1
|
Orfield C, Loosier PS, Wagner S, Sabin ER, Fiscus M, Matulewicz H, Vohra D, Staatz C, Taylor MM, Caruso EC, DeLuca N, Moonan PK, Oeltmann JE, Thorpe P. Design and Modification of COVID-19 Case Investigation and Contact Tracing Interview Scripts Used by Health Departments Throughout the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:336-345. [PMID: 38603742 DOI: 10.1097/phh.0000000000001875] [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: 04/13/2024]
Abstract
OBJECTIVES We sought to (1) document how health departments (HDs) developed COVID-19 case investigation and contact tracing (CI/CT) interview scripts and the topics covered, and (2) understand how and why HDs modified those scripts. DESIGN Qualitative analysis of CI/CT interview scripts and in-depth key informant interviews with public health officials in 14 HDs. Collected scripts represent 3 distinct points (initial, the majority of which were time stamped May 2020; interim, spanning from September 2020 to August 2021; and current, as of April 2022). SETTING Fourteen state, local, and tribal health jurisdictions and Centers for Disease Control and Prevention (CDC). PARTICIPANTS Thirty-six public health officials involved in leading CI/CT from 14 state, local, and tribal health jurisdictions (6 states, 3 cities, 4 counties, and 1 tribal area). MAIN OUTCOME MEASURE Interview script elements included in CI/CT interview scripts over time. RESULTS Many COVID-19 CI/CT scripts were developed by modifying questions from scripts used for other communicable diseases. Early in the pandemic, scripts included guidance on isolation/quarantine and discussed symptoms of COVID-19. As the pandemic evolved, the length of scripts increased substantially, with significant additions on contact elicitation, vaccinations, isolation/quarantine recommendations, and testing. Drivers of script changes included changes in our understanding of how the virus spreads, risk factors and symptoms, new treatments, new variants, vaccine development, and adjustments to CDC's official isolation and quarantine guidance. CONCLUSIONS Our findings offer suggestions about components to include in future CI/CT efforts, including educating members of the public about the disease and its symptoms, offering mitigation guidance, and providing sufficient support and resources to help people act on that guidance. Assessing the correlation between script length and number of completed interviews or other quality and performance measures could be an area for future study.
Collapse
Affiliation(s)
- Cara Orfield
- Author Affiliations: Mathematica, Princeton, New Jersey (Mss Orfield, Wagner, Sabin, Matulewicz, and Staatz and Dr Vohra); Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Loosier, Taylor, DeLuca, Moonan, Oeltmann, and Thorpe and Ms Caruso); and National Academy for State Health Policy, Washington, District of Columbia (Dr Fiscus)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Shallangwa MM, Bello HM, Musa SS, Iwenya HC, Hamid RM, Hussaini M. Sociodemographic factors associated with acceptance of index case testing among newly diagnosed human immunodeficiency virus-positive clients in southern borno, Nigeria. Int J STD AIDS 2024; 35:4-10. [PMID: 37678957 DOI: 10.1177/09564624231199521] [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: 09/09/2023]
Abstract
BACKGROUND The study aimed to explore the sociodemographic factors associated with the acceptance of index case testing (ICT) among newly diagnosed people living with HIV (PLHIV) in Southern Borno, Nigeria. METHODS The study involved four healthcare facilities providing antiretroviral therapy (ART) services in Southern Borno, Nigeria. Secondary data from the index case testing register were collected between April 2022 and April 2023. Categorical variables were analyzed using descriptive statistics, while bivariate and multiple logistic regression analyses was used to determine the factors associated with ICT acceptance, using a 95% confidence interval and significance level of p ≤ .05. RESULTS Among the 302 index cases offered ICT, the acceptance rate was 69.5%. Individuals aged 25-49 years (AOR: 0.294, 95% CI: 0.098-0.775) and 50 years and above (AOR: 0.210, 95% CI: 0.046-0.862) were less likely to accept ICT compared to those aged 18-24 years. Married individuals were 38.86 times more likely to accept ICT than those who were single and never married (AOR: 38.856, 95% CI: 12.620-171.674). CONCLUSION The study shows high ICT acceptance among newly diagnosed PLHIV in Southern Borno, with age and marital status as significant factors. These findings can guide targeted interventions to enhance ICT acceptance and enhance HIV care and prevention strategies in the region.
Collapse
|
3
|
Lariat J, Chikwari CD, Dauya E, Baumu VT, Kaisi V, Kafata L, Meza E, Simms V, Mackworth-Young C, Rochford H, Machiha A, Bandason T, Francis SC, Ferrand RA, Bernays S. "It's not safe for me and what would it achieve?" Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe. Sex Reprod Health Matters 2023; 31:2220188. [PMID: 37565610 PMCID: PMC10424614 DOI: 10.1080/26410397.2023.2220188] [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: 08/12/2023] Open
Abstract
Partner notification (PN) is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common PN strategy and relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. We conducted a mixed methods study to understand young people's experiences of PN, particularly the risks and challenges encountered during patient-referral. All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. PN slip uptake and partner treatment were recorded. Among 1807 young people (85.0% female) offered PN slips, 745 (41.2%) took up ≥1 PN slip and 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Between June and August 2021, youth researchers conducted in-depth interviews with 41 purposively selected young people diagnosed with an STI to explore their experiences of PN. PN posed considerable social risks, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect PN would achieve successful outcomes. Public health discourse, which constructs PN as "the right thing to do", influenced participants to adopt narratives that concealed the difficulties of PN and their unmet needs. Urgent interrogation is needed of whether PN is a suitable or constructive strategy to continue pursuing with young people. To improve the outcomes of preventing reinfection and onward transmission of STIs, we must consider developing alternative strategies that better align with young people's lived experiences.Plain language summary Partner notification is a public health strategy used to trace the sexual partners of people who have received a sexually transmitted infection (STI) diagnosis. It aims to interrupt the chains of STI transmission and prevent reinfection by treating both the person diagnosed and their sexual partners. The least effective but most common partner notification strategy used in many resource-limited settings is called "patient referral". This involves a sexual healthcare provider encouraging the person diagnosed to give a "partner notification slip" to their potentially exposed sexual partner/s and persuading them to access treatment. This research sought to better understand young people's experiences of partner notification, particularly the risks and challenges they faced during patient-referral.All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. Young people trained as researchers interviewed 41 young people who had received a STI diagnosis to explore their experiences of partner notification.Only a small number (5.7%) of the partners of those who took a slip attended the service for treatment. Most participants felt they did not have the preparation, skills, or resources to persuade their partners to seek treatment. Many described negative experiences during and after partner notification, including relationship breakdown, reputation damage, and physical violence.These findings suggest that we should reconsider if partner notification is suitable or effective for use with young people. We should explore alternative approaches that do not present risks to young people's social, emotional, and physical safety and well-being.
Collapse
Affiliation(s)
- Joni Lariat
- Associate Lecturer, School of Public Health, University of Sydney, Sydney, Australia
| | - Chido Dziva Chikwari
- Assistant Professor, THRU Zim, Harare, Zimbabwe; Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Study Coordinator, THRU Zim, Harare, Zimbabwe
| | | | | | | | - Esnath Meza
- Youth Researcher, THRU Zim, Harare, Zimbabwe
| | - Victoria Simms
- Associate Professor. THRU Zim, Harare, Zimbabwe; Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Anna Machiha
- STI Coordinator, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Suzanna C. Francis
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Professor, THRU Zim, Harare, Zimbabwe; Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- Associate Professor, School of Public Health, University of Sydney, Sydney, Australia; Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
4
|
Guang A, Howison M, Ledingham L, D’Antuono M, Chan PA, Lawrence C, Dunn CW, Kantor R. Incorporating Within-Host Diversity in Phylogenetic Analyses for Detecting Clusters of New HIV Diagnoses. Front Microbiol 2022; 12:803190. [PMID: 35250908 PMCID: PMC8891961 DOI: 10.3389/fmicb.2021.803190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Phylogenetic analyses of HIV sequences are used to detect clusters and inform public health interventions. Conventional approaches summarize within-host HIV diversity with a single consensus sequence per host of the pol gene, obtained from Sanger or next-generation sequencing (NGS). There is growing recognition that this approach discards potentially important information about within-host sequence variation, which can impact phylogenetic inference. However, whether alternative summary methods that incorporate intra-host variation impact phylogenetic inference of transmission network features is unknown. Methods We introduce profile sampling, a method to incorporate within-host NGS sequence diversity into phylogenetic HIV cluster inference. We compare this approach to Sanger- and NGS-derived pol and near-whole-genome consensus sequences and evaluate its potential benefits in identifying molecular clusters among all newly-HIV-diagnosed individuals over six months at the largest HIV center in Rhode Island. Results Profile sampling cluster inference demonstrated that within-host viral diversity impacts phylogenetic inference across individuals, and that consensus sequence approaches can obscure both magnitude and effect of these impacts. Clustering differed between Sanger- and NGS-derived consensus and profile sampling sequences, and across gene regions. Discussion Profile sampling can incorporate within-host HIV diversity captured by NGS into phylogenetic analyses. This additional information can improve robustness of cluster detection.
Collapse
Affiliation(s)
- August Guang
- Center for Computational Biology of Human Disease, Brown University, Providence, RI, United States
- Center for Computation and Visualization, Brown University, Providence, RI, United States
- *Correspondence: August Guang,
| | - Mark Howison
- Research Improving People’s Lives, Providence, RI, United States
| | - Lauren Ledingham
- Division of Infectious Diseases, The Alpert Medical School, Brown University, Providence, RI, United States
| | - Matthew D’Antuono
- Division of Infectious Diseases, The Alpert Medical School, Brown University, Providence, RI, United States
| | - Philip A. Chan
- Division of Infectious Diseases, The Alpert Medical School, Brown University, Providence, RI, United States
| | - Charles Lawrence
- Division of Applied Mathematics, Brown University, Providence, RI, United States
| | - Casey W. Dunn
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, United States
| | - Rami Kantor
- Division of Infectious Diseases, The Alpert Medical School, Brown University, Providence, RI, United States
| |
Collapse
|
5
|
Learner ER, Schlanger K, Mauk K, Pham CD, Mukai R, Mulleavey L, Kerani RP, Albano T, Sessoms B, Holderman JL, Toro B, Sankaran M, Kirkcaldy RD. Outcomes of Traditional and Enhanced Gonorrhea Partner Services in the Strengthening the US Response to Resistant Gonorrhea Project, 2017 to 2019. Sex Transm Dis 2021; 48:S124-S130. [PMID: 34407012 PMCID: PMC8767793 DOI: 10.1097/olq.0000000000001527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention implemented Strengthening the US Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners; (2) interviewing, testing, and treating partners; and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners. METHODS We analyzed partner services investigation data from 8 jurisdictions participating in SURRG from 2017 to 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data. RESULTS Of 1242 index patients identified, 506 named at least 1 sexual partner. Traditional partner services yielded 1088 sexual partners, and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters. CONCLUSIONS Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people.
Collapse
Affiliation(s)
- Emily R Learner
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Schlanger
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kerry Mauk
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cau D Pham
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lacy Mulleavey
- Colorado Department of Public Health and Environment, Denver, CO
| | - Roxanne P Kerani
- Division of Allergy and Infectious Disease, University of Washington/Public Health-Seattle & King County, Seattle, WA
| | | | | | | | - Brian Toro
- New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Robert D Kirkcaldy
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD Prevention and TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
6
|
Gannon-Loew KE, Holland-Hall C, Ebersole AM, Alexy E, Jackson K, Bonny AE. Expedited Partner Therapy in Female Adolescents: A Study of Acceptance and the Impact on Reinfection Rates. Sex Transm Dis 2021; 48:828-833. [PMID: 33833149 DOI: 10.1097/olq.0000000000001436] [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: 11/27/2022]
Abstract
BACKGROUND Given the high risk of sexually transmitted infections (STIs) in adolescents and young adults (AYAs), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in female AYA before and after availability of EPT. METHODS The pre-EPT cohort was a 3-year (November 2012 to November 2015) retrospective chart review of female AYA positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) before introduction of EPT. An EPT protocol for CT and TV infections was implemented after legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016-5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1-6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance. RESULTS Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre-EPT versus post-EPT cohorts (CT: 24% (57/240) vs 20% (38/192), P = 0.42; TV: 23% (22/97) versus 14% (12/87), P = 0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT, 13% (6/48) vs 21% (23/110), P = 0.50 and TV, 6% (1/18) vs 18% (9/49), P = 0.69). CONCLUSIONS Despite the implementation of an EPT protocol, STI reinfection rates among female AYA remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.
Collapse
|
7
|
A Systematic Review of the Social Network Strategy to Optimize HIV Testing in Key Populations to End the Epidemic in the United States. AIDS Behav 2021; 25:2680-2698. [PMID: 33871730 PMCID: PMC8054132 DOI: 10.1007/s10461-021-03259-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
The United States (U.S.) has a plan to end the HIV epidemic by 2030. The plan’s first pillar prioritizes HIV testing. Social Network Strategy (SNS) is an intervention to reach persons not routinely testing for HIV. We conducted a systematic review of SNS to understand its implementation to optimize HIV testing in the U.S. among key populations. The eligibility criteria included peer-reviewed papers based in the U.S. and focused on HIV testing. We identified and thematically analyzed 14 articles to explore factors associated with successful implementation. Key themes included: (1) social network and recruiter characteristics; (2) strategies for and effectiveness of recruiting key populations; (3) use of and types of incentives; (4) trust, confidentiality, and stigma concerns; and (5) implementation plans and real-world guidance. Cohort studies indicated that SNS detects more incident HIV cases. Partnerships with health departments are critical to confirm new diagnoses, as are developing plans that support recruiters and staff. SNS is a promising strategy to optimize HIV testing among key populations.
Collapse
|
8
|
Lash RR, Moonan PK, Byers BL, Bonacci RA, Bonner KE, Donahue M, Donovan CV, Grome HN, Janssen JM, Magleby R, McLaughlin HP, Miller JS, Pratt CQ, Steinberg J, Varela K, Anschuetz GL, Cieslak PR, Fialkowski V, Fleischauer AT, Goddard C, Johnson SJ, Morris M, Moses J, Newman A, Prinzing L, Sulka AC, Va P, Willis M, Oeltmann JE. COVID-19 Case Investigation and Contact Tracing in the US, 2020. JAMA Netw Open 2021; 4:e2115850. [PMID: 34081135 PMCID: PMC8176334 DOI: 10.1001/jamanetworkopen.2021.15850] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/20/2021] [Indexed: 01/17/2023] Open
Abstract
Importance Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. Objective To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. Design, Setting, and Participants This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. Main Outcomes and Measures For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. Results The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. Conclusions and Relevance In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts.
Collapse
Affiliation(s)
- R. Ryan Lash
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick K. Moonan
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brittany L. Byers
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert A. Bonacci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly E. Bonner
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Division, Oregon Health Authority, Portland
| | - Matthew Donahue
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Nebraska Department of Health and Human Services, Lincoln
| | - Catherine V. Donovan
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- North Carolina Department of Health and Human Services, Raleigh
| | - Heather N. Grome
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Tennessee Department of Health, Nashville
| | - Julia M. Janssen
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Reed Magleby
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- New Jersey Department of Health, Trenton
| | - Heather P. McLaughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James S. Miller
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Washington State Department of Health, Tumwater
| | - Caroline Q. Pratt
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Steinberg
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- South Dakota State Health Department, Sioux Falls
| | - Kate Varela
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Aaron T. Fleischauer
- North Carolina Department of Health and Human Services, Raleigh
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clay Goddard
- Springfield-Greene County Health Department, Springfield, Missouri
| | | | | | - Jill Moses
- Chinle Indian Health Service Unit, Chinle, Arizona
| | - Allison Newman
- Nebraska Department of Health and Human Services, Lincoln
| | | | - Alana C. Sulka
- Gwinnett, Newton, Rockdale Counties Health Departments, Lawrenceville, Georgia
| | - Puthiery Va
- Chinle Indian Health Service Unit, Chinle, Arizona
| | | | - John E. Oeltmann
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
9
|
Carvalho NSD, Silva RJDCD, Val ICD, Bazzo ML, Silveira MFD. Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection. Rev Soc Bras Med Trop 2021; 54:e2020790. [PMID: 34008731 PMCID: PMC8210485 DOI: 10.1590/0037-8682-790-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article addresses human papillomavirus (HPV) infection, one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects and guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is a significant public health issue since it is the most prevalent sexually transmitted infection globally, capable of triggering the oncogenic process of cervical cancer and the possibility of anogenital warts. Important information is presented for gaining knowledge about HPV and action strategies for infection prevention and control, provision of quality care, and effective treatment of the disease. Infection by the human papillomavirus is the sexually transmitted infection of the highest contagion, superior to genital herpes and HIV.
Collapse
Affiliation(s)
| | | | | | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Florianópolis, SC, Brasil
| | | |
Collapse
|
10
|
Dijkstra M, Mohamed K, Kigoro A, Mumba T, Mahmoud S, Wesonga A, Mukuria N, Oduor T, Gichuru E, Schim van der Loeff MF, Palmer S, Graham SM, van der Elst EM, Sanders EJ. Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections. Open Forum Infect Dis 2021; 8:ofab219. [PMID: 34113688 PMCID: PMC8186249 DOI: 10.1093/ofid/ofab219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) partner notification services (HPN), peer mobilization with HIV self-testing, and acute and early HIV infection (AEHI) screening among gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility, and linkage to antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) services. Methods Between April and August 2019, peer mobilizers mobilized clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilized participants received clinic-based rapid antibody testing and point-of-care HIV RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. Results Of 772 mobilized clients, 452 (58.5%) enrolled in the study as mobilized participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but 2 (14/16 [87.5%]) initiated ART. Thirty-five GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64 [60.9%] vs 5/14 [35.7%]) and partners with HIV (27/39 [69.2%] vs 2/5 [40.0%]) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilized participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilization-led self-testing strategy and AEHI screening for GBMSM and TGW, appears to be acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP services.
Collapse
Affiliation(s)
- Maartje Dijkstra
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Khamisi Mohamed
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Alex Kigoro
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Shally Mahmoud
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Abdalla Wesonga
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Nana Mukuria
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Tony Oduor
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Evans Gichuru
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Shaun Palmer
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,University of Washington, Seattle, Washington, USA
| | | | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Global Health, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Carvalho NSD, Silva RJDCD, Val ICD, Bazzo ML, Silveira MFD. [Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection]. ACTA ACUST UNITED AC 2021; 30:e2020790. [PMID: 33729414 DOI: 10.1590/s1679-4974202100014.esp1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
This article addresses human papillomavirus (HPV) infection, this being one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects, as well as guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is an important public health problem, since it is the most prevalent sexually transmitted infection in the world, capable of triggering the oncogenic process of cervical cancer, as well as the possibility anogenital warts occurring. Important information is presented for gaining knowledge about HPV, as well as action strategies for infection prevention and control, provision of quality care and effective treatment of the disease.
Collapse
Affiliation(s)
| | | | | | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Florianópolis, SC, Brasil
| | | |
Collapse
|
12
|
Leichliter JS, Lentine D, Weiss G. Extent and sufficiency of STD/HIV disease intervention specialists in the United States of America, 2016. Sex Health 2021; 18:280-282. [PMID: 33975671 DOI: 10.1071/sh20222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022]
Abstract
Disease intervention specialists (DIS) conduct partner notification for STD and HIV to interrupt the transmission of STD/HIV. In 2016, we collected information from health departments in the United States of America to determine the number of DIS and whether this number was sufficient for STD/HIV prevention. We identified 1610 STD/HIV DIS positions in the USA and 379 DIS supervisory positions. Of DIS positions, 85% were filled indicating potential issues with turnover. Using nationally reportable data from 2016, we found that states with more primary and secondary syphilis cases had more DIS. DIS participated in public health emergencies in 57% of states. Most USA states indicated that the DIS workforce was not sufficient for STD/HIV prevention. Knowledge of information about DIS workload (e.g. number of STD/HIV cases assigned per DIS) would be helpful.
Collapse
Affiliation(s)
- Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America; and Corresponding author.
| | - Dan Lentine
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America
| | - Gretchen Weiss
- HIV, STI, & Viral Hepatitis Program, National Association of County and City Health Officials, Washington, District of Columbia 20005, United States of America
| |
Collapse
|
13
|
Cavalcante EGF, Galvão MTG, Lima ICVD, Almeida PCD. Strategies for notifying sexual partners of people with sexually transmitted infections: a randomized clinical trial. Rev Esc Enferm USP 2020; 54:e03648. [PMID: 33295528 DOI: 10.1590/s1980-220x2019010103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of verbal communication and communication by card in getting sexual partners of people with sexually transmitted infections to attend a health service and the factors associated with the success of these types of communication. METHOD Clinical, controlled, and randomized study, whose intervention was offering a reporting card for index patients to hand to their sexual partners. RESULTS The sample was 189 index patients, 94 of whom were in the control group, and verbally invited their sexual partners to receive care, and 95 were allocated to the intervention group, and took their partner's reporting card to their partners as a way to invite them to receive care. The percentage of partners invited by card who came to the service was 52.6%, in contrast with 43.6% among partners who were invited verbally, but no significant statistical difference was found (p=0.215). The factors associated with failure to convince partners to come to the service were: not living with the partner (p=0.0001); not having a steady partner (p=0.0001); having casual partners (p=0.028); and using condoms with a steady partner (p=0.045). The infection type did not influence the studied partners' visits to the service. CONCLUSION Given the failure to achieve effectiveness when applying the reporting by card, the authors recommend another card model containing information for partners to be used in combination with other methods. Brazilian Clinical Trials Registry: RBR-7jp5mr.
Collapse
Affiliation(s)
| | | | | | - Paulo César de Almeida
- Universidade Estadual do Ceará, Programa de Pós-Graduação Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil
| |
Collapse
|
14
|
Keeling MJ, Hollingsworth TD, Read JM. Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19). J Epidemiol Community Health 2020; 74:861-866. [PMID: 32576605 PMCID: PMC7307459 DOI: 10.1136/jech-2020-214051] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Contact tracing is a central public health response to infectious disease outbreaks, especially in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (COVID-19) from China and elsewhere into the UK highlights the need to understand the impact of contact tracing as a control measure. DESIGN Detailed survey information on social encounters from over 5800 respondents is coupled to predictive models of contact tracing and control. This is used to investigate the likely efficacy of contact tracing and the distribution of secondary cases that may go untraced. RESULTS Taking recent estimates for COVID-19 transmission we predict that under effective contact tracing less than 1 in 6 cases will generate any subsequent untraced infections, although this comes at a high logistical burden with an average of 36 individuals traced per case. Changes to the definition of a close contact can reduce this burden, but with increased risk of untraced cases; we find that tracing using a contact definition requiring more than 4 hours of contact is unlikely to control spread. CONCLUSIONS The current contact tracing strategy within the UK is likely to identify a sufficient proportion of infected individuals such that subsequent spread could be prevented, although the ultimate success will depend on the rapid detection of cases and isolation of contacts. Given the burden of tracing a large number of contacts to find new cases, there is the potential the system could be overwhelmed if imports of infection occur at a rapid rate.
Collapse
Affiliation(s)
- Matt J Keeling
- Zeeman Institute (SBIDER), University of Warwick, Coventry, UK
| | | | - Jonathan M Read
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
15
|
Udeagu CCN, Shah S, Misra K, Xia Q. The usefulness of HIV partner services in the age of treatment as prevention: a registry-based study. Lancet HIV 2020; 7:e482-e490. [PMID: 32621875 DOI: 10.1016/s2352-3018(20)30116-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Partner services are effective tools to identify new cases among sex or needle-sharing partners of people with a new HIV diagnosis. Little is known about partners previously diagnosed with HIV who are not in care or are in care with unsuppressed HIV viral load. We aimed to quantify the previously diagnosed partners of people with a new HIV infection and examine their HIV care status and viral suppression in the 12 months before elicitation. METHODS We did a registry-based study. We used the New York City HIV Surveillance Registry to determine HIV care status and viral load of partners elicited from newly diagnosed people between Jan 1, 2007, and Dec 31, 2018. Previously diagnosed partners with no report of CD4 count or viral load in the preceding 12 months were presumed not to be in care, viral load suppression (<200 copies per mL) was based on the last viral load in the year preceding elicitation, and viraemia was defined as a viral load of 200 copies per mL or more. We used multinomial logistic regression to generate covariates of care and viral load status and their marginal effects. FINDINGS 11 964 partners were elicited; 2603 (33%) were previously diagnosed and 485 (20%) were not in care. 1153 (49%) of 2343 with a viral load report were in care and viraemic at elicitation. The odds of being not in care were higher in non-Hispanic black than non-Hispanic white or other partners (adjusted odds ratio 1·89, 95% CI 1·09-3·27) and lower in partners with male-to-male sex transmission risk (0·37, 0·26-0·51) and country of birth other than the USA (0·57, 0·39-0·85). The odds of being viraemic were higher in partners younger than 30 years than in those aged 30 years or older (1·68, 1·35-2·09) and lower among people with male-to-male sex transmission risk (0·36, 0·29-0·44) and country of birth other than the USA (0·78, 0·66-0·97). INTERPRETATION People with HIV should receive ongoing HIV prevention counselling and partner services data should inform engagement in care for previously diagnosed partners. FUNDING None.
Collapse
Affiliation(s)
- Chi-Chi N Udeagu
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA.
| | - Sharmila Shah
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Kavita Misra
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Qiang Xia
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA
| |
Collapse
|
16
|
Increase in Gonorrhea Incidence Associated With Enhanced Partner Notification Strategy. Sex Transm Dis 2020; 46:706-712. [PMID: 31644498 DOI: 10.1097/olq.0000000000001060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Partner notification services for reportable sexually transmitted infections vary based on jurisdiction, resources, type of infection, and whether an outbreak has been reported. The objective of this study was to determine whether case finding increased after implementation of enhanced notification and follow-up activities for contacts of cases of Neisseria gonorrhoeae in Central Zone, the largest health authority in Nova Scotia, Canada. METHODS Enhanced contact tracing by public health professionals was implemented in May 2015. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was conducted on all positive specimens. Epidemiologic and NG-MAST information for reported gonorrhea cases were captured and analyzed. Case numbers, rates, and NG-MAST results in the preintervention and postintervention periods were compared. Laboratory testing data were extracted and analyzed for association with reported incidence. RESULTS There was a significant increase in the number of reported gonorrhea cases per month when comparing the preintervention and postintervention periods. The reported gonorrhea rate in 2016 was 2.9 times that in 2014. This increase was not associated with changes in testing rates and was more pronounced among women than men. Larger groups of cases sharing the same NG-MAST profiles were detected postintervention. CONCLUSIONS The implementation of an enhanced contact tracing program for N. gonorrhoeae resulted in increased case finding and a notable increase in the reported rate of cases per 100,000 population. Owing to these findings, the practice of enhanced partner notification was continued as standard public health practice in Central Zone. An understanding of case finding efforts is required when interpreting observed trends in rates of N. gonorrhoeae, as early infection is highly asymptomatic in women and can be asymptomatic in men.
Collapse
|
17
|
Sexually Transmitted Disease Partner Services Costs, Other Resources, and Strategies Across Jurisdictions to Address Unique Epidemic Characteristics and Increased Incidence. Sex Transm Dis 2020; 46:493-501. [PMID: 31295215 DOI: 10.1097/olq.0000000000001010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sexually transmitted disease (STD) partner services (PS) are a core component of STD programs. Data on costs are needed to support PS programming. METHODS In Washington State STD PS programs, disease intervention specialists (DIS) conduct telephone-based interviews and occasional field visits, offer expedited partner therapy to heterosexuals with gonorrhea or chlamydia, and promote human immunodeficiency virus (HIV) testing, preexposure prophylaxis, and HIV care. We conducted activity-based microcosting of PS, including: observational and self-reported time studies and interviews. We analyzed cost, surveillance, and service delivery data to determine costs per program outcomes. RESULTS In King, Pierce, and Spokane counties, respectively, DIS allocated 6.5, 6.4, and 28.8 hours per syphilis case and 1.5, 1.6, and 2.9 hours per gonorrhea/chlamydia case, on average. In 2016, each full-time DIS investigated 270, 268, and 61 syphilis and 1177, 1105, and 769 gonorrhea/chlamydia cases. Greater than 80% of syphilis cases in King and Pierce were among men who have sex with men versus 38% in Spokane. Disease intervention specialists spent 12% to 39% of their time actively interviewing cases and notifying partners (clients), and the remaining time locating clients, coordinating and verifying care, and managing case reports. Time spent on expedited partner therapy, HIV testing, and referrals to HIV treatment or preexposure prophylaxis, was minimal (<5 minutes per interview) at locations with resources outside PS staff. Program cost-per-interview ranged from US $527 to US $2210 for syphilis, US $219 to US $484 for gonorrhea, and US $164 to US $547 for chlamydia. DISCUSSION The STD PS resource needs depended on epidemic characteristics and program models. Integrating HIV prevention objectives minimally impacted PS-specific program costs. Results can inform program planning, future budget impact, and cost-effectiveness analyses.
Collapse
|
18
|
Integrating Human Immunodeficiency Virus Testing Into Syphilis Partner Services in Mississippi to Improve Human Immunodeficiency Virus Case Finding. Sex Transm Dis 2020; 46:240-245. [PMID: 30870325 DOI: 10.1097/olq.0000000000000951] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mississippi has the 10th highest rate of new human immunodeficiency virus (HIV) infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case finding strategy has not been evaluated. METHODS We identified all early syphilis (primary, secondary, and early latent) case records reported from July 1, 2014, to December 31, 2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview as the number of syphilis index case patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. RESULTS A total of 1535 (95%) of the 1619 early syphilis index case patients were interviewed for PS. These case patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745 (56%) of 1321 partners not previously diagnosed with HIV were tested for HIV. Partner services identified 696 new early syphilis case patients (46%) and 24 (3.2%) new HIV case patients among partners. Sixty-four index case patient interviews were needed to identify 1 new case of HIV, and 2 interviews were needed to identify 1 new case of syphilis among partners. CONCLUSIONS Syphilis PS allowed MSDH to interact with 1592 men who have sex with men over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case patients could increase HIV case finding in Mississippi.
Collapse
|
19
|
Historical and Current Trends in the Epidemiology of Early Syphilis in San Francisco, 1955 to 2016. Sex Transm Dis 2019; 45:S55-S62. [PMID: 29787467 DOI: 10.1097/olq.0000000000000870] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seventeen years into a sustained epidemic, early syphilis (ES) rates in San Francisco (SF) are continuing to increase and the demographics of the affected population are changing. We provide a historical overview of ES in SF among men who have sex with men (MSM) and describe trends in the epidemiology and disease investigation outcomes. METHODS We examined data from the SF Department of Public Health's patient-based registry of integrated STD surveillance, clinical, and field investigation data to describe demographic and behavioral characteristics of ES cases, as well as outcomes of syphilis partner services (PS). χ Tests were performed to examine categorical differences across periods. Analysis of variance was used to examine differences in continuous variables. RESULTS In 2016, 1095 ES cases were reported among males in SF, a 219% increase from the 343 cases identified 10 years ago. Between 1996-1999 and 2010-2016, an increasing proportion of ES cases were among MSM younger than 25 years, nonwhite, and HIV negative (P < 0.05). A decreasing proportion of ES cases were assigned for PS, among whom a smaller proportion of reported sex partners were identified by name, resulting in an overall decline in the proportion of cases who had at least one named partner treated as a result of PS (Disease Intervention Rate) from 30.5 in 2000-2004 to 14.8 in 2010-2016. CONCLUSIONS Syphilis case rates continue to increase in SF and the epidemic is expanding beyond a core population. Additional resources and innovative prevention approaches are needed to reduce the burden of syphilis among MSM.
Collapse
|
20
|
Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. PLoS Biol 2019; 17:e3000250. [PMID: 31095567 PMCID: PMC6522007 DOI: 10.1371/journal.pbio.3000250] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/12/2019] [Indexed: 01/12/2023] Open
Abstract
Rapid point-of-care resistance diagnostics (POC-RD) are a key tool in the fight against antibiotic resistance. By tailoring drug choice to infection genotype, doctors can improve treatment efficacy while limiting costs of inappropriate antibiotic prescription. Here, we combine epidemiological theory and data to assess the potential of resistance diagnostics (RD) innovations in a public health context, as a means to limit or even reverse selection for antibiotic resistance. POC-RD can be used to impose a nonbiological fitness cost on resistant strains by enabling diagnostic-informed treatment and targeted interventions that reduce resistant strains' opportunities for transmission. We assess this diagnostic-imposed fitness cost in the context of a spectrum of bacterial population biologies and find that POC-RD have a greater potential against obligate pathogens than opportunistic pathogens already subject to selection under "bystander" antibiotic exposure during asymptomatic carriage (e.g., the pneumococcus). We close by generalizing the notion of RD-informed strategies to incorporate carriage surveillance information and illustrate that coupling transmission-control interventions to the discovery of resistant strains in carriage can potentially select against resistance in a broad range of opportunistic pathogens.
Collapse
|
21
|
Assessing Sexually Transmitted Disease Partner Services in State and Local Health Departments. Sex Transm Dis 2019; 45:e33-e37. [PMID: 29750775 DOI: 10.1097/olq.0000000000000803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
State and local health department sexually transmitted disease (STD) programs provide several partner services to reduce disease transmission. Budget cuts and temporary staff reassignments for public health emergencies may affect the provision of partner services. Determining the impact of staffing reductions on STD rates and public health response should be further assessed.
Collapse
|
22
|
Applying Clinical and Public Health Research to Prevent Sexually Transmitted Infections. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 23:239-241. [PMID: 28350626 DOI: 10.1097/phh.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Nakku-Joloba E, Kiguli J, Kayemba CN, Twimukye A, Mbazira JK, Parkes-Ratanshi R, Birungi M, Kyenkya J, Byamugisha J, Gaydos C, Manabe YC. Perspectives on male partner notification and treatment for syphilis among antenatal women and their partners in Kampala and Wakiso districts, Uganda. BMC Infect Dis 2019; 19:124. [PMID: 30727950 PMCID: PMC6366113 DOI: 10.1186/s12879-019-3695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Syphilis screening can be successfully integrated into antenatal clinics, and potentially avert significant morbidity and mortality to unborn infants. A minority of male partners report for testing and treatment, increasing the likelihood of reinfection. We conducted a qualitative study to understand factors influencing male partners to seek treatment after syphilis notification by their pregnant partners. Methods A purposeful sample of 54 adults who participated in the STOP (Syphilis Treatment of Partners) study was stratified by gender (24 women, 30 male partners) and enrolled for in-depth interviews which were audio recorded, transcribed, and analyzed using the thematic approach. Results The participants’ median age (IQR) was 32 years (25–44), 87% were married, and 57.4% (31/74) had attained secondary education. Fourteen of 22 (63%) female participants reported that they sometimes experienced domestic violence. Male participant’s knowledge of syphilis and their perception of their valued role as responsible fathers of an unborn baby facilitated return. Female’s fear of partner‘s violence and poor communication between partners, were barriers against delivery of the notification forms to partners and subsequent treatment of partners. For men, fear of injection pain, perceptions of syphilis as a genetic disease and as a woman’s problem, busy work schedules, poor access to good STD services, shared facilities with women in clinics, as well as HIV-related stigma were important barrier factors. Conclusions The return to the clinic for treatment of male partners after partner notification by infected pregnant women, was low due to limited knowledge about syphilis, fear of painful injection, fears of domestic violence, lack of communication skills (individual characteristics) and syphilis disease characteristics such as signs and symptoms. This, combined with health services characteristics such as structural barriers that hinder male partner treatment, low access, low capacity, work/time challenges, inadequate laboratory services and low clinic personnel capacity; threatens efforts to eliminate mother-to-child infection of syphilis. Improved public messaging about syphilis, better services, legal and policy frameworks supporting STD notification and treatment in resource-constrained settings are needed for effective STD control. Trial registration Clinicaltrials.govNCT02262390., Date Registered October 8 2014.
Collapse
Affiliation(s)
- Edith Nakku-Joloba
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. .,STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.
| | - Juliet Kiguli
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adeline Twimukye
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kimeze Mbazira
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Monica Birungi
- STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kyenkya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugisha
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Charlotte Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
24
|
Cope AB, Mobley VL, Samoff E, O'Connor K, Peterman TA. The Changing Role of Disease Intervention Specialists in Modern Public Health Programs. Public Health Rep 2018; 134:11-16. [PMID: 30500306 DOI: 10.1177/0033354918813549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anna B Cope
- 1 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Division of Public Health, North Carolina Department of Health and Human Services, Communicable Disease Branch, Raleigh, NC, USA
| | - Victoria L Mobley
- 2 Division of Public Health, North Carolina Department of Health and Human Services, Communicable Disease Branch, Raleigh, NC, USA
| | - Erika Samoff
- 2 Division of Public Health, North Carolina Department of Health and Human Services, Communicable Disease Branch, Raleigh, NC, USA
| | - Kevin O'Connor
- 1 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas A Peterman
- 1 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
25
|
Hino S, Grodensky C, Rutstein SE, Golin C, Smith MK, Christmas L, Miller W, Phiri S, Massa C, Kamanga G, Pettifor A. HIV status disclosure during acute HIV infection in Malawi. PLoS One 2018; 13:e0201265. [PMID: 30048496 PMCID: PMC6062079 DOI: 10.1371/journal.pone.0201265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023] Open
Abstract
Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT01450189.
Collapse
Affiliation(s)
- Sayaka Hino
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Catherine Grodensky
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah E. Rutstein
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Carol Golin
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- * E-mail:
| | - M. Kumi Smith
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Lawrenson Christmas
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - William Miller
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | | | - Cecilia Massa
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Gift Kamanga
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Audrey Pettifor
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| |
Collapse
|
26
|
Clark JL, Segura ER, Oldenburg CE, Salvatierra HJ, Rios J, Perez-Brumer AG, Gonzales P, Sheoran B, Sanchez J, Lama JR. Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e232. [PMID: 29970355 PMCID: PMC6053614 DOI: 10.2196/jmir.9821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: a Web-based notification system and patient-delivered partner referral cards. Methods During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. Trial Registration ClinicalTrials.gov NCT01720641; https://clinicaltrials.gov/ct2/show/NCT01720641 (Archived by WebCite at http://www.webcitation.org/70A89rJL4)
Collapse
Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eddy R Segura
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
| | - Amaya Gabriela Perez-Brumer
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, United States
| | | | | | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor San Marcos, Lima, Peru
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
| |
Collapse
|
27
|
The Number of Interviews Needed to Yield New Syphilis and Human Immunodeficiency Virus Cases Among Partners of People Diagnosed With Syphilis, North Carolina, 2015. Sex Transm Dis 2018; 44:451-456. [PMID: 28703722 DOI: 10.1097/olq.0000000000000637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Compare syphilis investigation yield among patient groups using number needed to interview. GOAL To increase investigation efficiency. STUDY DESIGN Retrospective review of North Carolina 2015 syphilis investigations, using the number of cases needed to interview (NNTI) and the total number of cases and contacts needed to interview (TNTI) to compare yield of new syphilis and human immunodeficiency virus diagnoses between patient groups. RESULTS We reviewed 1646 early syphilis cases and 2181 contacts; these yielded 241 new syphilis cases (NNTI, 6.9; TNTI, 16.4) and 38 new human immunodeficiency virus cases (NNTI, 43). Interviews of women (prevalence difference [PD] = 6%, 95% confidence interval [CI], 12-16), patients <30 years old (PD = 5%, 95% CI, 1-8), and patients with titer >1:16 (PD = 5%, 95% CI, 1-9) yielded more new syphilis cases in our adjusted model; no other patient factors increased investigation yield. CONCLUSIONS The NNTI and TNTI are useful measures of efficiency. Prioritizing early syphilis investigation by gender, rapid plasmin reagin titer, and age provides small increases in efficiency; no other factors increased efficiency.
Collapse
|
28
|
Kojima N, Klausner JD. Improving management of sexually transmitted infections in those who use pre-exposure prophylaxis for human immunodeficiency virus infection. AIDS 2018; 32:272-275. [PMID: 29256919 PMCID: PMC5739517 DOI: 10.1097/qad.0000000000001703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jeffrey D Klausner
- David Geffen School of Medicine
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
29
|
van den Broek IVF, Donker GA, Hek K, van Bergen JEAM, van Benthem BHB, Götz HM. Partner notification and partner treatment for chlamydia: attitude and practice of general practitioners in the Netherlands; a landscape analysis. BMC FAMILY PRACTICE 2017; 18:103. [PMID: 29262799 PMCID: PMC5738758 DOI: 10.1186/s12875-017-0676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chlamydia prevalence remains high despite scaling-up control efforts. Transmission is not effectively interrupted without partner notification (PN) and (timely) partner treatment (PT). In the Netherlands, the follow-up of partners is not standardized and may depend on GPs' time and priorities. We investigated current practice and attitude of GPs towards PN and PT to determine the potential for Patient-Initiated Partner Treatment, which is legally not supported yet. METHODS Multiple data-sources were combined for a landscape analysis. Quantitative data on (potential) PT were obtained from prescriptions in the national pharmacy register (2004-2014) and electronic patient data from NIVEL-Primary Care Database (PCD) and from STI consultations in a subgroup of sentinel practices therein. Furthermore, we collected information on current practice via two short questionnaires at a national GP conference and obtained insight into GPs' attitudes towards PN/PT in a vignette study among GPs partaking in NIVEL-PCD. RESULTS Prescription data showed Azithromycin double dosages in 1-2% of cases in the pharmacy register (37.000 per year); probable chlamydia-specific repeated prescriptions or double dosages of other antibiotics in NIVEL-PCD (115/1078) could not be interpreted as PT for chlamydia with certainty. STI consultation data revealed direct PT in 6/100 cases, via partner prescription or double doses. In the questionnaires the large majority of GPs (>95% of 1411) reported to discuss PN of current and ex-partner(s) with chlamydia patients. Direct PT was indicated as most common method by 4% of 271 GPs overall and by 12% for partners registered in the same practice. Usually, GPs leave further steps to the patients (83%), advising patients to tell partners to get tested (56%) or treated (28%). In the vignette study, 16-20% of 268 GPs indicated willingness to provide direct PT, depending on patient/partner profile, more (24-45%) if patients would have the chance to notify their partner first. CONCLUSION GPs in the Netherlands already treat some partners of chlamydia cases directly, especially partners registered in the same practice. Follow-up of partner notification and treatment in general practice needs more attention. GPs may be open to implement PIPT more often, provided there are clear guidelines to arrange this legally and practically.
Collapse
Affiliation(s)
- Ingrid V. F. van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
| | - Gé A. Donker
- NIVEL Primary Care Database, Sentinel Practices, Utrecht, The Netherlands
| | - Karin Hek
- NIVEL Primary Care database, Utrecht, The Netherlands
| | - Jan E. A. M. van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
- Department of General Practice, Academic Medical Center, Amsterdam; STI AIDS Netherlands, Amsterdam, The Netherlands
| | - Birgit H. B. van Benthem
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
| | - Hannelore M. Götz
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
30
|
Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010-2014). Sex Transm Dis 2017; 44:249-254. [PMID: 28282653 DOI: 10.1097/olq.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain. METHODS We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010 to 2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient [OP]) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, sex, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews. RESULTS For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI], 3.43; telephone index [TI], 2.06; adjusted relative risk [aRR], 1.68; 95% confidence interval [CI], 1.55-1.82), notified (IPI, 1.70; TI, 1.13; aRR, 1.39; 95% CI, 1.24-1.56), tested (IPI, 1.15; TI, 0.72; aRR, 1.34; 95% CI, 1.16-1.54), and empirically treated (IPI, 1.03; TI, 0.74; aRR, 1.19; 95% CI, 1.03-1.37), but no difference in infected partners treated (IPI, 0.28; TI, 0.24; aRR, 0.93; 95% CI, 0.72-1.21). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI, 1.87; TI, 1.28; aRR, 1.38; 95% CI, 1.18-1.62), notified (IPI, 1.38; TI, 0.92; aRR, 1.24; 95% CI, 1.03-1.50), and newly diagnosed with HIV (IPI, 0.10; TI, 0.05; aRR, 2.17; 95% CI, 1.04-4.50), but no difference in partners tested (IPI, 0.61; TI, 0.48; aRR, 1.15; 95% CI, 0.88-1.52). CONCLUSIONS Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.
Collapse
|
31
|
Oswalt SB, Eastman-Mueller HP. Chlamydia and gonorrhea screening and expedited partner therapy (EPT) practices of college student health centers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:542-547. [PMID: 28708025 DOI: 10.1080/07448481.2017.1351446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. PARTICIPANTS College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. METHODS Chi-square tests were conducted with Cramer's V providing a measure of association. RESULTS Chlamydia screening of women under 25 years of age was a well-established practice. Almost one-third of SHCs did not report screening practices of men who have sex with men (MSM) consistent with current chlamydia and gonorrhea guidelines; however, there was improvement over time. Few college SHCs utilized expedited partner therapy (EPT), though fewer had blanket restrictions prohibiting its use in 2014 compared to 2010. CONCLUSIONS Over the 5-year period, more SHCs followed current best practices. Improvement in compliance with guidelines related to MSM STD screening as well as increased usage of EPT is needed to best address the needs of the diverse college student population.
Collapse
Affiliation(s)
- Sara B Oswalt
- a Department of Kinesiology , Health and Nutrition, University of Texas at San Antonio , San Antonio , Texas , USA
| | - Heather P Eastman-Mueller
- b Department of Applied Health Science , Indiana University Bloomington , Bloomington , Indiana , USA
- c University Health Center , Indiana University Bloomington , Bloomington , Indiana , USA
| |
Collapse
|
32
|
Hopson LM, Opiola McCauley S. Expedited Partner Therapy: A Review for the Pediatric Nurse Practitioner. J Pediatr Health Care 2017; 31:525-535. [PMID: 28202204 DOI: 10.1016/j.pedhc.2017.01.001] [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: 11/22/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
The rate of sexually transmitted infections in the United States increased in 2015 for the second year in a row. Adolescents bear an undue portion of this burden because of increased physiologic susceptibility, higher rates of reinfection, and developmental age. Despite expedited partner therapy (EPT) being legalized in 39 states, health care providers still report infrequently providing EPT to their adolescent patients. Patients who benefit most from EPT include those with high-risk sexual behavior, a steady relationship status, higher education level, or an established relationship with the provider. This article will review the barriers to providing EPT and factors associated with patient acceptance or refusal, highlight current legal issues, and discuss the role of the pediatric nurse practitioner addressing specific strategies for implementation in practice. EPT is a valuable tool for the pediatric nurse practitioner to promote treatment and prevent reinfection with sexually transmitted infections.
Collapse
|
33
|
Hull S, Kelley S, Clarke JL. Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy. Popul Health Manag 2017. [DOI: 10.1089/pop.2017.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Seán Kelley
- Hull Associates, LLC, Rockland, Massachusetts
| | - Janice L. Clarke
- Jefferson College of Population Health, Philadelphia, Pennsylvania
| |
Collapse
|
34
|
Johnson BL, Tesoriero J, Feng W, Qian F, Martin EG. Cost Analysis and Performance Assessment of Partner Services for Human Immunodeficiency Virus and Sexually Transmitted Diseases, New York State, 2014. Health Serv Res 2017; 52 Suppl 2:2331-2342. [PMID: 28799163 DOI: 10.1111/1475-6773.12748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the programmatic costs of partner services for HIV, syphilis, gonorrhea, and chlamydial infection. STUDY SETTING New York State and local health departments conducting partner services activities in 2014. STUDY DESIGN A cost analysis estimated, from the state perspective, total program costs and cost per case assignment, patient interview, partner notification, and disease-specific key performance indicator. DATA COLLECTION Data came from contracts, a time study of staff effort, and statewide surveillance systems. PRINCIPAL FINDINGS Disease-specific costs per case assignment (mean: $580; range: $502-$1,111), patient interview ($703; $608-$1,609), partner notification ($1,169; $950-$1,936), and key performance indicator ($2,697; $1,666-$20,255) varied across diseases. Most costs (79 percent) were devoted to gonorrhea and chlamydial infection investigations. CONCLUSIONS Cost analysis complements cost-effectiveness analysis in evaluating program performance and guiding improvements.
Collapse
Affiliation(s)
- Britney L Johnson
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Brookhaven, GA, 30329
| | - James Tesoriero
- New York State Department of Health, AIDS Institute, Albany, NY
| | - Wenhui Feng
- Rockefeller Institute of Government, Albany, NY.,Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY
| | - Feng Qian
- University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Erika G Martin
- Rockefeller Institute of Government, Albany, NY.,Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY
| |
Collapse
|
35
|
A Review of Expedited Partner Therapy for the Management of Sexually Transmitted Infections in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:341-348. [PMID: 28167140 DOI: 10.1016/j.jpag.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/22/2022]
Abstract
Adolescents are at high risk of acquiring and becoming reinfected with sexually transmitted infections. Partner notification and treatment are essential to preventing the spread of sexually transmitted infections. Expedited partner therapy (EPT) is a method of partner treatment used by medical providers to treat patients' sexual partners without direct medical evaluation or counseling. The objective of this article is to review the current literature regarding EPT effectiveness, patients' attitudes and acceptance of EPT, and providers' views and practices surrounding the use of this method of partner treatment. In this article potential concerns associated with EPT use, current policy statements, and the legal status of EPT are discussed. EPT results in improved or equivalent rates of reinfection in adolescents and adults with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Overall, patients are accepting of this method of partner treatment, however, providers continue to have concerns that limit its routine use. Additional studies in adolescents will help providers better understand if EPT is a useful method to prevent reinfection in this population.
Collapse
|
36
|
Clark JL, Segura ER, Oldenburg CE, Rios J, Montano SM, Perez-Brumer A, Villaran M, Sanchez J, Coates TJ, Lama JR. Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. BMC Med 2017; 15:94. [PMID: 28468648 PMCID: PMC5415724 DOI: 10.1186/s12916-017-0858-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection. METHODS We enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up. RESULTS The median age of participants was 26 (interquartile range [IQR]: 23-31) with a median of 3 sexual partners (IQR: 2-4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0-2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68-7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0-62.0% versus 36.4%, 95% CI: 27.0-47.4%). CONCLUSIONS Provision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT01720654 . Registered on 10/29/2012.
Collapse
Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Infectious Diseases, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - Eddy R Segura
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Escuela de Medicina, Universidad de Ciencias Aplicadas, Lima, Peru
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | | | | | - Jorge Sanchez
- Universidad Nacional Mayor San Marcos, Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Thomas J Coates
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| |
Collapse
|
37
|
Owusu-Edusei K, Cramer R, Chesson HW, Gift TL, Leichliter JS. State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses. Public Health 2017; 147:101-108. [PMID: 28404485 DOI: 10.1016/j.puhe.2017.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. STUDY DESIGN Longitudinal study. METHODS We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. RESULTS For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. CONCLUSION We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners.
Collapse
Affiliation(s)
- K Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - R Cramer
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - H W Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - T L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - J S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| |
Collapse
|
38
|
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
|