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Welford E, Martin TCS, Martin NK, Tilghman W, Little SJ. Relative Cost and Infectious Days Averted Associated With Rapid Gonorrhea and Chlamydia Testing Among Men Who Have Sex With Men. Sex Transm Dis 2024; 51:388-392. [PMID: 38733972 PMCID: PMC11090409 DOI: 10.1097/olq.0000000000001956] [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] [Indexed: 05/13/2024]
Abstract
BACKGROUND Standard-of-care nucleic acid amplification tests (routine NAATs) for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) can take several days to result and therefore delay treatment. Rapid point-of-care GC/CT NAAT (rapid NAAT) could reduce the time to treatment and therefore onward transmission. This study evaluated the incremental cost per infectious day averted and overall cost of implementation associated with rapid compared with routine NAAT. METHODS Prospective sexually transmitted infection (STI) treatment data from men who have sex with men and transgender women in San Diego who received rapid NAAT between November 2018 and February 2021 were evaluated. Historical time from testing to treatment for routine NAAT was abstracted from the literature. Costs per test for rapid and routine NAAT were calculated using a micro-costing approach. The incremental cost per infectious day averted comparing rapid to routine NAAT and the costs of rapid GC/CT NAAT implementation in San Diego Public Health STI clinics were calculated. RESULTS Overall, 2333 individuals underwent rapid NAAT with a median time from sample collection to treatment of 2 days compared with 7 to 14 days for routine NAAT equating to a reduction of 5 to 12 days. The cost of rapid and routine GC/CT NAAT was $57.86 and $18.38 per test, respectively, with a cost-effectiveness of between $2.43 and $5.82 per infectious day averted. The incremental cost of rapid NAAT improved when at least 2000 tests were performed annually. CONCLUSIONS Although rapid GC/CT NAAT is more expensive than routine testing, the reduction of infectious days between testing and treatment may reduce transmission and provide improved STI treatment services to patients.
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Affiliation(s)
- Elliott Welford
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego
| | - Thomas C S Martin
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego
| | - Natasha K Martin
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego
| | - Winston Tilghman
- County of San Diego Health & Human Services Agency, San Diego, CA
| | - Susan J Little
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego
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2
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Menon-Johansson AS. Partner notification outcomes must treble for effective gonorrhoea control. Int J STD AIDS 2024; 35:319-320. [PMID: 38095665 DOI: 10.1177/09564624231222423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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3
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Rakeman-Cagno JL, Persing DH, Loeffelholz MJ. Maintaining point of care testing capacity and pandemic preparedness in the post-COVID-19 era. Expert Rev Mol Diagn 2024; 24:147-151. [PMID: 37724428 DOI: 10.1080/14737159.2023.2260743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Testing at the point of care (we also refer to the 'point of need'), with rapid, actionable results reported to the patient and provider within hours can impact the individual as well as public health. Faster testing is good for patients and public health outcomes during 'peace time' (outside of the pandemic setting). AREAS COVERED Testing at the point of need was important during the COVID-19 pandemic to meet testing capacity demands, providing actionable results, and for providing testing within communities to increase access for all populations. Resources were acquired and built up dramatically during the pandemic as part of the response. With the end of the COVID-19 public health emergency and transition back to 'peace time' some testing sites have successfully shifted to using this capacity for testing for other critical needs, like sexually transmitted infection (STI) testing, and response to other seasonal diseases and for outbreak response. EXPERT OPINION The increased testing capacity added to handle unprecedented testing volume during the COVID-19 pandemic can be repurposed for other critical infectious diseases during 'peace time' (post-COVID-19 pandemic). This maintains testing capacity for the next pandemic.
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Affiliation(s)
| | - David H Persing
- Department Pathology, Stanford University, Palo Alto, CA, USA
- Scientific Affairs, Cepheid, Sunnyvale, CA, USA
| | - Michael J Loeffelholz
- Department Pathology, University of Texas Medical Branch, Galveston, TX, USA
- Scientific Affairs, Cepheid, Sunnyvale, CA, USA
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4
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Marcus R, C P, Gill K, Smith P, Rouhani S, Mendelsohn A, Mendel E, Lince-Deroche N, Naidoo K, Ahmed N, Stirrup O, Roseleur J, Leuner R, Meyer-Rath G, Bekker LG. Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care. BMC Health Serv Res 2023; 23:1078. [PMID: 37817160 PMCID: PMC10566254 DOI: 10.1186/s12913-023-10068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Young people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town. METHODS YP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability. RESULTS Three hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%). Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire. CONCLUSION Curable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa.
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Affiliation(s)
- Rebecca Marcus
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
- North Middlesex University Hospital, London, UK.
| | - Pike C
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - K Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - P Smith
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - S Rouhani
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - A Mendelsohn
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - E Mendel
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Lince-Deroche
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - K Naidoo
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Ahmed
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Mortimer Market Centre, Central North West London NHS Trust, London, UK
| | - O Stirrup
- Institute for Global Health, University College London, London, UK
| | - J Roseleur
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - R Leuner
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Massachusetts, USA
| | - L G Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Riegler AN, Larsen N, Amerson-Brown MH. Point-of-Care Testing for Sexually Transmitted Infections. Clin Lab Med 2023; 43:189-207. [PMID: 37169442 DOI: 10.1016/j.cll.2023.02.006] [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: 05/13/2023]
Abstract
Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.
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Affiliation(s)
- Ashleigh N Riegler
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Natalie Larsen
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Megan H Amerson-Brown
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA.
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Walter SR, Jackson J, Myring G, Redaniel MT, Margelyte R, Gardiner R, Clarke MD, Crofts M, McLeod H, Hollingworth W, Phillips D, Muir P, Steer J, Turner J, Horner PJ, De Vocht F. Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study. BMJ Open 2023; 13:e064664. [PMID: 36631238 PMCID: PMC9835959 DOI: 10.1136/bmjopen-2022-064664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service. DESIGN Controlled interrupted time series study. SETTING Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site). PARTICIPANTS Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention. INTERVENTION Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways. OUTCOME MEASURES Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations. RESULTS Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%). CONCLUSIONS The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.
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Affiliation(s)
- Scott R Walter
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joni Jackson
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruta Margelyte
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Gardiner
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael D Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hugh McLeod
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Hollingworth
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillips
- Croydon Sexual Health, Croydon University Hospital, Croydon, UK
| | - Peter Muir
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Jonathan Steer
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Jonathan Turner
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Frank De Vocht
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mitchell HD, Whitlock G, Zdravkov J, Olsson J, Silalang P, Bardsley M, Blomquist PB, Jenkins C, Thomson NR, Field N, Hughes G. Prevalence and risk factors of bacterial enteric pathogens in men who have sex with men: A cross-sectional study at the UK's largest sexual health service. J Infect 2023; 86:33-40. [PMID: 36343788 PMCID: PMC10564623 DOI: 10.1016/j.jinf.2022.10.033] [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: 05/25/2022] [Revised: 10/05/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Outbreaks of bacterial enteric pathogens (BEPs) in men who have sex with men (MSM) associated with antimicrobial resistance are a public health concern. We investigated the prevalence and risk factors of BEPs in MSM to inform infection control. METHODS We conducted a cross-sectional study at a London sexual health clinic between 20/12/2017 and 06/02/2018. Residual rectal swabs from MSM attending for sexually transmitted infection (STI) testing were anonymously tested for a range of BEPs using real-time PCR. A sub-set of samples were tested for the mphA gene (a marker of azithromycin resistance). Results were linked to electronic health records. RESULTS BEPs were detected in 207 of 2116 participants, giving an overall prevalence of 9.8% (95% CI 8.5%-11.1%) ranging from 0.8% (0.4%-1.2%) for Shigella to 4.9% (4.0%-5.9%) for Enteroaggregative E. coli. MSM with BEPs were more likely to have a history of bacterial STIs (p = 0.010), to report more sexual partners (p<0.001), and among HIV-negative MSM, to report current HIV pre-exposure prophylaxis use (p<0.001). Gastrointestinal symptoms were rare (1.7%) and not associated with BEPs. 41.3% of MSM with BEPs and 14.1% of those without BEPs carried mphA (p<0.001). Among the former, this was associated with a history of bacterial STIs (51.5% vs 31.1%, p = 0.003). CONCLUSIONS One in ten MSM had a BEP detected and most did not report symptoms. MphA carriage was common, particularly among those with BEPs. Bacterial STI treatment might contribute to selection of resistant gut organisms, emphasising the need for better antimicrobial stewardship.
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Affiliation(s)
- Holly D Mitchell
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK.
| | - Gary Whitlock
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK
| | - Jey Zdravkov
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK
| | - Jenny Olsson
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK; Imperial College School of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Panida Silalang
- Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Megan Bardsley
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Paula B Blomquist
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Claire Jenkins
- Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool, UK
| | - Nicholas R Thomson
- Parasites and Microbes, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, CB10 1SA, UK; Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK
| | - Gwenda Hughes
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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8
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Montes-Olivas S, Ozten Y, Homer M, Turner K, Fairley CK, Hocking JS, Tse D, Verschueren van Rees N, Wong WCW, Ong JJ. Evaluating the impact and cost-effectiveness of chlamydia management strategies in Hong Kong: A modeling study. Front Public Health 2022; 10:932096. [PMID: 35968473 PMCID: PMC9363901 DOI: 10.3389/fpubh.2022.932096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To illustrate the epidemiologic and cost-effectiveness impact of shifting the focus from population-based screening toward a targeted management approach for genital chlamydia infection. Design Modeling study, implementing an individual-based, stochastic, dynamic network model. Setting Hong Kong. Population A hypothetical sample network of 10,000 people with a partnership distribution based on Hong Kong's sexually active population of reproductive age (age 18–49 years). Interventions In this study, we present several scenarios with different implementations of universal vs. targeted screening (based on partner numbers). We also explored the impact of (1) screening only, (2) screening plus expedited partner therapy, and (3) screening plus partner testing. Primary outcome measures Change of chlamydia prevalence before and after implementing the different strategies. The cost-effectiveness analysis reports total direct cost from a health provider perspective, the QALYs gained, and incremental cost-effectiveness ratios (ICER). Results In comparing the effects of universal screening only and targeted screening of the high-risk population, the mean prevalence during the 10th year of intervention was 2.75 ± 0.30% and 2.35 ± 0.21%, respectively (compared with 3.24 ± 0.30% and 3.35 ± 0.21% before the interventions, respectively). The addition of contact tracing to the latter targeted screening scenario reduces the mean prevalence during the 10th year of intervention to 1.48 ± 0.13% (compared with 3.31 ± 0.33% at baseline) in the best-case of testing before treatment and maximal contact-tracing effectiveness (40%). Overall, the most effective scenarios were those for which interventions focused on the high-risk population defined by the number of partners, with contact tracing included. The ICER for targeted screening with contact tracing at 20% and 40% efficiency was $4,634 and $7,219 per QALY gained, respectively (10-year time horizon). Expedited partner therapy did not significantly impact overall chlamydia prevalence and caused overtreatment. Conclusions Our study suggests that targeted screening with strengthened contact tracing efforts is the most cost-effective strategy to reduce the prevalence of chlamydia in Hong Kong.
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Affiliation(s)
- Sandra Montes-Olivas
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Yaz Ozten
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Martin Homer
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Katy Turner
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne Sexual Health Center, Melbourne, VIC, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Desiree Tse
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nicolas Verschueren van Rees
- Physics Department, University of California, Berkeley, Berkeley, CA, United States
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jason J. Ong
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Jason J. Ong
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9
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Proceedings of the Clinical Microbiology Open 2018 and 2019 - a Discussion about Emerging Trends, Challenges, and the Future of Clinical Microbiology. J Clin Microbiol 2022; 60:e0009222. [PMID: 35638361 DOI: 10.1128/jcm.00092-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical Microbiology Open (CMO), a meeting supported by the American Society for Microbiology's Clinical and Public Health Microbiology Committee (CPHMC) and Corporate Council, provides a unique interactive platform for leaders from diagnostic microbiology laboratories, industry, and federal agencies to discuss the current and future state of the clinical microbiology laboratory. The purpose is to leverage the group's diverse views and expertise to address critical challenges, and discuss potential collaborative opportunities for diagnostic microbiology, through the utilization of varied resources. The first and second CMO meetings were held in 2018 and 2019, respectively. Discussions were focused on the diagnostic potential of innovative technologies and laboratory diagnostic stewardship, including expansion of next-generation sequencing into clinical diagnostics, improvement and advancement of molecular diagnostics, emerging diagnostics, including rapid antimicrobial susceptibility and point of care testing (POCT), harnessing big data through artificial intelligence, and staffing in the clinical microbiology laboratory. Shortly after CMO 2019, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the need for the diagnostic microbiology community to work together to utilize and expand on resources to respond to the pandemic. The issues, challenges, and potential collaborative efforts discussed during the past two CMO meetings proved critical in addressing the COVID-19 response by diagnostic laboratories, industry partners, and federal organizations. Planning for a third CMO (CMO 2022) is underway and will transition from a discussion-based meeting to an action-based meeting. The primary focus will be to reflect on the lessons learned from the COVID-19 pandemic and better prepare for future pandemics.
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10
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Müller MC, Usadel S, Zimmermann S, Fahrhöfer A, Kern WV, Hoffmeister U, Rieg S. Closing Sexual Health Service Gaps With a New Service Model in Germany: Performance of an on-Site Integrated, Cross-Sectoral, Low Threshold Sexually Transmitted Infections/HIV Counseling and Treatment Service. Front Public Health 2022; 10:793609. [PMID: 35548069 PMCID: PMC9082412 DOI: 10.3389/fpubh.2022.793609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose In Germany, the incidence of bacterial sexual transmitted infections (STI) is on the rise and still high for HIV infections. The Center for Sexual Health Freiburg (CSHF) was established to offer low threshold access for STI/HIV counseling, testing, HIV pre-exposure prophylaxis (PrEP), and on-site treatment. The objective of this study was to analyze the performance of CSHF. Methods Longitudinal study that includes all clients presenting between 1 May 2020 and 28 February 2021 at CSHF and willing to sign informed consent. Results In the study period, 536 clients presented at CSHF of whom 417 clients were included in the study resulting in 668 client contacts. Clients' median age was 28.1 years (range: 18.0-73.1), 55.9% were men, 42.0% were women, 0.3% were transman, and 1.7% were not binary. Clients' sexual orientation was heterosexual (56.6%), homosexual men (26.2%), and bisexual (13.6%). STI screening resulted in the detection of any STI in 3.4% (95% confidence interval (CI): 0.7-6.1) of women, in 3.1% (95% CI: 0.0-6.5) of heterosexual men, and in 22.2% (95% CI: 13.0-31.5) of men having sex with men (MSM) not taking PrEP. Eighty-one MSM received PrEP with a total follow-up of 57.3 person-years and 0.44 STIs per person-year. Conclusion The substantial burden of STI in the study population emphasizes the need for regular and low threshold STI screening services. The concept of CSHF may facilitate access to STI/HIV counseling, testing, and PrEP for a wide spectrum of people and may prove to be an important contribution to the efforts to reduce STI and HIV incidence in Germany.
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Affiliation(s)
- Matthias C Müller
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Infection Medicine, Medical Service Centre Clotten, Freiburg im Breisgau, Germany
| | - Susanne Usadel
- Department of Infection Medicine, Medical Service Centre Clotten, Freiburg im Breisgau, Germany
| | | | | | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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11
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Donnell D, Zewdie K, Ratna N, Miller V, Saunders JM, Gill ON, Delpech V, Mohammed H. Association between rectal gonorrhoea and HIV incidence in men who have sex with men: a meta-analysis. Sex Transm Infect 2021; 98:492-496. [PMID: 34911750 DOI: 10.1136/sextrans-2021-055254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Incidence of rectal gonorrhoea (GC) has been hypothesised as a correlate of HIV exposure in prevention trials of men who have sex with men (MSM). High rectal GC incidence in MSM trials of new biomedical prevention drugs may provide supportive evidence for ongoing HIV risk. Empirical evidence of correlation between rectal GC and HIV incidence is needed to assess whether high rectal GC rates reliably correlate with high risk of HIV. METHODS Rectal GC and HIV are routinely tested in sexual health clinics (SHCs) throughout England. Through routine surveillance data collected at visits to SHCs, we assessed HIV incidence and new rectal GC diagnoses in repeat visits by HIV-negative MSM between 2011 and 2018, predating widespread roll-out of pre-exposure prophylaxis. Meta-analysis regression assessed population-level association between HIV and rectal GC incidence over time. FINDINGS Between 2011 and 2018, HIV and rectal GC incidence was assessed in 541 056 HIV-negative MSM attending SHCs in England. HIV incidence among MSM attending SHCs fell from 1.26/100 person-years (PYs) in 2011 to 0.28/100 PYs in 2018. Rectal GC rates increased from 3.5/100 PYs to 11.1/100 PYs over the same period. The rate of HIV incidence decreased by 22.3% for each percent increase in rectal GC (95% CI -30.8 to -14.7, p<0.001). INTERPRETATION Among the population of MSM attending SHCs in England, rectal GC rates increased substantially while HIV incidence rates decreased between 2011 and 2018. HIV incidence likely decreased through expanded HIV testing, prompt antiretroviral treatment (ART) initiation and increased viral suppression in persons living with HIV, interventions that did not decrease rectal GC. Rectal GC may not be an ideal proxy for HIV incidence in trials, as HIV exposure risk is complex and context dependent, given effective HIV prevention interventions in MSM. INTRODUCTION
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Affiliation(s)
- Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kidist Zewdie
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Natasha Ratna
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division-National Infection Service, Public Health England, London, UK
| | - Veronica Miller
- School of Public Health, University of California System, Oakland, California, USA.,Forum for Collaborative Research, Washington, District of Columbia, USA
| | - John Michael Saunders
- HIV & STI Department, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - O Noel Gill
- HIV & STI Department, Public Health England, London, UK
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12
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Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Ther Adv Infect Dis 2021; 8:20499361211061645. [PMID: 34881023 PMCID: PMC8647227 DOI: 10.1177/20499361211061645] [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: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient's visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.
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13
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Fuller SS, Clarke E, Harding-Esch EM. Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development. PLoS One 2021; 16:e0259593. [PMID: 34748579 PMCID: PMC8575247 DOI: 10.1371/journal.pone.0259593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections, including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), continue to be a global health problem. Increased access to point-of-care-tests (POCTs) could help detect infection and lead to appropriate management of cases and contacts, reducing transmission and development of reproductive health sequelae. Yet diagnostics with good clinical effectiveness evidence can fail to be implemented into routine care. Here we assess values beyond clinical effectiveness for molecular CT/NG POCTs implemented across diverse routine practice settings. METHODS We conducted a systematic review of peer-reviewed primary research and conference abstract publications in Medline and Embase reporting on molecular CT/NG POCT implementation in routine clinical practice until 16th February 2021. Results were extracted into EndNote software and initially screened by title and abstract by one author according to the inclusion and exclusion criteria. Articles that met the criteria, or were unclear, were included for full-text assessment by all authors. Results were synthesised to assess the tests against guidance criteria and develop a CT/NG POCT value proposition for multiple stakeholders and settings. FINDINGS The systematic review search returned 440 articles; 28 were included overall. The Cepheid CT/NG GeneXpert was the only molecular CT/NG POCT implemented and evaluated in routine practice. It did not fulfil all test guidance criteria, however, studies of test implementation showed multiple values for test use across various healthcare settings and locations. Our value proposition highlights that the majority of values are setting-specific. Sexual health services and outreach services have the least overlap, with General Practice and other non-sexual health specialist services serving as a "bridge" between the two. CONCLUSIONS Those wishing to improve CT/NG diagnosis should be supported to identify the values most relevant to their settings and context, and prioritise implementation of tests that are most closely aligned with those values.
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Affiliation(s)
- Sebastian S. Fuller
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Headington, Oxford, United Kingdom
| | - Eleanor Clarke
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emma M. Harding-Esch
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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14
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Llata E, Cuffe KM, Picchetti V, Braxton JR, Torrone EA. Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2021; 70:1-20. [PMID: 34735419 PMCID: PMC8575410 DOI: 10.15585/mmwr.ss7007a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM). PERIOD COVERED 2010-2018. DESCRIPTION OF THE SYSTEM The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM. RESULTS During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,733 in 2018). Among visits during which an acute STD (defined as chlamydia, gonorrhea, or primary or secondary syphilis) was diagnosed, the percentage of visits during which an HIV test was performed within approximately 14 days of the STD diagnosis increased from 58.2% in 2010 to 70.2% in 2018. Among those patients tested, 1,672 HIV infections were identified, of which 84.0% were among MSM. Among females aged 15-24 years, the percentage screened for chlamydia in any calendar year increased from 88.6% in 2010 to 90.6% in 2018. However, because fewer females aged 15-24 years attended these clinics during the study period, the crude number of adolescent and young females tested for chlamydia decreased from 14,249 in 2010 to 4,507 in 2018. During 2010-2018, the percentage of females retested after their first positive chlamydia diagnosis during the same year ranged from 11.4% to 13.3%. During 2010-2018, the percentage of MSM tested for rectal chlamydia and rectal gonorrhea increased (from 54.7% to 57.8% and from 55.0% to 58.4%, respectively). During the same period, increases were noted in the percentage of MSM with diagnosed rectal chlamydia (from 15.5% in 2010 to 17.7% in 2018) and rectal gonorrhea (from 13.3% in 2010 to 17.1% in 2018). In contrast with pharyngeal chlamydia, pharyngeal gonorrhea screening was more common (from 69.5% in 2010 to 74.6% in 2018), and the percentage positive doubled during the study period (from 7.3% in 2010 to 14.8% in 2018). Pharyngeal chlamydia testing also increased (from 50.3% in 2010 to 72.9% in 2018), with concurrent decreases in positivity (from 4.2% in 2010 to 2.6% in 2018). INTERPRETATION During 2010-2018, changes occurred in the demographic composition of patients attending STD clinics participating in SSuN. Understanding trends in the demographic profile of STD patients and services provided can help identify addressable gaps in STD control efforts and direct public health action. Overall, fewer females, especially those aged 15-24 years, accessed care in these STD clinics during the study period. Untreated STDs among adolescent and young females can have serious consequences, including pelvic inflammatory disease and infertility. Additional efforts to monitor where adolescent and young females seek care and to ensure they are receiving quality STD-related health services are needed, especially considering increases in reported cases of STDs among females. Increases in the number of MSM attending STD clinics present a unique opportunity to reach this population with STD and HIV prevention services. Although a large percentage of STD cases are diagnosed outside of STD clinics, publicly funded STD clinics are an important safety-net provider of STD-related health services and provide vital STD-related health services for patient populations at risk for the consequences of STDs and HIV infection. PUBLIC HEALTH ACTIONS STD-related health services represent effective strategies for preventing STD and HIV transmission and acquisition or STD-related sequelae. Ensuring that all persons receive quality HIV and STD prevention and treatment services is vital for an effective public health approach to reducing STDs. STD clinics provide crucial safety-net services for preventing STD-related morbidity, including timely identification and treatment of curable STDs such as chlamydia, gonorrhea, and syphilis. Increases in the numbers of MSM attending STD clinics participating in SSuN provide additional opportunities for linking patients to high-impact HIV preventive services (e.g., pre-exposure prophylaxis), and the clinics are positioned to facilitate initiation or resumption of treatment among persons living with HIV.
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Affiliation(s)
- Eloisa Llata
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Kendra M Cuffe
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Viani Picchetti
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jimmy R Braxton
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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15
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Earnest R, Rönn MM, Bellerose M, Menon-Johansson AS, Berruti AA, Chesson HW, Gift TL, Hsu KK, Testa C, Zhu L, Malyuta Y, Menzies NA, Salomon JA. Modeling the Cost-Effectiveness of Express Multisite Gonorrhea Screening Among Men Who Have Sex With Men in the United States. Sex Transm Dis 2021; 48:805-812. [PMID: 33993161 PMCID: PMC8505150 DOI: 10.1097/olq.0000000000001467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) experience high rates of gonococcal infection at extragenital (rectal and pharyngeal) anatomic sites, which often are missed without asymptomatic screening and may be important for onward transmission. Implementing an express pathway for asymptomatic MSM seeking routine screening at their clinic may be a cost-effective way to improve extragenital screening by allowing patients to be screened at more anatomic sites through a streamlined, less costly process. METHODS We modified an agent-based model of anatomic site-specific gonococcal infection in US MSM to assess the cost-effectiveness of an express screening pathway in which all asymptomatic MSM presenting at their clinic were screened at the urogenital, rectal, and pharyngeal sites but forewent a provider consultation and physical examination and self-collected their own samples. We calculated the cumulative health effects expressed as gonococcal infections and cases averted over 5 years, labor and material costs, and incremental cost-effectiveness ratios for express versus traditional scenarios. RESULTS The express scenario averted more infections and cases in each intervention year. The increased diagnostic costs of triple-site screening were largely offset by the lowered visit costs of the express pathway and, from the end of year 3 onward, this pathway generated small cost savings. However, in a sensitivity analysis of assumed overhead costs, cost savings under the express scenario disappeared in the majority of simulations once overhead costs exceeded 7% of total annual costs. CONCLUSIONS Express screening may be a cost-effective option for improving multisite anatomic screening among US MSM.
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Affiliation(s)
- Rebecca Earnest
- From the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Minttu M. Rönn
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meghan Bellerose
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Andrés A. Berruti
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell W. Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas L. Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Katherine K. Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, MA
| | - Christian Testa
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Lin Zhu
- Center for Health Policy/Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, CA
| | - Yelena Malyuta
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Nicolas A. Menzies
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Joshua A. Salomon
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Health Policy/Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, CA
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16
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Lorenc A, Brangan E, Kesten JM, Horner PJ, Clarke M, Crofts M, Steer J, Turner J, Muir P, Horwood J. What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service? BMJ Open 2021; 11:e050109. [PMID: 34686552 PMCID: PMC8543645 DOI: 10.1136/bmjopen-2021-050109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service. DESIGN A theory-based qualitative evaluation with a focused ethnographic approach using non-participant observations and interviews with patient and clinic staff. Normalisation process theory was used to structure interview questions and thematic analysis. SETTING A sexual health centre in Bristol, UK. PARTICIPANTS 26 patients and 21 staff involved in the rapid sexually transmitted infection (STI) service were interviewed. Purposive sampling was aimed for a range of views and experiences and sociodemographics and STI results for patients, job grades and roles for staff. 40 hours of observations were conducted. RESULTS Implementation of the new service required co-ordinated changes in practice across multiple staff teams. Patients also needed to make changes to how they accessed the service. Multiple small 'pilots' of process changes were necessary to find workable options. For example, the service was introduced in phases beginning with male patients. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. However, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care. Patients valued faster results and avoiding unnecessary treatment. Patients reported that they were willing to drop-off self-samples and return for a follow-up appointment, enabling infection-specific treatment in accordance with test results, thus improving antimicrobial stewardship. CONCLUSIONS The new service was acceptable to staff and patients. Implementation of service changes to improve access and delivery of care in the context of stretched resources can pose challenges for staff at all levels. Early evaluation of pilots of process changes played an important role in the success of the service by rapidly feeding back issues for adjustment. Visibility to staff of positive impacts on patient care is important in maintaining morale.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paddy J Horner
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Steer
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Peter Muir
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Naeem F, Karellis A, Nair S, Routy JP, Yansouni CP, Kim J, Pai N. Multiplexed technologies for sexually transmitted infections: global evidence on patient-centered and clinical health outcomes. BMJ Glob Health 2021; 6:bmjgh-2021-005670. [PMID: 34301675 PMCID: PMC8311302 DOI: 10.1136/bmjgh-2021-005670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Conventional care packages around screening for sexually transmitted infections (STIs) entail multiple clinic visits and precipitate losses to follow-up. To prevent these losses, multiplexed technologies for STIs (immunochromatographic tests/devices/assays and molecular assays that can screen multiple pathogens or multiple strains of one STI) can yield same-day results in a single visit. Research evidence of patient-centred (preference, satisfaction) and clinical health outcomes (feasibility, case positivity, uptake, impact) has not been synthesised. We conducted a systematic review to fill this gap. Methods For the period 2009–2020, two independent reviewers searched PubMed and Embase, retrieved 4440 citations and abstracted data from 42 relevant studies. Results Of 42 studies, 10 (23.8%) evaluated multiplexed immunochromatographic and 32 (76.2%) molecular assays. Outcomes were reported as follows: preference (n=3), satisfaction (n=2), uptake (n=1), feasibility (n=2), case positivity (n=42) and impact (n=11). Screened populations included various at-risk groups. A majority (86.1%–92.4%) of participants preferred (60.2%–97.2%) multiplexed technologies (over conventional testing). Compared with conventional lab-based testing, test uptake improved by 99.4% (hepatitis C), 99.6% (Trichomonas vaginalis), 78.6% (hepatitis B) and 42.0% (HIV). Varying case positivities were documented depending on populations screened: HIV (1.8%–29.3%), hepatitis B (1.1%–23.9%), hepatitis C (0.5%–42.2%), Chlamydia trachomatis (2.8%–30.2%), Neisseria gonorrhoeae (0.0%–30.3%) and T. vaginalis (0.0%–32.7%). Regarding impact, 70.0%–100.0% of screened participants were linked to care, with result turnaround times ranging from 14 min (immunochromatographic assays) to 300 min (molecular assays). Conclusions Compared with conventional lab-based testing, rapid multiplexed technologies were preferred by testees and led to quicker turnaround times for many STIs yielding same-day results thereby allowing to initiate rapid linkages to care. They were further shown to be highly feasible and impactful for detection and treatment facilitation. Based on these promising results, multiplexed technologies offer potential to screen at-risk populations to reduce onward STI transmission worldwide.
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Affiliation(s)
- Faheel Naeem
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,CORE, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Karellis
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,CORE, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Suma Nair
- Community Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cédric Philippe Yansouni
- J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Infectious Diseases and Department of Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kim
- National Laboratory for HIV Reference Services, Public Health Agency of Canada, Winnipeg, Quebec, Canada
| | - Nitika Pai
- Department of Medicine, McGill University, Montreal, Quebec, Canada .,CORE, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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18
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Girometti N, Delpech V, McCormack S, Khawam J, Nash S, Ogaz D, Mohammed H, Gedela K, Nugent D, Patel S, Suchak T, Tittle V, McOwan A, Whitlock G. The success of HIV combination prevention: The Dean Street model. HIV Med 2021; 22:892-897. [PMID: 34323336 DOI: 10.1111/hiv.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
The 56 Dean Street combination prevention model, a strong engagement with the LGBTQI community and flexible services adapted to users' changing needs led to an 80% drop in HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) from 2015 to 2017. We describe the service changes at 56 Dean Street since 2012 which resulted in an increase in the frequency of HIV testing, the introduction of pre-exposure prophylaxis, earlier HIV diagnosis and a shorter time to viral suppression in those living with HIV. This model could be adapted to deliver similar results in those settings of high HIV prevalence among GBMSM and where access to technological innovation in healthcare and engagement with the community can be achieved.
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Affiliation(s)
| | - Valerie Delpech
- Blood Safety, Hepatitis, STIs and HIV Directorate, Centre for Infections, Public Health England, London, UK
| | - Sheena McCormack
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.,Imperial College, London, UK
| | - Jameel Khawam
- Blood Safety, Hepatitis, STIs and HIV Directorate, Centre for Infections, Public Health England, London, UK
| | - Sophie Nash
- Blood Safety, Hepatitis, STIs and HIV Directorate, Centre for Infections, Public Health England, London, UK
| | - Dana Ogaz
- Blood Safety, Hepatitis, STIs and HIV Directorate, Centre for Infections, Public Health England, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STIs and HIV Directorate, Centre for Infections, Public Health England, London, UK
| | - Keerti Gedela
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Diarmuid Nugent
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheel Patel
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Tara Suchak
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Victoria Tittle
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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19
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Beayni NE, Hamad L, Nakad C, Keleshian S, Yazbek SN, Mahfouz R. Molecular prevalence of eight different sexually transmitted infections in a Lebanese major tertiary care center: impact on public health. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2021; 12:16-23. [PMID: 34093967 PMCID: PMC8166729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sexually transmitted diseases (STD) are caused by a variety of pathogens transmitted by sexual activity. Untreated infections can cause major complications with a substantial high cost on health sector. With the development of molecular techniques, STD screening became easier with a high sensitivity and specificity. OBJECTIVES In Lebanon, official data regarding STD trends are scarce. This study elucidates the STD molecular profile at a tertiary care center, American University of Beirut Medical Center (AUBMC), its distribution among gender and age groups, with a comparison to international studies. METHODS A retrospective data analysis was conducted on all STD panels performed at AUBMC from January 2017 till December 2019 to determine the molecular prevalence of eight different sexually transmitted organisms. RESULTS Our samples belonged to 248 females (41.5%) and 349 males (58.5%). Only 53.5% of the samples tested positive for one or more organisms. Ureaplasma urealyticum/parvum was found to be the most common pathogen (49.3%), followed by Gardenerella vaginalis (33.5%), Chlamydia trachomatis (5.36%), Mycoplasma genitalium (5.16%), Neisseria gonorrhea (2.5%), Herpes simplex virus (2.5%), and Trichomonas vaginalis (1.39%). Age was distributed between 5 and 80 years old. Regarding the pathogen's distribution among gender, Ureaplasma urealyticum/parvum, Herpes simplex virus, and Gardenerella vaginalis were more common in females, the rest was more detected in males. CONCLUSION Data will be of great importance for clinicians, in terms of diagnosis and treatment. It will help adopting an evidence based STI control programs in Lebanon, and it is essential for future larger studies and sexual health awareness programs.
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Affiliation(s)
- Nancy El Beayni
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical CenterBeirut, Lebanon
| | - Lina Hamad
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, American University of BeirutBeirut, Lebanon
| | - Christine Nakad
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical CenterBeirut, Lebanon
| | - Sose Keleshian
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical CenterBeirut, Lebanon
| | - Soha N Yazbek
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, American University of BeirutBeirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical CenterBeirut, Lebanon
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20
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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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21
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Rönn MM, Menzies NA, Gift TL, Chesson HW, Trikalinos TA, Bellerose M, Malyuta Y, Berruti A, Gaydos CA, Hsu KK, Salomon JA. Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis. Clin Infect Dis 2021; 70:1816-1823. [PMID: 31504314 PMCID: PMC7048627 DOI: 10.1093/cid/ciz519] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear. Methods Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay. Results In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9–8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1–2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000–22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%. Conclusions POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.
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Affiliation(s)
- Minttu M Rönn
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nicolas A Menzies
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas L Gift
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harrell W Chesson
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom A Trikalinos
- Department of Health Services Policy & Practice, Brown University, Providence, Rhode Island
| | - Meghan Bellerose
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yelena Malyuta
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrés Berruti
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, Maryland
| | - Katherine K Hsu
- Division of Sexually Transmitted Disease Prevention & Human Immunodeficiency Virus/AIDS Surveillance, Massachusetts Department of Public Health, Boston
| | - Joshua A Salomon
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, California
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22
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Pike C, Celum C, Bekker LG. Adolescent healthcare: I'm Lovin' it. South Afr J HIV Med 2020; 21:1147. [PMID: 33240538 PMCID: PMC7670027 DOI: 10.4102/sajhivmed.v21i1.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Carey Pike
- Desmond Tutu Health Foundation, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, United States of America.,Department of Medicine, University of Washington, Seattle, United States of America.,Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu Health Foundation, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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23
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Safety and Effectiveness of Same-Day Chlamydia trachomatis and Neisseria gonorrhoeae Screening and Treatment Among Gay, Bisexual, Transgender, and Homeless Youth in Los Angeles, California, and New Orleans, Louisiana. Sex Transm Dis 2020; 47:19-23. [PMID: 31688719 DOI: 10.1097/olq.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gay, bisexual, transgender, and homeless youth are at risk of sexually transmitted infections. As part of an adolescent human immunodeficiency virus prevention study, we provided same-day Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and treatment. We aimed to evaluate the feasibility and effectiveness of same-day CT and NG treatment on the proportion of participants receiving timely treatment. METHODS We recruited adolescents with high sexual risk behaviors aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, and community health centers in Los Angeles, California, and New Orleans, Louisiana from May 2017 to June 2019. Initially, participants were offered point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and referral to another clinic for treatment. After March 2018 in Los Angeles and November 2018 in New Orleans, we provided same-day treatment (and partner treatment packs) for study participants. We measured the proportion of participants who received same-day treatment and the median time to treatment. We collected frequency of partner treatment and any reported adverse treatment-related events. RESULTS The proportion of participants receiving same-day CT and NG treatment increased from 3.6% (5/140) to 21.1% (20/95; Δ17.5%; 95% confidence interval, 9.2%-26.9%) after implementation of same-day testing and treatment. The median time to treatment decreased from 18.5 to 3 days. Overall, 36 participants took a total of 48 partner treatment packs. There were no reported treatment-related adverse events. CONCLUSIONS Providing sexually transmitted infection treatment to adolescents at the same visit as testing is feasible and safe, and can increase the proportion of individuals receiving timely treatment.
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24
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Patients Are Willing to Wait for Rapid Sexually Transmitted Infection Results in a University Student Health Clinic. Sex Transm Dis 2020; 47:67-69. [PMID: 31856075 DOI: 10.1097/olq.0000000000001083] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the acceptability and feasibility of using a 30-minute chlamydia/gonorrhea test in a student health clinical setting. One hundred eight students were enrolled and 89.4% were willing to wait up to 20 minutes beyond the conclusion of their routine visit. The average amount of time added per clinic visit was less than 11 minutes. Patient and staff satisfaction were high.
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25
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Rowan SE, Patel RR, Schneider JA, Smith DK. Same-day prescribing of daily oral pre-exposure prophylaxis for HIV prevention. Lancet HIV 2020; 8:e114-e120. [PMID: 33128874 DOI: 10.1016/s2352-3018(20)30256-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV transmission but remains underutilised globally. Same-day PrEP prescribing and medication provision is an emerging implementation approach. The experiences of the three same-day PrEP programmes support the feasibility of the approach. Key elements of safe and effective same-day PrEP programmes include the ability to order laboratory tests at the time of the clinical visit and the ability to contact patients when laboratory results are available. Same-day PrEP has the potential to alleviate the attrition seen in usual care between initial evaluation and receipt of a PrEP prescription. A widespread application of same-day prescribing will be needed to assess its effect on PrEP usage.
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Affiliation(s)
| | - Rupa R Patel
- Division of Infectious Diseases, Washington University in St Louis, St Louis, MO, USA.
| | | | - Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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26
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Atim M, Girometti N, Hyndman I, McOwan A, Whitlock G, Gedela K, McCormack S, Nugent D, Patel S, Suchak T, Tittle V. Post‐exposure prophylaxis in the era of pre‐exposure prophylaxis. HIV Med 2020; 21:668-670. [DOI: 10.1111/hiv.12917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M Atim
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - N Girometti
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - I Hyndman
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - A McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - G Whitlock
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Keerti Gedela
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | | | - Diarmuid Nugent
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Sheel Patel
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Tara Suchak
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Victoria Tittle
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
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27
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Hansen GT. Point-of-Care Testing in Microbiology: A Mechanism for Improving Patient Outcomes. Clin Chem 2020; 66:124-137. [PMID: 31811002 DOI: 10.1373/clinchem.2019.304782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasingly, demands for improved health and quality of life conflict with the realities of delivering healthcare in an environment of higher expenditures, adherence to test utilization, and patient-centered experience. Patient-centered care is commonly identified as a goal of healthcare delivery, and yet healthcare systems struggle with delivery of care to patients, often failing to identify the seriously ill and capitalize on the predictive qualities of diagnostic testing. Point-of-care (POC) testing provides access to rapid diagnosis and predictive value key to realizing patient outcomes. An evaluation of cost-effective models and the clinical impact of POC testing for clinical microbiology is needed. CONTENT Accurate and rapid diagnostics have the potential to affect healthcare decisions to a degree well out of proportion to their cost. Contemporary healthcare models increasingly view POC testing as a mechanism for efficient deployment of healthcare. POC testing can deliver rapid diagnosis in environments where testing results can be used to direct management during patient visits and in areas where centralized laboratory testing may limit access to care. Nucleic acid assays, designed for POC testing, can match, or exceed, the sensitivity of conventional laboratory-based testing, eliminating the need for confirmation testing. Here, the goals of POC testing for microbiology, applications, and technologies, as well as outcomes and value propositions, are discussed. SUMMARY The combination of rapid reporting, an increasing array of organisms capable of causing disease, actionable resulting, and improved patient outcomes is key in the evolution of POC testing in clinical microbiology.
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Affiliation(s)
- Glen T Hansen
- Microbiology and Molecular Diagnostics, Hennepin County Medical Center, Department of Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN.,Department of Pathology & Laboratory Medicine University of Minnesota, School of Medicine.,Department of Medicine, Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN
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28
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Mohiuddin S, Gardiner R, Crofts M, Muir P, Steer J, Turner J, Wheeler H, Hollingworth W, Horner PJ. Modelling patient flows and resource use within a sexual health clinic through discrete event simulation to inform service redesign. BMJ Open 2020; 10:e037084. [PMID: 32641336 PMCID: PMC7348479 DOI: 10.1136/bmjopen-2020-037084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Continuous improvement in the delivery of health services is increasingly being demanded in the UK at a time when budgets are being cut. Simulation is one approach used for understanding and assessing the likely impact of changes to the delivery of health services. However, little is known about the usefulness of simulation for analysing the delivery of sexual health services (SHSs). We propose a simulation method to model and evaluate patient flows and resource use within an SHS to inform service redesign. METHODS We developed a discrete event simulation (DES) model to identify the bottlenecks within the Unity SHS (Bristol, UK) and find possible routes for service improvement. Using the example of the introduction of an online service for sexually transmitted infection (STI) and HIV self-sampling for asymptomatic patients, the impact on patient waiting times was examined as the main outcome measure. The model included data such as patient arrival time, staff availability and duration of consultation, examination and treatment. We performed several sensitivity analyses to assess uncertainty in the model parameters. RESULTS We identified some bottlenecks under the current system, particularly in the consultation and treatment queues for male and female walk-in patients. Introducing the provision of STI and HIV self-sampling alongside existing services decreased the average waiting time (88 vs 128 min) for all patients and reduced the cost of staff time for managing each patient (£72.64 vs £88.74) compared with the current system without online-based self-sampling. CONCLUSIONS The provision of online-based STI and HIV self-sampling for asymptomatic patients could be beneficial in reducing patient waiting times and the model highlights the complexities of using this to cut costs. Attributing recognition for any improvement requires care, but DES modelling can provide valuable insights into the design of SHSs ensuing in quantifiable improvements. Extension of this method with the collection of additional data and the construction of more informed models seems worthwhile.
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Affiliation(s)
- Syed Mohiuddin
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca Gardiner
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Muir
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Jonathan Steer
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Helen Wheeler
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - William Hollingworth
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Paddy J Horner
- Population Health Sciences, University of Bristol, Bristol, UK
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Health Protection Research Unit, University of Bristol, Bristol, UK
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29
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Population and Individual-Level Effects of Human Immunodeficiency Virus Preexposure Prophylaxis on Sexually Transmitted Infection Epidemics Among Men Who Have Sex With Men. Sex Transm Dis 2020; 46:759-761. [PMID: 31764765 PMCID: PMC10174221 DOI: 10.1097/olq.0000000000001080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Fisk KM, Derouin A, Holm G, Hicks L. Getting it Right: The Impact of Point-of-Care Testing for Gonorrhea and Chlamydia in the Urgent Care Setting. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Fernández-Huerta M, Zarzuela F, Barberá MJ, Arando M, Esperalba J, Rodríguez V, Vall M, Falcó V, García-Pérez JN, Pumarola T, Espasa M, Sulleiro E. Sexual Transmission of Intestinal Parasites and Other Enteric Pathogens among Men Who Have Sex with Men Presenting Gastrointestinal Symptoms in an STI Unit in Barcelona, Spain: A Cross-Sectional Study. Am J Trop Med Hyg 2020; 101:1388-1391. [PMID: 31549611 DOI: 10.4269/ajtmh.19-0312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sexually transmitted infections (STIs) are a major problem worldwide. In addition, the spectrum of STIs is now expanding, including parasitic, bacterial, and viral infections. The study retrospectively describes the presence of enteric pathogens among 73 patients with gastrointestinal symptoms of enteritis and proctocolitis attending to an STI unit in Barcelona, Spain, between 2015 and 2016. Only patients investigated for intestinal parasitic infections were included in the study. Different diagnostic procedures were established for the detection of parasites, bacterial enteropathogens, and other STI agents. Entamoeba histolytica was the most prevalent pathogen in our cohort (20.5%), especially among individuals with proctocolitis. Contrarily, Giardia intestinalis was detected in 11.0% of patients, only associated with enteritis cases. Polymicrobial infections were common in our study (45.2%). Of note, 55.6% of shigellosis cases were coinfected with E. histolytica. The investigation highlights the importance of including parasites as differential gastrointestinal diagnosis, disregarding travel history, particularly among risk populations.
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Affiliation(s)
- Miguel Fernández-Huerta
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Francesc Zarzuela
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - María-Jesús Barberá
- University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliana Esperalba
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Virginia Rodríguez
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Martí Vall
- Infectious Diseases Department, Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge-Néstor García-Pérez
- Infectious Diseases Department, Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Mateu Espasa
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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López de Munain J. El desafío de las infecciones de transmisión sexual en el siglo xxi: el tratamiento es la prevención. Med Clin (Barc) 2020; 154:218-220. [DOI: 10.1016/j.medcli.2019.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
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Taylor-Robinson D, Horner P, Pallecaros A. Diagnosis of some genital-tract infections: part 2. Molecular tests and the new challenges. Int J STD AIDS 2020; 31:198-207. [PMID: 32009570 DOI: 10.1177/0956462419890526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Promptly and accurately diagnosing genital-tract infections is key to instituting appropriate treatment and control of sexually transmitted infections (STIs). Ano-genital tract testing for STIs in the last two decades has not entirely moved away from insensitive methods but it is now at least dominated by highly sensitive molecular methods. These tests can be ordered through the internet for use at home, with self-taken specimens then returned, usually by post, to a clinic or laboratory for testing. The increasing ease of access of the public to this situation, together with increasing on-line health-seeking behaviour, has resulted in a gap between commercial and NHS management pathways for STIs. Crucially, patients who order multiplex test kits on-line for use at home, and other non-specialists, may not realize that it is worthwhile testing only for Neisseria gonorrhoeae, Chlamydia trachomatis, and possibly Trichomonas vaginalis, and Mycoplasma genitalium if the person is symptomatic or their current partner is infected. The detection and recommended treatment of micro-organisms which to some extent are part of the genital-tract microbiome, such as Mycoplasma hominis, Ureaplasma spp. or Gardnerella vaginalis, which do not cause symptoms in the majority of those infected, cannot be recommended. We argue that a shift from specialist-led to patient- and non-specialist-led STI management, in the presence of a clinical leadership vacuum, has increased the risk of inappropriate and unnecessary treatment which will drive macrolide, tetracycline and metronidazole antimicrobial resistance. However, in the past 5–6 years several groups have been able to show the value of on-line testing as a consequence of targeting the most important micro-organisms and using molecular tests to allow rapid and appropriately informed treatment. This should herald a brighter future, although there is still a need for leadership to expertly guide commercial and NHS sectors alike. In turn, this requires dedicated genito-urinary medicine commissioning to be maintained at a time when it appears to be most under threat.
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Affiliation(s)
- David Taylor-Robinson
- Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick Horner
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK.,Unity Sexual Health, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Anna Pallecaros
- Department of Genito-urinary Medicine, Princess Grace Hospital, London, UK
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Whitlock G, Scarfield P. HIV diagnoses continue to fall at 56 Dean Street. EClinicalMedicine 2020; 19:100263. [PMID: 32055792 PMCID: PMC7005422 DOI: 10.1016/j.eclinm.2020.100263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/29/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022] Open
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Semchenko EA, Chen X, Thng C, O'Sullivan M, Seib KL. Gonorrhoea: past, present and future. MICROBIOLOGY AUSTRALIA 2020. [DOI: 10.1071/ma20055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The sexually transmitted infection (STI) gonorrhoea is an ancient human disease caused by the Gram-negative bacterial pathogen Neisseria gonorrhoeae. Despite decades of research focused on preventing, diagnosing, and treating gonorrhoea, it remains a major global health concern due to its high prevalence, high rates of asymptomatic cases, the severe sequelae that can result from untreated infections, and the increasing difficulty in treating infections caused by multi-drug resistant strains of N. gonorrhoeae. It is estimated that there are more than 87 million cases of gonorrhoea worldwide each year, and the WHO, CDC and Australian National Antimicrobial Resistance (AMR) Strategy have prioritised N. gonorrhoeae as an urgent public health threat for which new therapeutics and a vaccine are needed.
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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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Wesolowski L, Fowler W, Luo W, Sullivan V, Masciotra S, Smith T, Rossetti R, Delaney K, Oraka E, Chavez P, Ethridge S, Switzer WM, Owen SM. Evaluation of the performance of the Cepheid Xpert HIV-1 Viral Load Assay for quantitative and diagnostic uses. J Clin Virol 2020; 122:104214. [PMID: 31835210 PMCID: PMC11089535 DOI: 10.1016/j.jcv.2019.104214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/27/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cepheid's Xpert HIV-1 Viral Load (Xpert VL), a simplified, automated, single-use quantitative assay used with the GeneXpert System, is not FDA approved. OBJECTIVES Using stored plasma, we conducted a study to assess the ability of Xpert VL to quantify viral load relative to the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 (Cobas VL) and to examine the use of the Xpert VL as a qualitative diagnostic test. STUDY DESIGN Following HIV-1 viral stock dilutions, we conducted a probit analysis to identify the concentration where 95 % of specimens had quantified VLs. We also examined Xpert and Cobas log VL correlation in linearity panels; compared the proportion of 220 seroconverter specimens with virus detected using McNemar's test; and tested specimens from persons with untreated, established HIV-1 infection (n=149) and uninfected persons (n=497). Furthermore, we examined Xpert VL as a qualitative test in seroconverter specimens with early (n=20) and later (n=68) acute infections. RESULTS At 1.80 log10 copies/mL, 95 % of specimens had quantifiable virus using Xpert VL. Xpert and Cobas VLs were highly correlated (R2=0.994). The proportion of seroconverter specimens with virus detected using Cobas and with Xpert VL was not statistically different (p=0.0578). Xpert VL detected 97.9 % of established infections, and specificity was 99.80 % (95 % CI 98.87%-99.99%). Xpert VL detected 90 % and 98.5 % of early and later acute infections, respectively. CONCLUSIONS If approved, Xpert VL could allow U.S. laboratories that cannot bring on large, complex testing platforms to conduct HIV monitoring. An approval for diagnostic use may provide timely identification of HIV infections.
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Affiliation(s)
- Laura Wesolowski
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - William Fowler
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Wei Luo
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Vickie Sullivan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Silvina Masciotra
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Tara Smith
- Oak Ridge Institute for Science and Education at the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Rebecca Rossetti
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kevin Delaney
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Emeka Oraka
- ICF at the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Pollyanna Chavez
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Steven Ethridge
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - William M Switzer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - S Michele Owen
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Girometti N, McCormack S, Devitt E, Gedela K, Nwokolo N, Patel S, Suchak T, McOwan A, Whitlock G. Evolution of a pre-exposure prophylaxis (PrEP) service in a community-located sexual health clinic: concise report of the PrEPxpress. Sex Health 2019; 15:598-600. [PMID: 30249318 DOI: 10.1071/sh18055] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022]
Abstract
Screening and treatment of sexually transmissible infections, including HIV, are free in the UK nations; pre-exposure prophylaxis (PrEP) became free in England in October 2017 through the PrEP Impact trial. Doctor-led PrEP clinics started at 56 Dean Street in September 2015, with the drug purchased privately at full price. The service was expanded to other staff to support initiation and monitoring of increasing numbers of attendees purchasing PrEP from online pharmacies. Nonetheless, when the clinic was given a target of 1700 for the PrEP Impact trial, it was clear this could not be achieved in a timely manner through 56 Dean Street alone. To prepare for the trial, all staff with HIV testing competencies were trained in good clinical practice and trial-specific procedures, and a patient group directive was approved to facilitate nurse prescribing and dispensing. Electronic pro formas to capture eligibility for starting or continuing PrEP were adapted for the Dean Street Express clinic, with some information collected directly from service users using touch screens. These interventions, together with an update to the 2016 information leaflet developed by the community, enabled enrolment and follow-up of 1700 participants in 4 months. PrEP advice and monitoring were easily accommodated in the 56 Dean Street sexual health service, but did require additional training and approval for nurse prescribing and dispensing drug in order to achieve the target, which still fell short of the demand.
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Affiliation(s)
- Nicolo Girometti
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Sheena McCormack
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Emma Devitt
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Keerti Gedela
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Nneka Nwokolo
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Sheel Patel
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Tara Suchak
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Alan McOwan
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
| | - Gary Whitlock
- 56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, W1D 6AQ, London, UK
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Wi TEC, Ndowa FJ, Ferreyra C, Kelly‐Cirino C, Taylor MM, Toskin I, Kiarie J, Santesso N, Unemo M. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J Int AIDS Soc 2019; 22 Suppl 6:e25343. [PMID: 31468679 PMCID: PMC6715950 DOI: 10.1002/jia2.25343] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point-of-care tests (POCTs), including those in the pipeline, to diagnose STIs in resource-constrained settings. METHODS We prioritized updating the systematic review and meta-analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer-reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. RESULTS AND DISCUSSIONS The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low-cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near-patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource-constrained settings. This is driving the development of lower cost solutions. CONCLUSIONS The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource-constrained settings to support the uptake of aetiological diagnosis and treatment.
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Affiliation(s)
- Teodora EC Wi
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | | | | | | | - Melanie M Taylor
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Igor Toskin
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - James Kiarie
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Nancy Santesso
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityOntarioCanada
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIsDepartment of Laboratory MedicineFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Rietmeijer CA. Improving care for sexually transmitted infections. J Int AIDS Soc 2019; 22 Suppl 6:e25349. [PMID: 31468743 PMCID: PMC6715945 DOI: 10.1002/jia2.25349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/21/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Rising rates of reported sexually transmitted infections (STIs) in the US and Europe are a public health priority and require a public health response. The diagnosis and treatment of STIs have been the cornerstone of STI control and prevention for many decades and, historically, publicly funded STI clinics have played a central role in the provision of STI care. Innovations in non-invasive diagnostic techniques, especially nucleic acid amplification tests in the mid-1990s, have facilitated the expansion of STI testing and treatment outside traditional STI clinics, including primary care, family planning, school-based health, outreach, corrections, emergency departments and HIV prevention and care settings. As a result, the continued need for categorical STI clinics has been debated. In this Commentary, we discuss how practice can be improved at each level of STI care. DISCUSSION STI practice improvement plans should be tailored to the strengths of each care setting. Thus, in primary care, the focus should be on improving STI screening rates, the provision of hepatitis B and human papillomavirus vaccines and, in jurisdictions where this is legal, expedited partner therapy for gonorrhoea and chlamydia. Extragenital (pharyngeal and rectal) testing for gonorrhoea and chlamydia should be available in settings serving populations more vulnerable to STI acquisition at these anatomical sites, including men who have sex with men. In family planning settings with a mostly female patient population, there are opportunities to serve male partners with both contraceptive and STI services. STI screening rates can also be improved in other settings serving populations at increased risk for STIs, including school-based clinics, emergency departments, correctional health facilities and providers of HIV care and prevention. These improvements are predominantly logistical in nature and not dependent on extensive STI clinical expertise. While some providers in these settings may have the clinical knowledge and skills to evaluate symptomatic patients, many do not, and STI speciality clinics must be available for consultation and referral and evolve from "safety net" providers of last resort to STI centres of excellence. CONCLUSIONS A tailored practice improvement plan can be envisioned to achieve an optimally functioning STI care continuum.
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Affiliation(s)
- Cornelis A Rietmeijer
- Rietmeijer ConsultingDenverCOUSA
- Colorado School of Public HealthUniversity of ColoradoDenverCOUSA
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Bristow CC, Morris SR, Little SJ, Mehta SR, Klausner JD. Meta-analysis of the Cepheid Xpert ® CT/NG assay for extragenital detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Sex Health 2019; 16:314-319. [PMID: 31296280 PMCID: PMC6954977 DOI: 10.1071/sh18079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
Abstract
Background Most studies evaluating extragenital testing performance for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) detection by the Xpert® CT/NG show high per cent agreement with comparison assays; however, the precision around positive per cent agreement is low and thus the values that have been reported are not highly informative. Therefore, a systematic review was conducted and data from five studies were combined to better assess positive per cent agreement. METHODS The literature indexed on PubMed.gov was searched. Included studies were those that were an evaluation of the Xpert CT/NG assay with rectal and/or pharyngeal specimen types compared with another nucleic acid amplification test (NAAT), the Aptima transcription mediated amplification assay. A full Bayesian method was used for bivariate fixed-effect meta-analysis of positive and negative per cent agreement and pooled estimates (and 95% confidence intervals (CI)) were presented for each. RESULTS The pooled positive and negative per cent agreement for detection of CT in rectal specimens was 89.72% (95% CI: 84.97%, 93.64%) and 99.23% (95% CI: 98.74%, 99.60%), and in pharyngeal specimens, they were 89.96% (95% CI: 66.38%, 99.72%) and 99.62% (95% CI: 98.95%, 99.95%) respectively. For NG detection in rectal specimens, the pooled positive and negative per cent agreement was 92.75% (95% CI: 87.91%, 96.46%) and 99.75% (95% CI: 99.46%, 99.93%), and in pharyngeal specimens, they were 92.51% (95% CI: 85.84%, 97.18%) and 98.56% (95% CI: 97.69%, 99.23%) respectively. CONCLUSIONS It was found that the Xpert CT/NG assay performed similarly to the Aptima transcription mediated amplification assay for the detection of CT and NG in extragenital specimens. The Xpert assay has the benefit of providing faster results at the point-of-care, thus reducing the turnaround time for results, potentially enabling same-day treatment.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; and Corresponding author.
| | - Sheldon R Morris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
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Fernández-Huerta M, Espasa M. Mycoplasma genitalium co-infection with Chlamydia trachomatis and Neisseria gonorrhoeae among asymptomatic patients: the silent wick for macrolide resistance spread. Sex Transm Infect 2019; 95:391. [DOI: 10.1136/sextrans-2018-053848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/04/2022] Open
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Cushman TA, Graves SK, Little SJ. Attitudes and Preferences Regarding the Use of Rapid Self-Testing for Sexually Transmitted Infections and HIV in San Diego Area Men Who Have Sex With Men. Open Forum Infect Dis 2019; 6:ofz043. [PMID: 30906798 PMCID: PMC6424479 DOI: 10.1093/ofid/ofz043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/03/2019] [Indexed: 01/04/2023] Open
Abstract
Background Sexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake. Methods MSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test. Results HIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age <45 years more frequently citing inconvenience as a barrier to testing (HIV: 50.9% vs 17.4%, P = .010; STI: 58.3% vs 31.8%, P = .070). Conclusions Although additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach.
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Affiliation(s)
- Teresa A Cushman
- Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado
| | - Susannah K Graves
- Division of Infectious Diseases, University of California San Diego, San Diego, California
| | - Susan J Little
- Division of Infectious Diseases, University of California San Diego, San Diego, California
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Sukhija-Cohen AC, Beymer MR, Engeran-Cordova W, Bolan RK. From Control to Crisis: The Resurgence of Sexually Transmitted Diseases. Sex Transm Dis 2019; 46:e8-e10. [PMID: 30640863 PMCID: PMC6336105 DOI: 10.1097/olq.0000000000000960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Prevention and treatment of sexually transmitted infections in high-risk individuals, including patients with HIV infection. Enferm Infecc Microbiol Clin 2018; 37:117-126. [PMID: 30591390 DOI: 10.1016/j.eimc.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/21/2022]
Abstract
Sexually transmitted infections are a global public health problem both due to their high prevalence and due to their morbidity. A rapid and precise diagnosis is key to establishing appropriate targeted treatment and also to decreasing dissemination of these diseases among the high-risk population. To perform adequate testing for sexually transmitted infections, many of which are asymptomatic, it is necessary to carry out the diagnostic testing according to the clinical and behavioural indicators. The preventive advice must be comprehensive and personalised. The incorporation and improvement of molecular biology techniques is a very useful tool, complementing the classic techniques, such as microscopy and culture. Correct diagnosis will allow for an adequate treatment from the beginning, preventing the possible onset and dissemination of antibiotic resistance, an emerging problem in the current context of sexually transmitted infections.
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