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Flannagan J, Davison KL, Reynolds C, Brailsford SR. Determining the strength of evidence for an association between sexual indicators and risk of acquiring HIV and sexulaly transmitted infections: Providing evidence for blood donation policy change. Transfus Med 2024. [PMID: 39039735 DOI: 10.1111/tme.13062] [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: 10/03/2023] [Revised: 04/18/2024] [Accepted: 06/16/2024] [Indexed: 07/24/2024]
Abstract
In 2019 the For The Assessment Of Individualised Risk (FAIR) project began a review of UK blood donor selection policy to determine if a more individualised approach to donor selection could be safely implemented. An evidence base was required to inform selection policy to move from a population to a more individual based policy, specifically what sexual behaviours/indicators should be considered as screening questions to maintain the safety of the blood supply. Eight sexual behaviours/indicators were reviewed: history of bacterial sexually transmitted infections (STIs), chemsex, number of recent partners, condom use, type of sex, sexual health service (SHS) attendance, new sexual partner and exclusivity. We conducted searches in multiple databases to identify literature looking at the association between these behaviours/indicators and HIV/STI acquisition risk. A scoring system to determine strength of evidence was devised and applied to papers that passed screening. Key studies were identified which achieved the maximum score and more in-depth reviews were conducted for these. We identified 58 studies, including 17 key studies. Strong evidence was found linking a previous bacterial STI, chemsex and increasing numbers of sexual partners to acquisition risk. Condom use, type of sex and new partners were found to have some strength of evidence for this link. SHS attendance and exclusivity had minimal evidence. We recommended that the behaviours/indicators viewed as having strong or some strength of evidence should be considered as screening questions in a more individualised approach to donor selection criteria.
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Karki S, Shaw S, Lieberman M, Pérez A, Pincus J, Jakhmola P, Tailor A, Ogunrinde OB, Sill D, Morgan S, Alvarez M, Todd J, Smith D, Mishra N. Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study. JMIR Form Res 2024; 8:e53000. [PMID: 38621237 PMCID: PMC11058559 DOI: 10.2196/53000] [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: 09/22/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. OBJECTIVE The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. METHODS We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name "X-Clinic." We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. RESULTS Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%). CONCLUSIONS We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use.
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Affiliation(s)
- Saugat Karki
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Shaw
- Public Health Informatics Institute, Decatur, GA, United States
| | - Michael Lieberman
- OCHIN, Portland, OR, United States
- Oregon Health & Sciences University, Portland, OR, United States
| | - Alejandro Pérez
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Priya Jakhmola
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amrita Tailor
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Danielle Sill
- Public Health Informatics Institute, Decatur, GA, United States
| | | | | | | | - Dawn Smith
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ninad Mishra
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Allan-Blitz LT, Sanders G, Shah P, Adams G, Jarolimova J, Ard K, Branda JA, Klausner JD, Sabeti PC, Lemieux JE. Clinical Performance of Cas13a-based Point-of-Care Lateral Flow Assay for Detecting Neisseria gonorrhoeae. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.01.24303603. [PMID: 38496586 PMCID: PMC10942539 DOI: 10.1101/2024.03.01.24303603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Diagnosis of Neisseria (N.) gonorrhoeae is dependent on nucleic acid amplification testing (NAAT), which is not available in resource-limited settings where the prevalence of infection is highest. Recent advances in molecular diagnostics leveraging the high specificity of CRISPR enzymes can permit field-deployable, point-of-care lateral flow assays. We previously reported on the development and in vitro performance of a lateral flow assay for detecting N. gonorrhoeae. Here we aimed to pair that assay with point-of-care DNA extraction techniques and assess the performance on clinical urine specimens. Methods We collected an additional urine specimen among individuals enrolling in an ongoing clinical trial at the Massachusetts General Hospital Sexual Health Clinic who presented with symptoms of urethritis or cervicitis (urethral or vaginal discharge, dysuria, or dyspareunia). We then assessed thermal, detergent, and combination DNA extraction conditions, varying the duration of heat at 95°C and concentration of Triton X. We assessed the efficacy of the various DNA extraction methods by quantitative polymerase chain reaction (qPCR). Once an extraction method was selected, we incubated samples for 90 minutes to permit isothermal recombinase polymerase amplification. We then assessed the performance of lateral flow Cas13a-based detection using our previously designed porA probe and primer system for N. gonorrhoeae detection, comparing lateral flow results with NAAT results from clinical care. Results We assessed DNA extraction conditions on 3 clinical urine specimens. There was no consistent significant difference in copies per microliter of DNA obtained using more or less heat. On average, we noted that 0.02% triton combined with 5 minutes of heating to 95°C resulted in the highest DNA yield, however, 0.02% triton alone resulted in a quantity of DNA that was above the previously determined analytic sensitivity of the assay. Given that detergent-based extraction is more easily deployable, we selected that as our method for extraction. We treated 23 clinical specimens with 0.02% triton, which we added to the Cas13a detection system. We ran all lateral flow detections in duplicate. The Cas13a-based assay detected 8 of 8 (100%) positive specimens, and 0 of 15 negative specimens. Conclusion Using point-of-care DNA extraction, isothermal amplification, and Cas13a-based detection, our point-of-care lateral flow N. gonorrhoeae assay correctly identified 23 clinical urine specimens as either positive or negative. Further evaluation of this assay among larger samples and more diverse sample types is warranted.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gabriela Sanders
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jana Jarolimova
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kevin Ard
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based assays for Neisseria gonorrhoeae detection and gyrase A determination. mSphere 2023; 8:e0041623. [PMID: 37732792 PMCID: PMC10597441 DOI: 10.1128/msphere.00416-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023] Open
Abstract
Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, the diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where the prevalence of infection is highest. Recent advances in molecular diagnostics, such as specific high-sensitivity enzymatic reporter unlocking (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. We designed and optimized RNA guides and primer sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the porA gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A (gyrA) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For porA, we created both a fluorescence-based assay and lateral flow assay using a biotinylated fluorescein reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyrA, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyrA genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates. IMPORTANCE Neisseria gonorrhoeae, the cause of gonorrhea, disproportionately affects resource-limited settings. Such areas, however, lack the technical capabilities for diagnosing the infection. The consequences of poor or absent diagnostics include increased disease morbidity, which, for gonorrhea, includes an increased risk for HIV infection, infertility, and neonatal blindness, as well as an overuse of antibiotics that contributes to the emergence of antibiotic resistance. We used a novel CRISPR-based technology to develop a rapid test that does not require laboratory infrastructure for both diagnosing gonorrhea and predicting whether ciprofloxacin can be used in its treatment, a one-time oral pill. With further development, that diagnostic test may be of use in low-resource settings.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Goldstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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López Corbeto E, Lugo Colón R, Montoro Fernández M, Casabona Barbara J. [Epidemiological situation of post-pandemic sexually transmitted infections in Catalonia, Spain]. Med Clin (Barc) 2023; 161:95-100. [PMID: 37244853 PMCID: PMC10209783 DOI: 10.1016/j.medcli.2023.03.014] [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: 12/05/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The growing trend of STIs in recent years was altered after the outbreak of the SARS-CoV-2 pandemic. OBJECTIVES Describe the impact of the SARS-CoV-2 pandemic on STI declarations received during the pre-pandemic to pandemic period and estimate the number of STI cases expected for the pandemic period. MATERIAL AND METHODS Descriptive analysis of STI declarations received during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. The influence of the number of positive cases of SARS-CoV-2 with the number of positive cases of STIs during the months of the pandemic was studied using a correlation model. Using the Holt-Wilson time series model, an estimate was made of the number of STI cases expected for the pandemic period. RESULTS The global incidence rate for all STIs in 2020 decreased by 18.3% compared to 2019. Chlamydia and syphilis presented a greater reduction in their incidence from 2019 to 2020 of 22.7% and 20.9%, respectively and 9.5% and 2.5% for gonorrhea and LGV. Estimates showed that in 2020 there would have been 44.6% more STIs than those declared. The proportions according to sex, country of birth and sexual orientation changed significantly in chlamydia and gonorrhea. CONCLUSIONS The measures adopted for the prevention of SARS-CoV-2 infections were able to achieve an initial decrease in STI cases in 2020, however, this change was not maintained during 2021, which ended with higher incidences recorded to date.
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Affiliation(s)
- Evelin López Corbeto
- Centro de estudios Epidemiológicos sobre las ITS y Sida de Cataluña (CEEISCAT), Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
| | - Rossie Lugo Colón
- Centro de estudios Epidemiológicos sobre las ITS y Sida de Cataluña (CEEISCAT), Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | - Marcos Montoro Fernández
- Centro de estudios Epidemiológicos sobre las ITS y Sida de Cataluña (CEEISCAT), Barcelona, España
| | - Jordi Casabona Barbara
- Centro de estudios Epidemiológicos sobre las ITS y Sida de Cataluña (CEEISCAT), Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, España; Departament de Pediatria, d'Obstetrícia, Ginecologia i de Medicina Preventiva i Salut Pública. Universitat Autónoma de Barcelona, Cerdanyola del Vallès, Barcelona, España
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6
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based Assays for Neisseria gonorrhoeae Detection and Gyrase A Determination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.21.23290304. [PMID: 37293004 PMCID: PMC10246164 DOI: 10.1101/2023.05.21.23290304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where prevalence is highest. Recent advances in molecular diagnostics, such as Specific High-sensitivity Enzymatic Reporter unLOCKing (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. Methods and Results We designed and optimized RNA guides and primer-sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the por A gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A ( gyr A) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For por A, we created both a fluorescence-based assay and lateral flow assay using a biotinylated FAM reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyr A, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyr A genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. Conclusion We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert Goldstein
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
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Liu G, Mugo NR, Brown ER, Mgodi NM, Chirenje ZM, Marrazzo JM, Winer RL, Mansoor L, Palanee-Phillips T, Siva SS, Naidoo L, Jeenarain N, Gaffoor Z, Nair GL, Selepe P, Nakabiito C, Mkhize B, Mirembe BG, Taljaard M, Panchia R, Baeten JM, Balkus JE, Hladik F, Celum CL, Barnabas RV. Prevalent human papillomavirus infection increases the risk of HIV acquisition in African women: advancing the argument for human papillomavirus immunization. AIDS 2022; 36:257-265. [PMID: 34172672 PMCID: PMC8702475 DOI: 10.1097/qad.0000000000003004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Vaccine-preventable human papillomavirus (HPV) infection is common, especially in sub-Saharan Africa where HIV risk is also high. However, unlike other sexually transmitted infections (STIs), HPV's role in HIV acquisition is unclear. We evaluated this relationship using data from MTN-003, a clinical trial of HIV chemoprophylaxis among cisgender women in sub-Saharan Africa. DESIGN A case-control study. METHODS We matched 138 women who acquired HIV (cases) to 412 HIV-negative controls. Cervicovaginal swabs collected within 6 months before HIV seroconversion were tested for HPV DNA. We estimated the associations between carcinogenic (high-risk) and low-risk HPV types and types targeted by HPV vaccines and HIV acquisition, using conditional logistic regression models adjusted for time-varying sexual behaviors and other STIs. RESULTS Mean age was 23 (±4) years. Any, high-risk and low-risk HPV was detected in 84, 74 and 66% of cases, and 65, 55 and 48% of controls. Infection with at least two HPV types was common in cases (67%) and controls (49%), as was infection with nonavalent vaccine-targeted types (60 and 42%). HIV acquisition increased with any [adjusted odds ratio (aOR) 2.5, 95% confidence interval (95% CI) 1.3-4.7], high-risk (aOR 2.6, 95% CI 1.5-4.6) and low-risk (aOR 1.8, 95% CI 1.1-2.9) HPV. Each additional type detected increased HIV risk by 20% (aOR 1.2, 95% CI 1.1-1.4). HIV acquisition was associated with HPV types targeted by the nonavalent (aOR 2.1, 95% CI 1.3-3.6) and quadrivalent vaccines (aOR 1.9, 95% CI 1.1-3.2). CONCLUSION HPV infection is associated with HIV acquisition in sub-Saharan African women. In addition to preventing HPV-associated cancers, increasing HPV vaccination coverage could potentially reduce HIV incidence.
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Affiliation(s)
- Gui Liu
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
| | - Nelly R. Mugo
- Department of Global Health, University of Washington,
Seattle, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
- Department of Biostatistics, University of Washington,
Seattle, USA
| | - Nyaradzo M. Mgodi
- Clinical Trials Research Centre, University of Zimbabwe,
Harare, Zimbabwe
| | | | - Jeanne M. Marrazzo
- Department of Medicine/Division of Infectious Diseases,
University of Alabama at Birmingham, Alabama, USA
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington,
Seattle, USA
- Kaiser Permanente Washington Health Research Institute,
Seattle, USA
| | - Leila Mansoor
- Centre for the AIDS Programme of Research in South Africa,
University of KwaZulu-Natal, Durban, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute in
Johannesburg, South Africa
- Faculty of Health Sciences, University of Witwatersrand,
Johannesburg, South Africa
| | | | | | | | - Zakir Gaffoor
- South Africa Medical Research Council, Durban, South
Africa
| | - Gonasagrie L. Nair
- Desmond Tutu HIV Centre, University of Cape Town, Cape
Town, South Africa
| | | | | | - Baningi Mkhize
- Faculty of Health Sciences, University of Witwatersrand,
Johannesburg, South Africa
| | | | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath
Hospital, Soweto, South Africa
| | - Jared M. Baeten
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
| | - Jennifer E. Balkus
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
| | - Floriand Hladik
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of
Washington, Seattle, USA
| | - Connie L. Celum
- Department of Global Health, University of Washington,
Seattle, USA
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington,
Seattle, USA
- Department of Global Health, University of Washington,
Seattle, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, USA
- Division of Allergy and Infectious Diseases, Department of
Medicine, University of Washington, Seattle, USA
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Allan-Blitz LT, Menza TW, Cummings V, Gaydos CA, Wilton L, Mayer KH. Multifactorial Correlates of Incident Bacterial Sexually Transmitted Infections Among Black Men Who Have Sex With Men Recruited in 6 US Cities (HIV Prevention Trials Network 061). Sex Transm Dis 2021; 48:720-725. [PMID: 34110740 PMCID: PMC10927028 DOI: 10.1097/olq.0000000000001414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black men who have sex with men are at a disproportionate risk for sexually transmitted infections (STI). Understanding the drivers of those disparities can lead to culturally tailored interventions. We aimed to characterize the incidence and correlates of STI among Black individuals from HIV Prevention Trials Network 061, a multicity cohort study conducted from 2009 to 2011 in the United States. METHODS We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHRs) accounting for within-participant correlation over multiple follow-up visits (enrollment, 6 and 12 months). We examined correlates of incident rectal and urethral STI as well as incident syphilis. RESULTS Among 1522 individuals, the incidences of urethral and rectal Neisseria gonorrhoeae infection were 1.0 (95% confidence interval, 0.6-1.8) and 4.6 (95% CI, 3.5-6.3) cases per 100 person-years, respectively. The incidences of urethral and rectal Chlamydia trachomatis infection were 2.5 (95% CI, 1.7-3.6) and 2.5 (95% CI, 1.7-3.7) cases per 100 person-years, respectively. The incidence of syphilis was 3.6 (95% CI, 2.7-4.9) cases per 100 person-years. Younger age was associated with increased odds of incident urethral (aHR, 5.1; 95% CI, 2.3-11.1) and rectal (aHR, 2.6; 95% CI, 1.6-4.3) STI. Diagnosis of a rectal STI at baseline (aHR, 2.3; 95% CI, 1.1-4.0) and use of saliva as lubricant (aHR, 1.7; 95% CI, 1.1-2.8) were associated with incident rectal STI. Diagnosis of syphilis at baseline was associated with incident syphilis during follow-up (aHR, 5.6; 95% CI, 2.5-12.2). CONCLUSIONS Younger participants had the highest STI incidence. Use of saliva as lubricant may be a driver of rectal infection, which deserves further study.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital
- Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Timothy W. Menza
- Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, Portland, OR
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine
| | | | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Kenneth H. Mayer
- The Fenway Institute of Fenway Health
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center
- Department of Medicine, Harvard Medical School, Boston, MA
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Yakubu K, Bowen P, Govender R. Determinants of HIV testing behaviour among male South African construction workers. AIDS Care 2021; 34:847-855. [PMID: 34581654 DOI: 10.1080/09540121.2021.1981222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The global trend of poorer outcomes across the HIV treatment cascade for men has drawn attention to the importance of engaging men in prevention and treatment services. The South African construction industry is one of the economic sectors most adversely affected by HIV/AIDS. Previous research on HIV testing behaviour among workers in the industry has revealed that male workers are less likely to be tested than female workers. Given this gender differential, this study employed a field-administered survey to gather data from 450 site-based, male construction workers in Western Cape, South Africa. An integrated model comprising demographic, cognitive, and behavioural factors was then hypothesised to explain HIV testing behaviour. Bivariate analysis and structural equation modelling were then used to test the model. Findings indicate that HIV knowledge, having previously had an STI, and possessing a positive attitude towards HIV testing are terminal predictors of testing behaviour. As a strategy for positively influencing testing behaviour, employers should ensure that effective communication about HIV testing is established with workers across all levels of education and ethnic groups. Interventions relating to risky sexual behaviour need particular attention, and where possible HIV testing should be coupled with general STI screening.
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Affiliation(s)
- Kamal Yakubu
- Nelson Mandela School of Public Governance, University of Cape Town, Cape Town, South Africa
| | - Paul Bowen
- Department of Construction Economics and Management, University of Cape Town, Cape Town, South Africa
| | - Rajen Govender
- Nelson Mandela School of Public Governance, University of Cape Town, Cape Town, South Africa.,Institute for Social and Health Sciences, University of South Africa, Lenasia, South Africa.,Violence, Injury and Peace Research Unit, South African Medical Research Council, Tygerberg, South Africa
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10
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Amusa L, Zewotir T, North D, Kharsany ABM, Lewis L. Association of medical male circumcision and sexually transmitted infections in a population-based study using targeted maximum likelihood estimation. BMC Public Health 2021; 21:1642. [PMID: 34496810 PMCID: PMC8425067 DOI: 10.1186/s12889-021-11705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 08/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background Epidemiological theory and many empirical studies support the hypothesis that there is a protective effect of male circumcision against some sexually transmitted infections (STIs). However, there is a paucity of randomized control trials (RCTs) to test this hypothesis in the South African population. Due to the infeasibility of conducting RCTs, estimating marginal or average treatment effects with observational data increases interest. Using targeted maximum likelihood estimation (TMLE), a doubly robust estimation technique, we aim to provide evidence of an association between medical male circumcision (MMC) and two STI outcomes. Methods HIV and HSV-2 status were the two primary outcomes for this study. We investigated the associations between MMC and these STI outcomes, using cross-sectional data from the HIV Incidence Provincial Surveillance System (HIPSS) study in KwaZulu-Natal, South Africa. HIV antibodies were tested from the blood samples collected in the study. For HSV-2, serum samples were tested for HSV-2 antibodies via an ELISA-based anti-HSV-2 IgG. We estimated marginal prevalence ratios (PR) using TMLE and compared estimates with those from propensity score full matching (PSFM) and inverse probability of treatment weighting (IPTW). Results From a total 2850 male participants included in the analytic sample, the overall weighted prevalence of HIV was 32.4% (n = 941) and HSV-2 was 53.2% (n = 1529). TMLE estimates suggest that MMC was associated with 31% lower HIV prevalence (PR: 0.690; 95% CI: 0.614, 0.777) and 21.1% lower HSV-2 prevalence (PR: 0.789; 95% CI: 0.734, 0.848). The propensity score analyses also provided evidence of association of MMC with lower prevalence of HIV and HSV-2. For PSFM: HIV (PR: 0.689; 95% CI: 0.537, 0.885), and HSV-2 (PR: 0.832; 95% CI: 0.709, 0.975). For IPTW: HIV (PR: 0.708; 95% CI: 0.572, 0.875), and HSV-2 (PR: 0.837; 95% CI: 0.738, 0.949). Conclusion Using a TMLE approach, we present further evidence of a protective association of MMC against HIV and HSV-2 in this hyper-endemic South African setting. TMLE has the potential to enhance the evidence base for recommendations that embrace the effect of public health interventions on health or disease outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11705-9.
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Affiliation(s)
- Lateef Amusa
- Department of Statistics, School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa. .,Department of Statistics, University of Ilorin, Ilorin, Nigeria.
| | - Temesgen Zewotir
- Department of Statistics, School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa
| | - Delia North
- Department of Statistics, School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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11
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 825] [Impact Index Per Article: 275.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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12
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Prevalence and Factors Associated With HIV and Sexually Transmitted Infections Among Female Sex Workers in Bamako, Mali. Sex Transm Dis 2021; 47:679-685. [PMID: 32932403 DOI: 10.1097/olq.0000000000001231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to (1) estimate the prevalence of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs) in Bamako, Mali, and (2) identify factors associated with STIs including HIV infection in this population. METHODS We analyzed baseline data from a prospective observational cohort study on cervical cancer screening, human papillomavirus, and HIV infections among FSWs 18 years or older recruited in Bamako. Multivariable log-binomial regression was used to estimate the adjusted prevalence ratios (APRs) with 95% confidence interval (95% CI) for HIV infection and STIs versus associated factors. RESULTS Among 353 women participating in the study, mean age was 26.8 (±7.6) years. HIV prevalence was 20.4%, whereas 35.1% of the FSWs had at least one STI. Factors significantly associated with HIV were older age (P < 0.0001, test for trend), duration of sex work ≥6 years (APR, 1.92; 95% CI, 1.22-3.02), uneducated status (APR, 2.24; 95% CI, 1.16-4.34), less than 10 clients in the last 7 days (APR, 1.55; 95% CI, 1.02-2.34), and gonococcal (APR, 1.85; 95% CI, 1.21-2.82) and chlamydial (APR, 2.58; 95% CI, 1.44-4.62) infections. Younger age (P = 0.018, test for trend), having ≥10 clients in the last week (APR, 1.47; 95% CI, 1.11-1.94), and HIV infection (APR, 2.00; 95% CI, 1.49-2.69) were significantly associated with STIs. CONCLUSIONS HIV and curable STI prevalence are high among FSWs in Bamako. There is thus a need to enhance the efficiency of interventions toward FSWs in Mali to reduce the burden of HIV and STIs among them and prevent HIV spread to the general population.
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13
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Amusa L, Zewotir T, North D, Kharsany AB, Lewis L. Medical male circumcision and HIV prevention among men in Kwazulu-Natal, South Africa: A propensity score analysis. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2020.e00683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Masanja V, Wafula ST, Ssekamatte T, Isunju JB, Mugambe RK, Van Hal G. Trends and correlates of sexually transmitted infections among sexually active Ugandan female youths: evidence from three demographic and health surveys, 2006-2016. BMC Infect Dis 2021; 21:59. [PMID: 33435882 PMCID: PMC7805221 DOI: 10.1186/s12879-020-05732-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female adolescents and young women have the highest risk of curable sexually transmitted infections (STIs) globally. Data on the prevalence of STIs among young women in Uganda are limited. In this study, we investigated the time trends and correlates of STIs among adolescent girls and young women (15-24 years) in Uganda. METHODS We estimated the percentage of women 15-24 years from three recent consecutive Uganda Demographic and Health Surveys (2006, 2011, and 2016), who reported suffering from genital sores, and or genital discharge or any other varginal complaints acquired after sexual intercourse within 12 months of the studies and examined the changes over time. A pooled multivariable logistic regression was used to examine the correlates of reporting an STI in the last 12 months preceding the study. Svyset command in Stata was used to cater for the survey sample design. RESULTS The pooled self-reported STI prevalence was 26.0%. Among these young women, 22.0, 36.3, and 23.1% reported a sexually transmitted infection in 2006, 2011, and 2016 respectively. Between 2006 and 2011, there was evidence of change (+ 14.3%, p < 0.001) in STI prevalence before a significant reduction (- 12.0%, p< 0.001) in 2016. Youths aged 20-24 years reported a higher STI prevalence (27.3%) compared to young participants (23.6%). Correlates of reporting an STI among rural and urban young women were: having multiple total lifetime partners (adjusted odds ratio (aOR 1.6, 95% CI 1.4-1.6), being sexually active in the last 4 weeks (aOR 1.3, 95% CI 1.1-1.6), and being affiliated to Muslim faith (aOR 1.3, 95% CI 1.1-1.6) or other religions (aOR 1.8, 95% CI 1.1-2.9) as compared to Christian were more likely to report an STI. Living in Northern Uganda compared to living in Kampala city was found protective against STIs (aOR 0.5, 95% CI 0.3-0.7). CONCLUSION The prevalence of STIs was high among female youths, 15-24 years. This highlights the need for a comprehensive STIs screening, surveillance, and treatment programme to potentially reduce the burden of STIs in the country.
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Affiliation(s)
- Veronicah Masanja
- Department of Epidemiology and social medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Solomon Tsebeni Wafula
- Department of Epidemiology and social medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda.
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Guido Van Hal
- Department of Epidemiology and social medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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15
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Williford SL, Humes E, Greenbaum A, Schumacher CM. HIV Screening Among Gonorrhea-Diagnosed Individuals; Baltimore, Maryland; April 2015 to April 2019. Sex Transm Dis 2021; 48:42-48. [PMID: 33319970 DOI: 10.1097/olq.0000000000001252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Individuals diagnosed with gonorrhea are at elevated risk for HIV. Per US Centers for Disease Control and Prevention guideline, individuals being evaluated for gonorrhea should be screened for HIV concurrently. There is limited information on HIV screening among gonorrhea-diagnosed individuals across different health care settings. Our objective was to identify potential gaps in HIV screening among gonorrhea-diagnosed individuals in Baltimore City, Maryland. METHODS We used Sexually Transmitted Disease Surveillance Network project data collected on a random sample of all gonorrhea diagnoses reported to the health department between April 2015 and April 2019. Individuals with known HIV diagnoses were excluded. HIV screening was confirmed through surveys administered to the gonorrhea-diagnosing provider. HIV screening across groups was assessed using Poisson regression models with robust SEs. We examined those with and without recent (≤12 months) sexually transmitted infection (STI) history separately. RESULTS Among 2830 gonorrhea-diagnosed individuals with completed Sexually Transmitted Disease Surveillance Network provider surveys, less than half (35.2% with and 44.8% without recent STI history) received concurrent HIV screening. HIV screening was 73% less prevalent among those diagnosed in emergency departments/urgent care centers/hospitals versus sexual health clinics (with and without recent STI history: adjusted prevalence ratio, 0.27 [95% confidence interval, 0.19-0.39]; adjusted prevalence ratio, 0.27 [0.23-0.33]), controlling for diagnosis year, sex, race/ethnicity, age, infection site, and insurance. CONCLUSIONS Our findings suggest a considerable gap in HIV screening among individuals at elevated risk for HIV acquisition in Baltimore City, particularly among those diagnosed in emergency departments/urgent care centers/hospital settings. Future work should focus on identifying provider-level barriers to concurrent HIV/STI screening to inform provider education programs.
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Affiliation(s)
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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16
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Moriarty KE, Segura ER, Gonzales W, Lake JE, Cabello R, Clark JL. Assessing Sexually Transmitted Infections and HIV Risk Among Transgender Women in Lima, Peru: Beyond Behavior. LGBT Health 2020; 6:370-376. [PMID: 31618167 DOI: 10.1089/lgbt.2018.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to explore risk factors for HIV and sexually transmitted infections (STIs) among transgender women (TW) in Lima, Peru. Methods: HIV-negative or serostatus unknown TW reporting recent condomless receptive anal intercourse underwent testing for STIs and HIV and completed a sociobehavioral survey. Results: Among 120 TW, 29.6% had rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) and 12.6% had HIV. Age and migrant status were associated with rectal GC/CT, and rectal GC/CT predicted HIV infection. Conclusions: Further study is needed to understand individual and social factors that contribute to HIV/STI vulnerability among TW.
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Affiliation(s)
- Kathleen E Moriarty
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Robinson Cabello
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Asociación Civil Vía Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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17
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Li KT, Huang W, Tang W, Wu F, Zhao Y, Wu D, Yang F, Zhang TP, Forastiere L, Alexander M, Kumar N, Tucker JD. A Secondary Mixed Methods Analysis of a Pay-it-Forward Gonorrhea/Chlamydia Testing Program Among Men Who Have Sex With Men in China. Sex Transm Dis 2020; 47:395-401. [PMID: 32149952 PMCID: PMC7230016 DOI: 10.1097/olq.0000000000001161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gonorrhea and chlamydia are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program where men receive a free gonorrhea/chlamydia test and can then donate toward future participants' tests. This study aims to investigate drivers of testing uptake and donation using a mixed methods approach. METHODS We used a sequential explanatory design to explore drivers of testing uptake and donation unique to pay-it-forward through a quantitative cross-sectional survey and a qualitative thematic analysis of semistructured interviews. We collected data on sociodemographics and perceived benefits of pay-it-forward among men offered the pay-it-forward interventionand analyzed testing uptake and donations using descriptive statistics and logistic regression. We then conducted 30 semistructured interviews with men and coded interview data to identify themes. RESULTS Three hundred and one MSM were offered pay-it-forward and 55% (165/301) received gonorrhea/chlamydia testing. Ninety-one percent (150 of 165) donated any amount with a mean of 58.31 ± 53.39 RMB (US $8.61 ± 7.88), or 39% of the standard price of gonorrhea/chlamydia testing. Getting tested was not associated with income, but donations were higher in the highest income bracket (adjusted odds ratio, 7.12; 95% confidence interval, 1.61-31.52). Fifty-eight percent (94 of 162) selected "more MSM can get tested," and 54% (88 of 162) selected "I can help someone else" as benefits of pay-it-forward. Qualitative themes for drivers of testing and donation included flexible pricing, generosity and reciprocity, and MSM community identity. CONCLUSIONS Quantitative and qualitative results suggest that this pay-it-forward program may increase gonorrhea/chlamydia testing by reducing cost barriers, leveraging generosity and reciprocity, and mobilizing community altruism.
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Affiliation(s)
- Katherine T Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wenting Huang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Southern Medical University, Guangzhou, China
| | - Feng Wu
- Sun Yat-sen University, Guangzhou, China
| | - Yang Zhao
- School of Social Science, University of Queensland, Brisbane, Australia
| | - Dan Wu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fan Yang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Tiange P Zhang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | | | - Navin Kumar
- Sociology Department, Yale University, New Haven, USA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- London School of Hygiene and Tropical Medicine, London, UK
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18
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Ooi C, Kong FYS, Lewis DA, Hocking JS. Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies. Sex Health 2020; 17:135-148. [PMID: 32228828 DOI: 10.1071/sh19150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Abstract
Background In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services. METHODS EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site. RESULTS Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants' mean age was 41.1 years (95% confidence interval (CI) 37.0-43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9-5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7-2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6-2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8-4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied. CONCLUSION This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons.
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Affiliation(s)
- Catriona Ooi
- Clinic 16, 2C Herbert Street, St Leonards, NSW 2065, Australia; and Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author.
| | - Fabian Y S Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Parkville, Vic. 3010, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia; and Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Parkville, Vic. 3010, Australia
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19
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Allan-Blitz LT, Konda KA, Vargas SK, Wang X, Segura ER, Fazio BM, Calvo GM, Caceres CF, Klausner JD. The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru. Sex Health 2019; 15:261-268. [PMID: 30021680 DOI: 10.1071/sh17118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. METHODS Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. RESULTS Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. CONCLUSIONS Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Silver K Vargas
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90095, USA
| | - Eddy R Segura
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Boris M Fazio
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Gino M Calvo
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
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20
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Abstract
BACKGROUND Southern non-Hispanic black persons are disproportionately represented in the HIV epidemic. Those previously diagnosed as having syphilis are at significant risk to become HIV infected within 36 months. Effective prevention strategies such as preexposure prophylaxis should be offered to those at highest risk to maximize prevention efforts. METHODS HIV-negative persons diagnosed as having primary or secondary (P&S) syphilis during 1998-2014 were matched with incident HIV cases diagnosed during 1998-2016 in Shelby County Tennessee. Person-year HIV incidence rate, Kaplan-Meier survival estimates, and Cox proportional regression model analyses were performed to explore predicting risk factors and quantifying risk factors associated with HIV-free survival time frames. RESULTS Among 2032 HIV-negative non-Hispanic black Shelby County residents diagnosed as having P&S syphilis, 139 (6.8%) were subsequently diagnosed as having HIV infection. Men who have sex with men (MSM) experienced the highest incidence of HIV diagnosis rate (4.98 per 100 person-years, 95% confidence interval, 4.76-5.2). Being male, MSM, younger than 30 years, or coinfected with gonorrhea increased risk of HIV acquisition 2.32, 11.80, 1.67, and 2.44 times, respectively, compared with being female, heterosexual men, 30+ years old, or not infected with other sexually transmitted infections. CONCLUSIONS Among our population diagnosed as having P&S syphilis, 1 in 6 MSM and 1 in 16 persons coinfected with gonorrhea were subsequently diagnosed as having HIV during 36 months of follow-up. These findings have implications for HIV screening and recruitment as priority preexposure prophylaxis candidates.
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Allan-Blitz LT, Herrera MC, Calvo GM, Vargas SK, Caceres CF, Klausner JD, Konda KA. Venue-Based HIV-Testing: An Effective Screening Strategy for High-Risk Populations in Lima, Peru. AIDS Behav 2019; 23:813-819. [PMID: 30506350 DOI: 10.1007/s10461-018-2342-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Venue-based testing may improve screening efforts for HIV and syphilis, thereby reducing transmission. We offered onsite rapid dual HIV and syphilis testing at venues popular among MSM and/or transgender women in Lima, Peru. We used Poisson regression to calculate adjusted prevalence ratios (aPRs) for factors associated with each infection. Most (90.4%) of the 303 participants would test more frequently if testing was available at alternative venues. New cases of HIV (69) and syphilis infection (84) were identified. HIV was associated with recent sex work (aPR 1.11; 95% CI 1.02-1.22), sex with a partner of unknown serostatus (aPR 1.18; 95% CI 1.09-1.27), exclusively receptive anal sex role (aPR 1.16; 95% CI 1.03-1.30) or versatile sex role (aPR 1.17; 95% CI 1.06-1.30) compared to insertive. Syphilis was associated with reporting role versatility (aPR = 2.69; 95% CI 1.52-5.74). Sex work venues had higher syphilis prevalence 47% versus 28% in other venues, p value = 0.012. Venue-based testing may improve case finding.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - M Christina Herrera
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Gino M Calvo
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Fielding School of Public Health, University of California, Los Angeles, USA.
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22
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A Cost Analysis of Gyrase A Testing and Targeted Ciprofloxacin Therapy Versus Recommended 2-Drug Therapy for Neisseria gonorrhoeae Infection. Sex Transm Dis 2019; 45:87-91. [PMID: 29329176 DOI: 10.1097/olq.0000000000000698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Novel approaches to combating drug-resistant Neisseria gonorrhoeae infections are urgently needed. Targeted therapy with ciprofloxacin has been made possible by a rapid assay for genotyping the gyrase A (gyrA) gene; a nonmutated gene reliably predicts susceptibility to ciprofloxacin. METHODS We determined the costs of running the gyrA assay, 500 mg of ciprofloxacin, 250 mg of ceftriaxone injection, and 1000 mg of azithromycin. Cost estimates for gyrA testing included assay reagents and labor. Cost estimates for ceftriaxone included medication, injection, administration, supplies, and equipment. We measured the cost of using the gyrA assay and treatment based on genotype using previously collected data over a 13-month period between November 2015 and November 2016 for all N. gonorrhoeae cases diagnosed at UCLA. We subsequently developed 3 cost models, varying the frequency of testing and prevalence of N. gonorrhoeae infections with ciprofloxacin-resistant or genotype-indeterminate results. We compared those estimates with the cost of recommended 2-drug therapy (ceftriaxone and azithromycin). RESULTS Based on a 65.3% prevalence of cases with ciprofloxacin-resistant or genotype indeterminate N. gonorrhoeae infections when running an average of 1.7 tests per day, the per-case cost of gyrA genotyping and targeted therapy was US $197.19. The per-case cost was US $155.16 assuming a 52.6% prevalence of ciprofloxacin-resistant or genotype-indeterminate infections when running an average of 17 tests per day. The per-case cost of 2-drug therapy was US $142.75. CONCLUSIONS Direct costs of gyrA genotyping and targeted ciprofloxacin therapy depend on the prevalence of ciprofloxacin-resistant or genotype-indeterminate infections and testing frequency.
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Liu A, Coleman K, Bojan K, Serrano PA, Oyedele T, Garcia A, Enriquez-Bruce E, Emmanuel P, Jones J, Sullivan P, Hightow-Weidman L, Buchbinder S, Scott H. Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10659. [PMID: 30681964 PMCID: PMC6367663 DOI: 10.2196/10659] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/08/2018] [Accepted: 09/13/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. OBJECTIVE The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). METHODS This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. RESULTS Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. CONCLUSIONS The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/10659.
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Affiliation(s)
- Albert Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Kelly Bojan
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Pedro Alonso Serrano
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Temitope Oyedele
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Amayvis Garcia
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | | | - Patricia Emmanuel
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Li B, Hocking JS, Bi P, Bell C, Fairley CK. The efficacy of azithromycin and doxycycline treatment for rectal chlamydial infection: a retrospective cohort study in South Australia. Intern Med J 2018; 48:259-264. [PMID: 28967178 DOI: 10.1111/imj.13624] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/14/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are ongoing concerns about treatment failure with azithromycin for the treatment of rectal chlamydia. AIM To investigate treatment efficacy of two treatments for rectal chlamydial infection. METHODS We performed a retrospective analysis of all patients diagnosed with rectal chlamydial infection between 2009 and 2015 in Adelaide, Australia. Patients were treated with either azithromycin (1 g single dose) or doxycycline (100 mg twice a day for 10 days) and returned for repeat testing 14-180 days after treatment commenced. Log-binomial models were used to estimate the relative risk (RR) of recurrent rectal chlamydia associated with the treatment with azithromycin versus doxycycline. RESULTS In men, rectal chlamydia prevalence was 6.7%, and in women, it was 8.1%. Of the 526 patients diagnosed with rectal chlamydial infections, 419 (79.7%), 93 (17.7%) and 14 (2.6%) patients were treated with doxycycline, azithromycin or other medication respectively. Of these patients, 173 (41.3%) of 419 doxycycline-treated patients and 31 (33.3%) of 93 azithromycin-treated patients were retested between 14 and 180 days after treatment commenced (P = 0.16). Among these patients, the repeat rectal chlamydia test was less commonly positive in those treated with doxycycline (5.8%; 95% confidence interval (CI) 0.03-0.10) compared with those treated with azithromycin (19.4%; 95% CI 0.09-0.36) and (P = 0.01). In the multivariate analysis, azithromycin-treated patients had a significantly higher risk of a positive test in the 14 and 180 days after treatment commenced (adjusted relative risk (aRR) 2.96, 95% CI 1.16-7.57). CONCLUSION The findings suggest that doxycycline may be more effective than azithromycin in treating rectal chlamydial infections.
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Affiliation(s)
- Bin Li
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,STI Services (Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charlotte Bell
- STI Services (Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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25
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Zwart JM, Mangen MJJ, Bartelsman M, van Rooijen MS, de Vries HJC, Xiridou M. Microscopic examination of Gram-stained smears for anogenital gonorrhoea in men who have sex with men is cost-effective: evidence from a modelling study. Sex Transm Infect 2018; 95:13-20. [PMID: 30196273 DOI: 10.1136/sextrans-2018-053578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men (MSM) at the Amsterdam STI clinic using a healthcare payer perspective. METHODS Three testing strategies for MSM were compared: (1) GSS in symptomatic MSM only (currently practised strategy), (2) no GSS and (3) GSS in symptomatic and asymptomatic MSM. The three testing protocols include testing with nucleic acid amplification test to verify the GSS results in (1) and (3), or as the only test in (2). A transmission model was employed to calculate the influence of the testing strategies on the prevalence of anogenital gonorrhoea over 10 years. An economic model combined cost data on medical consultations, tests and treatment and utility data to estimate the number of epididymitis cases and quality-adjusted life years (QALY) associated with gonorrhoea. Incremental cost-effectiveness ratios (ICERs) for the testing scenarios were estimated. Uncertainty and sensitivity analyses were performed. RESULTS No GSS testing compared with GSS in symptomatic MSM only (current strategy) resulted in nine extra epididymitis cases (95% uncertainty interval (UI): 2-22), 72 QALYs lost (95% UI: 59-187) and €7300 additional costs (95% UI: -€185 000 (i.e.cost-saving) to €407 000) over 10 years. GSS testing in both symptomatic and asymptomatic MSM compared with GSS in symptomatic MSM only resulted in one prevented epididymitis case (95% UI: 0-2), 1.1 QALY gained (95% UI: 0.1-3.3), €148 000 additional costs (95% UI: €86 000 to-€217 000) and an ICER of €177 000 (95% UI: €67 000-to €705 000) per QALY gained over 10 years. The results were robust in sensitivity analyses. CONCLUSIONS GSS for symptomatic MSM only is cost-effective compared with no GSS for MSM and with GSS for both symptomatic and asymptomatic MSM.
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Affiliation(s)
- Jolijn M Zwart
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,ChipSoft, Amsterdam, The Netherlands
| | - Marie-Josee J Mangen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Menne Bartelsman
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Martijn S van Rooijen
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Academic Medical Center (AMC), Amsterdam Infection and Immunity Institute (AI&II), University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Xiridou
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Phanuphak N, Pattanachaiwit S, Pankam T, Teeratakulpisarn N, Chamnan P, Pathipvanich P, Thongpaen S, Nonenoy S, Jantarapakde J, Pengnonyang S, Trachunthong D, Sungsing T, Parasate K, Seeneewong Na Ayutthaya S, Trairat K, Pussadee K, Lertpiriyasuwat C, Phanuphak P. Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme. J Int AIDS Soc 2018; 21:e25186. [PMID: 30225927 PMCID: PMC6141901 DOI: 10.1002/jia2.25186] [Citation(s) in RCA: 6] [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] [Received: 10/07/2017] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are common among HIV-positive men who have sex with men (MSM). There have been concerns that undiagnosed and untreated STIs could undermine efforts to use antiretroviral therapy (ART) for prevention due to genital secretion infectiousness. We evaluated the correlation between STIs and HIV RNA in anogenital compartments among HIV-positive MSM before and after ART. METHODS MSM participants newly diagnosed with HIV were offered ART regardless of CD4 count during November 2012 to November 2015. Syphilis serology, oropharyngeal swab, rectal swab, urine collection for gonorrhoea and chlamydia nucleic acid amplification testing, and HIV RNA measurement in blood, semen and rectal samples were performed at baseline, 12 and 24 months thereafter. RESULTS Of 143 HIV-positive MSM, 16.1% had syphilis, 23.1% had gonorrhoea and 32.8% had chlamydia at baseline. Participants with STIs at baseline had higher median HIV RNA levels in blood plasma (p = 0.053), seminal plasma (p = 0.01) and rectal secretions (p = 0.002) than those without STIs. Multivariate models identified HIV RNA 100,000 to 500,000 (OR 6.74, 95% CI 2.24 to 20.28, p = 0.001) and >500,000 (OR 9.39, 95% CI 1.08 to 81.72, p = 0.04) copies/mL in blood, CD4 count <350 cells/mm3 (OR 4.20, 95% CI 1.05 to 16.70, p = 0.04) and having any STIs (OR 2.62, 95% CI 1.01 to 6.80 p = 0.047) to be associated with detectable (>40 copies/mL) seminal plasma HIV RNA. Having chlamydia at any sites (OR 3.17, 95% CI 1.07 to 9.44, p = 0.04) was associated with detectable rectal HIV RNA. Incidences of syphilis, gonorrhoea and chlamydia were 13.4, 16.4 and 18.1 per 100 person-years respectively. Nine participants had detectable HIV RNA (five in blood, one in semen, two in rectal samples and one in both blood and rectal samples) at 12 and/or 24 months after ART. CONCLUSIONS STIs were extremely common among HIV-positive MSM prior to and after ART. ART effectively reduced HIV RNA in all compartments. The correlation between STIs and anogenital HIV RNA, especially prior to ART and likely until complete HIV RNA suppression from ART is achieved, points to the importance of integrating asymptomatic STIs screening into Treatment as Prevention programme for MSM.
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Affiliation(s)
| | | | - Tippawan Pankam
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
| | | | - Parinya Chamnan
- Tawanghin Community Medical Care Center‐Sanpasitthiprasong HospitalUbonratchathaniThailand
| | | | | | | | | | | | | | | | - Kittiyaporn Parasate
- Tawanghin Community Medical Care Center‐Sanpasitthiprasong HospitalUbonratchathaniThailand
| | | | | | | | | | - Praphan Phanuphak
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
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New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men. Sex Transm Dis 2018; 44:385-389. [PMID: 28608786 DOI: 10.1097/olq.0000000000000614] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rectal sexually transmitted infections (STI) have been associated with human immunodeficiency virus (HIV) diagnosis, but inferring a causal association requires disentangling them from receptive anal intercourse (RAI). METHODS We conducted a stratified case-control study by frequency matching 4 controls to each case within year using clinical data from men who have sex with men (MSM) attending the Seattle STD Clinic 2001 to 2014. Cases were MSM with a new HIV diagnosis and negative HIV test at 12 months or less. Controls were HIV-negative MSM. All included men had rectal STI testing, tested negative for syphilis, and had complete sexual behavior data. We categorized men by RAI: (1) none; (2) condoms for all RAI; (3) condomless RAI only with HIV-negative partners; and (4) condomless RAI with HIV-positive or unknown-status partners. We created 3 logistic regression models: (1) 3 univariate models of concurrent rectal gonorrhea, rectal chlamydia, and rectal STI in 12 months or less with new HIV diagnosis; (2) those 3 infections, plus age, race, year, number of sexual partners in 2 months or less, and methamphetamine use; and (3) model 2 with RAI categories. We calculated the population attributable risk of rectal STI on HIV diagnoses. RESULTS Among 176 cases and 704 controls, rectal gonorrhea, chlamydia and rectal STI in 12 months or less were associated with HIV diagnosis. The magnitude of these associations attenuated in the second model, but persisted in model 3 (gonorrhea: adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.3-3.8; chlamydia: aOR, 2.5; 95% CI, 1.5-4.3; prior STI: aOR, 3.0; 95% CI, 1.5-6.2). One in 7 HIV diagnoses can be attributed to rectal STI. CONCLUSIONS Rectal STI are independently associated with HIV acquisition. These findings support the hypothesis that rectal STI play a biologically mediated causal role in HIV acquisition and support screening/treatment of STI for HIV prevention.
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Allan-Blitz LT, Konda KA, Calvo GM, Vargas SK, Leon SR, Segura ER, Caceres CF, Klausner JD. High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru. Int J STD AIDS 2017; 29:568-576. [PMID: 29183269 DOI: 10.1177/0956462417744098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Kelika A Konda
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo R Leon
- 3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy R Segura
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Carlos F Caceres
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,4 Department of Epidemiology, Fielding School of Public Health, 12222 University of California Los Angeles , USA
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29
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Cunningham NJ, Beymer MR, Javanbakht M, Shover CL, Bolan RK. Concordance between self-reported STI history and biomedical results among men who have sex with men in Los Angeles, California. Sex Transm Infect 2017; 93:514-519. [PMID: 28554893 DOI: 10.1136/sextrans-2016-052933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/16/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV studies and risk assessments among men who have sex with men (MSM) frequently use self-reported STI history as a proxy for true STI history. The objective of our study was to assess the validity of self-reported STI history through comparison with laboratory-confirmed biomedical results. METHODS Data were analysed for MSM attending the Los Angeles LGBT Center (the Center) from August 2011 to July 2015. We identified 10 529 unique MSM who received testing for chlamydia, gonorrhoea and/or syphilis and had a later visit in which they self-reported their STI history to a clinic counsellor during a risk assessment. RESULTS MSM who had an STI in the past year self-reported their STI history with 51%-56% accuracy, and MSM who had an STI more than a year ago self-reported their STI history with 65%-72% accuracy. Among MSM with any positive STIs at the Center, black/African-American and Hispanic MSM were more likely to inaccurately self-report their positive results for gonorrhoea (adjusted OR (aOR): 1.48, 95% CI 1.09 to 2.01; aOR: 1.39, 95% CI 1.14 to 1.70). Additionally, HIV-positive MSM were more likely to inaccurately self-report their positive results for gonorrhoea (aOR: 1.63, 95% CI 1.22 to 2.18) and/or syphilis (aOR: 2.19, 95% CI 1.08 to 4.47). CONCLUSIONS This is the first study that attempts to evaluate the validity of self-reported STI history among MSM. We found that self-reported STI history may not be an appropriate proxy for true STI history in certain settings and minority populations. Clinical guidelines and research studies that rely on self-reported STI history will need to modify their recommendations in light of the limited validity of these data.
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Affiliation(s)
- Nicole J Cunningham
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Matthew R Beymer
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Division of Infectious Diseases, Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Chelsea L Shover
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Robert K Bolan
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
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Morris E, Topete P, Rasberry CN, Lesesne CA, Kroupa E, Carver L. School-Based HIV/STD Testing Behaviors and Motivations Among Black and Hispanic Teen MSM: Results From a Formative Evaluation. THE JOURNAL OF SCHOOL HEALTH 2016; 86:888-897. [PMID: 27866390 PMCID: PMC5921839 DOI: 10.1111/josh.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND This evaluation explores experiences with, and motivations for, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing among black and Hispanic school-aged young men who have sex with men (YMSM). METHODS Participants were recruited at community-based organizations that serve YMSM in New York City, Philadelphia, and San Francisco. Eligible participants were 13- to 19-year-old black or Hispanic males who reported attraction to or sexual behavior with other males and/or identified as gay or bisexual, and attended at least 90 days of school in the previous 18 months. Participants (N = 415) completed web-based questionnaires and/or in-depth interviews (N = 32). RESULTS In the past year, 72.0% of questionnaire participants had been tested for HIV, 13.5% of them at school or school clinic. Participants reported that they would be more likely to get an HIV test if they could be tested close to or at school (34.4%), and 64.4% would use HIV testing if offered in schools. Most interview participants reported willingness to use school-based services if they were offered nonjudgmentally, privately, and confidentially by providers with experience serving YMSM. CONCLUSION Schools can provide opportunities to make HIV and STD testing accessible to school-aged YMSM, but the services must be provided in ways that are comfortable to them.
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Affiliation(s)
- Elana Morris
- Behavioral Scientist, Division of HIV Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329
| | - Pablo Topete
- Technical Specialist, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
| | - Catherine N. Rasberry
- Health Scientist, Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329
| | - Catherine A. Lesesne
- Technical Director, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
| | - Elizabeth Kroupa
- Manager, ICF International, 710 Second Avenue, Suite 550, Seattle, WA 98104
| | - Lisa Carver
- Manager, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
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Girometti N, Gutierrez A, Nwokolo N, McOwan A, Whitlock G. High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy? Sex Transm Infect 2016; 93:320-322. [PMID: 28729516 DOI: 10.1136/sextrans-2016-052865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy for HIV prevention. Understanding the impact of risk factors for HIV transmission to identify those at highest risk would favour the implementation of PrEP, currently limited by costs. In this service evaluation, we estimated the incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with early syphilis attending a London sexual health clinic according to their HIV status. In addition, we estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis. METHODS We undertook a retrospective case note review of all MSM patients diagnosed with early syphilis between January and June 2014. A number of sexual health screens and diagnoses of chlamydia, gonorrhoea and HIV were prospectively analysed following the syphilis diagnosis. RESULTS 206 MSM were diagnosed with early syphilis. 110 (53%) were HIV-negative at baseline, 96 (47%) were HIV-positive. Only age (37 vs 32 years, p=0.0005) was significantly different according to HIV status of MSM at baseline. In HIV-negative versus HIV-positive MSM, incidence of rectal chlamydia infection at follow-up was 27 cases vs 50/100 person-years of follow-up (PYFU) (p=0.0039), 33 vs 66/100 PYFU (p=0.0044) for rectal gonorrhoea and 10 vs 26/100 PYFU (p=0.0044) for syphilis reinfection, respectively. Total follow-up for 110 HIV-negative MSM was 144 person-years. HIV incidence was 8.3/100 PYFU (CI 4.2 to 14). CONCLUSIONS A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.
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Affiliation(s)
- Nicolò Girometti
- Infectious Diseases Unit, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.,Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Nneka Nwokolo
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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Hashemi-Shahri SM, Sharifi-Mood B, Kouhpayeh HR, Moazen J, Farrokhian M, Salehi M. Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e28028. [PMID: 27818966 PMCID: PMC5086419 DOI: 10.5812/ijhrba.28028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Background Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS. Objectives This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection. Patients and Methods In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant. Results Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05). Conclusions Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don’t have such sore in their genital area.
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Affiliation(s)
| | - Batool Sharifi-Mood
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Hamid-Reza Kouhpayeh
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Javad Moazen
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mohsen Farrokhian
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Masoud Salehi
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Masoud Salehi, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-54132281012, Fax: +98-5413236722, E-mail:
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Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infect Dis Obstet Gynecol 2016; 2016:5758387. [PMID: 27366021 PMCID: PMC4913006 DOI: 10.1155/2016/5758387] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 12/30/2022] Open
Abstract
In the United States, sexually transmitted diseases due to Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.
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Recalled Explanations for Adolescent Girls' Engagement in Age-Discordant Sexual Relationships. AIDS Behav 2016; 20:1327-33. [PMID: 26662265 DOI: 10.1007/s10461-015-1259-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Age-discordant sexual relationships are associated with negative sexual health outcomes for adolescent females. We were particularly interested in females' motivations for engaging in these relationships, and in contextual factors that increase receptivity to age-discordant relationships in the United States (U.S.). However, recent research addressing this topic in the U.S. has been sparse. To address this gap in the literature, we recruited 15 women (Mdn age = 26 years; 93 % African American) from an urban, publicly funded sexually transmitted disease clinic to qualitative interviews. Reasons given by women for their involvement in age-discordant sexual relationships as adolescents included: (a) desire for an actively engaged father figure, (b) to obtain material support, (c) to escape from a troubled home life, and (d) to express independence and maturity. Thus, familial, economic, and developmental factors motivate socioeconomically disadvantaged adolescent females to enter into age-discordant sexual relationships. Efforts to reduce females' participation in these relationships will need to address socioeconomic vulnerability and family relationships.
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Bennett C, Knight V, Knox D, Gray J, Hartmann G, McNulty A. An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study. Sex Health 2016; 13:SH15174. [PMID: 27208975 DOI: 10.1071/sh15174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/09/2015] [Indexed: 02/28/2024]
Abstract
Background: Sydney Sexual Health Centre (SSHC) partnered with a large sex-on-premises venue, South Eastern Sydney Local Health District HIV and Related Programs Unit and AIDS Council of NSW (ACON) to develop and implement a community-based sexually transmissible infection (STI) screening model co-located in a sex-on-premises venue. This paper describes the process, the outcomes and examines the cost of this model. Methods: A retrospective cross-sectional study of gay and bisexual men (GBM) attending a STI testing service co-located in a sex-on-premises venue in Sydney city between the 1 November 2012 and 31 May 2014. Results: A total of 402 patrons had 499 testing episodes in the study period. Testing patrons were a median of 39.5 years of age, 221 (55%) were born overseas, 85 (21%) spoke a language other than English at home and 54 (13%) had a STI at first testing. A total of 105 (26%) testing patrons had never tested for a STI before. Of the 297 (74%) who had been tested before, 83 (21%) had not been tested within the last 12 months. A total of 77 STIs were detected in 63 people over 499 testing episodes, giving a STI positivity rate of 15% in the testing episodes. The prevalence of rectal chlamydia was the highest at 8% followed by pharyngeal gonorrhoea at 3%. A total of 97% of testing patrons were successfully relayed their results via their preferred methods within a median of 7.5 days. Conclusion: This paper highlights that offering STI screening in a community-based setting was an effective and low-cost alternative to traditional testing services.
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Barbee LA, Golden MR. Editorial Commentary: When to Perform a Test of Cure for Gonorrhea: Controversies and Evolving Data: Table 1. Clin Infect Dis 2016; 62:1356-9. [DOI: 10.1093/cid/ciw142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
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Lau JTF, Mo PKH, Gu J, Hao C, Lai CHY. Association of Situational and Environmental Factors With Last Episode of Unprotected Anal Intercourse Among MSM in Hong Kong: A Case-Crossover Analysis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:26-42. [PMID: 26829255 DOI: 10.1521/aeap.2016.28.1.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study investigates event-specific factors that differentiate the last episodes of unprotected anal intercourse (UAI) from protected anal intercourse (PAI) with regular partner (RP) among 213 men who have sex with men (MSM) who did not use condoms consistently using case-crossover analysis. Factors positively associated with the last episode of UAI with RP included: two situational factors (i.e., participant's suggestion to have UAI, alcohol use) and three environmental/setting factors (i.e., sex took place overseas, during a weekday and not at home). Negative associations with an episode of UAI with RP included: five situational factors (i.e., discussion about condom use prior to sex, RP's suggestion to have PAI, participant's suggestion to have PAI, perception that RP would like to use a condom, participant's planning to use a condom) and two environmental/setting factors (i.e., condoms placed at the venue where sex took place, partner possessed a condom). Thus, these significant event-specific factors explained under which circumstances some MSM would use and would not use condoms during anal sex with RP.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shatin, Hong Kong
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shatin, Hong Kong
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - CoCo H Y Lai
- Centre for Health Behaviours Research, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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Scott HM, Klausner JD. Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US. AIDS Res Ther 2016; 13:5. [PMID: 26793265 PMCID: PMC4719214 DOI: 10.1186/s12981-016-0089-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 02/03/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) has shown high efficacy in preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) in several large clinical trials, and more recently in “real world” reports of clinical implementation and a PrEP demonstration project. Those studies also demonstrated high bacterial sexually transmitted infection (STI) incidence and raised the discussion of how PrEP may impact STI control efforts, especially in the setting of increasing Neisseria gonorrhoeae antimicrobial resistance and the increase in syphilis cases among MSM. Here, we discuss STIs as a driver of HIV transmission risk among MSM, and the potential opportunities and challenges for STI control afforded by expanded PrEP implementation among high-risk MSM.
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Ham DC, Hariri S, Kamb M, Mark J, Ilunga R, Forhan S, Likibi M, Lewis DA. Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa: An Evaluation of Health Providers' Knowledge, Attitudes, and Practices. Sex Transm Dis 2016; 43:23-9. [PMID: 26650992 PMCID: PMC6756471 DOI: 10.1097/olq.0000000000000383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. METHODS From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. RESULTS Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management. CONCLUSIONS Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.
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Affiliation(s)
- David Cal Ham
- Division of HIV/AIDS Prevention and Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Susan Hariri
- Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Mary Kamb
- Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | | | - Ricky Ilunga
- National Institute for Communicable Diseases of National Health Laboratory Services, Johannesburg, South Africa
| | - Sara Forhan
- Division of CDC, Division of Global HIV/AIDS, Atlanta, GA
| | - Mupatal Likibi
- Alexandra Community Health Centre, Johannesburg, South Africa
| | - David A. Lewis
- Centre for HIVand STIs, National Institute for Communicable Diseases (NHLS), Sandringham, South Africa
- Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia eases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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The "3 in 1" Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men. J Clin Microbiol 2015; 54:650-6. [PMID: 26719439 DOI: 10.1128/jcm.02460-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) for Neisseria gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with either C. trachomatis or N. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly for C. trachomatis (P = 0.774) or N. gonorrhoeae (P = 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detecting C. trachomatis (P = 0.167). For N. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P < 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detect N. gonorrhoeae infections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.).
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Martí-Pastor M, García de Olalla P, Barberá MJ, Manzardo C, Ocaña I, Knobel H, Gurguí M, Humet V, Vall M, Ribera E, Villar J, Martín G, Sambeat MA, Marco A, Vives A, Alsina M, Miró JM, Caylà JA. Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study. BMC Public Health 2015; 15:1015. [PMID: 26438040 PMCID: PMC4594901 DOI: 10.1186/s12889-015-2344-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. METHODS Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. RESULTS HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. CONCLUSION An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.
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Affiliation(s)
- Marc Martí-Pastor
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain.
| | - Patricia García de Olalla
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Maria-Jesús Barberá
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Inma Ocaña
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Mercè Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Victoria Humet
- Departament de Justicia, Direcció General de Serveis Penitenciaris i de Rehabilitació, Barcelona, Spain.
| | - Martí Vall
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Esteban Ribera
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Judit Villar
- Infectious Diseases, Hospital del Mar, Barcelona, Spain.
| | - Gemma Martín
- Infectious Diseases, Hospital del Mar, Barcelona, Spain.
| | - Maria A Sambeat
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Andres Marco
- Departament de Justicia, Direcció General de Serveis Penitenciaris i de Rehabilitació, Barcelona, Spain.
| | | | - Mercè Alsina
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Josep M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Joan A Caylà
- Epidemiology Service, Agencia de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Hoenigl M, Green N, Mehta SR, Little SJ. Risk Factors for Acute and Early HIV Infection Among Men Who Have Sex With Men (MSM) in San Diego, 2008 to 2014: A Cohort Study. Medicine (Baltimore) 2015; 94:e1242. [PMID: 26222863 PMCID: PMC4554110 DOI: 10.1097/md.0000000000001242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objectives of this study were to identify risk factors associated with acute and early HIV infection (AEH) among men who have sex with men (MSM) undergoing community HIV testing and to compare demographics in those diagnosed with AEH with those diagnosed at chronic stage of HIV infection.In this retrospective cohort study, we analyzed risk factors associated with AEH among 8925 unique MSM (including 200 with AEH [2.2%] and 219 [2.5%] with newly diagnosed chronic HIV infection) undergoing community-based, confidential AEH screening in San Diego, California.The combination of condomless receptive anal intercourse (CRAI) plus ≥5 male partners, CRAI with an HIV-positive male, CRAI with a person who injects drugs, and prior syphilis diagnosis were significant predictors of AEH in the multivariable Cox regression model. Individuals reporting ≥1 of these 4 risk factors had a hazard ratio of 4.6 for AEH. MSM diagnosed with AEH differed in race (P = 0.005; more reported white race [P = 0.001], less black race [P = 0.030], trend toward less Native American race [P = 0.061]), when compared to those diagnosed with chronic HIV infection, while there was no difference observed regarding age.We established a multivariate model for the predicting risk of AEH infection in a cohort of MSM undergoing community HIV screening, which could be potentially used to discern those in need of further HIV nucleic acid amplification testing for community screening programs that do not test routinely for AEH. In addition, we found that race differed between those diagnosed with AEH and those diagnosed at chronic stage of HIV infection underlining the need for interventions that reduce stigma and promote the uptake of HIV testing for black MSM.
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Affiliation(s)
- Martin Hoenigl
- From the Division of Infectious Diseases, University of California San Diego (UCSD), San Diego, California (MH, NG, SRM, SJL); Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine (MH); Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria (MH); and Veterans Affairs Healthcare System, San Diego, California (SRM)
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Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1-137. [PMID: 26042815 PMCID: PMC5885289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
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Affiliation(s)
- Kimberly A. Workowski
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
- Emory University, Atlanta, Georgia
| | - Gail A. Bolan
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Hoenigl M, Weibel N, Mehta SR, Anderson CM, Jenks J, Green N, Gianella S, Smith DM, Little SJ. Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis 2015; 61:468-75. [PMID: 25904374 DOI: 10.1093/cid/civ335] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/12/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although men who have sex with men (MSM) represent a dominant risk group for human immunodeficiency virus (HIV), the risk of HIV infection within this population is not uniform. The objective of this study was to develop and validate a score to estimate incident HIV infection risk. METHODS Adult MSM who were tested for acute and early HIV (AEH) between 2008 and 2014 were retrospectively randomized 2:1 to a derivation and validation dataset, respectively. Using the derivation dataset, each predictor associated with an AEH outcome in the multivariate prediction model was assigned a point value that corresponded to its odds ratio. The score was validated on the validation dataset using C-statistics. RESULTS Data collected at a single HIV testing encounter from 8326 unique MSM were analyzed, including 200 with AEH (2.4%). Four risk behavior variables were significantly associated with an AEH diagnosis (ie, incident infection) in multivariable analysis and were used to derive the San Diego Early Test (SDET) score: condomless receptive anal intercourse (CRAI) with an HIV-positive MSM (3 points), the combination of CRAI plus ≥5 male partners (3 points), ≥10 male partners (2 points), and diagnosis of bacterial sexually transmitted infection (2 points)-all as reported for the prior 12 months. The C-statistic for this risk score was >0.7 in both data sets. CONCLUSIONS The SDET risk score may help to prioritize resources and target interventions, such as preexposure prophylaxis, to MSM at greatest risk of acquiring HIV infection. The SDET risk score is deployed as a freely available tool at http://sdet.ucsd.edu.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, University of California, San Diego Section of Infectious Diseases and Tropical Medicine Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Nadir Weibel
- Department of Computer Science and Engineering, University of California, San Diego
| | - Sanjay R Mehta
- Division of Infectious Diseases, University of California, San Diego Veterans Affairs Healthcare System, San Diego, California
| | | | - Jeffrey Jenks
- Division of Infectious Diseases, University of California, San Diego
| | - Nella Green
- Division of Infectious Diseases, University of California, San Diego
| | - Sara Gianella
- Division of Infectious Diseases, University of California, San Diego
| | - Davey M Smith
- Division of Infectious Diseases, University of California, San Diego Veterans Affairs Healthcare System, San Diego, California
| | - Susan J Little
- Division of Infectious Diseases, University of California, San Diego
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Taylor MM, Newman DR, Gonzalez J, Skinner J, Khurana R, Mickey T. HIV status and viral loads among men testing positive for rectal gonorrhoea and chlamydia, Maricopa County, Arizona, USA, 2011-2013. HIV Med 2015; 16:249-54. [PMID: 25230929 PMCID: PMC6754092 DOI: 10.1111/hiv.12192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Men diagnosed with rectal gonorrhoea (GC) and chlamydia (CT) have engaged in unprotected receptive anal intercourse. We reviewed the HIV positivity and HIV viral loads (VLs) of men who had rectal GC and CT testing to evaluate potential HIV acquisition and transmission risk. METHODS Rectal GC and CT testing data for men attending the Maricopa County STD clinic during the period from 1 October 2011 to 30 September 2013 were cross-matched with HIV surveillance data to identify men with HIV coinfection. We examined HIV status, HIV diagnosis date, and the values of VL collected nearest to the date of reported rectal infection. RESULTS During the 2-year time period, 1591 men were tested for rectal GC and CT. Of the men tested, 506 (31.8%) were positive for GC (13.2%), CT (12.2%) or both (6.4%); 119 (23.5%) of those with rectal GC or CT were coinfected with HIV. Among the 275 men with HIV at the time of rectal testing, 54 (19.6%) had no reported VL; 63 (22.9%) had an undetectable VL (< 20 HIV-1 RNA copies/mL) and 158 (57.4%) had a detectable VL collected within 1 year of rectal diagnosis. Mean VL was higher among HIV and rectal GC/CT coinfected cases compared with men with HIV alone (174 316 vs. 57 717 copies/mL, respectively; P = 0.04). CONCLUSIONS Approximately one-third of men undergoing rectal testing were positive for GC or CT and one-quarter of men with rectal GC or CT also had HIV infection. Of the HIV-infected men tested for rectal GC or CT, more than half had a detectable VL collected near the time of rectal testing, demonstrating a risk for transmitting HIV.
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Affiliation(s)
- M M Taylor
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Maricopa County Department of Public Health, Phoenix, AZ, USA; STD Program, Arizona Department of Health Services, Phoenix, AZ, USA
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Incident sexually transmitted infection as a biomarker for high-risk sexual behavior after diagnosis of acute HIV. Sex Transm Dis 2015; 41:447-52. [PMID: 24922104 DOI: 10.1097/olq.0000000000000147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sexually transmitted infection (STI) diagnosis after diagnosis of acute HIV infection (AHI) indicates ongoing high-risk sexual behavior and possible risk of HIV transmission. We assessed predictors of STI acquisition and the effect of time since care entry on STI incidence in patients with AHI in care and receiving consistent risk-reduction messaging. METHODS Data on incident gonorrhea, chlamydia, trichomoniasis, primary/secondary syphilis, demographic, and clinical risk factors were abstracted from medical charts for patients diagnosed as having AHI and engaged in care. Poisson regression models using generalized estimating equations were fit to estimate incidence rates (IRs), IR ratios, and robust 95% confidence intervals. RESULTS Among 185 patients with AHI, 26 (14%) were diagnosed as having at least 1 incident STI over 709.4 person-years; 46 STIs were diagnosed during follow-up (IR, 6.8/100 person-years). The median time from HIV care entry to first STI diagnosis was 609 days (range, 168-1681 days). Men who have sex with men (P = 0.03), a shorter time between presentation to medical care and AHI diagnosis (P = 0.06), and STI diagnosis before AHI diagnosis (P = 0.0003) were predictors of incident STI. Sexually transmitted infection IR greater than 1 year after entering care was double that of patients in care 1 year or less (IR ratio, 2.0; 95% confidence interval, 0.8-4.9). HIV viral load was above the limits of detection within 1 month of 11 STI diagnoses in 6 patients (23.1%) (median, 15,898 copies/mL; range, 244-152,000 copies/mL). CONCLUSIONS Despite regular HIV care, STI incidence was high among this primarily young, men who have sex with men AHI cohort. Early antiretroviral initiation may decrease HIV transmission given ongoing risk behaviors despite risk-reduction messaging.
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Wang Y, Huang Y, Chen H, Li L, Xu J, Li Z, Zhang G, Fan J, Zhao X, Jia S. Incidence and correlates of HIV and syphilis in a prospective cohort of men who have sex with men in Mianyang, China, over a 36-month period. Sex Health 2015; 12:546-55. [PMID: 26318795 DOI: 10.1071/sh14243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/09/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Estimates for the HIV/AIDS epidemic from the China Ministry of Health show that the epidemic is spreading rapidly among men who have sex with men (MSM). METHODS Respondent-driven sampling (RDS) was adapted in 2009 and snowball sampling was adapted to supplement the number of participants in 2010 and 2011. Interviewer-administered questionnaires and blood tests were conducted to confirm enrolment eligibility of participants. RESULTS A total of 725 HIV-negative participants were included into the cohort study. The cohort had a HIV incidence density of 5.6 (95% CI: 3.9-7.3)/100 person-years (PY) and a syphilis incidence density of 5.6 (95% CI:3.7-7.6)/100 PY. Age ≤20 years (21-25 years, hazard ratio (HR)=0.32, 95%CI: 0.11-0.95/≥26 years, HR=0.17, 95%CI: 0.05-0.66), having not participated in peer education in the past year (HR=2.96, 95%CI: 1.19-7.35), seeking male sexual partners in a public washroom/park (HR=3.61, 95%CI: 1.03-12.47), being currently infected with syphilis (HR=3.21, 95%CI: 1.31-7.91), having sex partners aged ≥30 years (HR=3.40, 95%CI: 1.11-10.39) and having more than four male sexual partners within the past 6 months (HR=3.34, 95%CI: 1.24-9.04) were found to be risk factors for HIV seroconversion (each P<0.05). Being married (HR=2.38, 95%CI: 1.04-5.46), having not participated in peer education in the past year (HR=2.28, 95%CI: 1.08-4.82), having limited HIV/AIDS knowledge (HR=4.28, 95%CI: 1.94-9.43) and having a sexually transmitted disease infection in the past 6 months (HR=4.74, 95%CI: 1.83-12.30) were identified as factors for syphilis infection (each P<0.05). CONCLUSION The incidence rates of HIV and syphilis in Mianyang City reamained high in the cohort of MSM for 36 months. Increased attention should be given to this serious epidemic, and appropriate interventions should be implemented to address MSM-specific issues in order to prevent HIV and syphilis infection in China.
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Affiliation(s)
- Yi Wang
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Yuling Huang
- Pi'xian Centre for Disease Control and Prevention, Chengdu 610000, Sichuan, China
| | - Huailiang Chen
- Department of Infectious Diseases Prevention and Healthcare, People's Hospital of Chengdu Tianfu new area, upper Zhengbei Street 97#, Huayang, Tianfu new area, Chengdu 610000, Sichuan Province, China
| | - Liulin Li
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Jie Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhijun Li
- China office of Global AIDS Program, the United States Centers for Disease Control and Prevention, Beijing 100050, China
| | - Guanggui Zhang
- Mianyang Bureau of Health, Mianyang 621000, Sichuan, China
| | - Jing Fan
- Mianyang MSM care group, Mianyang 621000, Sichuan, China
| | - Xihe Zhao
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Shuguang Jia
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
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Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study. Sex Transm Dis 2014; 41:79-85. [PMID: 24413484 DOI: 10.1097/olq.0000000000000088] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Centers for Disease Control and Prevention guidelines recommend azithromycin or doxycycline for treatment of rectal chlamydial infection. METHODS We created a retrospective cohort of male patients diagnosed as having rectal chlamydia between 1993 and 2012 at a sexually transmitted disease clinic in Seattle, Washington. Men were included in the analysis if they were treated with azithromycin (1 g single dose) or doxycycline (100 mg twice a day × 7 days) within 60 days of chlamydia diagnosis and returned for repeat testing 14 to 180 days after treatment. We compared the risk of persistent/recurrent rectal chlamydial infection among recipients of the 2 drug regimens using 4 follow-up testing time intervals (14-30, 60, 90, and 180 days). RESULTS Of 1835 cases of rectal chlamydia diagnosed in the study period, 1480 (81%) were treated with azithromycin or doxycycline without a second drug active against Chlamydia trachomatis. Of these, 407 (33%) of 1231 azithromycin-treated men and 95 (38%) of 249 doxycycline-treated men were retested 14 to 180 days after treatment (P = 0.12); 88 (22%) and 8 (8%), respectively, had persistent/recurrent infection (P = 0.002). Persistent/recurrent infection was higher among men treated with azithromycin compared with doxycycline at 14 to 30 days (4/53 [8%] vs. 0/20 [0%]), 14 to 60 days (23/136 [17%] vs. 0/36 [0%]), and 14 to 90 days (50/230 [22%] vs. 2/56 [4%]). In multivariate analysis, azithromycin-treated men had a significantly higher risk of persistent/recurrent infection in the 14 to 90 days (adjusted relative risk, 5.2; 95% confidence interval, 1.3-21.0) and 14 to 180 days (adjusted relative risk, 2.4; 95% confidence interval, 1.2-4.8) after treatment. CONCLUSIONS These data suggest that doxycycline may be more effective than azithromycin in the treatment of rectal chlamydial infections.
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Scott HM, Fuqua V, Raymond HF. Utilization of HIV prevention services across racial/ethnic groups among men who have sex with men in San Francisco, California, 2008. AIDS Behav 2014; 18 Suppl 3:316-23. [PMID: 23712733 DOI: 10.1007/s10461-013-0526-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection in the US is disproportionally higher among Black and Latino men who have sex with men (MSM), compared to other racial/ethnic groups. The 2008 US National HIV Behavioral Surveillance (NHBS) survey of MSM was analyzed to compare utilization of HIV testing, receiving condoms, and individual and group HIV prevention programs among racial/ethnic groups in San Francisco, CA. Using a weighted analysis of the time-location sampling method, racial/ethnic subpopulation estimates were obtained for utilization of these services in the prior 12 months. There was no significant difference in utilization of HIV prevention services among Black (N=37), Latino (N=128), and White (N=275) MSM in San Francisco, CA. Overall 60-70 % of MSM reported their last HIV test within the past 12 months and more than 75 % reported receiving condoms in the last 12 months. However, less than 15 % of MSM reported utilizing individual or group HIV prevention counseling sessions. The NHBS survey demonstrate that the majority of MSM in San Francisco, CA have utilized one or more HIV prevention service in the past 12 months and that there were no racial/ethnic disparities in utilization of these services. However, the utilization of individual or group HIV prevention programs is low and HIV testing is below current recommendations for MSM.
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The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV Infection. Sex Transm Dis 2013; 40:366-71. [PMID: 23588125 DOI: 10.1097/olq.0b013e318284e544] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) who have a current or recent history of rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection are at greater risk for HIV than MSM with no history of rectal infection. Screening and treating MSM for rectal CT/GC infection may help reduce any increased biological susceptibility to HIV infection. METHODS We used 2 versions of a Markov state-transition model to examine the impact and cost-effectiveness of screening MSM for rectal CT/GC infection in San Francisco: a static version that included only the benefits to those screened and a dynamic version that accounted for population-level impacts of screening. HIV prevention through reduced susceptibility to HIV was the only potential benefit of rectal CT/GC screening that we included in our analysis. Parameter values were based on San Francisco program data and the literature. RESULTS In the base case, the cost per quality-adjusted life year gained through screening MSM for rectal CT/GC infection was $16,300 in the static version of the model. In the dynamic model, the cost per quality-adjusted life year gained was less than $0, meaning that rectal screening was cost-saving. The impact of rectal CT/GC infection on the risk of HIV acquisition was the most influential model parameter. CONCLUSIONS Although more information is needed regarding the impact of rectal CT/GC screening on HIV incidence, rectal CT/GC screening of MSM can potentially be a cost-effective, scalable intervention targeted to at-risk MSM in certain urban settings such as San Francisco.
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