1
|
Nightingale KJ, Makeneni S, Bonett S, Wood SM. The Relationship Between Directly Observed Therapy for Chlamydia Infections and Retesting Rates in an Adolescent Population. Sex Transm Dis 2023; 50:342-345. [PMID: 36863059 PMCID: PMC10175119 DOI: 10.1097/olq.0000000000001790] [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] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes. METHODS We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ2 , Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression. RESULTS Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%-62%) less likely than individuals who received DOT to return for retesting within 6 months. CONCLUSIONS Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT.
Collapse
Affiliation(s)
| | | | - Stephen Bonett
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | | |
Collapse
|
2
|
Schirmer P, Sharma A, Lucero-Obusan C, Oda G, Holodniy M. Trends in Follow-up Testing Among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration, 2013 to 2019. Sex Transm Dis 2023; 50:258-264. [PMID: 36649595 PMCID: PMC10097481 DOI: 10.1097/olq.0000000000001765] [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: 10/07/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends testing patients with chlamydia (CT)/gonorrhea (GC) for other sexually transmitted infections (STIs) and repeating CT/GC testing 3 to 12 months later. We assessed repeat CT/GC testing and testing for HIV/syphilis in accordance with CDC guidelines in the US Veterans Health Administration. METHODS Molecular laboratory testing for CT/GC during January 1, 2013-December 31, 2020 was retrieved from Veterans Health Administration data sources. Patients were evaluated for syphilis, HIV, and repeat CT/GC testing within 1 year after a positive CT/GC test result. Differences of CT/GC-positive patients associated with receiving recommended testing were assessed using χ2 /Fisher exact tests. RESULTS A total of 41,630 of 1,005,761 CT (4.1%) and 17,649 of 1,013,198 GC (1.7%) results were positive. Median ages of positive CT/GC patients were 29 and 36 years, respectively. Repeat testing rates for CT/GC within 90 to 119 days were 3.9% and 2.9%, and rates within 90 to 365 days were 32.8% and 34.7%, with 8.6% and 15% being positive again, respectively. Guideline-compatible repeat testing in known HIV-positive patients nearly doubled (75.7% for CT and 67.8% for GC). The CDC-recommended HIV testing was performed for 72.4% and 65.5% CT and GC first positives, respectively, whereas syphilis testing was completed for 66.5% and 60.5% CT and GC, respectively. Compared with 25- to 34-year-old patients with CT or GC, those younger than 25 years had higher odds of guideline-discordant repeat testing but had lower odds of not receiving HIV/syphilis testing. CONCLUSIONS Nearly two-thirds of patients did not receive recommended repeat testing, and nearly one-third were not tested for HIV/syphilis. Veterans Health Administration providers may benefit from additional education on CDC-recommended sexually transmitted infection guidelines and testing recommendations.
Collapse
Affiliation(s)
| | - Aditya Sharma
- From the VHA Public Health National Program Office, Palo Alto
| | | | - Gina Oda
- From the VHA Public Health National Program Office, Palo Alto
| | - Mark Holodniy
- From the VHA Public Health National Program Office, Palo Alto
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA
| |
Collapse
|
3
|
Teixeira da Silva D, Petsis D, Santos T, Mahajan A, Bonett S, Wood S. Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network. J Adolesc Health 2022; 71:545-551. [PMID: 35963759 PMCID: PMC9588690 DOI: 10.1016/j.jadohealth.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
Collapse
Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tatiane Santos
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Mahajan
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen Bonett
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Gupta K, Harrison SA, Davis NA, Culp ML, Hand SC, Simpson T, Van Der Pol B, Galbraith JW, Van Wagoner NJ, Morrison SG, Morrison RP, Geisler WM. Prevalence of Chlamydia trachomatis Infection in Young Women and Associated Predictors. Sex Transm Dis 2021; 48:529-535. [PMID: 34110759 PMCID: PMC8847232 DOI: 10.1097/olq.0000000000001372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) infection remains highly prevalent, and young women are disproportionately affected. Most CT-infected women are asymptomatic, and their infection often goes unrecognized and untreated. We hypothesized that testing for active CT infection with molecular diagnostics and obtaining a reported history of CT infection underestimate the prevalence of current and past CT infection, and incorporating serum CT antibody testing in addition to these other prevalence measures would generate more accurate estimates of the prevalence of CT infection in asymptomatic young women. METHODS We enrolled 362 asymptomatic women aged 16 to 29 years at 4 different clinical settings in Birmingham, AL, between August 2016 and January 2020 and determined the prevalence of CT infection based on having 1 or more of the following prevalence measures: an active urogenital CT infection based on molecular testing, reported prior CT infection, and/or being CT seropositive. Multivariable regression analysis was used to determine predictors of the prevalence of CT infection after adjustment for participant characteristics. RESULTS The prevalence of CT infection was 67.7% (95% confidence interval, 62.6%-72.5%). Addition of CT antibody testing to the other individual prevalence measures more than doubled the CT infection prevalence. Non-Hispanic Black race, reported prior gonorrhea, and reported prior trichomoniasis predicted a higher prevalence of CT infection. CONCLUSIONS More than half of women were unaware of ever having CT infection, suggesting many were at risk for CT-associated reproductive complications. These data reinforce the need to adhere to chlamydia screening guidelines and to increase screening coverage in those at risk.
Collapse
Affiliation(s)
- Kanupriya Gupta
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally A. Harrison
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nkele A. Davis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matilda L. Culp
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel C. Hand
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tina Simpson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Van Der Pol
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James W. Galbraith
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas J. Van Wagoner
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra G. Morrison
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Richard P. Morrison
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William M. Geisler
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
5
|
Evaluation of Text Message Reminders to Encourage Retesting for Chlamydia and Gonorrhea Among Female Patients at the Municipal Sexually Transmitted Disease Clinic in Seattle, Washington. Sex Transm Dis 2021; 47:458-463. [PMID: 32541305 DOI: 10.1097/olq.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND United States guidelines recommend retesting for chlamydia (CT) and gonorrhea (GC) approximately 3 months after treatment, but adherence to these guidelines is poor. METHODS In May 2016, the municipal sexually transmitted disease (STD) Clinic in Seattle, WA, integrated opt-in short message system (SMS) (text message) retesting reminders for female patients into our clinic's routine electronic intake. Women were asked if they wanted to receive an SMS reminder for retesting for GC/CT in 3 months. We used Fisher exact tests to compare the proportion who returned to the clinic for retesting and the proportion who retested GC/CT positive 3 to 6 months after their initial diagnosis. We used sexually transmitted disease surveillance data to ascertain repeat GC/CT diagnoses. RESULTS From May 2016 to December 2017, 743 (36%) of 2067 women opted to receive an SMS reminder. Overall, 95 of these women tested positive for GC or CT and provided a valid phone number; 31 (33%) had opted into SMS reminders. The percentage of women who returned to the clinic 3 to 6 months after their initial GC/CT diagnosis did not significantly differ for women who did and did not opt in to receive SMS reminders (23% vs 9%; P = 0.11). Repeat GC/CT diagnosis 3 to 6 months after the initial GC/CT diagnosis was not significantly different between women who did and did not opt in (7% vs 3%; P = 0.58). CONCLUSIONS Uptake of automated SMS reminders among women was low, and most women who received reminders did not return for retesting. Despite this, SMS reminders integrated into an existing clinic infrastructure may somewhat increase retesting among women with GC/CT.
Collapse
|
6
|
Frequency of Sexually Transmitted Infection/HIV Testing Among Commercially Insured Patients With International Classification of Disease Tenth Revision Specified Sex Partners. Sex Transm Dis 2021; 47:347-353. [PMID: 32304529 DOI: 10.1097/olq.0000000000001145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-risk sexual behaviors (HRSB) are associated with sexually transmitted infections (STIs). The Centers for Disease Control and Prevention and US Preventive Services Task Force recommend routine testing for patients with HRSB. Providers can classify patients with HRSB based on the sex of their sex partners using the International Classification of Disease Tenth Revision. We analyzed STI/human immunodeficiency virus (HIV) testing frequencies among patients with HRSB. METHODS This study used a large US administrative outpatient medical claims data set from 2015 to 2017. Patients aged 15 to 64 years were identified with HRSB using International Classification of Disease Tenth Revision codes. An initial HRSB diagnosis in 2016 served as the index date. We assessed chlamydia, gonorrhea, syphilis, and HIV testing by HRSB at the index date, and 4 time intervals of 1 to 6 months, and 7 to 12 months before and after the index date. RESULTS We identified 52,160 patients with HRSB: 90.3% were patients with opposite-sex partners, 7.7% patients with same-sex partners, and 2.1% patients with same- and opposite-sex partners. There were 77.5% and 82.1% of the patients insured 6 months before and after the index, respectively. On the index date, patients with opposite-sex partners tested most for chlamydia (65.3%) and gonorrhea (65.2%), patients with same-sex partners tested most for syphilis (51.5%) and HIV (57.8%). Among insured patients, follow-up STI/HIV testing was 89.5% during 1 to 6 months and 33.1% during 7 to 12 months after the index date. Patients tested on the index date were more likely to have an STI/HIV test within 1 to 6 months after the index date. CONCLUSIONS The STI/HIV testing among patients with HRSB could improve. It is important for patients identified as HRSB to get tested and continue testing patients based on recommendations.
Collapse
|
7
|
Chlamydia trachomatis and Neisseria gonorrhoeae Retesting and Reinfection Rates in New Zealand Health Care Settings: Implications for Sexually Transmitted Infection Control. Sex Transm Dis 2021; 47:151-157. [PMID: 31880741 DOI: 10.1097/olq.0000000000001112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reinfection with chlamydia or gonorrhea is common and can lead to significant reproductive health complications so testing for reinfection after treatment is recommended. This study described retesting and reinfection rates in regions of New Zealand with higher-than-average population rates of chlamydia. METHODS This retrospective cohort study analyzed chlamydia and gonorrhea testing data from 2 laboratories providing community testing services for 4 higher-rate regions in the North Island of New Zealand. Three years of data were obtained (2015-2017) to include a minimum of 6-month follow-up for all individuals. Retesting and reinfection rates between 6 weeks and 6 months of a positive result were calculated, and time to retesting was plotted using Kaplan-Meier curves. Logistic regression modeling was used to determine the odds of retesting (outcome 1) and reinfection (outcome 2) between 6 weeks and 6 months of follow-up. RESULTS Overall, 34% (3151/9241) of the cohort was retested within the recommended period, of whom 21% retested positive. Significant differences were observed in the odds of retesting by sex, age band, ethnic group, clinic type, and region (P < 0.01). The odds of a subsequent positive on retesting within 6 months differed significantly by sex, age band, and ethnic group (P < 0.01). CONCLUSIONS These findings reflect substantial gaps in the delivery of best-practice sexually transmitted infection management in New Zealand. There is a clear need to prioritize the implementation of clinic-level processes to support clinicians in the routine delivery of best-practice sexual health care. These should include routine provision of patient advice about retesting and strategies to promote timely and equitable access to retesting.
Collapse
|
8
|
Nielsen A, de Costa A, Gemzell-Danielsson K, Boman J, Salazar M. 'Repeat testing without having 'the talk' is not meaningful'-healthcare providers' perceptions on finding a balance between Chlamydia trachomatis testing and primary prevention strategies. A qualitative study in Stockholm, Sweden. BMJ Open 2020; 10:e034179. [PMID: 32759237 PMCID: PMC7409961 DOI: 10.1136/bmjopen-2019-034179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Chlamydia trachomatis is a public health problem. Widespread testing and re-testing after a sexually transmitted infection (STI) is recommended to contain the epidemic and has been adopted by many countries. A recent study in Stockholm found that serial testing was used as a substitute for condom use by youth presenting at the Youth Health Clinics (YHC). The objectives of this study are to explore frontline healthcare provider's perception of youth testing repeatedly for C. trachomatis as a substitute for condom use and their views on how this might be addressed. DESIGN Qualitative study, in-depth interviews and analysed using content analysis. SETTING YHC in Stockholm County, Sweden. PARTICIPANTS Healthcare providers (HCPs) working at the YHC. FINDINGS Testing used as a method of prevention of STIs by youth has been a well-known phenomenon observed by HCPs at the YHC. Despite frustration regarding this behaviour, attitudes towards youth visiting the clinics repeatedly were overall positive. It is seen as an opportunity to reach youth with primary prevention strategies. Time for in-depth conversations with the youth is considered essential to understand the various reasons behind sexual risk-taking and to tailor counselling accordingly. Introducing concepts of self-compassion and self-respect in relation to sex is thought of as an effective intervention to improve sexual health among youth. CONCLUSION HCPs' views on testing repeatedly for C. trachomatis as means of prevention, range widely from seeing this as 'a positive strategy for C. trachomatis prevention' to 'a waste of healthcare resources'. There was a more unified view on how this should be addressed. Testing without having time to problematise sexual risk-taking was seen as meaningless. In depth, one-on-one counselling was deemed important. While scaling up accessibility to testing services, primary prevention strategies must not be neglected.
Collapse
Affiliation(s)
- Anna Nielsen
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ayesha de Costa
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Jens Boman
- Clinical Microbiology, Norrlands universitetssjukhus, Umea, Sweden
| | - M Salazar
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Abstract
BACKGROUND Chlamydial infections are common among young women and can lead to serious reproductive health complications. We assessed the risk of reported repeat chlamydial infection among young women in Louisiana and time interval between infections by age and race/ethnicity. METHODS We analyzed surveillance data on chlamydial infections reported among women in Louisiana from January 1, 2000, to December 31, 2015. Multiple reports for the same person were matched using unique codes. Chlamydial infections reported more than 30 days after a previous positive test were considered new infections. Women aged 15 to 34 years at first infection during 2000 to 2012 were censored after 3 years or after they had a repeat infection. Cumulative incidence and incidence rate of repeat chlamydial infection among women were determined by year of first infection. Race- and age-specific results were obtained using stratified analyses. RESULTS One in 4 women diagnosed with a chlamydial infection at 15-34 years of age in Louisiana had a reported repeat infection in 3 years or less. Risk of repeat infection increased for younger women, racial/ethnic minorities, and women in more recent cohorts. Young black women aged 15 to 19 years in 2012 had the highest risk (44%). Black women also had shorter intervals between infections than white women. CONCLUSIONS Repeat chlamydial infections were common, especially among young black women. The true number is likely higher because surveillance data only count infections that were detected and reported. Comprehensive prevention strategies are needed to address high rates of repeat chlamydial infections among women.
Collapse
|
10
|
Medina-Marino A, Mudau M, Kojima N, Peters RP, Feucht UD, Vos LD, Olivier D, Muzny CA, McIntyre JA, Klausner JD. Persistent Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis positivity after treatment among human immunodeficiency virus-infected pregnant women, South Africa. Int J STD AIDS 2020; 31:294-302. [PMID: 32089090 PMCID: PMC7174825 DOI: 10.1177/0956462419898612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study is to assess the predictors and frequency of persistent sexually transmitted infection (STI) positivity in human immunodeficiency virus (HIV)-infected pregnant women treated for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) or Trichomonas vaginalis (TV) infection. We enrolled HIV-infected pregnant women attending their first antenatal care visit and tested them for urogenital CT, NG and TV infection using Xpert® CT/NG and TV assays (Cepheid, Sunnyvale, CA). Those testing positive were treated. Participants either notified partners to seek treatment or were given extra medication to deliver to partners for treatment. Repeat testing was conducted approximately 21 days post-treatment or treatment initiation. Among 427 participants, 172 (40.3%) tested positive for any STI. Of the 136 (79.1%) that returned for repeat testing, 36 (26.5%) tested positive for the same organism: CT = 27 (26.5%), NG = 1 (6.3%), TV = 11 (16.7%). Persistent CT positivity was independently associated with having more than one sex partner in the preceding 12 months (adjusted-prevalence ratio [aPR] = 3.03, 95% CI: 1.44–6.37) and being newly diagnosed with HIV infection during the first antenatal care visit compared to those currently on antiretroviral therapy (aPR = 3.97, 95% CI: 1.09–14.43). Persistent TV positivity was associated with not knowing if a partner sought treatment following STI disclosure (aPR = 12.6, 95% CI: 2.16–73.5) and prior diagnosis of HIV but not currently on antiretroviral therapy. (aPR = 4.14; 95% CI: 1.25–13.79). We identified a high proportion of HIV-infected pregnant women with persistent CT or TV positivity after treatment. To decrease the risk of re-infection, enhanced strategies for partner treatment programmes are needed to improve the effectiveness of STI screening and treatment in pregnancy. The relationship between not being on antiretroviral therapy and persistent STI positivity needs further study.
Collapse
Affiliation(s)
- Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Maanda Mudau
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Noah Kojima
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Remco Ph Peters
- Anova Health Institute, Johannesburg, South Africa.,Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Medical Microbiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ute D Feucht
- Department of Health, Tshwane District, Gauteng, South Africa.,Department of Pediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, South African Medical Research Council, Pretoria, South Africa
| | - Lindsey De Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Dawie Olivier
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeffrey D Klausner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
11
|
Rose SB, Garrett SM, Hutchings D, Lund K, Kennedy J, Pullon SRH. Clinician education, advice and SMS/text reminders improve test of reinfection rates following diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae: before and after study in primary care. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 46:bmjsrh-2018-200185. [PMID: 31628155 DOI: 10.1136/bmjsrh-2018-200185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evidence-based guidelines for the management of Chlamydia trachomatis and Neisseria gonorrhoeae recommend testing for reinfection 3-6 months following treatment, but retesting rates are typically low. METHODS Participants included six primary care clinics taking part in a pilot study of strategies designed to improve partner notification, follow-up and testing for reinfection. Rates of retesting between 6 weeks and 6 months of a positive chlamydia or gonorrhoea diagnosis were compared across two time periods: (1) a historical control period (no systematic approach to retesting) and (2) during an intervention period involving clinician education, patient advice about reinfection risk reduction and retesting, and short messaging service/text reminders sent 2-3 months post-treatment inviting return for retesting. Retesting was calculated for demographic subgroups (reported with 95% CI). RESULTS Overall 25.4% (61 of 240, 95% CI 20.0 to 31.4) were retested during the control period and 47.9% (116 of 242, 95% CI 43.2 to 55.1) during the intervention period. Retesting rates increased across most demographic groups, with at least twofold increases observed for men, those aged 20-29 years old, and Māori and Pasifika ethnic groups. No significant difference was observed in repeat positivity rates for the two time periods, 18% (11 of 61) retested positive during the control and 16.4% (19 of 116) during the intervention period (p>0.05). CONCLUSIONS Clinician and patient information about retesting and a more systematic approach to follow-up resulted in significant increases in proportions tested for reinfection within 6 months. These simple strategies could readily be implemented into primary healthcare settings to address low rates of retesting for bacterial sexually transmitted infections. TRIAL REGISTRATION NUMBER ACTRN12616000837426.
Collapse
Affiliation(s)
- Sally B Rose
- Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan M Garrett
- Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | | | - Kim Lund
- Wellington Sexual Health Service, Wellington, New Zealand
| | - Jane Kennedy
- Wellington Sexual Health Service, Wellington, New Zealand
| | - Susan R H Pullon
- Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| |
Collapse
|
12
|
Dee EC, Hsu KK, Kruskal BA, Menchaca JT, Zambarano B, Cocoros N, Herrick B, Weiss MDP, Hafer E, Erani D, Josephson M, Young J, Torrone EA, Flagg EW, Klompas M. Temporal Patterns in Chlamydia Repeat Testing in Massachusetts. Am J Prev Med 2019; 56:458-463. [PMID: 30777163 PMCID: PMC6931253 DOI: 10.1016/j.amepre.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National guidelines recommend test-of-cure for pregnant women and test-of-reinfection for all patients with chlamydia infections in order to interrupt transmission and prevent adverse sequelae for patients, partners, and newborns. Little is known about retesting and positivity rates, and whether they are changing over time, particularly in private sector practices. METHODS Electronic health record data on patients with chlamydia tests were extracted from three independent clinical practice groups serving ≅20% of the Massachusetts population. Records were extracted using the Electronic medical record Support for Public Health platform (esphealth.org). These data were analyzed for temporal trends in annual repeat testing rates by using generalized estimating equations after index positive chlamydia tests between 2010 and 2015 and for differences in intervals to first repeat tests among pregnant females, non-pregnant females, and males. Data extraction and analysis were performed during calendar years 2017 and 2018. RESULTS An index positive C. trachomatis result was identified for 972 pregnant female cases, 10,309 non-pregnant female cases, and 4,973 male cases. Test-of-cure 3-5 weeks after an index positive test occurred in 37% of pregnant females. Test-of-reinfection 8-16 weeks after an index positive test occurred in 39% of pregnant females, 18% of non-pregnant females, and 9% of males. There were no significant increases in test-of-cure or test-of-reinfection rates from 2010 to 2015. Among cases with repeat tests, 16% of pregnant females, 15% of non-pregnant females, and 16% of males had positive results. CONCLUSIONS Chlamydia test-of-cure and test-of-reinfection rates are low, with no evidence of improvement over time. There are substantial opportunities to improve adherence to chlamydia repeat testing recommendations.
Collapse
Affiliation(s)
- Elizabeth C Dee
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - John T Menchaca
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Ellen Hafer
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Diana Erani
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Mark Josephson
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Jessica Young
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
13
|
Garton L, Dyda A, Guy R, Silver B, McGregor S, Hengel B, Rumbold A, Taylor-Thomson D, Knox J, Maher L, Kaldor J, Ward J. High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009-2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening. Sex Health 2018; 13:568-574. [PMID: 27764650 DOI: 10.1071/sh16025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/15/2016] [Indexed: 11/23/2022]
Abstract
Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. METHODS Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. RESULTS There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01). CONCLUSIONS Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.
Collapse
Affiliation(s)
- Linda Garton
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Amalie Dyda
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Bronwyn Silver
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Skye McGregor
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Belinda Hengel
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Alice Rumbold
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Debbie Taylor-Thomson
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Janet Knox
- Lismore Sexual Health Service, New South Wales Health, Sydney, NSW 2480, Australia
| | - Lisa Maher
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | | |
Collapse
|
14
|
Tao G, Owusu-Edusei K, Friedman E, Aslam M, Viall AH, Dietz P, Gift TL. Significant difference in HEDIS annual chlamydia testing rates between women who had given birth and those who had not among young Medicaid women. Sex Health 2018; 15:374-375. [PMID: 29860971 DOI: 10.1071/sh18003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022]
Abstract
We used the 2013 Medicaid Analytic eXtract (MAX) database to estimate chlamydia testing rates separately for sexually active women aged 15-25 years who had, or had not, given birth in 2013. Approximately 9.2% of sexually active women aged 15-25 years gave birth in 2013. The Healthcare Effectiveness Data Information Set (HEDIS) annual chlamydia testing rate was significantly higher among women who had given birth than women who had not in 2013 (59.7 vs 29.4%, P<0.05). Our findings suggest a need for more research to understand how differences in population mix changes and preventive screening practices for pregnant and non-pregnant women affect publicly reported chlamydia screening rates.
Collapse
Affiliation(s)
- Guoyu Tao
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kwame Owusu-Edusei
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Eleanor Friedman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Maria Aslam
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Abigail H Viall
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Patricia Dietz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Thomas L Gift
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| |
Collapse
|
15
|
Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
Collapse
Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
16
|
McArdle BJ, Buser GL, Hedberg K, Schafer S. Chlamydia Retesting Among Safety-Net Clinic Patients: Infertility Prevention Project. J Womens Health (Larchmt) 2018; 27:1135-1141. [PMID: 29694796 DOI: 10.1089/jwh.2017.6747] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Due to high reinfection rates, the Centers for Disease Control and Prevention (CDC) recommend retesting everyone diagnosed with chlamydia after treatment. However, retesting rates are often low, and research on retesting is limited. METHODS Infertility Prevention Project (IPP) was a national chlamydia screening and treatment project in the United States. We completed a retrospective longitudinal analysis using IPP testing data from 8,266 women with at least 1 positive test result from 2010 to 2013. We calculated the proportion of women retested 2-12 months after a chlamydia diagnosis and used Cox proportional hazards models to explore associated factors. RESULTS Only 32% of women had evidence of retesting by 12 months of follow-up. Being younger (multivariate hazard ratio [mHR]: 0.96; 95% confidence interval [CI]: 0.95-0.96), black (mHR: 1.29; 95% CI: 1.12-1.50), or attending a county sexually transmitted diseases (STD; mHR: 1.91; 95% CI: 1.68-2.17), county family planning (mHR: 1.53; 95% CI: 1.39-1.69), or school-based (mHR: 2.34; 95% CI: 2.07-2.65) clinic relative to a nonprofit community health clinic were associated with increased retesting rates. CONCLUSIONS Less than one-third of women are retested. Our results show that some clinic settings may have systematic differences which facilitate retesting, such as use of automated reminders, closed patient populations, and makeup of patient populations. Investigation of clinical environments through site visits and further data analyses may be keys to improving retesting rates.
Collapse
Affiliation(s)
- Breanna J McArdle
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Genevieve L Buser
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Katrina Hedberg
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Sean Schafer
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| |
Collapse
|
17
|
Sexually Transmitted Infections and Human Immunodeficiency Virus: Are We Applying the Lessons Learned? Sex Transm Dis 2018; 44:141-142. [PMID: 28178110 DOI: 10.1097/olq.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
18
|
Visser M, van Aar F, Koedijk FDH, Kampman CJG, Heijne JCM. Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study. BMC Infect Dis 2017; 17:782. [PMID: 29262776 PMCID: PMC5738891 DOI: 10.1186/s12879-017-2871-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous. METHODS Longitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test. RESULTS In total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3-5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test. CONCLUSIONS Repeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.
Collapse
Affiliation(s)
- Maartje Visser
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, the Netherlands
| | - Fleur van Aar
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, the Netherlands
| | - Femke D. H. Koedijk
- Public Health Service Twente, postbus 1400, 7500 BK Enschede, the Netherlands
| | | | - Janneke C. M. Heijne
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, the Netherlands
| |
Collapse
|
19
|
Marotta P. Assessing Spatial Relationships between Race, Inequality, Crime, and Gonorrhea and Chlamydia in the United States. J Urban Health 2017; 94:683-698. [PMID: 28831708 PMCID: PMC5610128 DOI: 10.1007/s11524-017-0179-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Incidence rates of chlamydia and gonorrhea reached unprecedented levels in 2015 and are concentrated in southern counties of the USA. Using incidence data from the Center for Disease Control, Moran's I analyses assessed the data for statistically significant clusters of chlamydia and gonorrhea at the county level in 46 states of the USA. Lagrange multiplier diagnostics justified selection of the spatial Durbin regression model for chlamydia and the spatial error model for gonorrhea. Rates of chlamydia (Moran's I = .37, p < .001) and gonorrhea (Moran's I = .38, p < .001) were highly clustered particularly in the southern region of the USA. Logged percent in poverty (B = .49, p < .001 and B = .48, p < .001) and racial composition of African-Americans (B = .16, p < .001 and B = .40, p < .001); Native Americans (B = .12, p < .001 and B = .20, p < .001); and Asians (B = .14, p < .001 and B = .09, p < .001) were significantly associated with greater rates of chlamydia and gonorrhea, respectively, after accounting for spatial dependence in the data. Logged rates of rates violent crimes were associated with chlamydia (B = .053, p < .001) and gonorrhea (B = .10, p < .001). Logged rates of drug crimes (.052, p < .001) were only associated with chlamydia. Metropolitan census designation was associated with logged rates of chlamydia (B = .12, p < .001) and gonorrhea (B = .24, p < .001). Spatial heterogeneity in the distribution of rates of chlamydia and gonorrhea provide important insights for strategic public health interventions in the USA and inform the allocation of limited resources for the prevention of chlamydia and gonorrhea.
Collapse
|
20
|
Kollars K, Plegue M, Riley M. Testing for Chlamydia Reinfection Among Adolescent Patients in Different Clinical Settings: How Are We Doing? PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2017; 1:16. [PMID: 32944702 DOI: 10.22454/primer.2017.582445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Chlamydia trachomatis is the most frequently reported infectious disease in the United States, with high reinfection rates and highest prevalence among adolescents and young adults. National guidelines suggest testing for reinfection 3 months after chlamydia treatment, and 3 to 4 weeks after treatment during pregnancy. Our needs assessment evaluated retesting rates among adolescent and young adult patients across several clinical settings within one community. Methods We performed retrospective chart reviews to examine chlamydia retest rates among 14 to 21-year-old patients treated for chlamydia within three different settings: an academic primary care site with family medicine and pediatrics clinics, an adolescent health center, and a group of school-based health centers (SBHCs). Per CDC guidelines, the goal treatment window was defined as retests conducted between 60 to 183 days after documented treatment for nonpregnant patients, and those conducted within 21 to 42 days posttreatment for pregnant patients. Results Overall, 77/134 (57.5%) of patients were retested, with 59/143 (44%) retested within the goal time frame. Site rates of retesting within guideline timeframe were as follows: 38.5% at the academic family medicine site, 46.2% at the academic pediatrics site, 42.7% at the adolescent health center, and 55.0% at SBHCs. The reinfection rate among those appropriately retested was 22.0% (13/59). Of patients not retested appropriately, 25.3% had return visits at which they were not retested (a missed opportunity). Conclusions Our results indicate a need for interventions that encourage patients to return for retesting, and that trigger retesting during unrelated return visits.
Collapse
Affiliation(s)
- Kate Kollars
- University of Michigan Medical School, Department of Family Medicine
| | - Melissa Plegue
- University of Michigan Medical School, Department of Family Medicine
| | - Margaret Riley
- University of Michigan Medical School, Department of Family Medicine
| |
Collapse
|
21
|
Rose SB, Garrett SM, Stanley J, Pullon SRH. Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study. BMC Infect Dis 2017; 17:526. [PMID: 28754106 PMCID: PMC5534075 DOI: 10.1186/s12879-017-2635-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Testing for reinfection at 3 to 6 months following treatment for Chlamydia Trachomatis or Neisseria gonorrhoea is recommended in best practice sexual health management guidelines. This study aimed to describe rates of retesting and repeat positivity following diagnosis of chlamydia or gonorrhoea in a defined geographic region of New Zealand. METHODS Retrospective cohort study in Wellington, New Zealand involving analysis of laboratory data for chlamydia and gonorrhoea tests performed in primary care and sexual health clinics (July 2012-July 2015). OUTCOME MEASURES rate of retesting and rate of repeat positivity 6 weeks to 6 months after a positive result (index event). Kaplan-Meier curves were used to plot time from first index event to retest. Logistic regression modelling was used to determine the odds of retesting and repeat positivity between 6 weeks and 6 months of follow-up, adjusting for potential confounders (age, gender, ethnicity and socioeconomic deprivation). RESULTS Overall 29.4% (1919/6530) of the cohort was retested between 6 weeks and 6 months, with 18% (347/1919) of those retested returning positive results. Lower odds of retesting were observed for males (OR 0.4, 95% CI 0.34-0.48), and individuals of NZ Maori (OR 0.72, 0.61-0.85) and Pacific ethnicities (OR 0.49, 0.39-0.62, reference European). Factors associated with higher odds of repeat positivity on retesting included male gender (OR 2.0, 1.14-2.82), age 15-19 years (OR 1.78, 1.32-2.41, reference 20-24 years), chlamydia/gonorrhoea co-infection (OR 2.39, 1.32-4.35, reference chlamydia only), Maori (OR 1.6, 1.18-2.17) and Pacific ethnicities (OR 1.88, 1.22-2.9, reference European). CONCLUSIONS We observed low adherence to STI retesting guidelines, and marked gender and ethnic disparities in rates of retesting and repeat positivity. Low retesting rates are suggestive of low levels of awareness of this aspect of patient management, and an absence of a systematic approach to retesting. High rates of repeat positivity reinforce the importance of advising patients about reducing their risk of reinfection, including notification and treatment of all recent sexual partners. Greater priority needs to be placed on increasing retesting and reducing rates of reinfection, with strategies implemented to improve these important aspects of patient care and population STI control.
Collapse
Affiliation(s)
- Sally B. Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
| | - Susan M. Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, P O Box 7343, Wellington South, 6242 New Zealand
| | - Susan R. H. Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
| |
Collapse
|
22
|
Lazenby GB, Korte JE, Tillman S, Brown FK, Soper DE. A recommendation for timing of repeat Chlamydia trachomatis test following infection and treatment in pregnant and nonpregnant women. Int J STD AIDS 2016; 28:902-909. [PMID: 27864473 DOI: 10.1177/0956462416680438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to describe the time required to obtain a negative chlamydia test in pregnant and nonpregnant women following treatment to inform test-of-cure collection and recommend an abstinence period to avoid reinfection. Seventy-two women with Chlamydia trachomatis infection, 36 pregnant and 36 nonpregnant, were enrolled in a prospective cohort study. Women were excluded less than 18 years of age, if they had been treated for chlamydia, reported an allergy to macrolide antibiotics, or if they had Myasthenia Gravis. Women were treated for chlamydia with single-dose therapy and submitted weekly vaginal chlamydia nucleic acid amplification tests (NAATs). Once NAAT were negative, the participants completed the study. Forty-seven women completed the study per protocol. The primary outcome was to determine the time to a negative chlamydia NAAT following treatment, with secondary outcomes of determining the appropriate time to collect a test-of-cure following chlamydia treatment and to recommend an appropriate abstinence period following treatment to avoid reinfection. Results showed that the time to a negative chlamydia NAAT was significantly different between groups (log-rank p = 0.0013). The median number of days to obtain a negative chlamydia NAAT was 8 days (IQR 7-14) in pregnant and 7 days (IQR 6-10) in nonpregnant women (WRST p = 0.04). All participants had a negative chlamydia NAAT by day 29 post-treatment. Following single-dose treatment for chlamydia, both pregnant and nonpregnant women should test negative with NAAT by 30 days post-treatment. Clinicians should collect a test-of-cure in pregnant women no earlier than 1 month. To avoid reinfection, women should avoid condomless intercourse for at least 1 month.
Collapse
Affiliation(s)
- Gweneth B Lazenby
- 1 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey E Korte
- 2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah Tillman
- 1 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Florence K Brown
- 1 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Soper
- 1 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
23
|
Tao G, Hoover KW, Nye MB, Peters P, Gift TL, Peruvemba R, Body BA. Rectal Infection With Neisseria gonorrhoeae and Chlamydia trachomatis in Men in the United States. Clin Infect Dis 2016; 63:1325-1331. [PMID: 27572098 DOI: 10.1093/cid/ciw594] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Centers for Disease Control and Prevention guidelines recommend at least annual rectal screening of men who have receptive anal intercourse for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). Only limited national data are available on the prevalence of rectal GC and CT infection among US men. METHODS In collaboration with a large US commercial laboratory, we estimated positivity of the first rectal GC and CT test ("index" test) in men aged 15-60 years tested between January 2013 and May 2015. We estimated the frequency and positivity of pharyngeal or urine specimens tested for GC and CT on the index date, and the frequency and positivity of repeat rectal testing or any follow-up testing at any anatomic site after the index date. RESULTS Of 52 063 tested men aged 15-60 years, approximately 6.1% were positive for GC only, 8.3% for CT only, and 2.7% for both GC and CT on their index date. On that date, 86.5% had either urine or pharyngeal specimens collected, and 56.1% had both specimens collected. Pharyngeal GC infection was highly associated with rectal GC infection. Follow-up testing after 12 months ranged from 42.4% among uninfected men to 56.7% among infected men on the index date. Positivity was at least 5.7% in rectal GC, rectal CT, or pharyngeal GC at their last test. CONCLUSIONS This analysis of a large number of male rectal specimens tested for GC and CT suggest that routine testing and timely repeat rectal GC and CT testing should be prioritized among men who report receptive rectal sex.
Collapse
Affiliation(s)
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melinda B Nye
- Laboratory Corporation of America Holdings, Burlington, North Carolina
| | - Philip Peters
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ram Peruvemba
- Laboratory Corporation of America Holdings, Burlington, North Carolina
| | - Barbara A Body
- Laboratory Corporation of America Holdings, Burlington, North Carolina
| |
Collapse
|
24
|
Owusu-Edusei K, Hoover KW, Gift TL. Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S. Am J Prev Med 2016; 51:216-224. [PMID: 26952078 PMCID: PMC6785744 DOI: 10.1016/j.amepre.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. METHODS Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. RESULTS Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. CONCLUSIONS The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.
Collapse
|
25
|
The Significant Impact of Different Insurance Enrollment Criteria on the HEDIS Chlamydia Screening Measure for Young Women Enrolled in Medicaid and Commercial Insurance Plans. Sex Transm Dis 2016; 42:575-9. [PMID: 26372930 DOI: 10.1097/olq.0000000000000338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The impact of length of enrollment in a health plan on eligibility of women under the Healthcare Effectiveness Data and Information Set (HEDIS) chlamydia screening measure is not fully understood. We assessed the representativeness of the measure among the proportion of women aged 15 to 24 years with a gap in coverage for Medicaid and commercial health insurance. METHODS Truven Health Marketscan Medicaid and commercial health insurance data from 2006 to 2012 were used to make comparisons between proportions of women with a gap in coverage to those enrolled in insurance plans for different numbers of months. RESULTS Approximately 48% of Medicaid-insured women and 31% of commercially insured women had an at least 2-month gap that disqualified them from eligibility for inclusion in the HEDIS chlamydia screening measure. Extending eligibility to women with at least 6 months of coverage, regardless of gap, would increase the proportion of insured women included in the HEDIS measure to 76% (from 52%) for Medicaid and 83% (from 69%) for commercial insurance, without much effect on chlamydia testing rate. This would make the measure more representative of all insured women. CONCLUSIONS The large proportion of young women who had a 2-month or greater gap in coverage in Medicaid had a significant impact on the overall representativeness of the current HEDIS chlamydia screening measure.
Collapse
|
26
|
Taylor MM, Frasure-Williams J, Burnett P, Park IU. Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings. Sex Transm Dis 2016; 43:S28-41. [PMID: 26779685 PMCID: PMC6751565 DOI: 10.1097/olq.0000000000000294] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The asymptomatic nature and suboptimal screening rates of sexually transmitted diseases (STD) call for implementation of successful interventions to improve screening in community-based clinic settings with attention to cost and resources. METHODS We used MEDLINE to systematically review comparative analyses of interventions to improve STD (chlamydia, gonorrhea, or syphilis) screening or rescreening in clinic-based settings that were published between January 2000 and January 2014. Absolute differences in the percent of the target population screened between comparison groups or relative percent increase in the number of tests or patients tested were used to score the interventions as highly effective (>20% increase) or moderately effective (5%-19% increase) in improving screening. Published cost of the interventions was described where available and, when not available, was estimated. RESULTS Of the 4566 citations reviewed, 38 articles describing 42 interventions met the inclusion criteria. Of the 42 interventions, 16 (38.1%) were categorized as highly effective and 14 (33.3%) as moderately effective. Effective low-cost interventions (<$1000) included the strategic placement of specimen collection materials or automatic collection of STD specimens as part of a routine visit (7 highly effective and 1 moderately effective) and the use of electronic health records (EHRs; 3 highly effective and 4 moderately effective). Patient reminders for screening or rescreening (via text, telephone, and postcards) were highly effective (3) or moderately effective (2) and low or moderate cost (<$1001-10,000). Interventions with dedicated clinic staff to improve STD screening were highly effective (2) or moderately effective in improving STD screening (1) but high-cost ($10,001-$100,000). CONCLUSIONS Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be tailored to different clinic settings to improve screening at a low cost.
Collapse
Affiliation(s)
- Melanie M Taylor
- From the *Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; †Arizona Department of Health Services, STD Program, Phoenix, AZ; ‡STD Control Branch, Division of Communicable Disease Control (DCDC), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Sacramento, CA; and §Baltimore Department of Public Health, Baltimore, MD
| | | | | | | |
Collapse
|
27
|
Smith KS, Kaldor JM, Hocking JS, Jamil MS, McNulty AM, Read P, Bradshaw CS, Chen MY, Fairley CK, Wand H, Worthington K, Blake S, Knight V, Rawlinson W, Saville M, Tabrizi SN, Garland SM, Donovan B, Guy R. The acceptability and cost of a home-based chlamydia retesting strategy: findings from the REACT randomised controlled trial. BMC Public Health 2016; 16:83. [PMID: 26822715 PMCID: PMC4730759 DOI: 10.1186/s12889-016-2727-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/13/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chlamydia retesting three months after treatment is recommended to detect reinfections, but retesting rates are typically low. The REACT (retest after Chlamydia trachomatis) randomised trial demonstrated that home-based retesting using postal home-collection kits and SMS reminders, resulted in substantial improvements in retesting rates in women, heterosexual men and men who have sex with men (MSM), with detection of more repeat positive tests compared with SMS reminder alone. In the context of this trial, the acceptability of the home-based strategy was evaluated and the costs of the two strategies were compared. METHODS REACT participants (200 women, 200 heterosexual men, 200 MSM) were asked to complete an online survey that included home-testing acceptability and preferred methods of retesting. The demographics, sexual behaviour and acceptability of home collection were compared between those preferring home-testing versus clinic-based retesting or no preference, using a chi-square test. The costs to the health system of the clinic-based and home retesting strategies and the cost per infection for each were also compared. RESULTS Overall 445/600 (74 %) participants completed the survey; 236/445 from the home-testing arm, and 141 of these (60 %) retested at home. The majority of home arm retesters were comfortable having the kit posted to their home (86 %); found it easy to follow the instructions and collect the specimens (96 %); were confident they had collected the specimens correctly (90 %); and reported no problems (70 %). Most (65 %) preferred home retesting, 21 % had no preference and 14 % preferred clinic retesting. Comparing those with a preference for home testing to those who didn't, there were significant differences in being comfortable having a kit sent to their home (p = 0.045); not having been diagnosed with chlamydia previously (p = 0.030); and living with friends (p = 0.034). The overall cost for the home retest pathway was $154 (AUD), compared to $169 for the clinic-based retesting pathway and the cost per repeat infection detected was $1409 vs $3133. CONCLUSIONS Among individuals initially diagnosed with chlamydia in a sexual health clinic setting, home-based retesting was shown to be highly acceptable, preferred by most participants, and cost-efficient. However some clients preferred clinic-based testing, often due to confidentiality concerns in their home environment. Both options should be provided to maximise retesting rates. TRIAL REGISTRATION The trial was registered with the Australia New Zealand Clinical Trials Registry on September 9, 2011: ACTRN12611000968976.
Collapse
Affiliation(s)
- K. S. Smith
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - J. M. Kaldor
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - J. S. Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - M. S. Jamil
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - A. M. McNulty
- Sydney Sexual Health Centre, Sydney, Australia
- School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia
| | - P. Read
- Kirketon Road Centre, Sydney, Australia
| | - C. S. Bradshaw
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - M. Y. Chen
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - C. K. Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - H. Wand
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | | | - S. Blake
- Sydney Sexual Health Centre, Sydney, Australia
| | - V. Knight
- Sydney Sexual Health Centre, Sydney, Australia
| | - W. Rawlinson
- Serology and Virology Division, (SAViD) SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia
| | | | - S. N. Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Department of Microbiology, Royal Children’s Hospital, Melbourne, Australia
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - S. M. Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Department of Microbiology, Royal Children’s Hospital, Melbourne, Australia
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - B. Donovan
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - R. Guy
- The Kirby Institute, UNSW Australia, Sydney, Australia
| |
Collapse
|
28
|
Teplow-Phipps R, Stockwell MS, Soren K. Adolescent Chlamydia Infection: Treatment, Expedited Partner Therapy, and Testing for Reinfection. Clin Pediatr (Phila) 2015; 54:1383-6. [PMID: 25627102 DOI: 10.1177/0009922814566934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Randi Teplow-Phipps
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Karen Soren
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
29
|
Angel G, Horner PJ, O'Brien N, Sharp M, Pye K, Priestley C, Macleod J, Looker KJ, Turner KME. An observational study to evaluate three pilot programmes of retesting chlamydia-positive individuals within 6 months in the South West of England. BMJ Open 2015; 5:e007455. [PMID: 26510723 PMCID: PMC4636643 DOI: 10.1136/bmjopen-2014-007455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate 3 pilot chlamydia retesting programmes in South West England which were initiated prior to the release of new National Chlamydia Screening Programme (NCSP) guidelines recommending retesting in 2014. METHODS Individuals testing positive between August 2012 and July 2013 in Bristol (n=346), Cornwall (n=252) and Dorset (n=180) programmes were eligible for inclusion in the retesting pilots. The primary outcomes were retest within 6 months (yes/no) and repeat diagnosis at retest (yes/no), adjusted for area, age and gender. RESULTS Overall 303/778 (39.0%) of participants were retested within 6 months and 31/299 (10.4%) were positive at retest. Females were more likely to retest than males and Dorset had higher retesting rates than the other areas. CONCLUSIONS More than a third of those eligible were retested within the time frame of the study. Chlamydia retesting programmes appear feasible within the context of current programmes to identify individuals at continued risk of infection with relatively low resource and time input.
Collapse
Affiliation(s)
- Georgina Angel
- Department of Screening and Immunisation, Public Health England, Bristol, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Norah O'Brien
- South West Office of Sexual Health, Public Health England, Bristol, UK
| | - Matt Sharp
- Cornwall Chlamydia Screening Office, Royal Cornwall Hospitals Trust, Truro, UK
| | - Karl Pye
- Young People Public Health Team, Public Health England, Bristol, UK
| | | | - John Macleod
- Department of Social Medicine, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Katharine J Looker
- Department of Screening and Immunisation, Public Health England, Bristol, UK
| | - Katherine M E Turner
- School of Social and Community Medicine/School of Veterinary Sciences, University of Bristol, Bath, UK
| |
Collapse
|
30
|
Hoover KW, Parsell BW, Leichliter JS, Habel MA, Tao G, Pearson WS, Gift TL. Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act. Am J Public Health 2015; 105 Suppl 5:S690-5. [PMID: 26447908 DOI: 10.2105/ajph.2015.302839] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues. METHODS In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity. RESULTS Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic. CONCLUSIONS Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients.
Collapse
Affiliation(s)
- Karen W Hoover
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Bradley W Parsell
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Jami S Leichliter
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Melissa A Habel
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Guoyu Tao
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - William S Pearson
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Thomas L Gift
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| |
Collapse
|
31
|
Smith KS, Hocking JS, Chen MY, Fairley CK, McNulty AM, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy RJ. Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations. Am J Prev Med 2015; 49:1-11. [PMID: 26094224 DOI: 10.1016/j.amepre.2015.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/10/2015] [Accepted: 01/22/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone. DESIGN In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status. SETTING/PARTICIPANTS Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services. INTERVENTION Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab; heterosexual men, Copan UriSwab; men who have sex with men, UriSwab and rectal swab). MAIN OUTCOME MEASURES The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014. RESULTS The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001); heterosexual men (56% [57/101] vs 34% [34/99], p=0.002); men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010); and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006). CONCLUSIONS The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
Collapse
Affiliation(s)
- Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Marcus Y Chen
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Anna M McNulty
- School of Public Health and Community Medicine, University of New South Wales, Sydney; Sydney Sexual Health Centre, Sydney, Australia
| | - Phillip Read
- Kirby Institute, University of New South Wales, Sydney, Australia; Kirketon Road Centre, Kings Cross, Australia
| | - Catriona S Bradshaw
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - William Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia; Sydney Sexual Health Centre, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
32
|
Age-specific chlamydial infection among pregnant women in the United States: evidence for updated recommendations. Sex Transm Dis 2015; 41:556-9. [PMID: 25118971 DOI: 10.1097/olq.0000000000000166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the United States, chlamydia screening has been recommended for all pregnant women by the Centers for Disease Control and Prevention (CDC) but only for pregnant women who are at increased risk by the US Preventive Services Task Force (USPSTF). Very limited evidence, such as age-specific chlamydia positivity in pregnant women, has been used to develop these recommendations. METHODS We analyzed data from a large commercial laboratory corporation in the United States in 2013. At the first prenatal visit made by women aged 15 to 44 years for whom a chlamydia test was performed between June 2008 and July 2010, we estimated positivity of chlamydia by age, insurance coverage, geographic region, and test type. RESULTS Of 601,001 pregnant women aged 15 to 44 years who had routine prenatal care, 62.9% had private insurance and 32.9% had Medicaid coverage, 60.3% resided in the South region, and 43.2% were aged 15 to 24 years, 26.8% were aged 25 to 29 years, and 19.1% were aged 30 to 34 years. Chlamydia positivity was 3.6% overall, and significantly decreased as age increased (15-19 years: 9.6 %; 20-24 years: 5.2%; 25-29 years: 1.8%; 30-34 years: 0.9%; and 35-44 years: 0.6%; P < 0.05). CONCLUSIONS Our findings of higher positivity among younger pregnant women suggest that the yield is likely to be greater from screening younger pregnant women than from screening older pregnant women to identify chlamydia infection. The benefits of harmonizing CDC and USPSTF recommendations for pregnant women could be explored by reviewing age-specific positivity data and estimating the frequency of prenatal adverse health outcomes caused by chlamydia to develop consensus regarding the age limit for pregnant women who should be screened.
Collapse
|
33
|
Marrazzo J, Suchland R. Recent advances in understanding and managing Chlamydia trachomatis infections. F1000PRIME REPORTS 2014; 6:120. [PMID: 25580274 PMCID: PMC4251420 DOI: 10.12703/p6-120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Worldwide, Chlamydia trachomatis infections rank among the most common sexually transmitted infections (STI), and cause notable reproductive morbidity in women. Although advances in highly accurate and non-invasive diagnostic testing have allowed for better estimation of the burden of disease—especially the asymptomatic state—we still lack a true point-of-care test, and many infections go undetected and untreated. Moreover, limited resources and effort for managing sexual partners of those in whom infection is actually identified comprise a major challenge to control. Here, we review the current state of understanding of this common infection, and efforts to control it.
Collapse
|
34
|
Abstract
Chlamydia trachomatis (CT) screening programs have been established in educational settings in many countries during the past 2 decades. However, recent evidence suggests that high uptake of screening and management (treatment, partner notification, and retesting for reinfection) improves program effectiveness. We conducted a systematic review to understand the screening strategies, the extent of screening conducted, and uptake of management strategies in educational settings. Screening studies in educational settings were identified through a systematic search of published literature from 2005 to 2011. We identified 27 studies describing 30 screening programs in the United States/Canada (n = 10), Europe (n = 8), Australia/New Zealand (n = 5), and Asia (n = 4). Most studies targeted both male and female students (74%). Classroom-based strategies resulted in 21,117 testes overall (4 programs), followed by opportunistic screening during routine health examination (n = 13,470; 5 programs) and opportunistic screening at school-based health centers (n = 13,006; 5 programs). The overall median CT positivity was 4.7% (range, 1.3%-18.1%). Only 5 programs reported treatment rates (median, 100%; range, 86%-100%), 1 partner notification rate (71%), 1 retesting rate within a year of an initial CT diagnosis (47%), and 2 reported repeat positivity rates (21.1% and 26.3%). In conclusion, this systematic review shows that a variety of strategies have been used to screen large numbers of students in educational settings; however, only a few studies have reported CT management outcomes.
Collapse
|
35
|
Peterman TA, Newman DR, Torrone E, Schmitt K, Shiver S. Cumulative risk of chlamydial infection among young women in Florida, 2000-2011. J Adolesc Health 2014; 55:241-6. [PMID: 24704369 PMCID: PMC6743075 DOI: 10.1016/j.jadohealth.2014.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Chlamydia trachomatis is a very common infection among young women in the United States; information on cumulative risk of infection is limited. We sought to estimate the cumulative risk of chlamydial infection for young women. METHODS We measured cumulative risk of reported chlamydial infection for 14- to 34-year-old women in Florida between 2000 and 2011 using surveillance records and census estimates. We calculated reported infections per woman, analyzed first infections to get cumulative risk, and calculated risk of repeat infection over the 12-year period. RESULTS There were 457,595 infections reported among 15- to 34-year-old women. Reports increased annually from 25,390 to 51,536. Nineteen-year-olds were at highest risk with 5.1 infections reported per 100 women in 2011. There were 341,671 different women infected. Among women aged 14-17 years in 2000, over 20% had at least one infection reported within 12 years, and among blacks, this risk was over 36%, and that underestimates risk because 18% of cases were missing race/ethnicity information. Repeat infections were common. Among 53,109 with chlamydia at the age of 15-20 years during 2000-2003, 36.7% had additional infections reported by 2011. CONCLUSIONS More than one out of five women in Florida was reported as having chlamydia during her young-adult years; risk was highest for black women. True infection risks were likely much higher because many infections were not diagnosed or reported. Young women who had chlamydia were very likely to get reinfected. Rates of infection remain high despite years of screening. More information is needed on how to prevent chlamydial infection.
Collapse
Affiliation(s)
- Thomas A. Peterman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Daniel R. Newman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Elizabeth Torrone
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Karla Schmitt
- Florida Department of Health, Division of Disease Control and Health Protection, Tallahassee, FL.,Florida State University, College of Nursing, Tallahassee, FL
| | - Stacy Shiver
- Florida Department of Health, Division of Disease Control and Health Protection, Tallahassee, FL
| |
Collapse
|
36
|
Variation in Adherence to the Treatment Guidelines for Neisseria gonorrhoeae by Clinical Practice Setting, California, 2009 to 2011. Sex Transm Dis 2014; 41:338-44. [DOI: 10.1097/olq.0000000000000113] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Smith KS, Hocking JS, Chen M, Fairley CK, McNulty A, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy R. Rationale and design of REACT: a randomised controlled trial assessing the effectiveness of home-collection to increase chlamydia retesting and detect repeat positive tests. BMC Infect Dis 2014; 14:223. [PMID: 24758169 PMCID: PMC4002559 DOI: 10.1186/1471-2334-14-223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Repeat infection with Chlamydia trachomatis is common and increases the risk of sequelae in women and HIV seroconversion in men who have sex with men (MSM). Despite guidelines recommending chlamydia retesting three months after treatment, retesting rates are low. We are conducting the first randomised controlled trial to assess the effectiveness of home collection combined with short message service (SMS) reminders on chlamydia retesting and reinfection rates in three risk groups. METHODS/DESIGN The REACT (retest after Chlamydia trachomatis) trial involves 600 patients diagnosed with chlamydia: 200 MSM, 200 women and 200 heterosexual men recruited from two Australian sexual health clinics where SMS reminders for retesting are routine practice. Participants will be randomised to the home group (3-month SMS reminder and home-collection) or the clinic group (3-month SMS reminder to return to the clinic). Participants in the home group will be given the choice of attending the clinic if they prefer. The mailed home-collection kit includes a self-collected vaginal swab (women), UriSWAB (Copan) for urine collection (heterosexual men), and UriSWAB plus rectal swab (MSM). The primary outcome is the retest rate at 1-4 months after a chlamydia diagnosis, and the secondary outcomes are: the repeat positive test rate; the reinfection rate; the acceptability of home testing with SMS reminders; and the cost effectiveness of home testing. Sexual behaviour data collected via an online survey at 4-5 months, and genotyping of repeat infections, will be used to discriminate reinfections from treatment failures. The trial will be conducted over two years. An intention to treat analysis will be conducted. DISCUSSION This study will provide evidence about the effectiveness of home-collection combined with SMS reminders on chlamydia retesting, repeat infection and reinfection rates in three risk groups. The trial will determine client acceptability and cost effectiveness of this strategy. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12611000968976.
Collapse
Affiliation(s)
- Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|