bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S7.12 STD testing in emergency department: a novel method to provide test results
Authors: Arno J , Messina F , Perkins A , Allen A 
Published: July 2011

BackgroundRealising the potential of broad based STD testing depends on treatment of those with positive results. Because emergency department (ED) physicians expressed reluctance to test for STD's because they had no mechanism for giving test results, we devised a system to provide results to patients tested for STD's at the county's public hospital by calling Bell Flower, the health department's STD program, to determine whether patients tested for STD's in the ED would call for their results.MethodsAn electronically generated individually modified referral note with instructions for calling Bell Flower for STD test results was given to all patients tested for STD's including gonorrhoea (GC), Chlamydia (CT) or syphilis, in the Wishard Hospital Emergency Department. The Bell Flower results clerk was given access to the hospital's electronic medical record system containing laboratory results. The clerk's access to a specific patient's results was recorded electronically by the system. Patient records accessed by the clerk were extracted and matched to patients given the discharge note. A patient was judged to have called if the clerk accessed that patient's test results. Continuous variables were compared using student t tests and proportions compared using χ2analysis. Because Hispanic patients used a different call mechanism, their data were excluded.ResultsFrom 1 January 2010 to 30 April 2010, 503 patients were given the STD referral note. Of these, 447 were >14 years old, not Hispanic and had complete medical record information. Of the 447 patients with analysable data, 146 (32.7%) called for test results. Age, race, sex, Chlamydia results or treatment and high risk zip codes were unrelated to whether or not a patient called for results. Of 65 patients infected with CT 33 (52.3%) were not treated in the ED of which 10 called. Of 45 patients with GC, 6 (13.3%) were not treated for it in the ED, of which 2 called. Patients infected with GC, were less likely to call for their results than those not infected (p=0.019), particularly those who were adequately treated in the ED (p=0.039).ConclusionsRoughly one third of patients in one public hospital ED instructed to call for STD results called for them. Most of those infected with GC but not CT were treated appropriately with empiric antibiotics while in the ED. Infected patients calling in for test results could facilitate prompt treatment.
P5-S7.13 Royal Perth Hospital emergency department screening project forChlamydia trachomatis
Authors: Dykstra C , Fatvich D , Flexman J , Phillips M , McCloskey J 
Published: July 2011

BackgroundWestern Australian (WA) rates of Chlamydia are consistently higher than the national average and continue to rise. Chlamydia screening programs often miss hard-to-reach populations, including young men, indigenous peoples, and the homeless. The objective of this pilot study was to determine if screening patients for genital Chlamydia in the Emergency Department (ED) of a large metropolitan hospital is: feasible, able to access the hard-to-reach populations, and follow-up for treatment is possible Methodology Urinary screening for Chlamydia was offered to asymptomatic people aged 18–25 years who attended the Royal Perth Hospital (RPH) including visitors. Recruitment via a nurse-led strategy was compared to a patient self-initiated strategy. A resource package (including brochure and DVD) was designed to facilitate recruitment and screening, as well as to provide information on Chlamydia to those choosing not to participate. Options for notifying patients of their results have been evaluated (including text messaging and e-mail). Statistical analysis was performed using SAS.Results823 people (male 532, female 291, aboriginal 58) were recruited. Of these 10% were homeless and 35% had moved residences in the last 3 months. The indigenous population of 7.1% was greater than that of the State (1.9% 2006 Census). The recruited asymptomatic population had a Chlamydia prevalence of 5.4%. When the nurse-led vs patient self-initiated strategies were compared there was a 23.8 to 1 ratio of recruitment.ConclusionsThis study was able to access the hard-to-reach population. The nurse-led recruitment was the most successful strategy to gain access to this group. This cohort engaged in many risk taking behaviours including higher than expected rates of current smoking (45.7%), binge drinking (72.1% male and 42.8% female), never using condoms (26.3%) and recreational drug use (62.4% ever). Most people preferred to get their results by mobile phone (54.1%). This was a feasible ED screening method with respect to notification success. Less than 7% of this hard-to-reach population with Chlamydia could not be informed of their infection. A quarter of the cases of Chlamydia required augmented efforts to notify them of their infection. The analysis of the data indicates that for every day there is a delay in attempting contact there is a 7.7 times increased chance of not having a successful contact.
P5-S7.14 High Chlamydia and gonorrhoea incidence, reinfection and HIV infection among workers in the adult film industry: time to regulate and protect workers
Authors: Rodriguez-Hart C , Goldstein B , Aynalem G , Kerndt P 
Published: July 2011

BackgroundAdult film industry (AFI) workers engage in prolonged and repeated unprotected oral, vaginal, and anal sex with multiple partners over short periods of time, creating ideal conditions for acquisition and transmission of sexually transmitted infection (STIs). Workers are often required to perform without condoms to maintain employment. Our objective was to estimate the annual cumulative incidence rate of chlamydia (CT) and gonorrhoea (GC), assess the rate of reinfection with CT and GC and describe past HIV outbreaks in the AFI.MethodsCT and GC cases in AFI workers reported to the Los Angeles, California health department surveillance registry between 2004 and 2008 were retrieved. Using 2008 data, CT and GC annual cumulative incidence rates were calculated based on estimates of the worker population. For cases reported between 2004 and 2007, the CT and/or GC reinfection rates within 1 year were determined; all reported HIV cases from 2004 to 2010 were investigated.ResultsFrom 2004 to 2008, 2633 cases were reported among 1849 AFI workers. Lower bounds for the annual cumulative incidence rate of CT and GC among AFI workers were estimated to be 14 300 and 5100 per 100 000 workers, respectively. Reinfection within 1 year was 26%. Female workers were 27% more likely to be reinfected than males (Prevalence Ratio=1.27, 95% CI 1.09 to 1.48). Between 2004 and 2010, 10 HIV cases were reported. In April 2004, 3/14 female workers were infected (attack rate 23%) as a result of workplace exposure. In October of 2010, an acute HIV infection was diagnosed in a male who worked over an 8-week period with 14 performers, including two later found to be HIV infected.ConclusionsCT and GC infection rates among AFI workers are high and repeat infection is common. Transmission of HIV in the workplace has been documented. This industry is not sufficiently regulated to protect workers from serious health risks.
P1-S2.06 HIV, sexually transmitted infections, and risk behaviours among clients of sex workers in Guatemala - are they a bridge in HIV transmission?
Authors: Sabidó M , Lahuerta M , Hernández G , Montoliu A , Gonzalez V , Giardina F , Monzón J E , Pedroza M I , Casabona J , Guevara R 
Published: July 2011

BackgroundClients of female sex workers (FSW) are an important target group for HIV/STI prevention. This study aimed to estimate the prevalence of HIV and other sexually transmitted infections (STI) prevalence in clients examine their risk behaviours and evaluate their role as a bridge population in the spread of HIV/STI.MethodsCross-sectional study conducted between 2008 and 2009 among 553 clients recruited through a two-stage convenient sample in commercial sex sites in the province of Escuintla, Guatemala. They were interviewed and tested for HIV and other STI. Bridge clients were defined as those who engaged in sex with both regular partners and FSWs but reported inconsistent condom use with FSWs whereas potential bridge as those reported consistent condom use with FSWs. Non-bridge clients engaged in sex with only FSWs. Multinomial and multivariable logistic regression models were used to identify risk factors associated with the bridge category and with having ≥1 STI/HIV, respectively.ResultsHalf of the clients approached refused participation. Median age was 28.9 years; 57.7% had a regular partner, of whom 10.1% had concurrent non-commercial partnerships. Consistent condom use with FSW and regular partners was 72.5% and 17.1%, respectively. The main reason for not using condoms was trust (49.5%). Approximately 18% formed a bridge, and 40.0% a potential bridge. Among those who provided samples (70.5% a blood sample and 89.7% urine sample), prevalence of HIV, syphilis, gonorrhoea, chlamydia, and herpes simplex virus 2 was 1.5%, 1.0%, 0.8%, 5.5%, and 3.4%, respectively. Unprotected sex with FSWs and drug use just before sex were risk factors for having any STI (9.8% of participants). Bridge clients were significantly less educated, more employed, paid lower prices to the FSW just visited, and had a previous STI.ConclusionsClients showed high-risk sexual behaviour, a relatively high prevalence of HIV in clients compared to national estimates and a substantial proportion of them act as a bridge for HIV/STI transmission between FSW and the general population in Escuintla. Given that this is fuelling the current HIV epidemic, preventive interventions addressing this hard-to-reach group are urgently required. A significant challenge is to overcome the difficulty of reaching clients as well as to address the variety of high-risk behaviours among clients by partner type in this setting and take into account traditional concepts of masculinity.
P1-S2.08 Geography, mobility, work venue, and sexually transmitted infections among 4100 female sex workers in 20 cities in Peru
Authors: Mejia C , Campos P , Carcamo C , Garcia P , Hughes J , Martin D , Garnett G , Holmes K 
Published: July 2011

ObjectivesTo estimate and compare prevalences of five STIChlamydia trachomatis(CT)Neisseria gonorrhoeae(NG),Trichomonas vaginalis(TV),T pallidum(syphilis), and HIV infection for female sex workers (FSW) according to home geographic region and mobility, and to identify other STI risk factors.MethodsData on geographic region, internal mobility (defined as having engaged in sex work in >2 Peruvian cities in the previous 12 months or was working away from their home city at enrolment), sex work characteristics, sociodemographics and, behaviours, were collected together with vaginal and blood specimens from 4100 FSW in 20 Peruvian cities. Multivariate analysis identified factors associated being infected with any of the five STI.ResultsFSW from the jungle region had higher prevalences of CT, NG, TV, syphilis, and HIV than FSW from the coastal or highlands regions. In univariate analysis, having worked in >2 more cities or working away from home were significantly negatively associated with having any STI. In multivariate analyses the mobility status variable showed a trend towards protective associations; neither remained significant. Risk of any STI was significantly and independently associated with bar/nightclub or street work, being from the jungle region, and not completing high school.ConclusionFindings suggest that internal mobility does not increase risk among Peruvian FSW. Preventive interventions should focus on FSW from the jungle region, those working in bars/nightclubs or on the street and those lacking secondary education to halt the spread of STI among FSW and, presumably, to the general population.
P1-S2.09 Who is at higher risk of STIs and HIV—brothel-based or street-based female sex workers? Evidence from two rounds of bio-behavioural surveys
Authors: Gautam A , Adhikary R , Ramanathan S , Goswami P , Khobragade S , Deshpande S M , Khazi S , Mainkar M M , Paranjape R S 
Published: July 2011

BackgroundFemale sex workers (FSWs) are considered a high-risk group for HIV and other STIs. Sex work practices of FSWs in Maharashtra are diverse and vary according to the sex work milieu (eg, street-, brothel- and bar-based). We examined changes in HIV and STI prevalence, associated risk behaviours and socio-economic variables among street-based (SB) and brothel-based (BB) FSWs in Maharashtra.MethodsTwo rounds of cross-sectional surveys were conducted in 2005 (R1) and 2009 (R2) in selected districts of Maharashtra. Probability sampling methods, such as conventional and time-location cluster sampling, were used to sample 2257 (1212 BB and 1045 SB) FSWs in R1 and 2228 (1182 BB and 1046 SB) FSWs in R2. Sexual behaviours were assessed, blood and urine samples were collected to measure the prevalence of HIV,Neisseria gonorrhoeae(NG),Chlamydia trachomatis(CT) and syphilis. Changes were analysed using bivariate and multivariate methods.ResultsHIV prevalence increased significantly among SB FSWs from 17.2% in R1 to 24.3% in R2 (OR 1.54, p=0.04), whereas among BB FSWs, there was no significant change (28.4 in R1 to 28.9 in R2, OR 1.03, p=0.88). Prevalence of active syphilis (TPHA and RPR positive at any titre) declined among BB FSWs from 15.4% (R1) to 11.0% (R2) (OR 0.67, p=0.05), while the decline among SB FSW was not significant (R1—13.6% to R2—10.6%; OR 0.75, p=0.22). NG prevalence fell from 7.7% (R1) to 3.9% (R2) (OR 0.48, p=0.006) for BB FSWs, whereas for SB FSWs, it declined from 7.2% in R1 to 4.2% in R2 (OR 0.56, p=0.07). No significant change was observed in the prevalence of CT in either group. Self-perceived risk of HIV among BB FSWs increased from 52.5% (R1) to 62.5% (R2), (OR 1.5, p=0.02); whereas among SB FSWs, it was unchanged (49.8% in R1 to 50.3% in R2; OR 1.02, p=0.23). The proportion of illiterate BB FSWs decreased from 80.1% (R1) to 74.3% (R2), (OR 0.72, p=0.02) while for SB FSWs, illiteracy increased significantly from 64.4% (R1) to 77.1% (R2), (OR 1.86, p<0.001). The proportion of FSWs having more than 10 clients per week was same over both rounds for BB FSWs but for SB FSWs, it increased significantly to 49.9% (R2) from 32.8% (R1) (OR 2.04, p<0.001).ConclusionSB FSWs are at higher risk of contracting HIV and other STIs and are more vulnerable compared to BB FSWs. Prevention interventions must account for differences in profiles, risk behaviours and sex work typology to customise strategies for these groups for maximum impact.
P1-S2.11 High prevalence of HIV, other sexually transmitted infections and risk profile in male commercial sex workers who have sex with men in the Netherlands
Authors: Cuypers W J , Niekamp A M , Keesmekers R , Spauwen L , Hollman D , Telg D , Dukers-Muijrers N , Hoebe C 
Published: July 2011

BackgroundLittle is known about the epidemiology and burden of sexually transmitted infections (STI) in male commercial sex workers who have sex with men (MSM-CSWs) in the Netherlands and other Western countries. MSM-CSWs are often hard to reach for prevention and STI testing. This feasibility study aimed to reach MSM-CSWs, assess their socio-demographics and prevalence of HIV and other STI, and their risk profile.MethodsRetrospective, cross sectional study. Demographic and STI diagnosis data were retrieved from standardised medical records of MSM-CSWs consulted during outreach activities by a public health service in Southern Limburg, The Netherlands (2009 and 2010).Chlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) were diagnosed by NAAT and serology was performed for HIV (HIV-Ag/Ab), syphilis (TPPA, FTA-ABS, VDRL) and hepatitis B (anti-HBc and HBsAg).ResultsIn 2009 and 2010 139 consultations by 99 MSM-CSW were performed. Their median age was 23.6 years; 56% of participants were of Romanian nationality, 20% of other (East) European nationality, 16% of South American nationality and 8% of Dutch nationality. Of participants, 50% self identified as homosexual, 33% as bisexual and 17% as heterosexual. All MSM-CSWs were tested for STI. Resultsof testing at first time consultation revealed that 45.5% was diagnosed with at least one STI—infection with CT was most prevalent (18.2%), followed by infection with NG (12.1%) and HIV (11.1%). Of participants, 24.2% had evidence of exposure toTreponema pallidum; half was infectious at time of diagnosis. Of participants, 28.3% had evidence of previous exposure to hepatitis B virus (anti-HBc positive); 8.1% was infectious at time of diagnosis (HBsAg positive). 24.2% was fully vaccinated against hepatitis B.ConclusionsIdentification and recruitment for STI testing and prevention of this population at high risk for HIV and STI is shown to be feasible. Follow-up and retention appears to be a challenge. MSM-CSWs who have sex with men pose a serious STI acquisition and transmission risk regarding MSM-CSWs users. Further research is urgently required to address the needs of MSM-CSWs and explore prevention strategies. Furthermore, targeted health education to encourage safer sex is needed.
P1-S2.12 Improving access to STI care among female sex workers by strengthening service provider networks in Bangalore, South India
Authors: Shetti B , Sunil P , Bhattacharjee P , Moses S , Prakash K H , Vidyacharan M 
Published: July 2011

BackgroundThe Karnataka Health Promotion Trust, in partnership with non-governmental and community-based organisations, has been implementing a focused HIV prevention project among female sex workers (FSWs) in Bangalore since 2005. Over 25 000 distinct female sex workers have been contacted to date, and approximately 10 000 distinct FSWs are regularly contacted each month. The majority of FSWs are street-based and home-based, and are dispersed throughout the city. In the first 3 years of the project, STI services were provided through eight program-linked clinics located in program drop-in-centres, and 20 external referral doctors. Discussions with FSWs indicated that distance and inconvenient timings of the clinics were major barriers to accessing STI services. A strategy was therefore developed in 2008 to expand the network of referral doctors. Referral doctor networks were established at sites based on recommendations made by FSWs, both in government facilities and in private clinics. A total of 70 referral doctors (preferred providers) were identified and trained to provide quality STI services. We evaluated the outcome of this changed strategy.MethodsIndicators related to STI services provided and their accessibility were extracted from the program's computerised management information system (CMIS).ResultsFollowing the change in strategy, average monthly clinic visits by FSWs increased from 16% to 28% of the total available population. Quarterly clinic visits increased from 41% in 2008 to 63% in 2010. Administration of presumptive STI treatment for newly identified FSWs increased from 35% in 2008 to 58% in 2010. Focus group discussions with FSWs indicated that they are more comfortable in accessing clinic services, as the preferred providers are closer to where they live and work, and are available at more convenient times, especially in the evenings. This resulted in the higher levels of service coverage. The sex workers also indicated that, although services currently are provided at no charge to them, they would continue to access them from the preferred providers if the project ended, even if they had to pay for the services.ConclusionsEstablishing a network of referral doctors who have been identified and sanctioned by the FSW community has complemented program-linked STI clinic services in the context of a large-scale HIV prevention program in the city of Bangalore, and has made STI services more accessible.
P1-S1.07 Multiple bacterial sexually transmitted infections in Ontario, Canada
Authors: Lee C , Whelan M , Achonu C , Bhanich-Supapol W , Christian J 
Published: July 2011

BackgroundIn 2009, there were 33 000 reported cases of chlamydia, gonorrhoea and infectious syphilis in Ontario. These reportable bacterial sexually transmitted infections (STIs) represented approximately 48% of all reportable disease cases reported in Ontario that year. A significant amount of resources is expended on public health case and contact management of bacterial STIs. The objective of our study was to use routine surveillance data from Ontario to quantify the incidence of persons with reported multiple bacterial STIs in Ontario from 2006 to 2009 in order to inform future public health interventions.MethodsAll bacterial STI records from 2006 to 2009 were extracted from Ontario's integrated Public Health Information System (iPHIS). Multiple STIs were defined as repeat bacterial STIs or infection with a different bacterial STI in the same individual. Repeat STIs were defined as diagnoses of chlamydia or gonorrhoea more than 28 days after the previous infection. The data were analysed using PASW 18 for Windows (SPSS Inc.).ResultsThere were almost 100 000 unique clients with at least one bacterial STI from 2006 to 2009 representing 113 097 STI cases. Approximately 24% of STI cases reported from 2006 to 2009 occurred in individuals with multiple STIs during the same timeframe. However, clients with multiple STIs accounted for only 12% of the total number of clients reporting at least one STI in this 4-year time period and clients with three or more STIs only accounted for 2.4% of all clients. The majority of clients (∼60%) with multiple STIs were infected within one year of their first STI. On average clients with multiple STIs had more sexual contacts recorded for their first STI than those clients who only had one STI (1.44 contacts vs 1.33 contacts, p<0.001). There was no difference in the number of clients lost to follow-up when comparing clients with only one STI to those with multiple STIs (p>0.9).ConclusionsPublic health resources may be well spent in case and contact management because almost 90% of individuals only have one STI reported. However, individuals who have multiple STIs account for a substantial proportion of reported bacterial STI cases in Ontario. Further work to identify additional characteristics of individuals at risk for multiple STIs would aid in informing future public health interventions aimed at these high-risk individuals.