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Hart TA, Noor SW, Tavangar F, Zahran A, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Lachowsky N, Sang JM, Palma PA, Zhang T, Dvorakova M, Cox J, Moore DM. Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men. Sex Transm Dis 2024; 51:178-185. [PMID: 38412464 DOI: 10.1097/olq.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUNDS Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities. METHODS We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus. RESULTS Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV. CONCLUSIONS The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.
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Affiliation(s)
| | | | | | - Adhm Zahran
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jordan M Sang
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Paolo A Palma
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Terri Zhang
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Yeung A, Lisk R, Rana J, Guiang CB, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH, Burchell AN. Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study. J Med Internet Res 2023; 25:e40477. [PMID: 37384393 PMCID: PMC10365575 DOI: 10.2196/40477] [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: 06/29/2022] [Revised: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. OBJECTIVE Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. METHODS The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ≥60% within a ±1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. RESULTS Of the community experts (CEs), 84% (43/51) completed all rounds; 19% (8/43) were living with HIV; 37% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95%), express testing (38/43, 88%), routine testing (36/43, 84%), an online booking app (36/43, 84%), online-based testing (33/43, 77%), and nurse-led testing (31/43, 72%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77% (37/48) completed all rounds; 59% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68%, to 39/39, 100%) but not for provider alerts (7/37, 19%) and provider audit and feedback (6/37, 16%). Express testing, online-based testing, and nurse-led testing were prioritized by >95% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. CONCLUSIONS Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13801.
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Affiliation(s)
- Anna Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | | | - Jayoti Rana
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | | | | | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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3
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Previous Syphilis Not Associated With Neurocognitive Outcomes in People Living With Human Immunodeficiency Virus in Ontario, Canada. Sex Transm Dis 2023; 50:34-41. [PMID: 36150077 DOI: 10.1097/olq.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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MacKinnon KR, Grewal R, Tan DH, Rousseau R, Maxwell J, Walmsley S, MacPherson PA, Rachlis A, Andany N, Mishra S, Allen VG, Burchell AN. Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial. BMC Health Serv Res 2021; 21:625. [PMID: 34193138 PMCID: PMC8243864 DOI: 10.1186/s12913-021-06602-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. METHODS Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. RESULTS A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. CONCLUSIONS Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02019043; registered December 23, 2013.
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Affiliation(s)
- Kinnon R MacKinnon
- School of Social Work, York University, 4700 Keele Street, M3J 1P3, Toronto, Ontario, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
| | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Research Institute, University Health Network, Toronto, Canada
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, 1 King's College Cir, M5S 1A8, Toronto, Ontario, Canada
| | - John Maxwell
- AIDS Committee of Toronto, 543 Yonge Street, 4th floor, M4Y 1Y5, Toronto, Ontario, Canada
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital, University Health Network, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, 501 Smyth Road, L1H 8L6, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Anita Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, 661 University Avenue, M5G 1M1, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
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Burchell AN, Tan DHS, Grewal R, MacPherson PA, Walmsley S, Anita R, Andany N, Mishra S, Gardner SL, Raboud J, Fisman D, Cooper C, Gough K, Maxwell J, Rourke SB, Rousseau R, Mazzulli T, Salit IE, Allen VG. Routinised Syphilis Screening among Men Living with HIV: A stepped wedge cluster randomised controlled trial. Clin Infect Dis 2021; 74:846-853. [PMID: 34175944 DOI: 10.1093/cid/ciab582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Frequent syphilis screening may increase early detection and decrease transmission. We implemented an opt-out clinic-based intervention pairing syphilis tests with routine HIV viral load testing. The primary objective was to determine the degree to which this intervention increased the detection of early syphilis. METHODS The Enhanced Syphilis Screening among HIV-positive Men (ESSAHM) Trial was a stepped wedge cluster-randomised controlled trial involving four urban HIV clinics in Ontario, Canada, from 2015 to 2017. Population: HIV-positive adult males. Intervention (I): standing orders for syphilis serological testing with viral loads. Control (C): usual practice. Outcome: early syphilis diagnosis. We obtained test results via linkage with the centralized provincial laboratory and defined cases using a standardized clinical worksheet and medical chart review. We employed a generalized linear mixed model with a logit link to estimate odds ratios (OR) and 95% confidence intervals (CI) of the intervention. FINDINGS 3,895 men were followed over 7,471 person-years (PY). The mean number of syphilis tests increased from 0.53 to 2.02 tests per person per year. There were 217 new diagnoses of syphilis (C: 81; I: 136), for which 147 (68%) were cases of early syphilis (C:61 (75%); I:86 (63%)). The annualized proportion with newly-detected early syphilis increased from 0.009 to 0.032 with implementation of the intervention; the corresponding time-adjusted OR was 1.25 (CI 0.71, 2.20). INTERPRETATION The implementation of standing orders for syphilis testing with HIV viral loads was feasible and increased testing yet produced less-than-expected increases in case detection compared to past uncontrolled pre-post trials.
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Affiliation(s)
- Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Darrell H S Tan
- Department of Medicine, University of Toronto, Toronto, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada.,Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rachlis Anita
- Department of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Medical Science and Institute of Health Policy, Management, and Evaluation, University of Toronto
| | - Sandra L Gardner
- Baycrest, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Kevin Gough
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada, Toronto, Ontario, Canada
| | | | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, King's College Cir, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Public Health Ontario Laboratories, Public Health Ontario
| | - Irving E Salit
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, Ontario, Canada
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6
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Grewal R, Allen VG, Bayoumi AM, Gardner SL, Kaul R, Mazzulli T, Moravan V, OʼNeill T, Raboud J, Rourke SB, Tan DHS, Burchell AN. Brief Report: Syphilis Coinfection Is Not Associated With an Increased Risk of Virologic Failure Among HIV-Positive Men Who Have Sex With Men on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2019; 80:585-589. [PMID: 30730358 DOI: 10.1097/qai.0000000000001962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incidence of syphilis continues to increase among HIV-positive men who have sex with men (MSM) in Ontario. Our objective was to determine the effect of acute syphilis on virologic failure (VF) among virally suppressed HIV-positive MSM taking antiretroviral therapy (ART) and determine if the relationship is confounded by drug use. SETTING The OHTN Cohort Study is a voluntary cohort of people receiving HIV care in Ontario. Syphilis and viral load (VL) data were retrieved via linkage with the provincial laboratory. METHODS Analyses included 2632 MSM from 2008 to 2015, on ART, with ≥1 questionnaire and 2 consecutive VL of <50 copies per milliliter 6 months apart. VF was defined as (1) VL of ≥1000 copies per milliliter or (2) 2 consecutive VLs of ≥200 copies per milliliter ≥1 month apart. We modeled acute syphilis as a time-varying covariate on VF using Poisson regression. Time-varying drug use was assessed for confounding using an iterative process where potential confounders were removed and then reintroduced into the model. Our model allowed for repeat observations using generalized estimating equations. RESULTS VF incidence was 3.5 per 100 person-years [95% confidence interval (CI): 3.4 to 4.2]. The rate ratio for VF for acute syphilis was 1.5 (95% CI: 0.9 to 2.4) in the unadjusted model; 1.6 (95% CI: 1.0 to 2.4) in the model adjusted for age, education, region, and income; and 1.2 (95% CI: 0.7 to 1.9) in the final model with additional adjustment for drug use. CONCLUSIONS Acute syphilis was not associated with VF among virologically suppressed MSM on ART. Consequently, ART may still reduce HIV transmission risk to sexual partners.
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Affiliation(s)
- Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra L Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada.,Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Veronika Moravan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tyler OʼNeill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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7
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Burchell AN, Lisk R, Yeung A, Rana J, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Guiang CB, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH. Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada. JMIR Res Protoc 2019; 8:e13801. [PMID: 31274111 PMCID: PMC6637728 DOI: 10.2196/13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/17/2023] Open
Abstract
Background HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men. Objective The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada. Methods Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority. Results On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers. Conclusions Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern. International Registered Report Identifier (IRRID) PRR1-10.2196/13801
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada
| | | | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jayoti Rana
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Hassle Free Clinic, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Darrell Hs Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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8
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Eaton EF, Joe W, Kilgore ML, Muzny CA. Reverse syphilis screening algorithm fails to demonstrate cost effectiveness in persons living with HIV. Int J STD AIDS 2017; 29:563-567. [PMID: 29173098 DOI: 10.1177/0956462417743409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the reverse syphilis screening algorithm is more efficient than the traditional algorithm, it may lead to exorbitant costs for health systems serving persons living with HIV needing annual syphilis screening. Alternatively, the traditional screening algorithm is cost saving in many scenarios.
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Affiliation(s)
- Ellen F Eaton
- 1 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Winston Joe
- 2 School of Medicine, 9967 University of Alabama School of Medicine , University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith L Kilgore
- 3 School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina A Muzny
- 1 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Tuite AR, Shaw S, Reimer JN, Ross CP, Fisman DN, Mishra S. Can enhanced screening of men with a history of prior syphilis infection stem the epidemic in men who have sex with men? A mathematical modelling study. Sex Transm Infect 2017; 94:105-110. [PMID: 28705938 DOI: 10.1136/sextrans-2017-053201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the transmission impact of using prior syphilis infection to guide a focused syphilis screening intervention among men who have sex with men (MSM). METHODS We parameterised a deterministic model of syphilis transmission in MSM to reflect the 2011-2015 syphilis outbreak in Winnipeg, Canada. Enhanced screening of 75% of men with prior syphilis every 3 months (A) was compared with distributing equivalent number tests to all MSM (B) or those with the highest partner number (C). We compared early syphilis incidence, diagnoses and prevalence after 10 years, relative to a base case of 30% of MSM screened annually. RESULTS Strategy A was expected to avert 52% of incident infections, 44% of diagnosed cases and reduce early syphilis prevalence by 89%. Strategy B had the least impact. Strategy C was most effective, averting 59% of incident cases. When screening frequency was semiannual or annual, strategy A was the most effective. CONCLUSIONS Enhanced screening of MSM with prior syphilis may efficiently reduce transmission, especially when identification of high-risk men via self-reported partner numbers or high-frequency screening is difficult to achieve.
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Affiliation(s)
- Ashleigh R Tuite
- T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Souradet Shaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Joss N Reimer
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Craig P Ross
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - David N Fisman
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
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10
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Roberts CP, Klausner JD. Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men. Expert Rev Anti Infect Ther 2016; 14:1037-1046. [PMID: 27626361 DOI: 10.1080/14787210.2016.1236683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Syphilis and human immunodeficiency virus (HIV) coinfection disproportionately affects men who have sex with men (MSM), and the rate of coinfection has been increasing over the last decade. HIV and syphilis coinfection is particularly challenging because the infections interact synergistically thereby increasing the risk of acquisition and transmission as well as accelerating disease progression. Areas covered: This paper reviews and summarizes the epidemiology, pathogenesis, diagnosis, clinical management and prevention of HIV and syphilis coinfection among MSM. Expert commentary: Research does not support a different syphilis treatment for coinfected individuals; however, coinfection may warrant a recommendation for antiretroviral therapy. In order to reverse the epidemic of syphilis and HIV coinfection, there needs to be greater awareness, improved cultural sensitivity among health care providers, improved access to preventative services and increased screening for syphilis and HIV.
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Affiliation(s)
- Chelsea P Roberts
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA
| | - Jeffrey D Klausner
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Division of Infectious Diseases, Department of Medicine , University of California, Los Angeles , Los Angeles , CA , USA
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11
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Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S, Kesler M, Halpenny R, Grennan T, Brunetta J, Smith G, Reko T, Kaul R. Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto. PLoS One 2016; 11:e0158090. [PMID: 27391265 PMCID: PMC4938580 DOI: 10.1371/journal.pone.0158090] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis B (HBV), hepatitis C (HCV) and other sexually transmitted infections (STIs) have been associated with HIV transmission risk and disease progression among gay men and other men who have sex with men (MSM), but the frequency and distribution of STIs in this community in Canada has not been extensively studied. Methods We recruited MSM living with and without HIV from a large primary care clinic in Toronto. Participants completed a detailed socio-behavioural questionnaire using ACASI and provided blood for syphilis, HIV, HBV and HCV, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea, and a self-collected anal swab for human papillomavirus (HPV) molecular diagnostics. Prevalences were expressed as a proportion and compared using chi-square. Results 442 MSM were recruited, 294 living with HIV and 148 without. Active syphilis (11.0% vs. 3.4%), ever HBV (49.4% vs. 19.1%), HCV (10.4% vs. 3.4%), HSV-2 (55.9% vs. 38.2%), CMV (98.3% vs. 80.3%) and high-risk (HR) anal HPV (67.6% vs. 51.7%) infections were significantly more common in men living with HIV. Chlamydia and gonorrhea were infrequent in both groups. Regardless of HIV infection status, age and number of lifetime male sexual partners were associated with HBV infection and lifetime injection drug use with HCV infection. Conclusions Syphilis and viral infections, including HBV, HCV, HSV-2, CMV, and HR-HPV, were common in this clinic-based population of MSM in Toronto and more frequent among MSM living with HIV. This argues for the implementation of routine screening, vaccine-based prevention, and education programs in this high-risk population.
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Affiliation(s)
- Robert S. Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Anuradha Rebbapragada
- Public Health Laboratory–Toronto Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sanja Huibner
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maya Kesler
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Troy Grennan
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Smith
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Tatjana Reko
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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12
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Burchell AN, Allen VG, Grewal R, MacPherson PA, Rachlis A, Walmsley S, Mishra S, Gardner SL, Raboud J, Cooper C, Gough K, Rourke SB, Rousseau R, Salit I, Tan DHS. Enhanced syphilis screening among HIV-positive men (ESSAHM): a study protocol for a clinic-randomized trial with stepped wedge design. Implement Sci 2016; 11:8. [PMID: 26772390 PMCID: PMC4715363 DOI: 10.1186/s13012-016-0371-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current syphilis epidemic among urban men who have sex with men (MSM) has serious implications for those co-infected with human immunodeficiency virus (HIV). Routine and frequent syphilis screening has the potential to ensure early detection and treatment, minimize disease burden, and help control the ongoing spread of syphilis and HIV. We aim to enhance syphilis screening among HIV-positive men by conducting a clinic-based intervention that incorporates opt-out syphilis testing into routine HIV laboratory evaluation for this population. Trial objectives are to determine the degree to which the intervention (1) increases the detection rate of untreated syphilis, (2) increases screening coverage, (3) increases screening frequency, and (4) reaches men at highest risk according to sexual behaviors. METHODS/DESIGN The trial is a pragmatic, stepped wedge cluster-randomized controlled trial that introduces the intervention stepwise across four urban HIV clinics in Ontario, Canada. The intervention includes standing orders for syphilis serological testing whenever a male in HIV care undergoes HIV viral load testing, which typically occurs every 3-6 months. The control condition is the maintenance of current, provider-initiated syphilis testing practice. Approximately 3100 HIV-positive men will be followed over 30 months. Test results will be obtained from the centralized provincial laboratory in Ontario and will be supplemented by a standardized clinical worksheet and medical chart review at the clinics. Detailed clinical, psychosocial, and behavioral data is available for a subset of men receiving HIV care who are also participants of the province-wide Ontario HIV Treatment Network Cohort Study. Process evaluation plans include audit and feedback of compliance of the participating centers to identify potential barriers to the introduction of this type of practice into routine care. Health economic components include evaluation of the impact and cost-effectiveness of the intervention. DISCUSSION This trial will be the first of its kind in Canada and will provide evidence regarding the feasibility, clinical effectiveness, and cost-effectiveness of a clinic-based intervention to improve syphilis screening among HIV-positive men. Involvement of knowledge users in all stages of trial design, conduct, and analysis will facilitate scale-up should the intervention be effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02019043.
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Affiliation(s)
- Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, Canada.
| | - Ramandip Grewal
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Anita Rachlis
- Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Hospital, University Health Network, Toronto, Canada.
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Sandra L Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Ontario HIV Treatment Network, Toronto, Canada.
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Toronto General Research Institute, University Health Network, Toronto, Canada.
| | | | - Kevin Gough
- Department of Medicine, University of Toronto, Toronto, Canada.
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.
| | - Sean B Rourke
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Ontario HIV Treatment Network, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, Toronto, Canada.
- Poz Prevention Working Group, Gay Men's Sexual Health Alliance, Toronto, Canada.
| | - Irving Salit
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Hospital, University Health Network, Toronto, Canada.
| | - Darrell H S Tan
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Research Institute, University Health Network, Toronto, Canada.
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.
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13
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SHIOTSUKA M, YAMAMOTO Y, YOTSUMOTO M, MURAMATSU T, ICHIKI A, CHIKASAWA Y, BINGO M, SEITA I, OTAKI M, OGATA K, HAGIWARA T, SUZUKI T, AMANO K, FUKUTAKE K. Syphilis Testing and High Rate of Infection Among HIV-infected Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.11150/kansenshogakuzasshi.90.798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mika SHIOTSUKA
- Department of Laboratory Medicine, Tokyo Medical University
| | | | | | | | - Akito ICHIKI
- Department of Laboratory Medicine, Tokyo Medical University
| | | | - Masato BINGO
- Department of Laboratory Medicine, Tokyo Medical University
| | - Ikuo SEITA
- Department of Laboratory Medicine, Tokyo Medical University
| | - Manabu OTAKI
- Department of Laboratory Medicine, Tokyo Medical University
| | - Kyoichi OGATA
- Department of Laboratory Medicine, Tokyo Medical University
| | | | - Takashi SUZUKI
- Department of Laboratory Medicine, Tokyo Medical University
| | - Kagehiro AMANO
- Department of Laboratory Medicine, Tokyo Medical University
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14
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Yang CJ, Tang HJ, Chang SY, Hsieh SM, Lee KY, Lee YT, Sheng WH, Yang SP, Hung CC, Chang SC. Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection. J Antimicrob Chemother 2015; 71:775-82. [PMID: 26604241 DOI: 10.1093/jac/dkv379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Effectiveness of single-dose azithromycin (2 g) in the treatment of early syphilis among HIV-infected patients has rarely been evaluated in the era of combination ART. METHODS Consecutive HIV-infected patients with early syphilis, who received 2 g single-dose azithromycin or 2.4 MU benzathine penicillin G, between 2007 and 2014, were prospectively observed. Genotypic resistance to macrolides was determined in Treponema pallidum isolates identified from clinical specimens using PCR assays. Rapid plasma reagin (RPR) titres were determined at baseline and every 3 months after treatment. Primary outcome was a decline of RPR titre by ≥4-fold at 12 months after treatment. RESULTS During the study period, 162 HIV-infected patients with early syphilis received benzathine penicillin G and 237 patients received azithromycin. At 12 months follow-up, the serological response rate for penicillin and azithromycin groups was 61.1% and 56.5% (P = 0.41), respectively; respective response rate was 61.1% and 65.9% (P = 0.49) if we only included patients infected with T. pallidum not harbouring macrolide resistance in the azithromycin group. In multivariate analysis, RPR titres ≥1:32 (OR 2.56; 95% CI 1.55-4.21) and prior syphilis (OR 0.54; 95% CI 0.35-0.81) were predictors of serological response. Most common adverse effects of azithromycin included diarrhoea (52.7%), nausea (22.4%), abdominal pain (18.6%), bloating (17.7%) and lassitude/somnolence (27.4%). CONCLUSIONS In the setting of a low prevalence of macrolide-resistant T. pallidum, 2 g single-dose azithromycin achieved a similar serological response to benzathine penicillin G in HIV-infected patients with early syphilis. Major adverse effects of azithromycin were gastrointestinal symptoms and lassitude/somnolence.
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Affiliation(s)
- Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yeh Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Center of Infection Control, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shang-Ping Yang
- Center of Infection Control, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Department of Medical Research, China Medical University Hospital, Taichung, Taiwan China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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15
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Cheeks MA, Fransua M, Stringer HG, Silva S, Relf M. A Quality Improvement Project to Increase Early Detection of Syphilis Infection or Re-infection in HIV-infected Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2015; 27:143-52. [PMID: 26646978 DOI: 10.1016/j.jana.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/05/2015] [Indexed: 11/29/2022]
Abstract
Our quality improvement project evaluated whether testing for syphilis every 3 to 6 months with routine HIV laboratory monitoring had an effect on early detection of asymptomatic syphilis infection/re-infection in HIV-infected men who have sex with men. Retrospective analysis of syphilis testing and infections in a sample of this population (N = 245) was conducted after establishing a change-of-practice quality improvement initiative in a not-for-profit, community-based, grant-funded clinic. We compared the clinic's annual rates of syphilis before and after intervention implementation. The detection rate was 6.6% in the preintervention practice change group and 15.5% in the postintervention group. Increased testing identified 27 syphilis cases that would not otherwise have been identified until the annual comprehensive examination. Increased testing frequency led to earlier detection of syphilis, which was clinically significant, showing a potential to decrease the number of new syphilis and HIV infections and to decrease health care expenditures.
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16
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Krakower DS, Beekmann SE, Polgreen PM, Mayer KH. Diffusion of Newer HIV Prevention Innovations: Variable Practices of Frontline Infectious Diseases Physicians. Clin Infect Dis 2015; 62:99-105. [PMID: 26385993 DOI: 10.1093/cid/civ736] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/12/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND US Public Health Service guidelines recommend early initiation of antiretroviral treatment (ART) for human immunodeficiency virus infection (HIV)-infected patients and preexposure prophylaxis (PrEP) as a prevention option for persons at risk for HIV acquisition. Before issuance of these guidelines, few clinicians reported prescribing early ART or PrEP. METHODS The Emerging Infections Network, a national network of infectious diseases physicians in the United States and Canada, was surveyed in September 2014 to assess practices of adult HIV-care providers with early ART, PrEP, and other guideline-recommended HIV prevention methods. RESULTS Almost half of the 1191 active members invited (48.1%) participated; 415 (72.4%) were HIV-care providers. Most providers (86.5%) indicated that they typically recommended ART initiation at diagnosis, irrespective of CD4(+) cell count. However, for patients with a CD4(+) cell count >500/µL, clinicians would defer ART if patients did not feel ready to initiate ART (94.7%) or had uncontrolled substance abuse (66.0%). Many providers had counseled HIV-infected patients about PrEP for partners (59.0%) or offered visits for partners to discuss PrEP (40.7%), and 31.8% had prescribed PrEP. Clinicians who deferred ART were less likely to endorse and engage in aspects of PrEP provision. CONCLUSIONS Concordant with guidelines, most infectious diseases physicians recommend early ART, and many have experience with aspects of PrEP provision, suggesting recent evolution of clinician practices. Providers who defer ART are also cautious about PrEP. Interventions that help physicians motivate patients to initiate ART and identify missed opportunities to provide PrEP could enhance HIV prevention.
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Affiliation(s)
- Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center.,The Fenway Institute, Fenway Health, Boston, Massachusetts
| | | | - Philip M Polgreen
- Departments of Internal Medicine.,Epidemiology, University of Iowa Carver College of Medicine, Iowa City
| | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center.,The Fenway Institute, Fenway Health, Boston, Massachusetts
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17
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Burchell AN, Allen VG, Gardner SL, Moravan V, Tan DHS, Grewal R, Raboud J, Bayoumi AM, Kaul R, Mazzulli T, McGee F, Rourke SB. High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada. BMC Infect Dis 2015; 15:356. [PMID: 26289937 PMCID: PMC4546079 DOI: 10.1186/s12879-015-1098-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/07/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The re-emergence of syphilis among HIV-positive gay and other men who have sex with men (MSM) requires vigilance. We estimated incidence of and risk factors for first and subsequent syphilis diagnoses among MSM in HIV care in Ontario, Canada. METHODS We analyzed data from 2,280 MSM under follow-up from 2006 to 2010 in the Ontario HIV Treatment Network Cohort Study (OCS), a multi-site clinical cohort. We obtained syphilis serology results via record linkage with the provincial public health laboratory. Rates were calculated using Poisson regression. RESULTS First syphilis diagnoses occurred at a rate of 2.0 per 100 person-years (95 % CI 1.7, 2.4; 121 cases) whereas the re-diagnosis rate was 7.5 per 100 person-years (95 % CI 6.3, 8.8; 136 cases). We observed higher rates over time and among men who were aged <30 years, receiving care in the two largest urban centers, or had a previous syphilis diagnosis. Syphilis diagnosis was less common among Indigenous men, men with higher CD4 cell counts, and, for first diagnoses only, among men with less than high school education. CONCLUSIONS Compared to reported cases in the general male population, incidence of a new syphilis diagnosis was over 300 times greater among HIV-positive MSM but year-to-year changes reflected provincial trends. Re-diagnosis was common, suggesting treatment failure or re-infection. Novel syphilis control efforts are needed among HIV-positive MSM.
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Affiliation(s)
- Ann N Burchell
- Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON, M4T 1X3, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
| | - Vanessa G Allen
- Public Health Laboratories, Public Health Ontario, Toronto, Canada.
| | - Sandra L Gardner
- Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON, M4T 1X3, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Veronika Moravan
- Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON, M4T 1X3, Canada.
| | - Darrell H S Tan
- Department of Medicine, University of Toronto, Toronto, Canada. .,Toronto General Research Institute, University Health Network, Toronto, Canada. .,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.
| | - Ramandip Grewal
- Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON, M4T 1X3, Canada.
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Toronto General Research Institute, University Health Network, Toronto, Canada.
| | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada. .,Centre for Research on Inner City Health, Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Tony Mazzulli
- Public Health Laboratories, Public Health Ontario, Toronto, Canada. .,Mount Sinai Hospital, Toronto, Canada.
| | - Frank McGee
- AIDS Bureau, Ontario Ministry of Health and Long Term Care, Toronto, Canada.
| | - Sean B Rourke
- Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON, M4T 1X3, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
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18
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Burchell AN, Grewal R, Allen VG, Gardner SL, Moravan V, Bayoumi AM, Kaul R, McGee F, Millson M(PE, Remis RS, Raboud J, Mazzulli T, Rourke SB. Modest rise in chlamydia and gonorrhoea testing did not increase case detection in a clinical HIV cohort in Ontario, Canada. Sex Transm Infect 2014; 90:608-14. [PMID: 25178285 PMCID: PMC4251188 DOI: 10.1136/sextrans-2014-051647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES We described patterns of testing for chlamydia and gonorrhoea infection among persons in specialty HIV care in Ontario, Canada, from 2008 to 2011. METHODS We analysed data from 3165 participants in the OHTN Cohort Study attending one of seven specialty HIV care clinics. We obtained chlamydia and gonorrhoea test results via record linkage with the provincial public health laboratory. We estimated the proportion of participants who underwent testing annually, the positivity rate among those tested and the proportion diagnosed with chlamydia or gonorrhoea among all under observation. We explored risk factors for testing and diagnosis using multiple logistic regression analysis. RESULTS The proportion tested annually rose from 15.2% (95% CI 13.6% to 16.7%) in 2008 to 27.0% (95% CI 25.3% to 28.6%) in 2011 (p<0.0001). Virtually all were urine-based nucleic acid amplification tests. Testing was more common among men who have sex with men (MSM), younger adults, Toronto residents, persons attending primary care clinics and persons who had tested in the previous year or who had more clinic visits in the current year. We observed a decrease in test positivity rates over time. However, the annual proportion diagnosed remained stable and in 2011 this was 0.97% (95% CI 0.61% to 1.3%) and 0.79% (95% CI 0.46% to 1.1%) for chlamydia and gonorrhoea, respectively. Virtually all cases were among MSM. CONCLUSIONS Chlamydia and gonorrhoea testing increased over time while test positivity rates declined and the overall proportion diagnosed remained stable, suggesting that the modest increase in testing did not improve case detection.
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Affiliation(s)
- Ann N Burchell
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Vanessa G Allen
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sandra L Gardner
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank McGee
- AIDS Bureau, Ontario Ministry of Health and Long Term Care, Toronto, Ontario, Canada
| | | | - Robert S Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Sean B Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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19
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González-Domenech CM, Antequera Martín-Portugués I, Clavijo-Frutos E, Márquez-Solero M, Santos-González J, Palacios-Muñoz R. [Syphilis and human immunodeficiency virus infection: an endemic infection in men who have sex with men]. Enferm Infecc Microbiol Clin 2014; 33:32-6. [PMID: 25444048 DOI: 10.1016/j.eimc.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/18/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE to analyse epidemiological, clinical, and analytical features of HIV-infected men who have sex with men (MSM) diagnosed with syphilis in the Infectious Diseases Unit (Hospital Virgen de la Victoria, Málaga, Spain) during 2004-2013. PATIENTS AND METHODS An observational study was conducted on 196 syphilis episodes in 167 MSM infected with HIV (2004-2013). Epidemiological, clinical, and analytical data were collected. Annual syphilis incidence among HIV-MSM is calculated as the number of syphilis episodes among MSM in one year divided by the number of MSM followed up in that year. RESULTS Incidence ranged from 1.2% (2007) to 7.8% (2012). There were asymptomatic episodes in 42.8% cases, and an HIV-syphilis coincident diagnosis in 28.5%. CONCLUSIONS The annual incidence of syphilis has increased within HIV infected MSM. One third of the syphilis episodes were simultaneous to HIV diagnosis and near half of them were asymptomatic.
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Affiliation(s)
- Carmen M González-Domenech
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, España
| | | | - Encarnación Clavijo-Frutos
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, España
| | - Manuel Márquez-Solero
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, España; Instituto de investigación biomédica de Málaga (IBIMA), España
| | - Jesús Santos-González
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, España; Instituto de investigación biomédica de Málaga (IBIMA), España
| | - Rosario Palacios-Muñoz
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Virgen de la Victoria, Málaga, España; Instituto de investigación biomédica de Málaga (IBIMA), España.
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21
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Spornraft-Ragaller P, Schmitt J, Stephan V, Boashie U, Beissert S. Charakteristika und Koinfektionen mit Syphilis bei neu mit HIV diagnostizierten Patienten aus dem Universitätsklinikum Dresden von 1987-2012. J Dtsch Dermatol Ges 2014; 12:707-716. [DOI: 10.1111/ddg.12382_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Petra Spornraft-Ragaller
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Victoria Stephan
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Ute Boashie
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Stefan Beissert
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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22
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Eradicating syphilis, hepatitis C and HIV in MSM through frequent testing strategies. Curr Opin Infect Dis 2014; 27:56-61. [PMID: 24275695 DOI: 10.1097/qco.0000000000000020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The rates of sexual transmission of HIV, syphilis and hepatitis C in MSM are rising in most countries. Recent research has raised the question of whether increasing testing and treatment of these infections could substantially reduce their transmission. RECENT FINDINGS Although mathematical models suggest this strategy could be potentially effective in reducing transmission, there is currently very limited evidence that community-wide incidence has been curtailed by this strategy. SUMMARY If increasing in testing is to substantially reduce the incidence of these infections then significant increases in testing are required together with innovative approaches to testing and healthcare delivery. Notwithstanding this, relatively simple approaches to increasing testing are currently underutilized.
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Tuite AR, Burchell AN, Fisman DN. Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men: a microsimulation model. PLoS One 2014; 9:e101240. [PMID: 24983455 PMCID: PMC4077736 DOI: 10.1371/journal.pone.0101240] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syphilis co-infection risk has increased substantially among HIV-infected men who have sex with men (MSM). Frequent screening for syphilis and treatment of men who test positive might be a practical means of controlling the risk of infection and disease sequelae in this population. PURPOSE We evaluated the cost-effectiveness of strategies that increased the frequency and population coverage of syphilis screening in HIV-infected MSM receiving HIV care, relative to current standard of care. METHODS We developed a state-transition microsimulation model of syphilis natural history and medical care in HIV-infected MSM receiving care for HIV. We performed Monte Carlo simulations using input data derived from a large observational cohort in Ontario, Canada, and from published biomedical literature. Simulations compared usual care (57% of the population screened annually) to different combinations of more frequent (3- or 6-monthly) screening and higher coverage (100% screened). We estimated expected disease-specific outcomes, quality-adjusted survival, costs, and cost-effectiveness associated with each strategy from the perspective of a public health care payer. RESULTS Usual care was more costly and less effective than strategies with more frequent or higher coverage screening. Higher coverage strategies (with screening frequency of 3 or 6 months) were expected to be cost-effective based on usually cited willingness-to-pay thresholds. These findings were robust in the face of probabilistic sensitivity analyses, alternate cost-effectiveness thresholds, and alternate assumptions about duration of risk, program characteristics, and management of underlying HIV. CONCLUSIONS We project that higher coverage and more frequent syphilis screening of HIV-infected MSM would be a highly cost-effective health intervention, with many potentially viable screening strategies projected to both save costs and improve health when compared to usual care. The baseline requirement for regular blood testing in this group (i.e., for viral load monitoring) makes intensification of syphilis screening appear readily practicable.
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Affiliation(s)
- Ashleigh R. Tuite
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ann N. Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - David N. Fisman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Spornraft-Ragaller P, Schmitt J, Stephan V, Boashie U, Beissert S. Characteristics and coinfection with syphilis in newly HIV-infected patients at the University Hospital Dresden 1987-2012. J Dtsch Dermatol Ges 2014; 12:707-16. [PMID: 24941863 DOI: 10.1111/ddg.12382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Germany, notification data cannot be used to determine HIV and syphilis coinfection. No regional cohort has been studied for this in Eastern Germany. The rising incidence of syphilis from 2010 to 2012, predominantly in men having sex with men (MSM), has been suggested as a cause for recent increases in HIV infection rates in this group. PATIENTS AND METHODS Characteristics of 355 consecutive patients newly diagnosed with HIV infection at the University Hospital Dresden 1987-2012 were retrospectively compared to German surveillance data from the region of Dresden. Additionally, coinfection with syphilis was determined. RESULTS Compared to German surveillance data, we observed higher proportions of persons originating from high prevalence countries and of AIDS cases. In the age group of up to 25 years, the proportion of MSM has risen 3-fold since 2001. At time of HIV diagnosis, seroprevalence of syphilis was 20.3 %. Active syphilis (VDRL ≥ 1: 8) occurred in 6.7 % of patients, predominantly MSM, who also exhibited a significantly higher HIV viral load. CONCLUSIONS Our findings suggest a causative relationship between recently rising incidences of syphilis and HIV infection in MSM. Early diagnosis of syphilis may promote earlier diagnosis of HIV infection; therefore, HIV prevention measures should also include other sexually transmitted infections.
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Affiliation(s)
- Petra Spornraft-Ragaller
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
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Ferreira SC, de Almeida-Neto C, Nishiya AS, Oliveira CDL, Ferreira JE, Alencar CS, Levi JE, Salles NA, Mendrone A, Sabino EC. Demographic, risk factors and motivations among blood donors with reactive serologic tests for syphilis in São Paulo, Brazil. Transfus Med 2014; 24:169-75. [PMID: 24779667 DOI: 10.1111/tme.12124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/12/2014] [Accepted: 04/07/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. BACKGROUND Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. METHODS This case-control study compares 75 Venereal Disease Research Laboratory (VDRL) > 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL-, EIA+ and FTA-ABS+; and 34 VDRL- and EIA- donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. RESULTS Donors with VDRL > 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30-120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12-44·62) and to report male-male-sex in the past 12 months (AOR=8·18; 95% CI 1·78-37·60). Donors with VDRL-, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07-0·96), more likely to be older (AOR=10·2; 95% CI 2·45-42·58 ≥ 39 and <60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49-46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL > 8) and 12·5% (VDRL-, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. CONCLUSION Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
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Affiliation(s)
- S C Ferreira
- Infectious Diseases Division, Federal University of São Paulo; Department of Molecular Biology, Fundação Pró-Sangue Hemocentro de São Paulo
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Salavec M, Bostik V, Kapla J, Plisek S, Prasil P, Prymula R, Bostik P. A repeated syphilis infection imported from Thailand in an HIV positive couple of men-who-have-sex-with-men in Czech Republic. Travel Med Infect Dis 2013; 12:84-7. [PMID: 24176669 DOI: 10.1016/j.tmaid.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022]
Abstract
Coinfection by HIV and syphilis has become a growing problem due to the re-appearance of unsafe sexual practices in the era of potent anti-retroviral drugs. We describe a repeated import of syphilis by a couple of men-who-have-sex-with-men from Thailand to Czech Republic likely due to non-adherence of the patients to physician recommendations. Such cases can become foci for dissemination of once locally rare infections and present a danger for the community.
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Affiliation(s)
- Miloslav Salavec
- Department of Dermatovenerology, Charles University Medical School and Faculty Hospital, Sokolská 581, Hradec Kralove, Czech Republic
| | - Vanda Bostik
- Faculty of Military Health Sciences, University of Defence, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Jaroslav Kapla
- Department of Infectious Diseases, Charles University Medical School and University Hospital, Sokolská 581, Hradec Kralove, Czech Republic
| | - Stanislav Plisek
- Department of Infectious Diseases, Charles University Medical School and University Hospital, Sokolská 581, Hradec Kralove, Czech Republic
| | - Petr Prasil
- Department of Infectious Diseases, Charles University Medical School and University Hospital, Sokolská 581, Hradec Kralove, Czech Republic
| | - Roman Prymula
- Faculty of Military Health Sciences, University of Defence, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Pavel Bostik
- Faculty of Military Health Sciences, University of Defence, Trebesska 1575, Hradec Kralove, Czech Republic; Department of Infectious Diseases, Charles University Medical School and University Hospital, Sokolská 581, Hradec Kralove, Czech Republic.
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27
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Tuite AR, Fisman DN, Mishra S. Screen more or screen more often? Using mathematical models to inform syphilis control strategies. BMC Public Health 2013; 13:606. [PMID: 23800206 PMCID: PMC3699384 DOI: 10.1186/1471-2458-13-606] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/20/2013] [Indexed: 11/15/2022] Open
Abstract
Background Syphilis incidence among men who have sex with men (MSM) continues to rise despite attempts to increase screening and treatment uptake. We examined the marginal effect of increased frequency versus increased coverage of screening on syphilis incidence in Toronto, Canada. Methods We developed an agent-based, network model of syphilis transmission, representing a core population of 2,000 high-risk MSM. Epidemiological and biological parameters were drawn from regional surveillance data and literature-derived estimates. The pre-intervention period of the model was calibrated using surveillance data to identify 1000 credible simulations per strategy. Evaluated strategies included: annual syphilis screening at baseline coverage, increased screening frequency at baseline coverage, and increased coverage of annual screening. Intervention impact was measured as annual prevalence of detected infectious cases and syphilis incidence per year over 10 years. Results Of the strategies evaluated, increasing the frequency of syphilis screening to every three months was most effective in reducing reported and incident syphilis infections. Increasing the fraction of individuals tested, without increasing test frequency, resulted a smaller decline in incidence, because reductions in infectious syphilis via treatment were counterbalanced by increased incident syphilis among individuals with prior latent syphilis. For an equivalent number of additional tests performed annually, increased test frequency was consistently more effective than improved coverage. Conclusions Strategies that focus on higher frequency of testing in smaller fractions of the population were more effective in reducing syphilis incidence in a simulated MSM population. The findings highlight how treatment-induced loss of immunity can create unexpected results in screening-based control strategies.
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Affiliation(s)
- Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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