bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S6.08 A multifaceted intervention to increase chlamydia testing in Australian general practice
Authors: Hocking J , Poznanski S , Vaisey A , Walker J , Wood A , Lewis D , Guy R , Temple-Smith M 
Published: July 2011

BackgroundThe Australian Government has funded the Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a randomised controlled trial of a chlamydia testing intervention to assess the feasibility, acceptability and cost-effectiveness of chlamydia testing in general practice clinics. There are well documented barriers to increased chlamydia testing in general practice including time, cost, and clinicians' knowledge and awareness of chlamydia. If an intervention is to successfully increase chlamydia testing, it must minimise these barriers and take the uniqueness of each general practice into consideration. This paper describes the chlamydia testing intervention being implemented in ACCEPt.MethodsClinics in the intervention group are being provided with a multifaceted evidence-based intervention designed to increase annual chlamydia testing for sexually active 16–29 year olds. The intervention includes: a computer alert prompting GPs to test; incentive payments for GPs and practice nurses to conduct testing; an annual recall system involving SMS, phone or mail reminders; a comprehensive education pack; and regular feedback on testing performance. The intervention will be in place for up to 4 years, and will be tailored to the resources and needs of each clinic. Prior to implementation, clinic staff are engaged and given the opportunity to identify methods for improving chlamydia testing within their clinic, using an evidence-based practice assessment tool.ResultsTo date, 69 clinics in 24 areas have been recruited across three Australian states. Four of these areas (9 clinics) have been randomised: two areas (7 clinics) are in the intervention group, and two areas (2 clinics) in the control group. The intervention has been customised to each clinic with two thirds of clinics receiving the computer alert, 4 clinics using SMS reminders for recall, others using a mail recall and some using practice nurses to initiate chlamydia testing. Where possible, doctors and practice nurses have been given one on one education and training about chlamydia and pelvic inflammatory disease.ConclusionsGiven that each Australian general practice is unique, it is vital that the intervention is tailored to individual clinic needs to achieve sustainable system changes. This enables maximum staff engagement to ensure the effective uptake of increased chlamydia screening in the Australian general practice setting.
P1-S6.15 Characteristics and predictors of women seeking rescreening for stis after using the http://www.iwantthekit.org program: were they infected or uninfected?
Authors: Gaydos C , Hsieh Y H , Barnes M , Jett-Goheen M , Quinn N , Agreda P , Whittle P , Hogan T 
Published: July 2011

BackgroundCDC recommends rescreening women who are infected with chlamydia (CT) and gonorrhoea (GC) in 3 months. The iwantthekit (IWTK) Internet screening program offered an opportunity to study women who seek rescreening, and determine reported infected status at the previous screening. Mailed IWTK home-collected vaginal swabs are tested for CT, GC, and trichomonas (TV) by NAATs.MethodsCharacteristics (demographics, risk behaviours, use perceptions) of repeat users were determined from questionnaires. Predictors of repeat users were measured in a matched case-control study by conditional logistic regression analysis. A case (N=304) was defined as reporting having ever used IWTK before. A control was a user who reported never using the program earlier. Two controls (N=608) were systematically sampled for each case by matching date of use of IWTK of the case within 3 months.ResultsFrom 2007 to 2010, 17% of 1747 women who used IWTK for STI testing indicated they had used IWTK previously. Of these, 45% used it >2 times. Mean age was 24.7±5.7 yr; most were African American (69%); single (87%); 57% had 2–4 sexual partners previous yr; 44% had new partners in last 3 months; 32% were currently having sex >1 person; 16% practiced anal sex in the last 3 months; 13% never used condoms; 77% had been treated for an STI; (5 HIV+). In multivariate analysis, repeat IWTK users were more likely to be ≥20 yr. (OR=2.10, 95% CI 1.30 to 3.38) and reside in Maryland (OR=2.03, 95% CI 1.31 to 3.13). They were more likely to have had a pelvic exam in past yr (OR=2.03, 95% CI 1.36 to 3.05); be treated for an STI (OR=2.32, 95% CI 1.57 to 3.44); to perceive internet screening as confidential (OR=1.98, 95% CI 1.32 to 2.97); report results from self-administrated swabs as accurate (OR=2.49, 95% CI 1.61 to 3.87); be less likely to drink alcohol before sex (OR=0.63, 95% CI 0.44 to 0.91); and to never use condoms with vaginal sex (OR=0.43, 95% CI 0.27 to 0.69). Of repeat users, 84.2% reported having a negative prior test and 48/304 (15.8%) reported last test positive; 27 had CT; 24 had TV; 3 had GC; 6 were mixed infections. At present test, 40 (13.2%) were positive: 14 had CT, 2 had GC, 28 had TV; 4 were mixed infections. Previous TV was associated with current TV positivity (p<0.05).ConclusionsIWTK attracted many previous participants who practiced high-risk sexual behaviours to use IWTK for repeat STI testing. IWTK may offer an alternate approach for rescreening previously infected women.
P1-S6.18 Characteristics of men who seek rescreening for STIs after once using the http://www.iwantthekit.org screening program
Authors: Hsieh Y H , Barnes M , Jett-Goheen M , Quinn N , Agreda P , Whittle P , Hogan T , Gaydos C 
Published: July 2011

BackgroundThe iwantthekit (IWTK) Internet screening program offered an opportunity to study characteristics of men who seek rescreening, as well as determine reported infected status at the previous screening.MethodsWe determined characteristics of male repeat users from questionnaires. Predictors of repeat users were identified in a matched case-control study by conditional logistic regression analysis. A case was defined as reporting ever having used IWTK before. A control was a user who reported never using the program before. Two controls were systematically sampled for each case by matching the date of use IWTK of the case within 3 months.ResultsDuring 2007–2010, 115 (14%) of 852 men who used IWTK for STI testing, indicated that they had used IWTK previously. Among them, 43% used it >2 times. Mean age was 25.8 yr ±8.5 yr, and 90% were currently sexually active. 17% reported having sex with a male; 35% had >5 partners in the past yr; 58% had new partners in last 3 months; 49% currently were having sex >1 person. 63% had been treated for an STI: chlamydia (CT)(74%), trichomonas (TV)(42%) and gonorrhoea (GC)(23%); 6 reported being treated for HIV. By matching time of enrolment, 230 controls were selected. In the multivariate analysis, repeat IWTK users were more likely to be <30 years (OR=2.04, 95% CI 1.04 to 4.02), have health insurance (OR=2.01, 95% CI 1.10 to 3.69), reported ever being tested for an STI (OR=2.01, 95% CI 1.02 to 3.97), ever been treated for an STI (OR=2.20, 95% CI 1.14 to 4.23), particularly TV (OR=5.16, 95% CI 1.80 to 14.81), and less likely to have penile discharge currently (OR=0.24, 95% CI 0.08 to 0.76). Of male repeaters, 80.9% reported previous test results from IWTK as negative and 22/115 (19.1%) reported previous result positive–11 had CT, 4 had GC, 8 had TV; 2 of these were mixed infections. At present test, 24 tested positive–19 had CT, 3 had GC, 5 had TV; 3 were mixed infections. Reported CT positivity in last test was associated with current CT test positivity (p<0.05).ConclusionsThe Internet screening program IWTK attracted a number of previous male users of IWTK, who practiced high-risk sexual behaviours, to use the program for repeat STI testing. IWTK provided an alternate approach for rescreening previously infected men as well as men reporting high-risk behaviours.
P1-S6.19 Comparing two methods of estimating chlamydia screening coverage in an urban neighbourhood, 2009
Authors: Nelson M , Pathela P , Blank S , Schillinger J 
Published: July 2011

BackgroundCDC recommends sexually active females aged <26 be screened annually forChlamydia trachomatis(Ct). Only Ct cases are reported to local health departments. Screening coverage estimates, defined as the proportion of the sexually active population tested for Ct, are not routinely available. Without such measures it is difficult to interpret increases in Ct case reports.MethodsWe compared 2 approaches to estimating screening coverage in the New York City neighbourhood of Central Brooklyn (CB) in 2009: The “indirect method” used public health surveillance data, and “back calculated” to get the number of sexually active females that must have been screened to yield the number of reported Ct cases in CB females aged 15–19 and 20–25 years. Data inputs included: reported number of females with ≥1 Ct case in 2009 (730 cases aged 15–19, 619 cases aged 20–25) population estimates (12 772 aged 15–19, 14 024 aged 20–25), proportion ever had sex (35% aged 15–19), proportion sexually active in last 12 months (76% aged 20–25), and Ct positivity (20% aged 15–19, 8% aged 20–25). The “direct method” used electronic health record (EHR) data from 8 primary care provider practices in CB and adjoining zip codes using a common EHR for >1 year. EHR data were analysed to determine: numbers of unduplicated female clients aged 15–19 and 20–25, proportion sexually active, and number of sexually active females screened for Ct. The sexually active population was measured in 2 ways; group 1 was defined as females that reported ever having sex (18% (246/1340) aged 15–19 and 12% (302/2419) aged 20–25). Group 2 was defined as females meeting >1 of: reported ever having sex; ever prescribed an oral contraceptive by the practice; ever had an STD; ever diagnosed with STD by the practice; ever pap ordered by the practice (38% (514/1340) aged 15–19 and 38% (910/2419) aged 20–25).ResultsSee Abstract P1-S6.19 table 1.Abstract P1-S6.19 Table 1Estimated Chlamydia Screening Coverage for Central Brooklyn Females by Method and Age Group, 2009MethodAge groupFemale populationPercent sexually activeNumber Ct testedEstimated screening coverageIndirect15–1912 77235% (4406)363282%20–2514 02476% (10 630)823477%EHR Group 115–19134018% (246)16768%20–25241912% (302)17859% Group 215–19134038% (514)31561%20–25241938% (910)51857%ConclusionThe indirect approach yielded a higher Ct screening coverage estimate than the direct approach. By both methods, screening coverage was higher in the 15–19 age group than the 20–25 age group. For the direct approach, definitions of sexually active women affected measures of screening coverage, particularly for 15–19 year olds. The indirect method can be easily replicated, with limited resources. The direct method requires more resources and is contingent on consistent and accurate provider documentation of sexual activity.
P1-S6.20 Perinatal Screening for STIs in the USA: adherence to preventive screening recommendations for HIV and syphilis among the commercially insured (2008)
Authors: Janes G , Beard A , Tao G , Hoover K , Kent C 
Published: July 2011

BackgroundPerinatal transmission of sexually transmitted infections is a preventable source of morbidity. In the USA, the incidence of congenital syphilis has increased by 23% since 2005 and, in 2008, 141 infants were infected with HIV, despite the fact that the CDC recommends routine prenatal syphilis and HIV screening. To encourage compliance with guidelines, many payers rely on claims data to track utilisation. In this study, the percentage of women screened for syphilis or HIV during their pregnancy was estimated using MarketScan claims data, as a measure of compliance and of the feasibility of using these data for assessment of prenatal screening.MethodsWe analysed data from the MarketScan database, that allows linkage of de-identified patient and utilisation data from varying sites of care. The analysis was restricted to women who delivered a live birth in 2008, and who were continuously enrolled in one health plan for at least 293 days prior to delivery. The eligible population was identified using the coding algorithm for a live birth defined by HEDIS.ResultsAmong the 220 571 women with a live birth in 2008, 87.0% received a syphilis test during their pregnancy, 74.1% received an HIV test and 73.3% received both. The test rate for syphilis was highest for those 31–35 yrs (88.2%) and lowest for those 15–20 yrs (78.3%). The test rate for HIV was highest among those 21–25 yrs (75.2%) and lowest among those 15–20 yrs (70%). Both prenatal syphilis and HIV test rates were highest among those insured by a preferred provider plan. Regionally, testing rates were highest in the South (89.8% for syphilis and 82.1% for HIV) and lowest in the Northeast for syphilis (82.8%) and in the West for HIV (62.9%).ConclusionsThe results suggest fairly good compliance with guidelines for prenatal HIV and syphilis screening, although utilisation still varies by age, insurance type and geographic region. The MarketScan database represents individuals covered by employment-based health plans, which is how most Americans are insured. These data provide a unique opportunity to assess utilisation among the insured, at a time when the USA is poised to move a larger proportion of the population into this group. Tracking of year-to-year changes could help public health and healthcare organizations partner to improve care and target interventions to ensure equal access to these critical services.
P1-S6.21 Chlamydia trachomatisscreening initiative among female US army soldiers deployed to Korea
Authors: Jordan N , Clemmons N , Gaydos J , Fishman J , Jacobsmuhlen T , Lee H Choon , Meyers M , Klein T 
Published: July 2011

ObjectivesTo determine the prevalence ofChlamydia trachomatis(Ct) infections among female US Army soldiers deployed to the Republic of Korea; to identify high-risk groups; and to develop data to inform Army leaders and public health decision makers regarding the program's impact.MethodsAll females reporting (in-processing) to the Eighth US Army, Republic of Korea, between 1 November 2007 and 31 December 2009 received an educational STI brief and a questionnaire, and were requested to provide a urine sample for Ct and gonorrhoea testing using the Aptima Combo 2 Assay. Contact tracing was conducted for all identified cases. Descriptive analyses of the population of interest and data collected during calendar years 2008–2009 were performed. A logistic regression model was generated to identify statistically significant risk factors.ResultsWomen deployed to Korea differed somewhat demographically when compared to the overall female Army population; a higher proportion of known high risk groups was observed (eg, women under 25 years of age). A total of 3761 women were screened during the 2 calendar years, with an overall positive rate of 5.7%. Ct rates were as high as 11.4% among women under 20 years, and decreased with increasing age. Rates varied considerably by race, with the highest rates observed among American Indians/Alaskan natives (9.3%), followed by Black females (6.5%). The Eighth US Army screening program was associated with diagnosis of infections at an earlier age (22.1 years on average during the screening program, as compared to 26.1 years on average before the program was initiated). Statistically significant differences were observed, with higher rates found among Black women and women <25 years of age.ConclusionA high prevalence of infection was observed, highlighting the need for a continued Eighth US Army screening program. Furthermore, the program demonstrated that universal screening during Army in-processing was feasible and resulted in detection of Ct at earlier ages, which likely reduces disease transmission, medical complications, and associated costs with treatment. These findings have implications not only for the continuation of the program in the Republic of Korea, but also for the expansion of such programs during in-processing activities among other military high risk populations (eg, Army recruits).
P1-S6.22 Characteristics of chlamydia testing by a large commercial laboratory corporation, USA, 2008–2010
Authors: Kent C , Tao G , Hoover K , Body B , Nye M 
Published: July 2011

BackgroundUS guidelines recommend chlamydia screening for all sexually active young women, HIV-infected persons, and men who have sex with men (MSM). Several types of chlamydia tests are available, including nucleic amplification tests (NAATs), DNA probe, and culture. Different assays have different sensitivity and specificity, and sensitivity and specificity also varies by specimen type. Because reported chlamydia trends could be impacted by shifts in the proportion of tests and specimen types used by providers and laboratories, it is important to monitor changes in test usage to help interpret reported trends in morbidity. We examined chlamydia testing data from one of the two largest commercial laboratories in the USAMethodsAmong chlamydia tests performed from June 2008—to July 2010 by this laboratory, we assessed the frequency of test types used by year, sex, specimen type, and positivity of these tests.ResultsDuring these 2 years, 2.9 million specimens were tested for chlamydia. Among those tested, 86% were women. Tests performed were: 77% NAATs, 23% DNA probes, and 0.3% cultures. Between year 1 and 2, NAATs increased from 73% to 80% of all tests, and DNA probes decreased from 27% to 19%. Test type varied by sex; 88% of tests among men were NAATs compared to 75% among women. The top specimen types among women tested by NAAT were: 45% cervical, 35% urine and 18% vaginal. Chlamydia positivity varied by test type: 5.1% NAAT, 1.4% DNA probe, and 2.3% culture.ConclusionsNAATs were the most frequently used chlamydia test and their use increased over the evaluation period, creating a smaller market for other tests. Although vaginal swabs are the most sensitive specimen for testing women by NAAT, currently they are the least common specimen type used for testing. This may reflect the delayed introduction (FDA clearance) of the vaginal swab compared to other collection devices. Stocking the wide assortment of collection devices required for testing different specimens in different populations might also be a barrier for providers. Because these data are from one of the largest U.S. laboratories, with representation by insurance type and geography of the U.S. population, they can be useful for monitoring testing trends. Laboratory testing data also might be a valuable adjunct for national surveillance of chlamydia positivity trends that would not be dependent on provider or health department reporting nor small sample size from national surveys.
P1-S6.24 Estimation of prenatal screening rates for chlamydia, syphilis, and HIV among low-income women, California, 2007
Authors: Chow J , Wright G , Bolan G 
Published: July 2011

BackgroundPrenatal screening for chlamydia (CT), syphilis, and HIV infection is recommended to diagnose and treat infection that might otherwise be transmitted to the neonate and result in perinatal complications. Assessment of screening is important for programs serving low-income women who may be more likely to initiate care late in pregnancy and may be at higher risk for adverse perinatal outcomes.MethodsWe analysed Medi-Cal program claims to identify low-income California female clients who delivered an infant in 2007 with ≥9 months Medi-Cal eligibility, ≥1 prenatal and family planning claim in the 42 weeks before delivery. Test claims in Medi-Cal and family planning claims during this period for CT, syphilis (including obstetric panels), and HIV were identified based on Common Procedural Terminology-4 codes. We estimated the percent of women screened for CT, syphilis, and HIV, and stratified by trimester screened, age (≤25 years; >25 years), and race/ethnicity. Results of 181 390 Medi-Cal clients who delivered in 2007, the percent with ≥1 prenatal test for all 3 STDs was 62% and for CT, syphilis, and HIV was 73%, 77%, and 62%, respectively, with little variation by age and race/ethnicity. Among 125 444 women who initiated care in the first trimester the percent tested for CT, syphilis, and HIV was 78%, 83%, and 68%, respectively. Among 11 802 women who initiated care in the third trimester the percent tested for CT, syphilis, and HIV of was lower at 43%, 48%, and 31%. Among women who were tested in the first trimester, the percent re-tested in the third trimester for CT, syphilis and HIV was 21%, 30%, and 5%, respectively.ConclusionsThese lower than expected STD prenatal screening rates should be considered minimum estimates. Estimates have not included testing from all other healthcare programs accessed by women prior to delivery in the Medi-Cal program and have not been validated against medical records. Nevertheless, the lower rates of testing among women with late prenatal care initiation and the relatively low rates of HIV testing as compared with syphilis testing despite legislative mandate are concerning and further studies are needed to understand reasons for these differential rates.
P1-S1.25 Trend of sexually transmitted diseases diagnosed by syndromic approach in an institute setting
Authors: Kanwar A 
Published: July 2011

BackgroundThe paradigm of research in sexually transmitted diseases (STD) has recently shifted to HIV/AIDS. Recent trend of sexually transmitted diseases in India is lacking.ObjectiveTo determine the trend in the syndromic diagnosis of sexually transmitted infections (STI).MethodsData of patients attending our STD clinic between 2008 and 2010 was retrieved. Aetiological diagnosis of individual patients as practiced in our clinic were fit into any of the following syndromic diagnoses—vaginal/cervical discharge, non-herpetic genital ulcer, herpetic ulcer, lower abdominal pain, urethral discharge, ano- rectal discharge, inguinal bubo, scrotal swelling, genital warts, and other STIs that could not be characterised into above syndromes. The syndromic approach as suggested by National AIDS Control Organization of India was followed. Trend of syndromic diagnosis of STIs was determined.ResultsIn 2008, majority (51.1%) of the new patients registered to the clinic (36, 26.66% herpetic genital ulcer, 33, 24.44% genital warts) had one or the other viral STI. In 2009, 43.68% patients had viral STIs (21.35% herpetic GUD, 22.33% genital warts). In 2010, there was a significant increase in the incidence of viral STIs; 72.6% patients (36.94% herpetic GUD and 35.66% genital warts) had one or the other viral syndromic diagnosis.ConclusionIn concurrence to observations worldwide, proportion of viral STIs have increased significantly recently due to widespread use of broad spectrum antibiotics. One more reason could be recurrent or persistent nature of these viral STIs. In our setting, incidences of herpetic GUD and genital warts were almost similar.