bluuebunny/crossref_metadata_2025_split huggingface dataset:
S9.4 International AIDS policy choices for a changing financing landscape
Authors: Wilson D 
Published: July 2011

BackgroundIn 2009, AIDS financing fell for the first time, reflecting the global financial crisis and shifting health and development priorities. In this context, future international AIDS policy must focus on efficiency, effectiveness and sustainability.EfficiencyThe surge of financing for AIDS over the last decade has sometimes led to sub-optimal efficiency. There is an urgent need to improve allocative efficiency, by ensuring resources are allocated for the best proven and most relevant interventions among the right groups in the right geographic areas. AIDS responses globally are beset by mismatches between investments and epidemiological context and program choices. There is also a need to improve technical efficiency, so that selected interventions are delivered at scale, for the lowest cost. Several studies show how the same services in the same context in the same country can vary by several orders of magnitude. In a resource constrained future, such variances must be reduced and technical efficiency constantly improved. Integration of health-related HIV services and other health services may also yield greater efficiencies.EffectivenessIn concentrated epidemics, particularly among sex workers, where we have well validated interventions, our major priorities are to improve allocative and technical efficiency, so we direct our resources towards effective interventions for priority populations. In generalised epidemics, we need to strengthen our evidence of what works. Beyond male circumcision, we have limited proven interventions to reduce general population adult sexual transmission. We also need to move from efficacy to effectiveness, demonstrating that proven approaches can have real world effect at scale. We need to strengthen the middle-ground between randomised control trials and observation, by using quasi-experimental techniques to construct robust counterfactuals—that is, what would have happened without the counterfactual. We also need to make biological end-points, primarily HIV incidence or credible incidence proxy measures.SustainabilityWe must move from an emergency response to longer-term sustainability. This will include increasing and diversifying domestic resource mobilisation, especially in middle-income countries and diversifying the sources of international financing. Services that are related to AIDS but also related to other elements of the health sector, such as blood safety and universal precautions will increasingly be financed from overall health sector resources.ConclusionWe must urgently re-position the global AIDS response, guided by the drive for greater efficiency, effectiveness and sustainability—we have no time to lose.
S11.2 Which algorithm performs better, screening with a non-treponemal or treponemal test?
Authors: Fortin C 
Published: July 2011

BackgroundA growing number of diagnostic laboratories have recently adopted treponemal EIA tests that permits automation for syphilis screening thus reducing time and labor. This leads to a reverse sequence approach of screening in which an EIA is performed first, followed by testing of reactive sera with a non-treponemal test. The province of Quebec implemented two revised algorithms for syphilis testing on 1 February 2010. The first algorithm (Algo 1) is adapted for low throughput laboratories who initiate testing with a non-treponemal test while the second (Algo 2), which is adapted for high throughput settings, follows the reverse sequence approach. Using these recently implemented algorithms in Quebec, the performance the reverse sequence algorithm will be discussed.MethodsThe performance algorithms 1 and 2 has been evaluated with a retrospective analysis of all sera sent by diagnostic laboratories to our reference laboratory for treponemal confirmation between 1 February 2010 and 31 January 2011. Positive sera by both EIA and RPR were not submitted for confirmation.ResultsA total of 3662 sera were sent for confirmation during the study period. Only sera from patients not known to have a previous positive treponemal test were analysed. Among the 929 RPR positive or indeterminate sera screened by Algo 1, only 315 (34%) were positive by TP-PA. Among the 904 EIA positive/RPR negative sera screened by Algo 2, 525 (58%) were positive, 333 (37%) were negative and 46 (5%) were indeterminate by TP-PA. The TP-PA negative or indeterminate sera were further tested using a line immunoassay. Among these 379 sera, 35 (9%) were positive and 108 (28%) were indeterminate by line immunoassay. The overall proportion of false positive EIA when reflex RPR test is negative (Algo 2) was 38% compared to a proportion of 66% (614/929) of false positive results when RPR is used as the first screening assay (Algo 1).ConclusionThe higher rate of false positive when sera are screened with Algo 1 can be explained by a low prevalence setting. The high rate of false positive EIA when RPR test is negative (Algo 2) confirms the need to reflexively test all such sera with at least a second treponemal test. Although most EIA positive/RPR negative/TP-PA negative sera truly are false positive EIA results, a second treponemal confirmatory test helps identifying more true-positive EIA positive/RPR negative sera, though more data are needed to generally recommend this approach.
S12.1 Transmission of human papillomavirus infections
Authors: Burchell A N , Coutlée F , Tellier P , Hanley J , Franco E L 
Published: July 2011

BackgroundThere have been few studies of the sexual transmission of human papillomavirus (HPV) between partners. Our objective was to estimate transmission rates among persons with documented sexual exposure to an infected partner and longitudinal follow-up.MethodsWe analysed data from the HITCH Cohort Study, a study of recently-formed couples. Women aged 18–24 attending a university or junior college in Montreal, Canada and their male partners were eligible. Self-collected vaginal swabs and clinician-obtained swabs of epithelial cells from the penis and scrotum were tested for DNA of 36 HPV types. We analysed follow-up data at visit 2 from 179 couples who were discordant for one or more HPV types at enrolment. We defined the index partner as that which was infected with a type(s) not found in the other partner, and a transmission event as subsequent detection of that HPV type in the non-index partner. Transmission rates are expressed as the number of transmissions per 100 person-months (PM), with 95% CI estimated using Poisson regression.ResultsTransmission was observed in 73 partnerships. There was little difference between the male-to-female (3.5 per 100PM, 95% CI 2.7 to 4.5) and the female-to-male transmission rate (4.0 per 100PM, 95% CI 3.0 to 5.5). These rates are consistent with a per-partnership transmission probability of 0.20 (95% CI 0.16 to 0.24) over 6 months. Transmission rates did not differ with the lifetime number of partners reported by the non-index partner at enrolment or with the circumcision status of the male partner. Rates were highest when the index partner was still positive for that type at follow-up; rates of male-to-female transmission quadrupled and female-to-male transmission tripled (5.2 and 6.2 per 100PM, respectively), compared to when the index partner was negative at follow-up (1.2 and 1.8 per 100PM, respectively, p<0.05).ConclusionsTransmission rates based on follow-up of discordant partners are probably underestimates of the true rate due to clearance in index partner and the depletion of susceptibles. Our results contribute to a small but growing evidence base regarding the natural history of HPV transmission and the probability of transmission. These estimates may be of utility to improve forecasting estimates from mathematical modelling efforts to project the public health impact and cost-effectiveness of HPV vaccination.
S2.1 Introduction of rapid syphilis tests in antenatal care services in Tanzania: clients' and service providers' acceptability and uptake of testing
Authors: Changalucha J , Mosha J , Mngara J , Masesa C , Kabalila L , Makaranga E , Sollis K , Kapiga S , Mabey D , Peeling R 
Published: July 2011

BackgroundSyphilis is still a major cause of morbidity and mortality in women and children. In Tanzania syphilis was shown to cause adverse pregnancy outcomes in 49% and stillbirth in 25% of pregnant women with high titre syphilis. Although syphilis screening and treatment is a national policy and is one of the most cost effective interventions, its implementation on a large scale is limited. Lack of a simple and rapid point of care diagnostic test for syphilis has been suggested as one of the major reasons for this limitation. We implemented a demonstration project in Geita district, Tanzania to assess the feasibility of introducing a rapid diagnostic test in antenatal care services. The objectives of the project were to determine (1) the feasibility of increasing access to antenatal syphilis screening using same day testing and treatment strategy, and (2) the acceptability of introducing rapid syphilis testing to service providers and clients.MethodsA health facility based baseline survey was carried out using a structured questionnaire to determine syphilis uptake before rapid test introduction. A team of four district trainers and supervisors were trained on how to perform the test, on quality assurance and stock management. Health workers were also trained on how to perform the test, quality assurance and stock management. Then rapid tests were introduced in all health facilities and qualitative data were collected to assess acceptability of the test. The uptake of syphilis testing and treatment among pregnant women in 3 months before and after rapid test introduction were compared using χ2test.ResultsNumbers of pregnant women tested in the 3 months after rapid test introduction were significantly higher than those tested before its introduction in the same period (p<0.01). Similarly a significantly higher number of syphilis positive women were treated compared to those treated before test introduction (p<0.01) see Abstract S2.1 figure 1. The same day testing and treatment strategy enabled 95% of women testing positive to be treated at their first visit. The rapid test was acceptable to both service providers and clients.Abstract S2.1 Figure 1Number of pregnant women tested and treated at clinics before and after Rapid Test introduction in 3 months.ConclusionsIntroduction of rapid syphilis tests has made it possible to implement national policy for screening pregnant women in Tanzania. Increasing access to screening and treatment will prevent many perinatal deaths.
S14.2 A study of African American and Latina women and human papillomavirus: lessons learnt
Authors: Bonney L , Fost M , Wang Y F , Green V L , Wingood G , del Rio C , Rothenberg R 
Published: July 2011

BackgroundAfrican American and Latina women in the United States suffer from sexually transmitted infections at higher rates than white women. It is particularly important to prevent HPV in these groups as they also suffer disproportionately from cervical cancer. From 2006, a prophylactic HPV vaccine has been approved for use in girls and women aged 9–26 years. However, public health focus has been on young girls and teens. There are limited options for young women over 19 years of age who have aged out of the Vaccines for Children entitlement program. The objectives of this study were to assess a sample of minority women who attend neighbourhood health centers to determine predictors of vaccination, and to assess for the presence of HPV infection in these women. Those without evidence of prior HPV infection may benefit from a prophylactic vaccine.MethodsBetween April 2009 and April 2010, we enrolled a convenience sample of 100 African American and 100 Latina women who completed a computer-assisted personal interview. Participants were queried regarding: demographics, risk for sexually transmitted infections including drug or alcohol use, HPV vaccine willingness, knowledge, attitudes and beliefs, and vaccination status. Frequencies were calculated using SAS, version 9.2. Self-collected vaginal swab samples from 118 participants were tested for HPV using line probe assay.ResultsParticipants were poor with 113 (57%) having a household income of <$20 000; and at risk for HPV infection. One hundred twenty-one (61%) did not use condom at last sex. However, only 17/118 (14%) were positive for any HPV. Predictors of vaccination could not be determined because there was not sufficient outcome response variation. A vast majority 161 (80%) of participants had not received HPV vaccination, though a most 136 (68%) reported willingness.ConclusionsThree years after vaccine approval, the majority in a sample of vulnerable women had not been vaccinated despite their willingness. Public health campaigns have been successful at raising awareness and making vaccine acceptable, but may be less successful at providing the vaccine to vulnerable women. Strategies should focus on delivering vaccine to African American and Latina women in order to decrease cervical cancer disparities.
S14.4 Detecting chlamydial and gonococcal infections through social and sexual networks
Authors: Al-Tayyib A A , Rietmeijer C A 
Published: July 2011

BackgroundThe overall goal of this ASTDA award was to adapt and evaluate Respondent-Driven Sampling (RDS) to enhanceChlamydia trachomatis(Ct) andNeisseria gonorrhoeae(GC) screening activities. Specifically, the aims were to develop and evaluate a programmatic approach using RDS as a method to prospectively screen for Ct/GC in networks of infected persons, to compare the prevalence of Ct/GC infections detected via current venue-based screening activities to the prevalence of infection detected using RDS as a referral mechanism, and to determine and compare the cost per infection detected via current screening activities to the cost per infection using RDS.MethodsUsing two components of RDS, the systematic referral scheme and the dual incentive structure, we developed a program to refer social and sexual contacts for Ct/GC screening. Initial seed participants ages 15–24 were identified and asked to recruit their peers for screening, who in turn recruited their peers, and so on. Persons received incentive for their own participation ($10) in addition to incentive for participation of those they refer ($10). Participants could refer up to 5 social and sexual contacts. Participants provided a urine specimen for Ct/GC screening and completed a brief survey questionnaire.ResultsBetween December 2008 and March 2010, 66 initial seeds were recruited. Of the 66 seeds, 17 (25%) were successful in recruiting referrals. A total of 439 referrals were recruited, resulting in 7 networks initiated from an infected seed and 10 networks from a non-infected seed. The majority of referrals, 372 (85%), belonged to a single network (Abstract S14.4 figure 1). The remaining 67 referrals belonged to 16 networks ranging in size from 2 to 18 members. Across all networks, 67% of referrals were male and 33% were female. The overall prevalence of infection was 5.7% for Ct and 6.9% for GC among the referrals. This is compared to a prevalence of 12.2% for Ct and 1.5% for GC detected through venue-based screening in the same age demographic.Abstract S14.4 Figure 1ConclusionsWith the exception of one large network, RDS was not a particularly efficient way to screen for Ct/GC. Only one-fourth of those initially recruited by research staff in turn referred their social and sexual contacts. While social network testing has been adopted in the HIV testing realm, in the Ct/GC screening realm a focus on messages encouraging those who are tested to get their friends tested may have the greatest public health impact.
S14.5 Treponema pallidumσ24 regulon and envelope stress response
Authors: Giacani L , Denisenko O , Tompa M , Molini B , Centurion-Lara A 
Published: July 2011

BackgroundDuring syphilis infection, the envelope ofTreponema pallidumis constantly exposed to the host environment and, therefore, the most likely target of the host defences against the invading spirochaete. The mechanisms that maintainT pallidumenvelope integrity and functionality, particularly in response to host-induced stresses, are however poorly understood, and their elucidation would likely help identify important pathogenesis-associated molecules, perhaps related toT pallidum'sability to persist in the host despite a robust immune response. We hypothesised that inT pallidum, similarly to other Gram-negative pathogens, the transcription factor σ24 (σ24, encoded by the rpoE gene, TP0092) might be a key element in maintainingT pallidumenvelope homeostasis. Putative σ24 binding motifs can be identified in silico upstream of severalT pallidumgenes that were experimentally shown to be involved in envelope stress response (ESR) inEscherichia coli. Furthermore, during early experimental syphilis σ24 is highly transcribed compared to other σ factors, and its expression increases even more as primary infection progresses. We therefore decided to investigate the possible role of σ24 inT pallidumESR by identifying the components of theT pallidumσ24 regulon.MethodsT pallidumcells grown in rabbits were fixed after harvest to crosslink DNA-binding proteins to their target sequences in the chromosome. DNA sequences recognised by σ24 in vivo were isolated using chromatin immunoprecipitation in combination with high-throughput DNA sequencing (ChIP-seq) to identify bound DNA regions.ResultsThirty-nine DNA fragments targeted by σ24 were identified in theT pallidumchromosome. Seven of these target genes (lon-1, greA, ftsZ, prfB, htrA, and rpoE) were previously reported to be induced in response to envelope stress inE coli, suggesting that theT pallidumσ24 regulon is likely to be similar to that of other bacteria. Other putative target genes encode transporters, cell division proteins and a subset of motility and chemotaxis proteins.ConclusionsInT pallidum, σ24 seems to control genes involved in a variety of cellular processes, including maintenance of envelope homeostasis and barrier function. Additional putative σ24-dependent functions, apparently not directly involved in ESR, could as well be important in helpingT pallidumadapt to the host environment during the infection.
S15.1 Sexually transmitted infections in Europe: coordinating the European STI network
Authors: van de Laar M 
Published: July 2011

BackgroundSince 2008, the European Centre for Disease Prevention and Control is coordinating the enhanced STI surveillance in 30 EU/EEA countries. Each country was requested to nominate experts for collaboration and data submission to the European Surveillance System. Five STI are under surveillance, syphilis, congenital syphilis, gonorrhoea, chlamydia and LGV, as per Decision 2119/98/EC of the European Commission.MethodsSurveillance objectives and the set of variables for enhanced STI surveillance were agreed upon in the annual network meeting and training session to use the European Surveillance System for data submission. Data were collected for the period 1990–2009; two network meetings were organised for all 30 EU/EEA countries to discuss the preliminary results.ResultsChlamydia is the most frequently reported STI in Europe, accounting for the majority of all STI reports with 343 958 cases in 2009 (185 per 100 000 population). Chlamydia was reported more in women than in men and 75% were reported in young people (15 and 24 years). Chlamydia is increasing continuously over time. In 2009, 29 202 gonorrhoea cases have been reported (9.7/100 000) and nearly a quarter of all gonorrhoea cases were reported in MSM. For syphilis, 18 317 cases have been reported (4.5 per 100 000) and half of syphilis cases were reported in MSM. The overall trend in gonorrhoea and syphilis across the EU/EEA showed a notable decreasing trend in countries which previously had reported very high rates. These declines are probably due to changes in healthcare systems, diagnostic capacity and reporting rather than true changes in the incidence. However, dramatic increases were noted in other countries and—based on the information from the male-to-female ratio—this is most likely due to recent increases of syphilis among MSM. The overall trend in chlamydia showed a continuously increasing trend, reflecting an increase in testing and screening practices across countries. These trends must be interpreted with caution due to the heterogeneity in reporting and healthcare systems. A further limitation to the interpretation is that many diagnoses are either not made or under-reported. Diagnoses from certain countries cannot be included in trend analyses as they do not have comprehensive surveillance for STI.ConclusionEnhanced surveillance of STI in Europe is essential to provide the information that is necessary to monitor the distribution of disease and to evaluate the public health response to control the transmission of infections. Collaborating within the European STI expert networks provides the platform for sharing best practices and expert knowledge across Europe.
S15.3 European MSM Internet Survey (EMIS): differences in sexually transmissible infection testing in European countries
Authors: Marcus U , Schmidt A J , Breveglieri M , Davila P F , Ferrer L , Folch C , Hickson F , Hospers H J , Mirandola M , Reid D , Weatherburn P ,   for the EMIS network
Published: July 2011

BackgroundComparing rates of sexually transmissible infections (STIs) among men who have sex with men (MSM) in different European countries is challenging due to national differences in reporting systems, healthcare systems, infectious disease surveillance methods, quality of data, and/or levels of social acceptance of homosexual behaviours and openness about homosexuality.MethodsFrom June through August 2010, the European MSM Internet Survey (EMIS) mobilised more than 180 000 respondents from 38 European countries to complete an online questionnaire in one of 25 languages. The questionnaire covered sexual happiness, HIV and STI-testing and diagnoses, unmet prevention needs, intervention performance, HIV-related stigma and gay-related discrimination. Recruitment was organised predominantly online, through gay social media, and links and banners on more than 100 websites for MSM all over Europe.ResultsPerceptions on access to free/affordable STI-testing differed across Europe (median: 80%; range: 40–95%); and was substantially correlated with reported recent STI-testing (R2=0.27). Quality of STI-testing was highly diverse: While blood-testing was common in all participating countries, only Ireland, Malta, and the UK seem to offer penile or particularly anal examinations as standard of care. In all participating countries HIV-positive respondents reported higher rates of both STI-testing and diagnosis. Self-reported STI-screening among men without HIV diagnosis ranged from 10% (Turkey) to 37% (Netherlands). Substantial correlations between rates of testing procedures appropriate for MSM (such as anal or genital swabs) and diagnosed gonorrhoea (R2HIV-pos=0.24) or Chlamydia infections were observed (R2HIV-pos=0.50; R2others=0.29).ConclusionSelf-reported testing and diagnosis rates for bacterial STIs suggest high levels of under-diagnosis and unmet sexual healthcare needs in most European countries. In Europe, there is an urgent need to implement or improve sexual healthcare tailored to MSM-specific needs.