1
|
Gaps in HIV PrEP Care Following State Partner Services for Massachusetts Primary and Secondary Syphilis Cases, 2017-2018. Sex Transm Dis 2022; 49:657-661. [PMID: 35797587 DOI: 10.1097/olq.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition. We used a PrEP continuum of care to measure impact of field epidemiologist-facilitated referrals for PrEP-naïve infectious syphilis cases across multiple clinical and pharmacy sites of care. METHODS Retrospective analysis of 2017-2018 primary and secondary syphilis cases, medical charts, and pharmacy data to identify PrEP education, referral offer, referral acceptance, first visit, prescription pickup (PrEP initiation) and 2-3 months (PrEP persistence). HIV seroconversion was determined using database match at syphilis diagnosis date and at 12 months. Chi-square or Fisher's exact tests were used to compare demographic characteristics associated with steps with lower progression rates. RESULTS Of 1077 syphilis cases, partner services engaged 662/787 (84%) HIV-negative cases; 490 were PrEP-naïve, 266 received education, 166 were offered referral, 67 accepted referral, 30 attended an initial appointment, and 22 were prescribed PrEP. Of 16 with pharmacy data, 14 obtained medication, and 8 persisted on PrEP at 2-3 months. Continuum progression was lowest from (1) PrEP-naïve to receiving PrEP education, (2) offered referral to referral acceptance, and (3) referral acceptance to initial PrEP appointment. Males with male partners were more likely to receive PrEP education or accept a referral. Higher social vulnerability was associated with increased PrEP referral acceptance. CONCLUSIONS Few individuals accepted PrEP referrals and persisted on PrEP. Field and clinic data capture were inconsistent, possibly underestimating referral volume and impact of field engagement. Efforts aimed at increasing referral acceptance and clinic attendance may improve PrEP uptake especially among women and heterosexual men with syphilis.
Collapse
|
2
|
Cope AB, Bernstein KT, Matthias J, Rahman M, Diesel JC, Pugsley RA, Schillinger JA, Chew Ng RA, Klingler EJ, Mobley VL, Samoff E, Peterman TA. Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions. Sex Transm Dis 2022; 49:160-165. [PMID: 34310526 PMCID: PMC9380961 DOI: 10.1097/olq.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient. METHODS We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate. RESULTS Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%). CONCLUSIONS Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.
Collapse
Affiliation(s)
- Anna Barry Cope
- Centers for Disease Control and Prevention, Atlanta, GA
- North Carolina Department of Health and Human Services, Raleigh, NC
| | | | - James Matthias
- Centers for Disease Control and Prevention, Atlanta, GA
- Florida Department of Health, Tallahassee, FL
| | - Mohammad Rahman
- Centers for Disease Control and Prevention, Atlanta, GA
- Louisiana Department of Health, New Orleans, LA
| | - Jill C. Diesel
- Michigan Department of Health and Human Services, Detroit, MI
| | - River A. Pugsley
- Centers for Disease Control and Prevention, Atlanta, GA
- Virginia Department of Health, Richmond, VA
| | - Julia A. Schillinger
- Centers for Disease Control and Prevention, Atlanta, GA
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Rilene A. Chew Ng
- Centers for Disease Control and Prevention, Atlanta, GA
- San Francisco Department of Public Health, San Francisco, CA
| | - Ellen J. Klingler
- New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Erika Samoff
- North Carolina Department of Health and Human Services, Raleigh, NC
| | | |
Collapse
|
3
|
Bonacci RA, Manahan LM, Miller JS, Moonan PK, Lipparelli MB, DiFedele LM, Davis LB, Lash RR, Oeltmann JE. COVID-19 Contact Tracing Outcomes in Washington State, August and October 2020. Front Public Health 2021; 9:782296. [PMID: 34900921 PMCID: PMC8661592 DOI: 10.3389/fpubh.2021.782296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Case investigation and contact tracing are important tools to limit the spread of SARS-CoV-2, particularly when implemented efficiently. Our objective was to evaluate participation in and timeliness of COVID-19 contact tracing and whether these measures changed over time. Methods: We retrospectively assessed COVID-19 case investigation and contact tracing surveillance data from the Washington State centralized program for August 1-31, 2020 and October 1-31, 2020. We combined SARS-CoV-2 testing reports with contact tracing data to compare completeness, reporting of contacts, and program timeliness. Results: For August and October respectively, 4,600 (of 12,521) and 2,166 (of 16,269) individuals with COVID-19 were referred to the state program for case investigation. Investigators called 100% of referred individuals; 65% (August) and 76% (October) were interviewed. Of individuals interviewed, 33% reported contacts in August and 45% in October, with only mild variation by age, sex, race/ethnicity, and urbanicity. In August, 992 individuals with COVID-19 reported a total of 2,584 contacts (mean, 2.6), and in October, 739 individuals reported 2,218 contacts (mean, 3.0). Among contacts, 86% and 78% participated in interviews for August and October. The median time elapsed from specimen collection to contact interview was 4 days in August and 3 days in October, and from symptom onset to contact interview was 7 days in August and 6 days in October. Conclusions: While contact tracing improved with time, the proportion of individuals disclosing contacts remained below 50% and differed minimally by demographic characteristics. The longest time interval occurred between symptom onset and test result notification. Improving elicitation of contacts and timeliness of contact tracing may further decrease SARS-CoV-2 transmission.
Collapse
Affiliation(s)
- Robert A Bonacci
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States
| | | | - James S Miller
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States.,Washington State Department of Health, Tumwater, WA, United States
| | | | | | - Lisa M DiFedele
- Washington State Department of Health, Tumwater, WA, United States
| | - Lora B Davis
- Washington State Department of Health, Tumwater, WA, United States
| | - R Ryan Lash
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States
| | | |
Collapse
|