bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S6.41 Determinants of human papilloma virus vaccination (HPVV) among Quebec (Canada) teenagers
Authors: Guay M , Clément P , Hamid A , Dubé E , Sauvageau C , Boulianne N , Landry M , Lemaire J 
Published: July 2011

BackgroundIn 2010, 76% of Quebec female students aged 14 and 15 received complete HPVV through a publicly funded school-based program where teenagers can elect to be vaccinated (parental consent not mandatory). Quebec's free HPVV program also targeted female teenagers up to age 18 in various settings (mostly public clinics and schools). A study was conducted to identify the determinants of HPVV among Quebec teenagers targeted by the program.MethodsA mailed and electronic survey was conducted in 2010 of a random sample of 3000 females (aged 14 to 18) listed in the public health insurance data registry. The survey questionnaire was based on a model elaborated following an extensive literature review and upon an adaptation of the Health Belief Model and the Walsh and McPhee model. The model developed takes into account the mutual influence of teenagers and their parents, as well as interactions with health professionals, on the vaccination decision. Prior to the survey, two focus groups were conducted with vaccinated and non-vaccinated teenagers to improve the model, and the questionnaire reliability was tested on 110 students aged 14 and 15. The final questionnaire had 38 Likert scale and multiple-choice questions. Bivariate and multivariate analyses were done.ResultsThe response rate was 46%. Generally, teenagers have a good knowledge of HPVV and the virus transmission. However, 68% thought that men cannot catch the virus. The HPVV coverage for one dose decreases with age: from 94% for teenagers aged 14 to 68% for those aged 17–18 (p<0.001). HPVV was significantly associated with better knowledge, HPVV perceived benefits, vaccination habits, encouragement from the school nurse or a teacher, relatives? Encouragement and parental approval (adjusted OR: 1.1–4.3). Not having HPVV was significantly associated with concern about HPVV side effects, family discouragement, and media promotion of HPVV (adjusted OR: 0.27–0.50).ConclusionsSchool-based HPVV is more effective in reaching high vaccine uptake. Information on the virus transmission has to be improved; by targeting girls, the program suggests that only females can be infected. Even if their consent is not mandatory for teenager HPVV, parents play a major role in their daughter's vaccination decision. The media influence on unvaccinated teenagers must be deepened as it has a paradoxical impact.
P1-S6.43 HPV vaccine coverage among high-risk women: racial and socioeconomic disparities and barriers
Authors: Niccola L , Mehta N , Julian P , Bilinski A , Sosa L , Meek J , Hariri S , Markowitz L , Hadler J 
Published: July 2011

BackgroundHuman papillomavirus (HPV) is a necessary cause of cervical cancer and two vaccines are recommended for routine use among females ages 11–12 years with catch-up through age 26. Reducing disparities in cervical cancer will depend on achieving adequate vaccine coverage among racial and ethnic minorities and low-income women. The purpose of this analysis was to describe racial, ethnic, and socioeconomic differences in HPV vaccine coverage and identify barriers to catch-up vaccination.MethodsTelephone interviews were conducted among women diagnosed with precancerous cervical lesions and reported to the CT Department of Public Health for routine surveillance during 2008–2010. The sample consisted of 269 women ages 18–27 years (age-eligible for catch-up vaccination after licensure) including 77% white, 15% black, and 17% Hispanic; median age was 23 years.ResultsOverall, 43% of women reported having received ≥1 dose of HPV vaccine (mean age at vaccination 22 years). Publicly insured and uninsured women were significantly less likely than privately insured women to have received vaccine (23% and 15% vs 52%, p<0.05 for both), and black women were marginally less likely to receive vaccine compared to white women (31% vs 48%, p=0.06). There was no significant difference for ethnicity. The most common self-reported barrier to vaccination was lack of provider recommendation (25%). Other common self-reported reasons were previous HPV diagnosis (20%) and being too old (15%). Women who did not discuss HPV vaccine with a provider were more likely to have not received vaccine compared to women who discussed vaccine (95% vs 44%, p<0.001) see Abstract P1-S6.43 Figure 1.Abstract P1-S6.43 Figure 1Self-reported barriers to hpv vaccination among women with precancerous cervical lesions (n=152).ConclusionsProvider interventions may be necessary to assure catch-up vaccine is offered to eligible women. A common reported barrier was being too old, yet all women in this sample were age-eligible for vaccination. Previous HPV infection was another common barrier, yet this is not a contraindication for vaccination to protect against infection from other HPV types. In particular, greater efforts are required to administer catch-up vaccine to low-income and black women. Providing vaccine for underinsured women in this age group will be a challenge because they are not eligible for some state or federal vaccination programs (eg, Vaccines For Children).
P1-S6.44 HIV vaccine clinical trial adherence and retention: high-risk drug-using women
Authors: Becher J , Chhatre S , Eisenberg M , Fiore D , Dominique T , Dunbar D , Frank I , Metzger D 
Published: July 2011

BackgroundClinical trial protocol adherence and retention are often considered challenges that are especially difficult to achieve among certain high-risk populations. The HIV infection rate among heterosexual African-American women is increasing, making their participation in clinical trials of HIV behavioural and biomedical prevention interventions more important. We identify drug use and sex risk factors associated with adherence to protocol and study retention among this population during the course of an HIV vaccine trial.MethodsData from participants at the Philadelphia, PA site for the HIV Vaccine Trials Network (HVTN) 502 study testing the Merck Adenovirus 5 gag-pol-nef HIV vaccine were used to examine factors associated with adherence (receipt of three vaccines) and retention (present for 12-month appointment). Enrollees included 123 HIV-negative women 18–45 years of age reporting regular use of crack cocaine and frequent unprotected sex, who were randomly assigned to receive three injections of either the study vaccine or a placebo vaccine.ResultsStudy participants had a mean age of 37 years and 91% were African–American. Overall adherence to study protocol was 89% and study retention at one year was 93.5%. Analyses found no association between drug use and high-risk sex behaviours and poorer rates of adherence and retention. In fact, participants who used recreational drugs at baseline were more likely than those who did not to adhere to study protocol (92% vs 75%, p<0.10). Participants who reported use of injectable contraceptives at baseline were less likely than those who did not to be retained in the study at 1 year (57% vs 96%, p<0.01). Other measures of drug use (whether injected recreational drugs, and used crack cocaine, speed and other drugs) and sex risk (whether had a STI, exchanged vaginal, oral or anal sex for money, drugs or services, used different methods of birth control, the number of male sex partners, whether aware of partner's HIV status and whether had protective and unprotected vaginal, anal or oral sex with them) were not associated with adherence and retention.ConclusionsFactors commonly assumed to interfere with trial participation were not associated with adherence to study protocol or retention. These findings suggest that drug use and sexual risk behaviours do not impede completion of vaccinations and protocol required visits in clinical trials of experimental HIV vaccines.
P1-S6.45 Impact of a community level, diffusion based HIV/STI intervention on heterosexually-identified, socially marginalised men in urban, coastal Peru
Authors: Konda K , Lescano A , Celentano D , Maiorana A , Salazar X , Rosasco A M , Montano S , Kochel T , Hall E , Coates T , Caceres C , Kegeles S ,   NIMH Collaborative HIV/STD Prevention Trial Group
Published: July 2011

ObjectivesThe NIMH Collaborative HIV/STD Intervention Trial implemented a 2-year intervention based on the theory of diffusion of innovations to decrease unprotected sex with non-primary partners among high-risk populations including heterosexually-identified, socially marginalised men in urban, coastal Peru.Methods20 communities in 3 cities were randomised to the intervention or comparison arm. In intervention communities, 15% of the target population was trained as Community Popular Opinion Leaders (CPOLs) to deliver HIV prevention messages to their peers. In all communities, yearly assessments of the study cohort, independent of the intervention, gathered information on sexual behaviour, provided pre-test counselling, and testing for HIV/STIs at baseline, 1 year, and 2 years after randomisation. This analysis included the 2146 heterosexually-identified men who fulfilled the trial's inclusion criteria (frequented community social venues, were aged 18 to 40, and had sex in the past 6 months).ResultsUnprotected sex with a non-primary partner decreased by 10% in both study arms among heterosexually identified men. Almost half of the participants, in both the intervention and in the comparison arms, reported unprotected intercourse with a non-primary partner at the final follow-up (47.6% vs 48.7%, p=0.694) and there was no difference after controlling for baseline behaviour, OR 1.04, (95% CI 0.79—to 1.38). STI incidence was also did not differ by randomisation condition, IRR 1.14 (95% CI 0.77—to 1.68) comparing incidence in intervention vs control communities.DiscussionWe speculate that the lack of effect of the intervention among the heterosexually-identified men may be attributable to 1) an insufficiently strong intervention approach, 2) this group of men did not feel vulnerable to HIV or STI, or 3) the repeated biomedical testing and ancillary required counselling were as potent as the CPOL intervention. Future HIV prevention trials with this population should try to tailor the intervention to this group's risk perceptions and behaviours.
P1-S6.47 Description and evaluation of a regional condom access program for community organizations
Authors: Petit G , Bigras A , Dubé C , Malo F C , Surprenant M C , Salvail M , Gagnon M 
Published: July 2011

BackgroundAs observed in the rest of Quebec province, the number of STD declared to public health authorities in Estrie have been increasing in the last years. It has also been evaluated that condom use in this region is not as high as expected, particularly by young people. The Estrie region began a program in 2008 to favour free access to condoms for community organizations in contact with groups known as vulnerable to STDs. Purpose Describe and evaluate the implementation of the program after a period of 3 years. The regional program aim is to provide free condoms to vulnerable groups through distribution by community organizations in contact with these groups. This program is conducted among others to increase use of condoms and reduce STDs in Estrie. Recommendations resulting from evaluation will be use to improve the program.MethodsThe process evaluation was conducted in two parts: 1. First part was conducted by analysing all relevant documents available at the public health department in charge. 2. Second part was conducted by interviewing all community organizations which participated in the program. Information was collected orally by two interviewers, using a standardised questionnaire.ResultsThe regional program is based on five components: 1) Annual launch (November) with a letter sent to all community organizations known to work with vulnerable groups. 2) Project submission by community organizations using a standardised form. 3) Distribution of condoms to community organizations. 4) Distribution of condoms to vulnerable groups by community organizations. 5) Annual report of activity by participating community organizations. Eleven community organizations had received condoms within the three years of the program. More than 100 000 condoms have been distributed in various projects. The regional budget allowed to the program has been able to covert the cost of all requested condoms, except for 1 year, where all projects were accepted, but with a somewhat reduced number of condoms per project. Participants were generally satisfied with the program. They confirmed its usefulness but proposed some modifications to it. Thirteen recommendations were made following evaluation. Some of them were about: 1) Favoured methods to approach community organizations. 2) Use more marketing so that more organizations know about the program. 3) Use of reminder for project submission and annual activity report. 3) Offering more kinds of condoms (especially large and without latex). 5) Offer education material to use in organizations along with condoms.ConclusionOverall, the regional condom access program is considered useful and satisfying by the participating organizations. The recommendations resulting from evaluation will be useful to optimise the implementation of program in the future, adapt it to the needs and therefore increase its efficacy to reach its STDs reduction goals.
P1-S6.49 Developing and validating a risk scoring tool for chlamydia infection among sexual health clinic attendees in Australia: a simple algorithm to identify those at high risk of Chlamydia infection
Authors: Wand H 
Published: July 2011

ObjectiveTo develop and validate a risk scoring tool for chlamydia infection to identify those who are at increased risk of chlamydia infection.MethodsWe used demographic, sexual behaviour information and chlamydia positivity results from more than 45 000 individuals who attended Sydney Sexual Health Centre between 1998 and 2009. Participants were randomly allocated to either the development or internal validation dataset. Using logistic regression, we created a prediction model and weighted scoring system using the development dataset and calculated the OR of chlamydia positivity for participants in successively higher quintiles of score. The internal validation dataset was used to evaluate the performance characteristics of the model for five quintiles of risk scores including population attributable risk (PAR), sensitivity and specificity.ResultsIn the prediction model, inconsistent condom use, increased number of sexual partners in last 3 months, genital or anal symptoms and presenting to the clinic for sexually transmitted infections (STIs) screening or contact of an STI case were consistently associated with increased risk of chlamydia positivity in all groups. High scores (upper quintile) were significantly associated with increased risk of chlamydia infection. A cut-point score of 20 or higher distinguished a “increased risk” group with a sensitivity of 95%, 67% and 79% among heterosexual men, women and MSM, respectively.ConclusionThe scoring tool may be included as part of a health promotion and/or clinic website to prompt those who are at increased risk of chlamydia infection which may potentially lead to increased uptake and frequency of testing.
P1-S6.50 Chlamyidia partner notification for adolescent females, San Francisco, 2010
Authors: Kohn R , McCright J , Ivory B , Snell A 
Published: July 2011

BackgroundIn 2009, African American women 15 to 19 years of age had the highest rate of chlamydia of any population in San Francisco (10 762.13 cases per 100 000 residents per year). Screening and education efforts had not succeeded in lowering rates in this population. Previous research suggests that adolescents may have fewer partners and fewer anonymous encounters than other patients with whom we conduct partner notification. We evaluated a pilot program of contact tracing aimed at male partners of adolescents women diagnosed with chlamydia living in selected neighbourhoods.MethodsResidential addresses for all reported females under 20 years of age reported with a Chlamydia infection were geocoded. Cases residing in neighbourhoods with the highest rates of Chlamydia in 2009 were assigned to a health worker for partner notification. Cases were interviewed at least two weeks after being tested in order to give providers time to disclose the results. Names of male partners during the previous three months were collected along with locating information. The total number of partners for each woman (including unnamed partners) was also recorded. Male partners were contacted by the health worker; if partners had not been tested or prophylactic ally treated, they were tested for Chlamydia and treated if positive.ResultsBetween 1 June 2010 and 31 December 2010, 296 Chlamydia cases were reported among women under 20 years of age. Of these, 106 (35.8%) resided in the priority neighbourhoods. Only 64 cases (60.4%) were located and interviewed; all but one of the remaining cases were not locatable. The cases claimed a total of 96 male partners, with 66% claiming just one partner in the previous 3 months, and only two cases claiming more than three partners. However, only 39 partners (40%) were named, including 11 partners residing out of jurisdiction, and 4 who had already been treated by the time they were located. Eleven (11) male partners were tested, and only 2 were positive for Chlamydia. The greatest barrier to contacting the cases and their male partners was cell phones numbers that were disconnected by the time we needed to use them.ConclusionWhile women in this population have fewer anonymous encounters than other populations targeted using partner notification, few cases among male partners were brought to treatment. Partner notification for adolescent females will likely have minimal impact on chlamydia transmission.
P1-S6.51 Antiretroviral therapy, sexual behaviour, and their simulated impact on HIV epidemiologic trends in Uganda
Authors: Shafer L A , Nsubuga R , Chapman R , O'Brien K , Mayanja B , White R 
Published: July 2011

BackgroundDebate exists concerning the potential impact of ART on the HIV epidemic in Africa. We combine empirical evidence for sexual behaviour change in response to ART in a Ugandan cohort, with mathematical modelling, to examine the likely impact of ART on the HIV epidemic, accounting for potential behaviour change.MethodsCohort participants are surveyed every 3 months on sexual behaviours. ART rollout began in 2004. Using regression, we examined potential associations between timing of ART initiation and sexual behaviour among HIV-infected, and timing of ART availability and sexual behaviour among HIV-uninfected. We then used a compartmental mathematical model to assess the impact of ART on HIV epidemiologic trends, under varying assumptions about rates of initiating ART and behaviour change. The model has been described previously in peer-reviewed literature.ResultsWe found no evidence of increased risk behaviour after ART initiation to levels higher than 2 years before initiation. There is some evidence of rising risk behaviour among HIV-uninfected people in response to ART availability. Among HIV-uninfected, the mean number of casual partners in the past 3 months fell from 0.02 in 2002 to 0.01 by 2004 and then rose to 0.03 by late 2008 (p for change in trend from declining to rising numbers of casual partners over the period 2002–2008=0.030). The mean number of new partners in the past 3 months fell from 0.13 in early 2002 to 0.02 in the late 2004. By 4th quarter of 2008, the number of new partners in the past 3 months had risen to 0.20 (p=0.058). Regardless of changing sexual behaviour, the model suggests that ART will reduce HIV incidence, but increase prevalence. This occurs even when ART initiation begins in HIV stage 2 (∼3 months after infection) and 90% of HIV-infected are on ART and the probability of transmission while on ART declines greatly (right panel of Abstract P1-S6.51 Figure 1 baseline of no ART displayed in left panel). The conditions required for ART to reduce prevalence had to be more extreme than this (left panel).Abstract P1-S6.51 Figure 1Sensitivity analyses of dual impact of ART and potential behaviour change on HIV prevalence.ConclusionsDue to HIV+ people enjoying a longer life expectancy, and an insufficient drop in incidence, HIV prevalence will rise as a result of ART. Modelling suggests that even small increases in risky sexual behaviour will lead to further substantial increases in HIV prevalence. Policy makers are urged to continue promoting sex education, and be prepared for a higher than previously suggested number of HIV+ people in need of treatment.
P1-S6.52 Is PEP a misused therapy? Cross sectional PEP study in sex worker outreach program clinic
Authors: Mungai Jane , Kiguoya Marion , Wachihi Charles , Kimani Joshua , Kiogora Festus , Mwanjewe James , Gelmon Lawrence 
Published: July 2011

BackgroundPost-exposure prophylaxis (PEP) is a short-term anti-retroviral (ARV) treatment that reduces the likelihood of HIV infection after exposure to HIV-infected blood or sexual contact with an HIV-positive person. We are able to offer PEP mediations in our SWOP clinics to clients reporting high risk exposure. Normally ARVs for PEP are given within 72 h of exposure for a period of 4 weeks. Our objective was to assess whether the clients had already established STIs prior administration of PEP. The clients were aged between 19 and 49 years with each having an average of 9 men clients per day.MethodsA cross sectional study was conducted on 91 female sex workers who came to the clinic for PEP in the period September 2009 to July 2010. The female sex workers were first given counselling, completed a standard questionnaire before having PEP administered. The samples taken included blood for HIV Elisa, high vaginal swab for Gonorrhoea Culture on Thayer martin media and Gram stain smear for Bacteria vaginosis, presence of spermatozoa and white blood cells.ResultsThe clients were all HIV seronegative. 76% of the women had come for PEP for the first time, 21% for the second time and 3% for the third time. 80% of the patients reported condom burst, 8.6% were as a result of rape or coerced sex, while 3.2% reported client refused condom use. However 73% smears of the women did not have spermatozoa. Overall 9% of the patients were GC positive but 3.2% had GC and spermatozoa while 6.6% had GC without spermatozoa. Trichomonas prevalence was 4.3% but all these patients did not have spermatozoa. 38% had a WBC count of over 6–30 field on gram stain Conclusion: The presence of high white cell count at the time of seeking PEP may indicate a pre-existing infection, hence presence of underlying high risk behaviour. Moreover presence of GC and TV without spermatozoa may also indicate exposure longer reported. There is need to educate sex workers on proper use of PEP and to maintain low risk behaviour. We also need to understand the decision making process of sex workers in choosing post-exposure prophylaxis and any barriers that may contribute to delays in seeking PEP.