bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S6.07 The management of syphilis and gonococcal infections among men who have sex with men (MSM) in a community medical center named “Centre Oasis, Ouagadougou, Burkina Faso”
Authors: Dah T T Elias 
Published: July 2011

Background“Centre Oasis” is a community medical center of an NGO named “Association African Soildarité” (AAS). It provides to MSM a framework for management and prevention of STIs and HIV/AIDS. The review of the NGO activities in the first half of 2010 showed high rates of syphilis and gonococcal infections, 21% and 17%. A special care of these infections has been established with the help of international and national partners in order to face this problem.MethodsAn active search for cases of syphilis and gonorrhoea among MSM who come in the center have made after obtaining their consent. They also answered a questionnaire. The search for gonococcie was by electron microscope on urethral and/or anal and/or buccal swabs. The syphilis infection was diagnosed by two tests recommended by WHO (VDRL and TPHA). The MSM who were positive for syphilis received antibiotics based Benzathine Penicillin (2.4 million IU intramuscular) and those who were positive for gonorrhoea received 400 mg of Cefixime. Doxycycline (100 mg×2 daily orally for 14 days) was given as an adjuvant therapy to treat a possible Chlamydia infection. The partner (s) of the positive subjects were also treated.ResultsFive months after the implementation of the program, we found prevalences of 12.2% for syphilis and 9.8% for gonorrhoea for a total of 316 consultations. In 71.1% of case the MSM had several sexual partners, 57% had used condoms during their last intercourse, 42% used lubricants (gels). 67.1% of MSM were bisexuals. All screened patients had received antibiotic treatment according to the protocols described above. 78% of identified partners had also benefited from antibiotic treatments in the medical center.ConclusionThe MSM community in Ouagadougou is highly vulnerable given the high rates of syphilis and gonorrhoea. Such programs help to fight against STDs and HIV/AIDS but are not sufficient when we know the condition of the homosexual in African countries. It is time for national health policies to fight against STIs and HIV to take more account of the population of MSM.
P5-S6.11 HIV prevention with positives provider training in a resource-constrained setting: the US Virgin Islands
Authors: Canete A , Nagendra G , Chun E , Olans R , Ciprian T , Dreisbach S 
Published: July 2011

BackgroundTo describe HIV Prevention with Positives training for healthcare providers in the USA Virgin Islands (USVI).MethodsThe Caribbean region has the world's second highest adult HIV prevalence after Africa. In 2007, the prevalence rate of HIV among adults and adolescents in the USVI was 641.3 per 100 000 population. In the USVI, HIV clinical care is provided by three physicians at the USVI Department of Health or at community health centers. Due to a shortage of trained clinicians, non-clinical providers play a crucial role in the delivery of comprehensive HIV care. Ask Screen Intervene (ASI), a training curriculum, was developed by the National Network of STD/HIV Prevention Training Centers and the AIDS Education and Training Centers with support from Centers of Disease Control and Prevention. ASI was designed for clinical HIV providers and discusses risk assessment, STD screening, prevention messages and partner services for HIV+ patients. In June 2010, the Region II STD/HIV Prevention Training Center offered ASI in the USVI, in St. Croix and St. Thomas. ASI was targeted to clinical and non-clinical providers to encompass the range of providers caring for HIV+ patients. Participants completed an evaluation rating the training and a retrospective self-assessment of their confidence to perform learning objectives on a 5 point Likert Scale; 1=not at all confident and 5=very confident.ResultsA total of 37 providers attended training in St. Croix and 42 in St. Thomas. Non-clinical providers represented a significant proportion of attendees; 62.2% in St. Croix, (23/37) and 40.5% in St. Thomas (17/42). Among all participants, course satisfaction ratings ranged from 4.28 to 4.59 (1=strongly disagree; 5=strongly agree), with high ratings for relevance of learning objectives and appropriateness of content. Participants reported post-training gains in confidence ranging from +0.69 to +1.24 Likert scale interval per each learning objective, including increased knowledge of STD screening and prevention counselling for HIV+ patients. The most frequently reported intended practice changes included asking more detailed questions routinely about sex practices and taking a more thorough sexual history.DiscussionASI training reached the intended target audience and resulted in gains in provider confidence and intention to change practice, and can be expected to positively impact patient outcomes. Further dissemination of ASI training appears warranted.
P5-S6.13 Objective assessment of patient satisfaction with their HIV care
Authors: Land L , Ross J 
Published: July 2011

BackgroundPatient engagement with HIV services is essential since early diagnosis and care has a direct impact on patient survival and also provides public health benefits associated with reduced infectivity. Positive physician/patient relationships have been linked to higher levels of treatment adherence. Determining and measuring patient priorities in the delivery of HIV services can therefore have a direct impact on perceived satisfaction with services and also improve clinical outcomes.MethodsA systematic review was undertaken to identify existing approaches to identifying patient derived key themes in the delivery of their care. These themes were then examined and expanded using 4 focus groups discussions with HIV services users.ResultsA search of 12 bibliographic databases, a hand search of journal bibliographies and a wider internet search yielded 1474 titles from which 150 study abstracts were appraised. 32 articles were retrieved and reviewed using a quality appraisal checklist. A data extraction form was used by two reviewers to extract relevant information for thematic analysis. The review identified key themes of principal importance to patients attending for HIV care—medical staffs' perceived knowledge about HIV, attitude of clinic staff, maintenance of patient dignity, patient autonomy, confidentiality and an appropriate care environment. Three specific survey tools were identified for measuring satisfaction with HIV services but none had wide geographical validity or else failed to reflected current clinical management of HIV disease. The subsequent focus groups supported the findings of the literature review but following the introduction of HAART issues of staff knowledge about HIV were given less prominence.ConclusionsExisting survey tools to measure patient satisfaction with HIV services lack validity or generalisability. The themes identified from this literature review and patient focus groups should be incorporated in the development of future assessment tools.
P5-S6.15 Social work services at New York City Health Department STD clinics
Authors: Ciprian T , Lifflander A , Sobin S , Kosovrasti M , Muzacz A 
Published: July 2011

ObjectiveTo describe the introduction of social work services in New York City Department of Health & Mental Hygiene Bureau of STD Control (NYC DOH) clinics.BackgroundEach year the NYC DOH STD clinics serve over 120 000 patients. Services include free and confidential testing for HIV and other STDs, STD treatment, emergency contraception and the hepatitis vaccine. Social work services were introduced at the STD clinics in 2008 to address mental health and social service needs that often drive high risk sexual behaviour, such as substance abuse, domestic violence and untreated mental illness. Social work services include short-term counselling and referrals to outside agencies.MethodsPatients are routinely screened for social work and mental health needs during interviews with physicians or disease intervention specialists (DIS), and are referred to a social worker or mental health counsellor assigned to the clinic. As appropriate, patients are provided with behavioural interventions utilising motivational interviewing techniques and short term counselling. Patients are also referred to local resources for additional services.ResultsSince July 2009, 471 patients were referred to the on-site social worker or mental health counsellor and 460 (97%) were evaluated. 40/460 patients (9%) received short-term counselling at a NYC DOH STD clinic. 200/460 patients (43%) were referred to local agencies specialising in domestic violence/sexual assault, public health benefits/health insurance to legal and housing services. 100/460 patients (22%) were referred to a health clinic and 120/460 (26%) patients were connected to mental health agencies. All 40 patients who received short term counselling at a DOH STD clinic returned for follow-up social work visits, independent of STD care.ConclusionIn a busy STD clinic, social work services can be introduced and utilised by patients, allowing physicians and DIS to focus on clinical patient issues. Offering more comprehensive care may be expected to improve patient outcomes and care. Follow-up data are required to measure the long-term impact of these services on sexual risk-taking and on rates of STDs and HIV.
P5-S6.21 Acyclovir for managing genital ulcer disease in South Africa: experiences of guideline introduction, implementation and uptake
Authors: Emge D , Delany-Moretlwe S , Mayaud P 
Published: July 2011

BackgroundHerpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer disease (GUD) worldwide. Treatment with acyclovir has been shown to shorten GUD duration, decrease plasma and genital HIV RNA levels and slow HIV disease progression in several trials. In South Africa, STI management guidelines were revised in 2008 to include acyclovir as first-line GUD therapy. However, acyclovir access appeared to be unequal across various settings. This study attempted to understand acyclovir access in South Africa from both a supply and demand perspective.MethodsThe study was cross-sectional and primarily qualitative. Three groups of participants were recruited to reflect acyclovir access and use: policymaker key informants, healthcare providers at public primary healthcare facilities and ART initiation sites in greater Johannesburg, and former HSV-2 treatment trial participants (both genders, HIV-positive and -negative). Information was collected following the WHO/Health Action International two-stage cluster random selection of health units through standardised questionnaires, complemented by in-depth interviews with selected stakeholders.ResultsAcyclovir was documented to be widely available. Challenges to access included the initial policy development and implementation process, staff training, accessibility and availability. The updated guidelines appeared to have been introduced with little high-level co-ordination and minimal staff training, although policymakers and staff thought that HSV-2 treatment was both efficacious and useful. Clinics did not experience drug stock outs. The demand for acyclovir appeared to be poor and influenced by limited knowledge of HSV-2 by the general public, negative perceptions associated with HSV-2 infection, adverse logistical factors like long waiting times at clinics and negative experiences with staff at clinics.ConclusionsThe South African guidelines were supported by local research evidence in line with WHO recommendations. Although little attention was paid to how the new guidelines had to be introduced, implemented and monitored, both the supply and prescribers' awareness improved rapidly. Access to acyclovir was undermined by poor demand from patients. Individuals possibly did not see herpes as enough of a problem to seek treatment. To ensure the success of new treatment approaches, it is essential to consider user and well as provider issues.
P5-S6.24 Comprehensive, competent and compassionate care for people living with HIV in coastal Andhra Pradesh
Authors: Washington R , Babu R 
Published: July 2011

BackgroundDistricts in coastal Andhra Pradesh, south India have the highest burden of HIV in both rural and urban areas. A comprehensive care program focused on improving clinical care and community outreach, complemented by a computerised management information system (CMIS), was implemented under the USAID supported Samastha project.MethodsFour community care centres covering 19 mandals were chosen as project sites. A mandal covers about 25 villages. Doctors, nurses and other members of the care teams were trained using the adapted “Integrated Management of Adult Illness” package and followed up with clinical mentorship visits every quarter. All on-site staffs were trained on infection prevention procedures. At the community level, people living with HIV (PLHIV) were involved in community outreach focused on treatment adherence, accompanied referrals for management of opportunistic infections and social linkages for livelihood options and basic nutrition. Small support groups of 10–12 individuals were formed at village or cluster level. Minor ailments and illnesses were treated at the local primary healthcare centers. Each community outreach worker maintained individual line-lists and prioritised outreach and follow-up for an average of 125 PLHIV, including children infected or affected by HIV. 6–8 outreach workers were supervised by a counsellor.ResultsBy the fourth year of implementation, 3257 PLHIV were registered with the project, of whom 1269 (38.9%) were initiated on Government supplied free ART. 2845 (87.3%) received nutrition support through education, supplementation and government schemes. 2085 (64%) were linked to social schemes such as widow pensions, bank loans or alternative livelihood options. Psychosocial support was provided to 2964 (91%) of the individuals registered. Loss to follow-up among those on ART reduced from 17% to <1% and annual death rates among those registered decreased from 21% to 4%. Success stories document the increased quality of life and ability to cope with stigma and discrimination.ConclusionsPeople living with HIV can be engaged in effective outreach when they function as spokes from the hub of a community care centre. Community outreach complements facility based clinical care and a comprehensive approach that includes both a bio-medical and social focus can improve quality of life and minimise death.
P5-S6.25 Integrating HIV/AIDS, family planning, and reproductive health service into Nigerian communities
Authors: Traffina C I 
Published: July 2011

BackgroundIn response to the rapid and complex HIV/AIDS epidemic, EPIC/DOD- Nigeria expanded its focus on family planning and reproductive health (FP/RH) to integrate HIV/AIDS prevention and care activities in 2008. Approaches include the establishment of work place programmes. Whereby peer promoters are selected from among the personnel. The peer promoters undergo a 2-week training that enables them to provide FP/RH and HIV/AIDS- related information and services to their co-workers.MethodsThe objective of the assessment was to identify the benefits of the workplace Programme as perceived by workplace organisations, peer promoters, and workers. The assessment was designed to obtain qualitative information through focus group discussions and reviews of client registration books.ResultsPeer promoters educate workers during tea and lunch breaks. They also provide pills and condoms and refer to nearby clinics for injectables and other services. From 2008 to 2009, they served 2215 new family planning users in two sites mainly in the medical centers of Mogadishu cantonment- Asokoro - Abuja. Uptake of condoms is high-for dual protection against unintended pregnancy and STI/HIV/AIDS. Condoms are also available in workplace restrooms for soldiers and their families, especially at the Defence Health Club (DHC). Peer promoters are more than satisfied to provide this service, and say that since their involvement in the project, they know more about HIV/AIDS and other health issues. The management also acknowledges benefits of the Programme, both financially and in terms of workers health.ConclusionMany people working in military units and establishments in Nigeria have reproductive health and HIV/AIDS needs. Due to the characteristics and timing of their work, they have limited access to needed FP/RH and HIV/AIDS information and services. Workplace and Programme benefit managers, peer promoters and workers and others they should be expanded in other barracks and defence locations across the nation.
P5-S6.29 Intensive use of a clinical documentation audit tool to bring about sustained improvement in the standard of record-keeping in a busy genito-urinary medicine (GUM) clinic
Authors: Spice W , Whitby R , Bhaduri S 
Published: July 2011

IntroductionAccuracy and consistency in clinical note-keeping is an essential element of clinical governance. In this busy GUM clinic, up to 12 different healthcare practitioners (both nurses and doctors) see patients for their history and examination, as well as taking tests, making microscopic diagnoses, giving treatment and notifying contacts. With this many staff of differing clinical backgrounds seeing patients autonomously, it is important that minimum standards of documentation are maintained. This study reports the use of an audit tool designed to provide clinic workers with regular feedback on their individual record-keeping performance compared to the clinic as a whole, thereby identifying areas where documentation standards can be improved.MethodsThe audit was started in January 2009 and carried out monthly for 12 months with three sets of clinical notes audited per clinician each month. Collective scores for the clinic were issued on a monthly basis, with individual clinicians also receiving their own scores confidentially every quarter. The audit was discontinued for a year, then repeated so as to evaluate the extent to which improvements made in the first year had been maintained. Clinicians were unaware that the re-audit was taking place. The audit was based on 31 separate criteria divided into administrative (7 criteria), clinical (20 criteria) and health adviser (4 criteria) sections. This report focuses on the outcome of the clinical section, which included criteria such as adequacy of history and examination records, choice of tests conducted, consistency of diagnoses with findings, and suitablility of treatments prescribed. The internal standard was set at 100% for each criterion.ResultsOverall scores for individual clinicians in the first month ranged from 72% to 96%, with median 82% and mean 83%. At month 12, the range was 87–100%, median 98%, mean 97%. The repeat audit conducted after a 12-month lapse revealed overall scores ranging from 89 to 100%, median 98%, mean 97%.ConclusionsThis study shows that it is possible to substantially improve standards of clinical record-keeping in a GUM clinic staffed by clinicians from a variety of backgrounds, through the intensive application of a wide-ranging audit tool and the use of individual feedback. The repeat audit conducted a year after the 12-month intensive phase shows that these improvements appear to be both sustainable and durable.
P5-S6.30 HPV catch-up vaccination among a community sample of young adult women
Authors: Manhart L , Burgess-Hull A , Fleming C , Bailey J , Haggerty K , Catalano R 
Published: July 2011

BackgroundDespite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to catch-up vaccination exist.MethodsA community sample of 428 women enrolled in a longitudinal study of social development were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22.Results19% of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (Adjusted Prevalence Ratio (APR) 2.5; 95% CI 1.7 to 3.8) and intention to vaccinate (APR 1.5; 1.2–1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4–0.9) or intention to vaccinate (APR 0.5; 0.4–0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.4–0.8) see Abstract P5-S6.30 table 4.Abstract P5-S6.30 Table 4Multivariable analyses of characteristics independently associated with vaccine initiation and intention to vaccinate among 428 young women who participated in the Raising Healthy Children (RHC) young adult survey during 2008 and 2009Vaccine initiationIntention to vaccinateAPR (95% CI)*p ValueAPR (95% CI)*p ValueDaily smoker0.5 (0.30 to 0.90)0.02––Illegal drug use†0.3 (0.07 to 0.99)0.05––Pelvic exam in the past year2.3 (1.30 to 4.15)0.005Belief vaccine is <75% effective0.6 (0.39 to 0.95)0.030.5 (0.39 to 0.71)<0.001Peers strongly approve of vaccine2.1 (1.42 to 3.20)<0.0011.5 (1.15 to 1.91)0.002Currently attending school––1.3 (1.03 to 1.70)0.03>5 sex partners––1.3 (1.02 to 1.71)0.04Low perceived susceptibility to HPV––0.6 (0.43 to 0.80)0.001*APR (95% CI) = adjusted prevalence ratio and 95% CI from Poisson regression with robust standard errors; adjusted for all characteristics listed in table. Further adjustment for the following characteristics made no appreciable difference in the estimates and were not included: race, education (self or parent), marital status, income, sexually active in the past 3 months, lifetime number of sex partners, condom use, history of HPV-related conditions, history of STD, religious preferences, physical health, mental health, binge drinking, and severity of or susceptibility to HPV infection.†Excluding marijuana use.ConclusionsHPV catch-up vaccination uptake was low in this community sample. Increasing awareness of susceptibility to HPV and the high vaccine efficacy, along with peer interventions to increase acceptability, may be most effective.