bluuebunny/crossref_metadata_2025_split huggingface dataset:
S02.3 Extra-Genital CT/GC Testing by NAATS: Use in Screening and Prevalence of Infection in MSM, Issues in Validation
Authors: Schachter J 
Published: July 2013

MostChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC) infections in men who have sex with men (MSM) are not in the urethra. This has been confirmed often since it was shown by Kent and colleagues, in 2 clinics in San Francisco, (J. Infect. Dis.2003). All of these studies have been made possible by the use of highly sensitive and specific nucleic acid amplification tests (NAATs) that are currently recommended for routine diagnosis of CT/GC infections. The increment in sensitivity for NAATs compared to culture is greater with pharyngeal and rectal specimens than with cervical and urethral specimens; doubling the number of rectal or pharyngeal infections detected.In MSM attending STD clinics the prevalence of rectal or urethral CT and GC is often in the 7–10% range. GC is found in the oropharynx at about the same level, but CT is less common there, typically 1–2%. Most STD clinics’ routine has been to test urethral specimens when evaluating males, with rectal or oropharyngeal specimens tested in symptomatic MSM. We need a paradigm shift: in MSM routine testing of oropharyngeal and rectal sites, as well as urethra, must become the norm. Whether testing should be based on a history of sex practises needs more research.Unfortunately, no NAATs have received FDA clearance for pharyngeal or rectal specimens. But CDC, recognising the superior performance of NAATs with these specimens, took an unusual step recommending NAATs for diagnosing CT/GC in oropharynx and rectum, despite absence of FDA clearance.It is possible to use tests that have not received FDA clearance for patient management. Large laboratories can verify use of NAATs for rectal and pharyngeal specimens by following Clinical Laboratory Improvement Act (CLIA) guidelines. We need NAATs with FDA clearance for use on oropharyngeal and rectal specimens to further expand clinical access to these tests.
S02.4 What Are the Most Efficient Ways to Communicate Research Derived Information to Clinical Practise: The Role of Diagnostic and Treatment Guidelines, Packet Inserts, Clinicians’ Perspective
Authors: White J 
Published: July 2013

When implementing innovative diagnostics or novel therapeutics in medicine, the modern process of knowledge transfer can be described in a stepwise progression from (1) knowledge creation, to (2) diffusion and dissemination, and finally (3) organisational adoption and implementation. We can observe how such processes have contributed to the STI testing and treatment guidelines that we use currently.As clinicians we strive to keep abreast of developments in our field that enable us to deliver the best quality management to our patients. The experience and intuition of an individual clinician is valuable, but all our practises should be subject to rigorous evaluation to ensure they are safe and effective. Without such processes, different and conflicting practises can persist, examples of which will be discussed. The need to implement evidence-based best practise has become widely accepted; however, this can still be hampered by financial constraints as well as the unavailability of specific resources locally. In addition, there is often a lag time in our ability to adopt new tests or treatments due to the need to adhere to local or national guidelines or a lack of evidence such as randomised controlled trials that drive changes in practise.This symposium allows us to examine the most effective ways of getting research into practise and this session will focus on the clinician’s viewpoint. Many knowledge gaps remain where further work is needed to better guide STI testing and treatment. More consideration is needed as to how new information is best disseminated to enable our patients to benefit most promptly from implementation of new information.
S03.1 Sexual Health: Conceptual Framework and Recommendations For Indicators
Authors: Toskin I A , Hawkes S , Moreno C Garcia , Caceres C F , Zohrabyan L 
Published: July 2013

BackgroundIn 2010 WHO convened an expert consultation to formulate recommendations and strategic directions for sexual health. Two specific recommendations, derived from the consultation were: (a) to develop a conceptual framework on sexual health that clearly outlines the elements of sexual health and how it overlaps and differs from reproductive health and the role of sexuality; (b) to develop, operationalize and promote sexual health indicators.MethodThe WHO Department of Reproductive Health and Research established consultative processes, including a review of the existing evidence, conducted interviews with key informants and held expert consultations to address the aforementioned recommendations.ResultsTwo documents;Towards a conceptual framework for sexual health: understanding and improving sexual health for allandCore Set of Sexual HealthIndicatorswere developed during 2011–2013.The conceptual framework outlines the central role that key sexual health concepts of autonomy, individual choice and protection of human rights play in achieving health and development outcomes. The document proposes new ways of ‘framing’ sexual health in order to reach the widest audience, which in turn can influence and deliver positive approaches for ensuring sexual health for all.The proposed indicators cover the following areas of sexual health: adolescent sexual health, family planning, harmful practises, healthy sexuality, sexual dysfunctions and concerns, STI/HIV, and sexual violence. Indicators range from policy, to services (access) to outcome/impact. Most of the proposed indicators have previously been validated, however some new population-based survey indicators have been submitted for validation through special surveys among men who have sex with men and people who inject drugs, to be conducted throughout 2012/2013 in the WHO European region. Preliminary validation results are available.ConclusionBoth documents are concrete steps towards promoting sexual health as a public health concept at international and national levels.
S03.2 Sexual Health Promotion Interventions: Results of a Systematic Review
Authors: Hogben M S , Ford J V , Becasen J 
Published: July 2013

BackgroundPopulation-level rates of sexual health indicators such as STI rates have stimulated interest in a public health approach to improving sexual health in the United States. We used several existing definitions (World Health Organization, U.S Surgeon-General’s office, CDC/HRSA Advisory Committee) to derive sexual health principles: recognition of sexuality as intrinsic to individual healthandrelationships should have positive outcomes for all partners involved.MethodsStudies for a systematic review of intervention literature were drawn from Medline and PsycInfo databases (English language, adult populations, published between 1996–2011, country with developed public health infrastructure). They addressed outcomes in one or more domains: knowledge, attitudes, communication, healthcare use, sexual behaviours or adverse events. Data were summarised in a narrative review organised by population (adults, parents, sexual minorities, vulnerable populations) across domains. Selected data from knowledge, attitudes and behaviours were summarised in meta-analyses.ResultsFrom 9064 studies, 58 were retained in the narrative review. Studies employed qualitative, experimental, pre-post and matched comparison group designs; the number of studies published was correlated with publication year (r = 0.77, p < 0.001). Interventions were predominantly individual and small-group in-person designs that addressed sexual behaviours (42 studies, 72%) and attitudes/norms (32, 55%). Studies with parents covered communication. All but one study reported at least one positive finding, but many (29 studies, 50%) also reported null findings. The most consistent positive effects on behaviours and adverse events were found for sexual minorities and vulnerable populations; interventions with parents uniformly increased attitudes and communication skills.ConclusionsSexual health-framed interventions generate positive effects across adult populations, as well as mental and behavioural domains and adverse outcomes. Interventions may be especially effective among vulnerable populations and in improving parent communication. Where scalable, incorporating aspects of existing sexual health definitions into public health may contribute to improving sexual health.
S03.4 Sexual Health in the European Union: An Inventory of Data, Programmes, Initiatives, and Policies
Authors: Laar M Van de 
Published: July 2013

BackgroundSexually transmitted infections and HIV represent a major public health challenge in European Union/European Economic Area. In 2011, 346911 chlamydia, 39179 gonorrhoea, 28038 HIV and 19798 syphilis cases were reported to the European Centre for Disease Prevention and Control (ECDC). Improving prevention efforts is therefore a priority, especially among populations groups that are most vulnerable to infection, including young people, MSM, migrants and people living with HIV/AIDS.MethodsA mapping exercise of European sexual health data, programmes, initiatives and policies was conducted aiming to increase the understanding of how HIV/STI can be prevented in the general population and among vulnerable population groups.ResultsSynergies and gaps in the availability of data and in policies and programming were identified across EU/EEA. Eleven countries ever adopted a national sexual health strategy and 24 implemented a national HIV/STI prevention strategy. Specific HIV/STI prevention strategies targeting vulnerable groups were identified for: young people (24 countries), MSM (22 countries), sex workers (19 countries), migrants (20 countries) and injecting drug users (24 countries). National surveys on sexual knowledge, attitude and practise were conducted in general population by 19 countries. Eighteen countries collect data on sexual health in MSM, 9 in PLHIV and 6 in migrants. Sexuality education is mandatory in 20 countries. In the last 5 years, 24 Member States conducted HIV/AIDS awareness campaigns.ConclusionsThe following mechanisms are considered to support Member States and to promote a comprehensive approach for HIV/STI prevention in the context of sexual health: endorse synergy between European bodies and NGOs in regards to data collection, reporting and publication; development of a standardised set of indicators for collecting comparable data; development of an evidence-based framework to allow countries to evaluate their sexual health interventions; facilitate communication among (inter)national experts through a dedicated sexual health platform.
S03.5 Advancing Sexual Health in the US: from Theory to Action
Authors: Douglas J M 
Published: July 2013

BackgroundThe United States faces a variety of public health issues related to sexual behaviour including HIV, STD, unintended pregnancy, and sexual violence. A 2010 CDC consultation onA Public Health Approach for Advancing Sexual Health in the United States(http://www.cdc.gov/sexualhealth/docs/SexualHealthReport-2011–508.pdf) provided recommendations on how CDC could enhance prevention programme impact by comprehensively addressing sexual health.MethodsSince the consultation, CDC has worked across its divisions and with external partners to translate the theoretical concept of sexual health into public health action through national leadership, partnership development, and scientific and programme efforts.ResultsInitially, we developed a sexual health framework emphasising the importance of using sexual health promotion to complement and enhance core disease control and prevention activities based on five key principles: acknowledgment of the impact of sexual health on overall health, consideration of underlying social issues, an emphasis on wellness, a focus on relationships, and integrated prevention approaches. Subsequently, we reviewed U.S. national data systems to identify existing measures of key domains of sexual health and conducted health communications research assessing optimal frameworks and messages for communicating with audiences with varied perspectives. Partnership development was accelerated by forming a National Sexual Health Coalition, with a spectrum of non-governmental partners addressing sexual health among the general population, adolescents, and MSM. Public health implementation of sexual health promotion has focused on supporting development of sexual health plans by U.S. states and sexual health training for providers in public health and primary care settings.ConclusionsImplementing actions to address sexual health in a society with diverse values is a challenging and evolving process, but has great potential to improve prevention efforts by engaging a spectrum of partners, facilitating societal dialogue around sexuality and sexual behaviour, reducing stigma and fear, and enhancing efficiency and effectiveness of prevention messages and services.
S04.1 Scaling Up of HIV Treatment Programmes Among the Most At-Risk Populations in Low- and Middle-Income Countries - Introduction
Authors: Alary M 
Published: July 2013

Although access to antiretroviral therapy (ART) for HIV infection in low- and middle-income countries has tremendously improved over the last decade, it remains far from optimal in most settings when it comes to the treatment of marginalised populations, such as sex workers, injection drug users and men who have sex with men. Small-scale demonstration projects indicate that ART can be successfully implemented among sex workers, with satisfactory immunological and virological responses, good treatment compliance levels, and maintenance or even improvement of safe sex behaviour. Some of the studies carried out so far underline the importance of strongly linking prevention with care through the integration of HIV/STI care services and community-based prevention packages. Scaling-up treatment programmes for marginalised, hard-to-reach populations, will undoubtedly be challenging. Nevertheless, in addition to the health equity issues related to access to ART for such populations, the application of targeted “test and treat” strategies could substantially impact HIV prevention at the general population level, given recent trial data showing that the implementation of this strategy among sero-discordant couples led to a 96% reduction in HIV transmission. Such a strategy should however be carefully evaluated in the target population before implementation and scale-up, and would require specific adherence support and community involvement.It is in this context that this symposium will present practical experiences in implementing ART programmes among female sex workers in the context of generalised, concentrated and mixed epidemics. Modelling studies of the preventive impact of such programmes across different epidemic contexts, and with different criteria for ART initiation (including “test and treat”), will also be presented. A similar study about injection drug users in the context of a concentrated epidemic will complete the presentations in this symposium that should stimulate a fruitful discussion period between the participants and the speakers.
S04.2 Modelling the Impact of Early Anti-Retroviral Treatment Amongst People Who Inject Drugs in a High Prevalence Setting
Authors: Vickerman P 
Published: July 2013

BackgroundHIV transmission in many settings is concentrated amongst people who inject drugs (PWID), and can reach high HIV prevalence. Early anti-retroviral treatment (ART) for PWID could be important for reducing HIV transmission in these settings. This modelling analysis projects the impact of such a strategy in a high HIV prevalence (30%) setting, and explores how behavioural and epidemiological factors affect the projections.MethodsA deterministic,model of HIV transmission amongst PWID is calibrated to HIV prevalence data from Manipur, India. The model is used to assess the 20 year impact (on HIV incidence/prevalence) of scaling up early ART to PWID, compared to a baseline of current ART access (20% of HIV+ individuals with CD4 < 350 cells/µL are recruited onto ART annually). An uncertainty analysis was undertaken using posterior model fits to consider which PWID behavioural/epidemiological factors affect impact.ResultsOnly small reductions in PWID HIV incidence/prevalence (< 10% over 20 years) will occur with current ART provision in Manipur. If current ART recruitment rates are maintained, but all HIV+ PWID become eligible for ART, then a median 12%/11% relative decrease in HIV incidence/prevalence occurs over 20 years compared to baseline. This increases to 22%/20% or 33%/28% if 40% or 80% of HIV+ PWID are recruited per year, respectively. If the ART LTFU amongst PWID is halved to 7.5% per year then impact increases by half. Uncertainty analyses suggest the impact achieved through scaling-up ART is highly dependent on baseline HIV prevalence and the cofactor increase in HIV infectivity during early infection, with less impact occurring for higher HIV prevalences and cofactors. The injecting cessation rate and level of mixing between risk groups are also important.DiscussionHIV treatment could result in large reductions in PWID HIV incidence, but is unlikely to result in local elimination except in low HIV prevalence settings.
S04.3 Antiretroviral Therapy Among Female Sex Workers in Burkina Faso: Current Situation
Authors: Konate I , Ouédraogo A , Bazié W W , Traoré I T , Sanon A , Huet C , Méda N , Mayaud P , Perre P Van De , Nagot N 
Published: July 2013

BackgroundIn Burkina Faso, female sex workers (FSW) are a core group in HIV transmission with 16.5% cases of HIV-infection, vs. 1.0% in the general population. Provision of ART to this core group may be key to controlling the HIV epidemic. We aimed at documenting the current situation regarding ART provision to FSW in Burkina Faso.MethodsWe reviewed the interventions of the national HIV/AIDS control programme (NACP) regarding ART provision to FSW, using grey literature and interviews of stakeholders. In addition, we reviewed the findings of the local research on this topic.ResultsBefore 2010, programmes targeting FSW in Burkina Faso focused only on prevention, mainly through local NGOs. From 2010, in each of the 13 regions, the NACP designated one primary health centre to care for FSW. No statistics are available yet from these centres, but NACP/MOH stakeholders admitted that few FSW adhere to it, mainly because of a lack of strategy to reach and retain FSW, and lack of health care workers training. The ANRS 1222 “Yerelon” research programme tested a FSW peer-led intervention integrating prevention and care activities within one dedicated centre in Bobo-Dioulasso. Beside care providers, peers and a psychologist much contributed to support ART adherence before and after initiation. Preliminary data among the 47 FSW treated with ART showed high adherence to ART (> 95%) at 12 months (92%) and 36 months (100%). At 36 months, plasma viral load was undetectable in 82% of FSW, with a mean CD4 increase of 230 cells/µL (IQR: 90–400).ConclusionDespite a specific programme, ART provision to FSW remains limited in Burkina Faso. The ‘Yerelon’ model of prevention and care intervention can serve as a strategy for the NACP FSW programme, and the research sites be used as training centres to improve ART provision coverage and efficiency.
S05.1 Antimicrobial Resistance in N. Gonorrhoeae: Update of the Situation
Authors: Wi T C 
Published: July 2013

BackgroundThe rapidly changing antimicrobial susceptibility ofN. gonorrhoeaesince the introduction of antibiotics has created challenges in gonorrhoea control. Antimicrobial resistance has regularly appeared and expanded with every release of new classes of antibiotics for gonorrhoea.MethodsThe Gonococcal Antimicrobial Surveillance Programme (GASP) has been documenting the emergence and spread of antimicrobial resistance in gonorrhoea since 1992 and has informed treatment guidelines.ResultsSixty two countries participated in GASP in varying degrees including the extend of specific antimicrobials tested for resistance in 2010. There are high rates of resistance inN. gonorrhoeaeto penicillin and quinolones. There are 36 countries reporting increasing minimum inhibitory concentration (MIC) to Cefixime (≥ 0.25 μg/mL) or Ceftriaxone (≥ 0.125 μg/mL). Treatment failures to Ceftriaxone were reported in Japan, Austria, Australia, Canada, France, Norway, Slovenia, Sweden, UK and South Africa. Majority of reports is from developed countries. This is only the tip of the global health burden as surveillance data from resource-constrained settings are scarce.Spectinomycin and azithromycin resistance are monitored in limited countries. Brunei, China, Mongolia and Russia reported decreased susceptibility to spectinomycin. Resistance to azithromycin has been identified in some European countries, US and Chile. Azithromycin resistance remains well below the 5% threshold in most countries.ConclusionsTreatment options for gonorrhoeae is dwindling. In the short term, options for treatment will include increasing dosage, using intramuscular or intravenous route and multiple doses of Ceftriaxone; use of alternative medication (e.g. gentamycin), and combination therapies. In the long term there is a need to develop newer classes of antibiotic. There is a need to ensure rational drug use and strengthen antimicrobial resistance monitoring in gonorrhoea including detection and management of treatment failure.
S05.4 Integrating Antimicrobial Susceptibility Monitoring inNeisseria Gonorrhoeaeto Broader AMR Agenda
Authors: Ghidinelli M , Ramon-Pardo P , Dillon J A , Galarza P 
Published: July 2013

BackgroundBased upon the strategies of the WHO “Global action plan to control the spread and impact of antimicrobial resistance inNeisseria gonorrhoeae”,a plan was developed and implemented to align GASP related activities within the broader agenda of the Antimicrobial Resistance Latin-America Network. Spite of the achievements of GASP in the last decades, there was a need to increase the number of countries and institutions collaborating inN. gonorrhoeaesusceptibility surveillance. In order to achieve this, a comprehensive plan to strengthen the capacity of the Latin-America National Reference Laboratories (NRL) to conduct AMR surveillance in a systematic and regular manner to ensure the early detection of resistantN. gonorroheaewas implemented.MethodsAfter a number of communications and training activities with the NRL,N. gonorrhoeaesusceptibility 2010 data were collected through a questionnaire sent to the National Reference Laboratories in Latin America. Data included country, number of isolated tested, and percentage of resistance to cefixime, ceftriaxone, ciprofloxacin, spectinomycin, penicillin, and tetracycline.ResultsFrom 21 Latin American countries integrating the network, 8 (38%) provide data. None of them detected decreased susceptibility to ceftriaxone; resistance to ciproloxacine ranked from 0% to 83%; penicillin from 6 to 78%; no resistance to spectinomycin; resistance to tetracyline from 27 to 83%.ConclusionsThe NRL demonstrated certain capacity and commitment to collect, analyse, and report data on N. gonorrhoeae susceptibility, however, this should be strengthned and expanded to more countries in the Region.Broad differences among countries were observed, specially on the susceptibility to ciprofloxacine and penicillin.Some challenges were identified, such the lack of a system for referral of specimens at national and regional level.This effort should be continued, emphasising the importance of periodicity on data collection, analysis and dissemination.