Results from this study indicate the need for UNAIDS to conduct a formal review of the MoT, and for further revisions to be made.
O13.3 Estimating the Epidemiological Impact of Antiretroviral Treatment on Heterosexual HIV Epidemics in South India: A Modeling Study
Authors: Mishra S , Mountain E , Pickles M , Vickerman P , Shastri S , Washington R , Becker M , Alary M , Boily M
Published: July 2013

Background

In south India, where intensive condom-based targeted interventions (TIs) for female sex workers (FSWs) have been successful, the potential impact of past, current, and proposed universal antiretroviral treatment (ART) eligibility criteria on concentrated HIV epidemics, remains unknown.

Methods

We developed a mathematical model of heterosexual HIV transmission to simulate the HIV epidemic in three south Indian districts, using district-specific epidemiological data. The model was calibrated to HIV prevalence by risk groups (low-risk, clients, FSWs), population size, and ART coverage. Assuming that condom-based TIs, HIV testing and treatment access, and retention in HIV-care are sustained at current levels, we compared the following scenarios against no ART: (a) continue with the previous eligibility criteria (CD4 ≤ 250 cells/μL) from the start of each district’s ART programme; (b) expand from previous to current eligibility (CD4 ≤ 350 cells/μL) after November 2011; and (c) expand to early ART at any CD4 cell count after January 2013.

Results

Without ART, the three districts achieve local elimination between the years 2040 and 2082, and by 2035–2063 under the current ART programme (eligibility criteria: CD4 ≤ 250 cells/μL prior to November 2011, CD4 ≤ 350 cells/μL thereafter). By January 2013, the current ART programme has potentially averted 7.8–11.0% of HIV infections, and saved 32–44 life-years per 100-person years on ART, in addition to gains achieved by local TIs. By 2023, the additional fraction of HIV infections averted by ART(compared to sustained TIs without ART) under scenarios A, B, and C are 21–42%, 33–57%, and 43–69%, respectively, and the incremental gains in life-years per 100-person years on ART are 120–140, 68–111, and 40–91, respectively.

Conclusions

In declining HIV epidemics with sustained TIs, current ART programmes and proposed ART expansion could provide additional epidemiological impact. The medium-term incremental gains become smaller as eligibility expands but access and retention in care remain constant.
O13.4 An Ethnographic Mapping Study of “Money Boys” and the Male Sex Trade Industry in Chengdu, South West China
Authors: Yu B , Wang X , Zhang J , Ma X , Khan S , Blanchard J , Lorway R
Published: July 2013

Background

HIV prevalence studies have found that male sex workers (MSWs) in China have high HIV prevalence, ranging from 5% to 9%. These “money boys” have been identified as a particularly vulnerable population, and it is imperative to develop effective programmes for HIV prevention in this population.

Objectives

The study had 4 objectives: (1) to describe the operation of the male sex work industry; (2) to identify the environmental and structural factors that shape the risk practises of MSWs (3) to map solicitation venues and estimate the size of the MSW population to guide programme design and focus.

Method

Ethnographic and geo-mapping techniques were combined to locate, enumerate and contextualise different aspects of the male sex trade industry. MSWs, network operators and brothel owners provided size estimates of MSWs for specific hotspots. Participant observation and key informant interviews were employed to understand the risk practises described by participants.

Results

According to the ethnographic findings, MSWs are often recruited from rural villages via labour markets and from the urban gay community; they had high client volumes and were mobile within the city and between cities throughout China. Thirty MSW venues were mapped and 23 venues were validated. Systematic review and validation of gay websites revealed 48 brothels. Local prevention programmes reached only 16 venues. Five public toilets, 4 bathhouses and 7 parks, where MSWs frequented, were also mapped. The majority of venues were located within the commercial core, with easy access to public transportation. The MSW population was estimated between 373 and 1200. Some MSWs (n = 97) advertised on gay websites and through cell phone applications.

Conclusion

Despite criminalization, there is a thriving male sex trade in Chengdu. Local efforts to reach these communities need to be scaled up to address programme coverage gaps.
O13.5 The HIV Modes of Transmission Model: A Systematic Review of Its Findings and Adherence to Guidelines
Authors: Shubber Z , Mishra S , Vesga J F , Boily M C
Published: July 2013

Background

The HIV Modes of Transmission model (MOT) estimates the annual percentage distribution of new HIV infections (PNI) by key risk groups. It was designed to guide country-specific HIV prevention policies. To determine if the MOT produced context-specific recommendations, we analysed the MOT results by regions and epidemic types and explored the factors (e.g. data inputs, adherence to guidelines) influencing the differences.

Methods

We systematically searched MEDLINE, EMBASE, UNAIDS reports, and contacted UNAIDS country directors for published MOT results from 2003 (1st published MOT).

Results

We included 4 journal articles and 20 UNAIDS reports covering 29 countries. The largest PNI was among the low-risk group (one heterosexual partner) in 13 countries [range 26–63%], and increased with low-risk population size. The estimated PNI among female sex workers (FSWs) was universally low [median 1.3%, range 0.04–14.4%], and showed little variability by region and epidemic type despite variation in sexual behaviour e.g. number of partners. In India and Thailand, where FSWs play an important role in transmission, the PNI among FSWs was 2% and 4% respectively. In contrast, the PNI among men who have sex with men (MSM) varied across regions [MSM, range 0.1–89%] and increased with MSM population sizes. The PNI among people who inject drugs [PWID, range 0–82%] was largest in ‘early-phase’ epidemics with low overall HIV prevalence. Most MOT studies are being conducted and reported as per guidelines. However, many countries (n = 23) reported data limitations - especially on high-risk groups - when parameterising the MOT.

Conclusion

Although countries are generally performing the MOT as per guidelines, results showed little variation in MOT outputs (except MSM and PWID) by regions and epidemic types. Homogeneity in MOT outputs for FSWs, clients and low-risk population may limit the utility of MOT for guiding country-specific interventions in heterosexual HIV epidemics.
O13.6 Focusing the Delivery of the English National Chlamydia Screening Programme: Exploring Opportunities to Expand Testing Within Local Services
Authors: Simms I , Woodhall S C , Nardone A , Mercer C H , Talebi A , Hughes G
Published: July 2013

Background

The National Chlamydia Screening Programme (NCSP) seeks to increase rates of chlamydia diagnosis amongst young people aged 15–24 across the 326 English Local Authorities (LA). 68% of screens and 79% of diagnoses are made in the community sexual health, general practise, pharmacy, termination of pregnancy (TOP) and genitourinary medicine (GUM) services that take part in the NCSP. These ‘Core Services’ are central to the delivery of the programme but not all clinics screen for chlamydia. This study was undertaken as part of a project to inform optimum services configuration to increase diagnostic rates to improve chlamydia detection and infection control.

Methods

Diagnoses of genital chlamydia recorded in data from sexually transmitted disease clinics and NCSP surveillance datasets for 2011 were aggregated to LA level. Overall diagnostic rates (outcome) were calculated using Office of National Statistics (ONS) population estimates for the 15–24 year age group. This information was analysed together with the total testing at each Core Service and ONS area classification. Data were analysed using multivariable negative binomial poisson regression and spatial mapping techniques.

Results

Overall chlamydia diagnostic rates were associated with increased rates of testing in community health services (RR = 1.02; p < 0.0001), general practise (RR = 1.01; p = 0.0176) and GUM (RR = 1.03; p < 0.0001) but not pharmacy or TOP. Diagnostic rates varied by geographic location (p < 0.0001), lower rates being seen in ‘Central London’ (RR = 0.63; 95% CI = 0.50–0.80), ‘London Suburbs’ (RR = 0.77; 95% CI = 0.61–0.96) ‘Southern England’ (RR = 0.63; 95% CI = 0.51–0.78) and ‘Outer London’ (RR = 0.64; 95% CI = 0.50–081). Diagnostic rates also increased as the range of service types contributing to testing increased (p = 0.0427).

Conclusions

The analysis highlights the importance of community based testing and the provision of a range of services to achieving high rates of chlamydia detection. The study is being extended to investigate patient flow and service attendances within and between LAs in relation to gender, age group, ethnicity and service type.
O14.1 Bacterial Vaginosis-Associated Bacteria (BVAB) and Non-Gonococcal Urethritis (NGU)
Authors: Manhart L E , Khosropour C M , Liu C , Gillespie C W , Depner K , Fiedler T , Marrazzo J M , Fredricks D N
Published: July 2013

Background

Traditional cultivation approaches have not identified additional pathogens responsible for the 45% of non-gonococcal urethritis (NGU) cases with no identified aetiology. Cultivation-independent methods have identified novel bacteria associated with female reproductive tract disease, particularly bacterial vaginosis (BV). We evaluated the association of NGU and 5 newly described BV-associated bacteria (BVAB).

Methods

English-speaking, heterosexual men aged 16 years attending the STD clinic in Seattle, WA between May 2007 and July 2011 were eligible if PCR tests forChlamydia trachomatis,Neisseria gonorrhoeae,Trichomonas vaginalis, Mycoplasma genitalium, andUreaplasma urealyticum-biovar2 were negative. Cases were men with visible urethral discharge or 5 PMNs/HPF in urethral exudates. Controls were men with no visible urethral discharge and < 5 PMNs/HPF. Urine was tested forAtopobium, BVAB-2, BVAB-3,Megasphaera spp., andLeptotrichia/Sneathia spp.using quantitative taxon-directed PCR.

Results

Cases (n = 157) and controls (n = 191) were similar with respect to age, education, and income. Mean age was 34.7 (SD ±9.9) and most were white.Leptotrichia/Sneathiawas significantly associated with NGU (25/157 (15.3%) vs. 6/102 (5.9%), p = 0.03) and BVAB-2 was detected more often in cases than controls (7/157 (4.5%) vs. 1/102 (1.0%), p = 0.15). BVAB-3 (n = 2) andMegasphaera(n = 1) were uncommon, but only detected in men with NGU. In contrast,Atopobiumwas not associated with NGU (8.3% vs. 7.8%, p = 1.0). Quantity of bacteria did not differ between cases and controls for any of the 5 candidate pathogens. Among treated cases, doxycycline was somewhat more effective than azithromycin for clinical cure of men withLeptotrichia/Sneathia(9/10 (90%) vs. 7/12 (58%), p = 0.16), and BVAB-2 (3/3 (100%) vs. 0/3 (0%), p = 0.10).

Conclusion

Leptotrichia/Sneathiawas significantly associated with NGU. BVAB-2, BVAB-3, andMegasphaerawere less commonly detected, but most often identified in men with NGU and rarely or never in men without NGU. Doxycycline may be more effective against these newly identified bacteria than azithromycin.
O14.3 Long-Term Efficacy of Human Papillomavirus Vaccination Against Cervical Cancer
Authors: Paavonen J
Published: July 2013

Human papillomavirus (HPV) vaccination trials have shown high efficacy (VE) against high grade cervical intraepithelial neoplasia (CIN2/3). CIN2/3 is a surrogate marker of invasive cervical cancer (ICC). These lesions may spontaneously regress. Therefore, long-term follow-up is needed to determine the overall VE against ICC. Between September 2002 and March 2003, 1,749 16- to 17-year old women from Finland were enrolled in the randomised FUTURE trial of the quadrivalent HPV vaccine (Gardasil) with active follow-up for 4 years. Passive follow-up using the population-based Cancer Registry started 6 months after the active follow-up ended in 2007. A cluster randomised, population-based reference cohort of 15,744 unvaccinated, 18–19 year old women was established. We linked these cohorts to compare the incidence rates of CIN3 and ICC. Passive follow-up after 4 years resulted in 3,464, 3,444 and 62,876 person years of follow-up for the HPV vaccinated cohort, the placebo vaccinated cohort and the reference cohort, respectively. The number of endpoints with CIN3 or ICC identified were 0 and 0, 3 and 0, and 59 and 3 for the three cohorts, respectively. The corresponding incidence rates were 0 (95% confidence interval 0.0–106.5), 87.1 (95% CI 17.9–254.5) and 93.8 (95% CI 71.4–121), respectively. Our study shows that evaluation of the long-term efficacy post vaccination for the most stringent endpoints is feasible using cancer registries.
O14.4 Microbiologic Aetiology of Proctitis Diagnosed in an Urban STD Clinic
Authors: Cohen S E , Bernstein K T , Stephens S C , Philip S S
Published: July 2013

Background

Sexually transmitted proctitis occurs among persons who participate in receptive anal intercourse and is a risk factor for HIV acquisition.N. gonorrhoeae,C. trachomatis(including LGV),T. pallidum, and Herpes Simplex Virus (HSV) are the most common pathogens identified. The distribution of microbiologic aetiology of proctitis has implications for empiric treatment guidelines. Methods: We describe the microbiologic aetiology of clinical proctitis among men who have sex with men seen at the municipal STD clinic in San Francisco.N. gonorrhoeaeandC. trachomatiswere tested using a nucleic acid amplification assay, HSV was tested using polymerase chain reaction, andT. pallidumwas tested using a non-treponemal antibody test, withT. pallidumparticle agglutination confirmation. Results: Between January 1, 2004 and December 31, 2012, there were 1271 men diagnosed with clinical proctitis at the clinic. The number of cases of proctitis diagnosed annually did not increase over this interval, despite increasing rates of rectal gonorrhoea and Chlamydia. Overall, 820 (65%) of the cases had no microbiologic aetiology identified and nearly half were among HIV-infected men. Two-hundred sixty-three (21%) had gonorrhoea, 205 (16%) had Chlamydia, 53 (4.2%) had both gonorrhoea and Chlamydia, 28 (2.2%) had syphilis and 105 (8.3%) had herpes. Cases in which no microbiologic aetiology was identified were not more likely to have a repeat clinic visit within 14 days of diagnosis compared with those with Gonorrhea or Chlamydia (6.3% vs. 6.8%).

Conclusion

STD clinics can be sentinel sites to assess proctitis trends. No microbiologic diagnosis was identified in almost half of proctitis cases evaluated during the study interval and these cases were not more likely to experience treatment failure, suggesting that current empiric treatment guidelines are effective. Future studies should use advanced molecular techniques to evaluate the role of novel and emerging pathogens in the aetiology of proctitis.
O14.5 Occurrence of Vaccine and Non-Vaccine Human Papillomavirus (HPV) Types in the Female Population Before and After the HPV Vaccination
Authors: Paavonen J
Published: July 2013

Understanding type replacement following HPV vaccination is important.

We studied the occurrence of specific HPV types in a large cohort of young women from Finland who participated in a population-based HPV vaccination trial. A total of 4,808 16- to 17-year-old women were enrolled in the randomised PATRICIA efficacy trial of HPV16/18 vaccine (Cervarix) compared to hepatitis A virus (HAV) vaccine. HPV infection was assessed from cervical samples obtained every 6 months for 4 years post-vaccination and tested for 14 high- risk HPV types and 2 low-risk HPV types. HPV16/18 vaccination coverage varied from 1% to 22% by participating community. HPV incidence rate ratios (IRRs) in baseline positive women vs. baseline negative women were calculated. In the control arm, baseline HPV18-positive women showed an increased risk of acquiring other clade A7 HPV types (39/45/59/68) (IRR 1.8, 95% confidence interval = 1.01–3.1). No excess risk of non-vaccine HPV types was observed in the baseline HPV DNA-negative HPV16/18-vaccinated women compared to the baseline HPV DNA-negative control women. Similarly, no excess risk was observed in the baseline HPV-16/18-positive HPV16/18-vaccinated women compared to the baseline HPV16/18-negative women. In conclusion, we found no increased rates of non-vaccine HPV types suggestive of type-replacement up to 4 years post-vaccination among HPV16/18-vaccinated young women. However, surveillance of clinical trial cohorts and other populations in countries with HPV vaccination programmes implemented with focus on vaccination coverage rates are warranted.
O14.6 Aetiology of Infectious Proctitis Differs by HIV Status
Authors: Bissessor M , Fairley C K , Read T R , Denham I M , Bradshaw C S , Chen M Y
Published: July 2013

Background

Sexually acquired rectal infections are common among men who have sex with men (MSM) and increase the risk of HIV acquisition. We aimed to compare the spectrum of pathogens responsible for infectious proctitis between HIV positive and HIV negative MSM.

Methods

We undertook a study of MSM who presented to Melbourne Sexual Health Centre with symptomatic proctitis between March 2003 and December 2011. Men with proctitis were tested for gonorrhoea by culture, chlamydia by strand displacement assay, and herpes simplex virus (HSV) by PCR. Chlamydia positive specimens were genotyped for lymphogranuloma venereum (LGV).

Results

Among the 279 men in the study, 141 were HIV positive and 138 were HIV negative. The median CD4 count among HIV positive men was 423 (range 189–1026). The prevalence of infections among HIV positive and HIV negative men respectively was: chlamydia (23.4% versus 21.7%, p = 0.7); gonorrhoea (13.4% versus 10.8%, p = 0.5); HSV-1 (14.2% versus 6.5%, p = 0.04); HSV-2 (22% versus 12.3%, p = 0.03); and LGV (7.8% versus 0.7%, p = 0.004). HIV positive men were more likely to have multiple infections (17.7% versus 8.6%, p = 0.017). Only 32% of men with HSV associated proctitis had visible anal ulceration.

Conclusion

Among MSM presenting with proctitis, HSV, LGV and multiple infections are more common among HIV positive men than among HIV negative men. MSM presenting with proctitis require comprehensive testing and treatment for possible pathogens including herpes in the absence of anal ulceration.
O15.1 Sub-Optimal CD4 T-Cell Recovery in HIV-1 Subtype C Patients on Antiretroviral Therapy: A Search For Predictive Biomarkers and Baseline Characteristics
Authors: Retshabile G , Kisanga E R , Gaseitsiwe S , Moyo S M , Bussmann H , Makhema J , Essex M , Marlink R , Musonda R
Published: July 2013

Background

Despite receipt of combination antiretroviral therapy (cART) and subsequent viral suppression some 15–30% of treated HIV infected patients fail to achieve optimal CD4 T-cell reconstitution. Sub-optimal CD4 recovery has been associated with unfavourable outcomes for patients on cART. We assessed markers of immune activation, microbial translocation and patient baseline characteristics for associations with sub-optimal CD4 T-cell recovery post cART initiation.

Methods

This was a retrospective case control analysis of CD4 T-cell recovery from a completed (2002–2007) clinical trial, the Adult Antiretroviral Treatment and Drug Resistance (“Tshepo”) Trial, in Gaborone, Botswana. Cases (sub-optimal CD4 response) were defined as CD4 ≤ 200 cells/µl at 12 months post ART initiation, with virologic suppression achieved within 6 months. Microbial translocation (sCD14) and immune activation (interferon-gamma) markers were quantified using Enzyme Linked Immuno-Sorbent Assays on a subset of 30 cases and 30 controls gender matched baseline and 12 month plasma samples. Univariate and logistic regression analysis were used to assess predictors of sub-optimal CD4 T-cell recovery.

Results

Fifty-one cases (21%) from 249 virologically suppressed patients had sub-optimal CD4 recovery. The median age was 33.39 years and 69.9% were female. Baseline CD4 count < 100cells, haemoglobin and aspartate transaminase were associated with sub-optimal CD4 recovery (adjusted OR (aOR) = 3.03 95% CI [1.65, 5.57], p < 0.001; aOR = 0.81 [0.67, 0.99], p = 0.038 and aOR = 1.03 [1.00, 1.05], respectively). sCD14 levels were significantly different between cases and controls, p = 0.0011, at 12 months. Baseline Tuberculosis infection, body-mass-index, interferon-gamma, alanine transaminase and age were not associated with poor CD4 T-cell response.

Conclusion

Low baseline CD4 T-cell count, haemoglobin, aspartate transaminase and sCD14 levels are predictive of suboptimal CD4 T-cell recovery in this cohort of HIV-1 subtype C infected patients. These markers are potentially useful in identifying patients who need frequent clinical monitoring to minimise unfavourable outcomes associated with poor CD4 T-cell recovery.
O15.2 Comparison of the Roche Cobas 4800 CTNG Test with Microbial Culture For DetectingNeisseria Gonorrhoeaein Genital and Non-Genital Specimens in New Zealand
Authors: Miller A , Bromhead C , Jones M , Whiley D , Upton A
Published: July 2013

Background

In New Zealand it has been usual practise to detectNeisseria gonorrhoeae(NG) by culturing endocervical and urethral specimens obtained by pelvic examination. However there is a significant false negative rate. The use of newer nucleic acid amplification tests (NAATS) increases the detection of NG and allows testing of non-invasively collected samples. A large retrospective audit was performed on 18,913 microbial culture and cobas 4800 NG PCR results with the aim to determine if urogenital and non-genital specimens could be screened without the need for supplementary testing of positive results.

Methods

Results from culture and PCR were compared; discrepancies were resolved by clinical correlation and/or an in-house assay targeting theopagene and theporApsuedogene.

Results

NG PCR diagnosed 33% more urogenital and 25% more rectal infections than culture; and testing of non-invasive specimens by PCR resulted in 37% more patients being screened for infection. Female urine is not suitable as a sole screening specimen by this assay as sensitivity was only 86.7%. There were insufficient pharyngeal or eye swabs available for the study to rule out the need for supplementary testing by additional DNA targets.

This study also showed an association between ‘failed’ cobas 4800 results and NG positive culture results, likely caused by mucopurulent discharge. Treating specimens with 1.4% Dithiothreitol enabled resolution of 89% of these specimens, of which 18% were positive for CT and/or NG.

In our population, 8% of NG positives wereporAnegative, and 22% wereopanegative. Confirmatory testing of a pharyngeal specimen identified a cross-reacting commensal Neisseria which gave a false positive cobas 4800 NG result.

Conclusion

The cobas 4800 NG test is acceptable for urogenital and rectal specimens without supplementary testing in our low prevalence (< 1%) population, however other non-genital sites require confirmation.
O15.3 Evaluation of an Immunochromatographic Point-Of-Care Test For the Simultaneous Detection of Nontreponemal and Treponemal Antibodies in Patients with Syphilis
Authors: Castro R , Lopes Â
Published: July 2013

Background

We described the evaluation of the DPP Syphilis Screen and Confirm Assay, a point-of-care test (POC) for the simultaneous detection of nontreponemal and treponemal antibodies for the serological diagnosis of patients with syphilis.

Methods

A total of 248 samples from patients with active syphilis (173), past syphilis (15) and from individuals considered as no infected byTreponema pallidum(60) were studied with the DPP Syphilis Screen and Confirm, Rapid Plasma Reagin (RPR), and fluorescent treponemal antibody absorption (FTA-Abs) tests. In addition patients with active syphilis cases (36) primary, (39) secondary, and (98) latent, were evaluated. The DPP Syphilis Screen and Confirm device consists of a plastic cassette with a recombinantT. pallidumand a synthetic nontreponemal test line antigens and a procedural control line.

Results

The sensitivity of the DPP Syphilis Screen and Confirm, nontreponemal and treponemal tests was 97.6% and 96.8% while the specificity was 94.7% and 93.1% respectively, when compared to the predicates RPR and FTA-abs tests. The treponemal and nontreponemal clinical sensitivity of primaries was 100% (36/36), for both and for secondary syphilis was also 100% (39/39), for both test and predicates. For patients with latent syphilis the sensitivity was 97.96% (96/98) for the treponemal test and 98.98% (97/98) for the nontreponemal test while for the predicates FTA-ABS and RPR was 100% (98/98) and 98.98% (97/98), respectively. With patients without syphilis the specificity of the DPP Syphilis Screen and Confirm test was 91.66% (55/60) for the treponemal line and 96.66% (58/60) for the nontreponemal line.

Conclusion

These results indicates that the DPP Syphilis Screen and Confirm POC test could be a useful tool for the serological diagnosis of syphilis, including resource-poor settings where there is a need to provide counselling and treatment on site and thus prevent the further spread of the disease.