bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S7.08 Assessment of chlamydia testing coverage using HEDIS data: USA, 2009
Authors: Tao G , Hoover K , Romaguera R , Kent C 
Published: July 2011

BackgroundIn the USA, chlamydia screening of all sexually active women aged ≤25 years is recommended, but screening rates are low. The Healthcare Effectiveness Data and Information Set (HEDIS) performance measure has tracked the time trend in screening since 2000. It has been found that among sexually active women aged 15–25 years, chlamydia testing rates increased from 25.3% to 41.6% during 2000–2007. While rates have increased, they remain suboptimal, and it is unknown whether testing rates differ significantly between 2007 and 2009 or by the type of health plan.MethodsThe 2009 HEDIS chlamydia testing dataset was analysed to estimate the annual coverage among sexually active women aged 15–25 years who were enrolled in commercial health plans. Sexually active women were defined as those who had a claim or visit for pregnancy, contraception, cervical cancer screening, or STD diagnosis, screening, or treatment. A woman was counted as having a test if she had a claim or healthcare visit for any chlamydia test. Health plan types included in the HEDIS data are health maintenance organisations (HMOs), preferred provider organisation (PPO), point of service (POS), and any combination of HMO, PPO, and POS.ResultsOf 2.4 million sexually active women, 54.5% were enrolled in PPOs, 28.7% in combined HMO/POSs, 13.8% in HMOs, 2.7% in combined HMO/POS/PPOs, and 0.3% in POSs. The overall annual chlamydia testing rate was 44.2% and significantly differed by plan type: 56.1% in HMOs, 45.7% in combined HMO/POSs, 44.6% in POSs, 41.2 in combined HMO/POS/PPOs, and 40.5% in PPOs.ConclusionsThe annual chlamydia testing rate continued to increase between 2007 and 2009 (41.6% to 44.2%). However, the testing rate remains suboptimal, suggesting that additional interventions are needed to further increase testing rates. The highest testing rates were found in HMOs, healthcare settings that have interventions in place to promote provision of recommended healthcare services. The 2010 Affordable Care Act requires insurance plans cover preventive services such as chlamydia screening without patient cost sharing, and has the potential to increase chlamydia screening coverage throughout the US healthcare system. In light of these changes, it is important to continue to monitor chlamydia testing practices and to overcome barriers to testing.
P1-S2.04 Impact of female sex worker turnover on HIV prevalence, incidence and core group intervention impact in Cotonou (Benin)
Authors: Boily M C 
Published: July 2011

BackgroundThe influence of turnover of female sex workers (FSW), resulting from different durations spent in sex work or migration patterns remains partly understood but is believed to be an important determinant of HIV/STI spread among FSW and overall populations and intervention impact.MethodsA deterministic transmission dynamics model, parameterised using serial cross-sectional data, was used to simulate the course of HIV and gonorrhoea (Gc) in FSW/clients and the general population of Cotonou. Different turnover patterns were produced by varying the time spent in sex work (SW duration=lifelong to 1 year) or, equivalently, time spent in the location by migrants (sojourn duration=lifelong, 5, 1 year). Each FSW leaving the local population was replaced by a new FSW with the same risk behaviour and with FSW HIV prevalence, for the SW duration scenarios, set to that of the low risk population and, for the migration scenarios, to 0%, 5% or 50%.ResultsShortening SW duration (or sojourn duration with initial 0% FSW HIV prevalence) from lifelong to 5- and 1-year delayed and reduced FSW HIV peak prevalence from ∼75% in 1999 to 56% in 2000 and ∼25% in 2020, respectively. The 1-year scenario increased long-term HIV prevalence of the overall female population by twofold, as the rapid turnover reduced the decline in Gc prevalence caused by AIDS differential mortality. With 1-year sojourn duration, local FSW HIV prevalence was mostly determined by the HIV prevalence of new FSW and FSW HIV incidence always exceeded prevalence (Abstract P1-S2.04 figure 1). Sudden increases in turnover of new HIV negative FSW (or sojourn duration=1 year & 0% HIV), in a maturing epidemic (1993), could reduce FSW HIV prevalence by >50% within 2 years but increase HIV incidence, in absence of intervention, compared to no turnover (ie, lifelong duration). The different SW and migration duration patterns did not significantly reduce the general population impact of a FSW targeted condom intervention per se, after controlling for epidemic stages, assuming similar exposure to the intervention by local and new FSW.Abstract P1-S2.04 Figure 1Cotonou.ConclusionsThe impact of FSW turnover on HIV is complex but relatively modest if occurring at a slower rate than 0.20 per person-year (ie 1/5 years). Monitoring change in FSW turnover is important to interpret HIV prevalence trends over time, especially following an HIV intervention. Targeted FSW intervention remains effective in presence of rapid turn-over if new FSW can be reached rapidly.
P1-S2.16 What do female sex workers do if they have genital symptoms?
Authors: Lee K , Wong K H 
Published: July 2011

BackgroundFemale sex workers (FSW) is an important population in sexually transmitted infection (STI) epidemiology because of their extended partnership pattern that possibly leads to rapid STI spread. Prompt STI diagnosis, treatment and surveillance among FSW is therefore necessary for effective control of STI in the community, and public STI clinics remain the key platform for such. Yet, much is unknown about the pattern of health-seeking behaviour including STI clinic attendance of the FSW.MethodsA cross-sectional survey of 986 FSWs sampled from one-woman brothels, bars, clubs and streets in Hong Kong were conducted in 2009. Questions on last year attendance at public STI clinics, NGO testing centres, prior 6-month self-reported STI, STI symptoms and the subsequent actions regarding the symptoms were asked. Descriptive analysis was performed to show these frequencies. Self-reported rate among those with or withot symptoms were calculated. Self-reported STI and STI symptoms among those STI clinic and NGO attendees and non-attendees were compared using χ2test.ResultsOverall, 7.8% respondents reported having at least one episode of STI in the last 6 month. About one-third reported either having abnormal vaginal discharge, growth or ulcer in recent 6 months. Strikingly, about two-thirds would either self-medicate or adopt wait and see approach and about one-third attended private doctor or doctor across the border. Altogether less than 5% would attend NGO/STI clinic. Only 26% reported attendance at public STI clinic and 25% in NGO testing centre in the past 1 year. Self-reported STI was reported by 4% of those asymptomatic respondents, and 14% among those reported having any genital symptoms (p<0.05). The self-reported STI rate and STI symptom pattern did not differ significantly between the public STI and NGO attendees and the non-attendees see Abstract P1-S2.16 Figure 1.Abstract P1-S2.16 Figure 1Actions subsequent to presence of genital symptoms (vaginal discharge, genital growth or ulcer). SHS, public STI clinic.ConclusionsSTI are three times more commonly reported among FSWs who reported genital complains. However, majority of them would not seek appropriate medical care when symptoms occur indicating that treatment might have been delayed. Self-medication is common and remain a challenge for health promotion in FSW. Although no significant difference is found between clinic attendees and non-attendees on STI symptoms, STI clinic data only captures a fraction of STI burden in FSW.
P1-S2.23 Transgender persons in Guatemala - over-exposed and under-protected - the findings of an RDS behavioural survey
Authors: Miller W , Alvarez B , Boyce S , Alvarado A , Barrington C , Paz-Bailey G 
Published: July 2011

BackgroundMale-to-female transgender persons experience the highest HIV prevalence rates of any high risk population in Central America. The purpose of this study is to compare HIV-related risk behaviours, knowledge and exposure to prevention activities among transgender persons and other men who have sex with men (MSM) in Guatemala City.MethodsFrom September—to December 2010, we conducted a probability-based survey of MSM, including male-to-female transgender persons who have sex with men, using respondent-driven sampling (RDS) in Guatemala City. Data on sexual and drug use behaviour, knowledge of HIV, attitudes, stigma, access to prevention, care, and treatment services were collected by interviewers using Personal Digital Assistants (PDA). Population proportions and 95% CIs, adjusted for RDS sampling weights, were calculated using the Respondent Driven Sampling Analysis Tool (version 6.0). Crude summary statistics were calculated in SAS (version 9.1).ResultsA total of 509 MSM, including 99 male-to-female transgender persons enrolled in the study. The mean age for transgendered persons was 29.1 vs 28.0 for non-transgender MSM. Education level and socio-economic status were comparable between the two groups. Transgender persons, in comparison to non-transgender MSM, had higher rates of transactional sex (77.6% vs 41.9% in the past year, respectively), drug use (26.7% vs 3.3% cocaine use in the past month) and prior HIV testing (95.7% vs 68.9%, during lifetime). On the other hand, transgender persons have similar levels of forced sex (14.1% vs 6.5% in the past year), exposure to HIV educational activities (74.2% to 67.8% in the past year), access to free condoms (83.9% to 79.6%) and correct knowledge of HIV prevention (54.8% vs 41.7%) see Abstract P1-S2.23 Figure 1. Conclusions—Compared to other MSM, transgender persons in Guatemala City more often receive money for sex and use cocaine and are at disproportionately higher risk for HIV infection. While prevention activities, such as HIV testing, seem to be reaching transgender persons, exposure may not translate into increased protection. Findings emphasise the need for innovative HIV prevention activities to address the many facets and levels of vulnerability and social marginalisation experienced by transgender persons in Guatemala City. Such efforts should extend beyond individual-level outreach and information provision to rigorously evaluated intervention strategies at the social and structural levels.Abstract P1-S2.23 Figure 1Behavioural and HIV Prevention Indicators. Non-transgender MSM and Transgender Persons, Guatemala City, 2010.
P1-S2.25 HIV serostatus knowledge, absence of previous testing and sexual behaviours among injecting drug users
Authors: Blouin K , Parent R , Leclerc P , Blanchette C , Alary M , Morissette C , Roy É , Claessens C 
Published: July 2011

BackgroundFew studies have examined the association between HIV status knowledge and sexual behaviours among injection drug users (IDUs). We tested the hypothesis that IDUs who know their HIV positive status will have safer sexual practices than IDUs aware of their HIV negative status or never tested for HIV.MethodsIDUs who had injected in the past 6 months were recruited in harm reduction programs across the Province of Quebec and Ottawa, Canada. Participants completed a questionnaire including questions on sexual behaviours and provided saliva for HIV antibody testing. For IDUs with multiple participations, the last interview was selected. Data from 2003 to 2009 were analysed. Three groups were compared—IDUs aware of their positive HIV status (n=510), IDUs aware of their HIV negative status (n=2928) and IDUs never tested for HIV (n=427). Proportions were compared using χ2tests.ResultsMale IDUs aware of their positive HIV status were less likely to have had sex in the last month (HIV positive—32.4%, HIV negative—47.2% and never tested—55.0%; p<0.0001, n=2741) and, among those sexually active, more likely to have used a condom at last sexual intercourse (HIV positive—57.4%, HIV negative—43.7% and never tested—51.7%; p<0.005, n=1249). This was not observed for women. In the last 6 months, the proportion of male IDUs who had always used condoms for vaginal or anal sex with their female sex partners was significantly higher in HIV positive than in HIV negative and in those never tested, for regular (54.3%, 22.4% and 33.1%, respectively, p<0.0001, n=1131), casual (77.4%, 54.4% and 51.2%, respectively, p=0.0002, n=933) and partners of whom they are a client (86.7%, 69.7% and 42.1%, respectively, p<0.02, n=123). Women never tested for HIV were less likely than the other groups to use condoms with their regular partners (never tested—4.7%, HIV positive—21.3% and HIV negative—20.2%; p<0.05, n=550) and their client sex partners (never tested—46.2%, HIV positive—82.1% and HIV negative—76.6%; p<0.05, n=259). Women aware of their HIV positive status were more likely to report condom use with their casual sex partners, whereas those never tested were less likely (HIV positive—66.7%, HIV negative—48.0% and never tested—15.8%; p<0.01, n=250).ConclusionsIDUs aware of their positive HIV serostatus reported more consistent condom use with their various types of sex partners than those aware of their HIV negative status or never tested.
P1-S2.26 Drug and sexual HIV risk among injection drug users - a latent class analysis
Authors: Noor S 
Published: July 2011

BackgroundInjection drug users (IDUs) are at increased risk of HIV infection because they are more likely to engage in high risk injection behaviours (eg, needle sharing) as well as in high risk sexual behaviours (eg, exchange sex). This analysis examines factors associated with HIV risk using a latent class approach.MethodsOur study includes 523 eligible injection drug users, recruited into the 2009 National HIV Behavioural Surveillance project. Using maximum likelihood we calculated the posterior probability of being in an HIV risk class from nine drug and sexual behaviours. We simultaneously fitted a multinomial regression model to identify socio-demographic factors associated with HIV risk class.ResultsWe identified 3 HIV risk classes—high (42%), moderate (25%) and low risk (33%). Compared to the high HIV risk class, homeless IDUs had lower odds to be in the moderate (OR=0.16, 95% CI 0.04 to 0.70) and in low risk HIV class (OR=0.28, 95% CI 0.15 to 0.52). Moreover, IDUs who were arrested in the past 12 month had also lower odds to be in low risk class (OR=0.52, 95% CI 0.32 to 0.86) compared to high HIV risk class.ConclusionsOur results show that the majority of our IDUs were engaged in high HIV risk behaviours. Though temporality cannot be established due to the cross-sectional study design our findings indicate that homelessness and history of incarceration are associated with HIV risk. Interventions targeting system-level change may help to reduce the burden of HIV among the injection drug user population.
P1-S1.09 Trends in the aetiology of sexually transmitted infections and HIV Coinfections among STI patients attending Alexandra Health Centre, Johannesburg, South Africa (2007–2010)
Authors: Lewis D , Ricketts C , Bhojraj N , de Gita G , Magooa P , Venter I , Mshibe L , Vezi A , Muller E , Radebe F 
Published: July 2011

ObjectivesTo determine trends in the relative prevalence of aetiologies of urethral discharge (UDS), vaginal discharge (VDS) and genital ulcer (GUS) syndromes, and in the seroprevalence of syphilis, HSV-2 and HIV.MethodsConsecutive male (UDS/GUS) and female (VDS/GUS) patients were enrolled at Alexandra Health Centre, Johannesburg from January to April each year during 2007–2010. Urethral swabs (UDS), endocervical swabs/vaginal smears (VDS), genital ulcer swabs/smears (GUS) and sera (all) were collected with written informed consent. Real-time PCR assays were used to detectNeisseria gonorrhoeae(NG),Chlamydia trachomatis(CT),Trichomonas vaginalis(TV) andMycoplasma genitalium(MG) from UDS/VDS swabs, and herpes simplex virus (HSV),Treponema pallidum(TP)Haemophilus ducreyi(HD) andChlamydia trachomatisL1-3 (LGV) from ulcer swabs. Slides were stained for bacterial vaginosis/candidiasis (BV/CA, VDS) and granuloma inguinale (GI, GUS). Sera were tested for syphilis (rapid plasmin reagin, RPR; Omega Diagnostics), for HSV-2 (HerpeSelect IgG; Focus Diagnostics) and for HIV (Determine; Abbott Laboratories). χ2for linear trend analyses were undertaken with summary data (Prism v.2, GraphPad Software).Results928 UDS, 805 VDS and 455 GUS patients were recruited overall. Trends in the relative prevalence of most syndrome aetiologies were non-significant between 2007 and 2011—NG (UDS, 71%–79%; VDS 11%–17%), CT (UDS, 20%–25%; VDS, 27%–37%), MG (UDS, 10%–13%; VDS, 11%–14%), BV (VDS, 30%–36%), CA (VDS, 26%–31%), HSV (GUS, 53%–75%), TP (GUS, 4%–7%), HD (GUS, 0%–2%), LGV (0%–2%). There were no cases of GI. There was, however, significant decreasing trends for TV detection among UDS (4%–13%, p=0.003) and VDS (19%–34%, p=0.001) patients. Serologically, VDS patients had a decreasing trend in RPR seropositivity (1–8%, p<0.001) and, importantly, HIV coinfections decreased among both UDS (29%–39%, p=0.011) and GUS (60%–75%, p=0.032) patients. Non-significant variations in seropositivity were observed for RPR tests among UDS (1%–3%) and GUS (4%–11%) patients, for HSV-2 among all groups (UDS, 50%–60%; VDS, 74%–84%; GUS, 81%–87%), and for HIV among VDS (48%–59%) patients.ConclusionsThese data suggest significant decreases in the prevalence of HIV coinfection in UDS/GUS patients and of trichomoniasis as a cause of UDS/VDS. Though the HIV trends are encouraging for men, the lack of a similar trend for women with VDS is of public health concern.
P1-S2.34 STI-Surveillance within AIDS Reference Centres in Belgium - high consistent STI incidence among HIV-positive Men having Sex with Men, 2008–2009
Authors: Verbrugge R , Van Beckhoven D , Sasse A 
Published: July 2011

BackgroundThe observation of STI in HIV-patients has triggered a STI-Surveillance in AIDS Reference Centres (ARC). The aim of this surveillance is to identify STI emerging in HIV-patients, to analyse STI-trends in this group and to describe patient characteristics.MethodsThere are nine ARC in Belgium. The ARC are specialised in HIV-patient care, STI-consultation and treatment. Since April 2007, seven ARC participate in the surveillance. STI included are limited toChlamydia, gonorrhoea, syphilis,Lymphogranuloma Venerum(LGV), hepatitis B (HBV) and hepatitis C (HCV) among men having sex with men (MSM).ResultsIn 2008, 6962 HIV-patients (36.8% women; 63.2% men) were followed and 7454 patients (35.7% women; 63.9% men) in 2009. The HIV-population under follow-up increased by 7.1% (8.3% in men; 4.7% in women). In 2008 as well as in 2009, 279 STI were reported among the HIV-patients. It concerns 250 men and two women in 2008 and 251 men and two women in 2009; 242 were MSM in 2008 and 244 in 2009 (96%). The finding observed in 2009, with 5.3% HIV-infected men presenting an STI vs 5.7% in 2008 prevails a lower incidence of STI. This decrease is not statistically significant (χ2=0.76, a=0.38). In 2008 as well as in 2009, 13 patients were diagnosed with more than 1 STI (4.6% of the STI patients) The most frequent STI was syphilis, with 171 cases (61% of STI diagnosis) in 2008 and 160 cases (59%) in 2009, of whom one woman; respectively 94% and 95% of the men were MSM. Chlamydia has been found in 30 men and two women in 2008 and in 28 men and one woman in 2009. LGV was confirmed in 12 men in 2008 and in 15 in 2009. Gonorrhoea was found in 29 men in 2008 and 32 in 2009. HBV and HCV were respectively diagnosed in 2 and 14 men in 2008 and in 7 and 17 men in 2009. All men reported with Chlamydia, LGV, gonorrhoea, HBV and HCV were MSM. 64% (2008) and 75 % (2009) of the homosexual men with STI mentioned having multiple partners.ConclusionsThe surveillance in 2008 and 2009 confirms an STI-problem among HIV-infected MSM. These results highlight unsafe sex behaviour among MSM, also reflected by the high proportion of MSM reporting multiple partners. HIV-positive MSM are particularly vulnerable for syphilis. The incidence of LGV and HCV among HIV-positive men should be followed closely and an adaptation of the international screening policy for LGV and HCV is needed. Chlamydia patients belonging to high risk groups should be tested for the LGV variant.
P1-S2.35 Increased HIV and primary and secondary syphilis diagnoses among young men who have sex with men, 2004–2008
Authors: Torrone E , Bertolli J , Li J , Sweeney P , Jeffries W , Peterman IVT 
Published: July 2011

BackgroundNational surveillance data document increases in HIV and syphilis diagnoses in young black men who have sex with men (MSM), but trends could be driven by increases in a few large areas. We assessed the extent to which metropolitan areas of varying population sizes have reported increases in HIV diagnoses among MSM and in syphilis diagnoses among men.MethodsWe examined trends in HIV and primary and secondary syphilis case report data in metropolitan areas with greater than 500 000 people, at least 500 black men aged 13–24 years, and with mature HIV reporting systems as of 2004 (n=73). We compared the average number of case reports in 2004–2005 and 2007–2008 and examined differences by age at diagnosis (13–24 years, 25–29 years, ≥30 years), race/ethnicity (white, black, and Hispanic), and area population size (500 000–999 999, 1 000 000–2 499 999, and ≥2 500 000 persons).ResultsAmong MSM aged 13–24 years, observed increases in HIV diagnoses were larger among blacks (average percent increase=68.7%) compared with Hispanics (36.7%) and whites (41.7%). Increases in HIV diagnoses were observed in more areas for black MSM aged 13–24 years (85% of areas) than for Hispanic MSM aged 13–24 years (62% of areas), or white MSM aged 13–24 years (58% of areas), or older MSM of any race/ethnicity (range—44%–62% of areas). (Abstract P1-S2.35 figure 1) Among men aged 13–24 years, primary and secondary syphilis diagnoses increased on average 203.5% among blacks, 99.7% among Hispanics, and 43.7% among whites, and increases were observed in more areas for blacks (70% of areas) than for Hispanics (44% of areas) or whites (59% of areas). (Abstract P1-S2.35 figure 1) The majority of areas (63%) had increases in both HIV and syphilis in black men aged 13–24 years. Across area size strata, the youngest group of black men had the highest average percent increase in diagnoses of HIV and syphilis as well as the highest percentage of areas with increases in diagnoses.Abstract P1-S2.35 Figure 1Change in average diagnoses of HIV among men who have sex with men and primary and secondary syphilis among men comparing 2004–2005 with 2007–2008, by age and race/ethnicity - selected areas (n=73). Increased HIV and Primary and Secondary Syphilis Diagnoses among Young Men Who Have Sex with Men, 2004–2008.ConclusionsHIV and syphilis diagnoses have increased among young black men in almost all areas, suggesting that national trends are not driven by increases in a few large areas. Findings highlight the need for improved prevention efforts for young MSM, particularly young black MSM.