bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S1.47 Measuring and prioritising congenital syphilis control in Guangdong China - a Markov model to inform policy implementation
Authors: Tucker J , Tan N , Rydzak C , Yang L G , Peeling R , Chen X S 
Published: July 2011

BackgroundSyphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing particular concern. Precisely determining the extent of CS burden has been challenging given incomplete prenatal screening coverage and limited CS diagnostic capacity. As a result, both net under and over-reporting are plausible. In addition, there are a range of policies that could be expanded as part of the new National Syphilis Control Plan. This paper uses a Markov model to estimate the number of CS cases and other adverse outcomes and prioritise control measures in Guangdong Province, China.MethodsWe developed a Markov model that incorporated age-stratified fertility rates, female adult syphilis reported cases, and empirical syphilis transmission rates to estimate the number of adverse pregnancy outcomes associated with prenatal syphilis infection on a yearly basis from 2005 to 2009. Guangdong Province was the focus of this analysis given access to high quality demographic and public health data required for model inputs. Adverse outcomes examined included CS, stillbirth, neonatal death, and low birth weight. Sensitivity analyses were performed to identify variables most influential for achieving WHO and Chinese program benchmarks.ResultsOur model estimates 264 CS cases per 100 000 live births in Guangdong during 2009, substantially greater than the 129 reported CS cases per 100 000 live births. This is consistent with a net 49% under-reporting of CS cases in 2009. Higher syphilis prevalence among women in their peak childbearing years (20–30 years old) is closely related to greater numbers of CS cases see Abstract P1-S1.47 Figure 1. Expanding prenatal screening coverage was the single most important mechanism for preventing CS cases; increasing prenatal screening from 50% to 100% coverage would be associated with 98 CS cases averted per 100 000 live births. Alternatively, a comprehensive syphilis control strategy including 100% prenatal screening, 100% treatment completion, and 100% early screening in pregnancy would be associated with 212 CS cases averted per 100 000 live births.Abstract P1-S1.47 Figure 1Predicted and reported CS cases in Guangdong Province, China, from 2005 to 2009.ConclusionsOur analysis illustrates the limitations of relying on CS reported cases alone to accurately track adverse pregnancy outcomes associated with syphilis infection in pregnant women. A comprehensive syphilis control strategy targeting universal prenatal screening coverage, treatment completion, and early screening in pregnancy is essential for successful achievement of overall WHO and Chinese CS objectives.
P3-S7.09 Mutations on gyrA or parC genes ofMycoplasma genitaliumand efficacies of treatment with fluoroquinolones againstM genitalium-related urethritis
Authors: Hamasuna R , Takahashi S , Matsumoto M , Sho T , Matsumoto T 
Published: July 2011

BackgroundMycoplasma genitaliumis one of the pathogens of male urethritis. Macrolides as azithromycin can be the first line-treatment, but macrolides-resistantM genitaliumstrains were isolated. We tried to use some fluoroquinolones againstM genitalium-related urethritis. In these studies, some patients could not treated by fluoroquinolone. In any bacteria, genetic mutations on gyrase genes were related to fluoroquinolone-resistance. In this study, quinolone-resistant determining regions (QRDR) on gyrase genes ofM genitaliumwere analysed and the relationship between the efficacies of fluoroquinolone againstM genitalium-related urethritis and genetic mutations on QRDR ofM genitaliumwas examined.MethodsThe QRDR on gyrA and parC genes ofM genitaliumwere sequenced and analysed. DNA samples were purified fromM genitalium-positive first-voided urine specimens before and after the treatment with fluoroquinolones as gatifloxacin or sitafloxacin. The QRDR of gyrA and parC genes ofM genitaliumwere analysed by using primers according to Shimada's report (Int J Antimicrob Agent, 2010).ResultsTwenty-two genomes ofM genitaliumbefore the treatment with fluoroquinolones and four genomes from patients with treatment-failure were analysed. Before the treatment,M genitaliumgenomes have no mutation on gyrA, but had four mutations on parC gene with amino-changes (Ala-69 to Thr, Pro-72 to Ser, Asp-87 to His and Ser-83 to Ile). After the treatment,M genitaliumwas found in four patients and all remainedM genitaliumwere found mutations on gyrA or parC with amino-changes.M genitaliumwith mutation on parC (Pro-72 to Ser and Ser-83 to Ile) before treatment was remained.M genitaliumwith mutation on parC (Pro-72 to Se and Ser-83 to Ile) before treatment was remained and was found additional gyrA mutation (Asp-99 to Asn). In two patients,M genitaliumwithout mutations before treatment remained after treatment. However, these genomes were found with newer mutations on gyrA (Asp-99 to Asn) or on parC (Ser-83 to Ile).ConclusionFrom the urine specimens of patients with treatment-failure of fluoroquinolones, some mutations with amino-change were found on QRDR of gyrA or parC genes ofM genitalium. It was suggested that these mutations are related with treatment-failure with fluoroquinolones.
P4-S1.04 11C-Choline small animal PET in experimentalChlamydia muridaruminfection
Authors: Marangoni A , Nanni C , Quarta C , Aldini R , Donati M , Nardini P , Foschi C , Fanti S , Cevenini R 
Published: July 2011

ObjectivesGenital tract infection of female mice withChlamydia muridarumclosely mimicsC trachomatisacute genital tract infection in women. Aim of this study was to assess the predictivity of 11C-Choline Small Animal PET for the identification of reactive animals and their follow-up at several times after vaginal challenge.MethodsChlamydiae were grown in LLC-MK2 cells, cultivated in Eagle's MEM and elementary bodies were purified from cells by sucrose-gradients density centrifugation. Animals used in this study were 10 female Balb/c mice, 6–8 weeks old. All the animals received 2.5 mg of medroxyprogesterone acetate intramuscular nine and 2 days prior the infection. Nine mice were infected by placing 106 IFUs ofC muridaruminto the vaginal vault. Infection was induced under Ketamine anaesthesia. As control, one animal was challenged with SPG. At 5, 10 and 20 days after challenge mice underwent a 11C-Choline PET, as follows: each animal was anaesthetised with Sevofluorane 3–5% oxygen 1 l/min and was injected with approximately 20 MBq of 11C-Choline, via the tail vein. The residual dose was measured to verify the effective dose injected. The animal was subsequently placed on the scanner bed in the prone position, after an uptake time of 5 min. Images were acquired with a small animal PET tomograph (GE, eXplore Vista DR) for a total acquisition time of 20 min. As the axial field of view was 4 cm, one bed position was sufficient to cover the whole body. Images were reconstructed iteratively (OSEM 2D) and read in three planes (axial, sagittal and coronal). The scan was considered positive if areas of increased Choline uptake were present at sites consistent with the site of inflammation. The standard uptake value (SUV) was calculated by measuring the concentration of the labelled tracer in the region of interest and correcting it for mice body weight and injected dose. Infection was monitored by culturing cervical-vaginal secretions 6, 11 and 21 days after infection.ResultsAt 5 days, the mean vaginal SUV (±SD) of the cases was 0.83±0.39, whereas the control showed a value of 0.278. At 10 and 20 days, SUVs of the cases were 0.94±0.25 and 1.17±0.21, respectively, whereas SUV of the control was 0.299 and 0.302, respectively.C muridarumwas isolated from all the infected animals during the study period.ConclusionsThese preliminary data indicate that 11C-Choline PET could be a promising technique to in vivo evaluate inflammatory response to Chlamydia infection.
P4-S4.04 Temporal dynamics of vaginal bacterial communities
Authors: Ravel J , Brotman R , Gajer P , Sakamoto J , Koenig S , Fu L , Zhou X , Abdo Z , Forney L , Ravel J 
Published: July 2011

BackgroundDysbiosis of vaginal bacterial communities have been associated with increased risk for sexually transmitted infections and bacterial vaginosis. This is the first observational study to model temporal dynamics of vaginal microbiota using frequently collected samples, behavioural data and culture-independent methods.MethodsThirty-three asymptomatic, reproductive-age women self-collected mid-vaginal swabs every 3rd day for 16 weeks (998 samples). Participants reported behaviours and menstrual data on daily diaries. Bacterial communities were determined by pyrosequencing of barcoded 16S rRNA genes (V1–V2 region). Participants were clustered into five community classes based on temporal patterns of vaginal bacterial community composition using transition probabilities. A linear mixed effect model for the log of Jensen-Shannon rate of community change was utilised. The model accounted for correlations between samples from the same participant and was adjusted for time-varying confounders and normalised menstrual cycle time.ResultsThree of the community classes were most often dominated byLactobacillus iners,L crispatus, orL gasseri, respectively, while two lacked significant numbers ofLactobacillusspp. The latter classes were split into subtype A typified by Corynebacterium, Anaerococcus, Peptinophilus, Prevotella, and Finegoldia, while those of subtype B showed a higher abundance of the genus Atopobium. The rank abundance and species composition of bacterial communities in some women changed markedly over short periods of time while others were relatively stable. Classes dominated byL crispatusandL gasseriexperienced the fewest fluctuations in community composition, and communities that lacked significant number ofLactobacillus spp. also demonstrated some stability. Vaginal communities dominated byL inersdemonstrated either a lack of constancy or notable stability. The menstrual cycle was associated with temporal dynamics, but these effects were influenced by bacterial community class. Sexual activity the day prior to sampling was of borderline statistical significance (p=0.065) and is a variable of interest in supplementary modelling.ConclusionsVaginal microbiota can fluctuate rapidly. Future studies should investigate the role of temporal changes in vaginal microbiota on sexually transmitted infection risk. Longitudinal studies of the vaginal microbiome may allow for the future development of targeted individualised therapeutic approaches.
P5-S3.05 A clinical practice intervention to increase chlamydial screening: sustaining the gain and translating into practice 4 years later
Authors: Tebb K , Shafer M A 
Published: July 2011

BackgroundChlamydia trachomatis(CT) continues to be a major public health problem among sexually active adolescent and young adult females. Although annual CT screening is recommended, actual rates remain low. System-based interventions are an effective approach to improve clinical practice including CT screening.ObjectiveThere are two objectives: (1) To describe the sustainability of a systems-based, clinical practice improvement intervention to increase urine-based CT screening among adolescent girls (14–18 years old) during routine check-ups in a paediatric clinic setting (2) To describe and evaluate the translation of this intervention into control clinics.MethodsThe study randomised 10 paediatric clinics (5 experimental, 5 control) within a large Northern California health maintenance organization (HMO). Clinics in the experimental group received a systems-based clinical practice improvement intervention (CPI) and controls received a traditional provider education intervention. The original study took place between 2000 and 2002 (Shaferet al JAMA, 2002). After the study ended, the intervention was translated to the remaining clinics including to the five controls. Data were tracked for four additional years (2003–2006). The proportion of 14–18-year-old girls who had sexual intercourse and who were screened for CT during their routine checkups was calculated using the same methodology as the original study. We assessed changes in the rate variable over time, within sites and between the intervention and control groups using linear mixed effects models with random intercepts.ResultsThe average screening rate in the intervention group was sustained at an average of 60% during the 4-year follow-up period (CI 0.41 to 0.79) with no significant increases over time. Prior to translation activities, the proportion screened in controls was 21%. After translation activities, the control group exhibited statistically significant linear and quadratic effects of time (p=0.0019 by Wald χ2test). The estimated rate for the controls was 0.42 (95% CI 0.25 to 0.59) at time 1, increased to a maximum of 0.69 (95% CI 0.55 to 0.83) at year 2.5, then declined to 0.52 (95% CI 0.35 to 0.70) at the end of year 4.ConclusionsThis CPI systems intervention was both translatable and sustainable to other paediatric clinics within this HMO.
P5-S4.06 Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among a cohort of unstably housed people living with HIV in BC, Canada
Authors: Parashar S , Palmer A , O'Brien N , Chan K , Shen A , Coulter S , Montaner J , Hogg R 
Published: July 2011

BackgroundHousing is a known determinant of health behaviour, including adherence to antiretroviral therapy. Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) cohort, unstable housing is inversely associated with adherence. The Maximally Assisted Therapy (MAT) program uses a multidisciplinary approach to support people living with HIV/AIDS (PHA) who have a history of addictions, mental health disorders and homelessness. We investigated the efficacy of support services, including the MAT program, in improving adherence for unstably housed PHA.MethodsThe LISA cohort is a cross-sectional study of individuals on antiretroviral therapy in British Columbia. Interviewer-administered surveys collect information regarding housing, drug use, utilisation of health services and other clinically relevant socio-demographic factors. Clinical variables, such as CD4 count and viral load, were obtained through longitudinal linkages with the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. Logistic regression was used to determine factors associated with adherence (≥95% vs <95%) among unstably housed LISA participants (n=212).ResultsBetween 2007 and 2010 approximately 1000 participants were interviewed. This analysis is based on 644 interviews, of which the DTP reports optimal adherence [≥95% 12 month refill] for 367 (57%) individuals. Median age was 46 and 475 (73.7%) were male. We found that unstably housed participants attending the MAT program were 4.76 times more likely to be ≥95% adherent [95% CI 1.72 to 13.13] than those who did not. Other factors associated with optimal adherence included recent incarceration (Adjusted OR [AOR]=0.20 [95% CI 0.05 to 0.80]) and not currently using illicit drugs (AOR=0.40 [95% CI 0.16 to 0.99]).ConclusionThe MAT program provides a model for other urban centers dealing with concurrent and interrelated adherence barriers: high-risk drug use, mental health disorders and homelessness. In the absence of sustainable housing solutions, programs such as MAT are crucial to achieving optimal treatment adherence in this population.
P5-S5.08 Efficient gonorrhoea and chlamydia control and prevention through partner notification in high morbidity STD states: a Louisiana perspective
Authors: Rahman M , Khan M , Longfellow L 
Published: July 2011

BackgroundCase detection through screening and partner notification are the two strategies used by the state Sexually Transmitted Disease (STD) Control Programs in USA for STD control and prevention. Most of the state programs do not use partner notification for Gonorrhoea and Chlamydia cases because of lack of personnel and financial resources. To focus the limited resources in high morbidity STD states, partner notification is solely targeted towards syphilis and HIV cases. However, systematic analysis is needed to understand the effectiveness of partner notification for STDs other than syphilis and HIV cases. The objective of this study is to carryout partner notification via telephone of Gonorrhoea and Chlamydia cases detected in two STD/ Family Planning clinics in Louisiana.MethodsAll Gonorrhoea and Chlamydia cases detected at two STD/Family Planning clinics (pilot sites) were selected for telephone interview. Three trained telephone interviewers are provided with the contact information of positive cases. The interviewers made up to seven attempts to interview the index cases. Information regarding sexual partners and contact information was obtained from the interviewed cases. Later the partners were notified for testing and treatment.ResultsFrom July to December 2010, 512 Gonorrhoea and Chlamydia cases were detected at these two pilot sites and 237 cases (46.3%) were interviewed. Missing valid contact numbers and inability to contact the case by the seventh attempt were the main reasons for the relatively low interview rate. A total of 129 partners were elicited from 237 index cases. 87 partners (67.4%) sought medical evaluation, 49 partners (37.9%) were infected and treated, and 38 partners (29.5%) received preventive treatment.ConclusionOur study shows that partner elicitation and notification for Gonorrhoea and Chlamydia cases via telephone can be an effective mechanism in high morbidity STD areas. In our pilot testing, 100 patients provided information on additional 54 contacts and 100 index cases lead to treatment of additional 21 cases. Treatment of these 21 cases and preventive treatment of additional cases should have significant impact on overall prevalence of the diseases if the program is adopted at the state level, especially in the high morbidity STD states.
P5-S6.01 Towards universal access to prevention mother to child HIV-transmission (PMTCT) services leading to elimination of mother to child HIV-transmission (MTCT) in Rwanda
Authors: Nyemazi J P 
Published: July 2011

BackgroundPMTCT related activities in Rwanda began in 1999 with a piloting phase in Kicukiro Health Centre in Kigali City. Subsequently, PMTCT service delivery has been expanded and over 74% of total health facilities are covered in the country.ObjectivesIn May 2010, Rwanda commissioned the Mid-term review of PMTCT scale up plan in order to document achievements made, best practices, challenges faced and guide a development of MTCT elimination plan.MethodsMid-term review was a cross-sectional descriptive and analytical study employing rapid participatory assessment techniques. Data collection was undertaken at national level and 15 selected health facilities located in five districts. In-depth interviews with local authorities, providers and HIV-infected mothers were conducted. Key programmatic indicators data were gathered. Data analysis was done using a range of qualitative techniques and secondary quantitative data.ResultsIn Rwanda, 96% of pregnant women attend antenatal care (ANC) at least once during pregnancy and receive HIV testing and counselling. In 2009, over 74% of pregnant women attended PMTCT sites and 97% of them got tested and received their HIV results. Of the expected HIV infected pregnant mothers, 78% actually received antiretroviral prophylaxis for the PMTCT. Of the expected HIV exposed infants, 64.3% actually received antiretroviral prophylaxis and the rate of MTCT dropped from 10.4% (2007) to 4.1% at 18 months of age in 2009.ConclusionsThe review showed that significant progress has been made in achieving national PMTCT targets; however there is a need for interventions to increase the uptake for the PMTCT program in the country to achieve the Millennium development Goals (MDG).ImplicationsRwanda is on-track to attain MDGs and the review findings lead to the development plan aiming at elimination of MTCT in Rwanda by 2012.
P1-S2.10 Female clients and partners of MSM sex workers in a resource-poor setting, West Africa
Authors: Busari O , Nakayima M , Busari A 
Published: July 2011

MSM are becoming increasingly important in HIV epidemics in Africa and their population is growing in Nigeria. However, there's paucity of data on HIV epidemics in MSM in Nigeria and West Africa region. Though HIV transmission in Africa is mainly heterosexual, interactions between HIV epidemics in MSM and heterosexual populations are not well understood. Objective was to describe female clients and partners of MSM sex workers (MSM-SW) in Lagos and to determine risk factors for unprotected sex between women and MSM-SW.MethodsMSM were recruited through respondent driven sampling, a novel methodology designed to access hidden populations. MSM-SW were identified through self-reporting and consent was obtained. Participants completed a pre-tested questionnaire and a behaviour diary. The questionnaire included questions on details of each sexual partner for 4 weeks; each sexual encounter with each partner; and the three most recent partnerships. Data were summarised as proportions and compared using chi square test.Results62 MSM-SW participated in the study and concluded the self-reported questionnaire and behaviour diary. MSM-SW recorded 311 partners, out of which 66(21.2%) were female and aged between 16 and 38 years. Thirty-two (10.3%) were recent female partners. Of the recent female partners, 17 (53.1%) were unmarried, 14 (43.8%) married and one was a spouse of MSM-SW. 60 (90.1%) of female partners of MSM-SW paid or were paid for sex (39/60,65% paid MSM-SW while 21/60, 35% were paid by them). There were 52 single episode sexual contacts and 14 regular partnerships. Of the 50 new transactional contacts, more than half (56%) met in the bars, restaurants, clubs, motels and beaches. All the sexual encounters between MSM-SW and their female partners involved penetrative sex—vaginal sex (VS)(53, 80%); anal sex (AS)(39, 59%); and both (31, 47%). Unprotected sex was significantly more frequently associated with sex with regular partner than with single episode sexual contact (79% vs 52%; p=0.02, OR=3.0) and non-transactional sex than sex paid for by the female partners (71% vs 46%; p=0.029,OR=2.8).ConclusionMSM-SW in Nigeria have a lot of female clients and partners and frequently engage in transactional and unprotected sex with them. Majority of these female partners are in heterosexual married relationships. Understanding these interactions between MSM and heterosexual populations is very crucial to any HIV intervention targeted on MSM and by extension the general population.