Opt-out testing for HIV: perspectives from a high prevalence community in south-east England, UK

Peoples' perspectives and attitudes towards being offered opt-out HIV testing were explored in a geographical area of high HIV prevalence. Users (n = 31) of sexually transmitted infection (STI) testing services took part in community focus groups in the south-east of England, UK. There was broad support for opt-out HIV testing based on public health and individual health benefits. For this sample, opt-out HIV testing when registering with a general practice surgery and on elective or emergency admission to a general hospital was acceptable, although there were concerns about the rigour of informed consent. Heterosexual participants' criticism of people from higher prevalence groups for HIV declining tests, while maintaining their own right to opt-out, suggested that attitudes towards testing may be influenced by levels of perceived risk. Innovations in HIV testing policies to increase testing rates will benefit from an acknowledgement of the different meanings that testing has.

Testing for sexually transmitted infections among students: a discrete choice experiment of service preferences

OBJECTIVES

To assess preferences among students for sexually transmitted infection (STI) testing services, with a view to establishing strength of preference for different service attributes.

DESIGN

Online discrete choice experiment (DCE) questionnaire.

SETTING

South East of England.

PARTICIPANTS

A convenience sample of 233 students from two universities.

OUTCOMES

Adjusted ORs in relation to service characteristics.

RESULTS

The study yielded 233 responses. Respondents' ages ranged from 16 to 34 years with a mean age of 22 years. Among this sample, the respondents demonstrated strong preferences for a testing service which provided tests for all STIs including syphilis, herpes and HIV (OR 4.1; 95% CI 3.36 to 4.90) and centres staffed by a doctor or nurse with specialist knowledge of STIs (OR 2.1; 95% CI 1.78 to 2.37). Receiving all test results, whether positive or negative, was also significantly preferable to not being notified when tests were all negative ('no news is good news'; OR 1.3; 95% CI 1.16 to 1.5). The length of time waiting for an appointment and the method by which results are received were not significant service characteristics in terms of preferences. Patient level characteristics such as age, sex and previous testing experience did not predict the likelihood of testing.

CONCLUSIONS

This study demonstrates that of the examined attributes, university students expressed the strongest preference for a comprehensive testing service. The next strongest preferences were for being tested by specialist STI staff and receiving negative as well as positive test results. However, it remains unclear how strong these preferences are in relation to characteristics which were not part of the study design and whether or not they are cost-effective.

Effects of external intermittency and mean shear on the spectral inertial-range exponent in a turbulent square jet

This study investigates by experiment the dependence of the inertial-range exponent m of the streamwise velocity spectrum on the external intermittency factor γ (≡ the fraction of time the flow is fully turbulent) and the mean shear S in a turbulent square jet. Velocity measurements were made using hot-wire anemometry in the jet at 15 < x/D(e) < 40, where D(e) denotes the exit equivalent diameter, and for an exit Reynolds number of Re = 50,000. The Taylor microscale Reynolds number R(λ) varies from about 70 to 450 in the present study. The TERA (turbulent energy recognition algorithm) method proposed by Falco and Gendrich [in Near-Wall Turbulence: 1988 Zoran Zariç Memorial Conference, edited by S. J. Kline and N. H. Afgan (Hemisphere Publishing Corp., Washington, DC, 1990), pp. 911-931] is discussed and applied to estimate the intermittency factor from velocity signals. It is shown that m depends strongly on γ but negligibly on S. More specifically, m varies with γ following m=m(t)+(lnγ(-0.0173))(1/2), where m(t) denotes the spectral exponent found in fully turbulent regions.

Assessing user preferences for sexually transmitted infection testing services: a discrete choice experiment

OBJECTIVE

To assess user preferences for different aspects of sexually transmitted infection (STI) testing services.

DESIGN

A discrete choice experiment.

SETTING

14 centres offering tests for STIs in East Sussex, England.

PARTICIPANTS

People testing for STIs.

MAIN OUTCOME MEASURE

(Adjusted) ORs in relation to preferred service characteristics.

RESULTS

3358 questionnaires were returned; mean age 26 (SD 9.4) years. 70% (2366) were recruited from genitourinary medicine (GUM) clinics. The analysis suggested that the most important characteristics to users were whether 'staff had specialist STI knowledge' compared with 'staff without it' (OR 2.55; 95% CI 2.47 to 2.63) and whether 'tests for all STIs' were offered rather than 'some' (OR 2.19; 95% CI 2.12 to 2.25). They remained the most important two service characteristics despite stratifying the analysis by variables such as age and sex. Staff levels of expertise were viewed as particularly important by people attending CASH centres, women and non-men who have sex with men. A 'text or call to a mobile phone' and 'dropping in and waiting' were generally the preferred methods of results reporting and appointment system, respectively.

CONCLUSIONS

This study suggests that people testing for STIs place particular importance on testing for all infections rather than some and staff with specialist STI knowledge. Thus, targets based purely on waiting up to 48 h for an appointment are misguided from a user perspective.

Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study

Objectives

To establish which aspects of sexually transmitted infection (STI) testing services are important to STI testing service users.

Methods

10 focus groups consisting of previous or existing users of STI testing services were conducted in community settings in the south east of England. Groups were quota sampled based on age, gender and sexual orientation. Data were analysed using Framework Analysis.

Results

65 respondents (58% men) participated. Perceived expertise of staff was the key reason for attendance at genitourinary medicine services rather than general practice. Although some respondents voiced a willingness to test for STIs within general practice, the apparent limited range of tests available in general practice and the perceived lack of expertise around sexual health appeared to discourage attendance at general practice. The decision of where to test for STIs was also influenced by past experience of testing, existing relationships with general practice, method of receiving test results and whether the patient had other medical conditions such as HIV.

Conclusions

No one type of STI testing service is suitable for all patients. This is recognised by policymakers, and it now requires commissioners and providers to make services outside of genitourinary medicine clinics more acceptable and attractive to patients, in particular to address the perceived lack of expertise and limited range of STIs tests available at alternative testing sites.

Abstract PD08-10: Breast Cancer Survivors Healthy Lifestyle Study: A Randomised Controlled Pilot To Test the Effects of a Behavioural Intervention (Information and Advice) on Uptake of Physical Activity in Breast Cancer Survivors

Background: Physical activity (PA) is a potentially modifiable behavioural risk factor for breast cancer recurrence. It declines during treatment, and most breast cancer survivors do not engage in PA at recommended levels. Effective interventions to increase PA after primary treatment for early stage breast cancer are needed.

Materials and Methods: Between November 2008 and January 2010, women who had completed primary treatment for early stage breast cancer, and not currently meeting PA guidelines, were randomly assigned to one of three conditions; 1) control group (UC) received a self-care fact sheet, or an intervention group 2) which received a theory based information booklet, diary and pedometer (INFO), or an alternate intervention group 3) which also received theory based information, diary and pedometer combined with a behavioural planning intervention (INFO+BPI). Measures (self reported PA, six minute walk test, mood, and quality of life) were collected at baseline (T1) and at 12 weeks (T2). The primary endpoint was self reported minutes of moderate to strenuous PA per week, secondary endpoints included mood and quality of life. A linear mixed models analysis approach was used to analyse data.

Results: 118 women were randomized and 107 completed T2 measures. The average age of participants was 54.6 years (Range 32-74), 31.8% had stage I disease, 38.3% had stage II disease, 15% had stage IIIa disease and 15% had DCIS, 58% had received adjuvant chemotherapy. Motivation (intention) to increase PA did not differ between groups at T1. There were no differences between groups in PA at T1. PA levels increased in all groups between T1 and T2 (P&lt;0.0001), but PA in the two intervention groups increased significantly more than in controls (+113.9 and +139.9 min per week increase in INFO and INFO + BPI respectively compared to +61.3 min per week in UC), such that at T2, there was a statistically significant difference between the intervention groups versus controls with +65 min per week increase on average (95% CI 25.3 to 104.8, p=0.02). There was no significant difference between the two intervention groups, with +25.9 min difference on average (95% CI -73.4 to 21.6, p=0.25). There were no significant differences in quality of life, anxiety or depression between groups at T1. No adverse events were reported.

Discussion: Minimally intensive, theory-based interventions increased PA participation over a 12 week period in this single centre study. The addition of a behavioural planning intervention to the INFO intervention did not significantly improve PA participation. Results of a T3, 12 month, follow up will be important in determining sustainability of the behaviour change following these interventions. A larger multicentre study is warranted to confirm the efficacy of the intervention.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-10.

Are home sampling kits for sexually transmitted infections acceptable among men who have sex with men?

Objective:

There is an urgent need to increase opportunistic screening for sexually transmitted infections (STIs) in community settings, particularly for those who are at increased risk including men who have sex with men (MSM). The aim of this qualitative study was to explore whether home sampling kits (HSK) for multiple bacterial STIs are potentially acceptable among MSM and to identify any concerns regarding their use. This study was developed as part of a formative evaluation of HSKs.

Methods:

Focus groups and one-to-one semi-structured interviews with MSM were conducted. Focus group participants (n = 20) were shown a variety of self-sampling materials and asked to discuss them. Individual interviewees (n = 24) had experience of the self-sampling techniques as part of a pilot clinical study. All data were digitally recorded and transcribed verbatim. Data were analysed using a framework analysis approach.

Results:

The concept of a HSK was generally viewed as positive, with many benefits identified relating to increased access to testing, enhanced personal comfort and empowerment. Concerns about the accuracy of the test, delays in receiving the results, the possible lack of support and potential negative impact on ‘others’ were raised.

Conclusion:

The widespread acceptability of using HSKs for the diagnosis of STIs could have important public health impacts in terms of earlier diagnosis of asymptomatic infections and thus a decrease in the rate of onward transmission. In addition, HSKs could potentially optimize the use of genitourinary medicine services and facilitate patient choice.

Automated PCR setup for forensic casework samples using the Normalization Wizard and PCR Setup robotic methods

Human genome, pharmaceutical and research laboratories have long enjoyed the application of robotics to performing repetitive laboratory tasks. However, the utilization of robotics in forensic laboratories for processing casework samples is relatively new and poses particular challenges. Since the quantity and quality (a mixture versus a single source sample, the level of degradation, the presence of PCR inhibitors) of the DNA contained within a casework sample is unknown, particular attention must be paid to procedural susceptibility to contamination, as well as DNA yield, especially as it pertains to samples with little biological material. The Virginia Department of Forensic Science (VDFS) has successfully automated forensic casework DNA extraction utilizing the DNA IQ(trade mark) System in conjunction with the Biomek 2000 Automation Workstation. Human DNA quantitation is also performed in a near complete automated fashion utilizing the AluQuant Human DNA Quantitation System and the Biomek 2000 Automation Workstation. Recently, the PCR setup for casework samples has been automated, employing the Biomek 2000 Automation Workstation and Normalization Wizard, Genetic Identity version, which utilizes the quantitation data, imported into the software, to create a customized automated method for DNA dilution, unique to that plate of DNA samples. The PCR Setup software method, used in conjunction with the Normalization Wizard method and written for the Biomek 2000, functions to mix the diluted DNA samples, transfer the PCR master mix, and transfer the diluted DNA samples to PCR amplification tubes. Once the process is complete, the DNA extracts, still on the deck of the robot in PCR amplification strip tubes, are transferred to pre-labeled 1.5 mL tubes for long-term storage using an automated method. The automation of these steps in the process of forensic DNA casework analysis has been accomplished by performing extensive optimization, validation and testing of the software methods.

Effect of Formulation and Manufacturing Parameters on Process Cheese Food Functionality—I. Trisodium Citrate

The objective of this research was to use a Rapid Visco Analyzer to study the effect of natural cheese age, trisodium citrate (TSC) concentration, and mixing speed on process cheese food (PCF) functionality. In this study 3 replicates of natural cheese were manufactured, and a portion of each cheese was subjected to 6 different PCF manufacturing treatments at 2, 4, 6, 12, and 18 wk of ripening. These treatments were factorial combinations of 3 levels of TSC (i.e., 2.0, 2.5, and 3.0%) and 2 mixing speeds during manufacture (450 and 1,050 rpm). Functional properties of the PCF evaluated included manufacturing properties [apparent viscosity after manufacture (VAM)], unmelted textural properties (firmness), melted cheese flow properties [hot apparent viscosity (HAV)], and cheese thickening during cooling [time at 5000 cP (T5)]. All 4 parameters (VAM, firmness, HAV, and T5) were significantly affected by natural cheese age and mixing speed, whereas VAM, HAV, and T5 were also significantly influenced by the amount of TSC. The VAM and firmness decreased as cheese age increased, whereas T5 values increased as cheese age increased. Similarly, VAM, HAV, and firmness values increased because of the increased mixing speed, whereas T5 values decreased. The age x mixing speed interaction was significant for VAM and firmness. The age x concentration of the TSC interaction term was significant for VAM, whereas the age x age x TSC concentration term was significant for HAV. The results demonstrate that natural cheese age, mixing speed during manufacture, and concentration of TSC have a significant impact on process cheese functionality.