bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S6.35 Effectiveness of mobilising medical facilities to participate in STD/HIV control activities
Authors: Liang G 
Published: July 2011

Since 2000, the STD clinics were brought into intervention service aimed at high-risk population by some projects, such as Health Project, Comprehensive Demonstration Area Project and the Global Fund to Fight AIDS Project. The ability of providing standardisation service in STD clinics was improved through the project activities. The outreach service increased awareness of STD clinics and attracted or made referral patients seeking service at standard clinic, and that strengthened the role of medical sites in preventing STD/AIDS.MethodTwo jobs improved the intervention service aimed at STD/AIDS at clinics. 1. The intervention service aimed at outpatient. Including the following service: (1) setting heath education bulletin and publicity photographs at STD clinics to spread information about prevention STD/AIDS (2) providing Health education prescription about prevention STD/AIDS freely (3) the medical staff provided health education and consultation after diagnosis and treatment and extended the use of condom (4) to advise patient to inform their partner of examination at clinic (5) the medical staff mobilised outpatients to accept HIV-test forwardly 2. The medical staff provided field service aimed at high-risk population (CSW, MSM).ResultSeveral projects evaluated prevention service effect at STD clinics. The rate of medical staff accepting training on STD standardisation service increased from 9.21 to 21.56% to 68.99–89.7%. The rate of object population knew information about STD/AIDS prevention increased from 31.02–45.52% to 72.4–87.86%. The rate of outpatients accepting HIV test increased from 3.45% to 44.25%. While STD clinic staff provided field service for high-risk population, they advised people who needed further service to seek help at STD clinic. From 2006 to 2009, the proportion of high-risk in outpatient was increasing yearly. The evaluation result from three STD clinics showed the proportion of MSM in outpatient was increasing from 0.97% to 8.15%, from 2006 to 2009. And the evaluation result from 7 STD clinics showed the proportion of CSW in outpatient was increasing from 1.57% to 9.74%, from 2006 to 2009. The outpatient at STD clinic is high-risk population for STD/AIDS infection and spread, and most male outpatient especially had high-risk act, but the intervention in China touched on that. The prevention service at STD clinic smoothed over routine prevention action and expanded the range that STD medical service covered, so this prevention controlled the spread of STD/AIDS furtherly.
P5-S6.37 A community led decentralised and integrated approach for personalised prevention and care services to PLHIV in Karnataka, South India
Authors: Kumar P Manish , Jayanna K 
Published: July 2011

BackgroundCare and support for People living with HIV (PLHIV) is often limited to institutional settings with considerable time lag between diagnoses and access to care, and poor linkages with other social support services. The USAID supported Samastha project aimed to address the gaps through an innovative approach.MethodDrop-in centres (DIC) were set up within the PLHIV networks as a hub of decentralised care and support. They offered psychosocial, outpatient medical care, positive prevention and nutritional services. To increase accessibility to general medical care, outreach clinics were clubbed with support group meetings and held in local government hospitals. The linkages to treatment, testing, screening for TB and institutional care were strengthened through referral systems, including accompaniment by outreach workers and coordination meetings at district level. All outreach workers were trained on government sponsored social entitlements and schemes for PLHIV and methods of assessing and addressing these needs.ResultsBy the fourth year of the project, 45 009 PLHIVs (53% female) had availed services of which 52% received clinical care, 99% of clinical visits screened for TB and 4% of PLHIV were treated for TB. 51% received positive prevention services, including treatment adherence counselling while 39% received treatment for minor OI and general ailments. 85% are registered at ART center and 44% are on ART. 91% were provided with psychosocial support, 81% received nutritional support and 51% attended support group meetings. Nutrition and livelihood support were leveraged from other sources.Lessons LearnedThe Drop-in centre run by people living with HIV makes a continuum of care possible. In resource poor settings, DICs helps in early enrolment of PLHIVs into care, thereby resulting in timely initiation of treatment for HIV and TB and a qualitative improvement in the life of a PLHIV.
P5-S6.38 NICE guidance on prevention of sexually transmitted infections and under 18 conceptions; has it influenced service providers?
Authors: Robinson A , Dixon K , Forbes K , Wilkinson D , Foley E 
Published: July 2011

BackgroundNational Institute of Health and Clinical Excellence (NICE) Public Health guidance on the prevention of sexually transmitted infections and under 18s conception was produced in 2007 for implementation in sexual health services in England. We undertook to find out what impact these had on Genito-urinary Medicine (GUM) service providers across UK.MethodsIn December 2009 lead consultants of UK GUM clinics were identified using the British Association for Sexual Health and HIV website and sent a postal survey as part of a larger study. Responses were analysed using a SPSS database.ResultsOf 222 clinics, 152 responses were from UK clinics overall of which 136 were from England. 115 of 148 (78%) from UK clinics answered that they had read the guidelines, 80% (106/132) for England only. For England 39% (54/133) of respondents were aware of a local lead to implement the guidance of which 9 (16.7%) named the Director of Public Health, 17 (31.5%) GUM physician with a variety of other healthcare professionals for the remainder. Only 30% had compared current service activity to NICE recommendations and 20% (26/132) were aware of an action plan being developed by local strategic partners to implement the guidance; 8% (10/128) had developed a business plan. Only three clinics had formally audited their clinic practice against the guidelines. In total, only 18 of 131 (13.7%) had implemented the recommendations but 56 (42.6%) had partially or were doing so. The barriers to implementation were cost pressure, cost of staff skills training, lack of time and capacity to implement, lack of leadership.ConclusionNICE takes an evidence-based approach to guidance development but has no mechanism to review implementation. There are no routine outcome measures to judge the effectiveness of this NICE guidance. The process measures above have demonstrated variable implementation in GUM services in England. With present resources, as one example providing 15–20 min of one-to-one structured discussions based on behavioural change theories is not deliverable. Service commissioners should ensure that services are implementing guidance and using recognised standards for the management of sexually transmitted infections. Prevention of sexually transmitted infections should be targeted, informed by the sexual health profile of local populations with resources identified by commissioners for prevention activities as integral to service delivery.
P5-S7.02 Trends in screening females for Chlamydia in juvenile detention centers US 2005–2009
Authors: Newman D R , Peterman T A , Collins D E 
Published: July 2011

BackgroundCDC began development of Performance Measures in 1999 and 58 Project Areas have continuously reported on the measures twice yearly since 2005. Two Performance Measures from Juvenile Detention Centers (screening in 2004 and positivity in 2009) were developed to capture the burden of chlamydia infection in this underserved population of adolescent females.ObjectivesTo assess changes in performance of screening of females in juvenile detention centers (JDC's) from the US as reported through Performance Measures and to obtain a measure of the positivity detected.Methods50 US States, six US cities, Washington, DC and Puerto Rico are asked to report the percentage of females screened for chlamydia twice yearly from all juvenile detention centers that admit 500 or more adolescent females annually. Project Areas with no facilities that admit 500 or more are to report on one or more facilities of their choice. A chlamydia positivity measure was added in 2009. We collapsed the 2 half-yearly reports for each Project Area into yearly summaries from 2005 to 2009.ResultsThe percentage of Project Areas that were able to report any chlamydia screening from their JDC's increased from 60% in 2005 to 84% in 2009. The mean percentage of Project Areas reporting any screening over the 5 years was 80%. Many Project Areas reported from multiple JDC's during 2005–2009 with California reporting from 12 facilities and Ohio reporting from 11 facilities. The reported percentage of juvenile females screened by year were 54, 63, 59, 60 and 51% from 2005 to 2009. The percentage screened ranged from 3% to 100%. The mean percentage of females screened over the 5 years was 57%. In 2009, the mean chlamydia positivity for all Project Areas was 13.8%. For facilities (n=69) that screened at least 100 females in 2009, the mean chlamydia positivity detected was 13.7%, with a median of 12.6% and positivity ranging from 6 to 31%. Almost half (48%) of the Project Areas reported from 49 facilities for all 10 reporting periods across the 5-year period. The percentage screened in these 49 facilities increased 59, 64, 66, 69 and 69% from 2005 to 2009. The mean per cent positivity for these facilities in 2009 was 12.5%.ConclusionsJuvenile Detention Centers are excellent venues from which to detect chlamydia infections in adolescent females. Additional efforts are needed to increase the number of facilities that routinely offer screening and increase the proportion screened.
P1-S2.03 Determinants of condom breakage among female sex workers in Karnataka, India
Authors: Bradley J , Rajaram S , Alary M , Isac S , Moses S , Ramesh B M 
Published: July 2011

BackgroundCondoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in the state of Karnataka in South India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions.MethodsWe explored determinants of reported condom breakage in the previous month among 1928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage controlling for several independent variables including the district and client load.ResultsOverall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (OR 3.43, p=0.005); if divorced/ separated/widowed (OR 1.52, p=0.012); if they were regular alcohol users (OR 1.63, p=0.005); if they mostly entertained clients in lodges/rented rooms (OR 2.99, p=0.029) or brothels (OR 4.77, p=0.003), compared to street based sex workers; if they had ever had anal sex (OR 2.03, p=0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (OR 1.90, p<0.001); if they were inconsistent condom users (OR 2.77, p<0.001); and if they had never seen a condom demonstration (OR 2.37, p<0.001).ConclusionsThe reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalised female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to provide information and skills on correct condom use. More research is also needed on what specific situational parameters might be important in predisposing to condom breakage.
P5-S7.06 Chlamydia screening implementation in the Netherlands is not cost-effective
Authors: Schmid B , Over E , van den Broek I , de Coul E O , van Bergen J , Group CSI , Kretzschmar M , de Wit A 
Published: July 2011

BackgroundChlamydia trachomatisis the most common sexually transmitted infection in western countries. Most infections are asymptomatic and may cause severe complications. In the Netherlands, 3 years of Chlamydia screening implementation (CSI) have been performed. Here, we model its cost-effectiveness after 10 years.MethodsA cost-effectiveness analysis compares the relative costs and effects of two or more scenarios, and is usually expressed as the incremental cost-effectiveness ratio (ICER). The costs of the CSI program included those for hospital care, antibiotics, testing, and productivity loss. We measured the effects as either Major Outcomes Averted (MOA) or Quality Adjusted Life Years (QALY) gained. In the Chlamydia literature, MOAs usually consist of symptomatic pelvic inflammatory disease, chronic pelvic pain (CPP), ectopic pregnancy, infertility, and neonatal pneumonia. We calculated the ICER, the ratio of the above-mentioned costs and effects, for four scenarios: the default screening scenario (annual invitation of all 16–29 year olds), screening for women 16–29 only, for all 16–24 year olds, and biennial screening of all aged 16–29. To account for uncertainty in model parameters, we conducted a probabilistic sensitivity analysis (PSA).ResultsIf we compare the results of the four different scenarios presented in the abstract P5-S7.06 table 1, the default scenario has the most favourable ICER. This is probably due to the fact that the total number of invitations (and thus people tested) per year is the largest in the default scenario, implying that the fixed annual program costs are spread over more tests (and outcomes), which improves the ICER. The cost per QALY of all four scenarios seems acceptable if we include CPP in our QALY estimate. However, the evidence base for CPP forming nearly 90% of all QALYs lost is extremely weak. Therefore, we prefer the cost-per-QALY estimate excluding CPP, which is 30 000–70 000. Considering previous decisions on population screening programs, this ratio is relatively high and cannot be regarded as cost-effective. However, these results should be interpreted with caution due to the weak evidence base for the disease progression model. Because of this, the PSA showed variability of the four ICERs of up to 50%.Abstract P5-S7.06 Table 1Results from the economic CSI modelScenario:Total costs (M EUR)MOAs avertedQALYs gainedQALYs gained [w/o CPP]Costs/MOA (k EUR)Costs/QALY (k EUR)Costs/QALY [w/o CPP] (k EUR)Default6.9120016002105.64.332Women only6.26709001309.26.94916-246.666086092107.672Biennial6.482011001407.96.047ConclusionsWe conclude that the evidence base for cost-effectiveness of Chlamydia screening is less strong than appeared from previous Dutch and foreign research, because of the much higher costs per MOA.
P5-S7.07 Chlamydia screening in Cornwall: How often do young people get retested?
Authors: Turner K , Trela-Larsen L , Gates P , May M , Horner P 
Published: July 2011

AimTo analyse the uptake of screening and rescreening in Cornwall, UK within the National Chlamydia Screening Programme (NCSP).MethodsWe tested for any association between gender, age, test result and the probability of retesting. The time between tests was estimated using a Cox proportional hazards model and we tested whether the result of first test or gender influenced whether or not individuals were retested.ResultsBetween 2003–2009, 66 513 tests in 46 950 individuals were analysed. Most people were tested once. During this period the number of tests increased dramatically and the positivity declined (shown in Abstract P5-S7.07 table 1). Compared with those negative at the first test, positive cases were more likely to be retested and were retested sooner. Abstract P5-S7.07 table 1 Positivity among those tested in Cornwall 2003–2009.Abstract P5-S7.07 Table 12003–20042004–20052005–20062006–20072007–20082008–2009TotalTests4794615311 15812 86414 44317 10166 513Positive5898051086110312139935789Positivity0.12870.13760.10190.09010.08740.06040.0910DiscussionWe found that even in an area which has achieved high screening coverage, few people were re-screened. However, positive cases are more likely to be retested than negatives. This detailed county level analysis will provide information to policy makers to develop a long-term, sustainable and effective screening strategy.
P5-S7.09 Is abandoning urethral smear microscopy for the detection of non-gonococcal non-chlamydial urethritis in asymptomatic men a cost effective strategy?
Authors: Caffrey O , Saunders J , Estcourt C , Birger R , White P , Roberts T 
Published: July 2011

BackgroundAsymptomatic non-gonococcal non-chlamydial urethritis (NCNGU) is common and can only be diagnosed by urethral smear microscopy. UK guidelines no longer recommend urethral smear microscopy in asymptomatic men, leaving men with this condition and their sexual partners untreated. The clinical and economic significance of this is unclear. We do not know if the costs of microscopy screening for asymptomatic NCNGU outweigh any future health benefits. We performed a model based economic evaluation to compare a screening strategy which includes microscopy to one which omits microscopy in asymptomatic men.MethodsThe economic model was from the perspective of the UK health service and so only direct medical costs and outcomes are included. A hypothetical cohort of asymptomatic men who present at sexual health clinics, or at primary care is assumed to haveChlamydia trachomatis,Neisseria gonorrhoeaeor NCNGU. In the economic model, untreated infections were taken into account for patients and their partners (pelvic inflammatory disease and tubal factor infertility in female partners). Probabilities and frequencies of these health events were informed by the outputs of a mathematical transmission model which used data from literature and national databases. A bottom-up costing estimated the cost for microscopy screening, while other cost inputs were sourced from published literature and online reference manuals for the economic evaluation. Appropriate sensitivity analyses were conducted to test the baseline results.ResultsCurrently, there are no robust quality-adjusted-life-year (QALY) data to value STI outcomes. Consequently, results will be presented as cost per major outcome avoided and cost per infection avoided, where major outcome averted refers to PID, infertility and tubal factor infertility. Incremental cost-effective ratios will be interpreted based on accepted precedents.ConclusionsThe UK's current financial restraint has increased the importance of allocating resources based on need and value-for-money. This in turn, requires the UK health service to eliminate ineffective and inefficient services to create additional source of funding. Results from this study will indicate whether microscopy testing for asymptomatic men is good use of public money and whether funding for the service should be maintained.
P5-S7.10 Chlamydia screening coverage among American Indian and Alaska native women in the USA
Authors: Tulloch S , Taylor M 
Published: July 2011

BackgroundRacial and ethnic minorities are often disproportionately affected by health disparities. In 2009, American Indian and Alaska Natives (AI/AN) had the 2nd highest rates of chlamydia in the USA. In an effort to eliminate health inequities and reduce the burden of disease, the US Centers for Disease Control and Prevention (CDC) recommends annual chlamydia screening for all sexually active women <25 while reducing screening among older less at-risk individuals. We sought to assess and describe geographic regional differences in how recommendations have been adopted across Indian Country to identify what opportunities exist for improving care within the Indian Health Service (IHS) National STD Program's Stop Chlamydia Project, a screening program that partners with IHS/Tribal/Urban Indian health centers (I/T/U) to enhance and expand chlamydia screening among AI/AN.MethodsWe calculated chlamydia screening coverage rates and associated per cent positivity for women <25 and >26 years of age screened through sites participating in the Stop Chlamydia Project by geographic region. Screening coverage was calculated using the 2009 Indian Health Services facility-level user population estimates as denominator values.ResultsScreening coverage among AI/AN women tested in Stop CT Project sites varied across geographic regions. Among women <25, rates ranged from 50.8% (Alaska) to 6.8% (California). Chlamydia positivity among this population also demonstrated variance across geographic regions ranging from 13.2% (Aberdeen) to 4.6% (California). Among >26-year-old women, similar levels of screening were seen ranging from 34.4% (Alaska) and 5.7% (Bemidji); however, significantly less positivity was identified (1.4%–5.6%) (Abstract P5-S7.10 table 1).Abstract P5-S7.10 Table 1Chlamydia screening coverage among AI/AN women (≤25 & ≥26) by geographic regions, Stop Chlamydia Project—2009Geographic Regions# of Tests≤25% Positive≥26% PositiveAberdeen (IA, NE, NS, SD)859031.70%13.20%19.00%3.80%Alaska (AK)12 18550.80%8.60%34.40%2.50%Bemidji (MI, MN, WI)19010.90%5.00%5.70%5.60%Billings (MT, WY)263028.70%9.20%18.70%1.40%California (CA)1736.80%4.60%6.10%1.90%Oklahoma (KS, OK)221114.70%11.60%10.90%2.80%Portland (ID, OR, WA)206328.80%9.20%23.80%2.40%Southwest (AZ, CO, NM, NV, TX, UT)15 50629.30%9.40%27.70%4.00%Nashville (AL, AR, CT, DE, FL, GA, IL, IN, KY, LA, MA, MD, ME, MO, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WV)No participating sitesOverall Total43 54831.50%10.00%23.80%3.30%ConclusionsThis is the first time screening coverage for American Indian/Alaska Native women has been evaluated by geographic regions. These data can help inform program improvement activities to maximise screening outcomes by expanding testing among women <25 years old and limiting routine screening efforts in older women (>26 years old) in order to better utilise testing resources to expand coverage among those at greatest risk for chlamydia (<25 years old).