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Goense CJDH, Doan THP, Kpokiri EE, Evers YJ, Estcourt CS, Crutzen R, Klausner JD, Tang W, Baraitser P, Hoebe CJPA, Dukers-Muijrers NHTM. Understanding Practical, Robust Implementation and Sustainability of Home-based Comprehensive Sexual Health Care: A Realist Review. AIDS Behav 2024; 28:3338-3349. [PMID: 38963569 PMCID: PMC11427609 DOI: 10.1007/s10461-024-04415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations.
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Affiliation(s)
- Cornelia Johanna Dorothy Hanneke Goense
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands.
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands.
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands.
| | | | - Eneyi E Kpokiri
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ymke J Evers
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | | | - Weiming Tang
- University of North Carolina at Chapel Hill, Project-China, Chapel Hill, NC, USA
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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Rose SB, Gardiner T, Dunlop A, Cole M, Garrett SM, McKinlay EM. Māori and Pacific young people's perspectives on testing for sexually transmitted infections via an online service: a qualitative study. J Prim Health Care 2024; 16:258-269. [PMID: 39321072 DOI: 10.1071/hc23136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 09/27/2024] Open
Abstract
Introduction International research suggests free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing. A user-pays online STI testing service exists in Aotearoa New Zealand, but acceptability among priority populations is unknown. Aim To explore Māori and Pacific young people's perspectives on online postal self-sampling for STI testing (as prospective service users). Methods Four wānanga (knowledge-sharing forum) were held between November 2022 and May 2023 with Māori and Pacific participants aged 15-24 years who were recruited via youth-focused community organisations. Three facilitators guided discussions about STI testing and use of an online service. Inductive thematic analysis was used to analyse data generated from audio-recorded discussions, group work notes and facilitator field notes. Results None of the 38 participants were aware of online STI testing and all considered it cost-prohibitive. Perceptions of online testing were mixed, and discussion about concerns outweighed perceived benefits. Three themes were identified: (i) potential to support autonomy (perceived benefits and positive features of self-sample collection kits); (ii) barriers and process-related concerns; and (iii) tailoring online STI testing to young people's needs (facilitating engagement with online testing). Discussion For online STI testing to be an accessible alternative to clinic-based testing for priority populations, cost, low awareness and other barriers in the testing pathway need to be addressed. Clinician follow-up on positive results and free treatment would be critical to ensure the cycle of best practice care is completed. Regardless of where testing is accessed, investment is needed to support young people's knowledge of when, why and how to access a sexual health check.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
| | - Tracey Gardiner
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
| | - Abigail Dunlop
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
| | - Marama Cole
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
| | - Eileen M McKinlay
- Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand
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Latt PM, Soe NN, Fairley C, Xu X, King A, Rahman R, Ong JJ, Phillips TR, Zhang L. Assessing the effectiveness of HIV/STI risk communication displays among Melbourne Sexual Health Centre attendees: a cross-sectional, observational and vignette-based study. Sex Transm Infect 2024; 100:158-165. [PMID: 38395609 PMCID: PMC11041604 DOI: 10.1136/sextrans-2023-055978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Increasing rates of sexually transmitted infections (STIs) over the past decade underscore the need for early testing and treatment. Communicating HIV/STI risk effectively can promote individuals' intention to test, which is critical for the prevention and control of HIV/STIs. We aimed to determine which visual displays of risk would be the most likely to increase testing or use of prevention strategies. METHODS A vignette-based cross-sectional survey was conducted with 662 clients (a median age of 30 years (IQR: 25-36), 418 male, 203 female, 41 other genders) at a sexual health clinic in Melbourne, Australia, between February and June 2023. Participants viewed five distinct hypothetical formats, presented in a randomised order, designed to display the same level of high risk for HIV/STIs: icon array, colour-coded risk metre, colour-coded risk bar, detailed text report and guideline recommendation. They reported their perceived risk, concern and intent to test for each risk display. Associations between the format of the risk display and the intention to test for HIV/STI were analysed using logistic regression. RESULTS About 378 (57%) of participants expressed that the risk metre was the easiest to understand. The risk metre (adjusted OR (AOR)=2.44, 95% CI=1.49 to 4.01) and risk bar (AOR=2.08, CI=1.33 to 3.27) showed the greatest likelihood of testing compared with the detailed text format. The icon array was less impactful (AOR=0.73, CI=0.57 to 0.94). The risk metre also elicited the most concern but was the most preferred and understood. High-risk perception and concern levels were strongly associated with their intention to have an HIV/STI test. CONCLUSIONS Displaying risk differently affects an individual's perceived risk of an HIV/STI and influences their intention to test.
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Affiliation(s)
- Phyu Mon Latt
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Nyi Nyi Soe
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Xianglong Xu
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Alicia King
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Rashidur Rahman
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tiffany R Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210008, China
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Murray C, Rose SB. Improving partner notification for sexually transmitted infections: Interviews with key informants in Aotearoa New Zealand. Int J STD AIDS 2024; 35:397-404. [PMID: 38225809 DOI: 10.1177/09564624241226740] [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: 01/17/2024]
Abstract
BACKGROUND Partner notification is a vital part of sexually transmitted infection (STI) control but evidence suggests that its practice in Aotearoa New Zealand (NZ) is inconsistent. This study sought to explore barriers to partner notification for STIs, identify areas for improvement and draw on lessons learnt from Covid-19. METHODS Semi-structured interviews with key informants working in primary care, sexual health, public health, management, and research were undertaken between December 2021 and March 2022. Interviews were audiorecorded, transcribed, coded, and analysed using thematic analysis. RESULTS The overarching theme was that partner notification for STIs needs to be improved, and must be a more acceptable experience for providers, cases and their contacts. Four themes described how this could be achieved: (i) destigmatise and increase understanding of STIs, (ii) ensure engagement with services is easy and affirming, (iii) prioritise and resource evidence-based services and (iv) develop tools to optimise partner notification. CONCLUSIONS Sexually transmitted infection partner notification in NZ needs prioritisation, resourcing and innovation. The inadequate resourcing of STI management in NZ contrasts with the well-funded response to Covid-19. Without a well-resourced action plan, NZ's high rates of STIs will persist and continue to inequitably impact Māori, Pacific, gay and bisexual men and young people.
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Affiliation(s)
- Catriona Murray
- Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand
| | - Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington South, New Zealand
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Séguin LJ, Gareau E, Bosom M. DépistaFest: The evaluation of an inclusive, positive, and playful STBBI screening campaign's effectiveness. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:250-258. [PMID: 38393551 PMCID: PMC11027723 DOI: 10.17269/s41997-024-00862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Young adults are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs), and rates of STBBI screening in this population are persistently low. The present study examined the effectiveness of Club Sexu's social marketing campaign, DépistaFest, in increasing STBBI screening, screening intentions, and general STBBI and STBBI screening knowledge among young adults in Quebec, Canada. Grounded in the health belief model, the campaign provided practical and scientifically accurate information on STBBIs and screening using an inclusive, positive, and playful approach. METHODS A sample of 686 participants (M = 28.0 years old) was recruited through Club Sexu's social media to complete an online survey assessing campaign exposure, recent STBBI screening, screening intentions, and general STBBI and screening knowledge. Logistic regressions and ANCOVAs were performed to examine group differences on outcome variables. RESULTS Compared to nonexposed participants, those who were exposed to the campaign were 2.11 times more likely to report having been tested in the past 6 months, and 2.07 times more likely to report planning to get tested in the next 6 months. Exposed participants were also more likely to correctly answer general STBBI knowledge questions and reported higher levels of self-perceived STBBI screening knowledge than nonexposed participants. CONCLUSION The findings support the effectiveness of an STBBI prevention campaign grounded in the health belief model. Future STBBI prevention campaigns aimed at young adults would benefit from destigmatizing STBBIs and normalizing STBBI screening using an inclusive, positive, and playful approach.
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Affiliation(s)
- Léa J Séguin
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada.
| | - Emmanuelle Gareau
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Morag Bosom
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada
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Harris A, Thompson C, James K, Holder-Nevins D. Unravelling Delay in Care for Sexually Transmitted Infections-Related Symptoms in a Developing Country Setting (Jamaica). COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:295-302. [PMID: 37395626 DOI: 10.1177/2752535x231187987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) and STI treatment remain a challenge in public health. There is little understanding of related factors influencing health seeking behaviour and delay of care among clinic attendees in Jamaica. AIM To determine socio-demographic profile of clinic attendees with STI and identify factors associated with delay in seeking care for STI-related symptoms. METHODS A cross-sectional study was done. 201 adult patients presenting with STI symptoms from four health centres in Kingston and St Andrew were selected. A 24-item interviewer-assisted questionnaire was used to obtain data on socio-demographic characteristics, patients' symptoms and duration, previous STIs, knowledge of complications and seriousness of STIs, and factors influencing decision to seek medical care. RESULTS Almost 75% delayed seeking care for STIs. Recurrent STIs was identified in 41% of patients. 'Could not find time' was the most commonly reported reason for delay in seeking care (36%). Females were 3.4 times more likely to delay seeking care for STI symptoms than males (OR 3.42, 95% CI: 1.73-6.73). Those with primary level education and below were 5 times more likely to delay seeking care for STI symptoms than those with at least secondary level education (OR 5.05, 95% CI: 1.09-23.46). Participants viewed staff as confidential (68%) and 65% thought health-care workers spent adequate time during consultations. CONCLUSION Lower education level and the female gender are associated with delay in seeking care for STI-related symptoms. These factors should be considered when developing interventions to reduce delay in care for STI-related symptoms.
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Affiliation(s)
- Ardene Harris
- The Ministry of Health and Wellness, Kingston, Jamaica
| | - Camelia Thompson
- The Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Kenneth James
- The Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Desmalee Holder-Nevins
- The Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
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Maviso M, Kalembo FW. Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016-2018. BMJ Open 2024; 14:e075424. [PMID: 38453195 PMCID: PMC10921496 DOI: 10.1136/bmjopen-2023-075424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of not testing for HIV and its determinants among young adult women aged 15-29 years in Papua New Guinea (PNG). DESIGN AND SETTING The study used secondary data from the 2016 to 2018 PNG Demographic and Health Survey (PNGDHS), a nationally representative cross-sectional survey that used a two-stage stratified sampling. PARTICIPANTS A total weighed sample of 5164 young adult women aged 15-29 years were included in the analysis. PRIMARY OUTCOME MEASURE Ever been tested for HIV was the primary outcome of the study. All analyses were adjusted using survey weights to account for unequal sampling probabilities. RESULTS The prevalence of not testing for HIV was 58.8% (95% CI: 57.4% to 60.1%). The mean age was 21.65 years (SD = 4.23). Of the women who were not tested for HIV, the majority were never married (79.4%), without formal education (63%), not working (60.2%), and from rural areas (62.9%). In the multivariable analysis, those who were never married (adjusted OR (AOR) 4.9, 95% CI 3.6 to 6.6), had poor wealth index (AOR 1.8, 95% CI 1.3 to 2.5), were from rural areas (AOR 2.0, 95% CI 1.5 to 2.6), were from the Momase region (AOR 1.3, 95% CI 1.0 to 1.7), did not read newspapers or magazines (AOR 1.7, 95% CI 1.3 to 2.1), did not listen to the radio (AOR 1.5, 95% CI 1.1 to 2.0), experienced early sexual debut (AOR 1.5, 95% CI 1.1 to 1.9), had one sexual partner (AOR 1.5, 95% CI 1.2 to 2.0) and reported no sexually transmitted infection (STI) in the past 12 months (AOR 1.8, 95% CI 1.1 to 3.1) had higher odds of not testing for HIV. CONCLUSIONS Our study found a very high unmet need for HIV testing among young adult women in PNG. Health promotion programmes should be designed to increase HIV knowledge and access to testing services, particularly targeting young women who are disadvantaged and from rural areas.
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Affiliation(s)
- McKenzie Maviso
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Rose SB, Dunlop A, Gardiner T, Cole M, Garrett SM, McKinlay EM. 'Every strategy needs to be contributing to erasing the stigma': Māori and Pacific young people talk about overcoming barriers to testing for sexually transmitted infections. Sex Health 2024; 21:SH23186. [PMID: 38507899 DOI: 10.1071/sh23186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Māori and Pacific young people are disproportionately impacted by sexually transmitted infections (STIs). Access to STI screening is important to reduce transmission and reproductive health complications. METHODS Between November 2022 and May 2023, we held four wānanga (workshops) with Māori and Pacific participants (15-24years old) to find out what barriers they encounter to STI testing, and hear their ideas about how to overcome these. Participants were recruited via youth-focused community organisations in the Wellington region of Aotearoa New Zealand. Inductive thematic analysis was used to understand data generated from discussions, drawing on Māori and Pacific models of wellbeing to frame themes. RESULTS Thirty-eight participants were involved in the wānanga. Barriers to STI testing related to five themes: (1) differences in cultural values and expression; (2) family/friends; (3) educational gaps; (4) psychological factors; and (5) structural obstacles. Suggested strategies to improve access to sexual health care included the need for free, flexible services, education and health promotion activities to reach young people in their spaces (e.g. church, marae, social media). Participants stressed the need for approaches to be community-based, delivered by trusted individuals using culturally appropriate messages, and saw participation in STI testing as beneficial for whānau/family and communities. CONCLUSIONS To improve access to STI testing, participants described the need for free services, together with education and health promotion to improve inter-generational sexual health knowledge. Reframing messages around STIs to align with Māori and Pacific models of wellbeing was identified as a way to normalise conversations, in turn reducing the stigma surrounding STI testing.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Abby Dunlop
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Tracey Gardiner
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Marama Cole
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
| | - Eileen M McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand
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Latt PM, Soe NN, Xu X, Ong JJ, Chow EPF, Fairley CK, Zhang L. Identifying Individuals at High Risk for HIV and Sexually Transmitted Infections With an Artificial Intelligence-Based Risk Assessment Tool. Open Forum Infect Dis 2024; 11:ofae011. [PMID: 38440304 PMCID: PMC10911222 DOI: 10.1093/ofid/ofae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background We have previously developed an artificial intelligence-based risk assessment tool to identify the individual risk of HIV and sexually transmitted infections (STIs) in a sexual health clinical setting. Based on this tool, this study aims to determine the optimal risk score thresholds to identify individuals at high risk for HIV/STIs. Methods Using 2008-2022 data from 216 252 HIV, 227 995 syphilis, 262 599 gonorrhea, and 320 355 chlamydia consultations at a sexual health center, we applied MySTIRisk machine learning models to estimate infection risk scores. Optimal cutoffs for determining high-risk individuals were determined using Youden's index. Results The HIV risk score cutoff for high risk was 0.56, with 86.0% sensitivity (95% CI, 82.9%-88.7%) and 65.6% specificity (95% CI, 65.4%-65.8%). Thirty-five percent of participants were classified as high risk, which accounted for 86% of HIV cases. The corresponding cutoffs were 0.49 for syphilis (sensitivity, 77.6%; 95% CI, 76.2%-78.9%; specificity, 78.1%; 95% CI, 77.9%-78.3%), 0.52 for gonorrhea (sensitivity, 78.3%; 95% CI, 77.6%-78.9%; specificity, 71.9%; 95% CI, 71.7%-72.0%), and 0.47 for chlamydia (sensitivity, 68.8%; 95% CI, 68.3%-69.4%; specificity, 63.7%; 95% CI, 63.5%-63.8%). High-risk groups identified using these thresholds accounted for 78% of syphilis, 78% of gonorrhea, and 69% of chlamydia cases. The odds of positivity were significantly higher in the high-risk group than otherwise across all infections: 11.4 (95% CI, 9.3-14.8) times for HIV, 12.3 (95% CI, 11.4-13.3) for syphilis, 9.2 (95% CI, 8.8-9.6) for gonorrhea, and 3.9 (95% CI, 3.8-4.0) for chlamydia. Conclusions Risk scores generated by the AI-based risk assessment tool MySTIRisk, together with Youden's index, are effective in determining high-risk subgroups for HIV/STIs. The thresholds can aid targeted HIV/STI screening and prevention.
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Affiliation(s)
- Phyu M Latt
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Nyi N Soe
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Xianglong Xu
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Clinical Medical Research Center, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210008, China
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Chongsuwat T, Cody PJ. At-Home Self-Collection of Urine or Vaginal Samples for Gonorrhea and Chlamydia Screening Among Young People Who Were Assigned Female at Birth. AJPM FOCUS 2023; 2:100138. [PMID: 37920401 PMCID: PMC10618694 DOI: 10.1016/j.focus.2023.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction The U.S. has seen a rise in sexually transmitted infections; the need to increase access to screening is essential to reverse this trend, especially for vulnerable populations such as lesbian, gay, bisexual, and transgender/transsexual plus individuals, people of color, or those at a low SES. This study's primary objective is to assess preferences among people who were assigned female at birth for at-home self-collection for gonorrhea and chlamydia screening. This study aims to provide insight into the need for clinicians to adopt at-home self-collection of urine or vaginal samples to improve access to sexually transmitted infection screening. Methods A recruitment mailer was distributed in September-October 2021. Inclusion criteria included established patients (seen within the last 3 years for clinical services either in person or through telemedicine) at a local urban federally qualified health center in the state of Wisconsin, assigned female at birth, aged 18-24 years, and speaking English language. Participants completed an anonymous online survey regarding their preferences, experiences, and likelihood of self-collecting either urine or vaginal samples for gonorrhea and chlamydia screening at home. Results Among the total participants (N=88), 69% (n=61) overall preferred home collection for screening with no significance based on age; lesbian, gay, bisexual, and transgender/transsexual plus status; and race and/or ethnicity. However, patients were less likely to prefer at-home self-collection screening if they had lower educational attainment (OR=0.25; 95% CI=0.08, 0.77; p<0.05), lacked insurance (OR=0.19; 95% CI=0.06, 0.67; p<0.05), or were unemployed (OR=0.28; 95% CI=0.08, 0.95; p<0.05). Conclusions There is overall acceptability for at-home self-collection sexually transmitted infections screening (61 of 88=0.69; 95% CI=0.59, 0.79). Primary care clinics can expand needed screening by integrating such methods into workflows for established patients. Although this study showed that patients who are employed, attained a higher education level, and have their own insurance may prefer at-home self-collection, there is a need to focus on social determinants of health to decrease rising sexually transmitted infection rates in the U.S.
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Affiliation(s)
- Tana Chongsuwat
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paula J. Cody
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Yesodharan R, Kamath P, Renjith V, Krishnan NM, Senarathne UD, Sasidharan SK, Jose TT, Nayak VC. The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault. Forensic Sci Med Pathol 2023; 19:440-451. [PMID: 36881378 PMCID: PMC10518277 DOI: 10.1007/s12024-023-00578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/08/2023]
Abstract
Sexual violence can have an overwhelming impact on the victim's physical and mental health; the consequences include unintended pregnancy and sexually transmitted infections (STIs). Therefore, the examiners must assess victims for possible pregnancy and sexually transmitted infections as a part of the sexual assault examination. This article aims to orient the medico-legal examiners towards their role in preventing unintended pregnancy and sexually transmitted infections among victims of sexual assault. Prompt detection of pregnancy or STIs is critical, as any delay would adversely affect the successful administration of emergency contraception and post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) and other sexually transmitted infections.
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Affiliation(s)
- Renjulal Yesodharan
- Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Pratibha Kamath
- Department of OBG Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Vishnu Renjith
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland
| | - Nirmal M. Krishnan
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Udara Dilrukshi Senarathne
- Faculty of Medical Sciences, Department of Biochemistry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Suja Kumari Sasidharan
- Department of Obstetrics and Gynaecological Nursing, Amrita College of Nursing, Amrita Vishwa Vidyapeetham, Ernakulum, Kerala India
| | - Tessy Treesa Jose
- Department of Psychiatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
| | - Vinod C. Nayak
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka India
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12
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Towns JM, Tieosapjaroen W, Mello MB, Baggaley RC, Johnson CC, Jamil MS, Rowley J, Barr-DiChiara M, Terris-Prestholt F, Chen MY, Chow EPF, Fairley CK, Zhang L, Ong JJ. The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e726-e734. [PMID: 37482070 DOI: 10.1016/s2468-2667(23)00128-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST. METHODS We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129). FINDINGS In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options. INTERPRETATION Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up. FUNDING WHO, Australian National Health and Medical Research Council, and Unitaid.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Jane Rowley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | | | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Taflan P, Simpson PL, Wilson M, Jones J, Donovan B, Amin J, Nathan S, Butler T. Sexually transmissible infections (STI) and HIV testing and diagnosis among Aboriginal and non-Aboriginal adolescents in contact with the Australian justice system: a cross-sectional study. Sex Health 2023; 20:303-314. [PMID: 37344218 DOI: 10.1071/sh23028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It is unclear what factors are associated with sexually transmissible infections (STI) and HIV testing and diagnosis among justice-involved adolescents, and if these differ for Aboriginal or Torres Strait Islander peoples. METHODS A cross-sectional survey of 465 justice-involved adolescents (aged 14-17years) from Australia was conducted between 2016 and 2018. Participants were asked about sexual behaviours, STI/HIV knowledge, and prior STI diagnoses and testing. RESULTS Approximately 38% (n =130) of those sexually active had ever been screened for STI/HIV and 17.8% (n =23) had been diagnosed with an STI. No participant reported living with HIV. For Aboriginal participants, being male (aOR 3.6, 95% CI 1.3-10.1) and having under three sexual partners in the past 12months (aOR 3.1, 95% CI 1.2-8.0) was associated with never having had an STI/HIV test. For non-Aboriginal participants, being male (aOR 2.7, 95%CI 1.2-5.7), single (aOR 2.4, 95% CI 1.2-4.9), attending school (aOR 2.4, 95% CI 1.1-5.1), not having sought sexual health information (aOR 2.8, 95% CI 1.4-5.8), and having a lower STI/HIV knowledge score (aOR 2.3, 95% CI 1.1-5.0) were associated with never having had an STI/HIV test. Factors associated with STI diagnosis were non-heterosexual sexual orientation (aOR 5.6, 95% CI 1.1-28.2), transactional sex (aOR 11.2, 95% CI 3.0-41.3), and having sought sexual health information (aOR 3.5, 95% CI 1.0-12.5). CONCLUSIONS Males, particularly Aboriginal male adolescents, should be engaged with sexual health promotion and testing services as soon as they come into contact with the justice system. Approaches should consider different cultural, gender and sexual orientations.
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Affiliation(s)
- Patricia Taflan
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Paul L Simpson
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Mandy Wilson
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Tony Butler
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
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Manca E, Van der Pol B, Exten C, Pinto CN. A Review of the Scope of Direct-to-Consumer Sexually Transmitted Infection Testing Services Offered on the Internet. Sex Transm Dis 2023; 50:323-328. [PMID: 36807311 DOI: 10.1097/olq.0000000000001783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The prevalence of sexually transmitted infections (STIs) is at an all-time high. Direct-to-consumer STI testing services may help alleviate this undue health burden. These products are sold online and rarely require interaction with a health care professional (HCP). Vendors offer STI self-collection kits or prescriptions for HCP specimen collection. The objective was to understand the scope of direct-to-consumer STI testing services offered and provide recommendations for consumers and industry. METHODS Seven volunteers searched for "STD tests" on Google from February 1 through March 31, 2021 and shared their top 3 results. The study team extracted data from consumer-facing information on each website. Descriptive statistics and thematic qualitative analyses were performed. RESULTS Twenty vendors were identified. Most vendors (95%) used Clinical Laboratory Improvement Amendments (CLIA)-certified or College of American Pathologists (CAP) accredited laboratories. Analyses distinguished between STI self-collection kits (n = 9) using independent laboratories and HCP specimen collection (n = 10), which used commercial laboratories (n = 1 offered both). The STI self-collection kits were cheaper per test and bundle on average (eg, $79.00 vs. $106.50 for chlamydia/gonorrhea), and more closely aligned with clinical recommendations compared with the HCP specimen collection options. Websites often contained inaccurate or misleading information (n = 13), often promoting testing outside of the recommendations. CONCLUSIONS Direct-to-consumer STI testing services are part of an emerging market lacking regulation. Consumers should select vendors offering prescriptions for HCP specimen collection at CAP accredited and CLIA-certified laboratories. Vendors should provide a screening tool to assess individual patient risk prior to test purchase.
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Affiliation(s)
- Ellie Manca
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Barbara Van der Pol
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cara Exten
- Ross & Carol Nese College of Nursing, The Pennsylvania State University, Hershey, PA
| | - Casey N Pinto
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
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15
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Wongsomboon V, Webster GD. Delay Discounting for HIV/STI Testing. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-10. [PMID: 37363350 PMCID: PMC10169202 DOI: 10.1007/s13178-023-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Introduction Wait time in healthcare is an important barrier to HIV/STI testing. Using a delay discounting approach, the current study examined a systematic reduction in testing likelihood as a function of delay (wait time) until testing. Methods In Study 1 (N = 421; data collected in 2019), participants were randomly assigned to either a chlamydia/gonorrhea group or HIV group. A delay discounting task asked them to report how likely they would get tested for the assigned STI if they had to wait for the test (the delay durations varied within persons). In Study 2 (N = 392; data collected in 2020), we added a smaller, sooner outcome (consultation without testing) and tested whether the effect of delay was mediated by perceived severity of the STIs. Results In both studies, the subjective value of a delayed STI test was discounted. That is, people were less likely to undergo STI testing as the delay to STI testing increased. The chlamydia/gonorrhea group discounted delayed testing more than the HIV group (i.e., the effect of delay on testing decisions was stronger for the former). This effect was statistically mediated by perceived severity. Conclusions We found evidence for delay discounting for HIV/STI testing and that testing decisions were more susceptible to delay when the test was for relatively mild STIs. Policy Implications Even mild STIs can cause serious health damage if left untreated. The findings provide strong argument for policies aimed to reduce wait times in healthcare, especially for relatively mild STIs.
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Affiliation(s)
- Val Wongsomboon
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave., Chicago, IL USA
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Twisk DE, Meima A, Richardus JH, Götz HM. Area-based comparison of risk factors and testing rates to improve sexual health care access: cross-sectional population-based study in a Dutch multicultural area. BMJ Open 2023; 13:e069000. [PMID: 37142318 PMCID: PMC10163550 DOI: 10.1136/bmjopen-2022-069000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES Areas with high sexually transmitted infection (STI) testing rates may not require additional strategies to improve testing. However, it may be necessary to intervene in areas with elevated STI risk, but with low STI testing rates. We aimed to compare STI-related risk profiles and STI testing rates by geographical area to determine areas for improvement of sexual healthcare access. DESIGN Cross-sectional population-based study. SETTING Greater Rotterdam area, the Netherlands (2015-2019). PARTICIPANTS All residents aged 15-45 years. Individual population-based register data were matched with laboratory-based STI testing data of general practitioners (GPs) and the only sexual health centre (SHC). OUTCOME MEASURES Postal code (PC) area-specific STI risk scores (based on age, migratory background, education level and urbanisation), STI testing rates and STI positivity. RESULTS The study area consists of approximately 500 000 residents aged 15-45 years. Strong spatial variation in STI testing, STI positivity and STI risk was observed. PC area testing rate ranged from 5.2 to 114.9 tests per 1000 residents. Three PC clusters were identified based on STI risk and testing rate: (1) high-high; (2) high-low; (3) low, independently of testing rate. Clusters 1 and 2 had comparable STI-related risk and STI positivity, but the testing rate differed greatly (75.8 vs 33.2 per 1000 residents). Multivariable logistic regression analysis with generalised estimating equation was used to compare residents in cluster 1 and cluster 2. Compared with cluster 1, residents in cluster 2 more often did not have a migratory background, lived in less urbanised areas with higher median household income, and more distant from both GP and SHC. CONCLUSION The determinants associated with individuals living in areas with high STI-related risk scores and low testing rates provide leads for improvement of sexual healthcare access. Opportunities for further exploration include GP education, community-based testing and service (re)allocation.
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Affiliation(s)
- Denise E Twisk
- Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Abraham Meima
- Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Zuid-Holland, The Netherlands
- Department Research and Business Intelligence, Gemeente Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Hannelore M Götz
- Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
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Nkwonta CA, Harrison SE. HIV knowledge, risk perception, and testing behaviors among college students in South Carolina. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:274-281. [PMID: 33759714 DOI: 10.1080/07448481.2021.1891078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 12/10/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
Objective: Human immunodeficiency virus (HIV) remains a critical public health challenge and disproportionately affects young adults, racial minorities, and residents of the Southern United States. This study aimed to investigate HIV knowledge, risk perception, and testing behaviors among a sample of college students in South Carolina (SC). Participants: Undergraduate students (N = 256) from a large public university in SC. Methods: Participants completed a cross-sectional survey on HIV knowledge, testing behaviors, and attitudes. Results: More than one-third of participants displayed misunderstanding about HIV transmission. Less than 20% perceived themselves to be at-risk for HIV, and only 8% reported having ever been tested for HIV. In addition, a majority of participants (83%) reported they would feel ashamed if they acquired HIV. HIV knowledge was negatively correlated with HIV testing. Conclusions: Results indicate the need for HIV education among college students in SC to clear misconceptions, minimize knowledge gaps, reduce HIV-related stigma, and promote HIV testing.
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Affiliation(s)
- Chigozie A Nkwonta
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sayward E Harrison
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA
- Department of Psychology, College of Arts & Sciences, University of South Carolina, Columbia, South Carolina, USA
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Abraham E, Fairley CK, Denham I, Bradshaw CS, Farquharson RM, Vodstrcil LA, Plummer EL, Ong JJ, Chen MY, Phillips TR, Chow EP. Positivity and Risk Factors for Trichomonas vaginalis Among Women Attending a Sexual Health Clinic in Melbourne, 2006 to 2019. Sex Transm Dis 2022; 49:762-768. [PMID: 35948300 PMCID: PMC9553257 DOI: 10.1097/olq.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trichomonas vaginalis is not a notifiable disease in Australia in most states, resulting in limited Australian epidemiological studies. This study aimed to examine the positivity of T. vaginalis in women attending the Melbourne Sexual Health Centre (MSHC) and identify associated factors. METHODS All women 16 years or older who were tested for T. vaginalis at MSHC from 2006 to 2019 were included. The diagnostic method changed from culture to nucleic acid amplification test in August 2018. The annual positivity of T. vaginalis was calculated. Because of the data completeness, we performed a generalized estimating equations multivariable logistic regression using data from 2011 to 2019 to examine factors associated with T. vaginalis positivity. RESULTS From 2006 to 2019, 69,739 tests for T. vaginalis were conducted, and 294 tested positive (0.42%; 95% confidence interval [CI], 0.37%-0.47%). Approximately 60% of women tested reported symptoms. After adjusting for potential confounders including the change in diagnostic method, there was a 21% (95% CI, 12%-31%) annual increase in T. vaginalis positivity between 2011 and 2019. Women with concurrent syphilis had the highest odds of testing positive for T. vaginalis (adjusted odds ratio [aOR], 21.55; 95% CI, 6.96-66.78), followed by women who had injected drugs in the last 12 months (aOR, 6.99; 95% CI, 4.11-11.87), were 35 years or older (aOR, 3.47; 95% CI, 2.26-5.35), or had concurrent chlamydia (aOR, 1.77; 95% CI, 1.05-2.99). CONCLUSIONS The rising positivity of T. vaginalis at MSHC irrespective of change in diagnostic method suggests a concurrent community-wide rise in Melbourne. Given the rising positivity, testing informed by risk factors should be considered.
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Affiliation(s)
- Esha Abraham
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Christopher K. Fairley
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Ian Denham
- From the Melbourne Sexual Health Centre, Alfred Health
| | - Catriona S. Bradshaw
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca M. Farquharson
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Lenka A. Vodstrcil
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L. Plummer
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Jason J. Ong
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Marcus Y. Chen
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Tiffany R. Phillips
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Eric P.F. Chow
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Wongsomboon V, Shepperd JA. Waiting for medical test results: A delay discounting approach. Soc Sci Med 2022; 311:115355. [PMID: 36122527 DOI: 10.1016/j.socscimed.2022.115355] [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: 04/06/2022] [Revised: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVE Delay discounting is the devaluation of an outcome as a function of delay until receiving that outcome. In two studies, we used a delay discounting approach to examine how wait times for a medical diagnosis can affect people's decision to undergo medical testing. METHODS In Study 1 (N = 151), participants rated the likelihood they would get tested for a severe and a mild disease with wait times ranging from 0 to 180 days (within persons). Study 2 (N = 400) randomized disease severity (severe vs. mild) between persons and manipulated disease curability (curable vs. incurable). RESULTS Likelihood of testing decreased as delay until receiving test results increased. This effect of delay on testing was stronger for the mild than for the severe disease, and for the curable than for the incurable disease. CONCLUSIONS We found strong evidence for a delay discounting effect, an effect that varied depending on aspects of diseases. The findings illustrate how delay discounting can affect screening uptake and how it is moderated by disease characteristics.
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Bragazzi NL, Woldegerima WA, Iyaniwura SA, Han Q, Wang X, Shausan A, Badu K, Okwen P, Prescod C, Westin M, Omame A, Converti M, Mellado B, Wu J, Kong JD. Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature. Front Microbiol 2022; 13:1011049. [PMID: 36246252 PMCID: PMC9563713 DOI: 10.3389/fmicb.2022.1011049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Monkeypox is an emerging zoonotic disease caused by the monkeypox virus, which is an infectious agent belonging to the genus Orthopoxvirus. Currently, commencing from the end of April 2022, an outbreak of monkeypox is ongoing, with more than 43,000 cases reported as of 23 August 2022, involving 99 countries and territories across all the six World Health Organization (WHO) regions. On 23 July 2022, the Director-General of the WHO declared monkeypox a global public health emergency of international concern (PHEIC), since the outbreak represents an extraordinary, unusual, and unexpected event that poses a significant risk for international spread, requiring an immediate, coordinated international response. However, the real magnitude of the burden of disease could be masked by failures in ascertainment and under-detection. As such, underestimation affects the efficiency and reliability of surveillance and notification systems and compromises the possibility of making informed and evidence-based policy decisions in terms of the adoption and implementation of ad hoc adequate preventive measures. In this review, synthesizing 53 papers, we summarize the determinants of the underestimation of sexually transmitted diseases, in general, and, in particular, monkeypox, in terms of all their various components and dimensions (under-ascertainment, underreporting, under-detection, under-diagnosis, misdiagnosis/misclassification, and under-notification).
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Woldegebriel Assefa Woldegerima
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Sarafa Adewale Iyaniwura
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Qing Han
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Xiaoying Wang
- Department of Mathematics, Trent University, Peterborough, ON, Canada
| | - Aminath Shausan
- School of Mathematics and Physics, University of Queensland, Saint Lucia, QLD, Australia
| | - Kingsley Badu
- Vector-borne Infectious Disease Group, Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Cheryl Prescod
- Black Creek Community Health Centre, Toronto, ON, Canada
| | | | - Andrew Omame
- Department of Mathematics, Federal University of Technology, Owerri, Nigeria
- Abdus Salam School of Mathematical Sciences, Government College University, Lahore, Pakistan
| | | | - Bruce Mellado
- School of Physics and Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa
- Subatomic Physics, iThemba Laboratory for Accelerator Based Sciences, Somerset West, South Africa
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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21
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D’Costa B, Lobo R, Sibosado A, Leavy JE, Crawford G, Ward J. Evaluation of the Young, Deadly, Syphilis Free multi-media campaign in remote Australia. PLoS One 2022; 17:e0273658. [PMID: 36084099 PMCID: PMC9462794 DOI: 10.1371/journal.pone.0273658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Since 2011, remote Australian Aboriginal and Torres Strait Islander communities have experienced an outbreak of infectious syphilis, with young people aged 15–29 years over-represented in notifications. The Young Deadly Syphilis Free multi-media campaign was implemented in 12 remote regions in four Australian jurisdictions over nine months from 2017–2018. Campaign components included television and radio advertisements, social media posts, and health promotion resources available via a dedicated website. The aim of this research was to evaluate the impacts (proximal, mediator, distal) of the Young Deadly Syphilis Free campaign for young Aboriginal people and health and community workers residing in remote campaign regions.
Methods
A cross-sectional (post-only) evaluation design was used. Data were collected through online surveys; metrics for social media (Facebook, Instagram) were also collected to determine campaign engagement via social media. A 22-item young people survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); along with intended behaviour and knowledge and attitudes (mediator variables). A 24-item health and community worker survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); and changes in professional practice (distal variable). Descriptive statistics summarised demographic characteristics and univariate analysis examined associations between key variables.
Results
Just over half (n = 25, 58%) of young people and three quarters (n = 36; 75%) of health and community workers were aware of the campaign. Recognition of key campaign messages was high for both participant groups (>64%), and television, Facebook, and website were the most common campaign exposure routes. Positive impacts on intended behaviour (young people) and professional practice (health and community workers) were also reported. Facebook was effective in engaging some young people in campaign content and was preferred by young people for accessing information.
Conclusion
The findings point to the value of utilising a multi-media campaign in raising awareness about syphilis among young Aboriginal people and health and community workers in remote Australian regions. A longer-term campaign that accommodates the diverse needs of Aboriginal young people from geographically remote communities would optimise campaign impacts and support behavioural change.
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Affiliation(s)
- Belinda D’Costa
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Roanna Lobo
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Amanda Sibosado
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Justine E. Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gemma Crawford
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- UQ Poche Centre for Indigenous Health, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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22
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Wenang S, Kurniawan M, Lelle RJ, Inayati I, Rismawati I. Neisseria gonorrhoeae Cases at AMC Muhammadiyah Hospital Indonesia: The Importance of Screening and Health Service Improvement to Prevent its Transmission and Complications. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Gonorrhoeae is a type of sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae (NG) bacteria. It is a commonly reported bacterial STD with rising cases in men and women in Indonesia. Gonorrhoeae is commonly asymptomatic. Therefore, the disease is often left undiagnosed, untreated, and causes further complications.
AIM: This study aims to describe the incidence and distribution of gonorrhoeae in AMC Muhammadiyah Hospital, Yogyakarta, Indonesia. The importance of screening and health service improvement toward preventing transmission and complications are also discussed.
METHODS: It is a descriptive observational study and aims to identify the percentage of NG in patients with clinical symptoms of STDs. The non-randomized sampling technique was used with 710 respondents. The inclusion criteria were women aged 15-44 years with STD symptoms who underwent vaginal smear examinations for NG, Bacterial Vaginosis (BV), yeast cells-pseudohyphae Candida sp, and were willing to be respondents. The exclusion criteria were women with STDs and HIV. Microscopic characteristics of NG were examined by Gram staining the vaginal swab samples from the respondents.
RESULTS: It was found that 623 (87.7%) out of 710 respondents had NG with clinical symptoms of leukorrhea and itchiness. The vaginal smear results also found bacterial vaginosis and candidiasis.
CONCLUSIONS: Screening and health facilities providing STI-related services are essential to prevent the transmission of gonorrhoeae and reduce the high incidence and severity of gonorrhoeae in reproductive health.
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23
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Twisk DE, Meima B, Nieboer D, Richardus JH, Götz HM. Distance as explanatory factor for sexual health centre utilization: an urban population-based study in the Netherlands. Eur J Public Health 2021; 31:1241-1248. [PMID: 34590688 PMCID: PMC8643404 DOI: 10.1093/eurpub/ckab177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The central sexual health centre (SHC) in the greater Rotterdam area in the Netherlands helps finding people unaware of their STI/HIV status. We aimed to determine a possible association between SHC utilization and travel distance in this urban and infrastructure-rich area. Insight in area-specific utilization helps adjust outreach policies to enhance STI testing. Methods The study population consists of all residents aged 15–45 years in the greater Rotterdam area (2015–17). We linked SHC consultation data from STI tested heterosexual clients to the population registry. The association between SHC utilization and distance was investigated by multilevel modelling, adjusting for sociodemographic and area-specific determinants. The data were also stratified by age (aged < 25 years) and migratory background (non-Western), since SHC triage may affect their utilization. We used straight-line distance between postal code area centroid and SHC address as a proxy for travel distance. Results We found large area variation in SHC utilization (range: 1.13–48.76 per 1000 residents). Both individual- and area-level determinants determine utilization. Travel distance explained most area variation and was inversely associated with SHC utilization when adjusted for other sociodemographic and area-specific determinants [odds ratio (OR) per kilometre: 0.95; 95% confidence interval (CI): 0.93–0.96]. Similar results were obtained for residents <25 years (OR: 0.95; 95% CI: 0.94–0.96), but not for non-Western residents (OR: 0.99; 95% CI: 0.99–1.00). Conclusions Living further away from a central SHC shows a distance decline effect in utilization. We recommend to enhance STI testing by offering STI testing services closer to the population.
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Affiliation(s)
- Denise E Twisk
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bram Meima
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hannelore M Götz
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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24
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Rose SB, Garrett SM, McKinlay EM, Morgan SJ. 'Be nice to us, we're still learning': an online survey of young people in Hawkes Bay, New Zealand, about unmet need for sexual health care and improving access to services. Sex Health 2021; 18:394-404. [PMID: 34731598 DOI: 10.1071/sh21092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Background Young people need equitable access to high-quality sexual and reproductive health care to enjoy good sexual health. Methods This online survey of people aged 15-24years in a defined region of New Zealand asked about unmet need for sexual health care and sought views on improving access to sexual health care. Results Fivehundred participants took part in the study between August and October 2020, of whom 60% were female, 25% were of Māori (indigenous) ethnicity, and 21.4% were gender and/or sexuality diverse. Sixty percent had ever received sexual health care (300/500), and 74.3% received it from a general practice clinic (223/300). Overall, 41% (204/500) reported they needed, but had not received sexual health care in the past ('unmet need'). Reasons for unmet need included being shy, embarrassed or ashamed (74.5%, 152/204), fear of judgment by clinic staff (42.6%, 87/204), cost (32.8%, 67/204), concerns about confidentiality (28.9%, 59/204), and not knowing where to go (24%, 49/204). Māori participants were more likely to report not knowing where to go (32.1% vs 20%, P=0.04). Participants identified the need to reduce stigma, normalise sexual health care, improve convenience, affordability and awareness of services as key to improving access. Reassurance about confidentiality and being treated with kindness, empathy and respect were deemed critical to service acceptability. Conclusions Action is urgently needed at policy, funding and practice levels to improve access to services by: reducing societal stigma, normalising discussions around sexual health, improving affordability and raising awareness of services. Quality improvement is also needed in general practice to ensure young people can routinely access youth-friendly sexual and reproductive health care.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
| | - Eileen M McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
| | - Sonya J Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
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25
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Ong JJ, Fairley CK, Hocking JS, Turner KME, Booton R, Tse D, Wong WWCW. Preferences for chlamydia testing and management in Hong Kong: a discrete choice experiment. Sex Transm Infect 2021; 98:408-413. [PMID: 34535577 DOI: 10.1136/sextrans-2021-055182] [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: 06/18/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As most chlamydia cases are asymptomatic, regular testing and timely management may be necessary for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services. METHODS An online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy, location, travel time, type of person consulted and attitude of staff). RESULTS In total, 520 individuals participated: average age 36.8 years (SD 9.9), 40% males and 66% had a bachelor's degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available and the least important was the location of testing. Choosing to attend for management was most influenced by staff's attitude, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location. CONCLUSION To design effective chlamydia testing and management services, it is vital to respond to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively.
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Affiliation(s)
- Jason J Ong
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katy M E Turner
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Ross Booton
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Desiree Tse
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong
| | - William W C W Wong
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong.,Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
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26
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Parker A, Harris P, Haire B. International students' views on sexual health: a qualitative study at an Australian university. Sex Health 2021; 17:231-238. [PMID: 32564781 DOI: 10.1071/sh19209] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022]
Abstract
Background The number of international students at Australian universities is rapidly increasing, and they contribute significantly to Australia's economy. However, concerns have been raised for the health and wellbeing of international students, and there is limited information concerning international students with regard to their sexual health. METHODS Overall, 13 individual semi-structured in-depth interviews were conducted with 13 international students at an Australian university, aiming to understand the views and experiences of international students with regard to their sexual health and wellbeing. The interviews were analysed thematically, generating four themes. RESULTS Participants had a varied understanding of sexual consent, which often included concerns about the practicalities of saying 'no' to unwanted sexual interactions and misinformation about the effect of reporting sexual misconduct on their privacy and visa status. Cultural and familial taboos were often inherited, but many participants described an evolution of personal views and attitudes regarding topics such as sex before marriage and same-sex relationships, which had occurred since moving to Australia. Participants expressed that they received large amounts of information about sexual health, but often lacked the skills to navigate that information and access relevant support. CONCLUSIONS These data, along with participants' suggestions for future support and education, are important for understanding the complex experiences of international students at Australian universities, and should be considered when implementing future sexual health education and support programs.
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Affiliation(s)
- Anneka Parker
- Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia; and Corresponding author.
| | - Peter Harris
- Office of Medical Education, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Bridget Haire
- Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia
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27
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Rose SB, Garrett SM, McKinlay EM, Morgan SJ. Experience of Sexual Healthcare by Māori and Non-Māori Young People: An Online Survey of 15-24 Year Olds in Hawkes Bay, New Zealand. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:118-129. [PMID: 38595686 PMCID: PMC10903665 DOI: 10.1080/19317611.2021.1926041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 04/11/2024]
Abstract
Objectives To understand young people's expectations of, and experience with sexual healthcare in New Zealand. Methods Online survey of 15-24 year olds in a region with high socioeconomic deprivation, with selected outcomes compared for Māori and Europeans. Results Of 500 respondents, 60% had received sexual healthcare (74.3% in general practice) and 81% were happy with care received. Fewer Māori and people not in education, employment, or training reported positive experiences of sexual healthcare on arrival and in the consultation. Conclusions Findings highlight the need for equitable delivery of youth-friendly, culturally safe, sexual and reproductive healthcare in general practice settings.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Eileen M McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sonya J Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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28
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Gan J, Kularadhan V, Chow EPF, Fairley CK, Hocking JS, Kong FYS, Ong JJ. What do young people in high-income countries want from STI testing services? A systematic review. Sex Transm Infect 2021; 97:574-583. [PMID: 34193529 DOI: 10.1136/sextrans-2021-055044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. METHODS We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. RESULTS We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. CONCLUSION We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.
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Affiliation(s)
- Joscelyn Gan
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eric P F Chow
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Fabian Y S Kong
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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29
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Hoyos-Mallecot Y, Garcia JN, Sulleiro E, Esperalba J, Salmeron P, Zarzuela F, Blanco A, Arando M, Descalzo V, Lopez L, Vall-Mayans M, Barberá MJ, Serra-Pladevall J, LLinas M, Almirante B, Pumarola T, Espasa M. Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification. Sex Transm Infect 2021; 98:166-172. [PMID: 33846278 DOI: 10.1136/sextrans-2020-054779] [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: 09/09/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed 'Drassanes Exprés', a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention. METHODS The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients' sample collection to notification and treatment are analysed. RESULTS Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26-39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2-3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days. CONCLUSIONS Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.
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Affiliation(s)
- Yannick Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain .,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Nestor Garcia
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Juliana Esperalba
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Paula Salmeron
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francesc Zarzuela
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Albert Blanco
- Department of Clinical Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maider Arando
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Vicente Descalzo
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Lopez
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martí Vall-Mayans
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Jesús Barberá
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judit Serra-Pladevall
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Department of microbiology, Consorci Hospitalari de Vic, Vic, Spain
| | - Montserrat LLinas
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Benito Almirante
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
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Ooi C, Donovan B, Lewis DA. Cross-sectional study of sexual behaviour and health of gay and bisexual men in suburban Sydney, New South Wales, Australia: contrasts between sex venue and clinic attendees. Sex Health 2021; 18:248-253. [PMID: 34011431 DOI: 10.1071/sh20196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Background In Australia, men-who-have-sex-with-men (MSM) have higher rates of sexually transmissible infections (STIs) and HIV compared with heterosexual men. We compared demographics, behaviour and HIV/STI prevalence for MSM attending a sex-on-premises-venue (SOPV) or the local sexual health clinic (SHC) to determine key differences. METHODS Men attending a SOPV during onsite HIV/STI screening from November 2015 for 12 months were compared with MSM attending a local SHC for screening. Each group completed a self-administered questionnaire and STI/HIV testing. Data analysis was performed using SPSS. RESULTS Compared with SHC participants (n = 108), SOPV participants (n = 84) had a higher median age (47 years [range, 22-88] vs 33 years [range, 19-71]; P < 0.001) and less likely to report previous HIV testing (73% vs 89%; P < 0.01), STI testing (60% vs 90%; P < 0.001) or be vaccinated for hepatitis A (32% vs 65%; P < 0.001) or hepatitis B (35% vs 73%; P < 0.001). SOPV participants were more likely to be married, widowed or have a long-term female partner (39% vs 7%; P < 0.001) and have a higher prevalence of urethral and rectal chlamydia (7% vs 1%; P = 0.02 and 8% vs 2%; P = 0.03, respectively). There was no significant difference between the groups for detection of syphilis (4% vs 9%), gonorrhoea (5% vs 9%) or HIV (1% vs 0%). CONCLUSION MSM attending the SOPV had higher anogenital chlamydial prevalence compared with those attending the SHC. They reported higher rates of sex with female partners, which may facilitate STI/HIV transmission to heterosexual populations. Our findings have implications for HIV/STI service provision, contact tracing and local health promotion initiatives.
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Affiliation(s)
- Catriona Ooi
- Northern Sydney Local Health District Sexual Health Service, NSW, Australia; and Northern Clinical School, Faculty of Health and Medicine, University of Sydney, NSW, Australia; and Corresponding author.
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia; and Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia
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Ukachukwu FU, Rafiq A, Snyder LAS. Challenges in treating ophthalmia neonatorum. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1829475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Faith Uche Ukachukwu
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Kingston upon Thames, UK
| | - Afshan Rafiq
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Kingston upon Thames, UK
| | - Lori A. S. Snyder
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Kingston upon Thames, UK
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Chow K, Edi R, Gin G, Morris SR. Attitudes of women participating in a clinical trial on point-of-care testing and home testing for STIs. Int J STD AIDS 2020; 31:1352-1358. [PMID: 32996866 DOI: 10.1177/0956462420955067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections are a public health concern and cost the United States' healthcare system 16 billion dollars annually. By minimizing barriers to testing, an increased number of infections can be detected and treated. A home-based point-of-care (POC) sexually transmitted infection (STI) test may reduce personal, structural, social and system-level barriers to STI testing. This study assesses patient preferences and acceptance of home-based POC STI testing. We performed a cross-sectional, single-visit study of women aged 18 years and older at a single site. Women completed an anonymous online survey evaluating interest in POC STI testing, comfort in self-collecting vaginal swabs and participant reaction to a positive STI result. 138 participants completed the anonymous online survey. The survey results indicate high acceptability with self-collection of samples and home POC STI testing. A majority of participants were interested or very interested in a home POC STI device-especially amongst women with a past history of a STI. If receiving a positive test result, participants indicated they would want to have someone to discuss their results with, most preferring to speak with their primary care provider. Women on lower incomes were less comfortable and less interested with home testing. Women are likely to be receptive to home POC STI testing. Adapting to home-based testing will require engagement of primary care providers for management and surveillance of STIs.
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Affiliation(s)
- Karen Chow
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Rina Edi
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Geneen Gin
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
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Ellis SJ, Aitken R. Sexual health practices of 16 to 19 year olds in New Zealand: an exploratory study. J Prim Health Care 2020; 12:64-71. [PMID: 32223852 DOI: 10.1071/hc19037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/16/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION New Zealand sexual health surveillance data suggest that young people aged 15-19 years are at considerable risk of contracting sexually transmitted infections. Although there is an established body of international research around sexual behaviours and sexual health practices among teenagers, there is a dearth of local research focusing on this age group. AIM The aim of this study was to explore the sexual repertoires and sexual health practices among teenagers in New Zealand with a view to better understanding levels of risk in this age group. METHODS This study comprised a cross-sectional online survey designed to ask questions about sexual behaviours. A convenience sample of young people (n=52) aged 16-19 years living in New Zealand completed the survey. RESULTS Most participants (71.2%) were sexually active, reporting engagement in a range of sexual practices. The most commonly reported sexual behaviours were penis-in-vagina sex (86.5%) and oral sex with a person-with-a-penis (81.1%). Infrequent and inconsistent use of barrier protection across all types of sexual behaviour was also reported. DISCUSSION The findings of this study highlight the importance of ensuring that young people have access to sexual health education that routinely includes health information and advice addressing the full range of sexual practices, regardless of the identity classifications they may use, or that may be attributed to them.
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Affiliation(s)
- Sonja J Ellis
- Te Kura toi Tangata (School of Education), The University of Waikato, Hamilton, New Zealand; and Corresponding author.
| | - Robyn Aitken
- Menzies School of Health Research, Charles Darwin University Australia; Top End Health Service, Darwin, NT, Australia
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Wagg E, Hocking J, Tomnay J. What do young women living in regional and rural Victoria say about chlamydia testing? A qualitative study. Sex Health 2020; 17:160-166. [PMID: 32183939 DOI: 10.1071/sh19182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Background Chlamydia trachomatis is the most commonly notified sexually transmissible infection in Australia, with almost 100000 cases diagnosed in 2018. Chlamydia is easy to diagnose and treat, but infections are underdiagnosed. Eighty per cent of chlamydia cases are asymptomatic. Without testing, infections will remain undetected. Several barriers to testing have been identified in previous research, including cost, privacy concerns for young rural people, knowledge gaps, embarrassment and stigma. The aim of this study was to investigate young regional and rural women's understanding of chlamydia and factors that may prevent or delay testing. METHODS Semistructured interviews were conducted with 11 women aged between 18 and 30 years residing in north-east Victoria, Australia. Interviews were transcribed verbatim and analysed thematically. RESULTS Themes were grouped under four categories: (1) chlamydia and stigma; (2) the application of stigma to self and others; (3) factors affecting testing; and (4) knowledge. A chlamydia infection was associated with stigma. The young women in this study anticipated self-stigma in relation to a positive diagnosis, but resisted stigmatising others. Increased knowledge about chlamydia prevalence was associated with reduced self-stigma. The most consistent factor affecting testing decisions was personal risk assessment. Knowledge gaps about symptoms, testing and treatment were also identified, with participants not always accessing information from reputable sources. CONCLUSION Chlamydia testing was viewed as a positive activity among this cohort. However, there is considerable perceived stigma about being diagnosed with an infection. Interventions that communicate prevalence, reduce stigma and provide factual information about testing and risk are still needed. Clinicians have an opportunity to convey this information at consultation. Health promotion workers should continue to develop and run campaigns at a community level to encourage regular screening.
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Affiliation(s)
- Emma Wagg
- Women's Health Goulburn North East (WHGNE), PO Box 853, Wangaratta, Vic. 3676, Australia; and Corresponding author.
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health (CERSH), Department of Rural Health, The University of Melbourne, 49 Graham Street, Shepparton, Vic. 3630, Australia
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Smith AJ, Wilby KJ. Health services for sexually transmitted infections: Where are we at in New Zealand? A narrative literature review. J Prim Health Care 2020; 12:335-344. [PMID: 33349321 DOI: 10.1071/hc20039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sexually transmitted infection (STI) rates continue to rise in New Zealand. To effectively prevent, test and diagnose STIs in a timely manner to limit their health effects, health services must be appropriate and accessible for all. AIM The aim of this review was to identify and collate the existing literature and identify gaps in research relating to STI health service delivery in New Zealand. METHODS A critical narrative literature review was conducted. A keyword search of PubMed (2010 to October 2020), EMBASE (2010 to October 2020) and Google Scholar (2010 to October 2020) was conducted. The electronic search was supplemented with manual screening of references from identified articles. Eligible studies reported on STI service delivery in New Zealand. Articles not meeting these criteria were excluded. Articles solely reporting on the human papillomavirus vaccine or condom use statistics or perceptions were also excluded. Data extracted included study year, authors, aim, methods and outcome results. RESULTS A total of 179 articles were identified, including 16 that met study inclusion criteria. Nine studies focused on STI testing, five on health-seeking behaviours and two had other foci. The results reflected substantial gaps in the funding and delivery of best-practice STI management across all New Zealand. DISCUSSION New strategies are needed to improve access to low-cost or free services for sexual health care in general and clinic-wide systems implemented to enable routine delivery of advice about STI prevention and testing by clinicians to patients.
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Affiliation(s)
- Alesha J Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand; and Corresponding author.
| | - Kyle J Wilby
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Hiransuthikul A, Sungsing T, Jantarapakde J, Trachunthong D, Mills S, Vannakit R, Phanuphak P, Phanuphak N. Correlations of chlamydia and gonorrhoea among pharyngeal, rectal and urethral sites among Thai men who have sex with men: multicentre community-led test and treat cohort in Thailand. BMJ Open 2019; 9:e028162. [PMID: 31253622 PMCID: PMC6609041 DOI: 10.1136/bmjopen-2018-028162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Routine screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in sexually exposed anatomical sites may be challenging in resource-limited settings. The objective of this study was to determine the proportion of missed CT/NG diagnoses if a single anatomical site screening was performed among men who have sex with men (MSM) by examining the pattern of anatomical sites of CT/NG infections. METHODS Thai MSM were enrolled to the community-led test and treat cohort. Screening for CT/NG infections was performed from pharyngeal swab, rectal swab and urine using nucleic acid amplification testing. The correlations of CT/NG among the three anatomical sites were analysed. RESULTS Among 1610 MSM included in the analysis, 21.7% had CT and 15.5% had NG infection at any anatomical site. Among those tested negative for CT or NG infection at either pharyngeal, rectal or urethral site, 8%-19% had CT infection and 7%-12% had NG infection at the remaining two sites. Of the total 349 CT infections, 85.9%, 30.6% and 67.8% would have been missed if only pharyngeal, rectal or urethral screening was performed, respectively. Of the total 249 NG infection, 55.7%, 39.6% and 77.4% would have been missed if only pharyngeal, rectal or urethral screening was performed, respectively. The majority of each anatomical site of CT/NG infection was isolated to their respective site, with rectal site having the highest proportion of isolation: 78.9% of rectal CT and 62.7% of rectal NG infection. CONCLUSIONS A high proportion of CT/NG infections would be missed if single anatomical site screening was performed among MSM. All-site screening is highly recommended, but if not feasible, rectal screening provides the highest yield of CT/NG diagnoses. Effort in lowering the cost of the CT/NG screening test or developing affordable molecular technologies for CT/NG detection is needed for MSM in resource-limited settings. TRIAL REGISTRATION NUMBER NCT03580512; Results.
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Affiliation(s)
| | | | | | | | | | - Ravipa Vannakit
- Office of Public Health, United States Agency for International Development, Bangkok, Thailand
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Hiransuthikul A, Janamnuaysook R, Sungsing T, Jantarapakde J, Trachunthong D, Mills S, Vannakit R, Phanuphak P, Phanuphak N. High burden of chlamydia and gonorrhoea in pharyngeal, rectal and urethral sites among Thai transgender women: implications for anatomical site selection for the screening of STI. Sex Transm Infect 2019; 95:534-539. [PMID: 30982000 DOI: 10.1136/sextrans-2018-053835] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/16/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Comprehensive data on Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections to guide screening services among transgender women (TGW) are limited. We studied the burden of CT/NG infections in pharyngeal, rectal and urethral sites of Thai TGW and determined missed CT/NG diagnoses if selected site screening was performed. METHODS Thai TGW were enrolled to the community-led test and treat cohort. CT/NG screening was performed from pharyngeal swab, rectal swab and urine using nucleic acid amplification test. CT/NG prevalence in each anatomical site was analysed, along with the relationships of CT/NG among the three anatomical sites. RESULTS Of 764 TGW included in the analysis, 232 (30.4%) had CT/NG infections at any anatomical site, with an overall incidence of 23.7 per 100 person-years. The most common CT/NG infections by anatomical site were rectal CT (19.5%), rectal NG (9.6%) and pharyngeal NG (8.1%). Among 232 TGW with CT/NG infections at any anatomical site, 22%-94.4% of infections would have been missed if single anatomical site testing was conducted, depending on the selected site. Among 668 TGW who tested negative at pharyngeal site, 20.4% had either rectal or urethral infections. Among 583 TGW who tested negative at the rectal site, 8.7% had either pharyngeal or urethral infections. Among 751 TGW who tested negative at the urethral site, 19.2% had either pharyngeal or rectal infections. CONCLUSION Almost one-third of Thai TGW had CT/NG infections. All-site screening is highly recommended to identify these infections, but if not feasible rectal screening provides the highest yield of CT/NG diagnoses. Affordable molecular technologies and/or CT/NG screening in pooled samples from different anatomical sites are urgently needed. TRIAL REGISTRATION NUMBER NCT03580512.
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Affiliation(s)
| | | | | | | | | | - Steve Mills
- LINKAGES Thailand FHI 360, Bangkok, Thailand
| | - Ravipa Vannakit
- Office of Public Health, US Agency for International Development, Bangkok, Thailand
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Kitunen A, Rundle-Thiele S, Kadir M, Badejo A, Zdanowicz G, Price M. Learning what our target audiences think and do: extending segmentation to all four bases. BMC Public Health 2019; 19:382. [PMID: 30953491 PMCID: PMC6451251 DOI: 10.1186/s12889-019-6696-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background While acknowledged as one of social marketing’s necessities, limited reporting of segmentation exists. The current study seeks to extend segmentation drawing on all four segmentation bases within the context of Queensland young adult sexual health behaviour. Methods An online survey was used to collect data from 15 to 29 year old people in Queensland, Australia. Data collection was undertaken online to capture the broader population of young adults and in person on campuses to gather data from students who were currently enrolled at University. Quotas were set to ensure a broad representation was attained reflecting the States demography. Results Two-step cluster analysis revealed three different segments. The most important variables in segment formation were age, household type, experience of risky sexual encounters and previously being tested or treated for sexually transmissible infections (STIs). The results suggest that demographic and behavioural variables were the most effective in segment definition. Conclusions This study investigated young people aged 15–29 in Queensland, Australia to examine group differences drawing from four bases. This study revealed three distinct segments in a sexual health context and highlighted the importance of behavioural variables in segment formation, insight and understanding. Electronic supplementary material The online version of this article (10.1186/s12889-019-6696-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Kitunen
- Social Marketing @ Griffith, Griffith University 170 Kessels Road Nathan, Qld, Brisbane, 4111, Australia.
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith University 170 Kessels Road Nathan, Qld, Brisbane, 4111, Australia
| | - Mohammad Kadir
- Social Marketing @ Griffith, Griffith University 170 Kessels Road Nathan, Qld, Brisbane, 4111, Australia
| | - Abi Badejo
- Social Marketing @ Griffith, Griffith University 170 Kessels Road Nathan, Qld, Brisbane, 4111, Australia
| | - George Zdanowicz
- Enhance Research, 30 Misterton Street Fortitude Valley Qld, Brisbane, 4006, Australia
| | - Megan Price
- Queensland Health, 33 Charlotte Street, Brisbane, Queensland, 4000, Australia
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Addressing the rising rates of gonorrhea and drug-resistant gonorrhea: There is no time like the present. ACTA ACUST UNITED AC 2019; 45:54-62. [PMID: 31015819 PMCID: PMC6461120 DOI: 10.14745/ccdr.v45i23a02] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Increasing rates of gonococcal (GC) infection and antimicrobial resistant (AMR) GC, are a serious public health concern for Canada and around the world. Previously recommended treatments are ineffective against many of the gonorrhea strains circulating today. The current recommendation for combination therapy is now being threatened by globally emerging and increasingly resistant strains. It is important that coordinated efforts be made now to ensure these new global strains do not become established in Canada. Otherwise, we will be faced with the possibility of persistent GC infection which can lead to pelvic inflammatory disease, infertility and chronic pelvic pain in women; and epididymitis in men. The presence of GC can also increase the risk of HIV acquisition and transmission. There are a number of reasons why we are facing this public health threat. GC infection is often asymptomatic and it is highly transmissible. People may hesitate to seek testing (or to offer testing). Treatment is complex: recommendations vary by site of infection and risk of resistance. Sexual contact during travel is an important source of imported emerging resistant global strains. The new screening and diagnostic Nucleic Acid Amplification Test (NAAT) is excellent but has decreased the number of cultures being done and therefore our capacity to track AMR-GC. There are four key actions that clinicians and front-line public health professionals can take to stem the increase in rates of GC and drug resistant GC. First, normalize and increase GC screening based on risk factors and emphasize the need for safer sex practices. NAAT is useful for screening, but culture is still needed for extra-genital sites. Second, conduct pretravel counselling and include a travel history as part of the risk assessment. Third, use culture along with NAAT to establish the diagnosis and follow up for test-of-cure. Finally, refer to the most current Canadian Guidelines on Sexually Transmitted Infections or provincial/territorial recommendations on combination therapies for patients and their contacts as recommendations may have changed in response to evolving AMR-GC trends.
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Li C, Deng YQ, Zu S, Quanquin N, Shang J, Tian M, Ji X, Zhang NN, Dong HL, Xu YP, Zhao LZ, Zhang FC, Li XF, Wu A, Cheng G, Qin CF. Zika virus shedding in the stool and infection through the anorectal mucosa in mice. Emerg Microbes Infect 2018; 7:169. [PMID: 30333476 PMCID: PMC6193040 DOI: 10.1038/s41426-018-0170-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/21/2022]
Abstract
Zika virus (ZIKV) has elicited global concern due to its unique biological features, unusual transmission routes, and unexpected clinical outcomes. Although ZIKV transmission through anal intercourse has been reported in humans, it remains unclear if ZIKV is detectable in the stool, if it can infect the host through the anal canal mucosa, and what the pathogenesis of such a route of infection might be in the mouse model. Herein, we demonstrate that ZIKV RNA can be recovered from stools in multiple mouse models, as well as from the stool of a ZIKV patient. Remarkably, intra-anal (i.a.) inoculation with ZIKV leads to efficient infection in both Ifnar1-/- and immunocompetent mice, characterized by extensive viral replication in the blood and multiple organs, including the brain, small intestine, testes, and rectum, as well as robust humoral and innate immune responses. Moreover, i.a. inoculation of ZIKV in pregnant mice resulted in transplacental infection and delayed fetal development. Overall, our results identify the anorectal mucosa as a potential site of ZIKV infection in mice, reveal the associated pathogenesis of i.a. infection, and highlight the complexity of ZIKV transmission through anal intercourse.
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Affiliation(s)
- Chunfeng Li
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
- Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, 215123, China
| | - Yong-Qiang Deng
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, China
| | - Shulong Zu
- CAS Key Laboratory of Infection and Immunity, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Natalie Quanquin
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, CA, 90095, USA
| | - Jingzhe Shang
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
- Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, 215123, China
| | - Min Tian
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Xue Ji
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Na-Na Zhang
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Hao-Long Dong
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Yan-Peng Xu
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Ling-Zhai Zhao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, China
| | - Fu-Chun Zhang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, China
| | - Xiao-Feng Li
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Aiping Wu
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
- Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, 215123, China
| | - Genhong Cheng
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.
- Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, 215123, China.
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, CA, 90095, USA.
| | - Cheng-Feng Qin
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China.
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, China.
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James TG, Ryan SJ. HIV knowledge mediates the relationship between HIV testing history and stigma in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:561-569. [PMID: 29405896 DOI: 10.1080/07448481.2018.1432623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE HIV-related stigma is one of the strongest barriers to prevention and treatment. HIV prevalence in U.S. college students is estimated around 0.02%, but is thought to be drastically underreported. We examined the influence of HIV knowledge on the relationship between HIV testing history and stigma in college students. PARTICIPANTS A random sample of 2343 students, over the age of 18, attending a large university in the southeastern United States completed the survey in January 2016. METHODS A mediation model was constructed in regression framework to explore the relationship between HIV testing history, knowledge, and stigma. RESULTS HIV testing history was associated with higher knowledge scores (a path: B = 4.08, p < .001) and higher knowledge scores were associated with lower stigma (b path: B = .01, p < .001). These results suggest that HIV knowledge partially mediates the relation between HIV testing history and stigma in college students. CONCLUSIONS HIV testing history may decrease stigma by increasing knowledge. Results can be used to inform college health promotion practice on developing programs and services.
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Affiliation(s)
- Tyler G James
- a Quantitative Disease Ecology and Conservation Lab, Department of Geography , University of Florida , Gainesville , Florida , USA
- b Emerging Pathogens Institute , University of Florida , Gainesville , Florida , USA
- c Department of Health Education and Behavior , University of Florida , Gainesville , Florida , USA
| | - Sadie J Ryan
- a Quantitative Disease Ecology and Conservation Lab, Department of Geography , University of Florida , Gainesville , Florida , USA
- b Emerging Pathogens Institute , University of Florida , Gainesville , Florida , USA
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Denison HJ, Woods L, Bromhead C, Kennedy J, Grainger R, Jutel A, Dennison EM. Healthcare-seeking behaviour of people with sexually transmitted infection symptoms attending a Sexual Health Clinic in New Zealand. THE NEW ZEALAND MEDICAL JOURNAL 2018; 131:40-49. [PMID: 30161111 PMCID: PMC6231543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS Untreated sexually transmitted infections (STIs) can lead to serious health complications and may be transmitted to uninfected individuals. Therefore, the early detection and subsequent management of STIs is crucial to control efforts. Time to presentation for STI symptoms and risk of transmission in this period has not been assessed in New Zealand to date. METHODS All new clients presenting to an urban sexual health clinic (SHC) were invited to complete a questionnaire, which included demographic information, sexual health history, and details about the clinic visit. RESULTS Of 331 people approached, 243 (73.4%) agreed to complete the questionnaire. Four incomplete questionnaires were excluded, leaving 239 participants (47.3% female and 52.7% male, 43.8% under the age of 25). The most common reason for seeking healthcare was experiencing symptoms (39.4%) and 41.7% of people with symptoms waited more than seven days to seek healthcare. Around a third (30.6%) of people with symptoms had sex after they first thought they may need to seek healthcare. Infrequent condom use was reported more often by people who had sex with existing partners (84.6%) than by people who had sex with new partners (10.0%). CONCLUSIONS This is the first study to quantify healthcare-seeking behaviour for STI in New Zealand. Delayed healthcare-seeking (defined as waiting more than seven days) was common and almost a third of people reported engaging in sex while symptomatic. Enabling prompt healthcare-seeking is crucial to minimise transmission risk. Structural barriers such as the financial cost of STI tests must be removed and education around symptom recognition and healthcare system navigation should be provided.
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Affiliation(s)
- Hayley J Denison
- Research Fellow, Centre for Public Health Research, Massey University, Wellington; Doctoral Candidate, School of Biological Sciences, Victoria University, Wellington
| | - Lisa Woods
- Statistical Consultant, School of Mathematics and Statistics, Victoria University, Wellington
| | | | - Jane Kennedy
- Sexual Health Physician, Wellington Sexual Health Service, Wellington
| | - Rebecca Grainger
- Senior Lecturer, Department of Medicine, University of Otago, Wellington
| | - Annemarie Jutel
- Professor, Graduate School of Nursing, Midwifery and Health, Faculty of Health, Victoria University, Wellington
| | - Elaine M Dennison
- Professor, School of Biological Sciences, Victoria University, Wellington; Professor, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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What influences university students to seek sexually transmitted infection testing?: A qualitative study in New Zealand. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:56-60. [PMID: 29804776 DOI: 10.1016/j.srhc.2018.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Untreated sexually transmitted infections (STIs) can lead to serious health complications, increase susceptibility to contracting further STIs including human immunodefiniceny virus (HIV), and can be transmitted to others. The early diagnosis and treatment of STIs is therefore central to comprehensive STI management and prevention, but this relies on those at risk of STIs presenting for testing. In order to understand STI testing behaviours in view of their improvement, this study aimed to elucidate why people seek STI testing. METHODS Qualitative semi-structured interviews were conducted with 24 university students who had recently had an STI test. Resulting data were analysed employing a qualitative thematic analysis method to produce a final set of themes. RESULTS Five drivers for STI testing were identified from the data: crisis, partners, clinicians, routines, and previous knowledge. The final driver, previous knowledge, intersected with the previous four, particularly in relation to routines. Many participants acknowledged that the more they knew about STIs the more likely they were to undertake routine tests. However, at the same time, many participants felt they did not have a good knowledge base and that their school-based sex education had been lacking. CONCLUSION This study highlights important drivers for STI testing, which may aid the design of public health campaigns. It also underlines that school-based education could provide stronger foundations with regards to STIs and their prevention.
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