bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S5.46 Assessing the relationship between sexually transmitted infection rates, ethnic group and socio-economic deprivation in England
Authors: Savage E , Leong G , Peters L , Duffell S , Hughes G 
Published: July 2011

BackgroundDisparities in the distribution of sexually transmitted infections (STIs), especially gonorrhoea, across ethnic groups in England are well recognised. Socio-economic deprivation (SED) is also a known determinant of poor health outcomes and is often more common in ethnic minorities, but it has not previously been possible to assess the relationship between ethnic group, SED and STI rates at the national level. We used data from a new national patient-level STI surveillance system to investigate the interplay between SED and ethnicity on population-level rates of STIs in England.MethodsData on patients diagnosed with syphilis, gonorrhoea, genital herpes and genital warts from all genitourinary medicine (GUM) clinics in England in 2009 were obtained through the GUM Clinic Activity Dataset (GUMCAD). Rates of STI diagnoses by ethnic group and deprivation quintile were calculated. Deprivation was measured using the Index of Multiple Deprivation for England for each lower-level super output area of residence.ResultsIn England in 2009 the rate of syphilis and gonorrhoea was over five times higher (7.7/100 000 vs 1.4/100 000 and 42.8/100 000 vs 8.0/100 000 respectively) in the most deprived areas than in the least deprived areas but there was less difference for genital herpes (49.4/100\000 vs 26.8/100\000) and warts (131.1/100 000 vs 79.0/100 000) (see Abstract P1-S5.46 figure 1). The highest crude rates of acute STI diagnoses were among black ethnic communities although the magnitude varied by STI. The rate of gonorrhoea in black communities was over eight times higher than in white ethnic groups (171/100 000 vs 20/100 000), however, for genital warts rates in black ethnic communities were only 1.5 times higher than those in white ethnic groups (194.5/100 000 vs 130/100 000). Asians had the lowest rates for all four infections.Abstract P1-S5.46 Figure 1Rates of diagnoses of STIs by deprivation quintile using the Index of Multiple Deprivation, England, 2009.ConclusionsRates of STIs are strongly associated with deprivation. Presentation of STI rates by ethnic categories should be adjusted to take into account the strong interaction between ethnicity and SED. While SED is a key determinant of ill health other cultural influences on sexual behaviour may contribute to STI risk exposure among ethnic groups. The high STI rates seen among black ethnic communities are likely to be the consequence of a complex interplay of cultural, economic and behavioural factors.
P1-S6.02 Contraceptive discontinuation by rural Kenyan women in HIV discordant partnerships after exiting an HIV prevention trial
Authors: Ngure K , Baeten J , Lingappa J , Heffron R , Musingila P , Irungu E , Mwaniki P , Mwaniki L , Wamae R , Mburu S , Mugo N 
Published: July 2011

BackgroundWomen in biomedical HIV prevention clinical trials are frequently counselled to use effective contraceptive methods in order to avoid pregnancy during the study and consequent withholding of study products. Moreover, research study participants often have access to medical care at research clinics that might not otherwise be as readily available in their communities. We evaluated change in contraceptive use among women after exiting from a biomedical HIV prevention clinical trial in Kenya.MethodsThe Partners in Prevention HSV/HIV Transmission Study enrolled HIV serodiscordant couples at 14 sites in East Africa and Southern Africa, including a site in Thika, Kenya. Participants were offered contraception free-of-charge at the research site during the clinical trial. Unblinding visits, at which the results of the trial were conveyed to participants, were conducted after the trial results were reported. Contraceptive use data were collected at the trial exit visit and at the later study unblinding visit.ResultsAmong 213 women from Thika in the trial, 114 returned for the unblinding visit, of whom 80 (70.2%) were HIV positive. The median time between exit and the unblinding visit was 1.11 years (ranging from 0.84—to 2.13 years). Non-barrier contraceptive prevalence (ie, use of oral, injectable, implantable contraceptives, intrauterine devices [IUD] or surgical) dropped from 62.3% to 47.4% (p=0.01) between exit and unblinding visits: from 70.0% to 53.8%, (p=0.03) among HIV positive women and from 44.1% to 32.4%, (p=0.31) among HIV negative women. However, the prevalence of IUD use among the HIV positive women increased from 3.8% to 20%, (p=0.002) during this period. Additionally, the proportion of women who were using condoms as their sole contraceptive method decreased, from 29% at study exit to 1.8% at the unblinding visit (p<0.0001), resulting in greater numbers of women who were not using any contraceptive method.ConclusionsThere was a high rate of contraceptive discontinuation, both hormonal and barrier methods, after women exited from a biomedical HIV prevention trial. Discontinuation of contraception may reflect participant fertility desires after trial procedures are completed, or may reflect loss of clinical and counselling services available during the study. Innovative strategies to support the contraceptive needs of women after exiting HIV prevention trials are urgently needed.
P1-S6.03 Why are so many of our biomedical and behavioural prevention trials failing?
Authors: Celentano D , Beyrer C 
Published: July 2011

BackgroundWith a few exceptions, most biomedical and behavioural randomised, controlled prevention trials have failed to demonstrate efficacy. The recently reported iPrEx Trial on pre-exposure prophylaxis, the Thai prophylactic vaccine trials and the CAPRISA 004 trial of a female-controlled microbicide demonstrated only modest protection from HIV acquisition in high-risk populations, although both attained statistical significance. Understanding why most trials fail is important to designing trials that may have greater success in the field.MethodsWe conducted a desk review of all Phase III biomedical and behavioural prevention trials reported in the past 10 years, including vaccines, microbicides, barrier methods, circumcision and behavioural prevention interventions, and assessed possible factors associated with success and failure to achieve anticipated outcomes.ResultsOf the hundreds of prevention trials conducted over the past decade, only six reported significant findings, of which three were male circumcision trials, with one each for prophylactic vaccines, Truvada for PREP, and TDF+FTC microbicide gel. Most biomedical prevention trials rely on patient reports of adherence to use, and generally adherence is significantly lower than advised. Condom use among treatment arms are also usually lower than in control arms, which when linked with insufficient product use, leads to increased risk of disease acquisition. Repeated behavioural prevention counselling, HIV testing, STD detection and treatment all lead to diminished reports of risk behaviour among both intervention and control participants, diminishing the statistical power of the planned trials. IRB requirements may lead to control conditions that provide prevention services dramatically greater than is involved in “usual care”. RCTs which randomise individuals can also lead to significant cross-exposure among treatment arms.ConclusionsAlternative to the RCT Conclusions: Design alternatives to the individual or community randomised controlled trial may be required in the future. Increased attention to improving adherence to recommended use of prevention approaches which must repeatedly conducted (eg, use of a microbicide before each sex act), and alternatives to enriching control conditions above that of usual care should be considered, while maintaining fidelity to ethical conduct of research.
P1-S6.05 Influence of social support networks on the HIV transmission risk behaviours of people living with HIV in Manitoba, Canada
Authors: Cameron A 
Published: July 2011

For people living with HIV/AIDS (PLWHA) positive social support networks (SSNs) can help improve quality of life, overall well-being, coping, and decrease mood disturbance, morbidity, mortality, sexual and substance associated HIV transmission risk factors. However, HIV diagnosis can cause a negative change in SSNs leading to social isolation (actual/perceived) and increase risk of HIV transmission behaviours. Having an effective strategy to encourage the development/maintenance of SSNs may have a positive effect upon the health outcomes and HIV transmission risk behaviours of PLWHA.ObjectiveTo describe the SSNs of Manitobans living with HIV/AIDS (MLHA) and determine the influence of SSNs on transmission risk behaviour. The relationship between independent variable (size and type of SSNs- positive/negative) and dependant variables (sexual risk behaviour, and alcohol, injection and non-injection drug use) was examined. Control variables included: age, gender, ethnicity, time since diagnosis, and sexual orientation. This data was collected in the Positive Prevention Study (PPS), a cross-sectional survey which included 135 MLHA aged 18 plus. The PPS assessed a broad list of transmission related determinants and only enrolled people if they were aware of their HIV diagnosis for at least 6 months, allowing for analysis of sustained positive behavioural changes. For this analysis SAS statistical software was used. Analysis of variance was done between the size and type (positive/negative) of SSNs and the chosen transmission risk behaviours; sexual behaviour, alcohol use, injection and non-injection drug use. Analysis of covariance was conducted with independent, dependent and control variables. Multiple regression analysis was run with independent and dependent variables to determine any relation. Level of social support achievable depends on one's attachment to those in their SSN and the role they play. It is not just the quantity of people but also the quality of relationships (eg, frequency, perceived support) that defines the success of SSNs. Not all SSNs are positive; some types may increase transmission risk behaviour. Only positive SSNs (regardless of size) are associated with avoidance of transmission risk behaviours. The results of this study help to assess the degree to which SSNs affect the sustainability of long-term secondary prevention measures, and thus inform groups offering services to MLHA with local scientific evidence.
P1-S1.23 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.
P1-S6.06 What has been the effect of the Avahan HIV intervention on condom use among female sex workers? Insights from a fully Bayesian inference methodology
Authors: Dureau J , Boily M C , Vickerman P , Pickles M , Isac S , Ramesh B , Verma S , Moses S , Alary M , Kalogeropoulos K 
Published: July 2011

BackgroundConsiderable efforts have been invested to evaluate the impact of the Avahan project, the India AIDS initiative, targeted to high risk groups. One measure of impact is the number of HIV infections prevented (PF) due to increases in condom use between FSWs and clients following the start of Avahan. PF estimates hinge on knowledge of the frequency of condom use over time. As there is no data on condom use prior to the first round of data collection post-Avahan, these trends must be estimated indirectly. We aim, using a Bayesian framework and Monte Carlo Markov Chains (MCMC) methodology, to determine if the trends in HIV prevalence among FSWs and clients can be used to infer changes in condom use between FSW and clients before and after the start of Avahan.MethodsWe used serial rounds of cross-sectional behavioural and biological survey (IBBA) data and a deterministic compartmental model of HIV transmission among FSW/clients in Mysore and Belgaum districts coupled with Bayesian inference procedures. Condom use was modelled as the fraction of FSW commercial sex acts protected by condoms. IBBA data was used to specify the model prior parameter distributions and estimate HIV prevalence at three time points among FWS, at one time point among their clients. The Particle MCMC algorithm was used to explore the posterior density of our complex parameter distribution, and to derive estimates of the evolution of condom use over time using either 2 or 3 rounds of HIV prevalence data among FSW.ResultsFor both districts, the results reveal a clear increase in condom use around the start of Avahan in 2004 (Abstract P1-S6.06 figure 1). Abstract P1-S6.06 figure 1 suggests condom use before the intervention (jan 1994) was lower in Mysore (15.7%, 95% CI 0 to 48%) than in Belgaum (19%, 95% CI 0 to 58%). In both districts, post intervention condom use stabilised at values above 80% (95% CI Mysore 65 to 100% and Belgaum 50 to 100%). Lastly, Abstract P1-S6.06 figure 1 A),C) vs B),D) show the information gained by using 3 rounds of data instead of 2.Abstract P1-S6.06 Figure 1A) Condom use in Mysore estimated from rounds 1 and 2. B) Condom use in Mysore estimated from rounds 1, 2 and 3. C) Condom use in Belgaum estimated from rounds 1 and 2. D) Condom use in Belgaum estimated from rounds 1, 2 and 3.ConclusionsThis is the first application of Particle MCMC in an intervention monitoring context. Our results consolidate previous back projections suggesting that condom use significantly increased since the start of Avahan, which sheds additional light on the potential intervention impact. This study illustrates the use of flexible Bayesian inference methodology to estimate time-varying parameters. It also informs the design of prevalence surveys for intervention monitoring.
P1-S6.09 An audit of management of prenatal syphilis serology in the STI Clinic, Calgary, AB, Canada
Authors: Chu A , Read R , Scarrott R 
Published: July 2011

BackgroundOutbreaks of syphilis have been occurring across Canada since 2001, with the province of Alberta having the 2nd highest incidence in 2007. As a result, there has been a national increase in the number of reported congenital cases. Current Canadian guidelines recommend performing syphilis serology at the 1st prenatal visit with rescreening at 28–32 weeks gestation, and at delivery in high-risk women. In our center, any positive syphilis serology is referred to the Calgary STI Clinic for staging and treatment recommendations. This is an internal audit of positive prenatal syphilis serologies from 2009 to 2010.MethodsCharts from pregnant women with a positive prenatal syphilis serology, defined as a positive or indeterminate syphilis EIA, from 1 January 2009 to 31 December 2010 were retrospectively reviewed. Syphilis staging was performed by the Medical Director according to national criteria.Results48 charts were reviewed: 9 were staged as biological false positives, 22 were previously adequately treated women with low or negative RPR titres not suggestive of reinfection, 13 were late latent (LL) treated with 7.2 μ of benzathine penicillin (PCN), and 4 were early latent (EL) treated with 2.4 μ of benzathine PCN. The mean number of days it took from receipt of a positive serology to contacting the patient were 9.8, 10.2, 2.3, and 1.8, respectively. The mean time to 1st dose of PCN was 8.8 for EL and 17.8 for LL (see Abstract P1-S6.09 table 1). There was 1 case of congenital syphilis in an infant whose mother presented in labour with no prenatal care-her RPR was 1:256. 1 woman with an RPR titre of 1:128 was treated with benzathine PCN 1 week before her estimated date of delivery. She went into preterm labour the afternoon post-injection; it is unclear whether or not the injection induced preterm labour. Her twins were treated with iv PCN with no adverse outcomes.Abstract P1-S6.09 Table 1Syphilis Stage= (N)/48Range (days) from Start of Investigation to First ContactMean Number of Days to First ContactMean Number of Days to 1stDoseBiological False Positives=91–299.8N/APreviously Treated=221–3110.2N/AEarly Latent=40–41.88.8Late Latent=130–72.317.8 (5.2 if outliers removed)**3 patients were difficult to contact or noncompliant, taking 44, 54, and 68 days.ConclusionsRoutine prenatal syphilis screening has identified 14/48 women who required PCN treatment, all of whom received PCN prior to delivery with only 1 woman experiencing a possible adverse event. The only congenital case occurred in a mother with no prenatal care, suggesting a need for a strategy to identify marginalised women with syphilis early in pregnancy. Although the average time to contact these patients was short, the time to administration of 1st dose of PCN was longer, reflecting the need to educate women about the importance of prompt and complete therapy in preventing congenital syphilis.
P1-S6.10 Acceptability of Anal Pap self-screening in high-risk women: findings from English and Spanish focus groups in Northern California
Authors: McNeil C , Piñera C , Maldonado Y , Levy V 
Published: July 2011

BackgroundHPV has a causative role in anogenital malignancies. During 2003–2007, the rate of anal cancer for women of all races in California was 2.2/100 000 compared to a national rate of 1.8/100 000. There are no national screening measures for preventing anal cancer, a rare disease that affects more women than men annually. Screening approaches have mainly been studied in men. In preparing for an anal cancer self-screening pilot study in high-risk women, we conducted focus groups in English and Spanish to assess HPV knowledge and acceptability and comprehension of anal Pap instruction materials. Qualitative data regarding acceptability and feasibility of anal pap screening in women have not previously been reported.MethodsWomen who were biological females >18 years of age and fluent and literate in English or Spanish were recruited from a public HIV or STD clinic for participation in focus groups conducted by two English and Spanish speaking moderators. Participants were asked a structured list of open ended questions on HPV knowledge, and the acceptability of study forms including an illustrated anal PAP instruction sheet. Qualitative data was collected and reviewed for common themes and emphasis.ResultsTwo focus groups included 6 English speaking (ES) women and 8 Spanish speaking (SS) women. Knowledge gaps identified for SS women included: basic anatomical terms, HPV can infect both women and men, HPV is a STI, HPV can cause cancer, and the existence of a preventive HPV vaccine. Stigma was identified as an issue associated with STI education for SS women only. Shared knowledge gaps for ES and SS women included: asymptomatic nature of HPV, symptoms potentially caused by HPV, and that warts can turn into cancer. Both groups agreed public health HPV campaigns should target both men and women. Whereas ES women encouraged a more media based approach to HPV education, SS women commented current campaigns are too vague and emphasised a more personal, interactive approach to HPV education in public venues. Self-sampling was viewed positively by participants, along with self-sampling instructions; some modifications to collection materials were suggested.ConclusionsFocus groups revealed significant knowledge gaps in HPV associated malignancies and cancer screening in high-risk females. Anal PAP self-screening appears to be an acceptable approach; however, the large scale implementation of such strategies may require targeted educational campaigns particularly in underserved communities.
P1-S6.11 Prevention of mother to child transmission of HIV (PMTCT) program in Burkina Faso: how high is the coverage of voluntary counselling and HIV Testing (VCT) services within a clinical trial supporting environment?
Authors: Traore H A , Some E , Meda N , Nagot N , Van De Perre P 
Published: July 2011

BackgroundSince 2003, Burkina Faso has set up a national PMTCT program. Programme monitoring 2009 annual report showed high health districts and facilities coverage. But at beneficiaries' level, how many women and children in need of PMTCT interventions have really access? The objective of our study was to measure the uptake of VCT with a comprehensive set of data collected in the recruitment process in a clinical trial evaluating postnatal chemoprophylaxis to reduce MTCT.MethodsWe carried out a cross-sectional study from 1 January 2010to 31 December 2010 in 26 out of 35 PMTCT sites in five health districts in Ouagadougou city. Weekly data collection in PMTCT registers and semi-structured interviews with the personals in charge of MCH departments.ResultsAmong the 44 484 new recorded Antenatal care (ANC) attendees, 37 539 received HIV counselling and 37 489 were tested for HIV (results returned immediately), an acceptance rate of 99, 86%. 6,945 new ANC did not profit from the HIV counselling equalling 15.61% of the participant population. This miss opportunity for VCT was related to test supplies out of stock (78%), lack of VCT offer due to opt in strategy still in place in many facilities (17%) and structural problems (no trained staff, lack of infrastructures) in the remaining cases.ConclusionOur results underline the overall good performance of the PMTCT program in the context of a clinical trial facilitating environment. However, a better organization of the supply procurement would allow improving VCT coverage rate. With this high coverage of VCT in research context, we can assume that the low VCT coverage at program (75%) level is mainly due to healthcare system problem.