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Cunningham VC, Hurdelbrink J, Smith HL, Sittig KR, Veach LA. Impact of education and clinic site champion on extragenital testing for sexually transmitted infections. Int J STD AIDS 2024; 35:814-817. [PMID: 38756016 DOI: 10.1177/09564624241254875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. METHODS Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. RESULTS Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. CONCLUSION EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.
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Smith AC, Thorpe PG, Learner ER, Galloway ET, Kersh EN. At-home specimen self-collection as an additional testing strategy for chlamydia and gonorrhoea: a systematic literature review and meta-analysis. BMJ Glob Health 2024; 9:e015349. [PMID: 39191483 PMCID: PMC11404247 DOI: 10.1136/bmjgh-2024-015349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/08/2024] [Indexed: 08/29/2024] Open
Abstract
INTRODUCTION Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies. METHODS We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs). RESULTS 19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)). CONCLUSION Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method.
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Affiliation(s)
- Amanda C Smith
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phoebe G Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily R Learner
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eboni T Galloway
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nieuwenburg SA, Bruisten SM, Heijman T, Vermeulen W, van Dam AP, Schim van der Loeff MF, de Vries HJC. Use of Home-Based Self-Collected Dried Blood Spots to Test for Syphilis, Human Immunodeficiency Virus, Hepatitis C and B Virus Infections and Measuring Creatinine Concentration. Sex Transm Dis 2024; 51:283-288. [PMID: 38430511 DOI: 10.1097/olq.0000000000001941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2024]
Abstract
INTRODUCTION Home-based self-collected dried blood spot (DBS) sampling could simplify sexual health and preexposure prophylaxis care and reduce sexually transmitted infections (STIs) clinic visits for men who have sex with men (MSM). We compared the performance of DBS to venipuncture collected blood samples to test four STIs and creatinine concentration. METHODS We invited MSM clients of the Amsterdam STI clinic to participate. Routinely collected peripheral blood was tested for syphilis treponemal antibody, HIV (HIV Ag/Ab), HCV (antibodies), HBV (HBsAg) and creatinine concentration. Participants received a home kit for DBS sampling, a return envelope and a questionnaire to evaluate the acceptability, feasibility and usability of DBS, measured on 5-point Likert scales, 1 representing complete disagreement and 5 complete agreement. We assessed sensitivity and specificity of DBS versus peripheral blood-based testing. RESULTS In 2020 to 2021, we included 410 participants; 211 (51.5%) returned a completed DBS card, 117 (28.5%) returned a partially filled card and 82 (20.0%) did not return a card. The sensitivity for syphilis was 90.8% and the specificity 84.3%. For both HIV Ag/Ab and HBsAg, the sensitivity and specificity were 100.0%. The sensitivity for HCV antibody was 80.0%, and the specificity was 99.2%. The DBS creatinine concentration was a mean of 5.3 μmol/L higher than in venipuncture obtained plasma. Participants' median willingness to take a future DBS was 4 (interquartile range, 3-5). DISCUSSION Dried blood spot may be an acceptable method among MSM for STI testing and creatinine follow-up during preexposure prophylaxis use. However, collecting enough blood on DBS cards was a challenge, and sensitivities for syphilis and HCV serology were too low.
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Affiliation(s)
| | | | - T Heijman
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - W Vermeulen
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
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Ogale YP, Grabowski MK, Nabakka P, Ddaaki W, Nakubulwa R, Nakyanjo N, Nalugoda F, Kagaayi J, Kigozi G, Denison JA, Gaydos C, Kennedy CE. Self-collected samples as an additional option for STI testing in low-resource settings: a qualitative study of acceptability among adults in Rakai, Uganda. BMJ Open 2023; 13:e073241. [PMID: 37963696 PMCID: PMC10649464 DOI: 10.1136/bmjopen-2023-073241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. METHODS Nested within the Rakai Community Cohort Study, we conducted semistructured interviews with 36 adults who SCS for STI testing. We analysed the data using an adapted version of the Framework Method. RESULTS Overall, SCS was acceptable to both male and female participants, regardless of whether they reported recent STI symptoms. Perceived advantages of SCS over provider-collection included increased privacy and confidentiality, gentleness and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. CONCLUSION SCS are acceptable among adults in this low-resource setting and could be offered as an additional option to expand STI diagnostic services.
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Affiliation(s)
- Yasmin Parvizi Ogale
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Proscovia Nabakka
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - William Ddaaki
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Rosette Nakubulwa
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Neema Nakyanjo
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Rakai, Central Region, Uganda
| | - Julie A Denison
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charlotte Gaydos
- Department of Infectious Diseases, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Pellegrino R, Villani S, Spagnolo D, Carofalo I, Carrino N, Calcagnile M, Alifano P, Madaghiele M, Demitri C, Nitti P. Development of PVA Electrospun Nanofibers for Fabrication of Bacteriological Swabs. BIOLOGY 2023; 12:1404. [PMID: 37998003 PMCID: PMC10669574 DOI: 10.3390/biology12111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
In recent years, the enormous demand for swabs for clinical use has promoted their relevance and, consequently, brought the environmental issues due to their single use and lack of biodegradability to the attention of the healthcare industry. Swabs consist of a stick that facilitates their easy handling and manoeuvrability even in complex districts and an absorbent tip designed to uptake and release biological samples. In this study, we focused on the fabrication of an innovative biodegradable poly(vinyl alcohol) (PVA) nanofiber swab tip using the electrospinning technique. The innovative swab tip obtained showed comparable uptake and release capacity of protein and bacterial species (Pseudomonas aeruginosa and Staphylococcus aureus) with those of the commercial foam-type swab. In this way, the obtained swab can be attractive and suitable to fit into this panorama due to its low-cost process, easy scalability, and good uptake and release capabilities.
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Affiliation(s)
- Rebecca Pellegrino
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
| | - Stefania Villani
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
| | - Daniela Spagnolo
- Microbiotech s.r.l., Via A. Tamborino s.n.c., 73024 Maglie, Italy; (D.S.); (I.C.)
| | - Irene Carofalo
- Microbiotech s.r.l., Via A. Tamborino s.n.c., 73024 Maglie, Italy; (D.S.); (I.C.)
| | - Nico Carrino
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
| | - Matteo Calcagnile
- Department of Biological and Environmental Sciences and Technologies, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (M.C.); (P.A.)
| | - Pietro Alifano
- Department of Biological and Environmental Sciences and Technologies, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (M.C.); (P.A.)
| | - Marta Madaghiele
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
| | - Christian Demitri
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
| | - Paola Nitti
- Department of Engineering for Innovation, Campus Ecotekne, University of Salento, Via per Monteroni, 73100 Lecce, Italy; (S.V.); (N.C.); (M.M.); (C.D.)
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Sallabank G, Stephenson R, Gandhi M, Merrill L, Sharma A. Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration. JMIR Form Res 2023; 7:e43539. [PMID: 37023442 PMCID: PMC10131702 DOI: 10.2196/43539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support. OBJECTIVE Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study's implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return. METHODS Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis. RESULTS University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box. CONCLUSIONS Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13647.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Monica Gandhi
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Leland Merrill
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
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Ogale YP, Grabowski MK, Nabakka P, Ddaaki W, Nakubulwa R, Nakyanjo N, Nalugoda F, Kagaayi J, Kigozi G, Denison JA, Gaydos C, Kennedy CE. The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286055. [PMID: 36865312 PMCID: PMC9980269 DOI: 10.1101/2023.02.17.23286055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Introduction Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. Methods Nested within the Rakai Community Cohort Study, we conducted semi-structured interviews with 36 symptomatic and asymptomatic adults who self-collected samples for STI testing. We analyzed the data using an adapted version of the Framework Method. Results Overall, participants did not find SCS physically uncomfortable. Reported acceptability did not meaningfully differ by gender or symptom status. Perceived advantages to SCS included increased privacy and confidentiality, gentleness, and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. Conclusion Despite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services.
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Human Papillomavirus Genotypes Infecting the Anal Canal and Cervix in HIV+ Men and Women, Anal Cytology, and Risk Factors for Anal Infection. Pathogens 2023; 12:pathogens12020252. [PMID: 36839524 PMCID: PMC9963202 DOI: 10.3390/pathogens12020252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
The incidence of anal intraepithelial neoplasias associated with HPV is rising worldwide. In the general population, this pathology is rare, but individuals living with HIV/AIDS are at a significantly higher risk. We aimed to study HPV infection and performed cytological screening to study the epidemiological and behavioral determinants in a group of men and women living with HIV from a region in Mexico with high HIV incidence. This was a cross-sectional study including adults living with HIV/AIDS performed in Merida (Mexico). We invited patients of public HIV/STD clinics and those affiliated with social organizations of people living with HIV to participate in the study. Participants responded to an instrument to assess their risky behaviors and clinical history. Swabs from the anal canal and cervix and anal cytology specimens were obtained by medical staff from women and by self-sampling from men. For the 200 participants, 169 men and 31 women, anal HPV PCR tests resulted in 59.8% positivity (62.6% of men and 45.2% of women), and 17 genotypes were identified. The most frequent high-risk (HR) types for the anal canal were: HPV33 (35.3%), HPV58 (20.6%), HPV66 (18.6%), HPV45 (17.6%), and HPV16 (14.7%). Multiple genotypes were found in over 80% of the participants. Receptive anal intercourse in the previous 12 months, inconsistent condom use, and detectable HIV titers (≥50 cc/mL) were associated with HPV infection (p < 0.05). Cytology (smears and liquid-based) identified that 34.6% of the participants had low-grade squamous intraepithelial lesions (LSILs), and 3.5% had high-grade squamous intraepithelial lesions (HSILs). Neither HPV nor lesions were associated with low CD4+ counts (<200 cells/mm3, p > 0.05). Of the women, 60% were infected in the cervix and 45% in the anal canal, with an agreement of at least one genotype in 90%. The HR-HPV types associated with HSILs were HPV66, 33, 52, 51, 45, 18, and 68.
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Weng R, Ning N, Zhang C, Wen L, Ye J, Wang H, Li J, Chen X, Cai Y. Acceptability of rectal self-sampling in non-clinical venues for chlamydia and gonorrhea testing among men who have sex with men: A cross-sectional study in Shenzhen, China. Front Public Health 2022; 10:992773. [PMID: 36466478 PMCID: PMC9712709 DOI: 10.3389/fpubh.2022.992773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) have become an increasingly important concern. The study aimed to explore (1) the acceptability of rectal self-sampling for chlamydia and gonorrhea testing among MSM in non-clinical venues in Shenzhen city, China; (2) factors associated with the acceptability of rectal self-sampling; and (3) factors associated with rectal CT and NG infections, respectively. Methods This cross-sectional study was conducted in two non-clinical settings in Shenzhen, China, from April 2021 to October 2021. Mixed-effects logistic regression analysis was performed to explore the factors associated with acceptance of rectal self-collection for CT and NG testing. Results Of the 306 MSM who were offered to perform rectal self-sampling, 133 (43.46%) accepted, and 96.24% (128/133) of them successfully provided a valid rectal sample. The prevalence of urogenital CT and NG infections among 303 MSM was 4.29 and 0.66%, respectively. The prevalence of rectal CT and NG infections among 128 participants was 31.25 and 9.38%, respectively. Participants having been diagnosed with HIV infection showed a higher acceptance of rectal self-collection for CT and NG testing. Conclusion This study reported that rectal self-sampling in non-clinical venues for CT and NG testing among MSM was barely acceptable and feasible in China. Most CT and NG infections would have been missed if urethral screening was offered alone, which implies that the CT and NG screening should be scaled up in the above setting. Integrating free CT tests into regular STI interventions for MSM could also be considered.
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Affiliation(s)
- Rongxing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Ning Ning
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,Shantou University Medical College, Shantou University, Shantou, China
| | - Chunlai Zhang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Lizhang Wen
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jianbin Ye
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Honglin Wang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jing Li
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xiangsheng Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China,National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, China
| | - Yumao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,*Correspondence: Yumao Cai
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Lindley LL, Sharif AM, Chowdhury T. College students' comfort with and intention to use self-collection services for STI testing. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1768-1777. [PMID: 33048627 DOI: 10.1080/07448481.2020.1820511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Sexually transmitted infections (STIs) are at unprecedented levels; yet most college students have never been tested. Offering asymptomatic individuals the option to collect their own samples for STI testing is an effective strategy to increase testing coverage. This study explores students' perceptions of self-collection services. Participants: Four hundred and thirty-four (434) students from a large public university completed an online survey in February 2018. Methods: The cross-sectional survey assessed students' human immunodeficiency virus (HIV)/STI testing behaviors, comfort with self-collection procedures, and intention to use self-collection services if offered on campus. Results: Most students (88%) said they would use self-collection test kits they could take home, followed by self-collection in a private room at student health services (59%). Students were most comfortable with testing procedures involving less human interaction and collecting specimens themselves. Cost, accuracy, confidentiality of tests, and provision of clear "how to" instructions, topped students' concerns. Conclusion: Offering self-collection options may increase STI testing among asymptomatic college students.
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Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - A'isha M Sharif
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tasnuva Chowdhury
- UCSD COVID Team, Department of Medicine, University of California San Diego, San Diego, California, USA
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Lin XX, Meng SY, Ke WJ, Zhang XH, Wang LY, Liao YY, Liu H, Zhao PZ, Liang CM, Chen HR, Long HY, Yang B, Yang LG. Community engagement on-site rapid test for chlamydia and gonorrhea among men who have sex with men: a pioneering study in Guangzhou, China. BMC Public Health 2022; 22:1036. [PMID: 35606713 PMCID: PMC9128213 DOI: 10.1186/s12889-022-13460-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are prevalent among men who have sex with men (MSM) in China. However, compared to syphilis and HIV, the testing rate for chlamydia and gonorrhea remains low. The purpose of this pilot study was to evaluate the feasibility for conducting rapid nucleic acid test for chlamydia and gonorrhea in MSM community-based organizations (CBO). Method We recruited our participants through an MSM CBO where free HV and syphilis testing were routinely provided. We collected data including social-demographic background, sexual history, chlamydia and gonorrhea testing history, and reasons for accepting this on-site rapid testing. Urine and/or anorectal swab samples were collected and tested for chlamydia and gonorrhea on-site and the testing results were delivered in about 1.5 h. Positive cases received on-site free treatment. Results From August 2020 to October 2020, 634 MSM visited the CBO for syphilis and HIV testing and 158 (158/634, 24.9%) accepted the on-site chlamydia and gonorrhea rapid test, 135 were finally enrolled. The positive rate fo chlamydia was 16.3% (22/135) and 3.0% (4/135) for gonorrhea, respectively. Only 19.3% participants had previously undergone chlamydia and gonorrhea testing and 68.9% (93/135) participants reported that they had heard of gonorrhea, 47.4% (64/135) had heard of chlamydia. The main reason for testing was “free for charge” (66.2%), followed by “convenient, ‘shorter waiting time” (45.2%) and “had high-risk sexual behavior recently” (16.3%). Conclusions This pilot study showed that the chlamydia and gonorrhea infection rate remains high among MSM, while the testing rate was low. On-site rapid testing is feasible and potentially preferred by MSM.
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Affiliation(s)
- Xiao-Xin Lin
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Si-Yan Meng
- UNC Project China, University of North Carolina at Chapel Hill, Guangzhou, China
| | - Wu-Jian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Xiao-Hui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Liu-Yuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Yu-Ying Liao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Han Liu
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Pei-Zhen Zhao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Chun-Mei Liang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hui-Ru Chen
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hai-Ying Long
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Bin Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
| | - Li-Gang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
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12
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Brennan DJ, Charest M, Turpin A, Griffiths D, Adam BD, Maxwell J, McCrady K, Ahmed R. "It's a win for the clinic, it's a win for the frontline, but, most importantly, it's a win for the client": Task Shifting HIV Prevention Services from Clinicians to Community Health Workers in Ontario, Canada. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:780-792. [PMID: 35505827 PMCID: PMC9049009 DOI: 10.1007/s13178-022-00721-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 05/28/2023]
Abstract
Introduction Despite strong evidence from low- and middle-income countries supporting the use of task shifting to provide quality, cost-effective HIV-related health services, this strategy has been adopted less widely in high-income countries such as Canada. Methods In 2020, we conducted semi-structured interviews with 19 clinicians (e.g., psychologists, nurses, physicians) and 14 community health workers (CHWs) in Ontario to examine their perspectives on the prospect of shifting HIV/STBBI testing services and PrEP in Ontario, Canada. Interviews were transcribed and then analyzed using content analysis. A community consultation with key stakeholders was also performed to assess the validity of the findings. Results There was substantial agreement between clinicians and CHWs with respect to shifting specific tasks related to HIV/STBBI testing and PrEP. In particular, most participants felt that rapid HIV testing could and should be provided by CHWs and that ASOs could be ideal sites for clients to obtain and use self-testing kits for STBBIs. Most respondents agreed that CHWs have the skills and expertise required to perform most non-clinical services related to PrEP (e.g., pre-counselling, follow-up, case management). The co-location of clinicians and CHWs could help support the development of task shifting initiatives. Conclusion Findings indicate that there is enthusiasm among both clinicians and CHWs with respect to shifting HIV prevention services. Creative solutions are required to have a meaningful impact on HIV incidence in this population. Policy Implications With adequate training and supervision, non-regulated CHWs should be allowed to provide certain HIV prevention services such as rapid HIV testing. A provincial, publicly funded program for PrEP is recommended.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | - Maxime Charest
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Aaron Turpin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | | | - Barry D. Adam
- Departments of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON Canada
- Ontario HIV Treatment Network, Toronto, ON Canada
| | | | - Keith McCrady
- 2-Spirited Peoples of the 1st Nations, Toronto, ON Canada
| | - Robbie Ahmed
- Alliance for South Asian AIDS Prevention, Toronto, ON Canada
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13
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Spaulding AC, Rabeeah Z, Del Mar González-Montalvo M, Akiyama MJ, Baker BJ, Bauer HM, Gibson BR, Nijhawan AE, Parvez F, Wangu Z, Chan PA. Prevalence and Management of Sexually Transmitted Infections in Correctional Settings: A Systematic Review. Clin Infect Dis 2022; 74:S193-S217. [PMID: 35416974 PMCID: PMC9989347 DOI: 10.1093/cid/ciac122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions-managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)-can counteract structural racism in healthcare.
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Affiliation(s)
- Anne C Spaulding
- Departments of Epidemiology and Global Health, Rollins School of Public Health; Emory University, Atlanta, Georgia, USA.,Department of Medicine, Division of Infectious Disease, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Zainab Rabeeah
- Departments of Epidemiology and Global Health, Rollins School of Public Health; Emory University, Atlanta, Georgia, USA
| | | | - Matthew J Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Brenda J Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Heidi M Bauer
- California Correctional Health Care Services, Elk Grove, California, USA.,Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Brent R Gibson
- National Commission on Correctional Healthcare, Chicago, Illinois, USA
| | - Ank E Nijhawan
- Department of Medicine, Division of Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farah Parvez
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Field Services Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Bureau of Tuberculosis Control, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Zoon Wangu
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Field Services Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Bureau of Tuberculosis Control, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, UMass Memorial Children's Medical Center & UMass Chan Medical School, Worcester, Massachusetts, USA.,Ratelle STD/HIV Prevention Training Center, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Philip A Chan
- Department of Medicine, Division of Infectious Disease, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences at the Brown University School of Public Health, Providence, Rhode Island, USA.,National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Elimination, National Centers for Disease Control and Elimination, Atlanta, Georgia, USA
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14
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Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center. Pilot Feasibility Stud 2021; 7:208. [PMID: 34782013 PMCID: PMC8591317 DOI: 10.1186/s40814-021-00928-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Men who have sex with men (MSM) are at increased risk for extra-genital sexually transmitted infections (STIs). Without extra-genital screening, many chlamydia and gonorrhea infections would be missed among MSM. Yet, many barriers exist to extra-genital testing, and, in particular, to rectal collection. Self-collection increases screening and detection of asymptomatic chlamydia and gonorrhea among at-risk MSM and transgender women. This feasibility study assessed use of rectal self-collection and its acceptance among patients and primary care providers (PCPs) at a large, general practice community health center. The primary objective of this project was to assess the feasibility of including rectal self-collection as part of an implementation study looking to embed an STI care program in a safety-net primary care setting that would shift routine screening tasks to non-provider clinical team members such as medical assistants and nurses. Methods Three PCPs identified and offered rectal self-collection to their MSM and transgender female patients who were due for routine or risk-based STI screening. For those patients who elected to participate in the study, the PCP’s medical assistant (MA) reviewed the self-collection instructions with them as part of their routine preventive care duties, and patients collected their own sample. Patients and PCPs completed brief cross-sectional surveys assessing the self-collection process. Results Of 1191 patients with sexual orientation and gender identity (SOGI) data on file who were seen for a medical visit by one of the three PCPs, 87 (7.3%) identified as MSM or transgender female. Seventy-five were due for rectal screening, of whom 33 (44%) were offered and completed rectal self-collection. Survey results indicated that self-collection was acceptable to and preferred over clinician-collection by both PCPs and patients. Conclusions This study demonstrated that rectal self-collection is feasible as part of STI screening in a high-volume primary care setting, and can be administered as part of the clinical tasks that MAs routinely conduct. The overall acceptance by both PCPs and patients will allow the inclusion of rectal self-collection in an implementation study looking to increase STI screening at a large community health center by facilitating MA-led collection during medical provider visits and by establishing standalone nurse-led STI visits.
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15
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Carveth-Johnson T, Dunin De Skrzynno S, Wynn A, Moshashane N, Ramontshonyana K, Lebelonyane R, Mussa A, Ramogola-Masire D, Klausner J, Morroni C. Integrating Sexually Transmitted Infection Testing and Treatment With Routine HIV Care in Gaborone, Botswana. Sex Transm Dis 2021; 48:887-894. [PMID: 34174039 PMCID: PMC8505143 DOI: 10.1097/olq.0000000000001492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infection (STI) testing is not routinely offered in many countries, and management is symptoms based. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are associated with an increased risk of HIV transmission. We assess the feasibility and acceptability of integrating CT/NG testing into routine HIV care in Botswana, as well as the prevalence and correlates of CT/NG infections. METHOD A prospective study was conducted at an HIV clinic in Gaborone between February and October 2019. Eligibility criteria included the following: ≥18 years, HIV infected, and not treated for CT/NG in the past month. Participants self-collected samples and responded to a questionnaire on sociodemographic and health characteristics. Samples were processed using the GeneXpert. Patients were offered same-day results in person or by telephone. Those who tested positive were treated. RESULTS Of 806 patients informed of the study, 526 (65%) expressed interest and 451 (60%) were enrolled. The median age was 48 years, and 66% were women. All participants provided self-collected samples, were successfully tested, and received results. Almost all reported sample self-collection was easy. The prevalence of CT/NG was 5%. Most participants (73%) with a positive result were asymptomatic. Among infected, 20 (91%) received same-day results and all were treated. Younger age, female sex, and pain during sex were associated with having CT/NG. CONCLUSIONS Integrating STI testing into routine HIV care was feasible, self-collecting specimens was highly acceptable, but uptake of testing was low. Where blanket screening to the entire clinic population may not be feasible because of resource limitation, one strategy could be to prioritize sexually active patients, younger patients, and women.
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Affiliation(s)
| | | | - Adriane Wynn
- From the Botswana-UPenn Partnership (BUP), Gaborone, Botswana
- Division of Infectious Diseases and Global Health, Department of Medicine, University of California, Los Angeles, California
| | - Neo Moshashane
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
| | | | | | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
| | | | - Jeffrey Klausner
- Department of Medicine, University of California, Los Angeles, California
| | - Chelsea Morroni
- From the Botswana-UPenn Partnership (BUP), Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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Abstract
Gonorrhea and chlamydia rates have risen to record-high levels in the United States over the past decade. Because these infections are often asymptomatic, effective clinical management relies on screening of asymptomatic patients, particularly women younger than 25 years and men who have sex with men. If undetected and untreated, gonorrhea and chlamydia can lead to infertility, ectopic pregnancy, and chronic pelvic pain and can facilitate HIV acquisition and transmission. Primary care providers need to be aware of recent changes in recommended treatments for both infections.
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Affiliation(s)
- Julia C Dombrowski
- University of Washington and Public Health - Seattle & King County, Seattle, Washington (J.C.D.)
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17
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Dovel K, Balakasi K, Gupta S, Mphande M, Robson I, Khan S, Amberbir A, Stilson C, van Oosterhout JJ, Doi N, Nichols BE. Frequency of visits to health facilities and HIV services offered to men, Malawi. Bull World Health Organ 2021; 99:618-626. [PMID: 34475599 PMCID: PMC8381098 DOI: 10.2471/blt.20.278994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To determine how often men in Malawi attend health facilities and if testing for human immunodeficiency virus (HIV) is offered during facility visits. Methods We conducted a cross-sectional, community-representative survey of men (15–64 years) from 36 villages in Malawi. We excluded men who ever tested HIV-positive. Primary outcomes were: health facility visits in the past 12 months (for their own health (client visit) or to support the health services of others (guardian visit)); being offered HIV testing during facility visits; and being tested that same day. We disaggregated all results by HIV testing history: tested ≤ 12 months ago, or in need of testing (never tested or tested > 12 months before). Findings We included 1116 men in the analysis. Mean age was 34 years (standard deviation: 13.2) and 55% (617/1116) of men needed HIV testing. Regarding facility visits, 82% (920/1116) of all men and 70% (429/617) of men in need of testing made at least one facility visit in the past 12 months. Men made a total of 1973 visits (mean two visits): 39% (765/1973) were as guardians and 84% (1657/1973) were to outpatient departments. Among men needing HIV testing, only 7% (30/429) were offered testing during any visit. The most common reason for not testing was not being offered services (37%; 179/487). Conclusion Men in Malawi attend health facilities regularly, but few of those in need of HIV testing are offered testing services. Health screening services should capitalize on men’s routine visits to outpatient departments as clients and guardians.
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Affiliation(s)
- Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, United States of America (USA)
| | | | - Sundeep Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, United States of America (USA)
| | | | | | | | | | | | | | - Naoko Doi
- Clinton Health Access Initiative, Boston, USA
| | - Brooke E Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, USA
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18
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Nyitray AG, Schick V, Swartz MD, Giuliano AR, Fernandez ME, Deshmukh AA, Ridolfi TJ, Ajala C, Brzezinski B, Sandoval M, Nedjai B, Smith JS, Chiao EY. Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening. BMJ Open 2021; 11:e051118. [PMID: 34187833 PMCID: PMC8245463 DOI: 10.1136/bmjopen-2021-051118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER NCT03489707.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Insitute, Tampa, Florida, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Ajala
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Micaela Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Belinda Nedjai
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jennifer S Smith
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Elizabeth Y Chiao
- Department Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mbulawa ZZA, Somdyala NI, Mabunda SA, Williamson AL. High human papillomavirus prevalence among females attending high school in the Eastern Cape Province of South Africa. PLoS One 2021; 16:e0253074. [PMID: 34143816 PMCID: PMC8213156 DOI: 10.1371/journal.pone.0253074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
As part of the human papillomavirus (HPV) vaccination strategy in South Africa, it is essential to have information on HPV prevalence, and HPV types distribution among the unvaccinated population. Information on the prevalence of HPV and the distribution of HPV types in adolescents and young women in South Africa’s Eastern Cape Province is minimal. Therefore, this study investigates the prevalence, distribution of HPV types, and factors associated with HPV infection amongst unvaccinated female learners. A sample composed of 213 sexually active female learners attending high schools in the Eastern Cape Province of South Africa; median age 18 years, who provided self-collected vaginal specimens. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection. HPV infection was detected in 76.06% (162/213) of participants. Of these 14.55% (31/213) were positive for HPV types targeted by the Cervarix® HPV vaccine (HPV-16 and/or 18), 20.66% (44/213) by Gardasil®4 (HPV-6, -11, -16 and/or -18) and 37.09% (79/213) by Gardasil®9 (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58). HPV-35, commonly detected in cervical cancer cases among women of African ancestry, was frequently detected (9.40%). Participants who reported to have ever consumed alcohol had a significantly higher risk of HPV infection (OR: 2.91, 95% CI: 1.38–6.11, p = 0.005). High HPV prevalence was observed among participants. The high prevalence of HPV types targeted by the Gardasil®9 vaccine encourages the introduction of the Gardasil®9 vaccine. Data from this study will inform both vaccination campaigns and monitor the impact on HPV types after vaccination.
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Affiliation(s)
- Zizipho Z. A. Mbulawa
- National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha, South Africa
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Nontuthuzelo I. Somdyala
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa
| | - Sikhumbuzo A. Mabunda
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Anna-Lise Williamson
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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20
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Zeidan AR, Strey K, Vargas MN, Reveles KR. Sexually transmitted infection laboratory testing and education trends in US outpatient physician offices, 2009-2016. Fam Med Community Health 2021; 9:e000914. [PMID: 34144971 PMCID: PMC8215241 DOI: 10.1136/fmch-2021-000914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe national rates of sexually transmitted infection (STI) testing and education overall and among patient subgroups in US outpatient physician offices from 2009 to 2016. DESIGN This was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Data weights were applied to extrapolate to national estimates. SETTING Data were collected from a systematic random sample of outpatient physician office visits throughout USA. Physician office types include free standing clinics, private or group setting practices, centres offering community and mental health services, family planning clinics and health maintenance organisations/other prepaid clinics. PARTICIPANTS All sampled patient visits were eligible for inclusion and were assessed for the provision of STI prevention education and STI testing for chlamydia, gonorrhoea, hepatitis, human papillomavirus (HPV) and HIV. RESULTS Of 7.6 billion total visits, 123 million included an STI test. Hepatitis was the most commonly tested STI (9.12 per 1000), followed by chlamydia (6.67 per 1000), gonorrhoea (6.00 per 1000), HIV (5.40 per 1000) and HPV (5.03 per 1000). Testing rates for the three STIs measured for the entire 8-year period increased over time and peaked in 2015 compared with 2009: chlamydia (R2=0.36), HPV (R2=0.28) and HIV (R2=0.51). Testing was highest among women (21.93 per 1000), 15-24-year olds (46.04 per 1000), non-Hispanic blacks (37.33 per 1000) and those seen by obstetrics/gynaecology specialists (103.75 per 1000). STI prevention education was provided to 4.89 per 1000 patients and remained relatively unchanged from 2013 to 2016. CONCLUSION STI testing in outpatient physician offices increased over the study period but varied by patient characteristics and site of care. Few patients received STI prevention education, highlighting a potential gap in resource utilisation in these settings.
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Affiliation(s)
- Amina R Zeidan
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kelsey Strey
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michelle N Vargas
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA
- Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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21
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Cockerill FR, Wohlgemuth JG, Radcliff J, Sabol CE, Kapoor H, Dlott JS, Marlowe EM, Clarke NJ. Evolution of Specimen Self-Collection in the COVID-19 Era: Implications for Population Health Management of Infectious Disease. Popul Health Manag 2021; 24:S26-S34. [PMID: 33544647 PMCID: PMC7875129 DOI: 10.1089/pop.2020.0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Laboratory testing is an important component in the diagnosis of respiratory tract infections such as with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, specimen collection not only risks exposure of health care workers and other patients to infection, but also necessitates use of personal protective equipment that may be in short supply during periods of heightened disease activity. Self-collection of nasal or oropharyngeal swabs offers an alternative to address these drawbacks. Although studies in the past decade have demonstrated the utility of this approach for respiratory infections, it has not been widely adopted in routine clinical practice. The rapid spread of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has focused attention on the need for safe, convenient, timely, and scalable methods for collecting upper respiratory specimens for testing. The goals of this article are to highlight the literature regarding self-collected nasal or oropharyngeal specimens for respiratory pathogen testing; discuss the role of self-collection in helping prevent the spread of the COVID-19 disease from infected patients and facilitating a shift toward “virtual” medicine or telemedicine; and describe the current and future state of self-collection for infectious agents, and the impacts these approaches can have on population health management and disease diagnosis and prevention.
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Affiliation(s)
| | | | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
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22
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Pottorff A, Duarte P, Chow J, Luque A, Nijhawan AE. Extragenital Testing for Neisseria gonorrhoeae and Chlamydia trachomatis in a Large HIV Clinic in the US South: Implementation and Epidemiology. Sex Transm Dis 2021; 48:e22-e26. [PMID: 33433170 PMCID: PMC7855633 DOI: 10.1097/olq.0000000000001349] [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: 11/25/2022]
Abstract
BACKGROUND Rectal and oral Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections are common among people with HIV, especially men who have sex with men (MSM); however, GC/CT testing rates remain low in many HIV clinics. We evaluated the real-world implementation and results of extragenital nucleic acid amplification testing for GC/CT in an urban HIV clinic. METHODS Electronic health records were reviewed for all patients 18 years or older with ≥1 outpatient visit to an HIV clinic in Dallas, TX, from February 2016 to May 2019. Extragenital nucleic acid amplification testing became available in February 2017, which was followed by active interventions to increase testing. RESULTS Overall, 5564 individual patients were included in the preintervention period (February 2016-January 2017), 5067 in the intervention period (February 2017-August 2017), and 7030 in the postintervention period (September 2017-May 2018). Tailored education was provided to patients, and nursing and medical providers, and a self-collection protocol was implemented beginning in spring 2017. A sustained increase in extragenital GC/CT testing among MSM patients, from 70% to 87% (P < 0.01), was observed. Among MSM, overall GC positivity increased from 3.2% to 8.5% and CT positivity increased from 3.9% to 8.3%. N. gonorrhoeae/C. trachomatis infections were highest among young (<35 years) MSM, and approximately 50% of GC/CT infections diagnosed were detected by oral and rectal tests. CONCLUSIONS Clinic-wide education and self-collection of extragenital specimens were associated with increased GC/CT testing and detection in a large HIV clinic.
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Affiliation(s)
| | - Piper Duarte
- Parkland Health and Hospital Systems, Department of HIV Services, Performance Improvement
| | - Jeremy Chow
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases
- Parkland Health and Hospital Systems
| | - Amneris Luque
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases
- Parkland Health and Hospital Systems
| | - Ank E. Nijhawan
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases
- Parkland Health and Hospital Systems
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23
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High prevalence of sexually transmitted coinfections among at-risk people living with HIV. J Formos Med Assoc 2020; 120:1876-1883. [PMID: 33341349 DOI: 10.1016/j.jfma.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/PURPOSE Concurrent sexually transmitted infections (STIs) are not uncommon in at-risk populations, for which control requires integrated testing, treatment and prevention. METHODS From May, 2019 to February, 2020, multiplex real-time PCR assays were prospectively performed to detect Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) in the urine and rectal/vaginal swab specimens collected from HIV-positive patients with a history of STIs or symptoms suggestive of STIs. Patients confirmed to have acquired STIs were treated according to treatment guidelines. RESULTS During the study period, 430 participants (99.1% men who have sex with men and median age 37 years) were included. The overall prevalence of CT, NG, and/or TV infection was 30.0%, including 24.7%, 12.1%, and 0.2% for CT, NG, and TV infection, respectively. The factors associated with CT, NG, and/or TV infection were hepatitis B surface antigen (HBsAg) seropositivity (AOR, 2.76; 95% CI, 1.22-6.26), recently acquired hepatitis C virus (HCV) infection (AOR, 5.62; 95% CI, 1.99-15.88), using mobile dating application (AOR, 2.08; 95% CI, 1.13-3.83), and oral sex (AOR, 2.12; 95% CI, 1.04-4.32). The rates of CT, NG, and/or TV infection were 50.0% in participants with recent HCV infection, 44.2% in those with HBsAg positivity, and 35.9% in those with incident syphilis. Among participants completing test-of-cure visits, the microbiological cure rate was 91.7% and 90.0% for chlamydia and gonorrhea, respectively. CONCLUSION HIV-positive participants had a high prevalence of CT and/or NG, especially those coinfected with viral hepatitis and syphilis. Our results strongly support integrated STI services in the population.
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Li KT, Tang W, Wu D, Huang W, Wu F, Lee A, Feng H, Pan SW, Han L, Mak V, Yang L, Tucker JD. Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study. THE LANCET. INFECTIOUS DISEASES 2020; 19:76-82. [PMID: 30587296 DOI: 10.1016/s1473-3099(18)30556-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chinese men who have sex with men (MSM) rarely receive gonorrhoea and chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase uptake of gonorrhoea and chlamydia testing among MSM. METHODS We performed a quasi-experimental pragmatic study to compare a pay-it-forward model with standard of care at two HIV testing sites for MSM in Guangzhou, China: an STD clinic for MSM and a local MSM community-based organisation. All men who arrived at the STD clinic or the community-based organisation were invited to participate. In the pay-it-forward programme, men were offered free gonorrhoea and chlamydia testing and given the option of donating money toward testing for future participants. In the standard-of-care group, men were offered gonorrhoea and chlamydia testing at the standard patient price of ¥150 (about US$21·50). The pay-it-forward programme was implemented for 3 months, after which both sites switched to standard of care offering dual testing for 3 months. The primary outcome for this study was uptake of dual gonorrhoea and chlamydia testing, which we compared using χ2 test and logistic regression, reported as crude odds ratios (cOR) and adjusted odds ratios (aOR), by adjusting for nationality, marital status, income, and site of testing. FINDINGS The pay-it-forward programme took place from Dec 2, 2017, to Feb 3, 2018, and the standard-of-care control took place from March 11, 2018, to May 1, 2018. 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Overall, 109 (54%) of 203 men in the pay-it-forward group and 12 (6%) of 205 men in the standard-of-care group received gonorrhoea and chlamydia testing (cOR 18·65, 9·78-35·54; p<0·0001; aOR 19·73, 95% CI 10·02-38·85; p<0·0001). Of all 121 men who tested, this was the first gonorrhoea test for 97 (80%) men and the first chlamydia test for 104 (86%) men. Five (4%) of these 121 men were diagnosed with gonorrhoea and 15 (12%) were diagnosed with chlamydia. 97 (89%) of 109 men who received testing in the pay-it-forward group donated some money toward testing for future participants. INTERPRETATION Pay-it-forward might be a sustainable model for expanding integrated HIV testing services among MSM in China. FUNDING National Institutes of Health, Southern Medical University Dermatology Hospital, Doris Duke Charitable Foundation.
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Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, New York, NY, USA; University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Dermatology Hospital, Southern Medical University, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Feng Wu
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Sun Yat-sen University, Guangzhou, China
| | - Amy Lee
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Henry Feng
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Duke University, Durham, NC, USA
| | | | - Larry Han
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of Cambridge Judge Business School, Cambridge, UK
| | - Vincent Mak
- University of Cambridge Judge Business School, Cambridge, UK
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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25
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Zhang TP, Yang F, Tang W, Alexander M, Forastiere L, Kumar N, Li K, Zou F, Yang L, Mi G, Wang Y, Huang W, Lee A, Zhu W, Vickerman P, Wu D, Yang B, Christakis NA, Tucker JD. Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men in China: a study protocol for a three-arm cluster randomized controlled trial. Infect Dis Poverty 2019; 8:76. [PMID: 31426869 PMCID: PMC6700988 DOI: 10.1186/s40249-019-0581-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men (MSM). A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM. Pay-it-forward offers an individual a gift (e.g., a free test) and then asks the same person if they would like to give a gift to another person. This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms - a pay-it-forward arm, a pay-what-you-want arm, and a standard of care arm. METHODS Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing. Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization. Eligible participants will be born biologically male, aged 16 years or older, reporting previous anal sex with another man, having never participated in the pay-it-forward program, without previous gonorrhea and chlamydia testing in the past 12 months, and residing in China. Following a cluster randomized design, every cluster of ten participants will be randomly allocated into one of three arms: (1) a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate ("pay it forward") toward testing for future testers; (2) a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test; (3) a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing. The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records. Secondary outcomes include incremental cost per test, incremental cost per diagnosis, community connectedness, and social cohesion. Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95% confidence intervals with a margin of 20% increase defined as superiority. DISCUSSION This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia. We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward. Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities. TRIAL REGISTRATION ClinicalTrials.gov, NCT03741725 . Registered on 12 November 2018.
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Affiliation(s)
- Tiange P. Zhang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | - Marcus Alexander
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Laura Forastiere
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | | | - Fei Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Ligang Yang
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | | | - Yehua Wang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Wenting Huang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Amy Lee
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Weizan Zhu
- Zhitong Guangzhou LGBT Center, Guangzhou, China
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Bin Yang
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | | | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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26
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Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001349. [PMID: 31139454 PMCID: PMC6509609 DOI: 10.1136/bmjgh-2018-001349] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Self-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services. METHODS Peer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR). RESULTS Eleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour. DISCUSSION While greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018114866.
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Affiliation(s)
- Yasmin Ogale
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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