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Karim PL, Aryani IA, Nugroho SA, Saleh I, Dewi L, Kurniawati Y, Fitriani F. Treponema Pallidum rapid syphilis compared diagnostic algorithm syphilis in men who have sex with men (MSM). Int J STD AIDS 2024; 35:543-549. [PMID: 38478741 DOI: 10.1177/09564624241239102] [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: 06/07/2024]
Abstract
BACKGROUND Syphilis infection can be asymptomatic and difficult to diagnose based on clinical symptoms. Early detection and treatment are critical for preventing and controlling syphilis as well as long-term serious complications. A serological examination based on the diagnostic algorithm was used to confirm the diagnosis of syphilis. Syphilis is frequent in high-risk groups, such as men who have sex with men (MSM). Treponema pallidum (TP) rapid can be used for early syphilis detection. The diagnostic value of TP rapid with diagnostic algorithm (RPR-TPHA) utilizing whole blood in MSM should be studied. OBJECTIVES To determine the diagnostic value of TP rapid syphilis test compared to a diagnostic algorithm (RPR-TPHA) among MSM. METHODS A diagnostic test with a cross-sectional design at Dr Mohammad Hoesin Palembang General Hospital from November 2022 to January 2023. The sampling method was consecutive sampling with a total sample of 83 MSM based on inclusion and exclusion criteria. All samples were tested for RPR, TPHA, and TP rapid. The diagnostic value of TP rapid was evaluated with RPR-TPHA as a diagnostic algorithm for syphilis. RESULTS The sensitivity and specificity value of the TP rapid compare diagnostic algorithm as gold standard were 95.8% and 96.6% respectively. Other metrics: positive predictive value (PPV) 92%, negative predictive value (NPV) 98%, positive likelihood ratio (PLR) 28.27, negative likelihood ratio (NLR) 0.04, accuracy 96% and AUC 0.962. CONCLUSION The TP rapid test has a high diagnostic value and can be used to establish an early diagnosis of syphilis in MSM.
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Affiliation(s)
- Putri L Karim
- Department of Dermatology, Venereology and Aesthetics, Medical Faculty of Sriwijaya University, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Inda A Aryani
- Department of Dermatology, Venereology and Aesthetics, Medical Faculty of Sriwijaya University, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Suroso A Nugroho
- Department of Dermatology, Venereology and Aesthetics, Medical Faculty of Sriwijaya University, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Irsan Saleh
- Medical Faculty of Sriwijaya University, Palembang, Indonesia
| | - Lisa Dewi
- Regional Health Lab (BBLK), Palembang, Indonesia
| | - Yuli Kurniawati
- Department of Dermatology, Venereology and Aesthetics, Medical Faculty of Sriwijaya University, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Fitriani Fitriani
- Department of Dermatology, Venereology and Aesthetics, Medical Faculty of Sriwijaya University, Dr Mohammad Hoesin General Hospital, Palembang, Indonesia
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Yang F, Zhao P, Tang W, Tucker JD, Xu W, Wang C. HIV self-testing adoption and post-test linkage to care among men who have sex with men in China: a nationwide cross-sectional survey. BMC Infect Dis 2024; 24:532. [PMID: 38802750 PMCID: PMC11129403 DOI: 10.1186/s12879-024-09419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) was recommended to improve HIV testing services. China initiated some of the first HIVST pilots in the world, providing a unique opportunity for implementation research. We aim to investigate HIVST adoption and its following linkage to care among Chinese men who have sex with men (MSM). METHODS Data were collected using an online questionnaire distributed on major social media platforms in 2018, one year after HIVST was officially endorsed and allowed for sale. MSM who were at least 16 years old, assigned as male at birth, and ever tested for HIV were eligible. Primary outcome, adoption was defined as ever use of HIVST. Bivariate and multivariable logistic regressions were performed to explore the association between HIVST adoption and sociodemographic and behavioral factors. Linkage to care was also described via the following sequential events as indicators: (1) receiving result after recent test (2), seeking care from healthcare facility if test result was positive or indeterminate, and (3) delayed time before seeking care. RESULTS A total of 540 participants were included with an average age of 27.4 ± 6.6. Most were never married (87.4%) and half completed college (52.2%). Overall, 75.2% had adopted HIVST. Self-test kits were commonly obtained from community-based organizations (54.4%) and from online (46.6%). HIVST adoption was positively associated with having college or higher education (OR = 1.66, 95%CI: 1.07-2.57), and negatively associated with age older than 30 (AOR = 0.52, 95%CI: 0.32-0.84). Adoption was not associated with other socio-demographic or behavioral factors. After receiving HIV-positive or indeterminate results, 25/25 of HIVST adopters sought care while 3 out of 7 (42.9%) non-adopters sought care (p < 0.001). Delays before seeking care were not significantly different between HIVST adopters compared to non-adopters (P = 0.366). CONCLUSION Many MSM adopted HIVST shortly after its launch. Our findings suggested that HIVST linkage to care is promising among MSM in China. Integration of HIVST with other essential sexual health services is needed.
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Affiliation(s)
- Fan Yang
- Institute of Population Research, Peking University, Beijing, China
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
| | - Weiming Tang
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph D Tucker
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | - Wenqian Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
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Nhamo D, Mangenah C, Chapwanya G, Mamvuto T, Mahaka I, Sri-Pathmanathan C, Ferrand RA, Kranzer K, Terris-Prestholt F, Marks M, Tucker JD. Feasibility and economic costs of syphilis self-testing to expand test uptake among gay, bisexual and transgender men: results from a randomised controlled trial in Zimbabwe. Sex Health 2023; 20:514-522. [PMID: 37666490 DOI: 10.1071/sh23038] [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: 02/23/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Access to syphilis testing and treatment is frequently limited for men who have sex with men (MSM). A two-armed randomised controlled trial compared feasibility and costs of facility-based syphilis testing with self-testing among MSM in Zimbabwe. METHODS This randomised controlled trial was conducted in Harare, with participants randomised 1:1. Syphilis self-testing was offered in community-based settings. The primary outcome was the relative proportion of individuals taking up testing. Total incremental economic provider and user costs, and cost per client tested, diagnosed and treated were assessed using ingredients-based costing in 2020US$. RESULTS A total of 100 men were enrolled. The two groups were similar in demographics. The mean age was 26years. Overall, 58% (29/50) and 74% (37/50) of facility- and self-testing arm participants, respectively, completed syphilis testing. A total of 28% of facility arm participants had a reactive test, with 50% of them returning for confirmatory testing yielding 28% reactivity. In the self-testing arm, 67% returned for confirmatory testing, with a reactivity of 16%. Total provider costs were US$859 and US$736, and cost per test US$30 and US$15 for respective arms. Cost per reactive test was US$107 and US$123, and per client treated US$215 and US$184, respectively. The syphilis test kit was the largest cost component. Total user cost per client per visit was US$9. CONCLUSION Syphilis self-testing may increase test uptake among MSM in Zimbabwe. However, some barriers limit uptake including lack of self-testing and poor service access. Bringing syphilis testing services to communities, simplifying service delivery and increasing self-testing access through community-based organisations are useful strategies to promote health-seeking behaviours among MSM.
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Affiliation(s)
- Definate Nhamo
- Pangaea Zimbabwe AIDS Trust (PZAT), Harare, Zimbabwe; and Department of Nursing and Public Health, University of KwaZulu Natal (UKZN), Durban, South Africa
| | - Collin Mangenah
- Centre for Sexual Health and HIV Research (CeSHHAR), Harare, Zimbabwe; and Department of International Global Public Health, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | | | | | - Imelda Mahaka
- Pangaea Zimbabwe AIDS Trust (PZAT), Harare, Zimbabwe
| | | | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; and Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; and Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; and UNAIDS, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Joseph D Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
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Towns JM, Tieosapjaroen W, Mello MB, Baggaley RC, Johnson CC, Jamil MS, Rowley J, Barr-DiChiara M, Terris-Prestholt F, Chen MY, Chow EPF, Fairley CK, Zhang L, Ong JJ. The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e726-e734. [PMID: 37482070 DOI: 10.1016/s2468-2667(23)00128-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST. METHODS We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129). FINDINGS In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options. INTERPRETATION Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up. FUNDING WHO, Australian National Health and Medical Research Council, and Unitaid.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Jane Rowley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | | | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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5
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Wang C, Zhao P, Weideman AM, Xu W, Ong JJ, Jamil MS, Yang B, Tucker JD. Expanding hepatitis C virus test uptake using self-testing among men who have sex with men in China: two parallel randomized controlled trials. BMC Med 2023; 21:279. [PMID: 37507702 PMCID: PMC10386771 DOI: 10.1186/s12916-023-02981-w] [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: 11/25/2022] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND HCV self-testing (HCVST) may be an effective strategy to address low rates of HCV test uptake among men who have sex with men (MSM). We evaluated the effectiveness and cost of providing HCVST to increase HCV test uptake among MSM in China. METHODS Two parallel, unmasked, individual-level randomized controlled trials were conducted. HIV-negative MSM and MSM living with HIV were enrolled from 22 cities in China. Men in both trials were randomly assigned (1:1) into standard-of-care (SOC) or HCVST arms. The primary outcome was the proportion of participants who tested for HCV during the trial period. Intervention effects were estimated using multiply imputed data in the main analysis. Costs were measured using a micro-costing approach. RESULTS A total of 84 men who were HIV-negative (trial 1) and 84 men living with HIV were enrolled (trial 2). Overall, the proportion of individuals who underwent HCV testing during the trial period was higher in the HCVST arm compared to SOC in trial 1 (estimated risk difference (RD): 71.1%, 95% CI: 54.6 to 87.7%) and trial 2 (estimated RD: 62.9%, 95% CI: 45.7 to 80.1%). Over half (58.6%, 34/58) of HCV self-testers reported the self-test was their first HCV test. The cost per person tested in trial 1 was $654.52 for SOC and $49.83 for HCVST, and in trial 2 was $438.67 for SOC and $53.33 for HCVST. CONCLUSIONS Compared to the standard of care, providing HCVST significantly increased the proportion of MSM testing for HCV in China, and was cheaper per person tested. TRIAL REGISTRATION Chinese Clinical Trial Registry. REGISTRATION NUMBER ChiCTR2100048379.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China.
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | - Ann Marie Weideman
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for AIDS Research Biostatistics Core, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Wenqian Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Peeling RW, Mabey D, Chen XS, Garcia PJ. Syphilis. Lancet 2023; 402:336-346. [PMID: 37481272 DOI: 10.1016/s0140-6736(22)02348-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 07/24/2023]
Abstract
Syphilis is a sexually and vertically transmitted bacterial infection caused by the bacterium Treponema pallidum. Its prevalence is high in low-income and middle-income countries, and its incidence has increased in high-income countries in the last few decades among men who have sex with men. Syphilis is a major cause of adverse pregnancy outcomes in low-income and middle-income countries. Clinical features include a primary chancre at the point of inoculation, followed weeks later by the rash of secondary syphilis, a latent period, and in some cases, involvement of the eyes, CNS, and cardiovascular systems. It is diagnosed serologically. A single intramuscular dose of long-acting benzathine penicillin is recommended for people who have had syphilis for less than 1 year and longer courses for people with late latent syphilis. Control strategies include screening and treatment of all pregnant women, and targeted interventions for groups at high risk. Vaccine development, research on antibiotic prophylaxis, and digital messaging as prevention strategies are ongoing.
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Affiliation(s)
- Rosanna W Peeling
- London School of Hygiene & Tropical Medicine, London, UK; University of Manitoba, Winnipeg, MB, Canada.
| | - David Mabey
- London School of Hygiene & Tropical Medicine, London, UK
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; National Center for STD Control, Nanjing, China; Center for Global Health, Southern Medical University, Guangzhou, China
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Washington, Seattle, WA, USA
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Huang J, Jiang Y, Lin W, Chen R, Zhou J, Guo S, Zhao M, Xie Q, Chen X, Zhao M, Zhao Z, Yang B, Zheng J, Liao Y. Virulence and Adhesion of the Treponema pallidum Nichols Strain Simultaneously Decrease in a Continuous-Infection New Zealand White Rabbit Model. ACS Infect Dis 2023; 9:1221-1231. [PMID: 37192527 DOI: 10.1021/acsinfecdis.2c00601] [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: 05/18/2023]
Abstract
Syphilis is a sexually transmitted disease caused by T. pallidum, and the T. pallidum Nichols strain is widely used with the New Zealand white rabbit model for evaluating drug and vaccine protection. However, changes in the virulence of T. pallidum during transmission are still unknown. Herein, we explored the virulence of T. pallidum in the rabbit model of continuous infection through phenotype observation and further investigated the relationship between virulence and adhesion. During the construction of the syphilis rabbit model, the optimal dose of 104/site of T. pallidum was determined to effectively observe the depiction of syphilis lesions and immune responses for further virulence evaluation. Its virulence was gradually weakened during the interaction with host cells or the testicular passage, which was also proven using the pathological phenotype of the syphilis rabbit model. In addition, the adhesive ability of T. pallidum was reduced with increasing generation, which was verified via the co-incubation of the pathogen with Sf1Ep cells. This study provides insight into the relationship by which the virulence and adhesion of T. pallidum were decreased in a New Zealand white rabbit model of continuous infection and contributes to our knowledge regarding the development of syphilis.
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Affiliation(s)
- Jialin Huang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Yinbo Jiang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Weiqiang Lin
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Rongyi Chen
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Jiajian Zhou
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Shuang Guo
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Minghai Zhao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Qiulin Xie
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Xu Chen
- Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, P. R. China
| | - Meijiao Zhao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Zhen Zhao
- Materials Interfaces Center, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, P. R. China
| | - Bin Yang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Judun Zheng
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
| | - Yuhui Liao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou 510091, P. R. China
- Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, P. R. China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan 750004, P. R. China
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8
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Wang D, Tan R, Marley G, Tucker JD, Tang W. Promoting STI self-testing through HIV self-testing. J Int AIDS Soc 2023; 26:e26138. [PMID: 37363937 DOI: 10.1002/jia2.26138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Dongya Wang
- University of Miami, School of Communication, Miami, Florida, USA
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Rayner Tan
- University of North Carolina Project-China, Guangzhou, China
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
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Nguyen PY, Caddy C, Wilson AN, Blackburn K, Page MJ, Gülmezoglu AM, Narasimhan M, Bonet M, Tunçalp Ö, Vogel JP. Self-care interventions for preconception, antenatal, intrapartum and postpartum care: a scoping review. BMJ Open 2023; 13:e068713. [PMID: 37164476 PMCID: PMC10173967 DOI: 10.1136/bmjopen-2022-068713] [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: 09/27/2022] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To identify current and emerging self-care interventions to improve maternity healthcare. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase, EmCare, PsycINFO, Cochrane CENTRAL/CDSR, CINAHL Plus (last searched on 17 October 2021). ELIGIBILITY CRITERIA Evidence syntheses, interventional or observational studies describing any tool, resource or strategy to facilitate self-care in women preparing to get pregnant, currently pregnant, giving birth or post partum. DATA EXTRACTION/SYNTHESIS Screening and data collection were conducted independently by two reviewers. Self-care interventions were identified based on predefined criteria and inductively organised into 11 categories. Characteristics of study design, interventions, participants and outcomes were recorded. RESULTS We identified eligible 580 studies. Many included studies evaluated interventions in high-income countries (45%) and during antenatal care (76%). Self-care categories featuring highest numbers of studies were diet and nutrition (26% of all studies), physical activity (24%), psychosocial strategies (18%) and other lifestyle adjustments (17%). Few studies featured self-care interventions for sexual health and postpartum family planning (2%), self-management of medication (3%) and self-testing/sampling (3%). Several venues to introduce self-care were described: health facilities (44%), community venues (14%), digital platforms (18%), partner/peer support (7%) or over-the-counter products (13%). Involvement of health and community workers were described in 38% and 8% of studies, who supported self-care interventions by providing therapeutics for home use, training or counselling. The most common categories of outcomes evaluated were neonatal outcomes (eg, birth weight) (31%), maternal mental health (26%) and labour outcomes (eg, duration of labour) (22%). CONCLUSION Self-care interventions in maternal care are diverse in their applications, implementation characteristics and intended outcomes. Many self-care interventions were implemented with support from the health system at initial stages of use and uptake. Some promising self-care interventions require further primary research, though several are matured and up-to-date evidence syntheses are needed. Research on self-care in the preconception period is lacking.
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Affiliation(s)
- Phi-Yen Nguyen
- Methods in Evidence Synthesis Unit, Monash University, Melbourne, Victoria, Australia
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Cassandra Caddy
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Alyce N Wilson
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Kara Blackburn
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua P Vogel
- International Development, Burnet Institute, Melbourne, Victoria, Australia
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Shifting the power: scale-up of access to point-of-care and self-testing for sexually transmitted infections in low-income and middle-income settings. Curr Opin Infect Dis 2023; 36:49-56. [PMID: 36753705 DOI: 10.1097/qco.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE OF REVIEW Point-of-care (POC) testing for sexually transmitted infections (STIs) can provide complementary coverage to existing HIV testing services in LMICs. This review summarizes current and emerging technologies for detecting STIs in LMICs, with an emphasis on women, discharge-causing infections (chlamydia, gonorrhoea, trichomoniasis, and syphilis), true POC, self-testing, ethics, and economic considerations related to equitable access. RECENT FINDINGS The WHO have recently adapted guidelines for treatment of STIs in women that advise the use of true-POC or near-POC tests to improve case finding. The number of rapid, sensitive, and specific POC diagnostics for STIs has increased significantly over the past 10 years, although adoption of these in low-income and middle-income countries (LMICs) remains limited. Barriers to POC adoption by patients include the cost of tests, the inconvenience of lengthy clinic visits, low perceived risk, stigma, lack of partner notification, and lack of trust in healthcare providers. Lowering the cost of true POC lateral flow devices, interfacing these with digital or eHealth technologies, and enabling self-testing/self-sampling will overcome some of these barriers in LMICs. Ensuring linkage of diagnostic tests to subsequent care remains one of the major concerns about self-testing, irrespective of geography, although available evidence from HIV self-testing suggests that linkage to care is similar to that for facility-based testing. SUMMARY Increasing access to sensitive STI true POC tests will strengthen reproductive healthcare in LMICs. Although HIV self-testing is demonstrably useful in LMICs, there is an urgent need for randomized trials evaluating the utility and cost-effectiveness of similar tests for other sexually transmitted infections.
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Wang Y, Zhang W, Gong X, Ong JJ, Marks M, Zhao P, Tucker JD, Tang W, Wu D, Wang C. Optimizing Peer Distribution of Syphilis Self-Testing Among Men Who Have Sex with Men in China: A Multi-City Pragmatic Randomized Controlled Trial. ARCHIVES OF SEXUAL BEHAVIOR 2023:1-12. [PMID: 36626071 PMCID: PMC9831370 DOI: 10.1007/s10508-022-02507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Syphilis testing uptake is low among men who have sex with men (MSM) around the world. Syphilis self-testing (SST) may complement facility-based testing; the distribution model is yet to be explored. This study aimed to investigate the effectiveness of peer distribution of syphilis self-testing on promoting syphilis testing. We conducted a three-arm, unblinded, parallel individually randomized controlled trial among MSM in three cities in Guangdong, China. Inclusion criteria were: men who were born biologically male, aged 18 or above, have ever had sex with a man, will refer the interventions to peers, and will take the three-month follow-up survey. Enrolled indexes were randomly assigned in a 1:1:1 ratio into standard-of-care arm (SOC arm), standard SST delivery arm (S-SST arm), and a web-based referral link SST delivery arm (RL-SST arm). The primary outcome was the number of returned photograph-verified syphilis testing results per index. A total number of 300 indexes were enrolled, with 100 indexes in each arm. The number of verified syphilis tests per index conducted by alters was 0.05 in the control arm, 0.51 in the S-SST arm, and 0.31 in the RL-SST arm. The cost per alter tested was $760.60 for SOC, $83.78 for S-SST, and $93.10 for RL-SST. Minimal adverse event was reported among both indexes and alters during the study. This study showed that peer distribution of SST could improve syphilis testing uptake among MSM in China compared to facility-based testing. This approach warrants further consideration as part of expanding syphilis self-testing.
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Affiliation(s)
- Yajie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Wei Zhang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Xiao Gong
- Department of Biostatistics, Guangzhou Jeeyor Medical Research Co., Ltd, Guangzhou, Guangdong, China
| | - Jason J Ong
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, 510091, China.
- Southern Medical University Institute for Global Health, Guangzhou, Guangdong, China.
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China.
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12
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Undelikwo VA, Shilton S, Folayan MO, Alaba O, Reipold EI, Martínez-Pérez GZ. COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection. PLoS One 2023; 18:e0282570. [PMID: 37053243 PMCID: PMC10101386 DOI: 10.1371/journal.pone.0282570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria. METHODS In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied. RESULTS The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive. CONCLUSION Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.
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Affiliation(s)
- Veronica A Undelikwo
- Department of Sociology, University of Calabar, Calabar, Cross River State, Nigeria
| | | | | | - Oluwatoyin Alaba
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Zhao P, Yang Z, Zhang Y, Chen J, Fu X, Tang W, Zhou J. Prevalence of syphilis and risk factors among HIV-positive men who have sex with men in Guangdong province. Front Public Health 2022; 10:1025221. [PMID: 36438237 PMCID: PMC9682027 DOI: 10.3389/fpubh.2022.1025221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background HIV-positive men who have sex with men (MSM) tend to have high syphilis incidence. Our objective is to evaluate the prevalence of syphilis and determine the risk factors of syphilis among HIV-positive MSM. Methods A cross-sectional study with convenience sampling was performed among HIV-positive MSM in six cities of Guangdong Province from June 2020 to August 2021. Participants completed a survey including social-demographic characteristics, sexual behaviors and self-reported syphilis, chlamydia, gonorrhea, herpes, human papillomavirus statuses after HIV diagnosis. Multivariate logistic regression was used to determine the factors associated with syphilis and sexually transmitted diseases (STD). Results Among 944 HIV-positive MSM, 141 (14.9, 95% CI: 12.7-17.2%) men had syphilis and 220 (23.3, 95% CI: 20.6-26.0%) men had STD. Multivariate analysis indicated that MSM who met male sexual partners mainly through traditional meeting places (spa or bath house, sauna, foot or body massage parlor) in the last 6 months [adjusted Odds Ratio (aOR) = 2.91, 95% CI: 1.09-7.79], and who were diagnosed with herps after the HIV diagnosis (aOR = 3.79, 95% CI: 1.16-12.39) were more likely to have syphilis. In addition, MSM who met male sexual partners mainly through traditional meeting places in the last 6 month (aOR = 2.55, 95% CI: 1.01-6.42), and who had more than one male sexual partner in the last 6 months (aOR = 1.88, 95% CI: 1.17-3.02) were more likely to have STD. Conclusions The prevalence of syphilis and other STDs is relatively high among HIV-positive MSM in southern China. Routine syphilis screening as a part of HIV monitoring among HIV-positive MSM will have important epidemiological significance for the management of infected patients, and can help reduce the spread of syphilis.
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Affiliation(s)
- Peizhen Zhao
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ziying Yang
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ye Zhang
- Kirby Institute, New South Wales University, Sydney, NSW, Australia
| | - Jinmei Chen
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xuezhen Fu
- International Department of Nanjing No.13 Middle School, Nanjing, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China,University of North Carolina Project-China, Guangzhou, China,*Correspondence: Weiming Tang
| | - Jiyuan Zhou
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China,Jiyuan Zhou
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14
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Hu H, Chen Y, Shi L, Liu X, Xu Z, Sun L, Zhao X, Zhou Y, Lu J, Zhang Z, Liu X, Fu G. Prevalence of syphilis and chlamydia trachomatis infection among men who have sex with men in Jiangsu province, China: A cross-sectional survey. Front Public Health 2022; 10:1006254. [PMID: 36304236 PMCID: PMC9592808 DOI: 10.3389/fpubh.2022.1006254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background Epidemics of sexually transmitted infections (STIs) among men who have sex with men (MSM) are major global public health concerns. This study aimed to examine the prevalence of syphilis and chlamydia trachomatis (CT) infection and associated factors among MSM in Jiangsu province, China, hoping to provide updated data for the formulation of relevant policies. Methods A cross-sectional survey was conducted among MSM from April to July 2021 in four cities in the province. Socio-demographic characteristics and behavioral information were collected through a face-to-face questionnaire interview. Venous blood specimens were collected for HIV, hepatitis C (HCV), and syphilis testing using serological testing methods. First-void urine specimens were collected for CT and Neisseria gonorrhoeae (NG) testing using nucleic acid amplification testing (NAAT) methods. Chi-square tests were used to compare differences in syphilis and CT infection between subgroups of variables. Multivariate logistic regression analysis was used to identify factors associated with syphilis and CT infection. Results A total of 1,087 participants were enrolled. The prevalence of HIV, HCV, syphilis, CT and NG infection were 6.6, 0.4, 6.3, 4.2, and 0.4%, respectively. MSM recruited online [adjusted odds ratio (aOR) = 2.189, P = 0.020], diagnosed with an STI in the past 12 months (aOR = 3.304, P < 0.001), and living with HIV (aOR = 4.721, P < 0.001) were more likely to have syphilis infection. MSM who were younger than 25 years (aOR = 4.286, P = 0.020), had senior high school level education (aOR = 2.521, P = 0.038), and were recruited via VCT clinics (aOR = 3.455, P = 0.001) were more likely to have CT infection. Conclusions Our study showed a high prevalence of syphilis and chlamydia among MSM in Jiangsu province, China. STI screening, diagnosis, and treatment services promotion should be a top priority on the prevention agenda.
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Affiliation(s)
- Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoxia Liu
- Zhenjiang Center for Disease Control and Prevention, Zhenjiang, China
| | - Zhuping Xu
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Lin Sun
- Yangzhou Center for Disease Control and Prevention, Yangzhou, China
| | - Xiuping Zhao
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ying Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zhi Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,*Correspondence: Gengfeng Fu
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15
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Theel ES, Pritt BS. The false promise of cellular tests for Lyme borreliosis. THE LANCET. INFECTIOUS DISEASES 2022; 22:1264-1265. [PMID: 35714661 DOI: 10.1016/s1473-3099(22)00230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Elitza S Theel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA.
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16
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Xu W, Reipold EI, Zhao P, Tang W, Tucker JD, Ong JJ, Wang J, Easterbrook P, Johnson CC, Jamil MS, Wang C. HCV Self-Testing to Expand Testing: A Pilot Among Men Who Have Sex With Men in China. Front Public Health 2022; 10:903747. [PMID: 35712303 PMCID: PMC9194083 DOI: 10.3389/fpubh.2022.903747] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hepatitis C virus self-testing (HCVST) may increase test uptake especially among marginalized key populations such as men who have sex with men (MSM). We conducted an observational study to assess the usability, acceptability and feasibility of HCVST among MSM in China. Methods An observational study with convenience sampling was performed among MSM in Guangzhou, China in 2019. The OraQuick® HCV Rapid Antibody Test kits were used in this study. Participants performed all 12 HCVST steps and interpreted the results in the presence of a trained observer. Usability was defined as the number and percentage of participants who completed all testing steps correctly without assistance and interpreted the results correctly. Inter-reader concordance was calculated as the percentage agreement between the results interpreted by the participant and those interpreted by a trained staff member. The same process was used to estimate inter-operator agreement between the self-testing and professional use test results. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. Results Among 100 participants with median age 27 (interquartile range 23–30) years, 4% reported prior history of HCV testing, 41% reported using blood-based HIV self-testing in the past, 54% (95%CI: 43.7–64.0%) completed all self-testing steps correctly without assistance and interpreted the results correctly. Both the inter-reader and inter-operator concordance were excellent at 97% (95%CI: 91.5–99.4%) and 98% (95%CI: 93.0–99.8%), respectively. The majority rated the HCVST process as very easy (52%, 95%CI: 41.8–62.1%) or easy (41%, 95%CI: 31.3–51.3%), 76% (95%CI: 66.4–84.0%) were willing to use HCVST again, and 75% (95%CI: 65.3–83.1%) would recommend it to their family and friends. Conclusions Our findings demonstrate that oral fluid HCVST has high usability and acceptability among Chinese MSM. More implementation research is needed to plan how best to position and scale-up HCVST alongside other facility-and community-based testing approaches and ensure data linkage into health systems.
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Affiliation(s)
- Wenqian Xu
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,Southern Medical University Institute for Global Health, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | | | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Southern Medical University Institute for Global Health, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Southern Medical University Institute for Global Health, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,School of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jinshen Wang
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,Southern Medical University Institute for Global Health, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Case Johnson
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheng Wang
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,Southern Medical University Institute for Global Health, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
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17
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Martin K, Wenlock R, Roper T, Butler C, Vera JH. Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review. BMC Infect Dis 2022; 22:561. [PMID: 35725437 PMCID: PMC9208134 DOI: 10.1186/s12879-022-07534-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07534-9.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Rhys Wenlock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tom Roper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ceri Butler
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Dzobo M, Dzinamarira T, Murewanhema G, Madziva R, Herrera H, Musuka G. Limited syphilis testing for key populations in Zimbabwe: A silent public health threat. S Afr J Infect Dis 2022; 37:385. [PMID: 35815225 PMCID: PMC9257705 DOI: 10.4102/sajid.v37i1.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022] Open
Abstract
In this article, the authors discuss the problem of high prevalences of active syphilis amongst key populations (KPs) in Zimbabwe, in combination with low testing rates, partly because of a difficult legal and social environment for these populations. The article highlights the need to develop strategies to address the high prevalence of syphilis amongst KPs. The authors discuss requirements for addressing deficits in existing clinical services, predominantly primary care settings, in providing primary healthcare, including sexually transmitted infection (STI) management, to Zimbabwe’s KP communities and utility of point-of-care testing and self-testing and other innovations to improve testing uptake.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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Zhao P, Shi Y, Wang C. Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China. BMC Infect Dis 2022; 22:485. [PMID: 35606752 PMCID: PMC9125904 DOI: 10.1186/s12879-022-07476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China. METHODS A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion. RESULTS Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion. CONCLUSIONS Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.
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Affiliation(s)
- Peizhen Zhao
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510095 China
- STD Control Department, Southern Medical University Institute for Global Health, Guangzhou, China
| | - Yijia Shi
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Cheng Wang
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510095 China
- STD Control Department, Southern Medical University Institute for Global Health, Guangzhou, China
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Wang C, Li X, Wang Y, Yang B. Syphilis Self-Testing Among Female Sex Workers in China: Implications for Expanding Syphilis Screening. Front Public Health 2022; 10:744240. [PMID: 35493357 PMCID: PMC9045586 DOI: 10.3389/fpubh.2022.744240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSyphilis self-testing (SST) may help expand syphilis test uptake among female sex workers. However, there has been no studies on examining SST among female sex workers. We aim to examine SST experience and its determinants among female sex workers in China.MethodsA venue-based, cross-sectional study of female sex workers was conducted in eight Chinese cities in 2019. Participants completed a survey including socio-demographic characteristics, sexual behaviors, and SST history. Multivariable logistic regression was conducted to evaluate the associated factors with SST.ResultsAmong 1,287 Chinese female sex workers, 72.1% (928/1,287) had ever tested for syphilis, and 5.9% (76/1,287) had ever used syphilis self-testing. Among syphilis self-testers, more than half (57.9%, 44/76) reported that the self-test was their first syphilis test, around one-fifth (18.4%, 14/76) reported that syphilis self-testing results influenced the price of commercial sex. After adjusting for covariates, female sex workers who received anal sex in the past month (adjusted odds ratio [aOR]: 2.6, 95%CI: 1.5–4.3, p < 0.001), used drugs before or during sex (aOR: 3.8, 95%CI: 2.3–6.4, p < 0.001), tested for other sexually transmitted infections (STIs) in the past 6 months (aOR: 3.4, 95%CI: 1.9–6.0), ever tested in the hospital (aOR: 5.1, 95%CI: 2.5–10.4, p < 0.001), and ever tested in the community (aOR: 1.7, 95%CI: 1.3–2.2, p < 0.001) were more likely to perform syphilis self-testing.ConclusionsSyphilis self-testing has the potential to expand testing coverage, and increase testing frequency with limited potential harms among FSW. Further evaluation on the intervention effects based on syphilis self-testing among FSW are needed.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
- *Correspondence: Cheng Wang
| | - Xia Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Yajie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
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21
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Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among men who have sex with men in China: A multiarm randomized controlled trial. PLoS Med 2022; 19:e1003930. [PMID: 35235573 PMCID: PMC8890628 DOI: 10.1371/journal.pmed.1003930] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. METHODS AND FINDINGS An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing. CONCLUSIONS Compared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested). TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1900022409.
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22
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Zhao P, Yang Z, Li B, Xiong M, Zhang Y, Zhou J, Wang C. Simple-to-use nomogram for predicting the risk of syphilis among MSM in Guangdong Province: results from a serial cross-sectional study. BMC Infect Dis 2021; 21:1199. [PMID: 34844553 PMCID: PMC8628378 DOI: 10.1186/s12879-021-06912-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to develop and validate a simple-to-use nomogram for the prediction of syphilis infection among men who have sex with men (MSM) in Guangdong Province. Methods A serial cross-sectional data of 2184 MSM from 2017 to 2019 was used to develop and validate the nomogram risk assessment model. The eligible MSM were randomly assigned to the training and validation dataset. Factors included in the nomogram were determined by multivariate logistic regression analysis based on the training dataset. The receiver operating characteristic (ROC) curves was used to assess its predictive accuracy and discriminative ability. Results A total of 2184 MSM were recruited in this study. The prevalence of syphilis was 18.1% (396/2184). Multivariate logistic analysis found that age, the main venue used to find sexual partners, condom use in the past 6 months, commercial sex in the past 6 months, infection with sexually transmitted diseases (STD) in the past year were associated with syphilis infection using the training dataset. All these factors were included in the nomogram model that was well calibrated. The C-index was 0.80 (95% CI 0.76–0.84) in the training dataset, and 0.79 (95% CI 0.75–0.84) in the validation dataset. Conclusions A simple-to-use nomogram for predicting the risk of syphilis has been developed and validated among MSM in Guangdong Province. The proposed nomogram shows good assessment performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06912-z.
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Affiliation(s)
- Peizhen Zhao
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ziying Yang
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Baohui Li
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Mingzhou Xiong
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ye Zhang
- Kirby Institute, New South Wales University, Sydney, Australia
| | - Jiyuan Zhou
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China. .,Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China.
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
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23
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Wu D, Zhou Y, Yang N, Huang S, He X, Tucker J, Li X, Smith KM, Ritchwood T, Jiang X, Liu X, Wang Y, Huang W, Ong J, Fu H, Bao H, Pan S, Dai W, Tang W. Social Media-Based Secondary Distribution of Human Immunodeficiency Virus/Syphilis Self-testing Among Chinese Men Who Have Sex with Men. Clin Infect Dis 2021; 73:e2251-e2257. [PMID: 32588883 PMCID: PMC8492201 DOI: 10.1093/cid/ciaa825] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Social media and secondary distribution (distributing self-testing kits by indexes through their networks) both show strong promise to improve human immunodeficiency virus (HIV) self-testing uptake. We assessed an implementation program in Zhuhai, China, which focused on the secondary distribution of HIV/syphilis self-test kits among men who have sex with men (MSM) via social media. METHODS Men aged ≥16 years, born biologically male, and ever had sex with another man were recruited as indexes. Banner ads on a social media platform invited the participants to apply for up to 5 self-test kits every 3 months. Index men paid a deposit of US$15/kit refundable upon submitting a photograph of a completed test result via an online submission system. They were informed that they could distribute the kits to others (referred to as "alters"). RESULTS A total of 371 unique index men applied for 1150 kits (mean age, 28.7 [standard deviation, 6.9] years), of which 1141 test results were returned (99%). Among them, 1099 were valid test results; 810 (74%) were from 331 unique index men, and 289 tests (26%) were from 281 unique alters. Compared to index men, a higher proportion of alters were naive HIV testers (40% vs 21%; P < .001). The total HIV self-test reactivity rate was 3%, with alters having a significantly higher rate than indexes (5% vs 2%; P = .008). A total of 21 people (3%) had a reactive syphilis test result. CONCLUSIONS Integrating social media with the secondary distribution of self-test kits may hold promise to increase HIV/syphilis testing coverage and case identification among MSM.
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Affiliation(s)
- Dan Wu
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Insititute of Global Health and Sexually Transmitted Infection Research, Southern Medical University, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Nancy Yang
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Shanzi Huang
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Joseph Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of North Carolina Project–China, Guangzhou, China
| | - Xiaofeng Li
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Kumi M Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Tiarney Ritchwood
- Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | | | - Xuan Liu
- University of North Carolina Project–China, Guangzhou, China
| | - Yehua Wang
- University of North Carolina Project–China, Guangzhou, China
| | - Wenting Huang
- Behavioral Sciences and Health Education, Emory University, Georgia, Atlanta, USA
| | - Jason Ong
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Huanyu Bao
- University of North Carolina Project–China, Guangzhou, China
| | - Stephen Pan
- Department of Health and Environmental Sciences, Xi’an Jiaotong Liverpool University, Suzhou, China
| | - Wencan Dai
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Insititute of Global Health and Sexually Transmitted Infection Research, Southern Medical University, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
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24
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Huang L, Wu H, Yan H, Liang Y, Li Q, Shui J, Han Z, Tang S. Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China. Front Med (Lausanne) 2021; 8:662689. [PMID: 34307399 PMCID: PMC8293274 DOI: 10.3389/fmed.2021.662689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives: The objectives of this study were to distinguish the role of men who have sex with men (MSM) with or without syphilis testing in HIV-1 transmission and to provide molecular evidence of syphilis testing as a proxy marker for identifying the subgroup of MSM. Methods: HIV-1 transmission clusters were constructed by HIV-TRACE and Cluster Picker using HIV-1 pol sequences from 729 newly diagnosed HIV-infected MSM from 2008 to 2012 in Guangzhou, China. The role of MSM in HIV-1 transmission networks was determined by a node influence measurement and centrality analysis. The association between syphilis testing and factors related to HIV-1 transmission and antiretroviral treatment (ART) were analyzed by the Cox regression model. Results: Among HIV-infected MSM, 56.7% did not test for syphilis at the time of HIV-1 diagnosis. MSM without syphilis testing was a specific subgroup of MSM with a larger closeness centrality and clustering coefficient than the recipients of syphilis testing (P < 0.001), indicating their central position in the HIV-1 transmission networks. The median degree and radiality within HIV-1 transmission networks as well as the median K-shell scores were also greater for MSM without syphilis testing (P < 0.001), suggesting their relatively greater contribution in transmitting HIV-1 than the receipts of syphilis testing. MSM with syphilis testing usually did not disclose their occupation or were more likely to be unemployed or to take non-skilled jobs, to have a history of sexually transmitted infections (STIs), and to be AIDS patients when diagnosed with HIV-1 infection (P < 0.05). Multivariable Cox regression analysis indicated that syphilis testing per se did not promote the engagement of ART (P = 0.233) or affect the speed of CD4+ T cell count recovery after treatment (P = 0.256). Conclusions: Our study identifies syphilis testing as a proxy marker of a specific subgroup of HIV-infected MSM who refuse syphilis testing during HIV-1 diagnosis with an important role in HIV-1 transmission. Specific prevention and intervention targeting MSM without syphilis testing during HIV-1 care are urgently needed.
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Affiliation(s)
- Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hao Wu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huanchang Yan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhao Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qingmei Li
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhigang Han
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.,Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.,Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
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25
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Wang Y, Zhang W, Bao D, Ong JJ, Tucker JD, Ye R, Zheng H, Yang B, Wang C. Social network distribution of syphilis self-testing among men who have sex with men in China: study protocol for a cluster randomized control trial. BMC Infect Dis 2021; 21:491. [PMID: 34044760 PMCID: PMC8161568 DOI: 10.1186/s12879-021-06137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis is a common sexually transmitted infection (STI) among men who have sex with men (MSM). Increasing syphilis testing is important to syphilis control. However, in low- and middle-income countries like China, syphilis testing rates remain low among MSM. We describe a randomized controlled trial protocol to examine the effectiveness of social network distribution approaches of syphilis self-testing among MSM in China. METHODS We will recruit index and alter MSM. Indexes will be eligible if they: are born biologically male; aged 18 years or above; ever had sex with another man; are willing to distribute syphilis testing packages or referral links to their alters; and willing to provide personal contact information for future follow-up. Three hundred MSM will be recruited and randomly assigned in a 1:1:1 ratio into three arms: standard of care (control arm); standard syphilis self-testing (SST) delivery arm; and referral link SST delivery arm. Indexes will distribute SST packages or referral links to encourage alters to receive syphilis testing. All indexes will complete a baseline survey and a 3-month follow-up survey. Syphilis self-test results will be determined by photo verification via a digital platform. The primary outcome is the mean number of alters who returned verified syphilis testing results per index in each arm. DISCUSSION The trial findings will provide practical implications in strengthening syphilis self-testing distribution and increasing syphilis testing uptake among MSM in China. This study also empowers MSM community in expanding syphilis testing by using their own social network. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2000036988 . Registered 26 August 2020 - Retrospectively registered.
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Affiliation(s)
- Yajie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Wei Zhang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Dongping Bao
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Rouxuan Ye
- Department of Biostatistics, Southern Medical University, Guangzhou, Guangdong, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China. .,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China. .,Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, China.
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26
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Sri-Pathmanathan C, Nhamo D, Mamvuto T, Chapwanya G, Terris-Prestholt F, Mahaka I, Marks M, Tucker JD. Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe. Sex Transm Infect 2021; 98:197-202. [PMID: 33927008 PMCID: PMC7612625 DOI: 10.1136/sextrans-2020-054911] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/22/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Self-testing for STIs such as HIV and syphilis may empower sexual minorities and expand uptake of STI testing. While much is known about HIV self-testing (HIVST), less is known about syphilis self-testing, particularly in low-income settings. The objective of this study is to determine context-specific facilitators and barriers for self-testing and to assess the usability of syphilis self-testing in Zimbabwe among men who have sex with men (MSM). Methods This mixed methods study was conducted in Harare as part of a larger syphilis self-testing trial. The study included in-depth interviews (phase I) followed by usability testing and a second interview (phase II). In-depth interviews were conducted with MSM and key informants prior to syphilis self-testing. The same MSM then used the syphilis self-test, quantitatively assessed its usability and participated in a second in-depth interview. Phase I data were analysed using a thematic approach, guided by an adapted social ecological model conceptual framework. Phase II interviews were analysed using rapid assessment procedure methodology, and usability was assessed using a pre-established index, adapted from existing HIVST scales. Results Twenty MSM and 10 key informants were recruited for phase I in-depth interviews, and 16 of these MSM participated in phase II by completing a syphilis self-test kit. Facilitating factors for self-testing included the potential for increased privacy, convenience, autonomy, and avoidance of social and healthcare provider stigma. Barriers included the fear to test and uncertainty about linkage to care and treatment. Data from the Usability Index suggested high usability (89.6% on a 0–100 scale) among the men who received the self-test. Conclusions MSM in Zimbabwe were willing to use syphilis self-test kits and many of the barriers and facilitators were similar to those observed for HIVST. Syphilis self-testing may increase syphilis test uptake among sexual minorities in Zimbabwe and other low-income and middle-income countries.
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Affiliation(s)
- Clarisse Sri-Pathmanathan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Fern Terris-Prestholt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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27
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Wang C, Wang YJ, Tucker JD, Xiong MZ, Fu HY, Smith MK, Tang WM, Ong JJ, Zheng HP, Yang B. Correlates of HIV self-testing among female sex workers in China: implications for expanding HIV screening. Infect Dis Poverty 2020; 9:147. [PMID: 33092641 PMCID: PMC7583185 DOI: 10.1186/s40249-020-00765-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) self-testing may help improve test uptake among female sex workers. China has implemented many HIV self-testing programs among men who have sex with men, creating an opportunity for promotion among female sex workers. However, there is a limited literature on examining HIV self-testing among female sex workers. This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China. Methods A venue-based, cross-sectional study was conducted among Chinese female sex workers in 2019. Participants completed a survey including social-demographic characteristics, sexual behaviors, and HIV self-testing history, the distribution of which were analyzed using descriptive analysis. Multivariable logistic regression was conducted to identify associations with HIV self-testing. Results Among 1287 Chinese female sex workers, 1072 (83.3%, 95% confidence interval [CI] 81.2–85.3%) had ever tested for HIV, and 103 (8.0%, 95% CI 6.6–9.6%) had ever used HIV self-testing. More than half reported that the self-test was their first HIV test (59.2%, 61/103), around one-fifth reported HIV self-testing results influenced the price of sex (21.4%, 22/103). A minority of individuals reported ever experiencing pressure to undertake HIV self-testing (6.8%, 7/103). After adjusting for covariates, HIV self-testing was positively associated with receiving anal sex in the past month (adjusted odds ratio [aOR] = 2.2, 95% CI 1.4–3.5), using drugs before or during sex (aOR = 2.8, 95% CI 1.8–4.5), injecting drugs in the past 6 months (aOR = 2.6, 95% CI 1.2–6.0), being diagnosed with other sexually transmitted infections (aOR = 1.6, 95% CI 1.0–2.5), tested for other sexually transmitted infections in the past six months (aOR = 3.4, 95% CI 2.1–5.5), ever tested in the hospital (aOR = 3.4, 95% CI 2.0–5.6), and ever tested in the community (aOR = 1.5, 95% CI 1.2–1.9). Conclusions Our findings suggest that HIV self-testing could expand overall HIV testing uptake, increase HIV testing frequency, reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers. HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China. .,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
| | - Ya-Jie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Ming-Zhou Xiong
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Hong-Yun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - Wei-Ming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Victoria, Melbourne, Australia
| | - He-Ping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
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Zhang J, Huang X, Chen Y, Wang H, Zhang Y, Wang H, Mei Z, Jia Y, Chu Z, Hu QH, He X, Zhang L, Hu Z, Bao R, Li S, Ding H, Jiang Y, Geng W, Tang W, Xu J. HIV and other STIs self-testing to reduce risk compensation among men who have sex with men who use oral pre-exposure prophylaxis in China: protocol for a randomised waitlist-controlled trial. BMJ Open 2020; 10:e036231. [PMID: 32690516 PMCID: PMC7371146 DOI: 10.1136/bmjopen-2019-036231] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection among men who have sex with men by up to 99%. However, in real-world settings, PrEP users may exhibit risk compensation after uptake of PrEP, including more condomless anal intercourse (CAI) and increased sexually transmitted infection (STI) acquisition. HIV self-testing (HIVST) decreases CAI among men who have sex with men (MSM) by providing awareness of the HIV status of oneself and one's sexual partners. Here, we describe the rationale and design of a randomised waitlist-controlled trial to examine the impact of HIVST on risk compensation among PrEP users. METHODS AND ANALYSIS The study is a two-arm randomised waitlist-controlled trial with 1000 HIV-negative MSM in four major cities in China who will be taking oral PrEP (involving tenofovir disoproxil fumarate/emtricitabine) either daily (n=500) or in an event-driven regimen (n=500). The participants will be randomised (1:1) to either the immediate HIVST intervention arm (HIVST plus standard facility-based counselling and testing from 0 to 12 months) or the waitlist arm (standard facility-based counselling and testing from 0 to 6 months, then crossover to receive the HIVST intervention in months 7-12). Participants will provide blood samples to assess the incidence of syphilis and herpes simplex virus type 2 (HSV-2) during a follow-up. The primary outcomes will be the occurrence of CAI, number of sexual partners and incidence of syphilis and HSV-2 during a follow-up. The secondary outcomes will be the HIV and STI testing frequency and STI treatment adherence during a follow-up. The planned start and end dates for the study is 26 December 2018 and 31 December 2020. ETHICS AND DISSEMINATION The Medical Science Research Ethics Committee of The First Affiliated Hospital of China Medical University has approved the study (IRB(2018)273). TRIAL REGISTRATION NUMBER ChiCTR1800020374.
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Affiliation(s)
- Jing Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaojie Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Chongqing Public Health Medical Center, Chongqing, China
| | - Hui Wang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Yonghui Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hongyi Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhu Mei
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yueru Jia
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - ZhenXing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaoqing He
- Chongqing Public Health Medical Center, Chongqing, China
| | - Lukun Zhang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Zhili Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Rantong Bao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Shangcao Li
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Promoting routine syphilis screening among men who have sex with men in China: study protocol for a randomised controlled trial of syphilis self-testing and lottery incentive. BMC Infect Dis 2020; 20:455. [PMID: 32600260 PMCID: PMC7325146 DOI: 10.1186/s12879-020-05188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/22/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low- and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China. METHODS Four hundred forty-four high-risk MSM will be recruited online and randomized in a 1:1:1 ratio to (1) standard syphilis self-testing arm; (2) a self-testing arm program enhanced with crowdsourcing and a lottery-based incentive, and (3) a standard of care (control). Self-testing services include a free syphilis self-test kit through the mail at monthly intervals. Participants in the lottery incentive arm will additionally receive health promotion materials generated from an open crowdsourcing contest and be given a lottery draw with a 10% chance to win 100 RMB (approximately 15 US Dollars) upon confirmed completion of syphilis testing. Syphilis self-test kits have step-by-step instructions and an instructional video. This is a non-blinded, open-label, parallel RCT. Participants in each arm will be followed-up at three and 6 months through WeChat (a social media app like Facebook messenger). Confirmation of syphilis self-test use will be determined by requiring participants to submit a photo of the used test kit to study staff via secure data messaging. Both self-testing and facility-based testing will be ascertained by sending a secure photographic image of the completed kit through an existing digital platform. The primary outcome is the proportion of participants who tested for syphilis in the past 3 months. DISCUSSION Findings from this study will provide much needed insight on the impact of syphilis self-testing on promoting routine syphilis screening among MSM. The findings will also contribute to our understanding of the safety, effectiveness and acceptability of syphilis self-testing. These findings will have important implications for self-testing policy, both in China and internationally. TRIAL REGISTRATION ChiCTR1900022409 (10 April, 2019).
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Ong JJ, Li CC, Fu H, Nie J, Tang W, Chang W, Smith MK, Marks M, Yang B, Wang C, Tucker J. Risk attitudes, risky sexual behaviours and willingness to test negative for syphilis using lottery-based financial incentives among Chinese men who have sex with men. Sex Transm Infect 2019; 96:355-357. [PMID: 31653680 DOI: 10.1136/sextrans-2019-054072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Individuals with risk-loving attitudes may be more likely to participate in high-risk sex and gambling. We investigated whether a lottery-based financial incentive to have a negative syphilis test may attract Chinese men who have sex with men (MSM) who practised risky sexual behaviours. METHODS In July 2018, a national online cross-sectional survey was conducted in China. We collected information on willingness to participate in a lottery-based financial incentive where men were eligible if they tested negative for syphilis, and the minimum prize that would attract them to participate. We used a validated risk attitude scale which asked about the willingness to take risks in six domains, ranging from 0 (avoids taking risk) to 10 (fully prepared to take risks). To avoid multicollinearity, we used principal components analysis to create a 'risk attitude index'. Bivariable and multivariable logistic regression explored factors associated with willingness to test negative for syphilis. RESULTS 699 MSM enrolled with a median age of 26 years (IQR: 23-30). 70% self-identified as gay and 52% reported ever testing for syphilis. 64% stated they were likely or very likely to test for syphilis linked with a lottery-based incentive. The median desired amount for the lottery had an expected value of ¥10 (US$1.50, IQR: ¥5-¥30). Men who had greater odds of willingness to participate in the lottery-based incentive were those scoring highest on the risk attitude index (adjusted OR (AOR) 2.6, 95% CI 1.5 to 4.3), those reporting more than one sexual partner in the last 3 months (AOR 1.7, 95% CI 1.2 to 2.4), those who had not used condoms during their last sex (AOR 1.5, 95% CI 1.0 to 2.2) and those who ever had group sex (AOR 1.5, 95% CI 1.0 to 2.2). CONCLUSION Chinese MSM with higher risk attitudes and who reported riskier sexual behaviours indicated greater interest in the concept of a lottery-based incentive for syphilis testing. A lottery-based incentive may be a promising strategy for promoting condom use among risk-loving men.
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Affiliation(s)
- Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Chang Chang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - HongYun Fu
- University of North Carolina Project China, Guangzhou, China.,Community Health and Research Division, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Juan Nie
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - WeiBin Chang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China .,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,University of North Carolina Project China, Guangzhou, China
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