1
|
Walden J, Stanek JR, Ebersole AM, Nahata L, Creary SE. Sexually transmitted infection testing and diagnosis in adolescents and young adults with sickle cell disease. Pediatr Blood Cancer 2024:e31240. [PMID: 39099153 DOI: 10.1002/pbc.31240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common and disproportionately affect Black adolescents and young adults (AYAs). Less is known about STIs among Black AYAs with chronic conditions, such as sickle cell disease (AYAs-SCD). This study compared STI testing and diagnosis between AYAs-SCD and their peers, overall and among STI-related encounters. PROCEDURE This retrospective, cross-sectional study used diagnosis and billing codes in the Pediatric Health Information System (PHIS) to identify inpatient and emergency department encounters from January 1, 2022 to May 31, 2023 among all AYAs 15-24 years and those with STI-related diagnoses (e.g., "cystitis"). STI testing and diagnosis rates were compared between AYAs-SCD, non-Black AYAs, and Black AYAs, controlling for age, sex, and encounter setting. RESULTS We identified 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs. AYAs-SCD were less likely to be tested for STIs than non-Black AYAs (odds ratio [OR] = 0.26; adj. p < .001) and Black AYAs (OR = 0.53; adj. p < .001). When tested, AYAs-SCD were more likely to be diagnosed with an STI than non-Black AYAs (OR = 2.39; adj. p = .006) and as likely as Black AYAs (OR = 0.67; adj. p = .15). Among STI-related encounters, AYAs-SCD were less likely to be tested than non-Black AYAs (OR = 0.18; adj. p < .001) and Black AYAs (OR = 0.44; adj. p < .001). No significant differences in STI diagnoses were found in this subset between AYAs-SCD and non-Black AYAs (OR = 0.32; adj. p = .28) or Black AYAs (OR = 1.07; adj. p = .99). CONCLUSIONS STI care gaps may disproportionately affect AYAs-SCD. STIs should be considered when evaluating symptomatic AYAs-SCD in acute settings. More research is needed to further contextualize STI care for AYAs-SCD.
Collapse
Affiliation(s)
- Joseph Walden
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ashley M Ebersole
- Division of Adolescent Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- Abigail Wexner Research Institute, Center for Biobehavioral Health, Columbus, Ohio, USA
- Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan E Creary
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
2
|
Strehlow M, Alvarez A, Blomkalns AL, Caretta-Wyer H, Gharahbaghian L, Imler D, Khan A, Lee M, Lobo V, Newberry JA, Riberia R, Sebok-Syer S, Shen S, Gisondi MA. Precision emergency medicine. Acad Emerg Med 2024. [PMID: 38940478 DOI: 10.1111/acem.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/13/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop personalized health solutions. To date, emergency medicine has not deeply engaged in the precision health movement. However, rapid advances in health technology, data science, and medical informatics offer new opportunities for emergency medicine to realize the promises of precision health. METHODS In this article, we conceptualize precision emergency medicine as an emerging paradigm and identify key drivers of its implementation into current and future clinical practice. We acknowledge important obstacles to the specialty-wide adoption of precision emergency medicine and offer solutions that conceive a successful path forward. RESULTS Precision emergency medicine is defined as the use of information and technology to deliver acute care effectively, efficiently, and authentically to individual patients and their communities. Key drivers and opportunities include leveraging human data, capitalizing on technology and digital tools, providing deliberate access to care, advancing population health, and reimagining provider education and roles. Overcoming challenges in equity, privacy, and cost is essential for success. We close with a call to action to proactively incorporate precision health into the clinical practice of emergency medicine, the training of future emergency physicians, and the research agenda of the specialty. CONCLUSIONS Precision emergency medicine leverages new technology and data-driven artificial intelligence to advance diagnostic testing, individualize patient care plans and therapeutics, and strategically refine the convergence of the health system and the community.
Collapse
Affiliation(s)
- Matthew Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andra L Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Holly Caretta-Wyer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Laleh Gharahbaghian
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Imler
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ayesha Khan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Moon Lee
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Viveta Lobo
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ryan Riberia
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stefanie Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sam Shen
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
3
|
Rodrigues R, Vieira-Baptista P, Catalão C, Borrego MJ, Sousa C, Vale N. Chlamydial and Gonococcal Genital Infections: A Narrative Review. J Pers Med 2023; 13:1170. [PMID: 37511783 PMCID: PMC10381338 DOI: 10.3390/jpm13071170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Sexually transmitted infections (STIs) constitute one of the leading causes of disease burden worldwide, leading to considerable morbidity, mortality, health expenditures, and stigma. Of note are the most common bacterial STIs, chlamydial and gonococcal infections, whose etiological agents are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. Despite being usually asymptomatic, in some cases these infections can be associated with long-term severe complications, such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of other STIs acquisition. As the symptoms, when present, are usually similar in both infections, and in most of the cases these infections co-occur, the dual-test strategy, searching for both pathogens, should be preferred. In line with this, herein we focus on the main aspects of CT and NG infections, the clinical symptoms as well as the appropriate state-of-the-art diagnostic tests and treatment. Cost-effective strategies for controlling CT and NG infections worldwide are addressed. The treatment for both infections is based on antibiotics. However, the continuing global rise in the incidence of these infections, concomitantly with the increased risk of antibiotics resistance, leads to difficulties in their control, particularly in the case of NG infections. We also discuss the potential mechanism of tumorigenesis related to CT infections. The molecular bases of CT and NG infections are addressed, as they should provide clues for control or eradication, through the development of new drugs and/or effective vaccines against these pathogens.
Collapse
Affiliation(s)
- Rafaela Rodrigues
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Pedro Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Catalão
- Roche Sistemas de Diagnósticos, Estrada Nacional, 2720-413 Amadora, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
| | - Carlos Sousa
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| |
Collapse
|
4
|
Ahmad FA, Fischer K, Gu H, Bailey TC, Jeffe DB, Carpenter CR, Payne PRO. Impact of risk-based sexually transmitted infection screening in the emergency department. Acad Emerg Med 2022; 29:879-889. [PMID: 35184344 PMCID: PMC10648282 DOI: 10.1111/acem.14465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and human immunodeficiency virus (HIV) pose a significant health burden in adolescents. Many adolescents receiving care in the emergency department (ED) are in need of testing, regardless of their chief complaint. Our objective was to determine whether an electronic, risk-based STI screening program in our ED was associated with an increase in STI testing among at-risk adolescents. METHODS We conducted a retrospective cohort analysis of patient outcomes in our pediatric ED after integrating an Audio-enhanced Computer-Assisted Self-Interview (ACASI) as standard of care. It obtained a focused sexual history and generated STI testing recommendations. Patient answers and testing recommendations were integrated in real-time into the electronic health record. Patients who tested positive received treatment according to our standard-of-care practices. All patients 15-21 years of age were asked to complete this on an opt-out basis, regardless of the reason for their ED visit. Exclusions included those unable to independently use a tablet, severe illness, sexual assault, or non-English speaking. Our primary outcome was to describe STI-testing recommendations and test results among ACASI participants. We also compared STI testing between ACASI participants and those who were eligible but did not use it. RESULTS In the first 13 months, 28.9% (1788/6194) of eligible adolescents completed the ACASI and 44.2% (321/790) accepted recommended STI testing. The mean age of participants was 16.6 ± 1.3 years, with 65.4% (1169) being female. Gonorrhea/chlamydia testing was significantly higher among participants vs. non-participants (20.1% [359/1788] vs 4.8% [212/4406]; p < 0.0001). The proportion of positive STI tests was similar between the two groups: 24.8% (89/359) vs. 24.5% (52/212; p = 0.94) were positive for chlamydia and/or gonorrhea, while 0.6% (2/354) participants vs. 0% non-participants (p > 0.99) were positive for HIV. Among participants whose chief complaints were unlikely to be related to STIs but accepted recommended testing, 20.9% (37/177) were positive for gonorrhea or chlamydia. CONCLUSIONS Our program facilitated STI testing in the ED and identified many adolescents with STIs, even when their ED complaint was for unrelated reasons. More rigorous implementation is needed to determine the impact of deployment of ACASI to all eligible adolescents and addressing barriers to accepting STI testing recommendations.
Collapse
Affiliation(s)
- Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kayleigh Fischer
- Department of Emergency Medicine, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas, USA
| | - Hongjie Gu
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Thomas C Bailey
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
5
|
Pickel J, Singapur A, Min J, Petsis D, Campbell K, Wood S. Variability in Sexual History Documentation in a Primary Care Electronic Health Record System. J Adolesc Health 2022; 70:435-441. [PMID: 34887198 PMCID: PMC8860853 DOI: 10.1016/j.jadohealth.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to evaluate sexual history documentation and corresponding Chlamydia trachomatis screening practices across a large pediatric primary care network in the context of patient and clinic characteristics. METHODS Demographic, chlamydia screening, and provider note data were collected via electronic health record and manual chart audit for females aged 15-19 years attending annual well-adolescent visits, from February 1 to 28, 2019. Inductive qualitative textual analysis evaluated sexual history documentation as informative (containing clear indication of patient as sexually active or not) or noninformative and identified documentation subtypes. We examined patient and clinic characteristics by sexual history documentation type (informative or noninformative) and chlamydia screening status and documentation subtypes across clinic types using chi-square and Fisher's exact tests. A multilevel logistic regression model considering clinic-specific random effects evaluated predictors of informative sexual history documentation. RESULTS Chart notes were examined for 1,062 patients across 31 unique clinics. Only 34.7% of chart notes were found to have informative sexual history documentation. Older patients (odds ratio: 1.51, 95% confidence interval: 0.99-2.31) and patients seen at clinics receiving U.S. Department of Health and Human Services Title-X funding (odds ratio: 11.05, 95% confidence interval: 1.34-90.86) had higher rates of informative documentation. The overall Chlamydia screening rate was 13.1%. CONCLUSION Sexual history documentation varied widely across clinics, and the majority of chart notes were found to have noninformative documentation. Understanding and addressing barriers to informative sexual history documentation and comprehensive sexual health care is fundamental to improve adolescent sexual health outcomes, particularly given recently enacted federal electronic health record transparency policies.
Collapse
Affiliation(s)
- Julia Pickel
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A,Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, 3550 Market St., Philadelphia, PA 19104, U.S.A,Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, U.S.A
| | - Anjali Singapur
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A
| | - Danielle Petsis
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, U.S.A,Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, 3550 Market St., Philadelphia, PA 19104, U.S.A
| | - Kenisha Campbell
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, 3550 Market St., Philadelphia, PA 19104, U.S.A,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civid Center Blvd, Philadelphia, PA, 19104, U.S.A
| | - Sarah Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
6
|
Affiliation(s)
- Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois
| | - Maggie W Collison
- Division of Infectious Disease, NorthShore University HealthSystem, Evanston, Illinois
| | - Andrew M Davis
- Section of General Internal Medicine, University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
7
|
Magee LA, Aalsma MC. Youth Involved in the Justice System: Emergency Department Screening and Health Promotion. J Pediatr 2021; 236:11-12. [PMID: 34033849 DOI: 10.1016/j.jpeds.2021.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|
8
|
A Clinic-Based Quality Improvement Initiative to Increase Screening for Gonorrhea and Chlamydia in Adolescents. Jt Comm J Qual Patient Saf 2021; 47:510-518. [PMID: 34074609 DOI: 10.1016/j.jcjq.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Universal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old. METHODS At an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims. RESULTS The mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims. CONCLUSION This QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.
Collapse
|
9
|
Chesson HW, Spicknall IH, Bingham A, Brisson M, Eppink ST, Farnham PG, Kreisel KM, Kumar S, Laprise JF, Peterman TA, Roberts H, Gift TL. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis 2021; 48:215-221. [PMID: 33492093 PMCID: PMC10684254 DOI: 10.1097/olq.0000000000001380] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We estimated the lifetime medical costs attributable to sexually transmitted infections (STIs) acquired in 2018, including sexually acquired human immunodeficiency virus (HIV). METHODS We estimated the lifetime medical costs of infections acquired in 2018 in the United States for 8 STIs: chlamydia, gonorrhea, trichomoniasis, syphilis, genital herpes, human papillomavirus (HPV), hepatitis B, and HIV. We limited our analysis to lifetime medical costs incurred for treatment of STIs and for treatment of related sequelae; we did not include other costs, such as STI prevention. For each STI, except HPV, we calculated the lifetime medical cost by multiplying the estimated number of incident infections in 2018 by the estimated lifetime cost per infection. For HPV, we calculated the lifetime cost based on the projected lifetime incidence of health outcomes attributed to HPV infections acquired in 2018. Future costs were discounted at 3% annually. RESULTS Incident STIs in 2018 imposed an estimated $15.9 billion (25th-75th percentile: $14.9-16.9 billion) in discounted, lifetime direct medical costs (2019 US dollars). Most of this cost was due to sexually acquired HIV ($13.7 billion) and HPV ($0.8 billion). STIs in women accounted for about one fourth of the cost of incident STIs when including HIV, but about three fourths when excluding HIV. STIs among 15- to 24-year-olds accounted for $4.2 billion (26%) of the cost of incident STIs. CONCLUSIONS Incident STIs continue to impose a considerable lifetime medical cost burden in the United States. These results can inform health economic analyses to promote the use of cost-effective STI prevention interventions to reduce this burden.
Collapse
Affiliation(s)
| | | | - Adrienna Bingham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Paul G Farnham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Henry Roberts
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | |
Collapse
|