bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S2.03 Phase 1 implementation of male circumcision as a comprehensive package of HIV prevention in Rwanda
Authors: Mbabazi J 
Published: July 2011

BackgroundRwanda adopted Male Circumcision (MC) as part of a comprehensive package of HIV prevention strategies since 2007. In order to facilitate national roll out of MC, a Phase 1 campaign involving training of healthcare providers in Nyanza and Ruhengeri District Hospitals and their affiliated health centers targeting adolescents and adults was held from 30 August to 24 September 2010. The Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics (TRAC Plus) provided MC kits and financial support (training, cost of MC procedure) to two selected districts hospitals (Nyanza and Ruhengeri) to implement phase 1. The aim of this training was to accelerate the implementation of safe, affordable and accessible male circumcision as an HIV prevention strategy while contributing in strengthening the existing programs. The quality of the MC services provided through routine data collection and formative supervision was ensured.MethodsThe training provided covered both theoretical and practical aspects of MC as an HIV prevention strategy considering the WHO training modules. The training was conducted by a team of five National trainers (three doctors, two counsellors) and the selection criteria of participants (doctors and nurses) considered those with minimum surgical skills.ResultsThe training was for 10 days and 25 trainees (Medical doctors and nurses) from each District Hospital and health centers were trained in both theory and practical courses on Male Circumcision as an HIV prevention strategy and also provision of counselling on MC to the client before surgery. A 1-day training of community health workers on community sensitisation was done. Following the 2-week practical session in the two DH, 120 male circumcisions were performed and acceptability for HIV testing was 100%. Communication messages on male circumcision as an HIV prevention strategy and the other benefits of MC were provided to the communities. The follow-up visit of all people circumcised was done, and no adverse events were reported.ConclusionThe MC phase 1 was successfully implemented in two district hospitals of Nyanza and Ruhengeri and the evaluation will be done. Among the lessons learnt were mainly on the coordination of MC activities as it requires a focal point to facilitate the activity on a continuous basis.
P5-S2.04 Assessing comprehension of key informed consent concepts among clients undergoing male circumcision during scale up of services in Zambia and Swaziland
Authors: Friedland B , Apicella L , Sheehy M , Schenk K D , Munjile K , Adams A , Hewett P C 
Published: July 2011

BackgroundWe evaluated the informed consent (IC) process for male circumcision (MC) as services were being scaled up in Swaziland and Zambia. A primary objective was to assess male clients' comprehension of key concepts in the informed consent process to improve, standardise and streamline consent procedures as service delivery was expanded.MethodsIn a post-test study design, we asked adult (18 years and older) and adolescent (13–17 years) clients who had completed counselling, but had not yet undergone MC, to respond to a 10-question, interviewer-administered, true-false comprehension test. We also collected data on demographics, recruitment for MC, and type of counselling received (group, one-on-one, VCT), and administered literacy and numeracy tests. Participants represented a convenience sample recruited from selected sites in urban Lusaka, and urban and rural sites in Swaziland. We used T-tests to test the null hypothesis that 90% of clients could pass the test (could score ≥80%), χ2tests to compare scores between sub-groups (eg, adults vs adolescents), and multivariate logistic regression models to explore factors associated with passing the comprehension test.ResultsBetween November 2009 and August 2010, 228 MC clients in Lusaka (n=159 adults, 69 adolescents) and 953 MC clients in Swaziland (n=756 adults, 197 adolescents) participated in the comprehension assessment. Most clients (90%, Swaziland; 89%, Zambia) passed the comprehension test; however, the pass rate in Swaziland was significantly higher among adults than adolescents (96% and 85%, respectively; p<0.001). The question that posed the greatest difficulty to clients was about surgical risks; 67% of Zambian clients (71% adults; 56% adolescents) and 87% of Swazi clients (adults and adolescents) incorrectly responded that MC surgery has no risks. Factors significantly (p<0.05) associated with passing the test included: literacy (both countries); advanced education (Zambia); counselling language (Zambia); and age (Swaziland). In addition, not passing the test was significantly associated with hearing about MC from a friend (vs any other source) in Swaziland.ConclusionsService providers must place greater emphasis on potential risks of MC surgery to ensure that clients are fully informed before they consent to the procedure. Counselling messages should be tailored for adolescent clients, who may have lower levels of education and less sexual experience than adults undergoing male circumcision.
P5-S3.02 Implementing widespread antenatal syphilis screening in poor regions of Guangdong, China: a health services investigation of implementation barriers
Authors: Yang L G 
Published: July 2011

BackgroundDecreasing the congenital syphilis burden across China is a national public health priority mandated by a newly issued National Syphilis Control Plan. But prenatal clinics in some less developed regions of China may have less capacity to implement a routine prenatal syphilis screening. This study examined the local capacity and coverage of syphilis prenatal screening in less developed regions of Guangdong Province, South China.Methods11 of the 14 less developed municipalities in Guangdong Province agreed to participate in this study and have a data collection survey under the auspices of the provincial health bureau. Health systems data about availability of syphilis testing, types of syphilis testing, and syphilis test screening among pregnant women were collected from all public medical settings in the study municipalities.ResultsAmong the 109 clinics where a newborn delivery services were provided, only 40 clinics had syphilis testing. Prenatal clinics that were not hygiene stations, at the municipal or county level, or had greater number of deliveries per year were more likely to have syphilis testing capacity. Overall syphilis screening rates in the 109 medical settings were slightly >50% with higher screening rates at women and children's hospitals, general hospitals, medical setting at higher administrative levels or with greater number of deliveries. Only one women and children hospital had the capacity to conduct both non-treponemal and treponemal tests which are necessary to have for diagnosis of syphilis according to national guidelines.DiscussionSyphilis screening is available at a limited number of township-level and other smaller prenatal clinics in Guangdong Province. With limited laboratory capacity at clinics at lower levels of the healthcare system and increasing prevalence of syphilis in the province, development and implementation of innovative testing strategies, including a rapid syphilis testing that can be easily performed in any healthcare setting is an urgent priority. These findings have important implications not only for successfully achieving the national plan targets of syphilis control but also for syphilis surveillance and monitoring.
P1-S1.54 High-risk Human Papilloma Virus (HPV) types prevalence in 20–64-years-old Women; Slovenian National HPV Prevalence Study, 2010
Authors: Klavs I , Ucakar V , Poljak M 
Published: July 2011

BackgroundTo estimate prevalence of 14 high-risk human papilloma virus (HPV) types among Slovenian women screened for cervical cancer.MethodsIn 2010, we conducted a cross-sectional study in a convenience sample of 4469 women 20–64 years old, who were eligible for a preventive cytological examination of the cervical smear according to the criteria of the Slovenian National Cervical Cancer Screening Program, presented during the study period within a network of 16 outpatient gynaecology services with a nationally wide geographical coverage and consented to participate. We used three-step HPV genotyping strategy on cervical smear specimens positive with Digene Hybrid Capture 2 HPV DNA Test and/or Abbot Real Time High Risk HPV Test. Infection with high-risk HPV types was defined as the presence of one or more of the following 14 HPV types—HPV16, HPV18, HPV31, HPV33, HPV35, HPV39, HPV45, HPV51, HPV52, HPV56, HPV58, HPV59, HPV66 and HPV68. The owerall prevalence of high-risk HPV types as well as individual high-risk HPV types was estimated with 95% CIs Statistical analyses were performed using the STATA package version 10.0.ResultsPrevalence of cervical infection with any high-risk HPV type examined was 13.1% (CI—12.1 to 14.0), prevalence of infection with HPV16 only was 3.5% (CI—3.0 to 4.1) and prevalence of infection with HPV18 was 1.0 (CI—0.7 to 1.3). The corresponding age specific prevalence estimates decreased with age and were the highest among 20–24 years old women—26.0% (CI 22.4 to 29.5), 9.2% (CI 6.8 to 11.5) and 1.9% (CI 0.8 to 3.0), respectively. Overall prevalence of infection with any high-risk HPV type examined was the lowest among participants without evidence of cervical disease 10.8% (CI 9.9 to 11.8) and increased with the severity of cervical disease to 72.5% (CI 61.7 to 83.3) in women with low grade squamous intraepithelial lesion (LSIL) and 83.7% (CI 72.2 to 95.2) in women with high grade squamous intraepithelial lesion (HSIL). Corresponding HPV16 prevalence estimates were 2.5% (CI 2.0 to 3.0), 26.1 (CI 15.5 to 36.7) and 41.9% (CI 26.5 to 57.2), and corresponding HPV18 prevalence estimates were 0.9% (CI 0.6 to 1.2), 7.3% (CI 1.0 to 13.5) and 7.0% (CI 0.0 to 14.9).ConclusionsOur results provide baseline high-risk HPV types prevalence estimates and will inform future monitoring of the impact of HPV vaccination program, including possible replacement of non-vaccine HPV types and design of effective cervical cancer screening strategies.
P5-S4.02 Routine HIV testing of family members of hospitalised patients: a novel approach to HIV testing in Nigeria, sub Sahara Africa
Authors: Busari O , Adeyemi A , Nakayima M 
Published: July 2011

BackgroundIn traditional African setting, family members are closely knitted and provide effective social and supportive care for their loved ones during admission in hospitals. HIV testing for family members of HIV positive (HIV+) patients may enhance disclosure of status of spouses, encourage family social support and improve access to HIV services. The objective was to evaluate the approach of HIV testing of family members of both HIV+ and HIV− patients on admission in a large national HIV-treatment centre in Nigeria, West Africa.MethodsThis was a prospective study in which HIV testing was offered to consented family members of HIV+ and HIV− patients on admission between January 2009 and June 2010.The family members included spouses, children of patients, parents of paediatric patients and other family members. Analysis was done in frequencies and percentages.Results2829 family members of 3284 patients were tested. The details are: spouses, 339 (12%); fathers, 255 (9%); mothers, 1442 (51%); and others family members, 792 (28%). 2630 (93%) of testers were first timers. Most of the testers (97%) had post-test counselling. Overall HIV prevalence was 14%: 7% among spouses; 11% and 7% among mothers and fathers respectively; and 4% among other family members. Discordant status occurred in 19% of couples tested.ConclusionThe results indicate that routine HIV testing of family members of patients on admission is a strategy for identification of large number of HIV infected persons. This method is not only innovative, but also a novel approach effective for scaling up of access to HIV prevention, care and treatment services in sub-Sahara Africa.
P5-S4.03 Systematic selection of screening participants by risk score in chlamydia screening programme is feasible and effective
Authors: Hoebe C J P A , Brouwers E E H G , van Bergen J E A M , Fennema J S A , Gotz H M , Koekenbier R H , Op de Coul E L M , Pars L , van Ravensteijn S M , van den Broek I V F 
Published: July 2011

BackgroundSystematic screening forChlamydia trachomatis(Ct) by individual invites ensures general reach, but is less (cost) effective, as it includes people at no or low risk. Selective systematic screening can overcome this. In a large-scale Chlamydia Screening programme in the Netherlands selection by risk score was applied in one region where relatively low prevalence was expected. Here we show the effect of selection on participation, positivity and acceptability in three srceening rounds.MethodsInvitees were alerted by personal letter to login tohttp://www.chlamydiatest.nl/and fill in an 8-item questionnaire before a test could be requested. Questions, based on a prediction rule assessed in a pilot, addressed age, place of residence, education, ethnicity, symptoms, condom use and sex partners. Answers yielded different points accumulating in a risk score. Only invitees with sufficient score of 6 or more could proceed and receive a testkit. Mailed samples were tested at a regional laboratory with NAAT. A sample of excluded participants received an acceptability questionnaire.ResultsThe selection led to exclusion of 36% of potential participants and a positivity rate of 4.8% among participants (see Abstract P5-S4.03 table 1 Women scored on average higher than men (6.6 with 95% CI 6.5 to 6.7 vs 5.8 with 95% CI 5.7 to 5.9, p<0.001). Higher scores were clearly related to higher positivity rates. Persons who were excluded from participation in the first year because of a low risk score had a significantly lower response to the invitation the second round (21% vs 29%, p<0.01). The acceptability questionnaire among excluded participants (n=67, response 34%) revealed disappointment about exclusion in 30% of them but most approved of the screening set-up; 8% still went to a GP or STI centre for a Ct test.Abstract P5-S4.03 Table 1Participation and selection in three screening roundsRound 1Round 2Round 3OverallInvited13 26925 18938 39576 853Filled in questionnaire (% of invited)2973 (22%)3825 (15%)4381 (11%)11 179 (15%)Average score* (95% CI)6.16 (6.07 to 6.25)6.41 (6.33 to 6.48)6.31 (6.23 to 6.38)6.30 (6.26 to 6.35)Sufficient score (% respondents)1851 (62%)2480 (65%)2777 (63%)7108 (64%)Package returned (% package requests)1477 (80%)1927 (78%)2149 (77%)5553 (78%)Positive test (% of tested)74 (5.0%)103 (5.3%)90 (4.2%)267 (4.8%)*Average score of all persons who filled in the questionnaire.ConclusionsSystematic selection of screening participants by risk score in Chlamydia screening is feasible and successful in realising higher positivity rates than without selection. A previous study showed a population prevalence of 2% in the same population. Acceptability of selection is high but could still be improved by better communication on expectations.
P5-S4.04 The interface between HPV vaccine implementation and STI prevention: HPV vaccine discussions as an opportunity to provide messages about sexual health
Authors: Gottlieb S , McRee A L , Reiter P , Dittus P , Halpern C , Brewer N 
Published: July 2011

BackgroundEarly parent–child communication about sex is associated with healthier behaviour during adolescence. Understanding parents' cues to initiating these conversations may provide new opportunities for public health intervention. Human papillomavirus (HPV) vaccine is recommended for all 11–12-year-old girls and is highly acceptable to parents. We sought to characterise mothers' communication with their daughters about HPV vaccine and the potential for HPV vaccine discussions to provide an opportunity for discussions about sex.MethodsDuring December 2009, we conducted an online survey with a nationally representative sample (n=900) of US mothers of adolescent females aged 11–14 years (response rate=66%). We compared the proportion of all mothers using HPV vaccine discussions as a cue to talking about sex vs other potential cues using McNemar's χ2. We also assessed whether communication about HPV vaccine was independently associated with communication about sex using multivariate logistic regression. Estimates are weighted.ResultsSixty-five per cent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Thus, 27% of all mothers talked about sex as a result of HPV vaccine conversations, similar to the proportion talking about sex as a result of some more widely recognised cues, such as their daughter starting menses (21%) or talking about alcohol or drugs (29%), but less than some others, such as their daughters showing an interest in boys (36%; p<0.05) or having sex education at school (46%; p<0.05). Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have ever talked with their daughters about sex (92% vs 74%, p<0.001), even after controlling for other cues and factors associated with communication about sex (OR=3.1, 95% CI 1.4 to 6.5). Among mothers who talked about sex when talking about HPV vaccine, many felt HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%).ConclusionsHPV vaccine discussions provide an acceptable opportunity for mothers to talk with their daughters about sex at an age when such communication is most influential. It may be possible to capitalise on HPV vaccine discussions to promote parent–child communication about sex and provide messages about sexual health and STI prevention to early adolescents.
P5-S4.08 Integration of syphilis point-of-care test into outreach intervention services at commercial sex venues in Southern China
Authors: Yin Y P , Li J , Wei W H , Wang H C , Peeling R W , Chen X S 
Published: July 2011

BackgroundIntroduction of the point-of-care tests (rapid tests) for sexually transmitted infections (STIs) presents an opportunity to expand screening and treatment services in non-clinical settings, such as commercial sex venues where individuals who do not access standard healthcare services can be reached. A free syphilis screening with the rapid test was implemented in two southern Chinese cities (LZ and JM) to assess the feasibility of integrating rapid syphilis testing into existing outreach services for female sex workers (FSWs).MethodsCommercial sex venues in the study sites were systematically mapped, and free rapid syphilis testing using whole blood from fingerstick was provided to the target population as a component of routine outreach services at those venues.ResultsFrom April 2009 to February 2010, a total of 2821 FSWs were approached by outreach workers and offered invitation to accept an onsite rapid syphilis testing, 95.1% of which accepted the test. Test acceptance rate varied a bit across different types of commercial sex venues, ranging from 91.5% among FSWs working at nightclubs to 97.6% among those on streets. Most (99.5%) preferred immediate onsite results notification or through cellphone rather than receiving it at a designated referral clinic. 182 (6.8%) respondents had a positive result, among whom 63.7% visited designated referral clinics for confirmatory test and treatment. Test uptake was positively correlated with JM (AOR 2.4, 95% CI 1.4 to 4.2), age 30–44 years old (AOR 1.9, 95% CI 1.1 to 3.3), no prior syphilis infection (AOR 2.7, 95% CI 1.3 to 5.5), or unknown history of syphilis infection (AOR 4.5, 95% CI 1.5 to 13.3), and negatively associated with working in roadside restaurants (AOR 0.3, 95% CI 0.1 to 0.9) or sauna/bathing centers (AOR 0.5, 95% CI 0.3 to 0.9) compared to FSWs working on streets.ConclusionsIt concludes that integration of a rapid and onsite syphilis testing into routine outreach services at sex work venues is feasible and well received at the study areas. However, linkage between onsite testing and referral services should be improved with further efforts to maximise the impact of onsite testing.
P5-S5.06 Population-based partner services for men who have sex with men (MSM) with gonorrhoea or chlamydial infection: a missed HIV prevention opportunity
Authors: Golden M , Stenger M , Kerani R , Dombrowski J , Stekler J 
Published: July 2011

BackgroundFew US health departments provide partner service (PS) to persons with gonorrhoea (GC) or chlamydia (CT). We sought to define the potential utility of providing PS to MSM with GC or CT as an HIV prevention intervention.MethodsWe analysed public health reporting and PS data from WA State, USA, 2007–2010 to evaluate whether provider initiated case reports could identify MSM with GC or CT, to assess engagement in HIV care among MSM with STIs previously diagnosed with HIV, and to determine how often MSM HIV test when diagnosed with GC or CT. Estimates of previously diagnosed HIV, engagement with care, and HIV testing were derived from a random sample of cases weighted to reflect cases' residence and receipt of care in the King County STD clinic. We linked STI and HIV reporting data to estimate the risk of subsequent HIV diagnoses among MSM reported with GC or CT.ResultsMedical providers recorded the gender of cases' sex partners on 19 000 (68%) of 27 762 case reports on men with GC or CT, 4281 (22%) of which indicated that the case had sex with men. Case report and PS interview data on cases' sexual orientation agreed in 6711 (96%) of 6999 cases for which both data sources were available (κ=0.90). Agreement was higher for STD clinic cases (κ=0.98) than for other King County cases (κ=0.86) or among men outside of King County (κ=0.68). Among a random sample of 1103 cases identified as MSM in both case report and PS data, 25% were previously diagnosed with HIV, of whom 87% were in care and 63% were on antiretrovirals. Among MSM without a prior HIV diagnosis, 55% reported that they HIV tested when diagnosed with GC or CT. The proportion of MSM who HIV tested was higher STD clinic cases (82%) than among other King County MSM (57%) or MSM outside of King County (41%) (p<0.0001). Nineteen (3.3%) of 583 tested MSM were newly diagnosed with HIV. Among MSM without a prior HIV diagnosis who were not diagnosed with HIV at time of their GC or CT diagnosis, the subsequent rate of new HIV diagnosis was 2.5/100 person years. Among 1421 MSM diagnosed with HIV in WA State 2007–2010, 6.3%, 9.6%, and 11.9% had been reported with GC or CT in the 1, 2, and 3 years prior to HIV diagnosis, respectively.ConclusionsMSM with GC and CT are an identifiable and accessible population at high risk for HIV acquisition and transmission who might benefit from efforts to increase HIV testing frequency and linkage to HIV care. Expanding PS for bacterial STI should be evaluated as a means to achieve these goals.