bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S5.40 Sex cells: a pilot study investigating cell phone-based sexual networks among men who have sex with men in South India
Authors: Thompson L H , Shaw S , Deering K , Reza-Paul S , Lorway R
Published: July 2011

Background

A high HIV prevalence (19–32%) has been reported among men who have sex with men (MSM) in South India. Indeed, sexual networks play a central role in the spread of HIV in these communities but have rarely been studied because of intense social stigma and methodological and ethical challenges. Although cell phones are commonly used among MSM to contact sexual partners in India, few studies have explored the formation of such sexual networks. This study sought to understand the structure, context and evolution of cell phone-based sexual networks of MSM in three South Indian cities.

Methods

Sampling frames in the three cities were established using MSM contacts stored in the cell phones of community-based researchers (CBRs). Study participant “seeds” were randomly selected from these social networks. Seeds were asked to recruit their sexual partners, who completed surveys about their sexual practices with regular partners and 7-day partners. Network diagrams were constructed using non-nominal codes linking study participants.

Results

Cell phone contacts represent a useful resource for constructing social networks. Preliminary results indicate the diversity of sexual networks and sexual practices within these networks.

Conclusions

New community-based methods of exploring sexual networks were assessed, and sexual practices, partner concurrency, and risk behaviours were explored. This information can be used to tailor more specific services for MSM in these communities. As this methodology sampled from social networks, more hidden “individuals who do not access health services were included in the study.”
P1-S5.41 Quantifying the contribution of re-infection within partnerships to persistent spread of Chlamydia
Authors: Kretzschmar M , Schmid B , Low N , Heijne J
Published: July 2011

Background

Many studies show that people testing positive and treated for genital chlamydia infection are at high risk of a repeat infection in the first year after treatment. Repeat infection can come from treatment failure, a new partner, or from within an existing partnership if the partner was not treated. Partnerships can therefore form a reservoir of chlamydia infections that might affect the effectiveness of population screening programs. It is not known how much reinfection within partnerships contributes to the persistent spread of chlamydia in heterosexual populations.

Methods

We derive an expression for the basic reproduction number of an SIS infection in a population with long term monogamous partnerships. The basic reproduction number contains an explicit term quantifying the contribution of re-infection within partnerships to the overall reproduction number. The derivation is then extended to include partner notification and treatment. Finally, the model is extended to include two types of partnerships with differing average duration.

Results

For small recovery rates and low transmission probabilities reinfection plays a minor role in sustaining chlamydia transmission. However, there is an optimal combination of duration of infection and transmission probability for which reinfection contributes substantially to keeping chlamydia endemic in a population. We discuss the functional dependency of the basic reproduction number on these parameters. Using a more complex model numerical scenarios were simulated showing that partner notification prevents a large proportion of re-infections.

Conclusions

The effect of screening depends, in part, on whether or not it succeeds in moving the basic reproduction number away from the transmission optimum via reinfection. This can be achieved either by choice of the screening interval or by rescreening those individuals who tested positive in a first screening test. There is an optimal time interval for retesting that minimises the basic reproduction number. The precise numerical value depends on partnership durations and transmission probabilities.
P1-S5.44 STD rates in the eight Americas: “Disparities in the burden of syphilis, gonorrhoea, and chlamydia across race and county”
Authors: Chesson H , Owusu-Edusei K , Kent C , Aral S
Published: July 2011

Background

The purpose of this study was to examine rates of three STDs (primary and secondary syphilis, gonorrhoea, and chlamydia) in eight subpopulations (known as the eight Americas) defined by a small number of sociodemographic and geographical characteristics.

Methods

A list of the race-county combinations comprising each of the eight Americas was obtained from the corresponding author of the original eight Americas project, which examined disparities in mortality rates across the eight Americas. Using county-level STD surveillance data, we calculated syphilis, gonorrhoea, and chlamydia rates (new cases per 100 000) for each of the eight Americas.

Results

STD rates varied substantially across the eight Americas. STD rates were generally lowest in America 1 (Asian and Pacific Islanders in selected counties) and America 2 (Northland low-income rural white) and highest in America 6 (Black Middle America), America 7 (Southern low-income rural black), and America 8 (High-risk urban black) see Abstract P1-S5.44 Table 1.

Abstract P1-S5.44 Table 1

STD rates (new cases per 100 000) in the Eight Americas, 2008

AmericaPrimary and secondary syphilisGonorrhoeaChlamydia1. Asian1.414.5100.62. Northland low-income rural white0.39.2125.53. Middle America2.730.0172.44. Low-income whites in Appalachia and the Mississippi Valley1.123.8139.45. Western Native American2.980.9820.76. Black Middle America14.5475.31,063.67. Southern low-income rural black15.3482.21,109.48. High-risk urban black25.3507.21,155.9

Conclusions

The disparities in STD rates we observed across the eight Americas were akin to the disparities in mortality rates and life expectancy reported by the authors of the original eight Americas study. Although disparities in STDs across the eight Americas are generally similar to the well-established disparities in STDs across race/ethnicity, the grouping of US race-counties into the eight Americas does offer additional insight into disparities in STDs in the USA. The high STD rates we found for Black Middle America relative to Middle America are consistent with the assertion that sexual networks and social factors are more important drivers of racial disparities in STDs than differences in sexual behaviours.
P1-S5.46 Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England
Authors: Savage E , Leong G , Peters L , Duffell S , Hughes G
Published: July 2011

Background

Disparities in the distribution of sexually transmitted infections (STIs), especially gonorrhoea, across ethnic groups in England are well recognised. Socio-economic deprivation (SED) is also a known determinant of poor health outcomes and is often more common in ethnic minorities, but it has not previously been possible to assess the relationship between ethnic group, SED and STI rates at the national level. We used data from a new national patient-level STI surveillance system to investigate the interplay between SED and ethnicity on population-level rates of STIs in England.

Methods

Data on patients diagnosed with syphilis, gonorrhoea, genital herpes and genital warts from all genitourinary medicine (GUM) clinics in England in 2009 were obtained through the GUM Clinic Activity Dataset (GUMCAD). Rates of STI diagnoses by ethnic group and deprivation quintile were calculated. Deprivation was measured using the Index of Multiple Deprivation for England for each lower-level super output area of residence.

Results

In England in 2009 the rate of syphilis and gonorrhoea was over five times higher (7.7/100 000 vs 1.4/100 000 and 42.8/100 000 vs 8.0/100 000 respectively) in the most deprived areas than in the least deprived areas but there was less difference for genital herpes (49.4/100\000 vs 26.8/100\000) and warts (131.1/100 000 vs 79.0/100 000) (see Abstract P1-S5.46 figure 1). The highest crude rates of acute STI diagnoses were among black ethnic communities although the magnitude varied by STI. The rate of gonorrhoea in black communities was over eight times higher than in white ethnic groups (171/100 000 vs 20/100 000), however, for genital warts rates in black ethnic communities were only 1.5 times higher than those in white ethnic groups (194.5/100 000 vs 130/100 000). Asians had the lowest rates for all four infections.

Abstract P1-S5.46 Figure 1

Rates of diagnoses of STIs by deprivation quintile using the Index of Multiple Deprivation, England, 2009.

Conclusions

Rates of STIs are strongly associated with deprivation. Presentation of STI rates by ethnic categories should be adjusted to take into account the strong interaction between ethnicity and SED. While SED is a key determinant of ill health other cultural influences on sexual behaviour may contribute to STI risk exposure among ethnic groups. The high STI rates seen among black ethnic communities are likely to be the consequence of a complex interplay of cultural, economic and behavioural factors.
P1-S6.02 Contraceptive discontinuation by rural Kenyan women in HIV discordant partnerships after exiting an HIV prevention trial
Authors: Ngure K , Baeten J , Lingappa J , Heffron R , Musingila P , Irungu E , Mwaniki P , Mwaniki L , Wamae R , Mburu S , Mugo N
Published: July 2011

Background

Women in biomedical HIV prevention clinical trials are frequently counselled to use effective contraceptive methods in order to avoid pregnancy during the study and consequent withholding of study products. Moreover, research study participants often have access to medical care at research clinics that might not otherwise be as readily available in their communities. We evaluated change in contraceptive use among women after exiting from a biomedical HIV prevention clinical trial in Kenya.

Methods

The Partners in Prevention HSV/HIV Transmission Study enrolled HIV serodiscordant couples at 14 sites in East Africa and Southern Africa, including a site in Thika, Kenya. Participants were offered contraception free-of-charge at the research site during the clinical trial. Unblinding visits, at which the results of the trial were conveyed to participants, were conducted after the trial results were reported. Contraceptive use data were collected at the trial exit visit and at the later study unblinding visit.

Results

Among 213 women from Thika in the trial, 114 returned for the unblinding visit, of whom 80 (70.2%) were HIV positive. The median time between exit and the unblinding visit was 1.11 years (ranging from 0.84—to 2.13 years). Non-barrier contraceptive prevalence (ie, use of oral, injectable, implantable contraceptives, intrauterine devices [IUD] or surgical) dropped from 62.3% to 47.4% (p=0.01) between exit and unblinding visits: from 70.0% to 53.8%, (p=0.03) among HIV positive women and from 44.1% to 32.4%, (p=0.31) among HIV negative women. However, the prevalence of IUD use among the HIV positive women increased from 3.8% to 20%, (p=0.002) during this period. Additionally, the proportion of women who were using condoms as their sole contraceptive method decreased, from 29% at study exit to 1.8% at the unblinding visit (p<0.0001), resulting in greater numbers of women who were not using any contraceptive method.

Conclusions

There was a high rate of contraceptive discontinuation, both hormonal and barrier methods, after women exited from a biomedical HIV prevention trial. Discontinuation of contraception may reflect participant fertility desires after trial procedures are completed, or may reflect loss of clinical and counselling services available during the study. Innovative strategies to support the contraceptive needs of women after exiting HIV prevention trials are urgently needed.
P1-S6.03 Why are so many of our biomedical and behavioural prevention trials failing?
Authors: Celentano D , Beyrer C
Published: July 2011

Background

With a few exceptions, most biomedical and behavioural randomised, controlled prevention trials have failed to demonstrate efficacy. The recently reported iPrEx Trial on pre-exposure prophylaxis, the Thai prophylactic vaccine trials and the CAPRISA 004 trial of a female-controlled microbicide demonstrated only modest protection from HIV acquisition in high-risk populations, although both attained statistical significance. Understanding why most trials fail is important to designing trials that may have greater success in the field.

Methods

We conducted a desk review of all Phase III biomedical and behavioural prevention trials reported in the past 10 years, including vaccines, microbicides, barrier methods, circumcision and behavioural prevention interventions, and assessed possible factors associated with success and failure to achieve anticipated outcomes.

Results

Of the hundreds of prevention trials conducted over the past decade, only six reported significant findings, of which three were male circumcision trials, with one each for prophylactic vaccines, Truvada for PREP, and TDF+FTC microbicide gel. Most biomedical prevention trials rely on patient reports of adherence to use, and generally adherence is significantly lower than advised. Condom use among treatment arms are also usually lower than in control arms, which when linked with insufficient product use, leads to increased risk of disease acquisition. Repeated behavioural prevention counselling, HIV testing, STD detection and treatment all lead to diminished reports of risk behaviour among both intervention and control participants, diminishing the statistical power of the planned trials. IRB requirements may lead to control conditions that provide prevention services dramatically greater than is involved in “usual care”. RCTs which randomise individuals can also lead to significant cross-exposure among treatment arms.

Conclusions

Alternative to the RCT Conclusions: Design alternatives to the individual or community randomised controlled trial may be required in the future. Increased attention to improving adherence to recommended use of prevention approaches which must repeatedly conducted (eg, use of a microbicide before each sex act), and alternatives to enriching control conditions above that of usual care should be considered, while maintaining fidelity to ethical conduct of research.
P1-S6.05 Influence of social support networks on the HIV transmission risk behaviours of people living with HIV in Manitoba, Canada
Authors: Cameron A
Published: July 2011

For people living with HIV/AIDS (PLWHA) positive social support networks (SSNs) can help improve quality of life, overall well-being, coping, and decrease mood disturbance, morbidity, mortality, sexual and substance associated HIV transmission risk factors. However, HIV diagnosis can cause a negative change in SSNs leading to social isolation (actual/perceived) and increase risk of HIV transmission behaviours. Having an effective strategy to encourage the development/maintenance of SSNs may have a positive effect upon the health outcomes and HIV transmission risk behaviours of PLWHA.

Objective

To describe the SSNs of Manitobans living with HIV/AIDS (MLHA) and determine the influence of SSNs on transmission risk behaviour. The relationship between independent variable (size and type of SSNs- positive/negative) and dependant variables (sexual risk behaviour, and alcohol, injection and non-injection drug use) was examined. Control variables included: age, gender, ethnicity, time since diagnosis, and sexual orientation. This data was collected in the Positive Prevention Study (PPS), a cross-sectional survey which included 135 MLHA aged 18 plus. The PPS assessed a broad list of transmission related determinants and only enrolled people if they were aware of their HIV diagnosis for at least 6 months, allowing for analysis of sustained positive behavioural changes. For this analysis SAS statistical software was used. Analysis of variance was done between the size and type (positive/negative) of SSNs and the chosen transmission risk behaviours; sexual behaviour, alcohol use, injection and non-injection drug use. Analysis of covariance was conducted with independent, dependent and control variables. Multiple regression analysis was run with independent and dependent variables to determine any relation. Level of social support achievable depends on one's attachment to those in their SSN and the role they play. It is not just the quantity of people but also the quality of relationships (eg, frequency, perceived support) that defines the success of SSNs. Not all SSNs are positive; some types may increase transmission risk behaviour. Only positive SSNs (regardless of size) are associated with avoidance of transmission risk behaviours. The results of this study help to assess the degree to which SSNs affect the sustainability of long-term secondary prevention measures, and thus inform groups offering services to MLHA with local scientific evidence.
P1-S1.23 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-S6.06 What has been the effect of the Avahan HIV intervention on condom use among female sex workers? Insights from a fully Bayesian inference methodology
Authors: Dureau J , Boily M C , Vickerman P , Pickles M , Isac S , Ramesh B , Verma S , Moses S , Alary M , Kalogeropoulos K
Published: July 2011

Background

Considerable efforts have been invested to evaluate the impact of the Avahan project, the India AIDS initiative, targeted to high risk groups. One measure of impact is the number of HIV infections prevented (PF) due to increases in condom use between FSWs and clients following the start of Avahan. PF estimates hinge on knowledge of the frequency of condom use over time. As there is no data on condom use prior to the first round of data collection post-Avahan, these trends must be estimated indirectly. We aim, using a Bayesian framework and Monte Carlo Markov Chains (MCMC) methodology, to determine if the trends in HIV prevalence among FSWs and clients can be used to infer changes in condom use between FSW and clients before and after the start of Avahan.

Methods

We used serial rounds of cross-sectional behavioural and biological survey (IBBA) data and a deterministic compartmental model of HIV transmission among FSW/clients in Mysore and Belgaum districts coupled with Bayesian inference procedures. Condom use was modelled as the fraction of FSW commercial sex acts protected by condoms. IBBA data was used to specify the model prior parameter distributions and estimate HIV prevalence at three time points among FWS, at one time point among their clients. The Particle MCMC algorithm was used to explore the posterior density of our complex parameter distribution, and to derive estimates of the evolution of condom use over time using either 2 or 3 rounds of HIV prevalence data among FSW.

Results

For both districts, the results reveal a clear increase in condom use around the start of Avahan in 2004 (Abstract P1-S6.06 figure 1). Abstract P1-S6.06 figure 1 suggests condom use before the intervention (jan 1994) was lower in Mysore (15.7%, 95% CI 0 to 48%) than in Belgaum (19%, 95% CI 0 to 58%). In both districts, post intervention condom use stabilised at values above 80% (95% CI Mysore 65 to 100% and Belgaum 50 to 100%). Lastly, Abstract P1-S6.06 figure 1 A),C) vs B),D) show the information gained by using 3 rounds of data instead of 2.

Abstract P1-S6.06 Figure 1

A) Condom use in Mysore estimated from rounds 1 and 2. B) Condom use in Mysore estimated from rounds 1, 2 and 3. C) Condom use in Belgaum estimated from rounds 1 and 2. D) Condom use in Belgaum estimated from rounds 1, 2 and 3.

Conclusions

This is the first application of Particle MCMC in an intervention monitoring context. Our results consolidate previous back projections suggesting that condom use significantly increased since the start of Avahan, which sheds additional light on the potential intervention impact. This study illustrates the use of flexible Bayesian inference methodology to estimate time-varying parameters. It also informs the design of prevalence surveys for intervention monitoring.
P1-S6.09 An audit of management of prenatal syphilis serology in the STI Clinic, Calgary, AB, Canada
Authors: Chu A , Read R , Scarrott R
Published: July 2011

Background

Outbreaks of syphilis have been occurring across Canada since 2001, with the province of Alberta having the 2nd highest incidence in 2007. As a result, there has been a national increase in the number of reported congenital cases. Current Canadian guidelines recommend performing syphilis serology at the 1st prenatal visit with rescreening at 28–32 weeks gestation, and at delivery in high-risk women. In our center, any positive syphilis serology is referred to the Calgary STI Clinic for staging and treatment recommendations. This is an internal audit of positive prenatal syphilis serologies from 2009 to 2010.

Methods

Charts from pregnant women with a positive prenatal syphilis serology, defined as a positive or indeterminate syphilis EIA, from 1 January 2009 to 31 December 2010 were retrospectively reviewed. Syphilis staging was performed by the Medical Director according to national criteria.

Results

48 charts were reviewed: 9 were staged as biological false positives, 22 were previously adequately treated women with low or negative RPR titres not suggestive of reinfection, 13 were late latent (LL) treated with 7.2 μ of benzathine penicillin (PCN), and 4 were early latent (EL) treated with 2.4 μ of benzathine PCN. The mean number of days it took from receipt of a positive serology to contacting the patient were 9.8, 10.2, 2.3, and 1.8, respectively. The mean time to 1st dose of PCN was 8.8 for EL and 17.8 for LL (see Abstract P1-S6.09 table 1). There was 1 case of congenital syphilis in an infant whose mother presented in labour with no prenatal care-her RPR was 1:256. 1 woman with an RPR titre of 1:128 was treated with benzathine PCN 1 week before her estimated date of delivery. She went into preterm labour the afternoon post-injection; it is unclear whether or not the injection induced preterm labour. Her twins were treated with iv PCN with no adverse outcomes.

Abstract P1-S6.09 Table 1Syphilis Stage= (N)/48Range (days) from Start of Investigation to First ContactMean Number of Days to First ContactMean Number of Days to 1stDoseBiological False Positives=91–299.8N/APreviously Treated=221–3110.2N/AEarly Latent=40–41.88.8Late Latent=130–72.317.8 (5.2 if outliers removed)*

*3 patients were difficult to contact or noncompliant, taking 44, 54, and 68 days.

Conclusions

Routine prenatal syphilis screening has identified 14/48 women who required PCN treatment, all of whom received PCN prior to delivery with only 1 woman experiencing a possible adverse event. The only congenital case occurred in a mother with no prenatal care, suggesting a need for a strategy to identify marginalised women with syphilis early in pregnancy. Although the average time to contact these patients was short, the time to administration of 1st dose of PCN was longer, reflecting the need to educate women about the importance of prompt and complete therapy in preventing congenital syphilis.
P1-S6.10 Acceptability of Anal Pap self-screening in high-risk women: findings from English and Spanish focus groups in Northern California
Authors: McNeil C , Piñera C , Maldonado Y , Levy V
Published: July 2011

Background

HPV has a causative role in anogenital malignancies. During 2003–2007, the rate of anal cancer for women of all races in California was 2.2/100 000 compared to a national rate of 1.8/100 000. There are no national screening measures for preventing anal cancer, a rare disease that affects more women than men annually. Screening approaches have mainly been studied in men. In preparing for an anal cancer self-screening pilot study in high-risk women, we conducted focus groups in English and Spanish to assess HPV knowledge and acceptability and comprehension of anal Pap instruction materials. Qualitative data regarding acceptability and feasibility of anal pap screening in women have not previously been reported.

Methods

Women who were biological females >18 years of age and fluent and literate in English or Spanish were recruited from a public HIV or STD clinic for participation in focus groups conducted by two English and Spanish speaking moderators. Participants were asked a structured list of open ended questions on HPV knowledge, and the acceptability of study forms including an illustrated anal PAP instruction sheet. Qualitative data was collected and reviewed for common themes and emphasis.

Results

Two focus groups included 6 English speaking (ES) women and 8 Spanish speaking (SS) women. Knowledge gaps identified for SS women included: basic anatomical terms, HPV can infect both women and men, HPV is a STI, HPV can cause cancer, and the existence of a preventive HPV vaccine. Stigma was identified as an issue associated with STI education for SS women only. Shared knowledge gaps for ES and SS women included: asymptomatic nature of HPV, symptoms potentially caused by HPV, and that warts can turn into cancer. Both groups agreed public health HPV campaigns should target both men and women. Whereas ES women encouraged a more media based approach to HPV education, SS women commented current campaigns are too vague and emphasised a more personal, interactive approach to HPV education in public venues. Self-sampling was viewed positively by participants, along with self-sampling instructions; some modifications to collection materials were suggested.

Conclusions

Focus groups revealed significant knowledge gaps in HPV associated malignancies and cancer screening in high-risk females. Anal PAP self-screening appears to be an acceptable approach; however, the large scale implementation of such strategies may require targeted educational campaigns particularly in underserved communities.
P1-S6.11 Prevention of mother to child transmission of HIV (PMTCT) program in Burkina Faso: how high is the coverage of voluntary counselling and HIV Testing (VCT) services within a clinical trial supporting environment?
Authors: Traore H A , Some E , Meda N , Nagot N , Van De Perre P
Published: July 2011

Background

Since 2003, Burkina Faso has set up a national PMTCT program. Programme monitoring 2009 annual report showed high health districts and facilities coverage. But at beneficiaries' level, how many women and children in need of PMTCT interventions have really access? The objective of our study was to measure the uptake of VCT with a comprehensive set of data collected in the recruitment process in a clinical trial evaluating postnatal chemoprophylaxis to reduce MTCT.

Methods

We carried out a cross-sectional study from 1 January 2010to 31 December 2010 in 26 out of 35 PMTCT sites in five health districts in Ouagadougou city. Weekly data collection in PMTCT registers and semi-structured interviews with the personals in charge of MCH departments.

Results

Among the 44 484 new recorded Antenatal care (ANC) attendees, 37 539 received HIV counselling and 37 489 were tested for HIV (results returned immediately), an acceptance rate of 99, 86%. 6,945 new ANC did not profit from the HIV counselling equalling 15.61% of the participant population. This miss opportunity for VCT was related to test supplies out of stock (78%), lack of VCT offer due to opt in strategy still in place in many facilities (17%) and structural problems (no trained staff, lack of infrastructures) in the remaining cases.

Conclusion

Our results underline the overall good performance of the PMTCT program in the context of a clinical trial facilitating environment. However, a better organization of the supply procurement would allow improving VCT coverage rate. With this high coverage of VCT in research context, we can assume that the low VCT coverage at program (75%) level is mainly due to healthcare system problem.
P1-S6.12 The contribution of a Chlamydia screening programme to testing and case-finding in addition to regular STI-care in three regions of The Netherlands
Authors: van den Broek I V F , Götz H M , Brouwers E E H G , Fennema H S A , Hoebe C J P A , Koekenbier R H , Pars L L , van Raveseijn S M , Op de Coul E L M , van Bergen J E A M
Published: July 2011

Background

The impact of a Chlamydia screening programme can be measured by the incremental amount of Chlamydia tests performed and cases detected as compared to the throughput in regular care. In the Netherlands, regular STI care is provided by specialised STI-centres (aimed at high-risk groups) and General Practitioners (GP's, basic opportunistic screening and care for symptomatic cases). An annual register-based Chlamydia screening programme is implemented in three regions since 2008.

Methods

The number of persons tested and cases detected in the Chlamydia Screening among 16–29 year olds in Amsterdam, Rotterdam and South Limburg, 2008–2010, were compared to consultations and diagnoses in this age group reported in surveillance data from STI centres in the regions and estimates of STI care in general practices in these regions, 2007–2010. Round 3 data are based on the first 6 months of the year.

Results

The baseline testing rates (at STI centers and by GP's in year pre-screening) were 10% in Rotterdam, 13% in Amsterdam and 6% in South-Limburg. CSI increased testing rates steeply in the first year to 26–30% in the cities and 17% in Limburg; this decreased to 20–21% and 13% in round 3, still doubling testing rates as compared to baseline. Positivity rates at regular STI-care facilities are higher than in CSI: 12–15% in regular care vs 4–5% in CSI; therefore the addition of CSI to case-finding in the three regions was lower than that to testing: the screening programme added about 41% on top of the cases found in regular care in round 1, but this decreased to 20% in round 3 due to lower participation and positivity rates in consecutive rounds.

Conclusions

By comparison to regular testing at STI centers and in general practice, the Chlamydia Screening had a major contribution towards the number of young people tested for Chlamydia in the three regions. The addition towards case-finding was lower, because the case-detection rate of the screening programme was lower than that in regular care. The Screening programme did not seem to affect the number of patients seen in regular care, but double “consumers” cannot be excluded.
P1-S6.13 A new approach to encourage HIV testing in high-risk populations at the Clinique l'Actuel
Authors: Thomas R , Machouf N , Trottier B , Vezina S , O'Brien R , Milne M , Lavoie S , Longpré D , Huchet E , Nguyen V K
Published: July 2011

Background

In Québec it is estimated that 1/3 of those infected do not know their HIV status, that HIV is diagnosed late in 41%, and that sex during primary infection is an important driver of the epidemic. In late 2008 Clinique l'Actuel launched a testing campaign tailored to MSM in Montréal using free rapid tests with the goal of increasing early diagnosis of HIV. In this study we evaluated the feasibility of and potential impact of facilitated access to rapid HIV-testing.

Methods

Rapid HIV-tests offered through dedicated clinics were widely advertised in Montréal's MSM community. Patients calling for testing deemed at high risk were given appointments within 2 weeks, where they filled out a short questionnaire, received medical consultation routine STI screening, pre- and post-test counselling and their HIV test results within the hour. Ongoing support, care, and treatment were offered to those testing positive.

Results

Over 9 months 2500 received HIV testing. 98% were men and median age was 34 (IQR=26–41). Of these patients, 42% were new to the clinic, 10% had never been tested previously, and 29% had not been tested within the past 2 years. 93% reported they were more likely to undergo repeat screening because of rapid testing. 2% were found to be HIV positive. Of these, 60% cited the rapid test as the primary reason for undergoing screening. 33% of those testing positive were in primary infection, as compared to 18% the previous year at Clinique l'Actuel (p=0.062) and 11% in Québec.

Conclusion

Facilitated access to rapid HIV testing can increase uptake in high-risk patients. This may increase early HIV diagnosis and intervention to decrease transmission.
P1-S6.14 Interventions to increase re-testing for repeat chlamydial infection: a systematic review and meta-analysis
Authors: Ali H , Guy R , Low N , Bauer H , Walker J , Klausner J , Donovan B , Kaldor J , Hocking J
Published: July 2011

Background

Repeat infection withChlamydia trachomatisfollowing treatment is common and increases the risk of sequelae. Despite clinical guidelines recommending re-testing within 3 months of treatment, re-testing rates remains low. We undertook a systematic review of studies which evaluated interventions aimed at increasing re-testing for repeat chlamydial infection.

Methods

We searched Medline, EMBASE, trial registries, and conference websites from 2000 to September 2010 using variations of the terms “chlamydia” and “re-testing” and “intervention” to identify studies which compared rates of re-testing for repeat chlamydial infection between patients receiving and not receiving an intervention. We used meta-analysis methods to calculate the overall RR effect on re-testing rates, as well as undertaking a sub-analysis by strategy type.

Results

We identified eight studies satisfying the inclusion criteria, including four randomised controlled trials and four controlled observational studies. The studies described 12 intervention strategies. All were conducted in the USA. The overall effect estimate RR for any strategy was 1.45 (95% CI 1.35 to 1.55); RR=1.80 (95% CI 1.63 to 1.97) for four studies using reminders such as postcards, phone calls, letters and emails (individually or in combination); 1.25 (95% CI 1.12 to 1.38) for four studies using mailed screening kits with or without reminders; 2.15 (95% CI 0.92 to 3.37) for two studies using motivational interviewing with or without reminders; 1.35 (95% CI 0.88 to 1.82) for one study promoting re-testing guidelines to clinicians; and 1.16 (95% CI 0.38 to 1.93) for one study using a $20 patient incentive to encourage re-testing.

Conclusion

Reminders and mailed screening kits can increase re-testing rates by 80% and 25% respectively.
P1-S1.24 Longitudinal trends in syndromic STI diagnoses in Lilongwe, Malawi: 2006–2010
Authors: Kamanga G , Powers K , Mapanje C , Mkandawire N , Milonde H , Kanyamula H , Wiyo P , Martinson F , Miller W , Hoffman I
Published: July 2011

Background

To understand longitudinal trends in sexually transmitted infection (STI) syndromes, we conducted a descriptive analysis of syndromic STI diagnoses at an STI clinic in Lilongwe, Malawi over the last 5 years.

Methods

Using data collected routinely at all STI clinic visits since March 2006, we calculated the proportion of patients seen in each of the last five calendar years (2006, 2007, 2008, 2009, and 2010) who were diagnosed with each of the following STI syndromes—genital ulcer disease, genital warts, abnormal vaginal discharge (females), lower abdominal pain (females), urethral discharge (males), balanitis (males), swollen inguinal lymph nodes (males), and scrotal swelling (males).

Results

An average of 6694 unique patients were seen each year; approximately 60% were female and 40% were male. Among males, the most common diagnoses were urethral discharge, genital ulcer disease, and balanatis (Abstract P1-S1.24 figure 1). There was an increase in the prevalence of urethral discharge over the period 2006–2010 (from 28% to 33%, p<0.0001), but there was a slight decrease in the prevalence of genital ulcer disease (from 22% to 20%, p=0.02) and balanitis (from 13.5% to 12%, p=0.0002). Among females, the most common diagnoses were abnormal vaginal discharge, lower abdominal pain, and genital ulcer disease. There was an increase in the prevalence of abnormal vaginal discharge over the period 2006–2010 (from 40% to 45%, p<0.0001), but there was a decrease in the prevalence of lower abdominal pain (from 50% to 33%, p<0.0001) and genital ulcer disease (from 13% to 10%, p<0.0001). The prevalence of all other STI syndromes remained below 10% throughout the study period.

Abstract P1-S1.24 Figure 1

Syndromic STI prevalence and 95% CI, Kamuzu Central Hospital STI Clinic, Lilongwe, Malawi, 2006–2010. LAP, lower abdominal pain; AVD, abnormal vaginal discharge; UD, urethral discharge; GUD, genital ulcer disease; BA, balanitis; F, female; M, male.

Conclusions

Urethral discharge and balanitis continue to be highly prevalent among males; abnormal vaginal discharge and lower abdominal pain continue to be highly prevalent among females; and genital ulcer disease continues at a high prevalence in both groups. Of note, the decline in lower abdominal pain coincides with a documented drop in cases of gonorrhoea and chlamydial infection in this population, and the small decline in genital ulcer disease may be due to recent improvements in chancroid treatment. The very high prevalence of urethral discharge among men and abnormal vaginal discharge among women may be due in part to observed high levels of trichomoniasis in this population, and the increases in these diagnoses suggest that trichomoniasis prevalence may be on the rise.
P1-S6.16 Australian chlamydia control effectiveness pilot: preliminary results from a trial of chlamydia testing in general practice
Authors: Hocking J , Temple-Smith M , Poznanski S , Guy R , Low N , Donovan B , Gunn J , Law M , Kaldor J , Fairley C
Published: July 2011

Background

While opportunistic chlamydia screening is conducted in several countries, debate remains about the effectiveness of population-based screening programs for reducing chlamydia transmission and its morbidity. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) aims to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing in general practice.

Methods

ACCEPt is a cluster randomised controlled trial targeting sexually active 16–29-year old women and men for annual chlamydia testing. 54 postcodes (towns) are being randomised and all GP clinics within each area invited to participate. A multifaceted intervention to maximise testing includes: a computer alert prompting GPs to test; incentive payments for GPs and payments for employing practice nurses; a recall system to encourage annual testing; partner notification, and; information/support with regular feedback on testing performance. Clinics in the control group are encouraged to continue their usual practice. The intervention will be in place for up to 4 years. The primary outcome is change in chlamydia prevalence among a consecutive sample of 80–100 patients attending participating clinics in each postcode (total sample size about 4500) measured at the beginning and end of the trial. Secondary outcomes include pelvic inflammatory disease and chlamydia testing rates.

Results

Recruitment began in July 2010 and 282 GPs in 69 clinics in 24 postcodes have been recruited to date in the States of Victoria, New South Wales and Queensland. Four clinics have refused so far and these postcodes have been excluded. To date, 615 16 to 29 year olds have been tested during the baseline prevalence survey with a participation rate of 70%. Overall chlamydia prevalence is 4.0% (95% CI 2.5% to 6.0%). Prevalence is slightly higher among males (4.5%; 95% CI 2.0% to 8.7%) than females (3.7%; 95% CI 2.0% to 6.3%, p=0.7) and in rural (6.9%; 95% CI 3.8% to 11.2%) compared with metropolitan areas (2.2%; 95% CI 0.9%, 4.4%, p<0.01). Recruitment will be completed by December 2011 with the intervention period running till end of 2014.

Conclusions

This study shows high participation rates by GP clinics and by individuals invited to take part in the prevalence survey. Results will determine whether annual chlamydia testing is effective at reducing transmission and morbidity and will inform the optimal design of a chlamydia testing program in Australia.
P1-S6.17 Opting out testing for HIV in Dutch STI clinics: does it work?
Authors: Koedijk F , van Bergen J , Dukers N , Hoebe C , van der Sande M
Published: July 2011

Background

In 2005, STI centres in the Netherlands started provider-initiated HIV testing policy, in order to decrease the proportion of people unaware of their positive HIV status and to enable interruption of transmission and create more opportunities for timely treatment. This policy gradually evolved towards opt-out HIV testing and in January 2010, this became the official policy within all Dutch STI centres. The effects of the change in HIV test policy were studied and factors associated with opting out for HIV testing were identified.

Methods

Data from January 2004 to June 2010 from 488 727 consultations registered in the Dutch national surveillance in the STI centres were used to characterise current practices on HIV testing. Known HIV positives were excluded from analyses. Logistic regression analyses were done separately for men having sex with men (MSM) and heterosexuals, to identify factors associated with refusing an HIV test.

Results

Since 2004, the percentages of HIV testing within an STI consultation have increased significantly from 56% up to 92% in 2009, and further to 97% in the first half of 2010 when opting out was implemented nationally (both p<0.001). STI were significantly more often diagnosed in clients not tested on HIV during their consultation (p<0.001), except in 2010. Using 2010 data, MSM being older than 25 years (OR: 1.8, 95% CI 1.2–2.6), those having STI symptoms (OR 2.2 95% CI 1.7 to 2.8) and those with a previous STI (OR: 1.5, 95% CI 1.2 to 2.0) more often refused an HIV test. For heterosexuals, having had a previous STI (OR: 1.6, 95% CI 1.3 to 2.0), being female (OR: 1.2, 95% CI 1.0 to 1.4) and being younger than 25 years (OR: 1.2, 95% CI 1.0 to 1.4) were independent factors associated with refusing an HIV test.

Conclusions

Although provider-initiated HIV testing already increased HIV testing rates, national implementation of opting out for HIV testing increased this uptake even more. Standard testing on HIV in every STI clinic is shown to be highly feasible and effective. In order to optimise the opt out policy, and thereby successful interruption of HIV transmission, interventions to motivate “opt-outers” should be studied, since the few clients still refusing an HIV test were linked to higher risk behaviour.
P1-S6.23 Impact evaluation of performance-based financing (PBF) for HIV testing and counselling for individuals and couples in Rwanda
Authors: Bautista S , Binagwaho A , de Dieu Bizimana J , Condo J , de Walque D , Gertler P , Kwan A , Sturdy J
Published: July 2011

Background

The Government of Rwanda has nationally implemented performance-based financing (PBF) to improve the satisfaction and motivation of health workers, as well as access and quality of HIV/AIDS services in the context of scaling-up services. The scheme pays for 10 HIV/AIDS indicators (two related to HIV testing and counselling (HTC), which is believed to be a core strategy for decreasing HIV incidence and improving prevention and care). We present the effect of Rwanda's PBF program on individual and couple/partner testing as an entry point to other HIV services and in the context of scale up.

Methods

Taking advantage of a prospective quasi-experimental design, an impact evaluation was conducted during phase-in of the Rwanda's PBF program in 2006 and 2008. Individual HTC was measured by whether or not the individual has ever been tested for HIV (371 treatment individuals (61.1% female), 378 control (56.6% female)), and partner testing was assessed by whether or not the sexual partners they had in the 12 months prior to the survey had ever been tested for HIV (208 treatment individuals (57.2% female), 202 control (52.0% females)). To evaluate the outcomes, a difference-in-difference fixed effects model was used with SEs clustered by district*year.

Results

PBF increased HTC at the individual level by 9.45% from baseline (p=0.07). This effect was mainly found among married individuals (10.87% increase, p=0.02), specifically males (15.75% increase, p=0.06). PBF also increased testing among couples by an estimated 16.14% (p=0.034) increase from baseline, as reported by one of two partners.

Conclusion

Our work provides evidence that PBF might be a useful tool to increase access to HTC for both individuals and couples. This is a remarkable result since couple testing has previously been difficult to encourage.