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Kong Y, Xing P, Huai P, Zhang F. The burden of skin diseases in China: global burden of Disease Study 2019. Arch Dermatol Res 2024; 316:277. [PMID: 38796625 DOI: 10.1007/s00403-024-03046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/07/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
Skin diseases continue to affect human health and cause a significant disease burden on the healthcare system.We aimed to report the changing trends in the burden of skin disease in China from 1990 to 2019, Which has an important role in developing targeted prevention strategies. We applied Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 analytical tools to calculate the age-standardized Prevalence and Incidence in 2019, number of years lived with disability (YLDs) and age-standardized YLDs from 1990 to 2019 of skin and subcutaneous diseases, notifiable infectious skin diseases and skin tumors in China. Among the skin and subcutaneous diseases in China in 2019, dermatitis contributed to the greatest YLD (2.17 million, 95% uncertainty interval[UI]: 1.28-3.36). Age-standardized YLD rates for leprosy decreased from 0.09 (95%UI: 0.06-0.13) in 1990 to 0.04 (95%UI: 0.03-0.06) in 2019; the proportional decrease was 55.56% over 30 years. Age-standardized YLDs for HIV and sexually transmitted infections increased by 26% during the same time period. Age-standardized YLDs for non-melanoma skin cancer increased at a much higher rate than melanoma between 1990 and 2019. Dermatitis and scabies continue to have an important role in the burden of skin and subcutaneous disease burden in China. The burden of non-melanoma cell cancer has increased most significantly over the past three decades.
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Affiliation(s)
- Yaoyao Kong
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
| | - Peiye Xing
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
| | - Pengcheng Huai
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China.
| | - Furen Zhang
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
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2
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Moncrieff L, O'Reilly M, Hall L, Heal C. Interventions aimed at increasing syphilis screening among non-pregnant individuals in healthcare settings: a systematic review and meta-analysis. Sex Health 2024; 21:SH24019. [PMID: 38771948 DOI: 10.1071/sh24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
Syphilis remains a pressing public health concern with potential severe morbidity if left untreated. To improve syphilis screening, targeted interventions are crucial, especially in at-risk populations. This systematic review synthesises studies that compare syphilis screening in the presence and absence of an intervention. A systematic search of four databases was conducted (Medline, Embase, Cinahl and Scopus). The primary outcomes evaluated included syphilis screening, re-screening and detection rates. Findings were synthesised narratively. Where multiple studies were clinically heterogenous, a pooled odds ratio was calculated. Twenty-four studies were included. A variety of interventions showed promise including clinician alerts, which increased syphilis screening rate (OR range, 1.25-1.45) and patient SMS reminders that mostly improved re-screening/re-attendance rates (OR range, 0.93-4.4). Coupling syphilis serology with routine HIV monitoring increased the proportion of HIV-positive individuals undergoing both tests. However, pooling three studies with this intervention using the outcome of syphilis detection rate yielded inconclusive results (pooled OR 1.722 [95% CI 0.721-2.723], I 2 =24.8%, P =0.264). The introduction of hospital-based packaged testing for screening high-risk individuals is unique given hospitals are not typical locations for public health initiatives. Nurse-led clinics and clinician incentives were successful strategies. Including syphilis screening with other existing programs has potential to increase screening rates (OR range, 1.06-2.08), but requires further investigation. Technology-driven interventions produced cost-effective, feasible and positive outcomes. Challenges were evident in achieving guideline-recommended screening frequencies for men who have sex with men, indicating the need for multifaceted approaches. Wider application of these interventions may improve syphilis screening and detection rates.
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Affiliation(s)
- Leah Moncrieff
- College of Medicine and Dentistry, James Cook University, Building K Level 1, 475 Bridge Road, Mackay, Qld 4740, Australia
| | - Morgan O'Reilly
- College of Medicine and Dentistry, James Cook University, Building K Level 1, 475 Bridge Road, Mackay, Qld 4740, Australia
| | - Leanne Hall
- College of Medicine and Dentistry, James Cook University, Building K Level 1, 475 Bridge Road, Mackay, Qld 4740, Australia
| | - Clare Heal
- College of Medicine and Dentistry, James Cook University, Building K Level 1, 475 Bridge Road, Mackay, Qld 4740, Australia
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Jenner E, Walsh S, Henley C, Demby H, Leger R, Falk G. Randomized Trial of a Sexual Health Video Intervention for Black and Hispanic Adolescent Females. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:262-271. [PMID: 36735143 PMCID: PMC10764370 DOI: 10.1007/s11121-023-01499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
Despite significant declines, adolescent birth rates in the USA are higher than other industrialized countries, with black and Hispanic youth disproportionately affected. This study assessed the efficacy of a single-session, entertainment-education sexual health video intervention for these populations. Using an individual-level randomized controlled trial, 1770 18- to 19-year-old black and Hispanic females were assigned to watch Plan A (n = 886) or a control video (n = 884) prior to a sexual reproductive health (SRH) visit. Participants self-reported data at baseline and 3 months post-baseline. Within an intent-to-treat framework, we estimated the average causal effect of assignment to Plan A on three confirmatory and five exploratory outcomes. We found that individuals assigned to Plan A had higher contraceptive knowledge, may be more likely to get sexually transmitted infection (STI) testing, and may have elevated HIV/STI risk perceptions 3 months post-video. Although we found no difference in long-acting reversible contraception (LARC) use nor frequency of condomless sex in the full sample, we did observe that first-time SRH visitors assigned to Plan A had a higher probability of using LARC than those in the control group. This study demonstrates that Plan A is a low-burden, inexpensive, and highly scalable video intervention for black and Hispanic adolescent females that has significant and borderline significant effects on protective sexual health behaviors and important antecedents. It adds to the evidence base of effective teen pregnancy prevention programs and the limited set of rigorous and causal studies investigating the effectiveness of entertainment-education interventions on sexual risk reduction. Registered in ClinicalTrials.gov (NCT03238313) on August 3, 2017.
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Affiliation(s)
- Eric Jenner
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Sarah Walsh
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Catherine Henley
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA.
| | - Hilary Demby
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Rebekah Leger
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Gretchen Falk
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
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4
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Peeling RW, Mabey D, Chen XS, Garcia PJ. Syphilis. Lancet 2023; 402:336-346. [PMID: 37481272 DOI: 10.1016/s0140-6736(22)02348-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 07/24/2023]
Abstract
Syphilis is a sexually and vertically transmitted bacterial infection caused by the bacterium Treponema pallidum. Its prevalence is high in low-income and middle-income countries, and its incidence has increased in high-income countries in the last few decades among men who have sex with men. Syphilis is a major cause of adverse pregnancy outcomes in low-income and middle-income countries. Clinical features include a primary chancre at the point of inoculation, followed weeks later by the rash of secondary syphilis, a latent period, and in some cases, involvement of the eyes, CNS, and cardiovascular systems. It is diagnosed serologically. A single intramuscular dose of long-acting benzathine penicillin is recommended for people who have had syphilis for less than 1 year and longer courses for people with late latent syphilis. Control strategies include screening and treatment of all pregnant women, and targeted interventions for groups at high risk. Vaccine development, research on antibiotic prophylaxis, and digital messaging as prevention strategies are ongoing.
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Affiliation(s)
- Rosanna W Peeling
- London School of Hygiene & Tropical Medicine, London, UK; University of Manitoba, Winnipeg, MB, Canada.
| | - David Mabey
- London School of Hygiene & Tropical Medicine, London, UK
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; National Center for STD Control, Nanjing, China; Center for Global Health, Southern Medical University, Guangzhou, China
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Washington, Seattle, WA, USA
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Dude AM, Drexler K, Yee LM, Badreldin N. Adherence to Sexually Transmitted Infection Screening in Pregnancy. J Womens Health (Larchmt) 2023; 32:652-656. [PMID: 37083421 PMCID: PMC10277975 DOI: 10.1089/jwh.2022.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Objective: Professional guidelines and state law require screening for sexually transmitted infections (STI) during pregnancy. Our objective was to evaluate adherence to these recommendations. Methods: This is a retrospective cohort study of patients initiating prenatal care before 20 weeks' gestation. Demographic characteristics and STI screening were abstracted from prenatal records. Tests of interest included initial syphilis, human immunodeficiency virus (HIV), hepatitis B, chlamydia, and gonorrhea tests, as well as repeat (third trimester) syphilis and HIV tests. All patients were eligible for initial screening. Patients were eligible for analysis of whether they received adherent repeat third trimester screening for syphilis (mandated by state law) and HIV (institutional protocol) if they delivered at or after 32 weeks' gestation. Adherent screening was defined as performance of all recommended screening. Results: Of 2370 patients, 1816 (76.6%) received adherent initial STI screening and 181 (7.8% of 2308 patients who delivered at or after 32 weeks' gestation) received adherent repeat third trimester STI screening. After adjusting for covariates, private insurance (adjusted odds ratio [aOR] 1.45, confidence interval [95% CI] 1.12-1.95) was associated with adherent initial screening, whereas being non-Hispanic Black or Hispanic were associated with lower odds of adherent initial screening. Factors associated with adherent repeat third trimester STI screening were younger age (aOR 0.93, 95% CI 0.90-0.97) and non-Hispanic Black race (aOR 3.24, 95% CI 1.94-5.42). Those with private insurance (aOR 0.10, 95% CI 0.06-0.15) were less likely to receive adherent repeat third trimester screening. Conclusion: STI screening rates remain suboptimal. Multiple disparities exist in performance both of initial and repeat third trimester screening.
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Affiliation(s)
- Annie M. Dude
- Division of Maternal—Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kallie Drexler
- Division of Maternal—Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lynn M. Yee
- Division of Maternal—Fetal Medicine, Department of Obstetrics & Gynecology, Northwestern University Chicago, Illinois, USA
| | - Nevert Badreldin
- Division of Maternal—Fetal Medicine, Department of Obstetrics & Gynecology, Northwestern University Chicago, Illinois, USA
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Bonett S, Teixeira da Silva D, Lazar N, Makeneni S, Wood S. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171-176. [PMID: 36423495 PMCID: PMC9576220 DOI: 10.1016/j.puhe.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic disrupted sexual health services for young people, with potential consequences of decreasing preventive screening and increasing undiagnosed sexually transmitted infections (STIs). This study aimed to assess trends in asymptomatic screening among patients receiving STI testing and to estimate the number of STI cases that were missed during the early months of the pandemic. STUDY DESIGN A cross-sectional study of electronic health records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014 to November 2020. METHODS A total of 35,548 testing encounters were analyzed, including 2958 during the pandemic. We assessed whether testing at each encounter was performed as asymptomatic screening, risk-based testing, or symptomatic testing. We evaluated screening trends over time and estimated the number of missed STI cases during the pandemic. RESULTS The mean monthly testing encounters decreased from 479 per month prepandemic to 329 per month during the pandemic. The percent of tests performed as asymptomatic screening dropped from 72.5% prepandemic to a nadir of 54.5% in April 2020. We estimate that this decrease in asymptomatic screening would represent 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. CONCLUSIONS During the pandemic, the total volume of STI testing encounters and the proportion of tests performed as asymptomatic screening decreased, potentially resulting in missed diagnoses. Undiagnosed STIs can result in severe sequelae and contribute to community transmission of STIs. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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Affiliation(s)
- S. Bonett
- School of Nursing, University of Pennsylvania, USA,Corresponding author. School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA. Tel.: +215-573-4299
| | | | - N. Lazar
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| | - S. Makeneni
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - S.M. Wood
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA,PolicyLab, Children's Hospital of Philadelphia, USA
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7
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Mathé PJG, Usadel S, Rieg S, Kern WV, Müller MC. Long-term follow-up after introduction of a systematic sexually transmitted infection screening program for men having sex with men living with HIV in a primary care setting: uptake, STI incidence, and risk factors for infection and reinfection. Infection 2022:10.1007/s15010-022-01946-0. [DOI: 10.1007/s15010-022-01946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Purpose
Annual screening for asymptomatic infections with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is recommended by international guidelines in people living with HIV but uptake in routine care remains poor. This study analyzed the effects of the implementation of a CT/NG screening program in a primary HIV treatment center.
Methods
In this single-center cohort study, we included men having sex with men (MSM) living with HIV during the study period from January 2016 to December 2019. From January 2018 on, annual sexual health counseling including CT/NG screening was proactively offered to all MSM presenting at the center. CT/NG screening rates, test positivity rates and case detection rates in the years 2018 and 2019 were compared to those in the years 2016 and 2017.
Results
A total of 234 patients were enrolled in the study contributing to 798.7 patient years (py) during the four-year study period. Screening rates increased from 3.1% and 3.9% in 2016 and 2017 to 51.1% in 2018 and decrease to 35.4% in 2019. Over the study period, 19.7% (46/234) had at least one positive CT/NG result. After the intervention, case detection per 100 py increased for CT (2016: 2.6, 2017: 3.7, 2018: 7.7, 2019: 7.1) and NG (2016: 3.2, 2017: 3.1, 2018: 5.3, 2019: 7.6). The number needed to test was 8.9 for CT and 10.4 for NG.
Conclusion
Regular CT/NG screening is feasible in a primary care setting, leads to an increase in case detection and may contribute to decrease transmission and complications of CT/NG.
Trial registration
The trial is registered in ClinicalTrials.gov (NCT02149004).
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Teixeira da Silva D, Petsis D, Santos T, Mahajan A, Bonett S, Wood S. Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network. J Adolesc Health 2022; 71:545-551. [PMID: 35963759 PMCID: PMC9588690 DOI: 10.1016/j.jadohealth.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
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Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tatiane Santos
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Mahajan
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen Bonett
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Lambert T, Finlay J, Krahn J, Meyer G, Singh AE, Kennedy M, Caine V. Incentive-Based Sexually Transmitted and Blood-Borne Infections Screening in High-Income Countries: A Systematic Review. Sex Transm Dis 2022; 49:398-402. [PMID: 35121716 PMCID: PMC9093728 DOI: 10.1097/olq.0000000000001614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Despite increasing access to treatment and screening, rates of sexually transmitted and blood-borne infections (STBBI) continue to rise in high-income countries. The high cost of undiagnosed and untreated STBBI negatively affects individuals, health care systems, and societies. The use of monetary and nonmonetary incentives may increase STBBI screening uptake in high-income countries. Incentivized screening programs are most effective when developed specific to context and target population. METHODS Our review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion criteria were as follows: English language, high-income countries, primary research studies, and older than 16 years. Study quality was assessed using Joanna Briggs Institute quality assessment tools. RESULTS The search yielded 6219 abstracts. Thirteen articles met the inclusion criteria. Studies took place in the United States, the United Kingdom, and Australia. Populations screened included: postsecondary and tertiary students, parolees or probationers, youth, and inner-city emergency department patients. Incentivized STBBI screened were human immunodeficiency virus (n = 5), chlamydia (n = 7), and multiple infections (n = 1). Incentives offered were monetary (cash/gift cards/not specified) (n = 10), nonmonetary (n = 1), and mixed (n = 2). Both monetary and nonmonetary incentives enhance STBBI screening in high-income countries. CONCLUSION Incentivized screening programs are most effective when developed specific to context and target population. Further research is needed to analyze incentivized screening across similar study designs and to evaluate long-term effectiveness.
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Affiliation(s)
- Teresa Lambert
- From the Sexually Transmitted Infections Program, Alberta Health Services, Edmonton
| | - Jenise Finlay
- From the Sexually Transmitted Infections Program, Alberta Health Services, Edmonton
- Faculty of Nursing
| | - Jessica Krahn
- Cumming School of Medicine, University of Calgary, Calgary
| | - Garret Meyer
- From the Sexually Transmitted Infections Program, Alberta Health Services, Edmonton
| | - Ameeta E. Singh
- From the Sexually Transmitted Infections Program, Alberta Health Services, Edmonton
- Department of Medicine, Faculty of Medicine and Dentistry
| | | | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, Fontaine G, Conway A, Valencia BM, Bajis S, Presseau J, Ward JW, Degenhardt L, Dore GJ, Hickman M, Vickerman P, Grebely J. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022; 7:426-445. [PMID: 35303490 DOI: 10.1016/s2468-1253(21)00471-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite the goal set by WHO to eliminate hepatitis C virus (HCV) as a public health threat, uptake of HCV testing and treatment remains low. To achieve this target, evidence-based interventions are needed to address the barriers to care for people with, or at risk of, HCV infection. We aimed to assess the efficacy of interventions to improve HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. METHODS In this systematic review and meta-analysis, we searched MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and PsycINFO without language restrictions for reports published between database inception and July 21, 2020, assessing the following primary outcomes: HCV antibody testing; HCV RNA testing; linkage to HCV care; and direct-acting antiviral treatment initiation. We also searched key conference abstracts. We included randomised and non-randomised studies assessing non-pharmaceutical interventions that included a comparator or control group. Studies were excluded if they enrolled only paediatric populations (aged <18 years) or if they conducted the intervention in a different health-care setting to that of the control or comparator. Authors were contacted to clarify study details and to obtain additional population-level data. Data were extracted from the records identified into a pre-piloted and standardised data extraction form and a random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. This study is registered in PROSPERO, CRD42020178035. FINDINGS Of 15 342 unique records identified, 142 were included, which reported on 148 unique studies (47 randomised controlled trials and 101 non-randomised studies). Medical chart reminders, provider education, and point-of-care antibody testing significantly improved at least three study outcomes compared with a comparator or control. Interventions that simplified HCV testing, including dried blood spot testing, point-of-care antibody testing, reflex RNA testing, and opt-out screening, significantly improved testing outcomes compared with a comparator or control. Enhanced patient and provider support through patient education, provider care coordination, and provider education also significantly improved testing outcomes compared with a comparator or control. Integrated care and patient navigation or care coordination significantly improved linkage to care and the uptake of direct-acting antiviral treatment compared with a comparator or control. INTERPRETATION Several interventions to improve HCV care that address several key barriers to HCV care were identified. New models of HCV care must be designed and implemented to address the barriers faced by the population of interest. Further high-quality research, including rigorously designed randomised studies, is still needed in key populations. FUNDING None.
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Affiliation(s)
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, National Infection Service, Public Health England Colindale, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, National Institute for Health Research, London, UK
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anna Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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11
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Zheng Y, Yu Q, Lin Y, Zhou Y, Lan L, Yang S, Wu J. Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend study. THE LANCET. INFECTIOUS DISEASES 2022; 22:541-551. [PMID: 34942091 DOI: 10.1016/s1473-3099(21)00448-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a major public health issue worldwide, but there is a paucity of literature on their burden and trends globally. We aimed to assess the global disease burden and trends of STIs from 1990 to 2019. METHODS In this observational trend study, we collected data on incident cases, age-standardised incidence rate, and disability-adjusted life-years (DALYs), and calculated age-standardised DALY rates, for five STIs (syphilis, chlamydia, gonorrhoea, trichomonas, and genital herpes) between 1990 and 2019, by sex, geographical region, and cause using data exclusively from the Global Burden of Disease study 2019. The estimated annual percentage changes in the age-standardised incidence rate and age-standardised DALY rate were calculated to quantify the changing trend. FINDINGS Globally, the age-standardised incidence rate of STIs showed a decreasing trend with an estimated annual percentage change of -0·04 (95% uncertainty interval [UI] -0·08 to 0·00) from 1990 to 2019, reaching 9535·71 per 100 000 person-years (8169·73 to 11 054·76) in 2019. The age-standardised DALY rate showed a decreasing trend with an estimated annual percentage change of -0·92 (-1·01 to -0·84) and reached 22·74 per 100 000 person-years (14·37 to 37·11) in 2019. The sub-Saharan African region had the highest age-standardised incidence rate (19 973·12 per 100 000 person-years, 17 382·69 to 23 001·57) and age-standardised DALY rate (389·32 per 100 000 person-years, 154·27 to 769·74). Adolescents had the highest incidence rate (18 377·82 per 100 000 person-years, 14 040·38 to 23 443·31) and showed stable total STI trends, except for an upward trend of syphilis between 2010 (347·65 per 100 000 person-years, 203·58 to 590·69) and 2019 (423·16 per 100 000 person-years, 235·70 to 659·01). Male individuals had a higher age-standardised incidence rate (10 471·63 per 100 000 person-years, 8892·20 to 12 176·10) than female individuals (8602·40 per 100 000 person-years, 7358·00 to 10001·18), whereas female individuals had a higher age-standardised DALY rate (33·31 per 100 000 person-years, 21·05 to 55·25) than male individuals (12·11 per 100 000 person-years, 7·63 to 18·93). INTERPRETATION Although most countries showed a decrease in age-standardised rates of incidence and DALYs for STIs, the absolute incident cases and DALYs increased from 1990 to 2019. Therefore, STIs still represent a global public health challenge, especially in sub-Saharan Africa and Latin America, which warrants more attention and health prevention service. FUNDING Mega-Project of National Science and Technology for the 13th Five-Year Plan of China and the National Natural Science Foundation of China.
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Affiliation(s)
- Yang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Yu
- Department of Cardiology and Endodontics, The Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yushi Lin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuqing Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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12
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Cullinen K, Hill M, Anderson T, Jones V, Nelson J, Halawani M, Zha P. Improving sexually transmitted infection screening, testing, and treatment among people with HIV: A mixed method needs assessment to inform a multi-site, multi-level intervention and evaluation plan. PLoS One 2021; 16:e0261824. [PMID: 34962965 PMCID: PMC8714108 DOI: 10.1371/journal.pone.0261824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Bacterial sexually transmitted infections (STIs) continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, that of chlamydia, gonorrhea, and syphilis have not. Despite national recommendations on prevention, screening, and treatment of these STIs, these practices have not been standardized. Nine Health Resources and Services Administration Ryan White HIV/AIDS Program funded clinics across 3 US jurisdictions (Florida, Louisiana, and Washington, DC), were selected as clinical demonstration sites to be evaluated in this mixed method needs assessment to inform a multi-site, multi-level intervention to evaluate evidence-based interventions to improve STI screening and testing of bacterial STIs among people with or at risk for HIV. These 3 US jurisdictions were selected due to having higher than national average incidence rates of HIV and bacterial STIs. Descriptive statistics and deductive analysis were used to assess quantitative and qualitative needs assessment data. Results indicate the following needs across participating sites: inconsistent and irregular comprehensive sexual behavior history taking within and among sites, limited routine bacterial STI testing (once/year and if symptomatic) not in accordance with CDC recommendations, limited extragenital site gonorrhea/chlamydia testing, limited annual training on STI-related topics including LGBTQ health and adolescent/young adult sexual health, and limited efforts for making high-STI incidence individuals feel welcome in the clinic (primarily LGBTQ individuals and adolescents/young adults). These findings were used to identify interventions to be used to increase routine screenings and testing for bacterial STIs.
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Affiliation(s)
- Kathleen Cullinen
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
- * E-mail:
| | - Macsu Hill
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Taylor Anderson
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Veronica Jones
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - John Nelson
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Mirna Halawani
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Peijia Zha
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
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13
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Tomcho MM, Lou Y, O'Leary SC, Rinehart DJ, Thomas-Gale T, Douglas CM, Wu FJ, Penny L, Federico SG, Frost HM. An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care. Pediatrics 2021; 148:e2020027508. [PMID: 34675130 PMCID: PMC8972200 DOI: 10.1542/peds.2020-027508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system. METHODS A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment. RESULTS In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic. CONCLUSIONS Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .
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Affiliation(s)
| | - Yingbo Lou
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Sonja C O'Leary
- Departments of General Pediatrics
- Departments of General Pediatrics
| | | | - Tara Thomas-Gale
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Claudia M Douglas
- Departments of General Pediatrics
- Departments of General Pediatrics
- Internal Medicine
| | - Florence J Wu
- Departments of General Pediatrics
- Departments of General Pediatrics
| | - Lara Penny
- Family Medicine
- Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Holly M Frost
- Departments of General Pediatrics
- Center for Health Systems Research, Denver, Colorado
- Departments of General Pediatrics
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14
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Abstract
Gonorrhea and chlamydia rates have risen to record-high levels in the United States over the past decade. Because these infections are often asymptomatic, effective clinical management relies on screening of asymptomatic patients, particularly women younger than 25 years and men who have sex with men. If undetected and untreated, gonorrhea and chlamydia can lead to infertility, ectopic pregnancy, and chronic pelvic pain and can facilitate HIV acquisition and transmission. Primary care providers need to be aware of recent changes in recommended treatments for both infections.
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Affiliation(s)
- Julia C Dombrowski
- University of Washington and Public Health - Seattle & King County, Seattle, Washington (J.C.D.)
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15
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Pham C, Sin MK. Use of Electronic Health Records at Federally Qualified Health Centers: a Potent Tool to Increase Viral Hepatitis Screening and Address the Climbing Incidence of Liver Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1093-1097. [PMID: 32242302 DOI: 10.1007/s13187-020-01741-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Viral hepatitis B and C are among the leading causes of acute and chronic liver disease in the USA. The nature of chronic liver disease is often asymptomatic. This is problematic because the majority of individuals living with chronic hepatitis B and chronic hepatitis C do not know that they are infected and can communicate the disease to others. Furthermore, early disease recognition and treatment have been shown to improve long-term outcomes and decrease healthcare cost. These diseases affect vulnerable populations disproportionately. Asian Americans and Pacific Islanders are more likely than the general US population to have CHB, and the baby boomer generation is more likely than any other age group to have CHC. Federally Qualified Health Centers play a vital role in providing comprehensive primary care to medically underserved populations. Utilization of electronic health records reminders in Federally Qualified Health Centers results in increased screening, reduced provider screening bias and improved opportunity for management of patients living with chronic viral hepatitis. Electronic health records technology is a potent tool kit to aggressively screen, treat, and prevent viral hepatitis, ultimately, leading to decreased incidence of liver cancer.
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Affiliation(s)
- Christina Pham
- Hepatology Nurse Practitioner, VA San Diego, 3350 La Jolla Village Dr. ,Building 1, Rm 3186A, San Diego, CA, 92037, USA
| | - Mo-Kyung Sin
- Seattle University College of Nursing, 901 12th Ave, P.O. Box 222000, Seattle, WA, 98122-1090, USA.
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16
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O'Byrne P, Musten A, Orser L, Buckingham S. Automated STI/HIV risk assessments: Testing an online clinical algorithm in Ottawa, Canada. Int J STD AIDS 2021; 32:1365-1373. [PMID: 34507508 PMCID: PMC8649814 DOI: 10.1177/09564624211031322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the ongoing transmission of sexually transmitted infections (STIs) and HIV, many people became unable to access testing due to COVID-19. To address this, we created a mail-out HIV self-test kit, which could be delivered without restrictions in our region. The uptake and feedback from this project made us realize that comprehensive STI testing was being sought. To ensure testing occurred correctly-that is, it would be targeted at the persons most affected by STIs/HIV-we automated clinical decision-making. We built this model based on a 2-by-2 matrix that plots the risk of STI/HIV transmission and risk of STI/HIV exposure. The intercept of these two measures classifies a person as low, medium, or high risk. After automating this logic, 16 expert clinicians in STI/HIV care tested this system with over 400 test patient cases and refined the algorithm until it yielded the exact outcomes that these clinicians would offer patients based on guidelines. Findings of interest are that the scale of the y-axis is exponential, in that risk factors for exposure do not climb cumulatively but do so according to a quadratic equation. This helps ensure that testing services are targeted at those who are most inequitably burdened by these infections.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, 6363University of Ottawa, Ottawa, ON, Canada
| | | | - Lauren Orser
- School of Nursing, 6363University of Ottawa, Ottawa, ON, Canada
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17
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MacKinnon KR, Grewal R, Tan DH, Rousseau R, Maxwell J, Walmsley S, MacPherson PA, Rachlis A, Andany N, Mishra S, Allen VG, Burchell AN. Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial. BMC Health Serv Res 2021; 21:625. [PMID: 34193138 PMCID: PMC8243864 DOI: 10.1186/s12913-021-06602-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. METHODS Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. RESULTS A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. CONCLUSIONS Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02019043; registered December 23, 2013.
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Affiliation(s)
- Kinnon R MacKinnon
- School of Social Work, York University, 4700 Keele Street, M3J 1P3, Toronto, Ontario, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
| | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Research Institute, University Health Network, Toronto, Canada
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, 1 King's College Cir, M5S 1A8, Toronto, Ontario, Canada
| | - John Maxwell
- AIDS Committee of Toronto, 543 Yonge Street, 4th floor, M4Y 1Y5, Toronto, Ontario, Canada
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital, University Health Network, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, 501 Smyth Road, L1H 8L6, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Anita Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, 661 University Avenue, M5G 1M1, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
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18
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A Clinic-Based Quality Improvement Initiative to Increase Screening for Gonorrhea and Chlamydia in Adolescents. Jt Comm J Qual Patient Saf 2021; 47:510-518. [PMID: 34074609 DOI: 10.1016/j.jcjq.2021.04.006] [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: 12/14/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Universal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old. METHODS At an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims. RESULTS The mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims. CONCLUSION This QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.
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19
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Gannon-Loew KE, Holland-Hall C. A review of current guidelines and research on the management of sexually transmitted infections in adolescents and young adults. Ther Adv Infect Dis 2021; 7:2049936120960664. [PMID: 33598210 PMCID: PMC7863142 DOI: 10.1177/2049936120960664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
Abstract
Adolescents and young adults are at high risk for sexually transmitted infections (STIs). Providers have the responsibility to accurately manage these infections to prevent medical complications and the spread of STIs. This article will review the epidemiology, screening recommendations, diagnostic tests, and treatment guidelines for STIs most commonly encountered in this population: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus, and Trichomonas vaginalis, as well as the sexually associated infection bacterial vaginosis. This review will discuss ongoing research that explores ways to improve the management of STIs in adolescents and young adults.
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20
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Sheddan AJ, Wood F. Use of an Evidence-Based Teaching Strategy to Improve Sexual Health Assessment Among Nurse Practitioners in the Retail Health Environment. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Hughes MS, Apostolou A, Reilley B, Leston J, McCollum J, Iralu J. Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population. Public Health Rep 2020; 136:320-326. [PMID: 33301693 DOI: 10.1177/0033354920970947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Indian Health Service (IHS) screening rates for Chlamydia trachomatis are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening. METHODS We conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only. RESULTS We found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department-specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics-gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics. CONCLUSIONS Awareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.
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Affiliation(s)
| | - Andria Apostolou
- 1246 Indian Health Service, Rockville, MD, USA.,SciMetrika, LLC, McLean, VA, USA
| | - Brigg Reilley
- 23762 Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jessica Leston
- 23762 Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Jonathan Iralu
- 1811 Harvard Medical School, Boston, MA, USA.,1246 Indian Health Service, Gallup, NM, USA
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22
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Wong WCW, Lau STH, Choi EPH, Tucker JD, Fairley CK, Saunders JM. A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing. Epidemiol Rev 2020; 41:168-175. [PMID: 31565737 DOI: 10.1093/epirev/mxz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis is the most common bacterial sexually transmitted infection, causing significant morbidity and economic burden. Strategies like national screening programs or home-testing kits were introduced in some developed countries, yet their effectiveness remains controversial. In this systematic review, we examined reviews of chlamydia screening interventions to assess their effectiveness and the elements that contribute to their success to guide public policy and future research. We assessed English material published after 2000 in PubMed, the Cochrane Library, the British Nursing Index, Medical Database, and Sociological Abstracts, in addition to World Health Organization Global Health Sector Strategies, the European Center for Disease Prevention and Control guidelines, and the Prospective Register of Systematic Reviews. Systematic reviews that focused on chlamydia screening interventions were included. Using the socioecological model, we examined the levels of interventions that may affect the uptake of chlamydia screening. A total of 19 systematic reviews were included. Self-collection in home-testing kits significantly increased screening among girls and women 14-50 years of age. At the organizational level, using electronic health records and not creating additional costs facilitated testing. At the community level, outreach interventions in community and parent centers and homeless shelters achieved high screening rates. At the policy level, interventions with educational and advisory elements could result in significant improvements in screening rates.
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Affiliation(s)
- William Chi Wai Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of General Practice, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Stephanie Tsz Hei Lau
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John M Saunders
- University College London Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, London, United Kingdom
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Turpin R, Rosario AD, Dyer T. Barriers to syphilis testing among men who have sex with men: a systematic review of the literature. Sex Health 2020; 17:201-213. [PMID: 32586417 DOI: 10.1071/sh19044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/11/2020] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM) represent the highest risk group for syphilis in the United States and several other countries. Improving uptake of syphilis testing among MSM requires understanding key barriers to testing in this population. Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review to assess proportions of syphilis testing among MSM and identify social, structural, and individual barriers to syphilis testing was conducted. All searches were conducted through the University of Maryland world catalogue search engine. Studies that measured syphilis testing in a sample of MSM were included. All studies were assessed for bias using JBI-MAStARI instruments. Studies were synthesised based on sample size, years of data collection, study selection method (e.g. hospital or clinic-based, community/venue-based), location (e.g. USA-based, other countries) and results of the bias assessment. For studies measuring barriers associated with testing, the measure of association, point estimate and statistical significance was assessed. Of 848 studies found in the initial search, 24 were included in the final review. The largest difference in syphilis testing proportions was based on hospital or clinic-based sampling (50-87%) compared with venue/community-based and online sampling (31-38%). Socioeconomic factors (four items, four studies, OR 0.23 to 0.68), healthcare interactions six items, five studies, OR 0.09 to 0.69) and community/interpersonal factors (seven items, five studies, OR 0.07 to 0.58) were identified as barriers to testing. Barriers to syphilis testing among MSM include socioeconomic factors, healthcare-related factors and community/interpersonal factors. Improving overall routine utilisation of healthcare services is an especially important focal point in testing promotion.
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Affiliation(s)
- Rodman Turpin
- University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, 4200 Valley Drive #2242, College Park, MD 20742, USA; and Corresponding author.
| | - Andre D Rosario
- Howard University Hospital, Psychiatry and Behavioral Sciences, 2041 Georgia Avenue NW, Washington, D.C. 20060, USA
| | - Typhanye Dyer
- University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, 4200 Valley Drive #2242, College Park, MD 20742, USA
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de Voux A, Bernstein KT, Bradley H, Kirkcaldy RD, Tie Y, Shouse RL. Syphilis Testing Among Sexually Active Men Who Have Sex With Men and Who Are Receiving Medical Care for Human Immunodeficiency Virus in the United States: Medical Monitoring Project, 2013-2014. Clin Infect Dis 2020; 68:934-939. [PMID: 29985985 DOI: 10.1093/cid/ciy571] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Guidelines recommend that sexually active men who have sex with men (MSM) including human immunodeficiency virus (HIV)-positive MSM be tested at least annually for syphilis, with testing every 3-6 months for MSM at elevated risk. We examined the proportion of HIV-positive MSM tested for syphilis in the past 3, 6, and 12 months by their HIV care provider during 2013-2014. METHODS Using data from the Medical Monitoring Project, a population-based HIV surveillance system, we evaluated the proportion of MSM who had documentation of being tested for syphilis by their HIV care provider in the past 3, 6, and 12 months. RESULTS During 2013-2014, 71% (95% confidence interval [CI]: 69%-73%) of sexually active HIV-positive MSM were tested for syphilis in the past year. This proportion was higher among MSM reporting condomless sex: (75%; 95% CI: 72%-78%), and among MSM reporting ≥ 2 sex partners (77%; 95% CI: 74%-79%), in the past 12 months. Among MSM reporting condomless sex, 49% (95% CI: 45%-53%) were tested in the past 6 months, and 26% (95% CI: 22%-30%) in the past 3 months. Among MSM reporting ≥ 2 sex partners, 49% (95% CI: 44%-54%) were tested in the past 6 months and 26% (95% CI: 22%-29%) in the past 3 months. CONCLUSIONS Nearly one-third of sexually active HIV-positive MSM were not tested annually, and many at increased risk were not tested at recommended frequencies. Efforts to improve compliance with screening guidelines for high-risk HIV-positive MSM are warranted.
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Affiliation(s)
- Alex de Voux
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle T Bernstein
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather Bradley
- Division HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yunfeng Tie
- Division HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Luke Shouse
- Division HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Using Provider Incentives and an Opt-Out Strategy in a Successful Quality Initiative to Increase Chlamydia Screening. Jt Comm J Qual Patient Saf 2020; 46:326-334. [PMID: 32386995 DOI: 10.1016/j.jcjq.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) is a highly prevalent sexually transmitted infection in adolescents that can lead to serious complications. San Francisco has one of the highest rates of CT infections in the United States. At baseline, screening rates at the Children's Health Center were significantly below national and network levels. This project aimed to increase screening rates for female patients age 16-24 from 29.2% to 44% in an 18-month period. METHODS The organization engaged providers, residents, and nursing staff to understand the root causes and choose the screening approach. The following strategies were used to implement this approach in primary and urgent care: (1) universal urine collection, (2) provider and staff education, and (3) adoption of faculty Maintenance of Certification (MOC) credit and resident physician financial incentives. RESULTS The annual screening rate for CT in primary care female patients 16-24 years old increased from 29.2% to 61.5% in 18 months, and improved to 71.2% one year after the project. Screening rates for female patients over age 15 seen in the colocated urgent care also increased significantly. The research team found no instances of false positive results and had 4 positive results in high-risk patients who initially reported abstinence. CONCLUSIONS The intervention design and engagement of stakeholders with incentives was associated with significant and sustainable improvements in the CT screening rate for female adolescent primary care patients. This work shows how universal opt-out screening can be a sustainable and effective method to address common barriers to increasing screening for CT in adolescents.
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Nolan MS, Cruz AT, Erickson T. Retrospective Chart Analysis of Child and Adolescent Trichomonas vaginalis Infection in Houston, Texas. J Pediatric Infect Dis Soc 2020; 9:75-81. [PMID: 30624683 DOI: 10.1093/jpids/piy134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Trichomonas vaginalis infection causes significant morbidity in the United States. Despite its high national disease burden, the epidemiologic characteristics of child and adolescent cases are not well understood. In this study, we aimed to describe the socioeconomic, transmission risk factors, clinical manifestations, and geospatial variables associated with cases of T vaginalis infection in the Houston, Texas, metropolitan area. METHODS We performed a retrospective chart abstraction of all T vaginalis cases at 2 large pediatric hospitals in Houston between 2008 and 2016. RESULTS We identified 87 patients (mean age, 16 years; range, 4-18 years); 30% of them were asymptomatic, and 39% were coinfected with another sexually transmitted infection(s). Almost all T vaginalis infections in sexually assaulted patients were diagnosed incidentally. Geospatial analysis identified clustering of cases in areas of high poverty and in minority populations. CONCLUSIONS Our findings indicate that children and adolescents are at risk for T vaginalis infection; however, their risk factors might differ from those in adults. In addition, our geospatial analysis revealed the need for dedicated resources in neighborhoods associated with health disparities to prevent future incident cases.
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Affiliation(s)
- Melissa S Nolan
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia
| | - Andrea T Cruz
- Section of Emergency Medicine & Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Tim Erickson
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices. Sex Transm Dis 2019; 45:e72-e74. [PMID: 29664767 DOI: 10.1097/olq.0000000000000858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using National Ambulatory Medical Care Survey data from 2006 to 2015, we estimated the proportions of young women tested for chlamydia who were symptomatic (urogenital symptoms) or asymptomatic in physician offices. Among women tested for chlamydia, the proportions of women with and without urogenital symptoms were 31.6% and 59.2%, respectively.
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Impact of Significant Decreases Over Time in the Proportion of Sexually Active Medicaid Women Who Had Papanicolaou Testing or Were Pregnant on Trends of Overall Chlamydia Testing Rates. Sex Transm Dis 2019; 45:e90-e93. [PMID: 30044337 DOI: 10.1097/olq.0000000000000895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined Medicaid claims data during 2004 to 2013. The proportion of sexually active females aged 15 to 25 years who had Papanicolaou testing or were pregnant significantly decreased during 2004 to 2013 (67.0% to 43.9%, P < 0.05), resulting in a slowed increasing trend in overall chlamydia screening rates. Structural-level interventions for improving chlamydia screening are urgently needed.
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Elshazzly M, Mnatsakanian A, Machiele R, Aghili R, Kuo YP, Hinkelman A. Analysis of Sexually Transmitted Diseases Within the Patient Population at a Student-Run Free Clinic. J Osteopath Med 2019; 118:e86-e91. [PMID: 30335878 DOI: 10.7556/jaoa.2018.150] [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: 11/24/2022]
Abstract
Context Uninsured patients living in rural areas of North Carolina have been inordinately affected by the increasing prevalence of sexually transmitted diseases (STDs) in the midst of severe budget cuts to treatment programs and a shortage of rural primary care physicians. The Campbell University Community Care Clinic, a self-funded, student-run clinic, provides free health care to uninsured residents of rural Harnett County. As a relatively new clinic serving a unique population, epidemiologic research is paramount to the clinic's continued efficacy. Objective To determine which STDs are present in this patient population and to identify demographic groups at higher risk of contracting STDs. Methods This study was a retrospective analysis of patient medical records from March 1, 2015, to March 6, 2018. Records were evaluated to identify STD cases based on diagnostic information, such as primary diagnoses, positive laboratory results, and clinical indicators. Results A total of 449 patient records were analyzed, revealing an STD incidence rate of 5.3%, which represents a higher STD frequency than the national average of 2%. Our results identified human papillomavirus infection and gonorrhea as the most frequent STDs (n=7 [29.2%] and n=6 [25%], respectively), followed by chlamydia (n=4 [16.7%]), herpes simplex virus (n=4 [16.7%]), syphilis (n=2 [8.3%]), hepatitis C virus (n=2 [4.2%]), trichomoniasis (n=1 [4.2%]), and HIV (n=1 [4.2%]) infections. Among racial/ethnic groups, Hispanics had a slightly higher relative risk (RR) for STDs by a factor of 1.3 when normalized to the average frequency. Patients aged 26 to 29 and 30 to 39 years had a significantly higher RR for STDs: 2.1 and 2.0, respectively. Furthermore, female patients had an STD frequency 3 times that of male patients. Conclusion This study reveals noteworthy health risks in a rural uninsured population, including a higher rate of gonorrhea compared with national rates and a higher RR for STDs in certain demographic groups. These findings form a foundation for improvements in care through earlier STD diagnoses, effective treatment, and enhanced patient education.
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Burchell AN, Lisk R, Yeung A, Rana J, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Guiang CB, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH. Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada. JMIR Res Protoc 2019; 8:e13801. [PMID: 31274111 PMCID: PMC6637728 DOI: 10.2196/13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/17/2023] Open
Abstract
Background HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men. Objective The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada. Methods Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority. Results On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers. Conclusions Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern. International Registered Report Identifier (IRRID) PRR1-10.2196/13801
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada
| | | | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jayoti Rana
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Hassle Free Clinic, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Darrell Hs Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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Wood SM, McGeary A, Wilson M, Taylor A, Aumaier B, Petsis D, Campbell K. Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care. J Pediatr Adolesc Gynecol 2019; 32:32-38. [PMID: 30394335 PMCID: PMC6413877 DOI: 10.1016/j.jpag.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To determine the impact of a multicomponent quality improvement (QI) intervention on Chlamydia trachomatis screening for young women in primary care. DESIGN Observational cohort analysis. SETTING Urban primary care site providing adolescent primary and confidential sexual health care. PARTICIPANTS Female adolescents aged 15-19 years. INTERVENTIONS From December 2016 to April 2018, we designed and implemented a multiphase QI intervention. The final intervention, beginning March 2017, consisted of the following at all adolescent well visits: (1) dual registration for well and confidential sexual health encounters; (2) urine collection during the rooming process; and (3) electronic health record-based prompts for chlamydia screening. MAIN OUTCOME MEASURES Annual chlamydia screening rates before and after the intervention, with a goal of achieving a relative increase of 10%. RESULTS There were 1550 well adolescent encounters from December 2016 to April 2018. The preimplementation chlamydia screening rate among 15- to 19-year-old female adolescents was 312/757 (41.2%) (95% confidence interval, 20.9%-61.5%). Postintervention, this increased to 397/793 (50.0%) (95% confidence interval, 28.6%-71.5%; P < .001). The clinic chlamydia test positivity rate remained stable, at 10.7% and 11.1% in the pre- and postintervention periods, respectively. There was no significant change in median visit length in the pre- (79.2 minutes; interquartile range, 59.5-103.3) and postintervention periods (80.4 minutes; interquartile range, 61.7-102.8; P = .63). CONCLUSION This practice-based QI intervention resulted in a statistically significant 21% relative increase in annual Chlamydia trachomatis screening rates among female adolescents, without lengthening median visit time.
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Affiliation(s)
- Sarah M Wood
- Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Andrea McGeary
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michele Wilson
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - April Taylor
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brenna Aumaier
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle Petsis
- Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kenisha Campbell
- Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review. Implement Sci 2018; 13:130. [PMID: 30348165 PMCID: PMC6196559 DOI: 10.1186/s13012-018-0821-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. Methods Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). Conclusions This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed. Trial registration PROSPERO CRD42016041786 Electronic supplementary material The online version of this article (10.1186/s13012-018-0821-y) contains supplementary material, which is available to authorized users.
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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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Ong JJ, Fu H, Smith MK, Tucker JD. Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations. Expert Rev Anti Infect Ther 2018; 16:423-432. [PMID: 29633888 PMCID: PMC6046060 DOI: 10.1080/14787210.2018.1463846] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.
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Affiliation(s)
- Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Central Clinical School, Monash University, Victoria, Australia
| | - Hongyun Fu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - M. Kumi Smith
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
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McArdle BJ, Buser GL, Hedberg K, Schafer S. Chlamydia Retesting Among Safety-Net Clinic Patients: Infertility Prevention Project. J Womens Health (Larchmt) 2018; 27:1135-1141. [PMID: 29694796 DOI: 10.1089/jwh.2017.6747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Due to high reinfection rates, the Centers for Disease Control and Prevention (CDC) recommend retesting everyone diagnosed with chlamydia after treatment. However, retesting rates are often low, and research on retesting is limited. METHODS Infertility Prevention Project (IPP) was a national chlamydia screening and treatment project in the United States. We completed a retrospective longitudinal analysis using IPP testing data from 8,266 women with at least 1 positive test result from 2010 to 2013. We calculated the proportion of women retested 2-12 months after a chlamydia diagnosis and used Cox proportional hazards models to explore associated factors. RESULTS Only 32% of women had evidence of retesting by 12 months of follow-up. Being younger (multivariate hazard ratio [mHR]: 0.96; 95% confidence interval [CI]: 0.95-0.96), black (mHR: 1.29; 95% CI: 1.12-1.50), or attending a county sexually transmitted diseases (STD; mHR: 1.91; 95% CI: 1.68-2.17), county family planning (mHR: 1.53; 95% CI: 1.39-1.69), or school-based (mHR: 2.34; 95% CI: 2.07-2.65) clinic relative to a nonprofit community health clinic were associated with increased retesting rates. CONCLUSIONS Less than one-third of women are retested. Our results show that some clinic settings may have systematic differences which facilitate retesting, such as use of automated reminders, closed patient populations, and makeup of patient populations. Investigation of clinical environments through site visits and further data analyses may be keys to improving retesting rates.
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Affiliation(s)
- Breanna J McArdle
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Genevieve L Buser
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Katrina Hedberg
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Sean Schafer
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
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Refugio ON, Klausner JD. Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care. Expert Rev Anti Infect Ther 2018; 16:321-331. [PMID: 29489420 DOI: 10.1080/14787210.2018.1446828] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Syphilis continues to be a growing epidemic among men who have sex with men (MSM), particularly for those living with the human immunodeficiency virus (HIV). In 2016, MSM accounted for 80% of primary and secondary syphilis diagnoses in men in the United States; almost half of who were also HIV-infected. The synergistic relationship between HIV and syphilis has significant implications not only for HIV patient management, but also for sexually transmitted infection (STI) control among MSM. Areas covered: We review the literature on STI screening and treatment barriers at the patient-, provider-, and health system-levels, and present strategies to incorporate STI prevention into HIV care settings. Expert commentary: Integration of STI prevention into HIV care is paramount to stop the epidemic of not only syphilis, but also other curable STIs like gonorrhea and chlamydia. Although guidelines have been established for STI testing in HIV-infected MSM, screening rates continue to be lower than desired. Gonorrhea and chlamydia screening is below 50% in HIV-infected MSM; interventions that improve testing of those two infections must be implemented. For syphilis control, other additional strategies such as chemoprophylaxis should be considered given syphilis screening is above 50% in HIV-infected MSM.
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Affiliation(s)
- Oliver N Refugio
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Jeffrey D Klausner
- b Division of Infectious Diseases, Department of Medicine , UCLA , Los Angeles , California , USA
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Syphilis Screening and Diagnosis Among Men Who Have Sex With Men, 2008-2014, 20 U.S. Cities. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S363-S369. [PMID: 28604440 DOI: 10.1097/qai.0000000000001412] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Annual screening for syphilis is indicated for all sexually active men who have sex with men (MSM). METHODS Using National HIV Behavioral Surveillance data from 2008, 2011, and 2014, we assessed trends in self-reported syphilis testing and diagnoses in the past 12 months among MSM. We calculated percentages of syphilis screening and diagnosis by selected characteristics for each year. Trends were assessed using Poisson regression models with generalized estimation equations. Analysis of syphilis diagnosis was limited to participants who reported syphilis screening. RESULTS Analysis included data from 28,295 sexually active MSM. Overall, 49% of MSM interviewed in 2014 reported syphilis screening, a significant increase from 40% in 2011 and 38% in 2008. In 2014, syphilis screening was most commonly reported by MSM who were aged 25-29 years (56%), HIV positive (68%), and had >10 sexual partners in the past 12 months (65%). The largest increases in syphilis screening between 2008 and 2014 were among MSM aged 30-39 years (37%-52%) and MSM who reported >10 sex partners (48%-65%). Among MSM who reported syphilis screening, the diagnoses of syphilis increased from 9% in 2008 to 11% in 2014. Increases in syphilis diagnosis were observed among MSM who were aged 25-29 years (6%-10%), black (9%-14%), HIV positive (15%-21%), and reported >10 sexual partners (11%-17%). CONCLUSIONS Although syphilis screening among MSM increased during 2008-2014, less than half of MSM reported recent syphilis screening in 2014. Given continued increases in syphilis among MSM, innovative interventions are needed to improve compliance with screening recommendations.
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The Impact of the American College of Obstetricians and Gynecologists Guideline Changes in Pap Tests on Annual Chlamydia Test Rates. J Adolesc Health 2017; 61:440-445. [PMID: 28754585 DOI: 10.1016/j.jadohealth.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess impact of the 2009 American College of Obstetricians and Gynecologists (ACOG) Pap guideline changes on chlamydia testing rates among sexually active young women. METHODS The study included sexually active women aged 15-25 years enrolled in commercial health plans from 2005 to 2014. We identified sexually active women by diagnosis, procedure, and drug codes in inpatient, outpatient, and drug claims databases. We identified Pap tests and chlamydia tests among sexually active adolescents (15-20 years) and young adults (21-25 years) over time. Using piecewise regression models, we compared the change in chlamydia testing rates before and after 2009 ACOG guidelines. RESULTS From 2005 to 2014, chlamydia testing rates in sexually active women increased from 23% to 37% among adolescents and from 24% to 43% among young adults. Although the overall increase in chlamydia testing was positive, the annual rate of change in chlamydia testing (slope) decreased significantly after the 2009 ACOG guideline change from 1.9% before to 1.0% after for adolescents (p < .05) and from 2.5% to 1.7% for young adults (p < .05). CONCLUSIONS Although chlamydia test rates are increasing among sexually active women aged 15-25 years from 2005 to 2014, the slower growth in chlamydia testing rate after 2009 may relate to the change in the Pap testing guidelines. Our finding that more than half of sexually active women aged 15-25 years did not have chlamydia testing and that the rate of increased chlamydia testing slowed after 2009 suggests that interventions to improve chlamydia testing apart from combining with Pap testing are still needed.
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Kennedy CE, Haberlen SA, Narasimhan M. Integration of sexually transmitted infection (STI) services into HIV care and treatment services for women living with HIV: a systematic review. BMJ Open 2017. [PMID: 28637733 PMCID: PMC5734446 DOI: 10.1136/bmjopen-2016-015310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review and critically appraise the existing evidence on integration of sexually transmitted infection (STI) services into HIV care and treatment services for women living with HIV. DESIGN Systematic review. DATA SOURCES Four electronic databases were searched through 16February 2017 using keywords for HIV, STIs and integration. Reference lists of included articles and other reviews were also screened. REVIEW METHODS We included studies that compared women living with HIV who received STI services integrated into HIV care and treatment services with those who received HIV care and treatment services without integrated STI services or standard of care. RESULTS Of 170 articles identified, 3 studies reported in 4 articles were included. Two studies evaluated comprehensive care for people living with HIV in the UK; in both cases, quality and uptake of STI services seemed to improve following integration. The third study conducted a comparative case study across different models of care in Swaziland: two clinics integrated with sexual and reproductive health services (including STI services), and two stand-alone HIV clinics (without STI services). Coverage for Pap smears among women living with HIV was higher at the fully integrated site, but there was no significant difference in the prevalence of sexual health screening or advice on sexual health. Reported client satisfaction was generally higher at the stand-alone HIV clinic, and a diverse range of factors related to implementation of different care models challenged the notion that integrated services are always superior or desired. CONCLUSION While there is a limited evidence base for integrating STI services into HIV care and treatment services, existing studies indicate that integration is feasible and has the potential for positive outcomes. However, diverse population needs and health system factors must be considered when designing models of care to provide STI services to women living with HIV.
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Affiliation(s)
- Caitlin E Kennedy
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabina A Haberlen
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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McDonagh LK, Saunders JM, Cassell J, Bastaki H, Hartney T, Rait G. Facilitators and barriers to chlamydia testing in general practice for young people using a theoretical model (COM-B): a systematic review protocol. BMJ Open 2017; 7:e013588. [PMID: 28279998 PMCID: PMC5353274 DOI: 10.1136/bmjopen-2016-013588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chlamydia is a key health concern with high economic and social costs. There were over 200 000 chlamydia diagnoses made in England in 2015. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing, yet efforts to increase testing in this setting have not been effective. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity and Motivation Model of Behaviour (COM-B model). The aim of this systematic review is to: (1) identify barriers and facilitators to chlamydia testing for young people in general practice and (2) use a theoretical model to conduct a behavioural analysis of chlamydia testing behaviour. METHODS AND ANALYSIS Qualitative, quantitative and mixed methods studies published after 2000 will be included. Seven databases (MEDLINE, PubMed, EMBASE, Informit, PsycInfo, Scopus, Web of Science) will be searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Risk of bias will be assessed using the Critical Appraisal Skills Programme. Data regarding study design and key findings will be extracted. The data will be analysed using thematic analysis and the resultant factors will be mapped onto the COM-B model components. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION Ethical approval is not required. The results will be disseminated via submission for publication to a peer-review journal when complete and for presentation at national and international conferences. The review findings will be used to inform the development of interventions to facilitate effective and efficient chlamydia testing in general practice.
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Affiliation(s)
- Lorraine K McDonagh
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - John M Saunders
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- National Chlamydia Screening Programme, Public Health England, London, UK
| | - Jackie Cassell
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Hamad Bastaki
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Thomas Hartney
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
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Carlson NS. Current Resources for Evidence-Based Practice, January/February 2017. J Obstet Gynecol Neonatal Nurs 2016; 46:91-99. [PMID: 27840207 DOI: 10.1016/j.jogn.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bernstein KT. Systems Approaches to Improving Rates of Extragenital Chlamydia and Gonorrhea Screening Among Men Who Have Sex With Men Engaged in Human Immunodeficiency Virus Care. Sex Transm Dis 2016; 42:599-600. [PMID: 26366511 DOI: 10.1097/olq.0000000000000354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kyle T Bernstein
- From the Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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