bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S6.26 Modelling the impact of rapid treponemal tests on syphilis prevalence among female sex workers in India
Authors: Mishra S , Moses S , Pickles M , Ramesh B M , Isac S , Washington R , Becker M , Blanchard J , Boily M C 
Published: July 2011

BackgroundRapid treponemal tests performed at point-of-care (POC) are being used to scale up syphilis (Tp) screening in high-prevalence resource-limited settings. However, their advantage over offsite rapid plasma reagin (RPR) may be offset by variable sensitivity when used as POC, and the potential for resurgence in infectious cases due to enhanced treatment of latent Tp and loss of acquired immunity. We compare the change in prevalence of infectious Tp using different screening methods within a community of female sex workers (FSWs) in Karnataka, India.MethodsWe developed a deterministic model of heterosexual Tp transmission between FSWs and their clients. Test sensitivities were estimated against a reference laboratory RPR with a confirmatory test. Main outcomes included predicted changes in FSW and client infectious Tp prevalence at 30 years, and post-intervention rebound in infectious Tp.ResultsReductions in infectious Tp prevalence achieved by screening were highest in areas with low initial treponemal test positivity, and were relatively insensitive to variations in parameter assumptions. At least once a year screening with a 100% sensitive POC test reduced infectious prevalence to an equal or greater extent as compared to a 100% sensitive offsite RPR test. A paradoxical rebound in infectious prevalence was observed after start of POC or RPR screening in approximately half of scenarios but resurgence above pre-intervention levels was rare (<5% of scenarios). Rebound was most likely in high-prevalence regions (treponemal test positivity 35–45%), where it manifested after 3.5 to 8.6 years, depending on assumptions on duration of immunity and sex-work turnover, and could be prevented with screening every 3 months. The ability to detect resurgence depended on frequency of monitoring and size of the surveyed population. POC screening of variable sensitivity was equally or more effective at reducing Tp prevalence than offsite RPR (sensitivity 100%) when follow-up was less than 50% (POC sensitivity 70%) and 70% (POC sensitivity 95%).ConclusionsRapid treponemal POC tests have the potential to be as or more useful than offsite RPR tests within a high-risk population, when offsite RPR is unfeasible or return visits are low, irrespective of the sensitivity of available POC tests. In high-prevalence settings, sufficient coverage and screening frequency must be maintained to avert an increase in infectious syphilis prevalence.
P1-S6.27 Could a peer driven intervention increase uptake of chlamydia screening? Proof of principle
Authors: Horner P , Loaring J , Matthew H , Oliver I , Campbell R , Trotter C , Macleod J , Pye K 
Published: July 2011

BackgroundUptake of the opportunistic National Chlamydia Screening Programme in England is low and below model estimates of the optimal level to reduce Chlamydia incidence. Peer led approaches may increase screening uptake but their feasibility and acceptability to young people is not known.MethodsFocus groups and interviews with young women and men. All participants had expressed an interest in undergoing Chlamydia screening or had already been screened. The focus group and interviews were audio taped and transcribed verbatim for analysis. Thematic analysis of the data was conducted to identify, compare and report patterns in the data. Following interview, Chlamydia postal kits were introduced to participants and their opinions on giving these out to their peers sought. Participants were asked for their views and experiences of discussing Chlamydia screening and distributing kits to their friends four to eight weeks after the focus group/interview. All kits returned over a 9-month period to the laboratory were recorded.ResultsSix men (mean age 19 years) and 6 women (mean age 20 years) were recruited. In total 45 kits were distributed, 33 (73%) to female participants. 26 (79%) and 3 (25%) of kits given to females and males respectively were given to peers. Of those tests distributed to peers there is a high return rate 34% (10/29) all of which had been given out by females. On average, 1.7 kits were returned for each female participant. Participants generally felt positive about the idea of peer-driven screening using postal kits. However, embarrassment was a key theme, particularly among men. Generally women but not men were able to discuss Peer Driven Screening among their close friends. Both sexes felt Peer Driven Screening would be easier if kits were readily available in multiple sites, and Chlamydia screening was more widely promoted.ConclusionFemale Peer Driven Screening but not male Peer Driven Screening was successful in recruiting peers to participate in Chlamydia screening. A peer driven intervention may increase uptake of Chlamydia screening.
P1-S6.29 Longitudinal trends in HIV testing and prevalence among STI clinic patients in Lilongwe, Malawi: 2006–2010
Authors: Powers K , Kamanga G , Mapanje C , Malava J K , Chindebvu M , Kamzati H , Martinson F , Miller W , Cohen M , Hoffman I 
Published: July 2011

BackgroundTo understand longitudinal trends in HIV status awareness, HIV test acceptance, and HIV prevalence among patients of a sexually transmitted infections (STI) clinic in Lilongwe, Malawi, we conducted descriptive analyses of these endpoints over the last 5 years.MethodsUsing data collected routinely at all STI clinic visits since March 2006, we calculated the proportion of visits in each of the last five calendar years (2006, 2007, 2008, 2009, and 2010) during which patients reported a previous HIV test, and among those, the proportions reporting positive and negative results. We also calculated the proportion accepting HIV tests at the clinic, and among those who received HIV tests at their visits, the proportion who had positive results. We conducted log-binomial regression with generalised estimating equations to analyse trends in each endpoint over time.ResultsAn average of 8944 clinic visits occurred each year, approximately 60% by females and 40% by males. The proportion of visits at which patients reported a previous HIV test increased from 57% in 2006 to 86% in 2010 (p<0.0001) (Abstract P1-S6.29 figure 1). Among those reporting a previous test, the proportions reporting negative or positive results remained relatively constant, at approximately 70% and 30%, respectively (results not shown). At visits where patients did not report a prior positive HIV test, the proportion accepting HIV antibody tests increased from 50% to 78% (p<0.0001). Among all those who received HIV antibody tests at a visit, the proportion who were found to be HIV-positive decreased from 31% to 17% (p<0.0001), with a decrease from 13% to 10% among those reporting a previous negative test (p<0.0001) (Abstract P1-S6.29 figure 1).Abstract P1-S6.29 Figure 1Longitudinal Trends in HIV Testing and HIV Prevalence, Kamuzu Central Hospital STI Clinic, Lilongwe, Malawi, 2006–2010.ConclusionsOver the last 5 years, the proportion of STI clinic visits at which patients reported awareness of their HIV status has increased, including an increase in known positives to 25% of all patients. At visits where patients did not report a previous positive result, the proportion who accepted rapid antibody tests has also increased. Among those receiving HIV tests at their clinic visits, the proportion testing HIV-positive has decreased substantially, although 10% of those with a previous negative result tested positive. These findings raise great concern about ongoing HIV acquisition and transmission in patients becoming aware of their serostatus through expanded HIV testing. Novel and better HIV prevention strategies for these patients are urgently needed.
P1-S6.30 HIV testing of patients receiving an STD Evaluation in a North Carolina Community Health Center
Authors: Klein P , Bishop A , Leone P 
Published: July 2011

BackgroundThe CDC has recommended HIV testing for persons with a suspected STD since 1987 and for all patients in clinical settings since 2006. However, HIV testing of suspected STD patients in emergency medical sites is inadequate, despite the high risk of HIV acquisition in this population. Community health centers may have better adherence to HIV testing recommendations due to a more personal relationship with their clientele and heightened awareness of state disease trends.MethodsRobeson Healthcare Corporation is a federally-qualified health center with 4 sites located in a county in the top 10% of HIV case rates and top 33% of syphilis case rates in North Carolina. A routine HIV testing program was started in June 2009. Patients receiving an STD evaluation 1 June 2009 through 31 January 2011 were examined for concurrent HIV testing. The association between age and HIV testing among STD testers was assessed with multivariate logistic regression with a robust variance estimator to account for patients with multiple clinic visits.ResultsOf the 6588 clinic visits that included an STD evaluation, 2324 also included an HIV test (35.3%, 95% CI 32.1 to 36.4%). Over 70% of patients tested for syphilis also received an HIV test (n=1531/2111, 72.5%, 95% CI 70.6 to 74.4%). Less than 30% of patients screened for gonorrhoea and Chlamydial infections were also tested for HIV (n=1545/5442, 28.4%, 95% CI 27.2 to 29.6%). During a statewide syphilis outbreak in 2009 with high HIV-syphilis coinfection rates, HIV testing of suspected syphilis patients reached 84.0% (95% CI 80.9 to 87.0%). Patients of older ages were less likely to be tested for HIV during their STD evaluation than patients of younger ages (Abstract P1-S6.30 table 1).Abstract P1-S6.30 Table 1HIV Testing of patients receiving an STD Evaluation by Patient Age, June 2009–January 2011OR (95% CI)OR (95% CI)OR (95% CI)Patient age (years) 13–241.001.001.00 25–340.76 (0.59 to 0.98)0.81 (0.71 to 0.91)0.45 (0.21 to 1.00) 35–440.31 (0.23 to 0.42)0.48 (0.40 to 0.58)0.55 (0.22 to 1.37) 45–540.16 (0.11 to 0.24)0.29 (0.22 to 0.40)0.23 (0.07 to 0.72) 55–640.10 (0.06 to 0.20)0.28 (0.17 to 0.44)0.39 (0.09 to 1.75) 65+0.05 (0.02 to 0.11)0.14 (0.03 to 0.59)0.39 (0.03 to 4.61)Age (10-year interval)0.51 (0.47 to 0.57)0.68 (0.63 to 0.72)0.75 (0.58 to 0.98)ConclusionsIn this community health center population, over 70% of patient visits with a syphilis evaluation included a concurrent HIV test order. This represents an improvement from an emergency department setting, in which less than 30% of syphilis testers were also tested for HIV. However, HIV testing among patients screened for gonorrhoea and Chlamydial infection was still low; the inclusion of HIV testing in the standard order panel for patients receiving an STD evaluation may increase HIV testing in this high-risk population.
P1-S6.33 Monitoring chlamydia testing and positivity in the USA using data from a large commercial laboratory corporation, 2008–2010
Authors: Hoover K , Tao G , Nye M , Body B , Kent C 
Published: July 2011

BackgroundGuidelines recommend chlamydia screening of sexually active young women. Screening rates have increased over the past 10 years, but remain low. Current data used to monitor chlamydia testing trends and positivity rates have limitations, for example, national surveys provide representative data but are cross sectional and use small sample sizes, so longitudinal and subgroup analyses are not possible. To monitor trends more effectively, we solicited chlamydia testing data from commercial laboratories to obtain a representative sample of the US market.MethodsDemographic characteristics of persons tested, their geographic location, assay types, specimen sources, and test positivity by sex, age, and insurance type were assessed for all chlamydia testing performed by this laboratory corporation during June 2008–July 2010.ResultsThe dataset contained 3.26 million specimen records. Among those tested, 86.2% were women, 41.0% were aged 15–24 years, 73.5% had commercial insurance, 21.8% had Medicaid insurance, and 56.6% resided in the South. The most frequently used type of chlamydia test was a nucleic acid amplification test (77.5%). Among women, 59.7% of specimens were cervical, 21.1% vaginal, and 18.8% urine. Overall, 4.0% of tests were positive. Positivity rates were highest in persons aged 15–19 years, and higher in men than women for all age groups. Rates also were higher in women with Medicaid insurance than women with private insurance.ConclusionsSystematically collected laboratory data can fill a critical gap in monitoring US chlamydia testing and positivity trends. These data are more representative of the US population by geographic distribution and insurance type than other data sources. The analysis of laboratory testing data might be useful for national surveillance that would not be dependent on provider or health department reporting. Our findings underscore the importance of screening young women for chlamydia, especially adolescents in whom screening rates are low. Men had higher positivity rates probably because they sought treatment for symptoms or were referred by an infected partner. Further analysis is needed to assess if testing of persons older than 25 years was according to guidelines, such as pregnant women, at-risk persons, or symptomatic persons.
P1-S6.34 Evaluation of risk-score algorithms for the detection of HIV infection and syphilis in North Carolina county jails
Authors: Sampson L A , Miller W C , Leone P A 
Published: July 2011

BackgroundIn North Carolina, the funding environment for jail screening has shifted from a syphilis-centred model to one based on integrating HIV and STI testing. We developed and evaluated risk score algorithms for HIV screening with and without the addition of syphilis screening in North Carolina county jails.MethodsThis study included 3610 inmates screened for both syphilis and HIV in two North Carolina jails, 2002–2005. We verified reactive syphilis tests against surveillance records to identify new syphilis cases. We created logistic regression models to predict two different outcomes: HIV only and HIV or syphilis. We created risk scores by rounding the β coefficients from the final models. Cut-offs were chosen based on testing 50% of the available inmate population. We calculated the sensitivity and specificity for each of the risk scores for three outcomes: HIV only, syphilis only, HIV or syphilis. Analyses were conducted using Stata.ResultsThe final model for the HIV-only outcome included sex, age, ever tested for HIV, and race/ethnicity. The lowest scoring individual type would be a heterosexual man, age 18–24, never tested for HIV, with a race/ethnicity in the referent group (total score=0). The highest scoring individual would be MSM, age 25 or older, previously tested for HIV, and of Hispanic or Black non-Hispanic race/ethnicity (total score=6). A risk score cutoff of three or above will lead to screening <50% of the available inmate population. The weighted risk scores from the HIV-only outcome model had better sensitivity for the detection of HIV (82.6, 95% CI 71.2—to 94.0) than the combined-outcome model (65.2 95% CI 50.9—to 79.5). If inmates are selected for screening based on the HIV model, the sensitivity for detection of new syphilis cases is also good (73.3, 95% CI 56.5—to 90.1) and is only slightly inferior to the HIV or syphilis model (80.0 95% CI 64.8—to 95.2).ConclusionsWe believe that the screening algorithm will perform well in the county from which the sample was drawn. Generalisation to other communities in the Southern USA with similar demographics and rates of HIV and syphilis is also possible. More generally, we recommend targeting HIV jail screening efforts based on HIV data. In communities with incident syphilis infections, we recommend adding syphilis screening to the HIV protocol.
P1-S6.37 Can rapid syphilis tests be implemented and improve screening for maternal syphilis in a third level hospital?
Authors: La Rosa Roca S , Garcia P 
Published: July 2011

BackgroundSyphilis continues to be one of the most important causes of maternal and child morbi-mortality, frequently being more common than HIV. Ideal diagnostic test should provide rapid and accurate results to provide timely diagnosis and treatment. Rapid syphilis testing is an excellent option. The objective of this study is to determine the feasibility of the implementation of Rapid Syphilis Testing (RST, Syphilis 3.0 BioLine) and the impact on maternal screening for syphilis at a third level hospital in Peru: the National Maternal and Perinatal Institute (INMP).MethodsBetween February and December of 2010, RST was implemented in the Antenatal care (ANC), labour and miscarriage services. The National guidelines recommended screening for syphilis in all those services with RPR. Health workers (midwives, nurses and laboratory technicians, depending on the service) were properly trained on the use of RST and their performance was monitored throughout the study.ResultsRST was performed on 15 116 women, with a prevalence of syphilis (RPR reactive, TPPA positive) of 1% for ANC, 0.7% for miscarriage services and 0.8% at labour. The coverage of screening for syphilis improved from 82% with RPR to 99% with RST at the ANC services; from 0% to 91% at the miscarriage services and from 79% to 94% at labour. At baseline, at the ANC visit, the results of the RPR were only available 15 days after the visit, resulting in a low coverage for treatment when the test was positive, 39%. With the implementation of the RST, the results and treatment were given immediately at the same visit, resulting on treatment coverage of 95%. The RST was very well accepted by the providers and patients.ConclusionsThis study shows the feasibility, acceptability and improvements on screening associated to the implementation of RST in a third level hospital. In addition of improving coverage and treatment, our results triggered changes in the institutional policies for syphilis control.
P1-S6.38 Interpretation of routine data from a youth friendly clinic in region F, Johannesburg
Authors: Lalla-Edward S T 
Published: July 2011

BackgroundThe Wits Institute for Sexual and Reproductive Health, HIV and Related Diseases (WrHI)'s Youth Friendly Programme aims to engage with young people and make reproductive healthcare accessible and non-threatening. The team educates and informs young people about HIV and has specially sensitised nurses and counsellors for HIV and STI testing who are skilled in working with youth. This abstract discusses the HIV and STI outputs of the Youth Friendly clinic based on the quantitative reported data.MethodsRoutine programme data submitted for the period October 2007–January 2011 was reviewed. Data was collated for the purposes of graphing, and calculating percentage difference and percentage change.ResultsThe target age for service delivery fluctuated in line with WHO and is currently 15–24 years. There was inconsistent reporting of headcounts for the review period. In 2007 the clinic saw 15–19 year olds (ration of 1 male: 2 female). From 2008 this changed to a ratio of 30% male: 70% female. The age threshold moved to 24 years and clinic population became 35% of 15–19 year olds: 65% of 20–24 year olds. Total number of HIV tests conducted was 10 132 (3515 males and 6617 females). 10% tested HIV positive. 77% (n=764) had blood draws for CD4 count testing. 722 results were received from the laboratory, of which 571 (79%) were collected by patients. 414 results were <200 cells/mm3see Abstract P1-S6.38 Figure 1. All eligible patients were worked up for ARVs and referred to the initiation facilities. 5176 clients accessed STI services. In 2007 50% males and 50% females were treated for STIs. During the review period this changed to 44% males and 56% females. Both HIV testing and STI services were lowest from October 2007 to February 2008 and peaked from May 2009—to July 2009 and again from September 2009 to November 2009. The reported data did not distinguish between new and repeat clients for HIV testing and STI treatment.Abstract P1-S6.38 Figure 1Cascade of HIV service bundling for October 2007–January 2011.ConclusionThe increase in target population age led to more services being accessed by 20–24 year olds. Over time there was an increase in the number of people accessing HIV and STI testing and treatment. There was an increase in males accessing the clinic and a decrease in STI services required by males. Lab reporting of CD4 counts and CD4 results collection needs to be strengthened. Routing data needs to be collected on new and repeat clients as a means of addressing casual factors for STI acquisition.
P1-S6.40 VCT sites in MSM from Mexico City: an opportunity to action
Authors: Magis-Rodríguez C , González-Rodríguez A , Bravo-García E , Juárez-Figuroa L , Rodríguez-Nolasco E , De Azcárraga Urteaga C 
Published: July 2011

BackgroundMexico has a concentrated HIV epidemic (15% HIV prevalence among Male Sex Workers; 11% in MSM; 5% in IDU; and 2% in FSW). Voluntary counselling and testing (VCT) for HIV is a strategy for case detection and deliver prevention messages. This study analyses the HIV prevalence in MSM in two different settings, in order to identify potential opportunities for HIV prevention.MethodsWe realised a comparative study between the men that received VCT inside the clinic, and the men reached with VCT in a mobile unit. Both services were offered by the Clinica Condesa in Mexico City (January, 2010). We described and analysed the population demographics, HIV prevalence, condom use, and sexual practices. All data were considered to identify the MSM and the factors associated with their HIV prevalence.Results956 men were HIV tested in January 2010 (401 in VCT site, and 555 in mobile unit). The percentage of MSM was 57.9 vs 47.9%, respectively; however, the HIV prevalence in MSM from the VCT site (27.6%), was seven times great than HIV prevalence in MSM from mobile unit (3.8%).ConclusionsResults suggest that the MSM attending the VCT site are different than the one attending the mobile unit. MSM tested in VCT site have the self-selection bias. However, due to higher HIV prevalence, the VCT site is an excellent place to develop intensive prevention programs in MSM.