bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S4.30 Point-of-Care HIV Testing with OraQuick Advance HIV-1/2 antibody assay: a systematic review of cost outcomes
Authors: Balram B , Johri M , Ako-Arrey D , Lambert G , Claessens C , Klein M , Cajas J M , Peeling R , Pai N Pant 
Published: July 2011

BackgroundRecently Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift from diagnostic accuracy to emphasis on patient-centred outcomes for making policy recommendations. While meta-analyses have evaluated diagnostic accuracy of POC HIV tests, a systematic appraisal of other implementation research outcomes, such as cost, is lacking. Within this context, we reviewed global evidence on cost outcomes of OraQuick Advance HIV—1/2 Antibody Test.MethodWe systematically searched six electronic databases for the period of January 1999 to January 2011. Cost outcomes with OraQuick tests were reviewed and data extracted. For economic evaluation we accepted both partial and full study designs. Outcomes were synthesised into a narrative review.ResultsWe identified nine studies offering economic evaluations of oral and blood based OraQuick, of which six were full economic evaluations and remaining were partial evaluations. The full economic evaluations included five Cost Effectiveness Analysis (CEA) and one Cost Utility Analysis (CUA) design; one partial evaluation was a cost comparison study and two were cost analysis studies. All studies were in the USA except one, which was from Mexico. All studies performed sensitivity analyses to explore the impact of uncertainty in their model parameters and findings. Methodological approaches applied by the authors were not standardised and program cost varied by location, but overall there was uniformity in the study conclusions. The studies concluded that OraQuick was cost effective in low prevalence settings and resulted in low rates of false positives which have favourable economic implications. The tests were found to be cost saving to the medical system, and offer the advantage of convenience in administration when compared to current standards of care. Since it was recognised that pre- and post-test counselling cost and personnel costs accounted for most of the overall costs for these rapid tests, one approach that was proposed to reduce this cost was to limit the time spent on counselling or by using lower-paid personnel for counselling activities.ConclusionThe economic evaluation results presented here can guide program managers and health policy decision makers in the research for efficient HIV testing options, for the proper allocation of healthcare resources and for adoption of models of healthcare delivery that represent the best value for money.
P1-S4.31 Failure of respondent driven sampling in a transgender population due to inadequate formative work and non-network associated selection criteria
Authors: Risser J , Padgett P , Montealegre J 
Published: July 2011

BackgroundIn 2009, the CDC funded the Transgender HIV Behavioural Surveillance pilot to assess the feasibility of using respondent driven sampling (RDS) to recruit ethnic minority male-to-female transgender (MTFTG) participants. RDS is a chain-referral strategy that restricts the number of people each participant can recruit and offers incentives for both participation and recruitment. With proper adjustment for sampling, data collected through RDS can be used to develop population prevalence estimates. RDS assumes that respondents know one another as members of the target population.MethodsBecause of funding constraints, formative work and data collection lasted only 4 months. Our goal was to recruit 100 MTFTG participants, at least 15 years old, who were assigned male sex at birth and who currently identified or presented as female. We established a field office in the Houston Transgender Center and identified a charismatic MTFTG interviewer. Office hours were set for early afternoon; incentives were $20 for the interview and $10 for each recruit (up to $50). Recruiter instructions were to give the RDS coupon to known Latina or Black MTFTG.ResultsOur University prohibited the hiring of our first-choice interviewer because she had a previous moral turpitude conviction. Recruitment was delayed until we hired another. We planted 11 seeds; 5 failed, 3 recruited 7 individuals in 2 waves; and 3 recruited 40 individuals with the longest chain consisting of 6 waves. We distributed 201 coupons and interviewed 48 eligible and consenting MTFTG.ConclusionsFormative work is essential to identify the size and features of the study population social networks, time and place for recruitment, and appropriate incentive. RDS requires respondents to be linked by the target attribute, in this case ethnic minority MTFTG. By restricting recruitment to transgender individuals of colour, we violated that assumption. Our sample networks were not structured around race/ethnicity; rather they were networked through work affiliations (sex worker, performer, unemployed). Recruitment also failed because the incentive was not enough to encourage performers and sex workers to participate in a health survey. Evening hours would have been better for our group's work schedules so they could participate on their way out for the evening. Our failure to get RDS initiated reinforces the importance of formative work to determine if RDS will succeed in your target population.
P1-S4.34 Can RDS be used to recruit unbiased samples from the same population with repeated sampling?
Authors: Risser J , Padgett P , Montealegre J 
Published: July 2011

BackgroundRespondent Driven Sampling (RDS) is a modified snowball sampling method that allows for recruitment of a probability sample, even when we cannot enumerate the population of interest. The National HIV Behavioural Surveillance project, designed to assess trends in risky behaviours, used RDS to recruit injection drug users (IDU) and heterosexuals at high risk of HIV infection (HET). In order to examine changes in behaviours over time, the sampling method must recruit homogeneous populations, so that observed differences across cycles can be attributed to changes in behaviour, rather than to errors in recruitment. This analysis was designed to determine if crude and adjusted measures within and between the IDU and HET cycles, are homogeneous on basic demographic characteristics. Our goal to assess if the samples may be considered to be from the same target population.MethodsData are from the Houston Texas site of NHBS-IDU 1 and 2 (2005, 2009), and HET 1 and 2 (2006, 2010). Adjusted population prevalence estimates are calculated using RDSAT, adjusting for design effect and sampling characteristics. Estimates were compared using the Mantel Haenszel test for heterogeneity.ResultsComparing IDU1 to IDU2, we found similar population estimates (p for heterogeneity >0.05) for age 40–49 years; Black race; had current health insurance; and currently homeless. The populations differed (p for heterogeneity <0.05) by the proportion that: graduated from high school; were arrested in the last year; and visited a doctor in the last year. Comparing HET1 and HET2, we found similar population estimates for the proportions that: had health insurance; visited a doctor in the last year; were arrested in the last year; graduated from high school; and were aged 30–49. The populations differed in the percent: Black; currently homeless; and aged 18–29.ConclusionUsing RDS to assess behaviour changes over time will be difficult if the study samples do not represent a fixed population. We looked at variables we thought would be stable over the two cycles and were surprised to find instability. With these differences, we cannot attribute the observed changes in risky behaviour solely to prevention efforts that occurred between the surveillance cycles. However, RDS remains an exceedingly easy and efficient sampling method and with appropriate multivariable analysis techniques can be used with repeated samples over time.
P1-S1.18 Investigating a cluster of neonatal herpes at a single institution
Authors: Desai N , Schillinger J , Bratu S , Eramo A , Bowers C , Agrawal A 
Published: July 2011

BackgroundNeonatal herpes (NH) is a reportable disease in New York City (NYC); annual incidence is ∼12/100 000 live births; rates are highest among young, and Black non-Hispanic women. Over a 6-month period at our institution, we identified four neonates with disseminated NH. We investigated the cluster to rule out a nosocomial cause.MethodsNH incidence was calculated for the institution and demographics of delivering mothers compared to NYC overall. NH cases were characterised with regard to viral type, birth history, syndrome classification, vital status, maternal serum antibody status, and herpes viral isolates were sought. We reviewed electronic medical records to identify staff common to >2 case-mothers or -infants. We interviewed staff about signs/ symptoms of herpes simplex virus (HSV) infection over the last year, or close contact with a family member with HSV. Maternal hospital rooms, infant isolettes, and ventilators were mapped to rule out common use by case-mothers or -infants. As NH cases were identified, protocols were implemented for notifying paediatrics of maternal post partum fever, and for initiating empiric treatment with IV acyclovir for neonates of febrile mothers.ResultsThe NH incidence rate at our institution (151/100 000 live births) was >10 times NYC incidence. Women delivering at our institution were younger (41% vs 27% NYC-wide aged <25), and more likely to be Black non-Hispanic (85% vs 22% NYC-wide). Details for case-infants are presented in Abstract P1-S1.18 table 1 below. Among three mothers to case-infants with type 2 HSV, two were antibody positive and one was negative, suggesting she may have had recent infection unapparent at delivery. Herpes viral isolates were retained for only 1 of 4 case-infants. The four case-mothers were delivered by four different obstetricians. Among 11 staff common to >1 case-infant, none had any history or symptoms of HSV infection; no equipment was common to the case-infants and no mothers shared a common room.Abstract P1-S1.18 Table 1MonthHSV TypeGest. Age (wks)Delivery TypeAge at first sign (days)Mat Age (yrs)Mat hx of lesionsPost Partum feverMat HSV IgMMat HSV IgGOutcomeCase 1Apr136Vaginal418NoneYesNANAExpiredCase 2May239C Section419NoneYesPosNegSurvivedCase 3Jul239+Vaginal1937NoneNoPosPosExpiredCase 4Oct233Vaginal321NoneYesNegNegExpiredGest, gestational; mat, maternal; hx, history.ConclusionsNH surveillance data provided important context for this investigation; incidence at this institution was much greater than expected, but the patient population is at increased risk for NH. Available data do not support a nosocomial cause for this cluster; retention of neonatal herpes viral isolates would have aided this investigation. Early recognition of the cluster by the treating team and prompt involvement of national and state public health agencies helped guide the investigation and establish novel preventive and empirical treatment protocols.
P1-S5.02 Towards more robust estimates of the per sex act transmission probability ofChlamydia trachomatis
Authors: Althaus C , Low N 
Published: July 2011

BackgroundEstimating the per sex act transmission probability ofChlamydia trachomatisis necessary to assess an individual's risk of infection and re-infection after sexual contacts with chlamydia-positive partners. Katz (1992,Stat Med) made one of the first attempts to estimate the probability of chlamydial transmission based on data about the proportions of concordant (both partners infected or uninfected) and discordant (only one partner infected) couples tested for chlamydia. This provides a cross-sectional per partnership transmission probability but did not address the duration of sexual partnerships and the spontaneous clearance of chlamydia. Mathematical models can be used to take these complexities into account.MethodsWe developed a simple mathematical model of chlamydia transmission that incorporates the formation and dissolution of sexual partnerships. Chlamydia can be transmitted from an infected to an uninfected partner throughout the duration of the partnership. Infected partners can also clear chlamydia spontaneously. The model was fitted to published data from a cross-sectional study of chlamydia infection status in heterosexual couples at a US sexually transmitted diseases clinic. The model was further parameterised with study data about overall chlamydia positivity and the number of sexual partners in the last 6 months.ResultsThe data showed similar proportions of infected female partners of infected men and infected male partners of infected women, suggesting similar transmission probabilities. Assuming an average infectious duration of 12 months for women and men, we obtained best-fit estimates for the transmission rate (0.0064 per day) and average duration of partnerships (6.0 months) in the study. The transmission rate per day corresponds to a per sex act transmission probability of 4.5%, assuming one unprotected episode of coitus per week in a partnership. Our analysis also shows that these estimates depend on the assumed infectious duration of chlamydia.ConclusionsOur approach shows how the dynamics of sexual partnership formation and disease transmission can be taken into account to derive the daily rate of chlamydia transmission within a partnership. The per sex act transmission probability can then be inferred. These refined estimates will help to parameterise future mathematical models of disease transmission and assess the risk of infection and re-infection after sexual contacts with chlamydia-positive partners.
P1-S5.03 Pattern of sexually transmitted infections (STIs) in hormonal contraceptives and intra-uterine devices (IUD) users attending family planning clinics in Ibadan, Nigeria
Authors: Fayemiwo S A , Fatiregun A A , Bakare R A 
Published: July 2011

The large majority of women who acquire HIV and other sexually transmitted infections (STIs) are in their childbearing years and are current or potential users of contraceptive methods. Using contraceptives has two main benefits; the primary benefit of preventing unplanned pregnancy and the potential secondary benefit of protecting against sexually transmitted infections (STIs). Unfortunately, the contraceptive with the best records for pregnancy prevention offers little if, any protection against STIs. The study aimed at assessing the pattern of sexually transmitted infections among hormonal contraceptives and intra-uterine contraceptive devices users attending family planning clinic, University College Hospital Ibadan.MethodsThis is a cross-sectional study in a population of women using Intra-Uterine Contraceptive Devices (IUCD) and hormonal contraceptive methods attending Family Planning clinics at University College Hospital, Ibadan. Detailed medical history, Endocervical and high vaginal swabs were collected from the participants to establish diagnosis after clinical examination and informed consent.ResultsThere were 200 participants with a mean age of 31.92 years (SD=8.33, range=16–55). The mean age of sexual debut of participants with any STI was 19.5 years. 102 (51.0%) of the women were using different methods of hormonal contraceptives while 84 (42.0 %) had intrauterine contraceptives devices inserted. About 54.5 % (109) had various STIs in both groups. The most common STI diagnosed was bacterial vaginosis (26.5%). Other STIs diagnosed were vaginal candidiasis (26.0 %), HIV (8.5%), trichomoniasis (7.5%), Chlamydia cervicitis (7.0%), syphilis (3.5%), Genital warts (3.5 %) and gonorrhoea (2.5 %). Even though bacterial vaginosis and candidiasis were diagnosed more in women with IUCD while Chlamydia cervicitis, syphilis and gonorrhoea occurred more in women using various types of hormonal contraceptives, there was no statistical relationship between the STIs and their sexual behaviours.ConclusionWomen seeking contraception to prevent unintended pregnancy are as much in need of education about prevention of STIs as much as the counselling regarding the most effective contraceptive methods. Younger age, increased numbers of sexual partners and oral mode of sexual intercourse were significantly associated with increased risk of acquiring vaginal tric.
P1-S5.07 Ongoing risk behaviours: new STD diagnoses in persons known to be HIV-infected in Miami-Fort Lauderdale (South Florida), 2000–2009
Authors: Peterman T A , Brewer T H , Newman D R , Shiver S 
Published: July 2011

BackgroundThe diagnosis of a new bacterial STD in a person with documented HIV- infection suggests ongoing high-risk sexual behaviours. While high rates of syphilis among HIV-positive MSM have been repeatedly noted in South Florida, little attention has been given to the incidence of gonorrhoea (GC) and chlamydia (CT) among HIV-positive individuals, due to use of separate surveillance systems, differing security requirements, and limited partner services staff available to investigate GC and CT cases.MethodsWe reviewed STD surveillance data from 2000 to 2009 after linking it to the HIV/AIDS surveillance data base. We analysed cases of GC and CT diagnosed >60 days after an HIV diagnosis.ResultsOverall 3.7% of GC (1504 of 40 214) and 1.2% of CT (1149/99 265) cases were in persons known to be HIV- positive. The percentage of cases diagnosed in HIV- positive persons increased steadily over the time period; GC coinfections increased from 2.3% in 2000 to 5.0% in 2009 and CT coinfections increased from 0.8% to 1.3%. Most of the GC coinfected cases were among males; 1144/21 360 (5.4%) of males with GC were coinfected with HIV while 360/18 854 (1.9%) of females with GC were coinfected with HIV. For CT, 559/22 735 (2.5%) of males with CT were coinfected with HIV while 590/76 530 (0.8%) of females with CT were coinfected with HIV. Most coinfections were among HIV positive males, 73.5% of whom were men who have sex with men (MSM). Coinfections among men increased over the time period, while among women the number peaked in 2006 and has declined thereafter. HIV- positive men accounted for over 10% of GC infections among men 35–59 years of age and over 10% of CT infections among males 40–59. HIV coinfection was present for over 5% of GC infections among women 30–44 years of age and 50–54 years of age.ConclusionsWhile males with GC or CT who are coinfected with HIV constitute a small fraction of the cases in South Florida, the proportion is increasing steadily. HIV+ MSM account for a high percentage of cases among males over 35 years of age. Timely, accessible linkage between HIV and STD databases is essential to direct partner services and risk reduction counselling to this high-risk population.
P1-S5.08 Attendance at local and national sex-events associated with STD diagnosis, San Francisco, 2010
Authors: Bernstein K , Hjord H , Marcus J , Kohn R , Philip S 
Published: July 2011

BackgroundA variety of sex-themed events draw crowds from across the USA and provide opportunities for sex partner recruitment, potentially amplifying local sexual networks and complicating disease prevention and control. We examined the frequency of attendance at such events and the association between attendance and incident STD diagnosis among patients visiting a municipal STD clinic.MethodsDuring 21 September 10–1 November 10, patients seeking services at San Francisco City Clinic were invited to complete a survey about their attendance at local and national events in the prior 12 months, including street fairs, gay pride events, Burning Man, leather events, and circuit parties. Survey results were linked with data from the clinic visit, including self-reported risk behaviours and STD diagnoses. Analyses were stratified by sexual orientation. Events traditionally associated with sex partner recruitment (sex events) were combined. χ2and Wilcoxon rank-sum statistics were used to compare patients who attended sex events with all other patients completing the survey.ResultsOf the 246 completed surveys, 106 (43.1%) were among heterosexual patients and 140 (56.9%) were among men who have sex with men (MSM). Twenty per cent of heterosexual patients and 47% of MSM patients reported attending a sex event in the prior 12 months. Among heterosexual patients, those attending a sex event were of younger age (median 25 vs 29 years, p=0.014), reported fewer sex partners in the prior 12 months (median 1 vs 2, p=0.021) and were more likely to be at their first visit to the STD clinic (71.4% vs 47.1%, 0.045). There was no association between STD diagnosis and event attendance among heterosexuals. Among MSM, those attending sex events reported more sex partners in the prior 12 months (median 10 vs 5, p=0.019), were more likely to be residents of San Francisco (83.3% vs 66.2%, p=0.021), and were more likely to be diagnosed with chlamydia (15.2% vs 4.1%, p=0.024) or any STD (29.0% vs 14.9%, p=0.045) at that visit.ConclusionsAttendance at sex events was common among patients at an urban STD clinic. Among MSM, attendance was associated with more sex partners and STD diagnosis. The ability of local programs to successfully prevent and control STDs may be complicated by recruitment of new sex partners at such events. Innovative collaborative prevention interventions at sex events and for residents returning from such events should be explored.
P1-S5.12 Population attributable risk for chlamydia infection in a cohort of young international travellers (backpackers) and residents in Australia
Authors: Wand H 
Published: July 2011

AimTo estimate the population attributable risk (PAR) forChlamydia trachomatisinfection in young men and women in Sydney, Australia.MethodMultivariate logistic regression was used to examine the association between demographic, sexual behaviour and other potential risk factors on chlamydia positivity in young (≤30 years) heterosexual international travellers (backpackers) and Australian residents attending a sexual health clinic. Point and interval estimates of PAR were calculated to quantify the proportion of chlamydia infections that can theoretically be prevented if a combination of risk factors is eliminated from a target population.ResultsIn males, the PAR associated with inconsistent condom use in the past 3 months was 65% (95% CI 56 to 71%) in backpackers compared to 50% (95% CI 41 to 56%) in non-backpackers and the PAR associated with reporting three or more female sexual partners in the past 3 months was similar between male backpackers and non-backpackers; 33% (95% CI 28 to 40%) and 36% (95% CI 32 to 41%), respectively. In females, the PAR associated with inconsistent condom use in the past 3 months was 51% (95% CI 42 to 59%) in backpackers compared to 41% (95% CI 31 to 51%) in non-backpackers, and the PAR associated with reporting three or more male sexual partners in the past 3 months was 14% (95% CI 11 to 18%) in backpackers compared to 30% (95% CI 25 to 37%) in non-backpackers.ConclusionThese findings suggest that the largest number of chlamydia infections could be avoided by increasing condom use, particularly in backpackers. Reporting multiple partners was also associated with a large proportion of infections and the risk associated with this behaviour should be included in health promotion strategies.