bluuebunny/crossref_metadata_2025_split huggingface dataset:
O5-S2.05 Role of regional reference laboratories for sexually transmitted infections in improvement of second generation HIV surveillance experience from the Central America Region
Authors: Ye T , Steele L , Juarez S I , Chen C Y , Ballard R C 
Published: July 2011

BackgroundWHO/UNAIDS recommends National HIV/AIDS and Sexually Transmitted Infection STI) Control Programs to implement integrated HIV, STI and behavioural surveillance to assess the disease burden, and to monitor the temporal trends of HIV/STI prevalence and high-risk sexual behaviours. Despite this recommendation, there is limited STI prevalence data available in many resource poor countries owing to lack of STI laboratory capacity to detect multiple STIs. The CDC STD lab explored the feasibility of a decentralised laboratory strengthening approach by applying more advanced molecular STI diagnostic methods to support the second generation surveillance (SGS) activities in the Central American Region during 2007–2011.MethodsCDC STD lab developed a real-time multiplex PCR (MPCR) to detectNeisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis,andMycoplasma genitalium. In collaboration with regional partners, CDC identified and transferred the diagnostic technology to a regional STI reference laboratory in 2008. The regional reference laboratory provides MPCR testing on specimens collected for surveillance purpose. This standardised SGS study design was implemented at regular intervals in multiple countries in the region to estimate the disease burden and to monitor temporal STI trends.ResultsDuring 2007–2010, four national integrated sexual behavioural and biomarker surveys were implemented using CDC's affiliated regional STI reference center. The quality STI prevalence data was made available to the national HIV/STI programs in Honduras, El Salvador, Nicaragua and Colombia. Similar CDC supported surveillance studies are in-preparation in Guatemala, Belize, Panama, Honduras (second round) and the Dominican Republic.ConclusionsBased on the experience from the Central American Region, it is feasible to implement integrated HIV, STI and behavioural surveillance surveys using robust molecular techniques in resource poor settings. In collaboration with regional partners, CDC's approach to STI laboratory capacity strengthening through establishing a regional reference laboratory should be expanded to other regions.
O5-S3.01 Use and effectiveness of expedited partner therapy in an inner-city STD clinic
Authors: Mickiewicz T , Al-Tayyib A , Mettenbrink C , Rietmeijer C 
Published: July 2011

BackgroundIn November 2006, the Denver Metro Health (STD) Clinic (DMHC) began offering Expedited Partner Therapy EPT) to heterosexual patients infected with Chlamydia trachomatis (Ct) orNeisseria gonorrhoeae(GC). Among those who accept EPT, the patient delivers treatment to his or her partner(s), removing the need for a clinic visit. We investigate demographic differences among patients who accepted EPT and examine re-infection rates among those who return to the clinic.MethodsData were extracted from the electronic medical record (EMR) for 2644 eligible patients offered EPT between November 2006 and October 2010. Acceptance rates are compared across demographics and infection status. Rates of re-infection are examined among the 339 patients who returned for re-testing within 21 to 90 days of treatment. Dual infections are excluded.ResultsOverall, 763 (28.3%) eligible patients accepted EPT. Women were more likely than men to accept EPT (35.9% vs 23.8%, p<0.01). Patients younger than 40 accepted EPT at a higher rate than those 40 or older (29.6% vs 20.0%, p<0.01). African Americans were least likely to accept EPT (23.0%), whereas approximately 30% of Hispanics and Whites accepted and those reporting multiple races accepted at the highest rate (43.6%) (p<0.01). Ct infected patients were significantly more likely to accept EPT than those infected with GC (32.7% vs 24.6%, p<0.01). Within 21 to 90 days of treatment initiation, 339 patients returned for re-testing (221 for Ct and 118 for GC). Overall, re-infection rates differed significantly by EPT acceptance at the initial visit with 11.1% re-testing positive among those who accepted EPT compared to 20.4% among those who refused (p=0.04) (Abstract O5-S3.01 table 1). When stratified by type of infection, the differences were no longer significant but the direction of the relationship remained. Among those originally Ct-infected, 9.1% of those who accepted EPT re-tested positive vs 15.3% among those who refused (p=0.19). Among those originally GC-infected, 16.1% of EPT acceptors re-tested positive compared to 28.7% of those who refused (p=0.17).Abstract O5-S3.01 Table 1Use and effectiveness of expedited partner therapy in an inner-city STD clinic Mickiewicz T, Al-Tayyib AA, Mettenbrink C, Rietmeijer CARe-infection rates among those returning to clinic for re-testingCtGCCt or GC*Accepted EPT7/77 (9.1%)5/31 (16.1%)12/108 (11.1%)Refused EPT22/144 (15.3%)25/87 (28.7%)47/231 (20.4%)*p<0.05.ConclusionsIn a busy inner-city STD clinic, EPT is more likely to be accepted by women, those who are younger and those infected with Ct. Re-infection rates among patients returning to the clinic suggest that EPT reduces the risk of re-infection, with the greatest benefit among those originally infected with GC.
O5-S3.02 Implementation of an Expedited Partner Therapy (EPT) Program in an inner-city STD clinic
Authors: Mickiewicz T , Al-Tayyib A , Mettenbrink C , Rietmeijer C 
Published: July 2011

BackgroundExpedited partner therapy (EPT) is the practice of treating sex partners of persons with sexually transmitted diseases (STD) without an intervening medical evaluation. In 2006, the CDC issued guidelines for providing EPT to heterosexual patients diagnosed with gonorrhoea/chlamydial infection, allowing them to deliver treatment to their partner(s). In November 2006, the Denver Metro Health (STD) Clinic (DMHC) began offering EPT. We describe EPT implementation challenges and process improvements.MethodsThree phases of implementation are described: 1) the pilot phase, 2) implementation of a quality assurance protocol and 3) initiation of a prompt in the electronic medical record (EMR). Data were extracted from the EMR to calculate acceptance rates of EPT among the 2056 eligible patients over this time period. Rates were examined by month and for each phase.ResultsBefore initiation of the pilot phase, a protocol to dispense EPT was developed and staff trained. During the pilot phase (September 2007–April 2008), patient acceptance rates averaged 17% (range: 8%–22%). As rates were not improving, EMR data were examined to determine potential areas for intervention. At DHMC, clinical services are provided by health care partners (HCP) and licensed nurse practitioners (LNP). Analyses revealed significant differences in patient acceptance of EPT by provider type: HCP providers were less likely to have patients accept EPT than LNP providers (prevalence ratio=1.7, 95% CI: 1.5% to 1.9%), likely due to the nature of the visit and the volume of patients seen by HCP providers. Targeted re-training was initiated and quality assurance reports were generated monthly. Although the acceptance rate increased significantly to 22% (p=0.04), there was no indication that rates were increasing with time. In January 2009, the EMR was amended, requiring all providers to document EPT referral, acceptance or refusal (and reason for refusal), before closing the patient EMR. Rates improved significantly to an overall rate of 49% (p<0.01) through October 2010 (Abstract O5-S3.02 figure 1). Reasons for refusal among those who did not accept EPT included that partner would be notified (42.5%), partner was being treated (30.1%) or the patient was not able to contact the partner (21.9%).Abstract O5-S3.02 Figure 1Acceptance rates of EPT Denver Metro Health (STD) clinic.ConclusionsIn a busy inner-city STD clinic, an automated EMR prompt that forces documentation of EPT provided the greatest success. An EPT acceptance rate of 50% may be the optimum rate in a real-world setting.
O5-S3.03 Incremental cost-effectiveness of introducing partner notification with selective screening for STD control in Louisiana
Authors: Rahman M , Khan M , Longfellow L 
Published: July 2011

BackgroundSelective screening and partner notification are the two strategies used by the STD control programs in USA to reduce and or eliminate syphilis. So far no study has assessed the cost and effectiveness of either approach at the state level. The objective of this study is to assess the incremental cost effectiveness (ICE) of adding partner notification with selective screening (SS) in detecting early syphilis and to measure ICE of intensity of partner notification in Louisiana.MethodThe cost effectiveness analysis (CEA) was done from the point of view of health care delivery. Micro costing approach was used in cost analysis and the CEA was performed by using the recurrent direct costs associated with detecting syphilis by SS and by SS with partner notification see Abstract O5-S3.03 figure 1. For ICE of intensity of partner notification, cost was calculated for every attempt made to contact a partner and effectiveness was calculated by the number of partners identified as well as the number of cases identified through partner notification.Abstract O5-S3.03 Figure 1Steps involved in syphilis case detection by partner notification and selective screening and cost associated in each method. Partner notification: A- cost for phlebotomy B- cost of tests C- cost for surveillance D- cost for case management including travel. Selective screening: 1- cost for phlebotomy, 2- cost of tests, 3- cost to contact infected patients including phone call and letter or field visit related supplies and travel.ResultsThe estimates of direct costs associated with SS was $6.4 million for 1005 early syphilis cases detected and $6.7 million for SS with partner notification. Partner notification detected additional 279 early syphilis cases with an additional cost of $314 498. Incremental cost of adding partner notification with SS was $2808 per primary and secondary syphilis case, $1883 per early latent syphilis case, and $1127 per early syphilis case identified. ICE of identifying partner showed a decline with the increase in number of attempts but the ICE values of case detection through partner notification did not show any systematic pattern.ConclusionThis study demonstrates that adding partner notification with SS is more CE in syphilis detection in Louisiana compared to case detection by SS alone. In terms of intensity of partner notification, it was found that increasing the number of attempts to contact the partners remained cost effective but due to variability in the number of attempts to contact cases, it was not possible to determine the optimal number of attempts.
O5-S3.04 Individual and population level effects of partner notification forChlamydia trachomatis
Authors: Althaus C L , Heijne J C M , Herzog S A , Roellin A , Low N ,   Partner Notification Modelling Project Group
Published: July 2011

BackgroundPartner notification (PN) is an essential part of the case management of sexually transmitted infections STI), including Chlamydia trachomatis. Failure to notify current partners might cause re-infection of the index case, whilst failure to notify previous partners could result in ongoing transmission in the population. The impact of PN at both the individual and population level is, however, unclear.MethodsWe developed an individual-based modelling framework called Rstisim, which can simulate transmission of any STI through a dynamic sexual network and track the history of an individual's partnerships. The effect of different PN strategies forC trachomatiswas investigated in three models with increasing levels of complexity of the sexual partnership dynamics: a) an instantaneous contact model which is based on the widely used assumption that sexual contacts happen instantaneously; b) a pair model where sexual partnerships last for a certain period; c) a triple model in which individuals can have up to two concurrent partnerships. We used data from the National Survey of Sexual Attitudes and Lifestyles (Natsal) 2000 for 16–25-year-old women and men to parameterise the sexual behaviour of young adults.ResultsThe models all have a baseline chlamydia prevalence of 3%. In the triple model, chains of contacts can be seen at cross-section, whereas there are, by definition, no ongoing partnerships in the instantaneous contact model. In all three models, we find that a substantial proportion of partners (>10%) from partnerships that ended as far back as 18 months is infected withC trachomatis. We then investigated the population level effect of PN (with 50% success) as a complementary strategy to screening (at a rate of 0.1 per year). Increasing both the number of notified partners and the PN period results in lower levels ofC trachomatis. Under the most realistic assumptions of the sexual partnership dynamic, most of the effect of PN results from notifying the current partner.ConclusionsWe found that extended PN periods can efficiently identify new chlamydia-infected cases. At low screening levels, the additional benefit of PN in decreasing chlamydia prevalence is minor and primarily derives from notifying the current partners in order to prevent re-infection. This study exemplifies the differences between individual and population level outcomes of PN as an intervention for the management ofC trachomatisinfections.
O5-S3.05 Partner notification for STI And HIV: patients' views and experiences of notifying partners
Authors: Wayal S , Cassell J , Scambler G , Hart G , Low N 
Published: July 2011

BackgroundPartner notification (PN) involves contacting the sexual and needle-sharing partners of patients diagnosed with STI/HIV. Effective PN can prevent onward STI/HIV transmission. However, little is known about the socio-cultural factors affecting PN. We synthesised qualitative literature on views and experiences of PN among people recently diagnosed with STI/HIV and their contacts.MethodsWe conducted a systematic search of 4 electronic databases for PN literature from 1990 to August 2009. Meta-ethnography was used to synthesise data from the 16 studies that met our inclusion criteria. We identified key metaphors and themes from individual studies and compared them and their explanations with other studies to enable further interpretations. We then examined the emerging concepts that have implications for STI/HIV PN policy and programs.ResultsOur synthesis revealed that PN is influenced not only by type of partnership or infection but also by the socio-cultural, religious, and legal framework governing sex and sexuality. Paradoxically while PN is perceived as altruistic, and as a moral responsibility towards partners, it is also feared as 'social suicide'. 'Breaking the bad news' is perceived as a difficult and potentially troublesome task; however, patient referral is preferred to provider referral. STI/HIV diagnosis invokes 'embodied shame' which can result in non-disclosure, or selective disclosure, or confronting and blaming the partner, especially a main current partner. While the experience of notifying partners is typically not as bad as expected, it occasionally results in violence against women. Injecting drug users felt less able to notify drug-using partners due to legal implications. Provider-led notification is considered protective against fear of violence and social stigma.ConclusionsMeta-ethnography enabled the synthesis of qualitative literature to derive new interpretations and comparative explanations from these data. Our synthesis reveals that PN should be voluntary and confidential and a choice of patient and provider referral methods should be offered. PN programmes should support patients in coping with feelings of shame and guilt to assist notification and facilitate timely testing and treatment of sexual partners. Further research on the sexual health outcomes of PN, its effect on partnerships and how best to reduce the fear of stigma and discrimination associated with STI and PN is needed.
O5-S3.06 Testing for STIs in population-based sexual health surveys without returning results: development of an ethical and pragmatic approach
Authors: Field N , Tanton C , Mercer C , Nicholson S , Sjordin S , Soldan K , Beddows S , Ison C , Johnson A , Sonnenberg P 
Published: July 2011

BackgroundSexual health surveys are enhanced by biological measures, such as non-invasive testing for STIs. The Third British National Survey of Sexual Attitudes and Lifestyles (Natsal 3) will estimate the population prevalence of five STIs (C trachomatis,N gonorrhoeae, type-specific Human Papilloma Virus, HIV andM genitalium) in a probability sample aged 16–44 y. This raises complex ethical issues, including return of results, testing in under-18s, appropriate consent and confidentiality. We describe the development of an ethically sound and acceptable approach to urine testing for STIs, without returning results, in Natsal 3.MethodsThe Natsal team considered the following: (1) more appropriate settings to obtain free STI testing and advice are now widely available, (2) survey conditions and sample type limit accuracy and timeliness, (3) for some STIs, the clinical and public health implications are unknown, (4) a uniform approach is easier to explain and be understood, (5) non-return of results is more cost efficient, enabling wider STI testing, (6) practical difficulties in returning results, (7) non-clinical interviewers. This rationale was subjected to peer-review as part of the funding process, stakeholders were engaged, and it was then submitted to a research ethics committee (REC). Piloting was performed in the general population to test acceptability and feasibility. Findings The agreed approach involved written consent for voluntary anonymised testing with the knowledge that results are not returned and the option of sample storage for future research. Confidentiality was assured by keeping STI data and personal identifiers at separate institutions, and a detailed protocol was designed to ensure that STI data were irreversibly unlinked after 3 months. In piloting, 61% (68/111) of participants agreed to provide a sample and 93% (63/68) agreed to sample storage for future research. All participants were given information about accessing clinical tests and STI advice.ConclusionsThe testing of STIs and the decision not to return results was accepted by a REC, in the context of a stakeholder consensus, and was acceptable to participants in developmental pilot work. Our experiences, both in developing the approach, and in the mechanisms to achieve this, may inform the ethical considerations of researchers, RECs and funders in study design and ethical approaches to population-based biological sampling.
O5-S4.03 HIV testing among patients infected withNeisseria gonorrhoeae-STD surveillance network, USA, 2009–2010
Authors: Bradley H , Asbel L , Bernstein K , Mattson M , Pathela P , Pino R , Samuel M , Schwebke J , Stenger M , Tabidze I , Zenilman J , Dowell D , Weinstock H 
Published: July 2011

BackgroundAn estimated 21% of 1.1 million HIV-infected US residents do not know they are infected and may unknowingly transmit HIV. Because people with sexually transmitted diseases (STDs) are at increased risk of HIV, CDC recommends HIV screening for patients seeking STD treatment. We investigated whether patients given a diagnosis ofNeisseria gonorrhoeaeduring January 2009-June 2010 were concurrently tested for HIV.MethodsWe used data from interviews with randomly selected gonorrhoea-infected patients in the 12 state and local health jurisdictions constituting the STD Surveillance Network. We compared the prevalence of HIV testing concurrent with gonorrhoea testing or treatment among patients seeking care in STD clinics and patients in other practice settings (emergency rooms, public and private outpatient facilities, hospitals, and family planning clinics).ResultsOf 6658 eligible patients, 3462 (52%) were successfully interviewed. Complete data were available for 1845/3462 (53%). Of these, 51% were tested for HIV when they were tested or treated for gonorrhoea. The proportion of gonorrhoea patients tested for HIV ranged from 22% to 74% by jurisdiction. STD clinic patients were more likely to be tested for HIV than those in other practice settings (61% vs 46%, p <0.01), see Abstract O5-S4.03 figure 1 and women were more likely than men to be tested for HIV in STD clinics (71% vs 58%, p=0.01). HIV testing was more common among black (53%) and Hispanic women (54%) compared with white women (36%, p=0.01). Men who have sex with men (MSM) were generally more likely to be tested for HIV compared with other men (56% vs 48%, p=0.02), though 58% of both MSM and MSW were tested for HIV in STD clinics. We found no association between HIV testing and race (among men), age, or having multiple sex partners.Abstract O5-S4.03 Figure 1Percentage of patients tested for HIV concurrently with gonorrhea testing or treatment by facility type and jurisdiction.ConclusionsHIV testing among gonorrhoea-infected patients is sub-optimal. While patients are more likely to be HIV-tested in STD clinics than in other practice settings, even STD clinics miss many opportunities to test high risk groups such as MSM, who are less likely than women to be HIV tested in this setting. Interventions are urgently needed to increase HIV testing among STD patients.