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Haag M, Zemp E, Hersberger KE, Arnet I. Who Is Best to Test? A Systematic Review of Chlamydia Infections in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249389. [PMID: 33333868 PMCID: PMC7765330 DOI: 10.3390/ijerph17249389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Abstract
In many countries, community pharmacies provide sexual-health-related services to limit the spread of sexually transmitted infections (STIs), including chlamydia testing. To identify suitable target groups for pharmacy-based chlamydia testing in Switzerland, we aimed to assess chlamydia prevalence, identify risk groups, and delineate screening strategies. We conducted a systematic literature search up to December 2019 in PubMed, EMBASE, and Web of Science, according to the PRISMA guidelines, using as keywords “chlamydia”, “screening”, and “Switzerland”. Two researchers screened the title, abstract, and full-text article and assessed the methodological quality. The literature search generated 108 hits, and nine studies were included. Chlamydia prevalence ranged between 0.8 and 12.8%. Most frequently affected were undocumented women undergoing voluntary termination of pregnancy (12.8%, 95% CI: 8.4–18.9), HIV-positive men who have sex with men (10.9%, 95% CI: 9.2–17.6), and adult offenders (6.5%, 95% CI: 3.2–9.0). Systematic screening was suggested for the first two risk groups and women suffering a miscarriage. To conclude, chlamydia infections are prevalent in Switzerland, but the identified risk groups are difficult to reach for a pharmacy-based testing service. More studies are needed to identify suitable target groups, including customers seeking sexual health services, particularly emergency contraception users who already receive counselling for STIs at community pharmacies.
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Affiliation(s)
- Melanie Haag
- Pharmaceutical Care Research Group, University of Basel, 4001 Basel, Switzerland; (K.E.H.); (I.A.)
- Correspondence: ; Tel.: +41-612071519
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Kurt E. Hersberger
- Pharmaceutical Care Research Group, University of Basel, 4001 Basel, Switzerland; (K.E.H.); (I.A.)
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, University of Basel, 4001 Basel, Switzerland; (K.E.H.); (I.A.)
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Haag M, Gudka S, Hersberger KE, Arnet I. Do Swiss community pharmacists address the risk of sexually transmitted infections during a consultation on emergency contraception? A simulated patient study. EUR J CONTRACEP REPR 2019; 24:407-412. [PMID: 31526080 DOI: 10.1080/13625187.2019.1661377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Since 2002, Swiss community pharmacists have dispensed emergency contraception (EC) as pharmacist-only medicine ideally using the official Swiss protocol. Our study aimed to determine pharmacists' resolution of an imaginary EC case, compliance with the protocol, and provision of information on the risk of sexually transmitted infections (STIs). Methods: We conducted a simulated patient study with 69 students who each visited a community pharmacy. The scenario started with the student requesting the 'morning after pill'. Current practice was assessed using an online evaluation form adapted from the Medication-Related Consultation Framework. Descriptive and statistical analyses were carried out. Results: All pharmacists correctly identified that the person needed EC. All pharmacists used an EC protocol and asked on average 10.9 (standard deviation 0.68) of 11 compulsory EC assessment questions. In total, 93% of pharmacists addressed EC counselling items and 56% addressed the risk of STIs, mainly by mentioning that condoms offered the best protection (76%). Conclusions: Community pharmacists correctly issued the EC, complied with the dispensing protocol and used their professional judgement to ensure optimal EC use. There is nevertheless room for improvement regarding pharmacists' STI counselling. Finally, the protocol's STI section could be enriched with specific information to guide counselling.
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Affiliation(s)
- Melanie Haag
- Pharmaceutical Care Research Group, University of Basel , Basel , Switzerland
| | - Sajni Gudka
- School of Population and Global Health, University of Western Australia , Perth , Australia
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel , Basel , Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, University of Basel , Basel , Switzerland
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Habel MA, Scheinmann R, Verdesoto E, Gaydos C, Bertisch M, Chiasson MA. Exploring pharmacy and home-based sexually transmissible infection testing. Sex Health 2015; 12:472-9. [PMID: 26409484 PMCID: PMC4809773 DOI: 10.1071/sh15031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/22/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background This study assessed the feasibility and acceptability of pharmacy and home-based sexually transmissible infection (STI) screening as alternate testing venues among emergency contraception (EC) users. METHODS The study included two phases in February 2011-July 2012. In Phase I, customers purchasing EC from eight pharmacies in Manhattan received vouchers for free STI testing at onsite medical clinics. In Phase II, three Facebook ads targeted EC users to connect them with free home-based STI test kits ordered online. Participants completed a self-administered survey. RESULTS Only 38 participants enrolled in Phase I: 90% female, ≤29 years (74%), 45% White non-Hispanic and 75% college graduates; 71% were not tested for STIs in the past year and 68% reported a new partner in the past 3 months. None tested positive for STIs. In Phase II, ads led to >45000 click-throughs, 382 completed the survey and 290 requested kits; 28% were returned. Phase II participants were younger and less educated than Phase I participants; six tested positive for STIs. Challenges included recruitment, pharmacy staff participation, advertising with discretion and cost. CONCLUSIONS This study found low uptake of pharmacy and home-based testing among EC users; however, STI testing in these settings is feasible and the acceptability findings indicate an appeal among younger women for testing in non-traditional settings. Collaborating with and training pharmacy and medical staff are key elements of service provision. Future research should explore how different permutations of expanding screening in non-traditional settings could improve testing uptake and detect additional STI cases.
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Affiliation(s)
- Melissa A. Habel
- Centers For Disease Control and Prevention, 1600 Clifton Road, Mailstop E-44, Atlanta, GA, USA
| | | | | | - Charlotte Gaydos
- Johns Hopkins University School of Medicine, 855 Wolfe Street, 530 Rangos Building, Baltimore, MD, USA
| | - Maggie Bertisch
- New York Walk-In Medical Group, 1627 Broadway, New York, NY, USA
| | - Mary Ann Chiasson
- Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA
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Gudka S, Misaghian J, Clifford RM. Future Pharmacy-Based Chlamydia Screening: Consumer Preference. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2013. [DOI: 10.1002/j.2055-2335.2013.tb00208.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Rhonda M Clifford
- School of Medicine and Pharmacology; The University of Western Australia; Crawley Western Australia
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Habel MA, Leichliter JS. Emergency contraception and risk for sexually transmitted infections among U.S. women. J Womens Health (Larchmt) 2012; 21:910-6. [PMID: 22731690 PMCID: PMC6737533 DOI: 10.1089/jwh.2011.3441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since Food and Drug Administration (FDA) licensure of emergency contraception (EC) over-the-counter (OTC) in 2006, this is the first U.S. study to use a nationally representative sample of reproductive-aged women (15-44) to explore the relationship between receipt and use of EC and sexually transmitted infection (STI)-related health services. METHODS Using a sample of 6329 women from the National Survey of Family Growth 2006-2008, we examined the relationship between lifetime EC use and recent receipt of EC and demographics, sexual behaviors, and STI-related services. Variables significant at p<0.10 in bivariate analyses were examined using multivariable logistic regression models. RESULTS Overall, 10% (704) of the sample had ever used EC. Most EC users had received EC from a family planning clinic (51%), drugstore (23%), or doctor's office (17%). In adjusted analyses, demographic factors associated with receipt of EC in the past 12 months included never married (adjusted odds ratio [AOR] 4.0) and living in a metropolitan statistical area (AOR 4.2). Women reporting multiple partners (2+) (AOR 2.4), inconsistent condom use (AOR 3.4), and having recently been tested for chlamydia (AOR 2.0) had higher odds of receiving EC in the past 12 months. Findings among women ever reporting EC use were similar, except women who had 4+ lifetime partners (AOR 2.5) and had recently received a chlamydia diagnosis (AOR 2.2) had higher odds of ever having used EC. CONCLUSIONS EC recipients were no more likely than nonrecipients to have received STI counseling or screening despite greater numbers of sex partners in the past year. This research indicates that women are accessing EC in pharmacies, which may be a missed opportunity for counseling and testing.
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Affiliation(s)
- Melissa A Habel
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Garley J, MacNamara V, Moses S, Oloto E. Thinking outside the box: meeting the sexual health needs of women presenting for emergency contraception. Int J STD AIDS 2012; 23:e9-10. [PMID: 22807553 DOI: 10.1258/ijsa.2009.009319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This was a retrospective audit of sexual health screening and advice for long-term contraception in 174 and 993 women attending genitourinary (GU) medicine and contraceptive services (CS), respectively, for emergency hormonal contraception (EHC) over a 21-month period (April 2007-September 2008). Assessment and screening for sexually transmitted infection (including HIV) were more comprehensive at GU medicine (78% offered screening at GU medicine versus 17% at CS) while contraceptive management was more complete at CS (ongoing contraception discussed in 99% at CS versus 78% at GU medicine). Follow-up was seldom recommended or attended. Local HIV prevalence necessitates a more pro-active approach to HIV testing. Women requesting EHC present to a variety of clinical settings, each with their own areas of expertise. In an age of integrated sexual and reproductive health, these women deserve a holistic approach to care.
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Affiliation(s)
- J Garley
- Department of Genito-Urinary Medicine, University Hospitals of Leicester, NHS Trusts, Leicester, UK.
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Watts LA, Thiel de Bocanegra H, Darney PD, Hulett D, Howell M, Mikanda J, Zerne R, Policar MS. In A California Program, Quality And Utilization Reports On Reproductive Health Services Spurred Providers To Change. Health Aff (Millwood) 2012; 31:852-62. [DOI: 10.1377/hlthaff.2011.1332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Leslie A. Watts
- Leslie A. Watts is an analyst at the Bixby Center for Global Reproductive Health at the University of California, San Francisco (UCSF) working on the statewide Family Planning, Access, Care, and Treatment (PACT) evaluation
| | - Heike Thiel de Bocanegra
- Heike Thiel de Bocanegra is an assistant professor at the Bixby Center and director of the UCSF evaluation of Family PACT
| | - Philip D. Darney
- Philip D. Darney is a Distinguished Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF. He is director of the Bixby Center
| | - Denis Hulett
- Denis Hulett is a programmer analyst with the California Medicaid Research Institute at UCSF
| | - Michael Howell
- Michael Howell is the data section manager of the UCSF evaluation of Family PACT
| | - John Mikanda
- John Mikanda is a state medical epidemiologist at the California Department of Public Health Office of Family Planning, in Sacramento
| | - Regina Zerne
- Regina Zerne is a health education consultant in the California Department of Public Health Office of Family Planning
| | - Michael S. Policar
- Michael S. Policar is a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF and medical director of the UCSF evaluation of Family PACT
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Sander PM, Raymond EG, Weaver MA. Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection. Am J Obstet Gynecol 2009; 201:146.e1-6. [PMID: 19646565 DOI: 10.1016/j.ajog.2009.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/03/2009] [Accepted: 05/12/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to examine whether emergency contraceptive use predicts future sex at risk for pregnancy, pregnancy, or sexually transmitted infection among young women. STUDY DESIGN A secondary analysis of control group participants (n = 718) from a recent trial of advanced provision of emergency contraception was conducted. RESULTS We found no association between use of emergency contraception and either pregnancy or infection. Recent use predicted decreased occurrence of subsequent sex at risk for pregnancy among women with a history of sexually transmitted infection (relative risk [RR], 0.39; 95% confidence interval [CI], 0.15-0.97), whereas ever having used predicted increased occurrence among women who either were highly effective method users (RR, 1.45; 95% CI, 1.05-2.01) or had no history of sexually transmitted infection (RR, 1.31; 95% CI, 1.04-1.65). CONCLUSION Information about prior emergency contraceptive use was not a useful predictor of subsequent pregnancy, infection, or sex at risk for pregnancy among these young women.
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Affiliation(s)
- Petra M Sander
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Brabin L, Thomas G, Hopkins M, O'Brien K, Roberts SA. Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study. BMC WOMENS HEALTH 2009; 9:7. [PMID: 19323804 PMCID: PMC2667404 DOI: 10.1186/1472-6874-9-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 03/26/2009] [Indexed: 12/03/2022]
Abstract
Background More women are requesting Emergency Hormonal Contraception (EHC) at pharmacies where screening for Chlamydia trachomatis is not routinely offered. The objective of this study was to assess the uptake of free postal chlamydia screening by women under 25 years who requested EHC at pharmacies in Manchester, UK. Methods Six Primary Care Trusts (PCTs) that had contracted with pharmacies to provide free EHC, requested the largest EHC providers (≥ 40 doses annually) to also offer these clients a coded chlamydia home testing kit. Pharmacies kept records of the ages and numbers of women who accepted or refused chlamydia kits. Women sent urine samples directly to the laboratory for testing and positive cases were notified. Audit data on EHC coverage was obtained from PCTs to assess the proportion of clients eligible for screening and to verify the uptake rate. Results 33 pharmacies participated. Audit data for 131 pharmacy months indicated that only 24.8% (675/2718) of women provided EHC were also offered chlamydia screening. Based on tracking forms provided by pharmacies for the whole of the study, 1348/2904 EHC clients (46.4%) who had been offered screening accepted a screening kit. 264 (17.6%) of those who accepted a kit returned a sample, of whom 24 (9.1%) were chlamydia-positive. There was an increase in chlamydia positivity with age (OR: 1.2 per year; 1.04 to 1.44; p = 0.015). Conclusion Chlamydia screening for EHC pharmacy clients is warranted but failure of pharmacists to target all EHC clients represented a missed opportunity for treating a well defined high-risk group.
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Affiliation(s)
- Loretta Brabin
- Academic Unit of Obstetrics & Gynaecology, University of Manchester, Manchester, M13 OJH, UK.
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Peremans L, Verhoeven V, Philips H, Denekens J, Van Royen P. How does a Belgian health care provider deal with a request for emergency contraception? EUR J CONTRACEP REPR 2008; 12:317-25. [PMID: 17853170 DOI: 10.1080/13625180701502377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate how Belgian health care providers deal with a request for emergency contraception. METHOD In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay. RESULTS All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents. CONCLUSION The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.
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Affiliation(s)
- Lieve Peremans
- University of Antwerp, Department of General Practice, Antwerp, Belgium.
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Geisler WM, James AB. Chlamydial and gonococcal infections in women seeking pregnancy testing at family-planning clinics. Am J Obstet Gynecol 2008; 198:502.e1-4. [PMID: 18295177 DOI: 10.1016/j.ajog.2007.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 09/12/2007] [Accepted: 11/08/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to assess genital chlamydia and gonorrhea prevalence and associated predictors in women seeking pregnancy testing. STUDY DESIGN The study included analysis of demographics and results of pregnancy, chlamydia, and gonorrhea testing in 1465 females seeking pregnancy testing at family-planning clinics in South Carolina. RESULTS The median age was 22 years (range 16-45), the race distribution consisted of 53% African Americans and 47% Caucasians, and 64% of subjects were pregnant. Chlamydia and gonorrhea were detected in 12% and 2% of subjects, respectively. Predictors of chlamydia and gonorrhea included younger age and African American race. Chlamydia and gonorrhea prevalence did not differ in pregnant vs nonpregnant subjects. CONCLUSION Chlamydia prevalence was high and gonorrhea prevalence low in women seeking pregnancy testing at family-planning clinics, and both were predicted by younger age and African American race but not pregnancy status. Because the majority seeking pregnancy testing were pregnant, chlamydia testing in this population at risk for chlamydia-associated morbidity has potential benefit.
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Bannister L, Macve J, Pinkey B, Webberley H. Is the faculty of family planning and reproductive health care guidance on emergency contraception being followed in general practice? An audit in the West Midlands, UK. ACTA ACUST UNITED AC 2008; 33:195-8. [PMID: 17609080 DOI: 10.1783/147118907781004787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND METHODOLOGY In 2003, the Faculty of Family Planning and Reproductive Health Care (FFPRHC) of the Royal College of Obstetricians and Gynaecologists published guidance on emergency contraception (EC). A literature search revealed no published work describing doctors' actions when prescribing EC. In order to assess the extent to which the FFPRHC Guidance is being followed in general practice, an audit of the medical notes of women requesting EC between January 2003 and December 2004 in six general practice surgeries located in the West Midlands, UK was conducted. From the medical notes, discussions between health care professionals and patients requesting EC regarding ongoing contraceptive needs, the risk of sexually transmitted infections (STIs) and the availability of the emergency intrauterine device (IUD) were recorded. RESULTS A total of 718 emergency contraceptive pill consultations were analysed. The median age for presentation was 24 years. The 20-24 years age group accounted for the most consultations (30.9%). In 40% of consultations there was no evidence of future contraceptive needs having been discussed. Only 20 (2.8%) consultation notes contained evidence that STIs had been discussed. Chlamydia tests were undertaken in only 15/718 (1.7%) consultations. In only 10 (1.4%) of the consultations was the IUD discussed with the patient as an alternative form of EC. DISCUSSION AND CONCLUSIONS This audit suggests that the FFPRHC Guidance on EC is not being followed in general practice, and therefore patients requesting EC may not be receiving the highest standard of care.
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Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care 2007; 16:303-7. [PMID: 17693680 PMCID: PMC2464947 DOI: 10.1136/qshc.2006.020883] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Chlamydia trachomatis infection is a common sexually transmitted infection with serious sequelae. Excellent access to testing, treatment and contact tracing are an essential part of strategies to control it. With traditional sexual health services over-stretched, community pharmacies are well placed to provide this service. They have the potential to improve access by offering chlamydia testing and treatment from high street venues with long opening hours. This study evaluated the feasibility and acceptability to users and pharmacists of this service in independent community pharmacies. METHOD A chlamydia testing and treatment service was offered in three community pharmacies in two inner London boroughs for a 3-month pilot. Data on the feasibility and acceptability of the new service were collected via a survey of client experience, in-depth semistructured interviews with clients and pharmacists, and structured evaluation reports completed by professional patients paid to visit the pharmacies. RESULTS 83 tests were taken with eight (9.5%) of these positive for C trachomatis. Of those tested, 94% (n = 73) were women and 71% (n = 56) were from ethnic minorities. 80 clients completed the questionnaires and 24 clients were interviewed. Most clients heard about the service from the pharmacist when requesting emergency contraception and 16% (n = 13) would not otherwise have been tested. Clients valued the speed and convenience of the service and the friendly, non-judgmental approach of the pharmacist. Confidentiality when asking for the service at the counter was suboptimal, and the pharmacist trained to deliver the service was not always available to provide it. CONCLUSIONS Chlamydia testing and treatment in community pharmacies is feasible and acceptable to users. The service increases access among young women at high risk of sexually transmitted infection but not among young men.
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Affiliation(s)
- P Baraitser
- Lambeth and Southwark Sexual Health Modernisation Programme, London, UK.
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Kachroo S. Misinformation about emergency contraception. Am J Health Syst Pharm 2007. [DOI: 10.2146/ajhp070116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Verhoeven V, Peremans L, Avonts D, Van Royen P. The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium. EUR J CONTRACEP REPR 2007; 11:175-80. [PMID: 17056447 DOI: 10.1080/13625180600766289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium. METHODS The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample. RESULTS Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI. DISCUSSION Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.
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Currie MJ, Bowden FJ. The importance of chlamydial infections in obstetrics and gynaecology: An update. Aust N Z J Obstet Gynaecol 2007; 47:2-8. [PMID: 17261092 DOI: 10.1111/j.1479-828x.2006.00670.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chlamydia is now the most common notifiable infectious disease in many countries, a fact that has serious ramifications for the reproductive health of women. This review highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined. Obstetricians and gynaecologists are ideally placed to play a major role in the primary prevention of this significant sexually transmitted infection.
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Affiliation(s)
- Marian J Currie
- Academic Unit of Internal Medicine, Australian National University, Australia.
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Sarkar NN. Emergency contraception: a contraceptive intervention approaching target despite controversy and opposition. J Public Health (Oxf) 2006. [DOI: 10.1007/s10389-006-0036-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33:36-51. [PMID: 16385221 DOI: 10.1097/01.olq.0000187908.42622.fd] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. OBJECTIVES The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. DESIGN We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. RESULTS Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). CONCLUSIONS Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.
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Affiliation(s)
- Lee Warner
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Abstract
The potential of mifepristone to be an emergency contraceptive is reviewed. Mifepristone prevents 92-100% of pregnancies with an acceptable side-effect profile on oral intake of a 10-600-mg dose within 72 h of unprotected intercourse. A single dose of 10 mg mifepristone resulted in a pregnancy rate of 1.5%, similar to a 1.5-mg single dose or two doses of 0.75 mg levonorgestrel 12 h apart, administered within 120 h (current standard) of unprotected sexual intercourse. Mifepristone and levonorgestrel do not differ in efficacy as emergency contraceptives. The mode of action of emergency contraception (EC) with mifepristone or levonorgestrel is primarily associated with inhibition of ovulation rather than prevention of implantation. Different doses of mifepristone appear to have similar effects. However, delay in the onset of subsequent menstruation caused by mifepristone is dose dependent and is reduced with a lower dose without affecting its efficacy. Patient acceptability of mifepristone as EC is high. However, the optimum standard dose of mifepristone is yet to be established for its application as an effective and acceptable emergency contraceptive drug for ordinary clinical use or practice.
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Affiliation(s)
- N N Sarkar
- Department of Reproductive Biology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Hamoda H, Ashok PW, Stalder C, Flett GMM, Kennedy E, Templeton A. A randomized trial of mifepristone (10 mg) and levonorgestrel for emergency contraception. Obstet Gynecol 2005; 104:1307-13. [PMID: 15572495 DOI: 10.1097/01.aog.0000146286.60138.47] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the efficacy, patient acceptability and adverse effects of low-dose mifepristone (10 mg) with the levonorgestrel regimen (2 doses of 750 microg given 12 hours apart) for emergency contraception. METHODS This randomized controlled trial compared mifepristone (10 mg) to levonorgestrel (2 doses of 750 microg given 12 hours apart) in the context of emergency contraception within 120 hours of unprotected intercourse. The primary outcome measure was unintended pregnancy. Secondary outcomes included adverse effects experienced by women, acceptability of the method of emergency contraception used, and the timing of the first menstrual cycle after treatment. RESULTS The total number of women recruited was 2,065. The crude pregnancy rates were 1.3% and 2.0% for mifepristone and levonorgestrel (P = .46), with 77% and 64% of expected pregnancies prevented, respectively. Women receiving mifepristone were more likely to have a delayed onset of the subsequent menstrual cycle after treatment (P < .001), whereas those having levonorgestrel were more likely to have an early onset of the subsequent menstrual cycle (P < .001). Acceptability levels were high for both methods, with 94% of women receiving mifepristone and 91% receiving levonorgestrel expressing satisfaction. There was no difference in adverse effects (nausea, vomiting, breast tenderness, abdominal pain, lethargy, headache, hot flushes, and dizziness) experienced by women in the 2 groups. CONCLUSION This study suggests that a small dose of mifepristone is not less effective than levonorgestrel for emergency contraception. Both regimens were highly acceptable to women.
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Affiliation(s)
- H Hamoda
- Department of Obstetrics and Gynaecology, University of Aberdeen, United Kingdom.
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Aneblom G, Lundborg CS, Carlsten A, Eurenius K, Tydén T. Emergency contraceptive pills over-the-counter: practices and attitudes of pharmacy and nurse-midwife providers. PATIENT EDUCATION AND COUNSELING 2004; 55:129-135. [PMID: 15477000 DOI: 10.1016/j.pec.2003.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2003] [Revised: 07/30/2003] [Accepted: 08/12/2003] [Indexed: 05/24/2023]
Abstract
Deregulation of emergency contraceptive pills (ECP) has led to pharmacy staff becoming a new provider group of ECP, together with nurse-midwives, who are already experienced in prescribing contraceptives. This postal questionnaire survey aimed to assess practices and attitudes towards ECP and the over-the-counter (OTC)-availability among pharmacy staff (n=237) and nurse-midwives (n=163). The overall response rate was 89%. Both study groups were positive to ECP and the OTC-availability and the vast majority agreed that sexually active women should be aware of ECP and that routine information about ECP should be included in contraceptive counseling. Verbal information on all aspects of ECP to clients was reported more often by nurse-midwives than by pharmacy staff. Both groups supported collaboration between providers. Our findings suggest that further collaboration between pharmacies and family planning clinics should be encouraged to ensure a competent and client-friendly provision of ECP.
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Affiliation(s)
- Gunilla Aneblom
- Department of Women's and Children's Health, Uppsala University, S-751 85 Uppsala, Sweden.
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Glasier A, Fairhurst K, Wyke S, Ziebland S, Seaman P, Walker J, Lakha F. Advanced provision of emergency contraception does not reduce abortion rates. Contraception 2004; 69:361-6. [PMID: 15105057 DOI: 10.1016/j.contraception.2004.01.002] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 01/05/2004] [Accepted: 01/07/2004] [Indexed: 10/26/2022]
Abstract
A number of small studies have demonstrated increased use of emergency contraception (EC) when women have a supply available at home. It has been suggested that widespread use of EC could reduce abortion rates. We undertook a community intervention study designed to determine whether offering advanced supplies of EC to large numbers of women influenced abortion rates. All women aged between 16 and 29 years living in Lothian, Scotland, were offered, through health services, five courses of EC without cost to keep at home. Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend. It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland. No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.
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Affiliation(s)
- Anna Glasier
- Lothian Primary Care NHS Trust Family Planning and Well Woman Services, Edinburgh EH4 1NL, Scotland, UK.
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Abstract
Adolescents and young adults continue to have the highest rates of sexually transmitted diseases. New chlamydia and gonorrhea diagnostic tests are being used in innovative ways to increase the number of infections that are detected. Nevertheless, challenges such as gonorrhea resistance and partner notification and treatment continue to hinder efforts to reduce the prevalence of these two bacterial infections. Although recent surveillance data suggest a decreasing trend of herpes simplex virus 2 (HSV-2) incidence among adolescents and young adults, the incidence of sexually transmitted human papillomavirus (HPV) in adolescent and young adult females remains high. Progress has been made toward the development of vaccines that may become available in the future to prevent infection with and sequelae from HSV-2 and HPV.
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Affiliation(s)
- Diane R. Blake
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Archivée: Consensus Canadien sur la Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Black A, Francoeur D, Rowe T, Collins J, Miller D, Brown T, David M, Dunn S, Fisher WA, Fleming N, Fortin CA, Guilbert E, Hanvey L, Lalonde A, Miller R, Morris M, O'Grady T, Pymar H, Smith T, Henneberg E. Canadian Contraception Consensus. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:143-56, 158-74. [PMID: 14965480 DOI: 10.1016/s1701-2163(16)30490-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Affiliation(s)
- Amanda Black
- Communications Message & More Inc., Montréal, QC
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Contraception d’urgence. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003. [DOI: 10.1016/s1701-2163(16)30127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peremans L, Verhoeven V, Van Royen P, Avonts D, Denekens J. Screening for Chlamydia trachomatis in the pharmacy? Contraception 2003; 67:491; author reply 492. [PMID: 12814820 DOI: 10.1016/s0010-7824(03)00072-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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FFPRHC Guidance: emergency contraception (April 2003). JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2003; 29:9-16. [PMID: 12681030 DOI: 10.1783/147118903101197458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reuter S. The emergency intrauterine device: an endangered species. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2003; 29:5. [PMID: 12681052 DOI: 10.1783/147118903101197421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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