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Dagnew Z, Mistir L, Abebe N, Alemayehu M, Tegegne E. Sexual partner referral and associated factors among patients with sexually transmitted disease in Jabi Tehnan district and Finote Selam town. Int J STD AIDS 2024; 35:287-295. [PMID: 37724040 DOI: 10.1177/09564624231196592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Partner referral (or contact tracing) is an essential approach for preventing sexually transmitted infections. Even though this approach has been used in Ethiopia, there is a scarcity of evidence in Ethiopia particularly in this study area. METHODS A cross-sectional study was conducted among 397 patients with curable sexually transmitted diseases. Factors associated to the practice of sexual partner referral were explored where variables having a p-value of <0.05 in multivariable analysis were considered statistically significant. RESULT Referrals for sexual partners were found to be 42.4% in this study (95% CI: 35.3, 45.3). Not expecting the end of the relationship among regular partnerships (AOR: 4.8; 95% CI: 1.9, 12.4), perceived risk of reinfection (AOR: 3.0; 95% CI: 1.8, 5.3), perceived self-efficacy (AOR: 3.8; 95% CI: 2.4, 6.3), intention to refer partners (AOR: 3.7; 95% CI: 2.0, 6.4), and knowledge of sexually transmitted infections (AOR: 3.0; 95% CI: 1.8, 5.0) were significantly associated with sexual partner referral. CONCLUSIONS This study showed that sexual partner referral was low. Perceived risks of reinfection, perceived self-efficacy, anticipating the end of a relationship, intention to refer partners, and knowledge of sexually transmitted infections were significant predictors of sexual partner referral. Intervention endeavors need to consider factors pointed out in this study to improve sexual partner referral.
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Affiliation(s)
- Zewdu Dagnew
- Department of Environmental Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Limenih Mistir
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Nurlign Abebe
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mulunesh Alemayehu
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Loh AJW, Ting EL, Wi TE, Mayaud P, Chow EPF, Santesso N, Falconer J, Ofori-Asenso R, Ong JJ. The Diagnostic Accuracy of Syndromic Management for Genital Ulcer Disease: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:806605. [PMID: 35071282 PMCID: PMC8767480 DOI: 10.3389/fmed.2021.806605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Genital Ulcer Disease (GUD) carries a significant disease burden globally. With limited access to diagnostics, the 2001 World Health Organization (WHO) sexually transmitted illnesses (STI) guidelines proposed a syndromic management algorithm that required a clinical decision to determine the management of GUD. We assessed the diagnostic accuracy of this algorithm. Methods: We conducted a systematic review (Prospero: CRD42020153294) using eight databases for publications between 1995 and January 2021 that reported primary data on the diagnostic accuracy of clinical diagnosis to identify aetiological agents of GUD. Titles and abstracts were independently assessed for eligibility, and data were extracted from full texts for sensitivity/specificity. A hierarchical logistic regression model was used to derive pooled sensitivity and specificity. We used GRADE to evaluate the certainty of evidence. Results: Of 24,857 articles, 151 full texts were examined and 29 included in the analysis. The majority were from middle-income countries [(14/29 (48%) lower middle, 10/29 (34%) upper middle)]. We pooled studies where molecular testing was using to confirm the aetiology of GUD: 9 studies (12 estimates) for herpes, 4 studies (7 estimates) for syphilis, and 7 studies (10 estimates) for chancroid. The pooled sensitivity and specificity of GUD for the detection of herpes was 43.5% [95% confidence interval (CI): 26.2-62.4], and 88.0% (95% CI: 67.0-96.3), respectively (high certainty evidence); and for syphilis were 52.8% (95% CI: 23.0-80.7), and 72.1% (95% CI: 28.0-94.5) (moderate certainty evidence); and for chancroid were 71.9% (95% CI: 45.9-88.5) and 53.1% (95% CI: 36.6-68.9) (moderate certainty evidence), respectively. Conclusion: Algorithms requiring a clinical diagnosis to determine and treat the aetiology of GUD have poor sensitivities for syphilis and herpes simplex virus, resulting in significant numbers of missed cases. There is an urgent need to improve access to affordable and efficient diagnostics (e.g., point-of-care tests) to be incorporated into GUD algorithms to better guide appropriate management. Systematic Review Registration: PROSPERO, identifier: CRD42020153294.
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Affiliation(s)
- Andre J W Loh
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ee Lynn Ting
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Teodora E Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Philippe Mayaud
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jane Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Ofori-Asenso
- Monash Outcomes Research and Health Economics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Real World Data Enabling Platform, Roche Products Ltd., Welwyn Garden City, United Kingdom
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
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High-Resolution Melting Analysis to Detect Antimicrobial Resistance Determinants in South African Neisseria gonorrhoeae Clinical Isolates and Specimens. Int J Microbiol 2022; 2022:9094328. [PMID: 35087590 PMCID: PMC8789472 DOI: 10.1155/2022/9094328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Antimicrobial resistance is limiting treatment options for Neisseria gonorrhoeae infections. To aid or replace culture and the syndromic management approach, molecular assays are required for antimicrobial susceptibility testing to guide appropriate and rapid treatment. Objective We aimed to detect single-nucleotide polymorphisms and plasmids associated with antimicrobial resistance from N. gonorrhoeae isolates from a clinic population in South Africa, using real-time PCR as a rapid test for AMR detection. Methods N. gonorrhoeae isolates, from female and male patients presenting for care at a sexually transmitted infections clinic in Durban, South Africa, were analysed using phenotypic and genotypic methods for identification and antibiotic susceptibility testing (AST). Real-time PCR and high-resolution melting analysis were used to detect porA pseudogene (species-specific marker) and resistance-associated targets. Whole-genome sequencing was used as the gold standard for the presence of point mutations. Results The real-time porA pseudogene assay identified all N. gonorrhoeae-positive isolates and specimens. Concordance between molecular detection (real-time PCR and HRM) and resistance phenotype was ≥92% for blaTEM (HLR penicillin), rpsJ_V57M (tetracycline), tetM (tetracycline), and gyrA_S91F (ciprofloxacin). Resistance determinants 16SrRNA_C1192U (spectinomycin), mtrR_G45D (azithromycin), and penA_D545S, penA_mosaic (cefixime/ceftriaxone) correlated with the WHO control isolates. Conclusions Eight resistance-associated targets correlated with phenotypic culture results. The porA pseudogene reliably detected N. gonorrhoeae. Larger cohorts are required to validate the utility of these targets as a convenient culture-free diagnostic tool, to guide STI management in a South African population.
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Vargas S, Calvo G, Qquellon J, Vasquez F, Blondel K, Ballard R, Toskin I. Point-of-care testing for sexually transmitted infections in low-resource settings. Clin Microbiol Infect 2021; 28:946-951. [PMID: 34118424 DOI: 10.1016/j.cmi.2021.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Both the global incidence and prevalence of sexually transmitted infections continue to increase, affecting hundreds of millions of individuals, particularly in low-to middle-income countries. While a definitive diagnosis is desirable to inform STI treatment, syndromic management is the most widely used strategy in resource-limited settings. With the development of point-of-care (POC) tests, it is important to discuss how laboratories will need to adapt to new training and supervisory roles in support of testing which will largely be performed by peripheral clinical staff. OBJECTIVES To discuss potential applications of STI POC tests, how they could improve existing STI control strategies and the role of clinical and reference laboratories in support of initiatives to improve STI management and control activities. SOURCES Narrative literature review and expert opinion. CONTENT The paper outlines the current status of the STI epidemic worldwide and discusses the problems associated with current approaches to control these infections, particularly in low resource settings. The roles of clinical and reference laboratories will need to change in order to provide support for POC and near-patient STI testing as these technologies are introduced into clinical as well as laboratory settings. IMPLICATIONS Laboratories will be expected to play a leading role in the introduction and implementation of POC and near-patient STI testing. They will be required to facilitate training and provide technical and supervisory support to clinical staff on the use of these technologies to augment existing STI management and surveillance programs. In order to provide quality service, they will need to develop, introduce and maintain sustainable local QC and EQA systems. Evidence from implementation research for introduction and scale up of STI POCTs in different STI epidemic and laboratory infrastructure settings is required.
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Affiliation(s)
- Silver Vargas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru; Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino Calvo
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jazmin Qquellon
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francesca Vasquez
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karel Blondel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Ronald Ballard
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa. Sci Rep 2021; 11:5431. [PMID: 33686218 PMCID: PMC7970874 DOI: 10.1038/s41598-021-84839-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15-59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.
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Moges NA, Adesina OA, Okunlola MA, Berhane Y. Same-day antiretroviral treatment (ART) initiation and associated factors among HIV positive people in Northwest Ethiopia: baseline characteristics of prospective cohort. Arch Public Health 2020; 78:87. [PMID: 32983450 PMCID: PMC7510057 DOI: 10.1186/s13690-020-00473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Despite a well-established fact that same-day or rapid ART initiation after a positive HIV test result is vital for faster viral suppression and for prevention of further sexual transmissions of HIV, there is a paucity of evidence on the uptake of same-day ART initiation among newly HIV diagnosed people in Northwest, Ethiopia. Methods A cross-sectional study was conducted between December 1st, 2018 and July 30, 2019. About 759 newly HIV diagnosed adults were recruited from 24 health facilities. Data were collected using interviewer-administered questionnaire. Data were entered using EPI-Data and exported to SPSS and STATA software for further analysis. Bivariate logistic regression was used to select candidate variables at p-value less than 0.25 for multivariate logistic regression. Then adjusted odds ratio with 95% Confidence Interval (CI) at p-value of less than 0.05 was used to declare the statistical associations between the dependent and independent variables. Result Magnitude of same-day ART initiation was 318 (41.90%) [(95% CI, 38.2–45.20%)]. Factors associated with same-day ART initiation were: Patients resided in West Gojjam Zone were 2.04 times more likely to initiate same-day ART compared to those in Bahir Dar city administration [AOR = 2.04 (1.04–3.97)], patients in the health centers were 3.06 times more likely to initiate same-day ART initiation compared to those in the hospitals [AOR = 3.06 (1.90–4.92)] and Patients who were diagnosed their HIV status at the same health facility where they linked for ART were 2.16 times more likely to initiate ART at the same-day of diagnosis [AOR = 2.16 (91.24–3.74)]. Moreover, patients with no opportunistic infection [AOR = 2.08 (1.04–4.19)] and pregnant women [AOR = 3.97 (1.78–8.87)] were more likely to initiate ART same-day of diagnosis. Conclusions Same-day ART initiation was low among HIV patients in Ethiopia. Patients attending their treatment at hospitals and those from big city (Bahir Dar) were less likely to initiate same-day ART. Clinical factors such as having opportunistic infections and non-pregnancy status affected the immediate initiation of treatment. HIV positive people who seek care in hospitals and those tested HIV positive from another health facilities in which they did not intend to continue their ART follow-up care need special attention.
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Qian S, Foster R, Bourne C, Vickers T, McIver R, McNulty A. Neisseria gonorrhoeae positivity in clients presenting as asymptomatic contacts of gonorrhoea at a sexual health centre. Sex Health 2020; 17:187-191. [DOI: 10.1071/sh19091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022]
Abstract
Background Previous guidelines at the Sydney Sexual Health Centre (SSHC) recommended empirical antibiotic treatment for asymptomatic contacts of Neisseria gonorrhoeae at the time of testing. With increasing concerns around gonorrhoea antibiotic resistance, it has been suggested that asymptomatic contacts should only be treated based on test results. Methods: This retrospective study of data from the SSHC electronic medical record included a total of 295 gonorrhoea contacts from 1 January 2018 to 30 June 2018. The primary outcome was the proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result from any anatomical site. Statistically significant differences in gonorrhoea positivity according to gender, sexual preference, use of PrEP, sex worker status, country of birth, preferred language and number of partners, were calculated using Fisher’s exact test. Results: The overall proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result was 27.1% (95% CI: 22.1–32.6%). The proportion of gonorrhoea positivity was significantly higher in females compared to males (52.0% vs 25.7%, P < 0.01), gay and bisexual men compared to heterosexual men (28.7% vs 0%, P < 0.01) and non-users of PrEP compared to PrEP users (31.2% vs 12.5%, P < 0.05). No statistically significant differences in gonorrhoea positivity were found in subgroups divided by sex worker status, country of birth, preferred language and number of partners. Conclusion: The relatively low gonorrhoea positivity rate (27.1%) in asymptomatic gonorrhoea contacts at the SSHC between January and June 2018 supports guideline changes to no longer provide empirical antibiotic treatment to asymptomatic contacts.
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Bell SFE, Coffey L, Debattista J, Badman SG, Redmond AM, Whiley DM, Lemoire J, Williams OD, Howard C, Gilks CF, Dean JA. Peer-delivered point-of-care testing for Chlamydia trachomatis and Neisseria gonorrhoeae within an urban community setting: a cross-sectional analysis. Sex Health 2020; 17:359-367. [PMID: 32731917 DOI: 10.1071/sh19233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022]
Abstract
Background The advent of fully automated nucleic acid amplification test (NAAT) technology brings new public health opportunities to provide Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) point-of-care testing (POCT) in non-traditional settings. METHODS This pilot study evaluated the integration of the CT/NG Xpert diagnostic assay into an urban peer-led community setting providing HIV and syphilis POCT. A comprehensive protocol of testing, result notification, referral and follow up, managed by peer test facilitators, was undertaken. RESULTS Over 67 weeks, there were 4523 occasions of CT/NG testing using urine, oropharyngeal and anorectal samples with 25.7% (803) of the 3123 unique participants returning for repeat testing. The prevalence of CT and NG was 9.5% and 5.4% respectively. Where CT and or NG infection was detected, 98.4% (604/614) of participants were successfully notified of detected infection and referred for treatment. Evaluation Survey responses (11.4%, 516/4523) indicated a substantial proportion of respondents (27.1%, 140/516) 'would not have tested anywhere else'. Of note, 17.8% (92/516) of participants reported no previous CT/NG test and an additional 17.8% (92/516) reported testing more than 12 months ago. A total of 95.9% (495/516) of participants 'Strongly agreed' or 'Agreed' to being satisfied with the service. CONCLUSION The project successfully demonstrated an acceptable and feasible model for a peer-delivered community-led service to provide targeted molecular CT/NG POCT. This model offers capacity to move beyond the traditional pathology and STI testing services and establish community-led models that build trust and increase testing rates for key populations of epidemiological significance.
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Affiliation(s)
- Sara F E Bell
- School of Public Health, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Luke Coffey
- RAPID, Queensland Positive People, 21 Manilla Street, East Brisbane, Qld 4169, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Bryden Street, Windsor, Qld 4030, Australia
| | - Steven G Badman
- Kirby Institute, L6, Wallace Wurth Building, High Street, The University of New South Wales Sydney, Randwick, NSW 2032, Australia
| | - Andrew M Redmond
- RAPID, Queensland Positive People, 21 Manilla Street, East Brisbane, Qld 4169, Australia; and Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield St, Herston, Qld 4029, Australia
| | - David M Whiley
- Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane and Women's Hospital Campus, Herston, Qld 4029, Australia; and Pathology Queensland, Block 7, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia
| | - Jime Lemoire
- RAPID, Queensland Positive People, 21 Manilla Street, East Brisbane, Qld 4169, Australia
| | - Owain D Williams
- School of Public Health, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Chris Howard
- RAPID, Queensland Positive People, 21 Manilla Street, East Brisbane, Qld 4169, Australia
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Judith A Dean
- School of Public Health, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia; and Corresponding author.
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Abstract
The bacterium Neisseria gonorrhoeae causes the sexually transmitted infection (STI) gonorrhoea, which has an estimated global annual incidence of 86.9 million adults. Gonorrhoea can present as urethritis in men, cervicitis or urethritis in women, and in extragenital sites (pharynx, rectum, conjunctiva and, rarely, systemically) in both sexes. Confirmation of diagnosis requires microscopy of Gram-stained samples, bacterial culture or nucleic acid amplification tests. As no gonococcal vaccine is available, prevention relies on promoting safe sexual behaviours and reducing STI-associated stigma, which hinders timely diagnosis and treatment thereby increasing transmission. Single-dose systemic therapy (usually injectable ceftriaxone plus oral azithromycin) is the recommended first-line treatment. However, a major public health concern globally is that N. gonorrhoeae is evolving high levels of antimicrobial resistance (AMR), which threatens the effectiveness of the available gonorrhoea treatments. Improved global surveillance of the emergence, evolution, fitness, and geographical and temporal spread of AMR in N. gonorrhoeae, and improved understanding of the pharmacokinetics and pharmacodynamics for current and future antimicrobials in the treatment of urogenital and extragenital gonorrhoea, are essential to inform treatment guidelines. Key priorities for gonorrhoea control include strengthening prevention, early diagnosis, and treatment of patients and their partners; decreasing stigma; expanding surveillance of AMR and treatment failures; and promoting responsible antimicrobial use and stewardship. To achieve these goals, the development of rapid and affordable point-of-care diagnostic tests that can simultaneously detect AMR, novel therapeutic antimicrobials and gonococcal vaccine(s) in particular is crucial.
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van Wees DA, den Daas C, Kretzschmar MEE, Heijne JCM. Who drops out and when? Predictors of non-response and loss to follow-up in a longitudinal cohort study among STI clinic visitors. PLoS One 2019; 14:e0218658. [PMID: 31216341 PMCID: PMC6583983 DOI: 10.1371/journal.pone.0218658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Response rates in health research are declining, and low response rates could result in biased outcomes when population characteristics of participants systematically differ from the non-respondents. Few studies have examined key factors of non-response beyond demographic characteristics, such as behavioral and psychological factors. The aim of the current study was to identify predictors of non-response and loss to follow-up in a longitudinal sexual health study. Materials and methods A longitudinal cohort study (iMPaCT) was conducted from November 2016 to July 2018 among heterosexual STI clinic visitors aged 18–24 years. At four different time points in one year, data was collected on sexual behavior, psychological determinants and chlamydia infections. The national STI surveillance database provided data on demographic, behavioral and sexual health-related characteristics for non-respondents. Predictors of non-response at baseline and of loss to follow-up were identified using multivariable logistic regression analyses. Results In total, 13,658 STI clinic visitors were eligible to participate, of which 1,063 (8%) participated. Male gender, low/medium education level, young age (≤ 20 years) and having a non-Dutch migration background were significant predictors of non-response at baseline. Furthermore, non-respondents at baseline were more likely to report STI-related symptoms, to have been notified by a partner, to have had condomless sex, and to have had ≤ 2 partners in the past six months, compared to participants. Psychological predictors of loss to follow-up differed between STI clinic regions, but low perceived importance of health at baseline was associated with loss to follow-up in all regions. The baseline chlamydia positivity rate was significantly higher in the non-respondents (17%) compared to the participants (14%), but was not a predictor of loss to follow-up. Discussion Targeted recruitment aimed at underrepresented groups in the population based on demographic, behavioral and psychological characteristics, might be necessary to decrease loss to follow-up, and to prevent non-response bias in health research.
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Affiliation(s)
- Daphne A. van Wees
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- * E-mail:
| | - Chantal den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mirjam E. E. Kretzschmar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke C. M. Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Tavakkoli A, Appelman HD, Beer DG, Madiyal C, Khodadost M, Nofz K, Metko V, Elta G, Wang T, Rubenstein JH. Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus. Clin Gastroenterol Hepatol 2018; 16:862-869.e3. [PMID: 29432922 PMCID: PMC5962402 DOI: 10.1016/j.cgh.2018.01.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/09/2018] [Accepted: 01/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Guidelines recommend that patients with nondysplastic BE (NDBE) undergo surveillance endoscopy every 3-5 years. We aimed to identify factors associated with surveillance endoscopy of patients with NDBE and identify trends in appropriate surveillance endoscopy of NDBE at a large tertiary care center. METHODS We performed a retrospective analysis of data from a Barrett's Esophagus Registry, identifying patients with NDBE who underwent endoscopy in 2002 or later. We identified patients with NDBE and collected data on length of BE segment, esophageal lesions, demographic features, medications, histology findings, comorbidities, development of EAC, and dates of follow-up endoscopies. We defined appropriate surveillance as 3-5 years between 2nd and 3rd endoscopies, over-utilizers as patients who had less than 3 years between their 2nd and 3rd endoscopies, under-utilizers as patients who had more than 5 years between their 2nd and 3rd endoscopies; and never-surveilled as patients who never received a 2nd endoscopy. The primary outcomes were effects of patient factors, year, and referring providers on appropriateness of surveillance intervals. RESULTS We identified 477 patients with NDBE. Only 15.9% had appropriate surveillance; 37.9% were over-utilizers 15.7% were under-utilizers and 30.4% were never surveilled. Patients were less likely to be over-surveilled if their primary care physician referred them for their 3rd endoscopy instead of a gastroenterologist (adjusted odds ratio, 0.51; 95% CI, 0.27-0.95). Male patients or those with an increased number of comorbidities were more likely to be under-surveilled or never-surveilled, whereas patients with long BE segment were more likely to be over-surveilled. CONCLUSIONS In a retrospective analysis of data from a registry of patients with BE, we found that less than 16% receive appropriate surveillance for NDBE. A primary care provider in the same health system as the endoscopy clinic reduced risk of over-surveillance. This could reflect better coordination of care between specialists and primary care providers.
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Affiliation(s)
- Anna Tavakkoli
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
| | - Henry D Appelman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - David G Beer
- Department of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chaitra Madiyal
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Maryam Khodadost
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan; Division of Gastroenterology, Veterans Affairs Hospital, Ann Arbor, Michigan
| | - Kimberly Nofz
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan; Division of Gastroenterology, Veterans Affairs Hospital, Ann Arbor, Michigan
| | - Val Metko
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan; Division of Gastroenterology, Veterans Affairs Hospital, Ann Arbor, Michigan
| | - Grace Elta
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Thomas Wang
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Joel H Rubenstein
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
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