bluuebunny/crossref_metadata_2025_split huggingface dataset:
O2-S3.05 STIs and neighbourhood drug markets: first a foray into measurement
Authors: Jennings J , Taylor R , Furr-Holden D , Ellen J 
Published: July 2011

BackgroundNeighbourhoods with drug markets (as compared to those without) may be more likely to have a greater concentration of STI infected sex partners. The objectives of this study were to assess the reliability and validity of three measures of neighbourhood drug markets.MethodsData were collected from a cross-sectional household study of English-speaking, sexually-active persons, 15–24 years of age (n=568) residing in selected neighbourhoods (n=63). Participants responded via ACASI to “In your neighbourhood, are there any places like a street corner, block, house, club, bar, or other place where drug activity, like people selling or buying drugs, happens?” Survey reports were aggregated to the neighbourhood level and coded to > (vs <) 50% of residents reporting yes. To supplement this measure, information was obtained from systematic social observations (SSOs) using a multi-item assessment tool. Multiple rater information on a block was aggregated to the greater value to generate one value for a block unit. Ratings were summed to create one continuous measure at the neighbourhood level. Additionally drug arrest data on drug manufacturing, distribution, or intent to distribute was measured as a count per neighbourhood. We conducted reliability analyses using intraclass correlations and inter rater reliabilities and convergent validity testing using Poisson and linear regression.ResultsWithin-neighbourhood respondent agreement on survey-reports of neighbourhood drug markets had a reliability 0.50 and an intra class correlation of 0.10 (p<0.001). Neighbourhood survey-reports were significantly associated with gonorrhoea counts (IRR) 3.05, 95 CI% 2.07 to 4.51, p<0.001) and socioeconomic status (SES) (ß −1.74, 95 CI% −2.54 to −0.93, p<0.001). The SSO drug market inter rater reliability was significant and moderate at the block level (0.57, p<0.05) with a reliability of 0.88. The SSO measure was not associated with gonorrhoea counts (IRR 1.18, 95 CI % 0.94 to 1.49, p=0.15) and was significantly associated with SES (ß −0.65, 95 CI% −0.99 to −0.31, p<0.000). Drug arrest counts were significantly associated with gonorrhoea counts (IRR 1.01, 95 CI% 1.00 to 1.01, p=0.002) and SES (ß −0.01, 95 CI% −0.02 to −0.01, p<0.001).ConclusionsThe results suggest that neighbourhood drug markets can be measured through the use of household survey-reports and drug arrest data; the use of SSOs was less clear. The mismatch of the drug market measures may have been due to differences between the measures in sensitivity and specificity.
O2-S4.01 Efficiency vs equity in screening: considerations in the scale-up of rapid syphilis testing in rural Tanzania
Authors: Sweeney S , Mosha J , Terris-Prestholt F , Changalucha J , Peeling R 
Published: July 2011

BackgroundThe burden of congenital syphilis remains high in many low-income countries, despite the availability of preventive therapy. Rapid syphilis tests (RSTs) could improve access to and cost-effectiveness of syphilis screening programs in low resource settings. The objective of this study was to inform programs how best to use RSTs based on relative efficiency, cost-effectiveness and access considerations.MethodsIncremental costs for RST screening in existing antenatal care settings in Tanzania were collected from nine health facilities varying in size, remoteness, and scope of services provided. The number of DALYs averted was modelled from project outputs. Economic costs per: woman tested, treated, and DALY were calculated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty.ResultsIn surveyed facilities a total 6362 women were tested with RSTs over a costing period of 9 months, as compared with just 224 tested with RPR over a similar time period the previous year. Total economic costs for RST screening ranged from $1758 to $6375. Unit costs ranged from $1.90 to $6.06 per woman screened, $17.76–$63.19 per woman treated, and $1.20–$4.26 per DALY. Larger facilities had lower unit costs, suggesting that economies of scale exist in screening services. Results were sensitive to assumptions regarding supply wastage, frequency of supervision, and program duration.ConclusionRST screening costs fall well below the WHO threshold for ‘highly attractive’ cost-effectiveness. Although RST costs are slightly higher than those for RPR, the number of women reached by screening services was increased under RSTs. Results suggest that RSTs can overcome critical barriers to antenatal syphilis testing and treatment. Through removal of supply chain barriers, RSTs enable the realisation of economies of scale in screening services. This suggests that larger facilities will benefit from implementation of RSTs. RSTs further allow for screening where a lack of infrastructure prevents consistent RPR testing. Therefore, in the effort to increase equity in access to screening, roll-out is also recommended in facilities not able to provide RPR screening. RSTs are currently being expanded throughout the country in the effort to increase access to syphilis screening in antenatal care. This could facilitate control of congenital syphilis and prevent countless unnecessary fetal and infant deaths.
O2-S4.02 Cost-effectiveness of screening forChlamydia trachomatisin Dutch pregnant women
Authors: Rours G I J G , Verkooijen R P , Verbrugh H A , Postma M J 
Published: July 2011

BackgroundChlamydia trachomatisinfections may have serious consequences for women, their offspring and pregnancy outcomes, but are largely asymptomatic. Prevention is therefore based on screening. Screening for Chlamydial infections during pregnancy is not part of routine antenatal care in many countries, as in the Netherlands.ObjectiveCost-effectiveness analysis ofC trachomatisscreening during pregnancy.MethodsA health-economic decision analysis model was designed, which included not only potential health outcomes ofC trachomatisinfection for women, partners and infants, but included also premature delivery. The cost-effectiveness was estimated from a societal perspective using recent prevalence data from a population-based prospective cohort study among pregnant women in the Netherlands. The prevented costs were calculated by linking health outcomes with health care costs and productivity losses. Cost-effectiveness was expressed as net costs per major outcome prevented and was estimated in a base-case analysis as well as a sensitivity- and scenario analysis.ResultsIn the base-case analysis (current base-case test cost €12), the costs to detect 1000 pregnant women withC trachomatiswere estimated at €378 300. Cost savings on complications were estimated at €924 600 resulting in net cost savings. Sensitivity analysis showed that net cost savings remained for a broad range of variation in underlying assumptions such as test costs (up to €32), proportion of complications that can be averted (between 25% and 75%), risk for PID (0.4% to 40%), and any other parameter within plausible ranges (between + to −25%). Cost savings were most sensitive to preterm delivery, but remained when preterm delivery was excluded (making the model comparable to other cost-effectiveness analyses). Scenario analysis showed even more cost savings with targeted screening for women's age (≥20 years, 26–30 years, and <30 years) or pregnancy rate (first pregnancies only). At base-case costs, screening appeared cost-saving in populations with a chlamydial prevalence beyond 1.7%. At the extremes, with test costs as low as €5 cost savings would already occur beyond a prevalence of 0.6% and with test costs as high as €40 cost savings would occur beyond a prevalence of 4.7% see Abstract O2-S4.02 figure 1.Abstract O2-S4.02 Figure 1Costs per QALY gained by prevalence when using different test costs forChlamydia trachomatisscreening in pregnant women.ConclusionsC trachomatisscreening of pregnant women in the Netherlands is cost-saving.
O2-S4.04 The cost of expedited partner therapy compared to the cost of standard partner referral for the treatment of chlamydia or gonorrhoea
Authors: Gift T , Kissinger P , Mohammed H , Leichliter J , Hogben M , Golden M 
Published: July 2011

BackgroundPartner treatment is an important component of sexually transmitted disease (STD) control. Several randomised controlled trials (RCTs) have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, and some found that EPT significantly lowered re-infection rates in index patients.MethodsWe collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient re-infection rates from two RCTs examining EPT and SR for patients diagnosed with chlamydia or gonorrhoea. Additional elements were estimated or drawn from the literature, such as the likelihood of progression to and QALY impact of sequelae. We used a Monte Carlo simulation (10 000 iterations) to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal. Sensitivity analyses assessed the impact of varying settings in which EPT might be employed, such as one in which no patient counselling or data entry costs were incurred when employing either EPT or SR.ResultsFrom a health care system or societal perspective, EPT was less costly and treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥ 40%–45% of male index patients’ female partners or ≥38% of female index patients’ male partners received care from the same payer. The Abstract O2-S4.04 figure 1 shows the Monte Carlo results for New Orleans and depicts the relationship between the cost difference between EPT and SR and the proportion of partners of the index patient who receive care from the same payer as the index. Negative values in the figure indicate EPT is less costly per patient. In sensitivity analyses, EPT was less costly than SR from all payer perspectives when counselling and data entry costs were eliminated; when counselling costs were applied to EPT alone, the payer-perspective cost of EPT was greater than SR for index women, but the additional cost was less than $2600 per QALY gained over SR.Abstract O2-S4.04 Figure 1Payer-perspective cost difference per index patient: Expected partner therapy (EPT)-standard referal (SR).ConclusionsEPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients’ partners receive care from the same payer.
O2-S4.05 Serosorting behaviours and beliefs among MSM at an urban LGBT health center
Authors: Hotton A , Gratzer B , Pohl D , Mehta S D 
Published: July 2011

BackgroundSerosorting, preferentially engaging in unprotected anal intercourse (UAI) with partners of the same HIV status, is practiced by some MSM as a risk reduction strategy.MethodsMay through November 2010, we assessed serosorting practices and beliefs among MSM seeking STI testing at an urban LGBT health center. We compared serosorting practices and beliefs by HIV status and partner characteristics with Pearson χ2tests. Sexual behaviours, partner characteristics, and HIV status were based on self-report.Results705 HIV-negative and 88 HIV-positive MSM completed the assessment. Median time since last HIV test was 7.5 months; nearly a third had not been tested in the last year. Overall, 53% reported no UAI, 27% reported seroconcordant UAI, and 18% reported serodiscordant UAI with last sex partner. UAI was more common with seroconcordant partners than with serodiscordant partners (55% vs 37%, p<0.001); 23% of HIV-positive and 17% of HIV-negative men reported serodiscordant UAI. 81% of men with seroconcordant partners said they knew their partner's status by getting tested together or talking with them; 5% determined partners' status indirectly and 14% did not report how they determined their partner's status. Seroconcordant UAI was more common among HIV-positive than HIV-negative men (53% vs 24%, p<0.001). Among 288 HIV-negative men reporting UAI: seroconcordant UAI was more common with main vs casual partners (76% vs 41%, p<0.001) and within monogamous vs non-monogamous relationships (69% vs 51%, p=0.003); serodiscordant UAI was more common among men with ≥3 recent sex partners vs <3 partners (50% vs 33%, p=0.005) and those who reported any anonymous sex partners vs none (53% vs 28%, p<0.001). Among men who said that they could not be talked out of safer sex with a seroconcordant partner, 10% of HIV-negative men and 16% of HIV-positive men reported serodiscordant UAI. 19% of HIV-negative men who endorsed seroconcordant partnerships reported serodiscordant UAI.ConclusionsDiscrepancies between serosorting endorsement and practice underscore the importance of assessing cognitions related to risk-taking and behaviour. High rates of partner concurrency, infrequent testing, and indirect assessment of partner serostatus may limit the effectiveness of serosorting as a risk reduction strategy, even with main partners. The contribution of serosorting to HIV transmission within primary relationships warrants further research.
O2-S5.05 Are MSM looking for lesions? Examining self and partners for syphilis
Authors: Surie D , Koumans E , Furness B , Perkins R , Brewer T , Turner D , Hernandez-Kline P , Gamerdinger K , Workowski K , Markowitz L 
Published: July 2011

BackgroundSyphilis rates among men who have sex with men (MSM) in the US are rising. In 2009, 62% of reported primary and secondary syphilis cases in the U.S. were among MSM. Self- and partner-examination for primary syphilis (painless chancre) might increase early detection and treatment and reduce transmission. As the first step in a study to increase syphilis lesion awareness, we collected baseline data on rates of self- and partner-examination.MethodsData were collected from five MSM STD or infectious disease clinics in the US before and after introduction of brochures with pictures and information about syphilis signs, transmission, and prevention. Surveys included questions about demographics, sexual behaviours, syphilis knowledge and self- and partner-examination. Data were analysed using SAS V.9.2.ResultsFrom September 2009 to January 2011, 586 sexually active men completed a survey; 124 (21%) from Arizona, 128 (22%) from the District of Columbia, 202 (34%) from Florida and 132 (22%) from Georgia; 542 (92.5%) reported having sex with men only and 44 (7.5%) reported having sex with men and women. Most participants (334, 57%) were aged 18–39 years, 240 (41%) were 40–59 years and 12 (2%) were older than 60 years; 222 (38%) reported one partner, 180 (31%) 2–3 partners, 133 (23%) 4–10 partners, and 51 (9%) >10 partners in the last 3 months or since their last clinic visit. Most participants correctly identified oral (510, 87%), anal (529, 90%) and oral-anal sex (487, 83%) as ways to transmit syphilis. Few recognised frottage that is, rubbing against someone (112, 19%) and kissing (196, 34%) as other modes of transmission. Over 50% reported self-examination of mouth, penis and skin at least once a week, whereas less than half reported partner-examination of these areas (Abstract O2-S5.05 table 1). Less than 50% reported self- or partner-examination of anus at least once a week. Rates of self-examination did not vary by number of partners or age; whereas, examining partner's mouth, penis and skin was less frequent (p<0.05) among MSM with >3 partners.Abstract O2-S5.05 Table 1Proportion of MSM reporting self- and partner-examination of mouth, anus, penis and skin, n=586)Body partsFrequency of examinationNever (%)Once a month (%)At least once a week (%)SelfMouth17.114.568.4Anus26.424.948.7Penis6.27.686.3Skin8.39.781.9PartnerMouth76.67.715.6Anus62.111.526.5Penis47.111.641.4Skin47.29.843.0ConclusionsThe majority of MSM reported examining themselves at least once a week, but did not examine their partners as frequently. MSM with >3 partners were less likely to examine their partners' bodies than those with fewer partners. Analysis of surveys from men after brochure introduction will determine whether education materials increase rates of self- and partner-examination.
O2-S6.02 Occupational and intimate partner violence and inconsistent condom use with clients among female sex workers in southern India
Authors: Deering K , Bhattacharjee P , Mohan H L , Bradley J , Shannon K , Boily M C , Ramesh B M , Isac S , Moses S , Blanchard J 
Published: July 2011

BackgroundGlobal reports suggest that interpersonal violence experienced by female sex workers (FSWs), including occupational violence (eg, by clients, CLViol) and intimate partner violence (IPViol) may be important structural determinants of vulnerability to HIV and sexually transmitted infections (STIs). This study characterised the type and frequency of CLViol and IPViol experienced by FSWs in southern India and examined the relationship between client violence and inconsistent condom use (ICU) with clients.MethodsData were analysed from cross-sectional surveys of FSWs in three districts in Karnataka state (2007). ICU was defined as condom use frequency reported as 'never/sometimes/often' vs ‘always’, by repeat and occasional clients. CLViol and IPViol measures included having experienced physical violence in the past 6 months (ie, hurt, hit, kicked, punched, choked, burned) or sexual violence in the past year (ie, beaten or otherwise physically forced to have sexual intercourse).ResultsOf our sample of 1245 FSWs, ICU was 13.0% with occasional and 20.2% with repeat clients. Overall, 13.1% of women reported physical violence from any perpetrator (CLViol: 5.5%; IPViol: 4.6%) and 9.7% reported sexual violence (CLViol: 5.2%; IPViol: 4.4%). In multivariable logistic regression analysis, the odds of ICU with occasional clients were significantly higher for women who had experienced physical CLViol (adjusted OR (AOR): 2.4, 95% CI: 1.2% to 4.8%) or sexual CLViol (AOR: 2.7, 95%CI: 1.3% to 5.5%). Similar results were found with repeat clients: AOR: 2.5, 95% CI: 1.4% to 4.6% and AOR 2.3, 95% CI: 1.3% to 4.2%, for physical and sexual violence respectively. A dose-response relationship between the number of times experiencing CLViol and increased ICU with both types of clients was also observed (p<0.001) (Abstract O2-S6.02 figure 1). IPViol was not significantly associated with ICU with clients. Experiencing CLViol was not associated with experiencing IPViol (p=0.321).Abstract O2-S6.02 Figure 1Proportion of female sex workers who used condoms inconsistently with occasional or repeat clients according to the number of times they experienced physical violence by clients in the last 6 months (did not experience, experienced one time, experienced 2-5 times, experienced 6+ times).DiscussionA strong independent relationship between experiencing client violence and inconsistent condom use with clients among FSWs in southern India was observed, highlighting FSWs' vulnerability to HIV/STI infection. Occupational violence against FSWs should be addressed within HIV/STI prevention programming. Structural-legal reforms to current sex work laws and safer-environment interventions should be developed to reduce violence and HIV/STI vulnerability among FSWs.
O2-S6.03 Heterogeneity of HIV risk: female sex worker clients and their non-commercial sexual partners in south India
Authors: Shaw S , Deering K , Isac S , Ramesh B , Washington R , Moses S , Blanchard J 
Published: July 2011

IntroductionClients of female sex workers (FSWs) are an important bridging population for the further transmission of HIV and other sexually transmitted infections (STIs). However, the extent of risk to non-commercial partners (NCP) of clients has rarely been quantified. This study sought to characterise the risk behaviours of clients with both non-commercial and commercial partners.MethodsData were collected from a cross-sectional integrated behavioural and biological survey of FSW clients from five districts in Karnataka state, southern India. Clients were classified into three groups: married (and thus with an NCP); unmarried with at least one NCP; and unmarried without an NCP. Bivariate and multivariable logistic regression models were constructed to examine the association between group membership and condom use patterns with regular and casual FSWs, and where applicable, non-commercial partners. Associations between the prevalences of HIV, HSV-2, syphilis, gonorrhoeal and chlamydial infections and group membership were examined in multivariable models. Normalised weights were used to account for a complex sampling design.ResultsThe total sample size was 2328. Most respondents (61%) were married, 9% were unmarried with an NCP, and 30% were unmarried without an NCP. Married clients were, on average 9 years older (34 vs 24.8 years), and had been visiting FSWs for an average of 12 years, vs 4 years in the other two marital categories. Compared to respondents without an NCP, married clients were at higher odds of reporting never using condoms with both casual (AOR: 1.8; 95% CI:1.3% to 2.4%, p<0.0001) and regular (AOR:1.8; 95% CI 1.2% to 2.7%, p=0.009) FSWs. Among the two groups reporting an NCP, 91% of married respondents reported never using condoms with their NCP, compared to 62% of unmarried clients (AOR: 5.2; 95% CI 3.3% to 8.1%, p<0.0001). HIV prevalence was 6 %, 5% and 8% among those that were married, those unmarried without an NCP, and those unmarried with an NCP, respectively (p=0.384). For the same groups, HSV-2 prevalence was 37%, 16% and 19% (p<0.0001). In adjusted analyses, married respondents remained at highest odds of being infected with HSV-2 (AOR: 1.5; 95% CI 1.1% to 2.1%, p=0.006).ConclusionMarried respondents were least likely to use condoms with both commercial and non-commercial sexual partners, while also having the highest prevalence of HSV-2. These findings illustrate the high risk posed to both commercial and non-commercial partners of married clients of FSWs.