bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S6.12 The contribution of a Chlamydia screening programme to testing and case-finding in addition to regular STI-care in three regions of The Netherlands
Authors: van den Broek I V F , Götz H M , Brouwers E E H G , Fennema H S A , Hoebe C J P A , Koekenbier R H , Pars L L , van Raveseijn S M , Op de Coul E L M , van Bergen J E A M 
Published: July 2011

BackgroundThe impact of a Chlamydia screening programme can be measured by the incremental amount of Chlamydia tests performed and cases detected as compared to the throughput in regular care. In the Netherlands, regular STI care is provided by specialised STI-centres (aimed at high-risk groups) and General Practitioners (GP's, basic opportunistic screening and care for symptomatic cases). An annual register-based Chlamydia screening programme is implemented in three regions since 2008.MethodsThe number of persons tested and cases detected in the Chlamydia Screening among 16–29 year olds in Amsterdam, Rotterdam and South Limburg, 2008–2010, were compared to consultations and diagnoses in this age group reported in surveillance data from STI centres in the regions and estimates of STI care in general practices in these regions, 2007–2010. Round 3 data are based on the first 6 months of the year.ResultsThe baseline testing rates (at STI centers and by GP's in year pre-screening) were 10% in Rotterdam, 13% in Amsterdam and 6% in South-Limburg. CSI increased testing rates steeply in the first year to 26–30% in the cities and 17% in Limburg; this decreased to 20–21% and 13% in round 3, still doubling testing rates as compared to baseline. Positivity rates at regular STI-care facilities are higher than in CSI: 12–15% in regular care vs 4–5% in CSI; therefore the addition of CSI to case-finding in the three regions was lower than that to testing: the screening programme added about 41% on top of the cases found in regular care in round 1, but this decreased to 20% in round 3 due to lower participation and positivity rates in consecutive rounds.ConclusionsBy comparison to regular testing at STI centers and in general practice, the Chlamydia Screening had a major contribution towards the number of young people tested for Chlamydia in the three regions. The addition towards case-finding was lower, because the case-detection rate of the screening programme was lower than that in regular care. The Screening programme did not seem to affect the number of patients seen in regular care, but double “consumers” cannot be excluded.
P1-S6.13 A new approach to encourage HIV testing in high-risk populations at the Clinique l'Actuel
Authors: Thomas R , Machouf N , Trottier B , Vezina S , O'Brien R , Milne M , Lavoie S , Longpré D , Huchet E , Nguyen V K 
Published: July 2011

BackgroundIn Québec it is estimated that 1/3 of those infected do not know their HIV status, that HIV is diagnosed late in 41%, and that sex during primary infection is an important driver of the epidemic. In late 2008 Clinique l'Actuel launched a testing campaign tailored to MSM in Montréal using free rapid tests with the goal of increasing early diagnosis of HIV. In this study we evaluated the feasibility of and potential impact of facilitated access to rapid HIV-testing.MethodsRapid HIV-tests offered through dedicated clinics were widely advertised in Montréal's MSM community. Patients calling for testing deemed at high risk were given appointments within 2 weeks, where they filled out a short questionnaire, received medical consultation routine STI screening, pre- and post-test counselling and their HIV test results within the hour. Ongoing support, care, and treatment were offered to those testing positive.ResultsOver 9 months 2500 received HIV testing. 98% were men and median age was 34 (IQR=26–41). Of these patients, 42% were new to the clinic, 10% had never been tested previously, and 29% had not been tested within the past 2 years. 93% reported they were more likely to undergo repeat screening because of rapid testing. 2% were found to be HIV positive. Of these, 60% cited the rapid test as the primary reason for undergoing screening. 33% of those testing positive were in primary infection, as compared to 18% the previous year at Clinique l'Actuel (p=0.062) and 11% in Québec.ConclusionFacilitated access to rapid HIV testing can increase uptake in high-risk patients. This may increase early HIV diagnosis and intervention to decrease transmission.
P1-S6.14 Interventions to increase re-testing for repeat chlamydial infection: a systematic review and meta-analysis
Authors: Ali H , Guy R , Low N , Bauer H , Walker J , Klausner J , Donovan B , Kaldor J , Hocking J 
Published: July 2011

BackgroundRepeat infection withChlamydia trachomatisfollowing treatment is common and increases the risk of sequelae. Despite clinical guidelines recommending re-testing within 3 months of treatment, re-testing rates remains low. We undertook a systematic review of studies which evaluated interventions aimed at increasing re-testing for repeat chlamydial infection.MethodsWe searched Medline, EMBASE, trial registries, and conference websites from 2000 to September 2010 using variations of the terms “chlamydia” and “re-testing” and “intervention” to identify studies which compared rates of re-testing for repeat chlamydial infection between patients receiving and not receiving an intervention. We used meta-analysis methods to calculate the overall RR effect on re-testing rates, as well as undertaking a sub-analysis by strategy type.ResultsWe identified eight studies satisfying the inclusion criteria, including four randomised controlled trials and four controlled observational studies. The studies described 12 intervention strategies. All were conducted in the USA. The overall effect estimate RR for any strategy was 1.45 (95% CI 1.35 to 1.55); RR=1.80 (95% CI 1.63 to 1.97) for four studies using reminders such as postcards, phone calls, letters and emails (individually or in combination); 1.25 (95% CI 1.12 to 1.38) for four studies using mailed screening kits with or without reminders; 2.15 (95% CI 0.92 to 3.37) for two studies using motivational interviewing with or without reminders; 1.35 (95% CI 0.88 to 1.82) for one study promoting re-testing guidelines to clinicians; and 1.16 (95% CI 0.38 to 1.93) for one study using a $20 patient incentive to encourage re-testing.ConclusionReminders and mailed screening kits can increase re-testing rates by 80% and 25% respectively.
P1-S1.24 Longitudinal trends in syndromic STI diagnoses in Lilongwe, Malawi: 2006–2010
Authors: Kamanga G , Powers K , Mapanje C , Mkandawire N , Milonde H , Kanyamula H , Wiyo P , Martinson F , Miller W , Hoffman I 
Published: July 2011

BackgroundTo understand longitudinal trends in sexually transmitted infection (STI) syndromes, we conducted a descriptive analysis of syndromic STI diagnoses at an STI clinic in Lilongwe, Malawi over the last 5 years.MethodsUsing data collected routinely at all STI clinic visits since March 2006, we calculated the proportion of patients seen in each of the last five calendar years (2006, 2007, 2008, 2009, and 2010) who were diagnosed with each of the following STI syndromes—genital ulcer disease, genital warts, abnormal vaginal discharge (females), lower abdominal pain (females), urethral discharge (males), balanitis (males), swollen inguinal lymph nodes (males), and scrotal swelling (males).ResultsAn average of 6694 unique patients were seen each year; approximately 60% were female and 40% were male. Among males, the most common diagnoses were urethral discharge, genital ulcer disease, and balanatis (Abstract P1-S1.24 figure 1). There was an increase in the prevalence of urethral discharge over the period 2006–2010 (from 28% to 33%, p<0.0001), but there was a slight decrease in the prevalence of genital ulcer disease (from 22% to 20%, p=0.02) and balanitis (from 13.5% to 12%, p=0.0002). Among females, the most common diagnoses were abnormal vaginal discharge, lower abdominal pain, and genital ulcer disease. There was an increase in the prevalence of abnormal vaginal discharge over the period 2006–2010 (from 40% to 45%, p<0.0001), but there was a decrease in the prevalence of lower abdominal pain (from 50% to 33%, p<0.0001) and genital ulcer disease (from 13% to 10%, p<0.0001). The prevalence of all other STI syndromes remained below 10% throughout the study period.Abstract P1-S1.24 Figure 1Syndromic STI prevalence and 95% CI, Kamuzu Central Hospital STI Clinic, Lilongwe, Malawi, 2006–2010. LAP, lower abdominal pain; AVD, abnormal vaginal discharge; UD, urethral discharge; GUD, genital ulcer disease; BA, balanitis; F, female; M, male.ConclusionsUrethral discharge and balanitis continue to be highly prevalent among males; abnormal vaginal discharge and lower abdominal pain continue to be highly prevalent among females; and genital ulcer disease continues at a high prevalence in both groups. Of note, the decline in lower abdominal pain coincides with a documented drop in cases of gonorrhoea and chlamydial infection in this population, and the small decline in genital ulcer disease may be due to recent improvements in chancroid treatment. The very high prevalence of urethral discharge among men and abnormal vaginal discharge among women may be due in part to observed high levels of trichomoniasis in this population, and the increases in these diagnoses suggest that trichomoniasis prevalence may be on the rise.
P1-S6.16 Australian chlamydia control effectiveness pilot: preliminary results from a trial of chlamydia testing in general practice
Authors: Hocking J , Temple-Smith M , Poznanski S , Guy R , Low N , Donovan B , Gunn J , Law M , Kaldor J , Fairley C 
Published: July 2011

BackgroundWhile opportunistic chlamydia screening is conducted in several countries, debate remains about the effectiveness of population-based screening programs for reducing chlamydia transmission and its morbidity. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) aims to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing in general practice.MethodsACCEPt is a cluster randomised controlled trial targeting sexually active 16–29-year old women and men for annual chlamydia testing. 54 postcodes (towns) are being randomised and all GP clinics within each area invited to participate. A multifaceted intervention to maximise testing includes: a computer alert prompting GPs to test; incentive payments for GPs and payments for employing practice nurses; a recall system to encourage annual testing; partner notification, and; information/support with regular feedback on testing performance. Clinics in the control group are encouraged to continue their usual practice. The intervention will be in place for up to 4 years. The primary outcome is change in chlamydia prevalence among a consecutive sample of 80–100 patients attending participating clinics in each postcode (total sample size about 4500) measured at the beginning and end of the trial. Secondary outcomes include pelvic inflammatory disease and chlamydia testing rates.ResultsRecruitment began in July 2010 and 282 GPs in 69 clinics in 24 postcodes have been recruited to date in the States of Victoria, New South Wales and Queensland. Four clinics have refused so far and these postcodes have been excluded. To date, 615 16 to 29 year olds have been tested during the baseline prevalence survey with a participation rate of 70%. Overall chlamydia prevalence is 4.0% (95% CI 2.5% to 6.0%). Prevalence is slightly higher among males (4.5%; 95% CI 2.0% to 8.7%) than females (3.7%; 95% CI 2.0% to 6.3%, p=0.7) and in rural (6.9%; 95% CI 3.8% to 11.2%) compared with metropolitan areas (2.2%; 95% CI 0.9%, 4.4%, p<0.01). Recruitment will be completed by December 2011 with the intervention period running till end of 2014.ConclusionsThis study shows high participation rates by GP clinics and by individuals invited to take part in the prevalence survey. Results will determine whether annual chlamydia testing is effective at reducing transmission and morbidity and will inform the optimal design of a chlamydia testing program in Australia.
P1-S6.17 Opting out testing for HIV in Dutch STI clinics: does it work?
Authors: Koedijk F , van Bergen J , Dukers N , Hoebe C , van der Sande M 
Published: July 2011

BackgroundIn 2005, STI centres in the Netherlands started provider-initiated HIV testing policy, in order to decrease the proportion of people unaware of their positive HIV status and to enable interruption of transmission and create more opportunities for timely treatment. This policy gradually evolved towards opt-out HIV testing and in January 2010, this became the official policy within all Dutch STI centres. The effects of the change in HIV test policy were studied and factors associated with opting out for HIV testing were identified.MethodsData from January 2004 to June 2010 from 488 727 consultations registered in the Dutch national surveillance in the STI centres were used to characterise current practices on HIV testing. Known HIV positives were excluded from analyses. Logistic regression analyses were done separately for men having sex with men (MSM) and heterosexuals, to identify factors associated with refusing an HIV test.ResultsSince 2004, the percentages of HIV testing within an STI consultation have increased significantly from 56% up to 92% in 2009, and further to 97% in the first half of 2010 when opting out was implemented nationally (both p<0.001). STI were significantly more often diagnosed in clients not tested on HIV during their consultation (p<0.001), except in 2010. Using 2010 data, MSM being older than 25 years (OR: 1.8, 95% CI 1.2–2.6), those having STI symptoms (OR 2.2 95% CI 1.7 to 2.8) and those with a previous STI (OR: 1.5, 95% CI 1.2 to 2.0) more often refused an HIV test. For heterosexuals, having had a previous STI (OR: 1.6, 95% CI 1.3 to 2.0), being female (OR: 1.2, 95% CI 1.0 to 1.4) and being younger than 25 years (OR: 1.2, 95% CI 1.0 to 1.4) were independent factors associated with refusing an HIV test.ConclusionsAlthough provider-initiated HIV testing already increased HIV testing rates, national implementation of opting out for HIV testing increased this uptake even more. Standard testing on HIV in every STI clinic is shown to be highly feasible and effective. In order to optimise the opt out policy, and thereby successful interruption of HIV transmission, interventions to motivate “opt-outers” should be studied, since the few clients still refusing an HIV test were linked to higher risk behaviour.
P1-S6.23 Impact evaluation of performance-based financing (PBF) for HIV testing and counselling for individuals and couples in Rwanda
Authors: Bautista S , Binagwaho A , de Dieu Bizimana J , Condo J , de Walque D , Gertler P , Kwan A , Sturdy J 
Published: July 2011

BackgroundThe Government of Rwanda has nationally implemented performance-based financing (PBF) to improve the satisfaction and motivation of health workers, as well as access and quality of HIV/AIDS services in the context of scaling-up services. The scheme pays for 10 HIV/AIDS indicators (two related to HIV testing and counselling (HTC), which is believed to be a core strategy for decreasing HIV incidence and improving prevention and care). We present the effect of Rwanda's PBF program on individual and couple/partner testing as an entry point to other HIV services and in the context of scale up.MethodsTaking advantage of a prospective quasi-experimental design, an impact evaluation was conducted during phase-in of the Rwanda's PBF program in 2006 and 2008. Individual HTC was measured by whether or not the individual has ever been tested for HIV (371 treatment individuals (61.1% female), 378 control (56.6% female)), and partner testing was assessed by whether or not the sexual partners they had in the 12 months prior to the survey had ever been tested for HIV (208 treatment individuals (57.2% female), 202 control (52.0% females)). To evaluate the outcomes, a difference-in-difference fixed effects model was used with SEs clustered by district*year.ResultsPBF increased HTC at the individual level by 9.45% from baseline (p=0.07). This effect was mainly found among married individuals (10.87% increase, p=0.02), specifically males (15.75% increase, p=0.06). PBF also increased testing among couples by an estimated 16.14% (p=0.034) increase from baseline, as reported by one of two partners.ConclusionOur work provides evidence that PBF might be a useful tool to increase access to HTC for both individuals and couples. This is a remarkable result since couple testing has previously been difficult to encourage.
P1-S6.31 HIV intertest interval among MSM in King County, Washington
Authors: Katz D , Dombrowski J , Buskin S , Golden M , Stekler J 
Published: July 2011

BackgroundHIV testing remains one of the most effective HIV prevention interventions because most persons newly diagnosed with HIV alter their behaviours to reduce the risk of transmission to others. We examined temporal trends and correlates of the frequency of HIV testing among men who have sex with men (MSM) in King County, WA.MethodsWe evaluated electronic medical records of MSM testing for HIV at the Public Health—Seattle & King County (PHSKC) STD Clinic. The intertest interval (ITI) was defined as the number of days between the last reported HIV test and the current visit. ITIs ≤30 days were not considered to be new tests. Correlates of the ITI were determined using Wilcoxon rank-sum tests, Spearman's correlation coefficients, and median regression.ResultsBetween 1 January 2003 and 7 December 2010, there were 13 637 HIV testing visits among MSM who reported a prior negative HIV test or did not know their status. These men reported a median ITI of 215 days (range: 31–8536; IQR: 124–409); 10 567 (77%) reported an ITI consistent with at least annual testing (<15 months) and 1693 (12%) reported no HIV test in the last 2 years. The median ITI decreased from 229 days in 2003 to 198 days in 2010 (p<0.001). Having sex with men only (vs men and women; p<0.0001), ≥10 male sex partners (p<0.0001), unprotected anal intercourse with a male partner of unknown or positive HIV status (p<0.0001), methamphetamine use (p=0.018), and poppers use (p<0.0001) in the last year were all associated with shorter ITIs, as were decreasing age (p<0.0001) and ever having been diagnosed with syphilis, gonorrhoea, or chlamydial infection (p<0.0001). Race, ethnicity, and injection drug use were not associated with ITI. In multivariate analyses, decreasing age, later visit year, sex with men only, ≥10 male sex partners in the last year, and history of bacterial STI remained associated with shorter ITIs (p<0.001 for all). The median ITI was longer in the 337 men (2.5%) newly diagnosed with HIV compared to those who tested HIV-negative (279 vs 213 days, respectively; p<0.0001).ConclusionsFrom 2003 to 2010, the median ITI among MSM attending the PHSKC STD Clinic was 215 days, and this has decreased over time. Encouragingly, MSM at highest risk for HIV acquisition have even shorter ITIs, although those newly diagnosed with HIV continue to have longer ITIs. Further efforts are needed to reduce the time that HIV-infected persons are unaware of their status.
P1-S6.32 Optimising clinical systems to increase HIV/STI testing in gay men: the eTEST project
Authors: Drummond F , Lewis L , Bourne C , Ramanathan V , Hocking J , Wand H , Donovan B , Kaldor J , Guy R 
Published: July 2011

BackgroundDespite HIV/STI testing rates being high (∼60%) on an annual basis in gay men in Australia, the proportion of “high risk” gay men having two or more HIV/STI tests per year, as specified in clinical guidelines, appears quite low (20%). Mathematical modelling predicts that increasing the frequency of HIV/STI testing among gay men with high numbers of sexual partners to 3–6 monthly would effectively stop the HIV and syphilis epidemics over a ten year period. We developed a multi-faceted intervention package based on information technology which aims to increase STI/HIV testing in high-risk men gay men. We describe the process and outcomes of the development stage of the intervention.MethodsThe intervention will be conducted over 2 years at 10–15 general practice clinics which see a high case load of gay men. These clinics provide both general healthcare and specialist sexual health and HIV management. All of these clinics utilise different patient management systems. We engaged a software company to develop a program adaptable to multiple clinic systems which aims to increase clinic efficiency and enhance sexual health testing. The process was undertaken over 12-month period in 2010 and involved extensive consultation with clinicians, stakeholders and information technology specialists.ResultsThe program has now been developed and has four key elements: (i) passive prompts to remind clinicians when the next HIV/STI test is due based on the patient's risk assessment profile, testing guidelines and clinic record of past testing; (ii) SMS-based recalls which are automatically sent to patients when HIV/STI testing is overdue; (iii) a sexual health resource tool bar on the computer desktop of primary care providers to provide partner notification websites, up-to-date education brochures and referral systems that support collaboration between providers; and (iv) a reporting enhancement which allows practice staff to look at their data for the achievement of best practice and data quality targets. Further details of the system and functionality will be provided in the poster.ConclusionThe program is the first clinical intervention we are aware of that addresses a range of important barriers to HIV/STI testing in a single information technology program. The system is currently being rolled out into the 10–15 clinics in Sydney and the impact of this intervention will be assessed by measuring the change in HIV/STI testing rates before-and-after the program. Interviews will also be conducted with clinicians and practice managers before and after the intervention to assess barriers to testing and acceptability and transferability of the intervention.