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Understanding Relationships Between Chlamydial Infection, Symptoms, and Testing Behavior: An Analysis of Data from Natsal-3. Epidemiology 2021; 31:263-271. [PMID: 31794495 PMCID: PMC7004460 DOI: 10.1097/ede.0000000000001150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Supplemental Digital Content is available in the text. Genital chlamydia is the most commonly diagnosed sexually transmitted infection worldwide and can have serious long-term sequelae. Numerous countries invest substantially in testing but evidence for programs’ effectiveness is inconclusive. It is important to understand the effects of testing programs in different groups of people.
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Aicken CRH, Wayal S, Blomquist PB, Fabiane SM, Gerressu M, Hughes G, Mercer CH. Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys. BMC Health Serv Res 2019; 19:668. [PMID: 31533716 PMCID: PMC6749649 DOI: 10.1186/s12913-019-4396-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.
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Affiliation(s)
- Catherine R. H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- School of Health Sciences, University of Brighton, Village Way, Falmer, Brighton, BN1 9PH UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Stella M. Fabiane
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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