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Stocks D, Nixon E, Trickey A, Homer M, Brooks-Pollock E. Limited impact of contact tracing in a University setting for COVID-19 due to asymptomatic transmission and social distancing. Epidemics 2023; 45:100716. [PMID: 37690279 DOI: 10.1016/j.epidem.2023.100716] [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: 10/29/2021] [Revised: 06/21/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
Contact tracing is an important tool for controlling the spread of infectious diseases, including COVID-19. Here, we investigate the spread of COVID-19 and the effectiveness of contact tracing in a university population, using a data-driven ego-centric network model constructed with social contact data collected during 2020 and similar data collected in 2010. We find that during 2020, university staff and students consistently reported fewer social contacts than in 2010, however those contacts occurred more frequently and were of longer duration. We find that contact tracing in the presence of social distancing is less impactful than without social distancing. By combining multiple data sources, we show that University-aged populations are likely to develop asymptomatic COVID-19 infections. We find that asymptomatic index cases cannot be reliably discovered through contact tracing and consequently transmission in their social network is not significantly reduced through contact tracing. In summary, social distancing restrictions had a large impact on limiting COVID-19 outbreaks in universities; to reduce transmission further contact tracing should be used in conjunction with alternative interventions.
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Affiliation(s)
- Daniel Stocks
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1TW, United Kingdom.
| | - Emily Nixon
- School of Biological Sciences, University of Bristol, Bristol BS8 1TQ, United Kingdom; Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, United Kingdom
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol BS8 1TW, United Kingdom
| | - Martin Homer
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1TW, United Kingdom
| | - Ellen Brooks-Pollock
- Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, United Kingdom
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Cope AB, Kirkcaldy RD, Weidle PJ, Jackson DA, Laramee N, Weber R, Rowse J, Mangla A, Fox B, Saunders KE, Taniguchi K, Usagawa L, Cahill ME, Harrington P, Ricketts EK, Harbi K, Malec L, Templin TG, Drociuk D, Hannibal T, Klos R, Bernstein KT. Evaluation of Public Health Contact Tracing for Mpox Among Gay, Bisexual, and Other Men Who Have Sex With Men-10 US Jurisdictions, May 17-July 31, 2022. Am J Public Health 2023; 113:815-818. [PMID: 37141555 PMCID: PMC10262246 DOI: 10.2105/ajph.2023.307301] [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] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
Objectives. To examine the potential impact of contact tracing to identify contacts and prevent mpox transmission among gay, bisexual, and other men who have sex with men (MSM) as the outbreak expanded. Methods. We assessed contact tracing outcomes from 10 US jurisdictions before and after access to the mpox vaccine was expanded from postexposure prophylaxis for persons with known exposure to include persons at high risk for acquisition (May 17-June 30, 2022, and July 1-31, 2022, respectively). Results. Overall, 1986 mpox cases were reported in MSM from included jurisdictions (240 before expanded vaccine access; 1746 after expanded vaccine access). Most MSM with mpox were interviewed (95.0% before vaccine expansion and 97.0% after vaccine expansion); the proportion who named at least 1 contact decreased during the 2 time periods (74.6% to 38.9%). Conclusions. During the period when mpox cases among MSM increased and vaccine access expanded, contact tracing became less efficient at identifying exposed contacts. Public Health Implications. Contact tracing was more effective at identifying persons exposed to mpox in MSM sexual and social networks when case numbers were low, and it could be used to facilitate vaccine access. (Am J Public Health. 2023;113(7):815-818. https://doi.org/10.2105/AJPH.2023.307301).
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Affiliation(s)
- Anna Barry Cope
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Robert D Kirkcaldy
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Paul J Weidle
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - David A Jackson
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Nicholas Laramee
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Robyn Weber
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Julia Rowse
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Anil Mangla
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Brian Fox
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Katharine E Saunders
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Kristen Taniguchi
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Lauren Usagawa
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Megan E Cahill
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Pauline Harrington
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Erin K Ricketts
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Khalil Harbi
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Lenka Malec
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Tingting Gu Templin
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Dan Drociuk
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Terri Hannibal
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Rachel Klos
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
| | - Kyle T Bernstein
- Anna Barry Cope, Robert D. Kirkcaldy, Paul J. Weidle, David A. Jackson, and Kyle T. Bernstein are with the Centers for Disease Control and Prevention (CDC) Mpox Emergency Response Team, Atlanta, GA. Nicholas Laramee and Robyn Weber are with the Colorado Department of Public Health and Environment, Denver. Julia Rowse and Anil Mangla are with the District of Columbia Department of Health, Washington, DC. Brian Fox and Katharine E. Saunders are with the Florida Department of Health, Tallahassee. Kristen Taniguchi and Lauren Usagawa are with the Hawaii State Department of Health, Honolulu. Megan E. Cahill is with the Idaho Department of Health and Welfare, Boise. Pauline Harrington is with the Michigan Department of Health and Human Services, Detroit. Erin K. Ricketts and Khalil Harbi are with the North Carolina Department of Health and Human Services, Raleigh. Lenka Malec and Tingting Gu Templin are with the New York City Department of Health and Mental Hygiene, New York, NY. Dan Drociuk and Terri Hannibal are with the South Carolina Department of Health and Environmental Control, Columbia. Rachel Klos is with the Wisconsin Department of Health Services, Madison. Katharine E. Saunders, Megan E. Cahill, and Erin K. Ricketts are also with the Epidemic Intelligence Service, CDC, Atlanta
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Golden MR, AugsJoost B, Bender M, Brady KA, Collins LS, Dombrowski JD, Ealey J, Garcia C, George D, Gilliard B, Harris T, Johnson C, Khosropour CM, Rumanes SF, Surita K, Tabidze I, Udeagu CCN, Walker-Baban C, Cramer NO. The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States. J Acquir Immune Defic Syndr 2022; 89:498-504. [PMID: 34974472 DOI: 10.1097/qai.0000000000002904] [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: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain. SETTING State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative. METHODS The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity. RESULTS Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019. CONCLUSIONS HIV case-finding resulting from APS in the United States is low.
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Affiliation(s)
- Matthew R Golden
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | | | | | | | - Lyell S Collins
- Nevada Division of Public and Behavioral Health, Las Vegas, NV
| | - Julia D Dombrowski
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Jamila Ealey
- Georgia Department of Public Health, Atlanta, GA
| | | | - Dan George
- Florida Department of Health, Tallahassee, FL
| | - Bernard Gilliard
- South Carolina Department of Health and Environmental Control, Columbia, SC
| | | | | | - Christine M Khosropour
- Center for AIDS and STD
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Sophia F Rumanes
- County of Los Angeles, Department of Public Health Division of HIV and STD Programs, Los Angeles, CA
| | - Karen Surita
- HIV/STD Prevention and Care Unit, Texas Department of State Health Services, Austin, TX
| | | | - Chi-Chi N Udeagu
- Bureau of Hepatitis, HIV and STIs, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - Cherie Walker-Baban
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA; and
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Cope AB, Bernstein KT, Matthias J, Rahman M, Diesel JC, Pugsley RA, Schillinger JA, Chew Ng RA, Klingler EJ, Mobley VL, Samoff E, Peterman TA. Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions. Sex Transm Dis 2022; 49:160-165. [PMID: 34310526 PMCID: PMC9380961 DOI: 10.1097/olq.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient. METHODS We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate. RESULTS Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%). CONCLUSIONS Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.
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Affiliation(s)
- Anna Barry Cope
- Centers for Disease Control and Prevention, Atlanta, GA
- North Carolina Department of Health and Human Services, Raleigh, NC
| | | | - James Matthias
- Centers for Disease Control and Prevention, Atlanta, GA
- Florida Department of Health, Tallahassee, FL
| | - Mohammad Rahman
- Centers for Disease Control and Prevention, Atlanta, GA
- Louisiana Department of Health, New Orleans, LA
| | - Jill C. Diesel
- Michigan Department of Health and Human Services, Detroit, MI
| | - River A. Pugsley
- Centers for Disease Control and Prevention, Atlanta, GA
- Virginia Department of Health, Richmond, VA
| | - Julia A. Schillinger
- Centers for Disease Control and Prevention, Atlanta, GA
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Rilene A. Chew Ng
- Centers for Disease Control and Prevention, Atlanta, GA
- San Francisco Department of Public Health, San Francisco, CA
| | - Ellen J. Klingler
- New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Erika Samoff
- North Carolina Department of Health and Human Services, Raleigh, NC
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Learner ER, Schlanger K, Mauk K, Pham CD, Mukai R, Mulleavey L, Kerani RP, Albano T, Sessoms B, Holderman JL, Toro B, Sankaran M, Kirkcaldy RD. Outcomes of Traditional and Enhanced Gonorrhea Partner Services in the Strengthening the US Response to Resistant Gonorrhea Project, 2017 to 2019. Sex Transm Dis 2021; 48:S124-S130. [PMID: 34407012 PMCID: PMC8767793 DOI: 10.1097/olq.0000000000001527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention implemented Strengthening the US Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners; (2) interviewing, testing, and treating partners; and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners. METHODS We analyzed partner services investigation data from 8 jurisdictions participating in SURRG from 2017 to 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data. RESULTS Of 1242 index patients identified, 506 named at least 1 sexual partner. Traditional partner services yielded 1088 sexual partners, and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters. CONCLUSIONS Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people.
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Affiliation(s)
- Emily R Learner
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Schlanger
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kerry Mauk
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cau D Pham
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lacy Mulleavey
- Colorado Department of Public Health and Environment, Denver, CO
| | - Roxanne P Kerani
- Division of Allergy and Infectious Disease, University of Washington/Public Health-Seattle & King County, Seattle, WA
| | | | | | | | - Brian Toro
- New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Robert D Kirkcaldy
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
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Lukac CD, Consolacion T, Ryan V, Cumming E, Mercado J, Ford G, Ogilvie GS, Gilbert M, Grennan T, Wong J. Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada. Sex Transm Dis 2021; 48:901-908. [PMID: 34030159 DOI: 10.1097/olq.0000000000001477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts. METHODS All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches. RESULTS Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10-9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271). CONCLUSIONS Public health- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.
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Affiliation(s)
| | | | - Venessa Ryan
- Clinical Prevention Services, BC Centre for Disease Control
| | - Emma Cumming
- Clinical Prevention Services, BC Centre for Disease Control
| | - Janyn Mercado
- Clinical Prevention Services, BC Centre for Disease Control
| | - Geoffrey Ford
- Clinical Prevention Services, BC Centre for Disease Control
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Samarasekara K, Ringshall M, Parashar K, Pickering A, Buss Z, Nichols K, Devlin J, Fitzpatrick C, Williams D, Richardson D. Contribution of men who have sex with men (MSM) attending due to contact tracing to the diagnoses of HIV, syphilis and gonorrhoea in MSM from a clinic-based population. Sex Transm Infect 2021; 98:307-309. [PMID: 34452992 DOI: 10.1136/sextrans-2021-055169] [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: 06/04/2021] [Accepted: 07/24/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Rates of HIV, syphilis and gonorrhoea have increased over the past 20 years in men who have sex with men (MSM). Contact tracing strategies have increased the number of MSM attending clinics as sexual contacts. Understanding the outcomes of contact tracing could inform future public health policies to reduce the burden of STIs in MSM. METHOD We aimed to describe the contribution of MSM attending as notified sexual contacts of patients with HIV, syphilis and gonorrhoea to the overall diagnoses of HIV, syphilis and gonorrhoea in MSM in a cross-sectional study. We collected data on all MSM diagnosed with HIV, syphilis and gonorrhoea in 2019 and evaluated which of these MSM were tested due to attending as a sexual contact. RESULTS Sexual contacts of HIV, syphilis and gonorrhoea contributed to 20% (95% CI=17.3% to 23.7%) of all diagnoses of HIV (3 of 30, 10%), syphilis (28 of 183, 15%) or gonorrhoea (98 of 420, 23%) in the study period. Asymptomatic sexual contacts contributed to 12% (95% CI=9.6% to 14.9%) of all diagnoses of HIV (3 of 30, 10%), syphilis (16 of 183, 9%) and gonorrhoea (57 of 420, 14%). The proportion of MSM diagnosed with gonorrhoea attending as sexual contacts of gonorrhoea (21%) was significantly greater than MSM diagnosed with HIV, attending as sexual contacts of HIV (3%) or MSM diagnosed with syphilis, attending as a sexual contact of syphilis (4%) (p<0.001). Furthermore, the proportion of MSM diagnosed with syphilis, attending as a sexual contact of another STI (11%) was significantly greater than MSM diagnosed with HIV, attending as a contact of another STI (7%) or MSM diagnosed with gonorrhoea, attending as a sexual contact of another STI (2%) (p<0.001). CONCLUSION Contact tracing contributes significantly to the overall diagnoses of HIV, syphilis and gonorrhoea including asymptomatic sexual contacts in our population. Further efforts to increase the yield from contact tracing may continue to reduce the burden of HIV, syphilis and gonorrhoea within sexual networks of MSM.
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Affiliation(s)
| | | | - Kuhuk Parashar
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Alice Pickering
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Zoe Buss
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - John Devlin
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK .,Brighton and Sussex Medical School, Brighton, UK
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Udeagu CCN, Shah S, Misra K, Xia Q. The usefulness of HIV partner services in the age of treatment as prevention: a registry-based study. Lancet HIV 2020; 7:e482-e490. [PMID: 32621875 DOI: 10.1016/s2352-3018(20)30116-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Partner services are effective tools to identify new cases among sex or needle-sharing partners of people with a new HIV diagnosis. Little is known about partners previously diagnosed with HIV who are not in care or are in care with unsuppressed HIV viral load. We aimed to quantify the previously diagnosed partners of people with a new HIV infection and examine their HIV care status and viral suppression in the 12 months before elicitation. METHODS We did a registry-based study. We used the New York City HIV Surveillance Registry to determine HIV care status and viral load of partners elicited from newly diagnosed people between Jan 1, 2007, and Dec 31, 2018. Previously diagnosed partners with no report of CD4 count or viral load in the preceding 12 months were presumed not to be in care, viral load suppression (<200 copies per mL) was based on the last viral load in the year preceding elicitation, and viraemia was defined as a viral load of 200 copies per mL or more. We used multinomial logistic regression to generate covariates of care and viral load status and their marginal effects. FINDINGS 11 964 partners were elicited; 2603 (33%) were previously diagnosed and 485 (20%) were not in care. 1153 (49%) of 2343 with a viral load report were in care and viraemic at elicitation. The odds of being not in care were higher in non-Hispanic black than non-Hispanic white or other partners (adjusted odds ratio 1·89, 95% CI 1·09-3·27) and lower in partners with male-to-male sex transmission risk (0·37, 0·26-0·51) and country of birth other than the USA (0·57, 0·39-0·85). The odds of being viraemic were higher in partners younger than 30 years than in those aged 30 years or older (1·68, 1·35-2·09) and lower among people with male-to-male sex transmission risk (0·36, 0·29-0·44) and country of birth other than the USA (0·78, 0·66-0·97). INTERPRETATION People with HIV should receive ongoing HIV prevention counselling and partner services data should inform engagement in care for previously diagnosed partners. FUNDING None.
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Affiliation(s)
- Chi-Chi N Udeagu
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA.
| | - Sharmila Shah
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Kavita Misra
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Qiang Xia
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
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Integrating Human Immunodeficiency Virus Testing Into Syphilis Partner Services in Mississippi to Improve Human Immunodeficiency Virus Case Finding. Sex Transm Dis 2020; 46:240-245. [PMID: 30870325 DOI: 10.1097/olq.0000000000000951] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mississippi has the 10th highest rate of new human immunodeficiency virus (HIV) infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case finding strategy has not been evaluated. METHODS We identified all early syphilis (primary, secondary, and early latent) case records reported from July 1, 2014, to December 31, 2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview as the number of syphilis index case patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. RESULTS A total of 1535 (95%) of the 1619 early syphilis index case patients were interviewed for PS. These case patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745 (56%) of 1321 partners not previously diagnosed with HIV were tested for HIV. Partner services identified 696 new early syphilis case patients (46%) and 24 (3.2%) new HIV case patients among partners. Sixty-four index case patient interviews were needed to identify 1 new case of HIV, and 2 interviews were needed to identify 1 new case of syphilis among partners. CONCLUSIONS Syphilis PS allowed MSDH to interact with 1592 men who have sex with men over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case patients could increase HIV case finding in Mississippi.
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Wang C, Zhao P, Tang W, Smith MK, Ong JJ, Wong NS, Fu H, Tucker JD, Zheng H, Luo Z, Yang B. Partner Notification Among Persons With Early Syphilis in Shenzhen, China, 2011-2017: Implications for Practice and Policy. Sex Transm Dis 2020; 47:232-237. [PMID: 32011419 PMCID: PMC8190519 DOI: 10.1097/olq.0000000000001135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Partner notification (PN) is an essential component of syphilis control and is recommended by Chinese Sexually Transmitted Disease guidelines. However, in China, studies examining local practice are limited. This study evaluated PN outcomes among persons with early syphilis infection in an urban district in China. METHODS From 2011 to 2017, persons diagnosed with early syphilis were asked to participate in an evaluation of supportive patient referral partner services for all recent sex partners, and the contact and case finding indices were determined in Nanshan District, Shenzhen, China. RESULTS During the study period, 642 index patients with early syphilis reported 1749 sex partners. Of those partners, 678 were potentially contactable and 525 (30%) were contacted. The overall contact index was 0.82. Among the 1749 partners reported, 1108 (63%) were described as casual partners, and only 37 (3%) were contacted (contact index 0.13) compared with 641 partners who were either spouses and regular partners (contact index, 1.37). Among those 525 partners contacted, 418 (80%) were tested, and 205 (39%) were diagnosed with and treated for syphilis. Among those, 9 (4%) were primary, 26 (13%) were secondary, 16 (8%) were early latent, and 154 (49%) were other syphilis infections. The overall case finding index was 0.29. CONCLUSIONS There is a need to improve PN practices in China, which include developing operational guidelines of PN and to develop and evaluate novel PN ways like using Internet-based strategy.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - 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
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, 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
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
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Historical and Current Trends in the Epidemiology of Early Syphilis in San Francisco, 1955 to 2016. Sex Transm Dis 2019; 45:S55-S62. [PMID: 29787467 DOI: 10.1097/olq.0000000000000870] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seventeen years into a sustained epidemic, early syphilis (ES) rates in San Francisco (SF) are continuing to increase and the demographics of the affected population are changing. We provide a historical overview of ES in SF among men who have sex with men (MSM) and describe trends in the epidemiology and disease investigation outcomes. METHODS We examined data from the SF Department of Public Health's patient-based registry of integrated STD surveillance, clinical, and field investigation data to describe demographic and behavioral characteristics of ES cases, as well as outcomes of syphilis partner services (PS). χ Tests were performed to examine categorical differences across periods. Analysis of variance was used to examine differences in continuous variables. RESULTS In 2016, 1095 ES cases were reported among males in SF, a 219% increase from the 343 cases identified 10 years ago. Between 1996-1999 and 2010-2016, an increasing proportion of ES cases were among MSM younger than 25 years, nonwhite, and HIV negative (P < 0.05). A decreasing proportion of ES cases were assigned for PS, among whom a smaller proportion of reported sex partners were identified by name, resulting in an overall decline in the proportion of cases who had at least one named partner treated as a result of PS (Disease Intervention Rate) from 30.5 in 2000-2004 to 14.8 in 2010-2016. CONCLUSIONS Syphilis case rates continue to increase in SF and the epidemic is expanding beyond a core population. Additional resources and innovative prevention approaches are needed to reduce the burden of syphilis among MSM.
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Integration of Contact Tracing and Phylogenetics in an Investigation of Acute HIV Infection. Sex Transm Dis 2019; 45:222-228. [PMID: 29465708 DOI: 10.1097/olq.0000000000000726] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The integration of traditional contact tracing with HIV sequence analyses offers opportunities to mitigate some of the barriers to effective network construction. We used combined analyses during an outbreak investigation of spatiotemporally clustered acute HIV infections to evaluate if the observed clustering was the product of a single outbreak. METHODS We investigated acute and recent HIV index cases reported in North Carolina from 2013 to 2014 and their reported contacts. Contact tracing networks were constructed with surveillance data and compared with phylogenetic transmission clusters involving an index case using available HIV-1 pol sequences including 1672 references. Clusters were defined as clades of 2 or more sequences with a less than 1.5% genetic distance and a bootstrap of at least 98% on maximum-likelihood phylogenies. RESULTS In total, 68 index cases and 210 contacts (71 HIV infected) were reported. The contact tracing network involved 58 components with low overall density (1.2% statewide); 33% of first-degree contacts could not be located. Among 38 (56%) of 68 index cases and 34 (48%) of 71 contacts with sequences, 13 phylogenetic clusters were identified (size 2-4 members). Four clusters connected network components that were not linked in contact tracing. The largest component (n = 28 cases) included 2 distinct phylogenetic clusters and spanned 2 regions. CONCLUSIONS We identified the concurrent expansion of multiple small transmission clusters rather than a single outbreak in a largely disconnected contact tracing network. Integration of phylogenetic analyses provided timely information on transmission networks during the investigation. Our findings highlight the potential of combined methods to better identify high-risk networks for intervention.
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Li XC, Kusi L, Marak T, Bertrand T, Chan PA, Galárraga O. The Cost and Cost-utility of Three Public Health HIV Case-finding Strategies: Evidence from Rhode Island, 2012-2014. AIDS Behav 2018; 22:3726-3733. [PMID: 29079947 DOI: 10.1007/s10461-017-1940-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To evaluate three testing strategies to identify new HIV diagnoses in Rhode Island (RI). RI deployed three testing strategies, by using rapid HIV tests at clinical settings, community-based organization (CBO) settings, and the Partner Notification Services (PNS) program from 2012 to 2014. We reviewed the rapid HIV test results and confirmatory test results to identify new diagnoses, and conducted a cost-utility analysis. The average cost per new diagnosis was $33,015 at CBO settings, $5446 at clinical settings, and $33,818 at the PNS program. The cost-utility analysis showed the state-wide program was cost-saving; testing was cost-saving at clinical settings, and cost-effective at CBO settings and the PNS program. Further analyses showed that cost-effectiveness varied widely across CBOs. The HIV testing expansion program in RI was cost-saving overall. The heterogeneity of cost-effectiveness across settings should provide guidance to officials for allocation of future resources to HIV testing.
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Affiliation(s)
- Xinqi C Li
- Department of Health Services Research, Policy, and Practice, Brown University School of Public Health, South Main Street, Box G-S121-7, Providence, RI, 02903, USA
| | - Lillian Kusi
- Center for HIV/AIDS, STDs, Viral Hepatitis, and TB, Rhode Island Department of Health, 3 Capitol Hill, Providence, 02908, RI, USA
| | - Theodore Marak
- Center for HIV/AIDS, STDs, Viral Hepatitis, and TB, Rhode Island Department of Health, 3 Capitol Hill, Providence, 02908, RI, USA
| | - Thomas Bertrand
- Center for HIV/AIDS, STDs, Viral Hepatitis, and TB, Rhode Island Department of Health, 3 Capitol Hill, Providence, 02908, RI, USA
| | - Philip A Chan
- Center for HIV/AIDS, STDs, Viral Hepatitis, and TB, Rhode Island Department of Health, 3 Capitol Hill, Providence, 02908, RI, USA
| | - Omar Galárraga
- Department of Health Services Research, Policy, and Practice, Brown University School of Public Health, South Main Street, Box G-S121-7, Providence, RI, 02903, USA.
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Golden MR, Dombrowski JC. Syphilis Control in the Postelimination Era: Implications of a New Syphilis Control Initiative for Sexually Transmitted Disease/Human Immunodeficiency Virus Programs. Sex Transm Dis 2018; 45:S86-S92. [PMID: 30102682 PMCID: PMC6002884 DOI: 10.1097/olq.0000000000000775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
BACKGROUND The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective. METHODS We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness. RESULTS Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women. CONCLUSIONS So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.
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Affiliation(s)
- Thomas A Peterman
- From the Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
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Semple SJ, Pines HA, Strathdee SA, Vera AH, Rangel G, Magis-Rodriguez C, Patterson TL. Uptake of a Partner Notification Model for HIV Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico. AIDS Behav 2018; 22:2042-2055. [PMID: 29159592 DOI: 10.1007/s10461-017-1984-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Undiagnosed HIV infection is common among men who have sex with men (MSM) and transgender women (TW) in Latin America. We examined uptake of a partner notification (PN) model among MSM and TW in Tijuana, Mexico. Forty-six HIV-positive MSM/TW enrolled as index patients, and reported 132 MSM/TW sexual partners for PN. Of notified partners (90/132), 39% declined eligibility screening or participation, 39% tested for HIV, and of those 28% were newly-diagnosed HIV-positive. Partners who were seen by the index patient more than once in the past 4 months and those who primarily had sex with the index patient in one of their homes were more likely to be notified via PN (76% vs. 50%; p = 0.01 and 86% vs. 64%, p = 0.02, respectively). Lower than expected PN uptake was associated with problems identifying index patients, obtaining reliable partner contact information, and engaging notified partners.
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The Number of Interviews Needed to Yield New Syphilis and Human Immunodeficiency Virus Cases Among Partners of People Diagnosed With Syphilis, North Carolina, 2015. Sex Transm Dis 2018; 44:451-456. [PMID: 28703722 DOI: 10.1097/olq.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Compare syphilis investigation yield among patient groups using number needed to interview. GOAL To increase investigation efficiency. STUDY DESIGN Retrospective review of North Carolina 2015 syphilis investigations, using the number of cases needed to interview (NNTI) and the total number of cases and contacts needed to interview (TNTI) to compare yield of new syphilis and human immunodeficiency virus diagnoses between patient groups. RESULTS We reviewed 1646 early syphilis cases and 2181 contacts; these yielded 241 new syphilis cases (NNTI, 6.9; TNTI, 16.4) and 38 new human immunodeficiency virus cases (NNTI, 43). Interviews of women (prevalence difference [PD] = 6%, 95% confidence interval [CI], 12-16), patients <30 years old (PD = 5%, 95% CI, 1-8), and patients with titer >1:16 (PD = 5%, 95% CI, 1-9) yielded more new syphilis cases in our adjusted model; no other patient factors increased investigation yield. CONCLUSIONS The NNTI and TNTI are useful measures of efficiency. Prioritizing early syphilis investigation by gender, rapid plasmin reagin titer, and age provides small increases in efficiency; no other factors increased efficiency.
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Delivering Partner Services to Reduce Transmission and Promote Linkage to Care: Process Outcomes Varied for Chlamydial Infection, Gonorrhea, HIV, and Syphilis Cases. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:242-246. [PMID: 26480283 DOI: 10.1097/phh.0000000000000351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Partner services for HIV and sexually transmitted diseases, a public health intervention activity recommended by the Centers for Disease Control and Prevention, includes counseling, partner notification, linkage to care, and referral to other services. OBJECTIVE A time study of partner services case investigations documented differences in times to process HIV/sexually transmitted disease cases. SETTING Cases were from 9 local and regional sites in New York. PARTICIPANTS Fifty-two partner services disease investigators documented 542 randomly selected cases (271 chlamydial infections, 162 gonorrhea, 48 HIV, and 61 syphilis cases) assigned between June and September 2014. Cases were the unit of the analysis and represented 6.9% of all partner services investigations in 2014. DESIGN Cases were selected via stratified random sampling of infections assigned to staff. For each case, disease investigators completed a standard time study form to document the time spent on specific tasks and other outcomes. Kruskal-Wallis tests for continuous variables and χ tests for categorical variables assessed variation in outcomes across infection type. MAIN OUTCOME MEASURES Outcomes included minutes spent on specific tasks (such as medical provider and index case outreach, travel, and partner notification), days the case remained open, disposition codes, and number of partners reached. RESULTS Case processing times varied, with HIV and syphilis tasks taking more minutes (P < .001) and cases staying open for more days (P < .001). Partners were notified in 33% of cases overall, with more notifications in syphilis (44%). Most time (median = 77%) was spent on index cases and 2% (median) on partner notification, with a wide range across cases. CONCLUSIONS Given their chronic resource constraints, public health agencies must identify efficient methods to allocate resources, including which infections to prioritize. Documenting how workers allocate time across cases is essential to improving the effectiveness and efficiency of this program and generating the data to model return on investment.
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Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. AIDS 2018; 32:407-417. [PMID: 29381558 DOI: 10.1097/qad.0000000000001733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
: The current review re-conceptualizes seek and test strategies, particularly given the changing importance of HIV testing as care continuum entry for persons irrespective of their HIV status. Care continuum entry advances previous seek and test strategies for client engagement with two next-generation functions: use of testing to engage (or re-engage) HIV negative clients in preexposure prophylaxis (PrEP) care; and testing individuals who may already be known positives for care continuum re-entry. We review existing seek and test strategies for most impacted community members with a goal of optimizing care continuum entry as we move towards HIV transmission elimination. These strategies are context, sub-group, community and epidemic-specific. This review is timely, given the initiation of routine PrEP care, which shifts and broadens our conceptualization of care continuum entry triggered by the HIV testing event. In addition, as the epidemic becomes more concentrated, focusing on re-engagement of HIV-infected persons becomes increasingly important given that transmission events involve both those acutely and newly infected as well as the large numbers who may not be virally suppressed. We start with examination of routine testing in healthcare settings, emphasizing its potential role in re-engagement for persons out of care. Subsequently, we describe risk-based testing to identify key populations. We then review network-based approaches and their impact on the epidemic. We close with future directions for individual and combination care continuum entry strategies most relevant to elimination of HIV transmission in the United States.
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Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010-2014). Sex Transm Dis 2017; 44:249-254. [PMID: 28282653 DOI: 10.1097/olq.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain. METHODS We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010 to 2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient [OP]) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, sex, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews. RESULTS For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI], 3.43; telephone index [TI], 2.06; adjusted relative risk [aRR], 1.68; 95% confidence interval [CI], 1.55-1.82), notified (IPI, 1.70; TI, 1.13; aRR, 1.39; 95% CI, 1.24-1.56), tested (IPI, 1.15; TI, 0.72; aRR, 1.34; 95% CI, 1.16-1.54), and empirically treated (IPI, 1.03; TI, 0.74; aRR, 1.19; 95% CI, 1.03-1.37), but no difference in infected partners treated (IPI, 0.28; TI, 0.24; aRR, 0.93; 95% CI, 0.72-1.21). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI, 1.87; TI, 1.28; aRR, 1.38; 95% CI, 1.18-1.62), notified (IPI, 1.38; TI, 0.92; aRR, 1.24; 95% CI, 1.03-1.50), and newly diagnosed with HIV (IPI, 0.10; TI, 0.05; aRR, 2.17; 95% CI, 1.04-4.50), but no difference in partners tested (IPI, 0.61; TI, 0.48; aRR, 1.15; 95% CI, 0.88-1.52). CONCLUSIONS Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.
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Dalal S, Johnson C, Fonner V, Kennedy CE, Siegfried N, Figueroa C, Baggaley R. Improving HIV test uptake and case finding with assisted partner notification services. AIDS 2017; 31:1867-1876. [PMID: 28590326 PMCID: PMC5538304 DOI: 10.1097/qad.0000000000001555] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the enormous expansion of HIV testing services (HTS), an estimated 40% of people with HIV infection remain undiagnosed. To enhance the efficiency of HTS, new approaches are needed. The WHO conducted a systematic review on the effectiveness of assisted partner notification in improving HIV test uptake and diagnosis, and the occurrence of adverse events, to inform the development of normative guidelines. METHODS We systematically searched five electronic databases through June 2016. We also contacted experts in the field and study authors for additional information where needed. Eligible studies compared assisted HIV partner notification services to passive or no notification. Where multiple studies reported comparable outcomes, meta-analysis was conducted using a random-effects model to produce relative risks (RRs) or risk ratios and 95% confidence intervals (CIs). RESULTS Of 1742 citations identified, four randomized controlled trials and six observational studies totalling 5150 index patients from eight countries were included. Meta-analysis of three individually randomized trials showed that assisted partner notification services resulted in a 1.5-fold increase in HTS uptake among partners compared with passive referral (RR = 1.46; 95% CI: 1.22-1.75; I = 0%). The proportion of HIV-positive partners was 1.5 times higher with assisted partner notification than with passive referral (RR = 1.47; 95% CI: 1.12-1.92; I = 0%). Few instances of violence or harm occurred. CONCLUSION Assisted partner notification improved partner testing and diagnosis of HIV-positive partners, with few reports of harm. WHO strongly recommends voluntary assisted HIV partner notification services to be offered as part of a comprehensive package of testing and care.
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Affiliation(s)
- Shona Dalal
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Carmen Figueroa
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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Enanoria WTA, Liu F, Zipprich J, Harriman K, Ackley S, Blumberg S, Worden L, Porco TC. The Effect of Contact Investigations and Public Health Interventions in the Control and Prevention of Measles Transmission: A Simulation Study. PLoS One 2016; 11:e0167160. [PMID: 27941976 PMCID: PMC5152814 DOI: 10.1371/journal.pone.0167160] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measles cases continue to occur despite its elimination status in the United States. To control transmission, public health officials confirm the measles diagnosis, identify close contacts of infectious cases, deliver public health interventions (i.e., post-exposure prophylaxis) among those who are eligible, and follow-up with the close contacts to determine overall health outcomes. A stochastic network simulation of measles contact tracing was conducted using existing agent-based modeling software and a synthetic population with high levels of immunity in order to estimate the impact of different interventions in controlling measles transmission. METHODS AND FINDINGS The synthetic population was created to simulate California`s population in terms of population demographics, household, workplace, school, and neighborhood characteristics using California Department of Finance 2010 census data. Parameters for the model were obtained from a review of the literature, California measles case surveillance data, and expert opinion. Eight different scenarios defined by the use of three different public health interventions were evaluated: (a) post-exposure measles, mumps, and rubella (MMR) vaccine, (b) post-exposure immune globulin (IG), and (c) voluntary isolation and home quarantine in the presence or absence of public health response delays. Voluntary isolation and home quarantine coupled with one or two other interventions had the greatest reduction in the number of secondary cases infected by the index case and the probability of escape situations (i.e., the outbreak continues after 90 days). CONCLUSIONS Interrupting contact patterns via voluntary isolation and home quarantine are particularly important in reducing the number of secondary cases infected by the index case and the probability of uncontrolled outbreaks.
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Affiliation(s)
- Wayne T. A. Enanoria
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Fengchen Liu
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Jennifer Zipprich
- Immunization Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California, United States of America
| | - Kathleen Harriman
- Immunization Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California, United States of America
| | - Sarah Ackley
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Seth Blumberg
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Lee Worden
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Travis C. Porco
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
- * E-mail:
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Peterman TA, O’Connor K, Bradley HM, Torrone EA, Bernstein KT. Gonorrhea Control, United States, 1972-2015, A Narrative Review. Sex Transm Dis 2016; 43:725-730. [PMID: 27835623 PMCID: PMC6106780 DOI: 10.1097/olq.0000000000000515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gonorrhea is the second most commonly reported infection. It can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Rates of gonorrhea decreased after the National Gonorrhea Control Program began in 1972, but stabilized in the mid 1990s. The emergence of antimicrobial resistant strains increases the urgency for enhanced gonorrhea control efforts. To identify possible approaches for improving gonorrhea control, we reviewed historic protocols, reports, and other documents related to the activities of the National Gonorrhea Control Program using Centers for Disease Control and Prevention records and the published literature. The Program was a massive effort that annually tested up to 9.3 million women, and treated up to 85,000 infected partners and 100,000 additional exposed partners. Reported gonorrhea rates fell by 74% between 1976 and 1996, then stabilized. Testing positivity was 1.6-4.2% in different settings in 1976. In 1999-2008, the test positivity of a random sample of 14- to 25-year-olds was 0.4%. Gonorrhea testing rates remain high, however, partner notification efforts decreased in the 1990s as attention shifted to human immunodeficiency virus and other sexually transmitted diseases. The decrease and subsequent stabilization of gonorrhea rates was likely also influenced by changes in behavior, such as increases in condom use in response to acquired immune deficiency syndrome. Renewed emphasis on partner treatment might lead to further decreases in rates of gonorrhea.
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Affiliation(s)
- Thomas A. Peterman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Kevin O’Connor
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Heather M. Bradley
- Currently with Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Elizabeth A. Torrone
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
| | - Kyle T. Bernstein
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
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Abstract
BACKGROUND Partner services have been a mainstay of public health sexually transmitted disease (STD) prevention programs for decades. The principal goals are to interrupt transmission and reduce STD morbidity and sequelae. In this article, we review current literature with the goal of informing STD prevention programs. METHODS We searched the literature for systematic reviews. We found 9 reviews published between 2005 and 2014 (covering 108 studies). The reviews varied by study inclusion criteria (e.g., study methods, geographic location, and infections). We abstracted major conclusions and recommendations from the reviews. RESULTS Conclusions and recommendations were divided into patient referral interventions and provider referral interventions. For patient referral, there was evidence supporting the use of expedited partner therapy and interactive counseling, but not purely didactic instruction. Provider referral through Disease Intervention Specialists was efficacious and particularly well supported for HIV. For other studies, modeling data and testing outcomes showed that partner notification in general reached high-prevalence populations. Reviews also suggested more focus on using technology and population-level implementation strategies. However, partner services may not be the most efficient means to reach infected persons. CONCLUSIONS Partner services programs constitute a large proportion of program STD prevention activities. Value is maximized by balancing a portfolio of patient and provider referral interventions and by blending partner notification interventions with other STD prevention interventions in overall partner services program structure. Sexually transmitted disease prevention needs program-level research and development to generate this portfolio.
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Martí-Pastor M, García de Olalla P, Barberá MJ, Manzardo C, Ocaña I, Knobel H, Gurguí M, Humet V, Vall M, Ribera E, Villar J, Martín G, Sambeat MA, Marco A, Vives A, Alsina M, Miró JM, Caylà JA. Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study. BMC Public Health 2015; 15:1015. [PMID: 26438040 PMCID: PMC4594901 DOI: 10.1186/s12889-015-2344-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. METHODS Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. RESULTS HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. CONCLUSION An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.
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Affiliation(s)
- Marc Martí-Pastor
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain.
| | - Patricia García de Olalla
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Maria-Jesús Barberá
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Inma Ocaña
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Mercè Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Victoria Humet
- Departament de Justicia, Direcció General de Serveis Penitenciaris i de Rehabilitació, Barcelona, Spain.
| | - Martí Vall
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Esteban Ribera
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Judit Villar
- Infectious Diseases, Hospital del Mar, Barcelona, Spain.
| | - Gemma Martín
- Infectious Diseases, Hospital del Mar, Barcelona, Spain.
| | - Maria A Sambeat
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Andres Marco
- Departament de Justicia, Direcció General de Serveis Penitenciaris i de Rehabilitació, Barcelona, Spain.
| | | | - Mercè Alsina
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Josep M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Joan A Caylà
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Seth P, Wang G, Sizemore E, Hogben M. HIV Testing and HIV Service Delivery to Populations at High Risk Attending Sexually Transmitted Disease Clinics in the United States, 2011-2013. Am J Public Health 2015; 105:2374-81. [PMID: 26378854 DOI: 10.2105/ajph.2015.302778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated HIV testing and service delivery in Centers for Disease Control and Prevention (CDC)-funded sexually transmitted disease (STD) clinics. METHODS We assessed HIV testing, HIV positivity, receipt of HIV test results, linkage to medical care, and referral services from 61 health department jurisdictions from 2011 to 2013. RESULTS In 2013, 18.6% (621 010) of all CDC-funded HIV-testing events were conducted in STD clinics, and 0.8% were newly identified as HIV-positive. In addition, 27.3% of all newly identified HIV-positive persons and 30.1% of all newly identified HIV-positive men who have sex with men were identified in STD clinics. Linkage to care within any time frame was 63.8%, and linkage within 90 days was 55.3%. Although there was a decrease in first-time HIV testers in STD clinics from 2011 to 2013, identification of new positives increased. CONCLUSIONS Although linkage to care and referral to partner services could be improved, STD clinics appear successful at serving populations disproportionately affected by HIV. These clinics may reach persons who may not otherwise seek HIV testing or medical services and provide an avenue for service provision to these populations.
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Affiliation(s)
- Puja Seth
- Puja Seth, Guoshen Wang, and Erin Sizemore are with Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Matthew Hogben is with Division of STD Prevention, Centers for Disease Control and Prevention
| | - Guoshen Wang
- Puja Seth, Guoshen Wang, and Erin Sizemore are with Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Matthew Hogben is with Division of STD Prevention, Centers for Disease Control and Prevention
| | - Erin Sizemore
- Puja Seth, Guoshen Wang, and Erin Sizemore are with Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Matthew Hogben is with Division of STD Prevention, Centers for Disease Control and Prevention
| | - Matthew Hogben
- Puja Seth, Guoshen Wang, and Erin Sizemore are with Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Matthew Hogben is with Division of STD Prevention, Centers for Disease Control and Prevention
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Bergman J, Gratrix J, Pillay T, Houston S, Cooper R, Charlton CL, Lemire S, Paradis K, Birse T, Singh AE. Intensive HIV Partner Notification Is Effective in Identifying New and Previously Diagnosed HIV Infections in Edmonton, Canada. AIDS Patient Care STDS 2015; 29:419-22. [PMID: 26097980 DOI: 10.1089/apc.2015.0033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua Bergman
- Alberta Health Services, Edmonton STI Clinic, Edmonton, Canada
| | | | | | - Stan Houston
- Northern Alberta HIV Program, Edmonton, Canada
- Medicine/Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Ryan Cooper
- Northern Alberta HIV Program, Edmonton, Canada
- Medicine/Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Carmen L. Charlton
- Provincial Laboratory for Public Health, and the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Shannon Lemire
- Alberta Health Services, Edmonton STI Clinic, Edmonton, Canada
| | | | - Ted Birse
- Northern Alberta HIV Program, Edmonton, Canada
| | - Ameeta E. Singh
- Medicine/Infectious Diseases, University of Alberta, Edmonton, Canada
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Previously undiagnosed HIV infections identified through cluster investigation, North Carolina, 2002-2007. AIDS Behav 2015; 19:723-31. [PMID: 25331264 DOI: 10.1007/s10461-014-0913-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
During cluster investigation, index patients name social contacts that are not sex or drug-sharing partners. The likelihood of identifying new HIV infections among social contacts is unknown. We hypothesized greater odds of identifying new infections among social contacts identified by men who report sex with men (MSM). We reviewed North Carolina HIV diagnoses during 2002-2005 and used logistic regression to compare testing results among social contacts of MSM, men who report sex with women only (MSW) and women. HIV was newly diagnosed among 54/601 (9.0 %) social contacts tested named by MSM, 16/522 (3.1 %) named by MSW, and 23/639 (3.6 %) named by women. Compared with those named by MSW, odds of new HIV diagnosis were greater among MSM social contacts (adjusted odds ratio: 2.5; 95 % confidence interval: 1.3-4.7). Testing social contacts identified previously undiagnosed HIV infections and could provide an opportunity to interrupt transmission.
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Peterman TA, Furness BW. Public health interventions to control syphilis. Sex Health 2015; 12:126-34. [PMID: 25588031 PMCID: PMC6746170 DOI: 10.1071/sh14156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/29/2014] [Indexed: 12/22/2022]
Abstract
Syphilis control strategies are old, but interventions have changed and there is now a more scientific approach to evidence of effectiveness. We searched PubMed using 'syphilis control' to identify papers that measured the effectiveness of interventions. We also included novel approaches and comprehensive responses to outbreaks. Few papers used high-quality research methodology and fewer evaluated impact on prevalence or incidence; most assessed intermediate outcomes. Syphilis can often be controlled by a combination of case finding, treatment and education. However, outbreaks are unique and ongoing evaluation is needed to see if interventions are producing intended intermediate outcomes at reasonable costs.
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Affiliation(s)
- Thomas A Peterman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop E02, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Bruce W Furness
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop E02, 1600 Clifton Road, Atlanta, GA, 30333, USA
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Hoots BE, Lewis FMT, Anschuetz G, Schillinger JA, Blank S, Foskey T, Stover JA, Peterman TA. Would targeting increase efficiency of syphilis partner services programs?--Data from New York City, Philadelphia, Texas, and Virginia. Sex Transm Dis 2015; 41:407-12. [PMID: 24825340 DOI: 10.1097/olq.0000000000000130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Targeted partner notification (PN), or limiting PN to groups in which efforts are most successful, has been suggested as a potentially cost-effective alternative to providing PN for all syphilis case-patients. The purpose of this study was to identify index case characteristics associated with highest yield partner elicitation and subsequent case finding to determine whether some groups could be reasonably excluded from PN efforts. METHODS We examined index case characteristics and PN metrics from syphilis case management records of 4 sexually transmitted disease control programs--New York City, Philadelphia, Texas, and Virginia. Partner elicitation was considered successful when a case-patient named 1 or more partners during interview. Case finding was considered successful when a case-patient had 1 or more partners who were tested and had serologic evidence of syphilis exposure. Associations between case characteristics and proportion of pursued case-patients with successful partner elicitation and case finding were evaluated using χ2 tests. RESULTS Successful partner elicitation and new case finding was most likely for index case-patients who were younger and diagnosed at public sexually transmitted disease clinics. However, most characteristics of index case-patients were related to success at only a few sites, or varied in the direction of the relationship by site. Other than late latent case-patients, few demographic groups had a yield far below average. CONCLUSIONS If implemented, targeted PN will require site-specific data. Sites may consider eliminating PN for late latent case-patients. The lack of demographic groups with a below average yield suggests that sites should not exclude other groups from PN.
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Affiliation(s)
- Brooke E Hoots
- From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Division of Applied Sciences, Atlanta, GA; ‡Philadelphia Department of Public Health, Philadelphia, PA; §New York City Department of Health and Mental Hygiene, New York City, NY; ¶Texas Department of State Health Services, HIV/STD Prevention and Care Branch, Austin, TX; and ∥Virginia Department of Health, Division of Disease Prevention, Richmond, VA
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Trecker MA, Gu W, Jolly A, Waldner CL, Dillon JAR. Female partner notification is a promising prevention strategy for controlling sexually transmitted infections in Shanghai: demographic and behavioral data from a Shanghai clinic. Sex Transm Dis 2015; 41:702-5. [PMID: 25581804 DOI: 10.1097/olq.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We identified predictors of partner presentation and condom use among male gonorrhea patients in Shanghai, China. Stable relationships, intercourse in the preceding week, and longer duration of symptoms were associated with partner presentation. Men were more likely to use condoms with their spouse and if they were 35 years or younger.
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Affiliation(s)
- Molly A Trecker
- From the *Vaccine and Infectious Disease Organization-International Vaccine Centre, Saskatoon, Saskatchewan, Canada; †School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; ‡Shanghai Skin Disease and Sexually Transmitted Disease Hospital, Shanghai, China; §Centre for Infectious Disease Prevention and Control, Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada; ¶Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; and ║Western College of Veterinary Medicine and **Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Conflicts of interest during contact investigations: a game-theoretic analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:952381. [PMID: 24982688 PMCID: PMC4052784 DOI: 10.1155/2014/952381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/04/2014] [Accepted: 03/06/2014] [Indexed: 11/17/2022]
Abstract
The goal of contact tracing is to reduce the likelihood of transmission, particularly to individuals who are at greatest risk for developing complications of infection, as well as identifying individuals who are in need of medical treatment of other interventions. In this paper, we develop a simple mathematical model of contact investigations among a small group of individuals and apply game theory to explore conflicts of interest that may arise in the context of perceived costs of disclosure. Using analytic Kolmogorov equations, we determine whether or not it is possible for individual incentives to drive noncooperation, even though cooperation would yield a better group outcome. We found that if all individuals have a cost of disclosure, then the optimal individual decision is to simply not disclose each other. With further analysis of (1) completely offsetting the costs of disclosure and (2) partially offsetting the costs of disclosure, we found that all individuals disclose all contacts, resulting in a smaller basic reproductive number and an alignment of individual and group optimality. More data are needed to understand decision making during outbreak investigations and what the real and perceived costs are.
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McCann L, Allan W, Read P, McNulty A. Contact tracing using provider referral: how difficult is it? Sex Health 2014; 10:472-3. [PMID: 24074813 DOI: 10.1071/sh13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/19/2013] [Indexed: 11/23/2022]
Abstract
Contact tracing using provider referral is often perceived as time-consuming. To assess the workload involved in provider referral at a sexual health clinic, we studied the number of attempts required, the contact method used, the time taken and the success of provider referral for 230 contacts referred over a 3-year period. For 87% of these contacts, a mobile number was available; 78.7% of these were successfully contacted. A median of two calls was required and the median time to complete the contact tracing process was within the same day. In 91% of cases, contact tracing was successful. In our setting, provider notification was not time-consuming.
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Affiliation(s)
- Lisa McCann
- Sydney Sexual Health Centre, Sydney/Sydney Eye Hospital, Sydney, NSW 2000, Australia
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Rutstein SE, Brown LB, Biddle AK, Wheeler SB, Kamanga G, Mmodzi P, Nyirenda N, Mofolo I, Rosenberg NE, Hoffman IF, Miller WC. Cost-effectiveness of provider-based HIV partner notification in urban Malawi. Health Policy Plan 2014; 29:115-26. [PMID: 23325584 PMCID: PMC3872371 DOI: 10.1093/heapol/czs140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/13/2022] Open
Abstract
Provider-initiated partner notification for HIV effectively identifies new cases of HIV in sub-Saharan Africa, but is not widely implemented. Our objective was to determine whether provider-based HIV partner notification strategies are cost-effective for preventing HIV transmission compared with passive referral. We conducted a cost-effectiveness analysis using a decision-analytic model from the health system perspective during a 1-year period. Costs and outcomes of all strategies were estimated with a decision-tree model. The study setting was an urban sexually transmitted infection clinic in Lilongwe, Malawi, using a hypothetical cohort of 5000 sex partners of 3500 HIV-positive index cases. We evaluated three partner notification strategies: provider notification (provider attempts to notify indexes' locatable partners), contract notification (index given 1 week to notify partners then provider attempts notification) and passive referral (index is encouraged to notify partners, standard of care). Our main outcomes included cost (US dollars) per transmission averted, cost per new case identified and cost per partner tested. Based on estimated transmissions in a 5000-person cohort, provider and contract notification averted 27.9 and 27.5 new infections, respectively, compared with passive referral. The incremental cost-effectiveness ratio (ICER) was $3560 per HIV transmission averted for contract notification compared with passive referral. Provider notification was more expensive and slightly more effective than contract notification, yielding an ICER of $51 421 per transmission averted. ICERs were sensitive to the proportion of partners not contacted, but likely HIV positive and the probability of transmission if not on antiretroviral therapy. The costs per new case identified were $36 (provider), $18 (contract) and $8 (passive). The costs per partner tested were $19 (provider), $9 (contract) and $4 (passive). We conclude that, in this population, provider-based notification strategies are potentially cost-effective for identifying new cases of HIV. These strategies offer a simple, effective and easily implementable opportunity to control HIV transmission.
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Affiliation(s)
- Sarah E Rutstein
- Department of Health Policy and Management CB #7411, University of North Carolina Chapel Hill, Chapel Hill, NC 27599-7411, USA. E-mail:
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Theunissen KATM, Hoebe CJPA, Crutzen R, Kara-Zaïtri C, de Vries NK, van Bergen JEAM, van der Sande MAB, Dukers-Muijrers NHTM. Using intervention mapping for the development of a targeted secure web-based outreach strategy named SafeFriend, for Chlamydia trachomatis testing in young people at risk. BMC Public Health 2013; 13:996. [PMID: 24148656 PMCID: PMC4015304 DOI: 10.1186/1471-2458-13-996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 10/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many young people at high risk for Chlamydia trachomatis (Ct) are not reached by current sexual health care systems, such as general practitioners and public sexual health care centres (sexually transmitted infection clinics).Ct is the most frequently diagnosed bacterial sexually transmitted infection (STI) among sexually active people and in particular young heterosexuals. Innovative screening strategies are needed to interrupt the transmission of Ct among young people and connect the hidden cases to care. METHODS Intervention Mapping (IM), a systematic approach to develop theory- and evidence-based interventions, was used to develop a strategy to target Ct testing towards young people who are currently hidden to care in The Netherlands. Both clinical users (i.e. sexual health care nurses) and public users (i.e., young people at risk for Ct) were closely involved in the IM process. A needs assessment study was carried out using semi-structured interviews among users (N = 21), a literature search and by taking lessons learned from existing screening programmes. Theoretical methods and practical applications to reach high risk young people and influence testing were selected and translated into specific programme components. RESULTS The IM approach resulted in the development of a secure and web-based outreach Ct screening strategy, named SafeFriend. It is developed to target groups of high-risk young people who are currently hidden to care. Key methods include web-based Respondent Driven Sampling, starting from young Ct positive sexual health care centre clients, to reach and motivate peers (i.e., sex partners and friends) to get tested for Ct. Testing and the motivation of peers were proposed as the desired behavioural outcomes and the Precaution Adoption Process Model was chosen as theoretical framework. End users, i.e., young people and sexual health care nurses were interviewed and included in the development process to increase the success of implementation. CONCLUSIONS IM proved useful to develop an intervention for targeted Ct testing among young people. We believe this to be the first web-based outreach screening strategy which combines chain referral sampling with the delivery of targeted Ct testing to high risk young people within their sexual and social networks.
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Affiliation(s)
- Kevin ATM Theunissen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Services South Limburg, Geleen, The Netherlands
| | - Christian JPA Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Services South Limburg, Geleen, The Netherlands
- Department of Medical Microbiology Maastricht Infection Centre (MINC), School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Nanne K de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jan EAM van Bergen
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- The national institute for STI and AIDS Control, Amsterdam, The Netherlands
- Department of General Practice, AMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne AB van der Sande
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nicole HTM Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Services South Limburg, Geleen, The Netherlands
- Department of Medical Microbiology Maastricht Infection Centre (MINC), School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Thapa DK, Niehof A. Women's autonomy and husbands' involvement in maternal health care in Nepal. Soc Sci Med 2013; 93:1-10. [PMID: 23906115 DOI: 10.1016/j.socscimed.2013.06.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/02/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
Abstract
Both increasing women's autonomy and increasing husbands' involvement in maternal health care are promising strategies to enhance maternal health care utilization. However, these two may be at odds with each other insofar as autonomous women may not seek their husband's involvement, and involved husbands may limit women's autonomy. This study assessed the relationship between women's autonomy and husbands' involvement in maternal health care. Field work for this study was carried out during September-November 2011 in the Kailali district of Nepal. In-depth interviews and focus group discussions were used to investigate the extent of husbands' involvement in maternal health care. A survey was carried out among 341 randomly selected women who delivered a live baby within one year prior to the survey. The results show that husbands were involved in giving advice, supporting to reduce the household work burden, and making financial and transportation arrangements for the delivery. After adjustment for other covariates, economic autonomy was associated with lower likelihood of discussion with husband during pregnancy, while domestic decision-making autonomy was associated with both lower likelihood of discussion with husband during pregnancy and the husband's presence at antenatal care (ANC) visits. Movement autonomy was associated with lower likelihood of the husband's presence at ANC visits. Intra-spousal communication was associated with higher likelihood of discussing health with the husband during pregnancy, birth preparedness, and the husbands' presence at the health facility delivery. The magnitude and direction of association varied per autonomy dimension. These findings suggest that programs to improve the women's autonomy and at the same time increase the husband's involvement should be carefully planned. Despite the traditional cultural beliefs that go against the involvement of husbands, Nepalese husbands are increasingly entering into the area of maternal health which was traditionally considered 'women's business'.
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Abstract
BACKGROUND Timely notification and treatment of sex partners exposed to a sexually transmitted disease (STD) is essential to reduce reinfection and transmission. Our objectives were to determine factors associated with patient-initiated notification of sex partners and preferences regarding standard partner referral versus expedited partner therapy (EPT). METHODS Participants diagnosed with gonorrhea, chlamydia, trichomoniasis, or nongonococcal urethritis within the previous year were administered a baseline survey asking about demographics, sexual history, and partner treatment preferences (standard partner referral vs. EPT). They identified up to 4 sex partners within the past 2 months, and answered questions on relationship characteristics, quality, and notification self-efficacy. At follow-up, participants with a current STD were asked whether they notified their partners. Generalized estimating equations were used to evaluate the associations between predictor variables and partner notification. RESULTS Of the 201 subjects enrolled, 157 had a current STD diagnosis, and 289 sex partners were identified. The rate of successful partner notification was 77.3% (157/203 sex partners). Partner notification was increased if the subject had a long-term relationship with a sex partner (odds ratio: 3.07; 95% confidence interval: 1.43, 6.58), considered the partner to be a main partner (odds ratio: 2.53; 95% confidence interval: 1.43, 6.58), or had increased notification self-efficacy. Overall, participants did not prefer EPT over standard referral; however, females, those with higher education levels, and those with a prior STD preferred EPT. CONCLUSIONS Patient-initiated partner referral is more successful in patients with increased self-efficacy who have stronger interpersonal relationships with their sex partners.
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Helleringer S, Mkandawire J, Kalilani-Phiri L, Kohler HP. Cohort Profile: The Likoma Network Study (LNS). Int J Epidemiol 2013; 43:545-57. [PMID: 23543589 DOI: 10.1093/ije/dyt001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The Likoma network study (LNS) investigates the sexual networks connecting the inhabitants of Likoma, a small island of Lake Malawi with high HIV prevalence. Whereas previous studies of sexual networks and HIV/AIDS in sub-Saharan countries have focused solely on the personal networks of a small number of respondents, the LNS attempts to document the sexual networks of the entire adult population of Likoma. To do so, it uses a unique sociocentric study design, in which all members of the local population are contacted for a survey interview and are asked to nominate their five most recent sexual partners. Using these data, quasi-complete 'maps' of the sexual networks connecting inhabitants of the island can be constructed. These maps allow investigation of the impact of networks on HIV epidemiology and can inform mathematical models of HIV prevention. In addition to data on sexual networks, the LNS data include information on the social networks (e.g. friendship), socioeconomic characteristics and HIV status of Likoma's residents. Baseline data were collected in 2005-06. A first follow-up was conducted in 2007-08 and a second follow-up is planned for early 2013. Access to the LNS data is contingent upon review of a short concept paper and forming collaborations with LNS investigators.
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Affiliation(s)
- Stéphane Helleringer
- Mailman School of Public Health, Columbia University, New York, NY, USA, University of Malawi, College of Medicine, Blantyre, Malawi and University of Pennsylvania, Population Studies Center, Philadelphia, PA, USA
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Community-embedded disease intervention specialist program for syphilis partner notification in a clinic serving men who have sex with men. Sex Transm Dis 2012; 39:701-5. [PMID: 22902665 DOI: 10.1097/olq.0b013e3182593b51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the effectiveness of a Community-Embedded Disease Intervention Specialist (CEDIS) in providing partner notification (PN) for primary syphilis cases in a high STD morbidity, community-based clinic serving men who have sex with men in Los Angeles. METHODS The CEDIS was trained by the same standards as the local health department Disease Investigator Specialists but was employed by and stationed at the clinic where the primary cases were diagnosed. We compared the CEDIS on specific PN outcomes before and after placement of the CEDIS and among countywide men who have sex with men primary syphilis cases, excluding the cases from the CEDIS clinic. RESULTS In 2009-2010 after placement of the CEDIS, 100% (87) of primary cases assigned were interviewed; 28% (26) on the same day as their clinic visit and 64% (59) within 7 days. In 2006-2007 before placement of the CEDIS, 67% (43) of primary cases assigned were interviewed; only 2% (1) were interviewed within 7 days. In 2009-2010 countywide, 9% (21) of 252 primary cases assigned were interviewed on the same day as their clinic visit; 18% (45) within 7 days. After placement of the CEDIS, 15% (21) of 140 partners elicited were identified with early syphilis and brought to treatment compared with 0% of 13 partners elicited before placement of the CEDIS, and 15% (25) of 171 partners elicited countywide. CONCLUSION The CEDIS program fosters key elements to a successful PN program, such as prompt interviewing of newly diagnosed cases and community trust.
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van Aar F, Schreuder I, van Weert Y, Spijker R, Götz H, Op de Coul E. Current practices of partner notification among MSM with HIV, gonorrhoea and syphilis in the Netherlands: an urgent need for improvement. BMC Infect Dis 2012; 12:114. [PMID: 22583517 PMCID: PMC3472393 DOI: 10.1186/1471-2334-12-114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 05/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partner notification (PN) among individuals newly diagnosed with HIV/STI is seen as a vital tool to identify others at risk of infection. However, hardly any data are available on the effectiveness of PN on HIV/STI transmission in the Netherlands. This study aims to fill this gap by assessing current PN practices, case-finding effectiveness, and determinants of being notified among men having sex with men (MSM) in the Netherlands. METHODS Nurses from five STI centers participated in a prospective pilot study on PN outcomes (partners being: at risk, notifiable, notified, and tested) for HIV/STI, by completing a newly developed PN registration form (PN database). PN outcomes including case-finding effectiveness (number of newly diagnosed cases in partners/number of partners being tested) for HIV, syphilis, and gonorrhoea were studied among MSM. Furthermore, the national STI database was analyzed to identify determinants of being notified. The number of infections that remained undetected was estimated based on these two databases. RESULTS In total 105 MSM, newly diagnosed with HIV/STI, reported 612 sexual partners at risk of whom 41% were notifiable and 31% were notified. Patient referral was the predominant PN method (90%). The overall case-finding percentage was 36% (HIV: 15-33%, gonorrhoea: 17-50% and syphilis: 4-11%). Case-finding percentages were lower in the national STI database: 21% (5%, 28%, 12%). Persons with one or more sexual partners, known HIV positives, and IDU were more likely to be notified to the STI clinic. Notified clients were more likely to have HIV/STI than unnotified clients (OR 1.7-2.5). Based on these two databases, an estimated 75 to 133 infections remained undetected (HIV: 12-90; gonorrhoea: 28-97; syphilis: 5-12 infections). CONCLUSIONS Partner notification among MSM in the Netherlands is suboptimal; an extensive number of STI/HIV infections remained undetected mainly due to unnotifiable partners. To enhance PN practices, combined and innovative PN interventions such as Internet-based PN will be implemented for hard-to-reach MSM and other risk groups.
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Affiliation(s)
- Fleur van Aar
- Epidemiology & Surveillance department, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Imke Schreuder
- Department of Virology, Erasmus MC, Rotterdam, the Netherlands
| | - Yolanda van Weert
- Epidemiology & Surveillance department, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Hannelore Götz
- Department of Infectious Disease Control – division STI/HIV, GGD Rotterdam-Rijnmond, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
| | - Eline Op de Coul
- Epidemiology & Surveillance department, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Affiliation(s)
- Lorna Thorpe
- City University of New York, School of Public Health, New York, NY, USA
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Exploring the relative costs of contact tracing for increasing HIV case finding in sub-Saharan countries. J Acquir Immune Defic Syndr 2011; 58:e29-36. [PMID: 21725247 DOI: 10.1097/qai.0b013e31822a9fa8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Contact tracing (CT) has rarely been used to improve HIV case finding in sub-Saharan Africa because of concerns regarding privacy protection and possibly high costs. METHODS We estimate the relative cost of identifying an undiagnosed HIV infection through CT compared with client-initiated voluntary counseling and testing (VCT) and door-to-door provider-initiated testing (PIT). We used data from the Likoma Network Study, a study of sexual networks and HIV infection conducted on the small island of Likoma in northern Malawi, to inform these calculations. RESULTS In Likoma, the probability that partners of HIV index cases could be traced and that they would consent to HIV testing and counseling was high and varied by partner type. HIV prevalence ranged from 48.1% to 66.7% among the partners who were tested. Per newly diagnosed infection, CT is rarely a cheaper case finding approach than VCT in populations with HIV prevalence > 5%. In populations with HIV prevalence < 5%, CT is an attractive case-finding approach relative to VCT when few HIV-infected individuals are aware of their status. Compared with door-to-door PIT, CT is almost always preferred when the population prevalence is below 10%, unless CT costs are prohibitively high. When HIV prevalence is >10%, providing CT for current spouses of index cases remains an attractive approach to HIV case finding. CONCLUSIONS CT could complement client-initiated VCT or door-to-door PIT in a large number of sub-Saharan populations affected by generalized epidemics of varying magnitudes.
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Bell G, Potterat J. Partner notification for sexually transmitted infections in the modern world: a practitioner perspective on challenges and opportunities. Sex Transm Infect 2011; 87 Suppl 2:ii34-6. [PMID: 22110152 PMCID: PMC3610390 DOI: 10.1136/sextrans-2011-050229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2011] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gill Bell
- Department of Genitourinary Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Puzzling observations in a trial of HIV partner notification in sub-Saharan Africa. J Acquir Immune Defic Syndr 2011; 56:381-3. [PMID: 21317797 DOI: 10.1097/qai.0b013e318211b451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sexually Transmitted Diseases Program Performance Measures: How Are They Performing? Sex Transm Dis 2011; 38:610-6. [DOI: 10.1097/olq.0b013e31820a8d9b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Estudios de contactos para infecciones de transmisión sexual. ¿Una actividad descuidada? GACETA SANITARIA 2011; 25:224-32. [DOI: 10.1016/j.gaceta.2010.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/16/2010] [Accepted: 12/19/2010] [Indexed: 11/17/2022]
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Katz DA, Hogben M, Dooley SW, Golden MR. Increasing public health partner services for human immunodeficiency virus: results of a second national survey. Sex Transm Dis 2011; 37:469-75. [PMID: 20661113 DOI: 10.1097/olq.0b013e3181e7104d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent US national efforts taken to prevent human immunodeficiency virus (HIV) infection have emphasized HIV case-finding, including partner services (PS). METHODS We collected data on HIV PS procedures and outcomes in 2006 from health departments in US metropolitan areas with the highest number of cases of acquired immunodeficiency syndrome, gonorrhea, chlamydial infection, and primary and secondary syphilis, and compared our results with the data collected through a similar study carried out in 2001. RESULTS Of the 71 eligible jurisdictions, 51 (72%) participated in this study. In 2006, health departments interviewed 11,270 (43%) of the 26,185 persons with newly reported HIV, which was an increase from the 32% reported in 2001 (P < 0.01). Among 10,498 potentially exposed partners, 2228 (21%) had been previously diagnosed with HIV, 803 (8%) were newly HIV-diagnosed, 3337 (32%) tested HIV-negative, and 4130 (39%) were not successfully notified, were notified but refused HIV testing and denied previous diagnosis, or did not have an outcome recorded. Combining data from all jurisdictions, public health staff needed to interview 13.6 persons with HIV to identify one new case of infection; this number was unchanged from 2001 (13.8; P = 0.75). CONCLUSION In the United States, the proportion of persons diagnosed with HIV receiving PS has increased since 2001, whereas HIV case-finding yields have remained stable. Despite this, most people newly diagnosed with HIV still do not receive PS.
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Affiliation(s)
- David A Katz
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
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Abstract
BACKGROUND/OBJECTIVES Notifying partners of HIV-infected persons and referring them for testing and treatment is an effective method of disease control and identification of undiagnosed STD and/or HIV. To improve partner elicitation interviews, disease intervention specialists (DIS) were placed in 3 HIV clinics during 2008 and 2009. METHODS We reviewed the Arizona state STD surveillance database for 2007 to identify the providers (outside of the public STD clinics) reporting the highest number of syphilis cases. DIS were placed in the clinics for half a day per week (2 clinics) or on an on-call basis (1 clinic) to deliver penicillin and interview patients. We calculated changes in the number of patients interviewed, days elapsed from specimen collection to treatment (time to treatment), days elapsed from specimen collection to initial DIS contact (time to interview), and number of reported and locatable partners from these 3 clinics before and after the clinic placement of DIS. RESULTS Before the placement of clinic-based DIS, 219 syphilis cases were diagnosed at the 3 clinics (January 2006 through January 2008). After DIS placement, 115 syphilis cases were diagnosed (February 2008 through September 2009) for a total of 334 cases in this analysis. A greater percent of patients completed a partner elicitation interview during the period of DIS placement (94% after vs. 81% before, P = 0.001). There were increases in the average number of locatable partners (1.1 after vs. 0.6 before, P = 0.004) and an increase in the average number of partners exposed and brought to treatment (CDC Disposition A) or infected and brought to treatment (CDC Disposition C) (0.6 after vs. 0.3 before, P = 0.02), and the time to interview decreased (18 days before vs. 9 days after, P = 0.02). CONCLUSIONS/IMPLICATIONS Placing DIS within community HIV clinics improved partner services. STD and/or HIV programs should consider this method to improve partner notification.
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Khan MR, Ravelomanana N, Van Damme K, Randrianasolo BS, Ramaniraka V, Ranaivo N, Ratsiambakaina D, Cohen M, Behets F. Notifying partners of patients with early syphilis in Madagascar: case-finding effectiveness and public health implications. Trop Med Int Health 2010; 15:1090-8. [PMID: 20636304 PMCID: PMC5824628 DOI: 10.1111/j.1365-3156.2010.02588.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the case-finding effectiveness of a clinic-based partner notification effort for early syphilis in Madagascar. METHODS We asked index cases who had proven early syphilis to identify and provide contact information of recent sex partners (in the past 3, 6, and 12 months for primary, secondary, and early latent syphilis, respectively). Named sex partners were contacted by index cases (patient notification) or, if approved by the index case, clinic staff members (provider notification); notified of their potential exposure to syphilis; and asked to come to the clinic for evaluation. We assessed case-finding effectiveness and calculated the 'brought-to-treatment' index (number of newly-diagnosed syphilis cases per number of index cases interviewed). RESULTS Of 565 index cases, 534 reported recent sex with at least one sex partner. A total of 3167 sex partners were reported, of whom 276 were contactable (9% of 3167). Providers notified 76% and cases notified 24% of these partners. 270 partners were contacted (98% of 276), and of these, 199 presented to the clinic for evaluation (74% of 270). A total of 99 partners tested positive for syphilis and received treatment (50% of 199). The 'brought-to-treatment' index was 0.18 (99 diagnoses per 565 index cases). CONCLUSION Partner notification was possible in this setting, resulting in treatment of syphilis-infected individuals who otherwise would likely have remained untreated. However, given <10% of the partners reported by index cases were contactable; the results highlight the limitations of partner notification and the need for additional sexually transmitted infection control strategies.
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Affiliation(s)
- Maria R Khan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.
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Prediction Model to Maximize Impact of Syphilis Partner Notification—San Francisco, 2004–2008. Sex Transm Dis 2010; 37:109-14. [DOI: 10.1097/olq.0b013e3181bbf985] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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