bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S6.17 Facilitating access to sexual health services for men who have sex with men (MSM) and transgender persons in Guatemala city
Authors: Boyce S , Barrington C , Bolanos J Herbert , Arandi C Galindo , Paz-Bailey G 
Published: July 2011

BackgroundMen who have sex with men (MSM) and transgender persons are disproportionately affected by sexually transmitted infections (STIs), including HIV, in Guatemala. Access to integrated sexual health prevention and treatment services is limited. The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual, and non-gay identified MSM and male-to-female transgender persons in Guatemala City to inform the development of high quality and population-friendly services that are sensitive to the needs of this population.MethodsSemi-structured in-depth interviews were conducted with 27 purposively sampled participants, including 7 transgender, 11 gay, 5 bisexual, and 4 non-gay-identified participants, in Guatemala City. Interview topics included experiences with sexual health services, perceived barriers to access, social and sexual network characteristics, and HIV risk behaviours. Topical codes were developed based on readings of interview transcripts and codes were applied to the data using the qualitative software Atlas.ti. Data were compared between study sub-groups using thematic matrices and analytic memos.ResultsAcross all participants, public clinics were the most commonly used sexual health services due to their lower cost and greater accessibility, but many participants provided examples of discrimination, violation of confidentiality, and distrust in the quality of services offered. Transgender and gay participants preferred clinics where they felt a sense of belonging while non-gay identified participants preferred clinics that were not associated with the MSM community. The most prominent barriers to sexual health services described by participants included fear of discrimination related to sexual identity and/or behaviour, fear of having HIV and the associated stigmatisation, cost, and lack of social support.ConclusionsFindings highlight the need to strengthen and expand existing public STI clinics to improve access to services among MSM and transgender populations in Guatemala City. These services must address the multiple layers of stigma and discrimination that MSM and transgender persons experience related to identity, behaviour, and STI/HIV. Insights from this study are currently being applied to the implementation of two public clinics in Guatemala City that seek to provide a discrete, non-judgemental environment where individuals can seek affordable services without fear.
P5-S6.18 Cost-effectiveness of introducing rapid syphilis testing in the Amazon Region, Brazil
Authors: Carvalho C H , Benzaken A , Peeling R , Santos A , Terris-Prestholt F 
Published: July 2011

BackgroundThis study aims to estimate the costs-effectiveness of introducing a universal syphilis screening and treatment package with an enhanced quality assurance system among isolated indigenous populations in the Amazon region of Brazil.MethodsIn three indigenous health units (Umariacu II, Vendaval and Betania), incremental financial and economic costs of the full programme were collected including start-up, training and quality assurance, supervision and implementation. These units were chosen because of their different geographic access levels (easy to very difficult) so that results can be extrapolated to other health districts of the Amazon state. Unit cost per person screened and treated was estimated as well as the cost-effectiveness per adverse outcome and DALY averted. This study also provides the first data on prevalence rates in this population.ResultsUsing rapid syphilis tests, the prevalence of syphilis was 1.56% and 2.2% in the sexually active population and in pregnant women respectively at the three health units. The total financial cost of syphilis screening 4173 people was $277 853. The total economic cost was $285 995.67. The economic cost per person screened was US$68.53 and treated was US$4028.11. The cost per DALY saved was US$484.31 (including stillbirth). Personnel costs contributed the largest input category consisting of 87.5% of the total costs, due to the high cost of labour of FUNASA (National Health Foundation) personnel. Training costs are also high due to the frequency of staff turnover and thus the need for repeated trainings.ConclusionsAlthough the cost per person screened and per person treated for syphilis could be considered high by international standards, the only alternative to screening in the health units for this population would be transporting people to the nearest larger town for screening in the nearest health facility with a laboratory. This would clearly exceed the costs of treating the cases locally by far. This therefore makes rapid syphilis testing the most cost-efficient alternative for testing these remotely located populations. Additionally, because of cultural behaviour of the indigenous populations and the fact that some of them are located near border regions of Brazil, the prevalence scenario can change quickly, increasing the number of syphilis and HIV cases in the absence of prompt identification and treatment.
P5-S6.19 Prevalence and incidence of sexually transmitted infections among female sex workers in two cities in India: implications for STI control strategies
Authors: Das A , Prabhakar P , Narayanan P , Neilsen G , Morineau G , Mehendale S , Risbud A 
Published: July 2011

BackgroundIndia is a large country with marked heterogeneity in prevalence of sexually transmitted infections (STIs) which has implications for STI control strategies. The study objective was to measure the prevalence and incidence of common bacterial STIs in a cohort of female sex workers (FSWs) in known high STI prevalence cities in response to a package of standardised interventions under Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation.MethodsFSWs attending clinics were followed up periodically over 6–9 months. At every visit, vaginal swabs were tested forNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) by Gen-Probe APTIMA Combo II. During the baseline and final visits, vaginal swabs were tested forTrichomonas vaginalis(TV) by PCR and blood was tested for syphilis using Rapid Plasma Reagin (RPR) with confirmatoryTreponema pallidumHaemagglutination Assay (TPHA). All participants received presumptive treatment for gonorrhoea and chlamydia at the baseline visit and syndromic STI management at all subsequent visits.ResultsA total of 417 FSWs were recruited, 360 returned for at least one follow-up visit, and 282 completed the final visit. The total follow-up period was 109.4 person years (median 0.18 years, maximum 1.07 years). Self-reported consistent condom use with commercial and regular partners was 70% and 17%, respectively. A substantial proportion of cervical and trichomonal infections were asymptomatic (see Abstract P5-S6.19 table 1). The incidence of GC/CT and TV was 1.0 and 2.0 per person year respectively. Three new cases of latent syphilis were detected at the final visit.Abstract P5-S6.19 Table 1Prevalence of STIs and asymptomatic infections (n=282)PathogenBaseline visit1st follow-upFinal visitCervical infections (GC and/or CT)27.7% (asymptomatic 35.9%)16.7% (asymptomatic 60.5%)21.3% (asymptomatic 76.7%)TV29.9% (asymptomatic 27.2%)46.6% (asymptomatic 82.2%)Latent syphilis (RPR titre >1:8)6.8%2.5%ConclusionsThe incidence of GC, CT and TV and the considerable burden of asymptomatic infections indicate the need for periodic presumptive treatment at high STI prevalence sites in India. The current regime of bi-annual syphilis screening is justified. Consistent condom use and partner treatment, particularly for regular partners, need to be re-emphasised.
P5-S6.20 STIs and healthcare reform. Will it really improve America's sexual health?
Authors: Mettenbrink C , Cornelis R 
Published: July 2011

BackgroundThe implementation of healthcare reform in the U.S has led to a debate on whether publicly-funded STI clinics will continue to be necessary. A large proportion of STIs are reported from non-STI clinic providers and this proportion will grow with universal access to care. However, STI clinics serve vulnerable populations such as men who have sex with men (MSM) and racial/ethnic minorities who have no other access to STI care. In addition, many prefer the confidentiality and expertise of STI clinics. We studied characteristics of patients reported with gonorrhoea in the City and County of Denver and compared those reported from the Denver Metro Health (STI) clinic (DMHC) with those reported from elsewhere.MethodsAs part of the CDC-funded STD Surveillance Network (SSuN), DMHC and the Colorado Department of Public Health and Environment (CDPHE) collect additional risk information for gonorrhoea cases residing in the SSuN catchment area. Of all incident gonorrhoea cases within a given month, 40 are randomly selected for an interview by CDPHE staff to collect demographic, treatment, and risk information. All gonorrhoea cases diagnosed between 1 January 2008 and 31 October 2010 were examined.ResultsOf 2933 gonorrhoea cases for the 2-year period, 932 (32%) were diagnosed at DMHC. Cases diagnosed at DMHC were considerably more likely to be male (74% vs 38% p<0.0001), and tended to be slightly older (mean age 27.0 vs 24.9, p=<0.0001) than cases diagnosed elsewhere. CDPHE successfully contacted 41% of selected cases for interviews. A significantly higher proportion of cases diagnosed in the STI clinic were MSM compared to cases diagnosed elsewhere (34.7% vs 14.5%, p≤0.0001). No differences were found in terms of race/ethnicity, number of reported sex partners, education level, or previous gonorrhoea infection.ConclusionsIn the City and County of Denver, heterosexual men and MSM are more likely to be diagnosed with gonorrhoea in the STI clinic than women. The successful transition of STI services to non-STI healthcare systems in the context of healthcare reform, will not only depend on the STI expertise in those settings, but in large part on a shift in health seeking behaviours among men, many of whom may be considered core STI transmitters. The continued need for and utilisation of STI clinics in countries with long-standing universal access to care, should give us pause in abandoning our STI clinical system to soon.
P5-S6.22 Social-structural factors associated with supportive service use in a cohort of HIV-positive individuals on ARV therapy in British Columbia, Canada
Authors: O'Brien N , Palmer A K , Zhang W , Michelow W , Shen A , Roth E , Rhodes C L , Montaner J S G , Hogg R S 
Published: July 2011

IntroductionMedical services are seldom the only assistance required for HIV-positive individuals to lead longer, healthier lives. The clinical complexities of HIV infection and the multiple needs of people living with HIV often require additional assistance to ensure optimal health outcomes. Supportive services (eg, housing, food, counselling, addiction treatment) are increasingly conceptualised as critical components of care. Our study investigates social and clinical correlates of supportive service use across differing levels of engagement. Abstract P5-S6.22 figure 1 presents the conceptual model of the study.Abstract P5-S6.22 Figure 1Conceptual model for factors associated with supportive service use.MethodsThe Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) is a cross-sectional cohort of HIV-positive persons on antiretroviral therapy in British Columbia, Canada. Interviewer-administered surveys collected information regarding sociodemographic factors, substance use, social support networks, and supportive services. Clinical variables were obtained through longitudinal linkages with the Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. Participants were stratified by level of service engagement (daily, weekly, and 1–3 months). Bivariate analysis and a logistic regression proportional odds model were used to identify variables significantly associated with supportive service use.ResultsAmong 915 participants, 742 (81%) reported using supportive services, of which 344 were highly engaged, 280 moderately engaged, and 118 minimally engaged. Food programs, medication support, and counselling and social supports groups were services most accessed. Multivariate results demonstrated that those most engaged in supportive services were more likely to report poor social determinants of health such as low income [adjusted OR (AOR)=1.81]; not having completed high school (AOR=1.97); unstable housing (AOR=1.89); and current illicit drug use (AOR=1.60). After adjusting for social determinants, there were no significant differences in clinical measures across different levels of engagement with supportive services.ConclusionHigh service use by those demonstrating social and clinical vulnerabilities reaffirms the need for continued expansion of supportive services to facilitate a more equitable distribution of health among persons living with HIV.
P1-S2.01 Prevalence of HIV and sexually transmitted infections among clients of female sex workers in Karnataka, South India
Authors: Shaw S , Deering K , Reza-Paul S , Isac S , Ramesh B , Washington R , Moses S , Blanchard J 
Published: July 2011

IntroductionSeveral studies have demonstrated the importance of commercial sex work in the transmission of HIV and other sexually transmitted infections (STIs) in India. Clients of female sex workers (FSWs) are thought to be an important bridging population for HIV and STIs. However, there is little information on basic characteristics of sex work clients. This study sought to describe the prevalence of HIV and other STIs, as well as examine the determinants of these pathogens, among a sample of clients in south India.MethodsData were from a cross-sectional biological and behavioural survey of FSW clients from six districts in Karnataka State, India. The prevalence of HIV, syphilis, herpes simplex virus type 2 (HSV-2), chlamydia (CT) and gonorrhoea (GC) among clients was examined. Multivariable logistic regression models were used to analyse the socio-demographic, sexual behaviour and sex-work related characteristics related to the prevalence of each pathogen. Sampling weights and appropriate survey methods were utilised in regression models to account for a complex sampling design.ResultsThe total sample size was 2745. The average age of clients was 30.4 years (SE—0.3). Across the total sample, the prevalences of HIV, HSV-2, syphilis and CT/GC were 5.6%, 28.4%, 3.6% and 2.2%, respectively. The prevalence of HIV/STIs varied substantially across districts, reaching statistical significance for HIV (p<0.0001) and CT/GC (p=0.005). In multivariable models, duration of paying for commercial sex was associated with increased risk for HIV and HSV-2 (both AORs—1.1; 95% CI 1.0 to 1.1, p<0.0001). Clients using brothels as a main FSW solicitation site were associated with increased risk of HIV (AOR—2.4; 95% CI 1.2 to 4.7, p=0.001), while those frequenting lodges were at increased risk for CT/GC (AOR—6.3; 95% CI 1.9 to 20.6, p=0.03). Clients with HSV-2 infection were at substantially higher risk of being HIV-positive (AOR—10.4; 95% CI 6.1 to 17.7, p<0.0001).ConclusionsThis study fills in important gaps in knowledge regarding clients of FSWs in Southern India. FSW clients clearly constitute an important bridging population between FSWs and their other sexual partners in the population. It is important to design and implement effective prevention and care programs for this well-hidden population.
P5-S6.26 Prevention with positives in Nigeria: what have we learnt?
Authors: Traffina C I 
Published: July 2011

BackgroundThe introduction of care and treatment at the service delivery points at the community and the clinical settings- hospital facilities for prevention with the positives have giving the HIV/AIDS, STIs, TB management high quality significant improvement in the first 8 months of implementation in Nigeria.MethodsAssociation of positive youth in Nigeria is a national non-governmental organisation in Nigeria, involved in HIV prevention, care and support. APYIN started implementing HIV prevention strategies in 2009 with a focus on involving HIV—positive people in prevention. The strategies included; counselling on prevention of HIV to positive persons this involved discussion of behavioural intervention in medical and counselling visits. Promoting the use and provision of condoms to sexually active HIV—positive individuals, promoting adherence to antiretroviral drugs, by counselling, use of pills boxes, and medicine companions. Encouraging HIV-positive persons to disclose HIV status to sex partners either by self or counsellor mediated during home visits or at the nearest opportunity. Home base management, HIV counselling and testing targeting partners and children born to all people living with HIV/AIDS.ResultsMost of the persons living with HIV realise that they have a role to play in prevention of HIV. There is 8.5% increase in the uptake of condoms by HIV -positive person between the year 2008 and 2009. Antiretroviral therapy adherence levels of 92% of the clients on ART with adherence >95%. In the same period there is an increase of 50% of HIV -positive individuals disclosing HIV status to partners. Community awareness of HIV has increased in the area serviced by the organisation.ConclusionIncrease collaboration between the clinical and community base interventions. Regular monitoring of the community response for improvement. The capacity building of for community staff. HIV-positive persons are very important partners in HIV prevention. Therefore their involvement should be prioritised.
P5-S6.27 New avenues to increase quality of STI-care in general practice
Authors: van Bergen J E A M 
Published: July 2011

BackgroundThe role of primary care in STI-control has long been neglected. Although national STI surveillance often thrives on data of STI-Clinics, recent research in the Netherlands shows that approximately 70% of all STI-related consultations are in General Practice (GP). More attention for sexual health in primary care is warranted.MethodsIn 2004 the Dutch College for Family Physicians (NHG) added a guideline about the “STI consultation” to their list of GP certified “standards of care”. The guideline describes care for patients with complaints of STI, for patients with questions about STI (test request), and also describes pro-active testing policies for persons visiting the health centre for a not-STI related reason. The guideline is currently being updated. Implementation of the guideline is facilitated by regional “expert” GP, united in the GP-advisory group on STD, HIV and Sexuality (the Expert group Sexual Health (SeksHAG). Such Expert Groups within the GP institutional body are relatively new and also exist, for example, diabetes and Asthma/COPD.ResultsAnnually approximately 1500 GP receive a continuous education session on STI facilitated by the GP expert in their region. Previous research showed moderate impact on testing habits and case detection. Qualitative interviews describe insight in personal barriers as a positive gain in training sessions. Prescribing habits of GP for Gonococcal infections are legging behind, half of GP prescribing ciprofloxacin, for which resistance is well above 40%.DiscussionA substantial but often hidden proportion of STI consultations take place in general practice. More interventions on STI-care in GP are recommended. An expert group within the national GP body can enhance attention for quality of care. The new emerging paradigm within primary care to focus not only on disease (pathogenesis) but also on health (salutogenesis) might open new avenues for sexual health counselling. New technology also has potential: continuous education sessions have limited impact on prescribing habits for infrequent conditions with fast changing resistance patterns like gonoccocal infections; learning GP to use more and better their electronic prescription expert-system based on patient ICPC code (Prescriptor) is a better option and now available in most GP operating systems in the Netherlands.
P5-S6.32 Using a contingent valuation method to understand consumer preferences for care of adolescents with pelvic inflammatory disease (PID)
Authors: Trent M , Qian Q , Frick K , Thompson C , Butz A , Ellen J , Lehmann H 
Published: July 2011

ObjectiveAdolescent girls diagnosed with PID are at higher risk for subsequent sexually transmitted infection (STI), pregnancy, and long-term pelvic pain. Although the 72-h post-PID evaluation provides an opportunity for risk reduction counselling, few adolescents adhere. Use of public health nurses (PHN) for clinical follow-up may meet the needs of this vulnerable population. The objective of this study is to estimate consumers' willingness-to-pay (WTP) for follow-up PID services by physicians and PHNs, differences by consumer type, and the differences in health-provider predicted consumer WTP values and actual consumer WTP values.MethodsA contingent valuation method was used to collect WTP data regarding co-payments to physicians or nurses for clinical service delivery from the consumers of adolescent PID services (parents (n=121) and adolescents (n=134)) and a national sample of health providers (n=102). Consumers were recruited from an academic paediatric practice and school-based health clinics in a large urban community with high STI prevalence. Participants completed a web-based survey with data uploaded to a secure server after obtaining online consent. Data were analysed using linear regression analyses.ResultsThe mean WTP for physician services was $16 (SD $16.9) for clinicians, $81.9 ($34.0) for parents, and $72 (SD $ 39.1) for adolescents. The mean WTP for PHN services was $13.6 (SD $17.4) for physicians, $62.4 (SD $44.1) for parents, and $49.7 (SD $44) for adolescents. Using physician estimates for WTP as the reference group, adolescents were willing to pay $56 more (95% CI 48.6 to 63.4) for physician care and parents were willing to pay $66 more (95% CI 59.0 to 72.8) than physician's predicted controlling for informant employment status. Adolescents were willing to pay $36 more (95% CI 48.6 to 63.4) for community-based nursing care and parents were willing to pay $48 more (95% CI 59.0 to 72.8) than physician's predicted. Consumers' (adolescents' & parents') WTP for physician services were on average $18.50 higher than PHN services (p=0.01).ConclusionWhile adolescents and parents prefer physician follow-up for PID based on WTP, they are amenable to PHN follow-up visits. Our data suggest that health providers underestimate the value the consumers place on clinical service for PID. Given poor adherence to office-based follow-up and consumer interest in PHN visits, additional research evaluating the effectiveness of PHN visits for PID is warranted.