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Gutiérrez-Cardona JY, Calderón-Jaimes E, Ortega-Cuellar D, Sánchez-Carrillo A, Castillo-Rodríguez RA, Canseco-Ávila LM, Rocha-Ramírez LM, Martínez-Rosas V, Gómez-Manzo S, Hernández-Ochoa B. Effect of Trichomonacide 6-Nitro-1 H-benzimidazole Derivative Compounds on Expression Level of Metabolic Genes in Trichomonas vaginalis. Int J Mol Sci 2024; 25:4568. [PMID: 38674152 PMCID: PMC11050703 DOI: 10.3390/ijms25084568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The parasite Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease worldwide. This infection often remains asymptomatic and is related to several health complications. The traditional treatment for trichomoniasis is the use of drugs of the 5-nitroimidazole family, such as metronidazole; however, scientific reports indicate an increasing number of drug-resistant strains. Benzimidazole derivatives could offer an alternative in the search for new anti-trichomonas drugs. In this sense, two attractive candidates are the compounds O2N-BZM7 and O2N-BZM9 (1H-benzimidazole derivatives), since, through in vitro tests, they have shown a higher trichomonacide activity. In this study, we determined the effect on the expression level of metabolic genes in T. vaginalis. The results show that genes involved in redox balance (NADHOX, G6PD::6PGL) are overexpressed, as well as the gene that participates in the first reaction of glycolysis (CK); on the other hand, structural genes such as ACT and TUB are decreased in expression in trophozoites treated with the compound O2N-BZM9, which would probably affect its morphology, motility and virulence. These results align with the trichomonacidal activity of the compounds, with benzimidazole O2N-BZM9 being the most potent, with an IC50 value of 4.8 μM. These results are promising for potential future therapeutic applications.
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Affiliation(s)
- Jocelyn Yamin Gutiérrez-Cardona
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico; (J.Y.G.-C.); (E.C.-J.); (A.S.-C.)
| | - Ernesto Calderón-Jaimes
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico; (J.Y.G.-C.); (E.C.-J.); (A.S.-C.)
| | - Daniel Ortega-Cuellar
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico;
| | - Adrián Sánchez-Carrillo
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico; (J.Y.G.-C.); (E.C.-J.); (A.S.-C.)
| | - Rosa Angélica Castillo-Rodríguez
- Centro de Investigacion en Ciencia Aplicada y Tecnología Avanzada (CICATA) Unidad Morelos, Instituto Politécnico Nacional, Boulevard de la Tecnología, 1036 Z-1, P 2/2, Atlacholoaya 62790, Mexico;
| | - Luis Miguel Canseco-Ávila
- Facultad de Ciencias Químicas, Campus IV, Universidad Autónoma de Chiapas, Tapachula City 30580, Mexico;
| | - Luz María Rocha-Ramírez
- Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Colonia Doctores, Mexico City 06720, Mexico;
| | - Víctor Martínez-Rosas
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico;
| | - Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico;
| | - Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico; (J.Y.G.-C.); (E.C.-J.); (A.S.-C.)
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McCormack H, Wand H, Bourne C, Ward J, Bradley C, Mak D, Guy R. Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis. Sex Health 2023; 20:488-496. [PMID: 37690512 DOI: 10.1071/sh23107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16-29years in Aboriginal Community Controlled Health Services between 2018 and 2020. METHODS Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. RESULTS Of the 13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20-24years (OR 1.2, 95% CI 1.1-1.4) and 25-29years (OR 1.1, 95% CI 1.0-1.2) compared to 16-19years and patients residing in very remote (OR 4.2, 95% CI 3.7-4.8), remote (OR 2.4, 95% CI 2.1-2.8), and regional areas (OR 2.5, 95% CI 2.2-2.8) compared to metropolitan areas. There was no association with patient sex. CONCLUSIONS Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women.
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Affiliation(s)
- Heather McCormack
- Kirby Institute, UNSW, Sydney, NSW, Australia; and NSW STI Programs Unit, Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Handan Wand
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Christopher Bourne
- Kirby Institute, UNSW, Sydney, NSW, Australia; and NSW STI Programs Unit, Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia; and Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Qld, Australia
| | - Clare Bradley
- UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Qld, Australia
| | - Donna Mak
- Department of Health, East Perth, WA, Australia; and School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, NSW, Australia
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McCormack H, Wand H, Newman CE, Bourne C, Kennedy C, Guy R. Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation. JMIR Med Inform 2023; 11:e51387. [PMID: 38032729 PMCID: PMC10722379 DOI: 10.2196/51387] [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: 07/30/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. OBJECTIVE We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. METHODS We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. RESULTS Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. CONCLUSIONS This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.
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Affiliation(s)
- Heather McCormack
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Christy E Newman
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Christopher Bourne
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | | | - Rebecca Guy
- Kirby Institute, University of New South Wales, Kensington, Australia
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Genital Tract Infections in Women, Pregnancy and Neonates. Obstet Gynecol Clin North Am 2022; 49:751-769. [DOI: 10.1016/j.ogc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kridin K, Ingram B, Becker D, Shiloah N, Azrad M, Habib S, Peretz A. Sexually Transmitted Diseases in Northern Israel: Insights From a Large Referral Laboratory. J Low Genit Tract Dis 2022; 27:51-55. [DOI: 10.1097/lgt.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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McCormack H, Guy R, Bourne C, Newman CE. Integrating testing for sexually transmissible infections into routine primary care for Aboriginal young people: a strengths-based qualitative analysis. Aust N Z J Public Health 2022; 46:370-376. [PMID: 35238454 DOI: 10.1111/1753-6405.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This paper examines factors that enabled successful integration of testing for sexually transmissible infections into routine care in Aboriginal Community Controlled Health Services. METHODS This paper reports analysis of qualitative interview data recorded with 19 purposively sampled key informants in New South Wales, Australia, representing six Aboriginal Community Controlled Health Services and five government health bodies supporting those services. The analysis explicitly adopted a strengths-based approach. RESULTS Participants reported a strong belief that routine screening overcomes shame and increases engagement with sexual health screening. Incorporating sexual health screening into general medical consultations increases the capture of asymptomatic cases. The Medicare Benefits Schedule 715 Adult Health Check was highlighted as an ideal lever for effective integration into routine care. CONCLUSION Integration of testing for sexually transmissible infections into routine care is widely perceived as best practice by senior stakeholders in Aboriginal healthcare in NSW. Findings support continued work to optimise the MBS 715 as a lever to increase testing. IMPLICATIONS FOR PUBLIC HEALTH Identifying accessible strategies to increase testing for sexually transmissible infections in Aboriginal Community Controlled Health Services can reduce disparities in notifications affecting Aboriginal young people.
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Affiliation(s)
- Heather McCormack
- The Kirby Institute, UNSW Sydney, New South Wales
- NSW STI Programs Unit, Centre for Population Health, New South Wales Health
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, New South Wales
| | - Christopher Bourne
- The Kirby Institute, UNSW Sydney, New South Wales
- NSW STI Programs Unit, Centre for Population Health, New South Wales Health
- Sydney Sexual Health Centre, New South Wales
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, New South Wales
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Cheluvappa R, Selvendran S. Strengths-Based Nursing to Combat Common Infectious Diseases in Indigenous Australians. NURSING REPORTS 2022; 12:22-28. [PMID: 35225889 PMCID: PMC8883947 DOI: 10.3390/nursrep12010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Problem: The increasing incidence and prevalence of infectious diseases in Indigenous Australians (Aboriginal groups and Torres Strait Islanders) are concerning. Indigenous Australians experience the burden of infectious diseases disproportionately when compared to non-Indigenous Australians. (2) Aim: Our report aims to describe how to apply Strengths-Based Nursing (SBN) to ameliorate the impact of the most common infectious diseases in Indigenous Australians. Specifically, we aim to describe how nurses can use SBN to partner with Indigenous Australian communities to remediate, control, and mollify the impact of the most common infectious diseases encountered by them using their limited resources. (3) Methods: Meticulous PubMed, Google Scholar, and web searches were conducted pertaining to Strengths-Based Nursing and common infectious diseases in Indigenous Australians. (4) Findings: The two groups of infectious diseases considered are sexually transmitted infections (STIs) and infectious skin diseases (including parasitic infestations). The prevalence of these infectious diseases in Indigenous Australians is deliberated on, with data when possible, or known trends and impacts. Finally, existing, evidence-based, prudent, and possible SBN approaches are discussed towards tackling these infectious diseases judiciously with available local resources, in conjunction with the support of impacted people, their families, and their communities. (5) Discussion and Conclusion: The SBN approach is a relatively new perspective/approach to clinical and nursing care. In contradistinction to the commonly utilised medical model, SBN pits strengths against deficits, available resources against professional judgment, solutions against unavailable items, and collaborations against hierarchy. In light of the current situation/data, several SBN approaches to combat STIs and skin infections in Indigenous Australians were identified and discussed for the first time in the “Results” section of this paper.
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Affiliation(s)
- Rajkumar Cheluvappa
- Nursing and Midwifery, Australian Catholic University, Watson, ACT 2602, Australia
- Correspondence: ; Tel.: +61-0406-0406-20
| | - Selwyn Selvendran
- Department of Surgery, St. George Hospital, Kogarah, NSW 2217, Australia;
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Lafferty L, Smith K, Causer L, Andrewartha K, Whiley D, Badman SG, Donovan B, Anderson L, Tangey A, Mak D, Maher L, Shephard M, Guy R. Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers' perceptions of the barriers and facilitators. Implement Sci Commun 2021; 2:127. [PMID: 34743760 PMCID: PMC8572571 DOI: 10.1186/s43058-021-00232-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia. Methods A total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health services involved in the TTANGO2 program to participate in semi-structured in-depth interviews. Health services’ clinics were purposively selected to include those with high or low STI POCT uptake. Personnel participants were selected via a hybrid approach including nomination by clinic managers and purposive sampling to include those in roles relevant to STI testing and treatment and those who had received TTANGO2 training for POCT technology. Milat’s scaling up guide informed the coding framework and analysis. Results Acceptability of STI POCT technology among healthcare workers and managers was predominantly influenced by self-efficacy and perceived effectiveness of POCT technology as well as perceptions of additional workload burden associated with POCT. Barriers to integration of STI POCT included retention of trained staff to conduct POCT. Patient reach (including strategies for patient engagement) was broadly considered an enabler for STI testing scale up using POCT technology. Conclusions Remote healthcare clinics should be supported by both program and clinic management throughout scaling up efforts to ensure broad acceptability of STI POCT as well as addressing local health systems’ issues and identifying and enhancing opportunities for patient engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00232-8.
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Affiliation(s)
- Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kirsty Smith
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louise Causer
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - David Whiley
- University of Queensland, Brisbane, QLD 4006, Australia
| | - Steven G Badman
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Annie Tangey
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Ngaanyatjarra Health Service, Alice Springs, NT, 0870, Australia
| | - Donna Mak
- Department of Health, Western Australia, East Perth, WA, 6004, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, WA, 6160, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Mark Shephard
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
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Delfosse A, Bouscaren N, Dupin N, Jaubert J, Tran PL, Saint Pastou C, Manaquin R, Poubeau P, Gerardin P, Bertolotti A. High prevalence of syphilis in women, minors and precarious patients: a cross-sectional study in a Reunion Island sexually transmitted infection clinic, 2017-2020. J Eur Acad Dermatol Venereol 2021; 35:2287-2292. [PMID: 34331780 DOI: 10.1111/jdv.17572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high-income countries and remains at endemic levels in low- and middle-income countries. This trend, however, has not been observed in Reunion Island. OBJECTIVES To determine the prevalence, clinical characteristics and risk factors of syphilis in at-risk patients visiting the South Reunion STI clinic in Reunion Island. METHODS This monocentric cross-sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self-administered questionnaire. RESULTS Over the 3-year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n = 195, 95% CI, 6.50-8.65%) in the overall study population, 11.76% (n = 18, 95% CI, 6.97-18.59%) in minors (aged under 18 years) and 36.36% (n = 16, 95% CI, 21-59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10-3.11], being MSM (aPR 2.87, 95% CI, 1.71-4.80), being aged under 18 years (aPR 3.54, 95% CI, 1.90-6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11-4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42-4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). CONCLUSIONS These findings suggest a high prevalence of syphilis in at-risk patients visiting our STI clinic. Unlike the situation in other high-income countries, the people most at risk of syphilis in Reunion Island are local-born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island.
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Affiliation(s)
- A Delfosse
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - N Bouscaren
- Inserm CIC1410, CHU Réunion, Saint Pierre, France
| | - N Dupin
- Service de Dermatologie, Hôpital Cochin, AP-HP, CNR de la syphilis, Institut Cochin, U1016, Université Paris Descartes, Paris, France
| | - J Jaubert
- Laboratoire de Microbiologie, CHU Réunion, Saint Pierre, France
| | - P L Tran
- Service de Gynécologie Obstétrique, CHU Réunion, Saint Pierre, France
| | - C Saint Pastou
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - R Manaquin
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - P Poubeau
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - P Gerardin
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - A Bertolotti
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France.,Inserm CIC1410, CHU Réunion, Saint Pierre, France
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Abstract
BACKGROUND In recent years, gonorrhea notifications have increased in women in Australia and other countries. We measured trends over time and risk factors among Australian Aboriginal and Torres Strait Islander ("Aboriginal") and non-Aboriginal women. METHODS We conducted a cross-sectional analysis of data from 41 sexual health clinics. Gonorrhea positivity at each patient's first visit (first-test positivity) during the period 2009 to 2016 was calculated. Univariate and multivariate analyses assessed risk factors for first-test positivity in Aboriginal and non-Aboriginal women. RESULTS Gonorrhea positivity decreased among Aboriginal women (7.1% in 2009 to 5.2% in 2016, P < 0.001) and increased among non-Aboriginal women (0.6%-2.9%, P < 0.001). Among Aboriginal women, first-test positivity was independently associated with living in a regional or remote area (adjusted odds ratio [aOR], 4.29; 95% confidence interval [CI], 2.52-7.31; P < 0.01) and chlamydia infection (aOR, 4.20; 95% CI,3.22-5.47; P < 0.01). Among non-Aboriginal women, first-test positivity was independently associated with greater socioeconomic disadvantage (second quartile: aOR, 1.68 [95% CI, 1.31-2.16; P < 0.01]; third quartile: aOR, 1.54 [95% CI, 1.25-1.89; P < 0.01]) compared with least disadvantaged quartile: recent sex work (aOR, 1.69; 95% CI, 1.37-2.08; P < 0.01), recent injecting drug use (aOR, 1.85; 95% CI, 1.34-2.57; P < 0.01), and chlamydia infection (aOR, 2.35; 95% CI, 1.90-2.91; P < 0.01). For non-Aboriginal women, being aged 16 to 19 years (aOR, 0.62; 95% CI, 0.49-0.80; P < 0.01) compared with those ≥30 years was a protective factor. CONCLUSIONS These findings highlight 2 different epidemics and risk factors for Aboriginal and non-Aboriginal women, which can inform appropriate health promotion and clinical strategies.
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Elliott SR, Betts S, Hobbs K, Wand H, Rumbold AR, Ward J, Johnson DR. Analysis of diagnostic data for sexually transmissible infections in South Australian Aboriginal Community Controlled Health Services (2008-16). Sex Health 2020; 16:566-573. [PMID: 31623703 DOI: 10.1071/sh18189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008-16). METHODS Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. RESULTS From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27-38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013-16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4; 95% confidence interval (CI) 0.2-0.5) and TV positivity (aOR 0.6, 95% CI 0.4-0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9; 95% CI 0.5-1.5). CONCLUSIONS Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.
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Affiliation(s)
- Salenna R Elliott
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia; and SA Health, Adelaide, SA 5000, Australia; and Corresponding author.
| | - Sarah Betts
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
| | - Katie Hobbs
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and SA Health, Adelaide, SA 5000, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Alice R Rumbold
- The Robinson Research Institute, University of Adelaide, North Adelaide, SA 5006, Australia
| | - James Ward
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia
| | - David R Johnson
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
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Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103702. [PMID: 32456323 PMCID: PMC7277238 DOI: 10.3390/ijerph17103702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48-60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion.
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Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4562385. [PMID: 31392211 PMCID: PMC6662498 DOI: 10.1155/2019/4562385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022]
Abstract
Objective Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design Systematic review and meta-analysis. Data Sources Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.
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Reekie J, Donovan B, Guy R, Hocking JS, Kaldor JM, Mak DB, Pearson S, Preen D, Wand H, Ward J, Liu B. Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001-2013: a population-based cohort study. Sex Health 2019. [PMID: 28648150 DOI: 10.1071/sh16207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to examine trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age. METHODS A cohort of 318002 women, born between 1974 and 1995, residing in Western Australia (WA) was determined from birth registrations and the 2014 electoral roll. This cohort was then probabilistically linked to all records of chlamydia and gonorrhoea nucleic acid amplification tests conducted by two large WA pathology laboratories between 1 January 2001 and 31 December 2013. Trends in chlamydia and gonorrhoea testing and positivity were investigated over time and stratified by Aboriginality and age group. RESULTS The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 from 24.5% to 36.6% in Aboriginal and 4.0% to 8.5% in non-Aboriginal women (both P-values <0.001). Concurrent testing was high (>80%) and so patterns of gonorrhoea testing were similar. Chlamydia and gonorrhoea positivity were substantially higher in Aboriginal compared with non-Aboriginal women; age-, region- and year-adjusted incidence rate ratios were 1.52 (95% confidence interval (CI) 1.50-1.69, P<0.001) and 11.80 (95% CI 10.77-12.91, P<0.001) respectively. Chlamydia positivity increased significantly in non-Aboriginal women aged 15-19 peaking in 2011 at 13.3% (95% CI 12.5-14.2%); trends were less consistent among 15-19-year-old Aboriginal women but positivity also peaked in 2011 at 18.5% (95% CI 16.9-20.2%). Gonorrhoea positivity was 9.7% (95% CI 9.3-10.1%), 6.7% (95% CI 6.4-7.0%), 4.7% (4.4-5.0%), and 3.1% (2.8-3.4%) among Aboriginal women aged respectively 15-19, 20-24, 25-29 and ≥30 years, compared with <1% in all age groups in non-Aboriginal women. Over time, gonorrhoea positivity declined in all age groups among Aboriginal and non-Aboriginal women. CONCLUSION Between 2001 and 2013 in WA chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities.
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Affiliation(s)
- Joanne Reekie
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Jane S Hocking
- School of Population and Global Health, University of Melbourne, Bouverie Street, Melbourne, Vic. 3053, Australia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Donna B Mak
- School of Medicine, The University of Notre Dame, Henry Street, Fremantle, WA 6160, Australia
| | - Sallie Pearson
- Faculty of Pharmacy and School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - David Preen
- Centre for Health Services Research, Stirling Highway, University of Western Australia, Perth, WA 6009, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Sydney, Samuels Avenue, Sydney, NSW 2052, Australia
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Hope A, Haire B. "No-one's driving this bus" - qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men. Aust N Z J Public Health 2018; 43:18-23. [PMID: 30516311 DOI: 10.1111/1753-6405.12852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/01/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE HIV prevention tools such as pre-exposure prophylaxis require equitable access and uptake to protect all at-risk populations. This project assessed the perceived barriers to accessible HIV prevention for Aboriginal and Torres Strait Islander gay and bisexual men (GBM) and evaluated the presence of health promotion for pre-exposure prophylaxis (PrEP) for this population from the perspective of service providers. METHODS Eighteen semi-structured interviews with healthcare providers, researchers and AIDS Council employees were qualitatively analysed for themes and concepts related to PrEP-specific health promotion. RESULTS Respondents noted AIDS Councils and affiliated sexual health clinics had been instrumental in promoting PrEP to at-risk GBM. However, many Aboriginal gay and bisexual men who are not well connected with these communities and services may not have been exposed to this health promotion and therefore have not accessed PrEP effectively. CONCLUSIONS Aboriginal community and gay community controlled health organisations need to collaborate to ensure they deliver effective and tailored health promotion to Aboriginal communities. Implications for public health: The rising HIV notification rates in Aboriginal Australians is an example of the health gap experienced by First Nation people. Effective HIV prevention is required to ensure this gap does not widen further, and that Australia meets its goal of preventing all new HIV infections. However, these efforts will be hampered by ineffective health promotion of HIV prevention tools, such as PrEP, for Aboriginal Australians.
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Affiliation(s)
- Alec Hope
- Kirby Institute, University of New South Wales
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