bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S6.33 HIV/AIDS impact mitigation in resource-poor settings: scaling-up a multi-sectoral response
Authors: Mwendwa A , Kyalo N , Kihara W , Mburu J , Mutua M 
Published: July 2011

Background/issuesThe HIV and AIDS epidemic constitutes not only the worst scourge and onslaught with which peoples in resource-limited places must contend; It also occurs in a context in which the effects of the epidemic and key issues which they engender are juxtaposed with a multiplicity of societal problems. Many high HIV/AIDS prevalence countries apparently remain unconvinced of the longer term impact of this epidemic, and have not yet developed strategies to cope with the obvious and incontrovertible impact of HIV and AIDS. Impact mitigation of HIV and AIDS is not high on the agenda of the many organisations which are involved in mounting a response to this epidemic. These organisations have assumed HIV/AIDS to be a public health issue and failed in many cases to recognise it for the socio-economic development challenge it more properly represents. Empirical research findings and Observations/In resource poor settings, greed and avarice of the political leadership overwhelms their responsibilities take urgent action to mitigate HIV/AIDS impact. There are small islands of dazzling abundance which exist side by side with a cheerless ocean of absolute poverty, dehumanising HIV/AIDS high prevalence rate and wide-scale social exclusion. Africa's famed traditional extended family system, exemplary at absorbing members under stress, is confronted with HIV and AIDS impact on every constituent part of its network and may reach breaking point without some assistance. This strain may have the effect of not only accelerating the reversal of development gains of the last decade but of fragmenting the very societal structure that has so far sustained marginal societies.Conclusions/policy implicationsThere's the pressing moral, social, political and economic imperative to scale up the impact mitigation of HIV/AIDS among residents of poor areas. The immediate focus of managing the crisis of HIV and AIDS in resource-limited settings will impact every aspect of multi-sectoral, systemic functioning, response. The advent of a vastly improved prognosis of new classes of ARV drugs and their use in combination can dramatically improve rates of mortality and morbidity, prolonged lives, improved quality of life, revitalised communities and transformed perceptions of HIV/AIDS from a plague to a manageable, chronic illness in resource poor settings.
P1-S2.02 HIV prevalence in female sex workers in a focused HIV prevention project in Mumbai and Thane District, India
Authors: Bhardwaj S , Roy S , Gaikwad S , Ranebennur V 
Published: July 2011

BackgroundSince 2004, FHI has been implementing Aastha, a Bill & Melinda Gates Foundation supported HIV/STI prevention project for 24 000 sex workers (SWs) in Mumbai and Thane. It provides STI services to approximately 11 000 SWs monthly. HIV counselling and testing services were strengthened from March 2009 and by October 2010, 13 669 individuals had been tested for HIV. This abstract discusses the prevalence of HIV in female sex workers (FSWs) registered with the project by age and typology. When the project commenced its intervention in 2004, the HIV prevalence in brothel-based FSWs according to the HIV Sentinel Survey 2004 was 44.76%.MethodsFrom March 2009 to October 2010, 13 669 FSWs underwent voluntary counselling and testing for HIV. The results were analysed across age and typology. HIV tests were conducted and interpreted as per Indian national guidelines using three rapid tests.ResultsOf the 13 669 tested, 623 individuals tested HIV-positive for HIV (4.6%). Among the 623 HIV-positive individuals, 177 individuals (28.4%) were aged 18–24 years; 404 individuals (64.8%) were aged 25–36 years and 42 individuals (6.7%) were aged 37 years or older. By FSW typology, HIV prevalence was as follows—13.1% brothel-based; 3.3% bar-based; 4.7% street-based; 1.6% home-based; and 1.6% lodge-based. The difference in HIV prevalence is statistically highly significant across different typologies (p=0.0001). All the sex workers who tested HIV-positive and were willing to disclose their status were linked to care, support and treatment services.ConclusionsIn this study, overall HIV prevalence among sex workers was 4.6%. The highest HIV prevalence (13.1%) was observed in the brothel-based SWs. A change in the national policy for HIV testing for brothel-based sex workers from biannually to quarterly is recommended. Historically, in Maharashtra, it has been observed that brothel-based sex workers have high incidence and this has been corroborated even after scaling up testing in this group. Given this scenario and considering the duration of the window period in any high-risk group, we can inform policy-makers to increase the frequency of HIV testing. This will provide an opportunity for early testing and inclusion of newly identified HIV-positives for referral for care and treatment.Abstract P1-S2.02 Figure 1HIV prevalence by SW typology.
P5-S6.34 Provider characteristics associated with gonorrhoea treatment errors, Massachusetts, 2010
Authors: Swails J , Smock L , Tang Y , Hsu K 
Published: July 2011

BackgroundMassachusetts experienced a 29% increase in gonorrhoea cases during 2010. In 4% of cases where treatment was known, treatment was inconsistent with public health guidelines. We examined healthcare provider characteristics associated with gonorrhoea treatment errors to help target future educational outreach strategies.MethodsCase-control study where treatment error cases were defined as any patient 15–65 years of age, diagnosed with gonorrhoea in 2010, who did not receive ceftriaxone 125 mg or 250 mg IM or other approved cephalosporin regimen, or azithromycin 2 g PO. Two controls were randomly selected from patients who received correct treatment, matched to cases in regard to age, sex, and month of diagnosis. Data regarding exposures to various provider characteristics were collected from case report cards, provider licensing databases, and direct provider phone calls. Proportions of cases and controls were compared on the basis of provider training, years in practice, specialty, and practice type by χ2analysis or Fisher's exact test.Results76 cases were matched to 152 controls. In preliminary analysis, no differences were identified with respect to provider degree (MD/DO or NP/PA; p>0.25). More treatment errors occurred in private practice/health maintenance organisations compared to STD or family planning clinics (p<0.0001), emergency departments (p<0.0001), or community health centers/hospital clinics (p=0.0004). Among physicians, no differences were identified with respect to years since residency graduation (p>0.25). More treatment errors occurred with family medicine physicians compared to OB/GYN (p=0.0225) and emergency medicine physicians (p=0.0101), but not compared to paediatricians or internists see Abstract P5-S6.34 table 1.Abstract P5-S6.34 Table 1Analysis to dateControls (n, %)Cases (n, %t)p ValueProvider degree NP/PA49 (45%)30 (41%)NS MD/DO59 (55%)43 (59%)Practice location Private practices/HMOs22 (18%)41 (56%)Reference STD clinics15 (13%)0<0.0001 Emergency departments40 (33%)11 (15%)<0.0001 Community health centers/hospital clinics43 (36%)21 (29%)0.0004Residency graduation year After 200027 (47%)15 (39%)NS 1990s16 (28%)13 (33%) Before 199014 (25%)11 (28%)Physician specialty Family Medicine5 (9%)11 (24%)Reference Paediatrics3 (5%)5 (11%)NS Internal Medicine10 (18%)10 (22%)NS OB/GYN18 (32%)7 (16%)0.0225 Emergency Medicine20 (36%)7 (16%)0.0101ConclusionsAlthough gonorrhoea treatment errors were rare, specific practice locations and physician specialties were significantly associated with gonorrhoea treatment errors, suggesting important opportunities for educational intervention. Further studies may determine reasons for errors, relative importance of provider factors, and what systems support accurate treatment.
P5-S6.39 Integrating medication assisted therapy with buprenorphine and other harm reduction interventions into an urban public health department STD clinic in the Southwestern USA
Authors: Trigg B , Murphy M , Tsang A 
Published: July 2011

BackgroundPublic Health Department STD clinics often serve high risk populations that have limited access to treatment of opiate addiction using evidence-based medication assisted therapies (buprenorphine and methadone) and to other clinical preventive services. In Albuquerque, New Mexico, in the southwestern US, an urban STD clinic has developed an integrated buprenorphine induction program for injecting heroin users that prioritises those recently released from a county jail. Patients are also recruited directly from the STD clinic and from a co-located syringe exchange program.MethodsPatients enrolled in the buprenorphine induction program who met specific screening criteria were tested for chlamydia, gonorrhoea, HIV, hepatitis C and syphilis. Patients who completed 2 months of buprenorphine were referred to primary care providers for continuation of treatment.ResultsIn the first 2 years, a total of 291 patients received buprenorphine. 85 clients (29.2%) were referred to the program from public health programs including STD clinic, family planning and harm reduction. 67 (23.0%) were recently released from jail. Of the first 191 patients, 55 (28%) completed 2 months of buprenorphine treatment. 1 of 160 clients screened for syphilis were positive. 68 of 131 (51.9%) screened for hepatitis C were positive. 10 of 89 (11.2%) screened for gonorrhoea and chlamydia were positive for one or both infections. 194 were tested for HIV; none were positive.ConclusionAn integrated STD clinic and opiate addiction treatment program can provide comprehensive services to a high risk population.
P5-S7.01 Exploring the acceptability of medical, educational and sport settings for STI screening: stratified random probability survey of young men in the UK
Authors: Estcourt C , Saunders J , Mercer C , Sutcliffe L , Hart G 
Published: July 2011

BackgroundUK prevalence of STIs in young people is rising. Although a similar number of infections are diagnosed in men and women, men account for only 20% of National Chlamydia Screening Program tests. New strategies are required to increase uptake of STI screening in young men.MethodsStratified random probability survey of men (18–35 years) using computer-assisted personal- and self-interviews, including use of healthcare; sporting activity; acceptability of accessing urine/oral fluid self-taken tests for STIs and HIV in a variety of healthcare and non-healthcare settings.ResultsData were collected from 411 (632 weighted) men median age 28 y; 39% aged <25 y. 29% and 20% of men had previously tested for STIs and HIV, respectively. Two-thirds of men <25 y had tested in the last year vs one-fifth of men >25 y (p<0.0001). 75% of men had seen their Family Physician within the last year. 91% of men would be willing to self-test for STI/ HIV. Primary Care settings (80%), sexual health clinics (67%) and pharmacies (65%) were the most acceptable test kit pick-up points. Further education settings were more popular than school settings as pick-up points (42% vs 28%) and the workplace was acceptable to 22% of men. Of the 391 (69%) men who reported playing sport in the last 4 weeks 18% found a sports club/centre acceptable. Among the 37% men who reported playing the most popular sport (soccer), 47% and 43% said they would be willing to pick-up STI and HIV test kits, respectively, from their club. This did not vary by whether they had previously tested for STI/ HIV.ConclusionsAlmost one-third of men under 25 have already tested for STI/ HIV. Most men have seen their Family Physician in the last year, which challenges the assumption that young men infrequently attend primary care. Primary care is a highly acceptable setting for STI/ HIV screening. Non-traditional settings such as soccer clubs are acceptable to some men but further research is needed to better understand the barriers and opportunities with this approach to testing.
P5-S7.03 Syphilis screening for high-risk groups in a large-scale HIV prevention program in India: uptake and trends
Authors: Parthasarathy M , Potty N , Gurung A , Das A , Parimi P 
Published: July 2011

BackgroundAvahan, a large-scale HIV prevention program in India, provides syphilis screening as a part of its service package for high-risk groups (HRGs) including female sex workers, men who have sex with men (MSM) and injecting drug users through its targeted intervention clinics. The objective of this retrospective study was to understand the uptake and trends in reactivity patterns of syphilis screening tests at Avahan clinics from 2005 to 2009.MethodsSyphilis screening was done with either Rapid Plasma Reagin (RPR test, provided on-site or through referrals to local laboratories) or a point-of-care immunochromatographic strip test (ICST) using whole blood. ICST was introduced to the program in 2007. The clinical records of the HRGs attending Avahan clinics in six high HIV prevalence states in India from January 2005 to December 2009 were collated in an “individual tracking sheet” database and analysed with STATA software version 10.ResultsThe overall proportion of clinic attendees screened for syphilis increased consistently during the study period from 2.6% in 2005 to 21% in 2009. The increasing trend in uptake and actual proportions were similar in all risk groups. The use of ICST as a screening test increased from 8% in 2007 to 70% in 2009 thus becoming the predominant screening method. During this period, the uptake of syphilis screening also increased from 9% in 2007 to 21% in 2009 see Abstract P5-S7.03 table 1. A declining trend was found with the overall syphilis sero-reactivity rates (ICST and RPR), from 7% in 2006 to 4% in 2009 and this decreasing trend was found in all risk groups. The proportion of active high-titre syphilis (>1:8) to all reactive RPR tests (any titre) declined from 61% in 2005 to 30% in 2009.Abstract P5-S7.03 Table 1Uptake of syphilis screening by RPR and ICSTYearTotal individuals attending clinics# Screened for syphilis (%)Proportion screened with RPR (%)Proportion screened with ICST (%)200543 3941112 (2.6%)10002006108 8365700 (5.2%)10002007169 61215 179 (8.9%)91.88.22008220 87728 502 (12.9%)60.139.92009286 99160 412 (21.1%)30.869.2ConclusionsThe improved uptake of syphilis screening has lead to improved detection and appropriate management of cases of latent syphilis. The results show that introduction of rapid point-of-care tests likely contributed to the improved uptake of syphilis screening. Rapid tests may be considered for syphilis screening at other resource-constrained primary care sites in India such as targeted intervention and ante-natal clinics.
P5-S7.04 Who participates in the Dutch chlamydia screening? A study on demographic and behavioural correlates of (repeated) participation and positivity
Authors: de Coul E O , Götz H , Van Bergen J , Brouwers E , Fennema H , Hoebe C , Koekenbier R , van Ravesteijn S , Pars L , van den Broek I 
Published: July 2011

BackgroundAchieving adequate levels of participation and capturing high risk groups are key stones for the effectiveness of large-scale Chlamydia screening programs. We examined the determinants of (repeated) participation and Chlamydia positivity to evaluate to what extent high risk groups were reached in a large scale Internet-based screening program in the Netherlands.MethodsThe Chlamydia Screening Implementation was initiated in three regions among people aged 16–29 years. Data from the first two screening rounds (2008–2010), in which approximately 280 000 persons were invited annually, were analysed. Socio-demographic and behavioural correlates of screening participation and positivity were studied in multilevel logistic regression models. Cluster was added as a second level of analysis, taking into account the effect of the neighbourhood-based invitations (to cover social or sexual networks).ResultsThe same socio-demographic factors associated with lower screening uptake were also associated with higher Ct-positivity such as young age, non-Dutch origin, lower education, high community risk, low SES, in round 1 as well as 2. At the same time, behavioural risk factors such as having casual partners, ≥2 partners in <6 months, concurrent partners, and a history of STI, were associated with higher participation. A small cluster effect for screening uptake was observed, independent from community risk and individual risk factors. The model for repeated participation showed that men, Turkish/Moroccans and persons ≤20 years were less likely to participate twice, while people having a short-term relationship, a non-Dutch partner or concurrent partners were more likely to participate again. Ct-positives, who did not participate in the rescreening after 6 months, were also less likely to participate in the second screening round.ConclusionsSocio-demographic factors associated with lower participation were also associated with higher Ct-positivity, showing that, high-risk demographic groups were more difficult to mobilise than low-risk groups. However, independent of this, higher behavioural risk levels were associated with higher participation rates (especially in the model for repeated participation), suggesting self-selection for screening based on the persons’ risk (perception) in both low and high community risk groups. Our study shows the complexity of the process—including individual as well as community factors and their interaction—as to whether or not be screened for chlamydia.
P1-S1.06 Rectal health: prevalence of rectal STIs and associations with clinical signs and self-reported symptoms
Authors: Gorbach P M , Javanbakht M , Fuchs E , Weiss R E , Hezerah M , Brown S , Voskanian A , Anton P , Cranston R 
Published: July 2011

BackgroundPredictors of rectal health are needed for public health programs and planning rectal microbicide clinical trials.MethodsFrom October 2006 to December 2008, 896 men and women in Los Angeles and Baltimore in a rectal health and behaviours study (UCLA IPCP U19 0606414) completed interviews and rectal sexually transmitted infections (STIs) testing including Gonorrhoea (GC), Chlamydia (CT) and high-risk human papilloma-virus (HR-HPV). Rectal signs detected by High Resolution Anoscopy (HRA) and self-reports of symptoms in the past month were analysed for associations with STIs (GC (n=7), CT (n=15) and HR-HPV (n=178)), demographics and receptive anal intercourse (RAI) in the past month. Those with active haemorrhoids were excluded (n=77) from analyses of STI predictors.ResultsSIGNS—Men reporting RAI (n=234) had a higher prevalence of swelling seen by HRA than men not reporting RAI (6.4% vs 1.9%; p value 0.02). Prevalence of erythema or haemorrhoids was lower among men reporting RAI (2.2% vs 6.8%; p value=0.02 and 18.3% vs 30.8%; p value<0.01 respectively). There were no differences in signs between women by RAI. More erythema and discharge were HRA detected among HIV-positive men; more HIV positive men and women than HIV negative had ulceration. SYMPTOMS—Significantly more RAI+ men reported symptoms (swelling, itching, burning and irritation) but there were no differences in reported symptoms among women by RAI. HIV positive men (n=218) and women (n=186) reported more symptoms (swelling, itching, discharge and burning) than HIV negative men and women; HIV positive men reported more pain and irritation than HIV negative men (n=227). STIs—No HRA detected signs were associated with rectal GC or CT. Bleeding (OR 5.06, 95% CI 1.09 to 23.45) and leukoplakia (OR 5.06 95% CI 1.22 to 25.66) were significantly associated with detection of HR-HPV. No symptoms were associated with GC or CT; discharge in the past month was associated with HR-HPV (OR 2.16, 95% CI 1.07 to 4.35).ConclusionsLack of association between signs or symptoms and prevalent rectal STI suggests syndromic approaches may be problematic requiring laboratory testing for detection of rectal STIs. Prevalence of signs varied little by RAI practice but there was a higher prevalence of self-reported symptoms among men reporting RAI. These findings can serve as a reference for expected rates to be found in clinical trials testing rectal microbicides and interpretation of adverse events.
P5-S7.05 Chlamydia screening in an international resort community: an outreach program to expand access
Authors: Collins M , Holehouse R , Kaczorowski J 
Published: July 2011

ObjectiveTo evaluate an event-based outreach Chlamydia (CT) screening program pilot developed to address barriers to access in a resort community with an international, transient and disproportionally large young adult population. A local sexual health clinic operates at capacity. There is no provincial or national outreach CT screening campaign.MethodsSeries of 15 outreach CT screening sessions, each 2–3 h duration, held in Whistler, BC, Canada in 2009 & 2010. Sessions were held at resort staff-housing dinners, staff-housing lounge, entertainment, educational and sport events. Men and women <30 years were offered free CT nucleic acid amplification tests on urine. Positive cases were notified, with treatment and partner notification per standard of care. Primary outcome measures were age, gender and infection rates of outreach participants compared to <30 age cohort tested for CT at the sexual health clinic during same calendar years. Anonymous, post-test survey queried interval since last CT test, intention to test, health insurance, and satisfaction with the outreach experience. Unpaired t test & χ2analysis.Results112 tests for CT were obtained through outreach; 87.5% response rate to post-test survey. Mean outreach age of 23.3 years was 14.4 months younger than comparison age cohort tested at clinic (p=0.0001). Males were tested at outreach in greater proportion than at clinic (57.1% vs 46.5%, p=0.04). Proportion of asymptomatic cases was greater at outreach than clinic (90% vs 46.6%, p=0.01), yet positive test rates at outreach (8.9%, 10/112) and clinic (8.5%, 58/686) were comparable (p=0.87). On survey, 43.9% had never previously tested for CT, 53.7% were not already considering a test, 61.7% would not have gone for a test within the next 2 months. Only 27.6% had Canadian health insurance. 93.9% were satisfied or very satisfied with CT screening in an outreach setting.ConclusionsIntermittent, free, event-based outreach CT screening was operationally feasible, effective at increasing case detection, and highly acceptable to participants. Outreach attracted a younger age and more men than clinic. A large proportion of participants were first-time testers, over half were without prior intent to test or likelihood to test in near future, and most would have had to pay up-front for CT testing in a clinic setting. This study demonstrates both need and benefit of expanded CT screening efforts in the international resort setting.