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Lim S, Mantsios A, Braithwaite RS, Pitts R. A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis. AIDS Care 2024; 36:692-702. [PMID: 38466205 DOI: 10.1080/09540121.2024.2325070] [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: 03/08/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ronald S Braithwaite
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Pitts
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Infectious Diseases, NYC Health + Hospitals/Bellevue, New York, NY, USA
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2
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Quilter LAS, St Cyr SB, Barbee LA. The Management of Gonorrhea in the Era of Emerging Antimicrobial Resistance: What Primary Care Clinicians Should Know. Med Clin North Am 2024; 108:279-296. [PMID: 38331480 PMCID: PMC11150008 DOI: 10.1016/j.mcna.2023.08.015] [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: 02/10/2024]
Abstract
Gonorrhea rates continue to rise in the United States and Neisseria gonorrhoeae's propensity to develop resistance to all therapies used for treatment has complicated the management of gonorrhea. Ceftriaxone is the only remaining highly effective recommended regimen for gonococcal treatment and few new anti-gonococcal antimicrobials are being developed. The 2021 CDC STI Treatment Guidelines increased the dose of ceftriaxone to 500 mg (1 g if ≥ 150 kg) for uncomplicated infections. It is recommended that all clinicians should be aware of antimicrobial resistant gonorrhea and be able to appropriately manage any suspected gonorrhea treatment failure case.
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Affiliation(s)
- Laura A S Quilter
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA.
| | - Sancta B St Cyr
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
| | - Lindley A Barbee
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
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Sawras V, Deuffic-Burban S, Préau M, Spire B, Yazdanpanah Y, Champenois K. Assessing complex interventions: a systematic review of outcomes used in randomised controlled trials on STI partner notification in high-income countries. BMC Public Health 2023; 23:1838. [PMID: 37735382 PMCID: PMC10512513 DOI: 10.1186/s12889-023-16763-9] [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: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Partner notification interventions are complex and assessing their effectiveness is challenging. By reviewing the literature on the effectiveness of partner notification interventions, our aim was to evaluate the choice, collection, and interpretation of outcomes and their impact on study findings. METHODS We conducted a systematic review of individual-level randomised controlled trials evaluating the effectiveness of partner notification interventions for bacterial STIs, HIV or sexually transmitted HCV in high-income countries since 2000. Partner notification interventions included assisted patient referral interventions and expedited treatment. The content analysis was carried out through a narrative review. RESULTS In the 9 studies that met the inclusion criteria, 16 different outcomes were found. In most studies, one or two outcomes assessing partner notification practices were associated with an outcome reflecting STI circulation through index case reinfections. These outcomes assessed the main expected effects of partner notification interventions. However, partner notification is composed of a succession of actions between the intervention on the index case and the testing and/or treatment of the notified partners. Intermediate outcomes were missing so as to better understand levers and barriers throughout the process. Potential changes in participants' sexual behaviour after partner notification, e.g. condom use, were outcomes reported in only two studies assessing interventions including counselling. Most outcomes were collected through interviews, some weeks after the intervention, which might lead to desirability and attrition biases, respectively. Assessment of the effectiveness of partner notification interventions on partner testing/treatment was limited by the collection of data from index cases. Few data describing index cases and their partners were provided in the studies. Additional data on the number and type of exposed partners and the proportion of partners already aware of their infection before being notified would help to interpret the results. CONCLUSIONS These insights would help to understand why and under what conditions the intervention is considered effective and therefore can be replicated or adapted to other populations and contexts.
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Affiliation(s)
- Victoire Sawras
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
| | - Sylvie Deuffic-Burban
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
| | - Marie Préau
- Institut de Psychologie, Université Lumière Lyon 2, Inserm, U1296, Lyon, France
| | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Yazdan Yazdanpanah
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
- Service de maladies infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, F-75018, France
| | - Karen Champenois
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France.
- Inserm IAME - Faculté de Médecine Bichat, 16 rue Henri Huchard, Paris, 75018, France.
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Hansman E, Klausner JD. Approach to Managing Sex Partners of People with Sexually Transmitted Infections. Infect Dis Clin North Am 2023; 37:405-426. [PMID: 36931992 DOI: 10.1016/j.idc.2023.02.003] [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: 03/17/2023]
Abstract
Partner management of sexually transmitted infection (STIs) is essential to identify and treat new cases, prevent reinfection in the index case, interrupt chains of transmission, reduce STI-related morbidity, and target STI screening and treatment interventions. The responsibility for partner notification and treatment falls on the health care provider. Approaches to partner management include patient referral, provider referral, contractual referral, and expedited partner therapy (EPT), with EPT and enhanced partner referral outperforming other methods. This article provides an overview of clinical recommendations regarding partner management, with particular emphasis on EPT, and an update on new and emerging evidence in the field.
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Affiliation(s)
- Emily Hansman
- David Geffen School of Medicine University of California Los Angeles, Los Angeles, CA, USA.
| | - Jeffrey D Klausner
- University of Southern California Keck School of Medicine, 1845 North Soto Street, Health Sciences Campus, Los Angeles, CA 90032, USA
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 816] [Impact Index Per Article: 272.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Miranda AE, da Silveira MF, Pinto VM, Alves GC, de Carvalho NS. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause cervicitis. Rev Soc Bras Med Trop 2021; 54:e2020587. [PMID: 34008716 PMCID: PMC8210491 DOI: 10.1590/0037-8682-587-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis. Associated factors to cervicitis: sexually active women younger than 25 years old, new or multiple sexual partners, partners with STI, previous history or presence of other STI, and irregular use of condoms.
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Affiliation(s)
| | | | - Valdir Monteiro Pinto
- Secretaria Estadual de Saúde de São Paulo, Programa Estadual de DST/Aids, São Paulo, SP, Brasil
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Miranda AE, Silveira MFD, Pinto VM, Alves GC, Carvalho NSD. [Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause cervicitis]. ACTA ACUST UNITED AC 2021; 30:e2020587. [PMID: 33729399 DOI: 10.1590/s1679-4974202100008.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis, as well as recommendations on screening, diagnosis and treatment of affected people and their sexual partnerships. In addition, it discusses strategies for surveillance, prevention and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cevicitis.
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Affiliation(s)
| | | | - Valdir Monteiro Pinto
- Secretaria Estadual de Saúde de São Paulo, Programa Estadual de DST/Aids, São Paulo, SP, Brasil
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Mathews C, Lombard C, Kalichman M, Dewing S, Banas E, Dumile S, Mdlikiva A, Mdlikiva T, Jennings KA, Daniels J, Berteler M, Kalichman SC. Effects of enhanced STI partner notification counselling and provider-assisted partner services on partner referral and the incidence of STI diagnosis in Cape Town, South Africa: randomised controlled trial. Sex Transm Infect 2020; 97:38-44. [PMID: 32482641 PMCID: PMC7841487 DOI: 10.1136/sextrans-2020-054499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/18/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives We investigated the effects of an enhanced partner notification (PN) counselling intervention with the offer of provider-assisted referral among people diagnosed with STI in a Cape Town public clinic. Methods Participants were adults diagnosed with STI at a community clinic. After the standard STI consultation, participants were randomly allocated in a 1:1:1 ratio to (1) ‘HE’: 20 min health education; (2) ‘RR’: 45 min risk reduction skills counselling; or (3) ‘ePN’: 45 min enhanced partner notification communication skills counselling and the offer of provider-assisted referral. The primary outcome was the incidence of repeat STI diagnoses during the 12 months after recruitment, and the secondary outcome was participants’ reports 2 weeks after diagnosis of notifying recent partners. Incidence rate ratios (IRRs) were used to compare the incidence rates between arms using a Poisson regression model. Results The sample included 1050 participants, 350 per group, diagnosed with STI between June 2014 and August 2017. We reviewed 1048 (99%) participant records, and identified 136 repeat STI diagnoses in the ePN arm, 138 in the RR arm and 141 in the HE arm. There was no difference in the annual incidence of STI diagnosis between the ePN and HE arms (IRR: 1.0; 95% CI 0.7 to 1.3), or between the RR and HE arms (IRR: 0.9; 95% CI 0.7 to 1.2). There was a greater chance of a partner being notified in the ePN condition compared with the HE condition, 64.3% compared with 53.8%, but no difference between the RR and HE arms. Conclusions PN counselling and education with provider-assisted services has the potential to change the behaviour of people diagnosed with STIs, increasing the number of partners they notify by more than 10%. However, these changes in behaviour did not lead to a reduction of repeat STI diagnoses. Trial registration number PACTR201606001682364.
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Affiliation(s)
- Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa .,School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Tygerberg, South Africa
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Sarah Dewing
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Ellen Banas
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Sekelwa Dumile
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Amanda Mdlikiva
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Thembinkosi Mdlikiva
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Karen Ann Jennings
- City Health Department of Cape Town Municipality, Cape Town, South Africa
| | - Johann Daniels
- City Health Department of Cape Town Municipality, Cape Town, South Africa
| | - Marcel Berteler
- City of Cape Town IS&T Department, City of Cape Town, Cape Town, Western Cape, South Africa
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
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Chayachinda C, Kerdklinhom C, Tachawatcharapunya S, Saisaveoy N. Video-based education versus nurse-led education for partner notification in Thai women with sexually transmitted infections: a randomized controlled trial. Int J STD AIDS 2018; 29:1076-1083. [PMID: 29788827 DOI: 10.1177/0956462418775507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health education on sexually transmitted infections (STIs), condom use, and partner notification (PN) is required to increase partner evaluation/treatment (PET) rate. To examine this issue, a randomized controlled trial comparing video-based and nurse-led education in women diagnosed with their first STI at the Siriraj Female STI clinic was conducted from March 2015 to March 2017. PN was assessed at two weeks and PET was done at four weeks. Of 330 patients, 225 were included in the analysis (N = 113 and N = 112 for video-based and nurse-led groups, respectively). Each participant reported one partner who needed to be notified. The participants' median age was approximately 30 years old and they had been diagnosed with PID (N = 85), hepatitis B (N = 49), trichomoniasis (N = 45), syphilis (N = 30), and gonorrhea (N = 16). Characteristics were comparable between groups. There was no statistical difference in the PN rates (95.6% vs. 90.2%, p = 0.116), while the PET rate was significantly higher in the nurse-led group (49.6% vs. 67.9%; OR 0.47, 95% CI: 0.27-0.81; p = 0.005). Having endured symptoms for <7 days, being pregnant and detection of STIs during antenatal/pre-operative blood tests were positive predictors of PET (OR: 3.34, 95% CI: 1.81-6.14; 18.70, 95% CI: 5.61-62.31; and 22.07, 95% CI: 6.46-75.41, respectively). In conclusion, video-based education is as effective as nurse-led education in terms of PN rate but results in lower PET.
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Affiliation(s)
- Chenchit Chayachinda
- 1 Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Chanakarn Kerdklinhom
- 2 Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaphon Tachawatcharapunya
- 1 Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Nattha Saisaveoy
- 3 Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Assessing Different Partner Notification Methods for Assuring Partner Treatment for Gonorrhea: Looking for the Best Mix of Options. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:247-254. [PMID: 27902560 DOI: 10.1097/phh.0000000000000458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Partner notification for gonorrhea is intended to interrupt transmission and to bring people exposed to infection to care. Partner notification may be initiated through public health professionals (disease intervention specialist: DIS referral) or patients (patient referral). In some cases, patients may carry medications or prescriptions for partners (patient-delivered partner therapy: PDPT). OBJECTIVE To examine how patterns of notifying and treating partners of persons with gonorrhea differ by partner notification approach. DESIGN From published literature (2005-2012), we extracted 10 estimates of patient referral data from 7 studies (3853 patients, 7490 partners) and 5 estimates of PDPT data from 5 studies (1781 patients, 3125 partners). For DIS referral estimates, we obtained 2010-2012 data from 14 program settings (4581 patients interviewed, 8301 partners). For each approach, we calculated treatment cascades based on the proportion of partners who were notified and treated. We also calculated cascades based on partners notified and treated per patient diagnosed. RESULTS Proportions of partners notified and treated were, for patient referral, 56% and 34%; for PDPT, 57% and 46%; for DIS referral, 25% and 22%. Notification and treatment estimates for patient referral and PDPT were significantly higher than for DIS referral, but DIS referral was more efficacious than the other methods in assuring treatment among those notified (all Ps < .001). The notification and treatment ratios per patient seen were, for patient referral, 0.96 and 0.61; for PDPT, 0.90 and 0.73; for DIS referral, 0.45 and 0.40. CONCLUSION Patient-based methods had higher proportions of partners treated overall, but provider referral had the highest proportion treated among those notified. These data may assist programs to align the most efficacious strategies with the most epidemiologically or clinically important cases while assuring the best scalable standard of care for others.
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Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS. Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr 2018; 77:119-127. [PMID: 29084044 PMCID: PMC5762416 DOI: 10.1097/qai.0000000000001579] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. SETTING Clinical care settings, public health programs, and community-based organizations (CBOs). METHODS Critical review of recent peer-reviewed literature. RESULTS More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. CONCLUSIONS PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI
| | - Rupa R Patel
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Charlene A Flash
- Section of Infectious Diseases, Division of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Magaziner S, Montgomery MC, Bertrand T, Daltry D, Jenkins H, Kendall B, Molotnikov L, Pierce L, Smith E, Sosa L, van den Berg JJ, Marak T, Operario D, Chan PA. Public health opportunities and challenges in the provision of partner notification services: the New England experience. BMC Health Serv Res 2018; 18:75. [PMID: 29386023 PMCID: PMC5793459 DOI: 10.1186/s12913-018-2890-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partner notification services (PNS) are recommended by the Centers for Disease Control and Prevention as a public health intervention for addressing the spread of HIV and other sexually transmitted diseases (STDs). Barriers and facilitators to the partner notification process from a public health perspective have not been well described. METHODS In 2015, a coalition of New England public health STD directors and investigators formed to address the increasing STD prevalence across the region (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and to promote communication between state STD programs. To evaluate barriers and facilitators of PNS programs, a survey was administered to representatives from each state to describe PNS processes and approaches. RESULTS Of the six PNS programs, Connecticut, Maine, Massachusetts, Vermont, and New Hampshire had combined HIV and STD PNS programs; Rhode Island's programs were integrated but employed separate disease intervention specialists (DIS). All states performed PNS for HIV and syphilis. Maine, New Hampshire and Vermont performed services for all gonorrhea cases. Rhode Island, Connecticut, and Massachusetts performed limited partner notification for gonorrhea due to lack of resources. None of the six states routinely provided services for chlamydia, though Maine and Vermont did so for high-priority populations such as HIV co-infected or pregnant individuals. Across all programs, clients received risk reduction counseling and general STD education as a component of PNS, in addition to referrals for HIV/STD care at locations ranging from Planned Parenthood to community- or hospital-based clinics. Notable barriers to successful partner notification across all states included anonymous partners and index cases who did not feel comfortable sharing partners' names with DIS. Other common barriers included insufficient staff, inability of DIS to identify and contact partners, and index cases declining to speak with DIS staff. CONCLUSIONS In New England, state health departments use different strategies to implement PNS programs and referral to STD care. Despite this, similar challenges exist across settings, including difficulty with anonymous partners and limited state resources.
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Affiliation(s)
- Sarah Magaziner
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
| | - Madeline C. Montgomery
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
| | - Thomas Bertrand
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908 USA
| | - Daniel Daltry
- Vermont Department of Health, 108 Cherry Street, Burlington, VT 05402 USA
| | - Heidi Jenkins
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134 USA
| | - Brenda Kendall
- Maine Center for Disease Control and Prevention, State House Station 11, Augusta, ME 04333 USA
| | - Lauren Molotnikov
- Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108 USA
| | - Lindsay Pierce
- New Hampshire Department of Health and Human Services, 29 Hazen Drive, Concord, NH 03301 USA
| | - Emer Smith
- Maine Center for Disease Control and Prevention, State House Station 11, Augusta, ME 04333 USA
| | - Lynn Sosa
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134 USA
| | - Jacob J. van den Berg
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
| | - Theodore Marak
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
| | - Don Operario
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
| | - Philip A. Chan
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908 USA
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
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Tsadik M, Berhane Y, Worku A, Terefe W. The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis. BMJ Open 2017; 7:e016864. [PMID: 28716795 PMCID: PMC5726144 DOI: 10.1136/bmjopen-2017-016864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The loss to follow-up (LTFU) among patients attending care for sexually transmitted infections (STIs) in Sub-Saharan Africa is a major barrier to achieving the goals of the STI prevention and control programme. The objective of this study was to investigate individual- and facility-level factors associated with LTFU among patients treated for STIs in Ethiopia. METHODS A prospective cohort study was conducted among patients attending care for STIs in selected facilities from January to June 2015 in the Tigray region of Ethiopia. LTFU was ascertained if a patient did not present in person to the same facility within 7 days of the initial contact. Multilevel logistic regression was used to identify factors associated with LTFU. RESULTS Out of 1082 patients, 59.80% (647) were LTFU. The individual-level factors associated with LTFU included having multiple partners (adjusted OR (AOR) 2.89, 95% CI 1.74 to 4.80), being male (AOR 2.23, 95% CI 1.63 to 3.04), having poor knowledge about the means of STI transmission (AOR 2.08, 95% CI 1.53 to 2.82), having college level education (AOR 0.38, 95% CI 0.22 to 0.65), and low perceived stigma (AOR 0.60, 95% CI 0.43 to 0.82). High patient flow (AOR 3.06, 95% CI 1.30 to 7.18) and medium health index score (AOR 2.80, 95% CI 1.28 to 6.13) were facility-level factors associated with LTFU. CONCLUSIONS Improving patient retention in STI follow-up care requires focused interventions targeting those who are more likely to be LTFU, particularly patients with multiple partners, male index cases and patients attending facilities with high patient flow.
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Affiliation(s)
- Mache Tsadik
- College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Song W, Mulatu MS, Rorie M, Zhang H, Gilford JW. HIV Testing and Positivity Patterns of Partners of HIV-Diagnosed People in Partner Services Programs, United States, 2013-2014. Public Health Rep 2017; 132:455-462. [PMID: 28614670 PMCID: PMC5507429 DOI: 10.1177/0033354917710943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Human immunodeficiency virus (HIV) partner services are an integral part of comprehensive HIV prevention programs. We examined the patterns of HIV testing and positivity among partners of HIV-diagnosed people who participated in partner services programs in CDC-funded state and local health departments. METHODS We analyzed data on 21 484 partners submitted in 2013-2014 by 55 health departments. We conducted descriptive and multivariate analyses to examine patterns of HIV testing and positivity by demographic characteristics and geographic region. RESULTS Of 21 484 partners, 16 275 (75.8%) were tested for HIV; 4503 of 12 886 (34.9%) partners with test results were identified as newly HIV-positive. Compared with partners aged 13-24, partners aged 35-44 were less likely to be tested for HIV (adjusted odds ratio [aOR] = 0.86; 95% confidence interval [CI], 0.78-0.95) and more likely to be HIV-positive (aOR = 1.35; 95% CI, 1.20-1.52). Partners who were male (aOR = 0.89; 95% CI, 0.81-0.97) and non-Hispanic black (aOR = 0.68; 95% CI, 0.63-0.74) were less likely to be tested but more likely to be HIV-positive (male aOR = 1.81; 95% CI, 1.64-2.01; non-Hispanic black aOR = 1.52; 95% CI, 1.38-1.66) than partners who were female and non-Hispanic white, respectively. Partners in the South were more likely than partners in the Midwest to be tested for HIV (aOR = 1.56; 95% CI, 1.35-1.80) and to be HIV-positive (aOR = 2.18; 95% CI, 1.81-2.65). CONCLUSIONS Partner services programs implemented by CDC-funded health departments are successful in providing HIV testing services and identifying previously undiagnosed HIV infections among partners of HIV-diagnosed people. Demographic and regional differences suggest the need to tailor these programs to address unique needs of the target populations.
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Affiliation(s)
- Wei Song
- 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
| | - Mesfin S. Mulatu
- 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
| | - Michele Rorie
- 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
| | - Hui Zhang
- 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
| | - John W. Gilford
- 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
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Abstract
BACKGROUND Partner services have been a mainstay of public health sexually transmitted disease (STD) prevention programs for decades. The principal goals are to interrupt transmission and reduce STD morbidity and sequelae. In this article, we review current literature with the goal of informing STD prevention programs. METHODS We searched the literature for systematic reviews. We found 9 reviews published between 2005 and 2014 (covering 108 studies). The reviews varied by study inclusion criteria (e.g., study methods, geographic location, and infections). We abstracted major conclusions and recommendations from the reviews. RESULTS Conclusions and recommendations were divided into patient referral interventions and provider referral interventions. For patient referral, there was evidence supporting the use of expedited partner therapy and interactive counseling, but not purely didactic instruction. Provider referral through Disease Intervention Specialists was efficacious and particularly well supported for HIV. For other studies, modeling data and testing outcomes showed that partner notification in general reached high-prevalence populations. Reviews also suggested more focus on using technology and population-level implementation strategies. However, partner services may not be the most efficient means to reach infected persons. CONCLUSIONS Partner services programs constitute a large proportion of program STD prevention activities. Value is maximized by balancing a portfolio of patient and provider referral interventions and by blending partner notification interventions with other STD prevention interventions in overall partner services program structure. Sexually transmitted disease prevention needs program-level research and development to generate this portfolio.
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Communicating risk with relatives in a familial hypercholesterolemia cascade screening program: a summary of the evidence. J Cardiovasc Nurs 2016; 30:E1-E12. [PMID: 24831729 DOI: 10.1097/jcn.0000000000000153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is the most common inherited, potentially deadly disease, affecting an estimated 600 000 people in the United States. When FH is undiagnosed and untreated, it is linked with early coronary heart disease in more than 50% of men by age 50 years and 30% of women by age 60 years. Cascade screening is the most cost effective method available to identify family members with this disease; however, cascade screening guidelines do not specify best methods to use when contacting relatives. Therefore, I conducted an exhaustive search of the literature to find the most successful communication methods used in contact tracing and cascade screening. PURPOSE The purpose of this summary of the evidence was to identify the communication method with greatest impact in having at-risk populations present to a provider for disease screening. These findings will inform clinicians of the most successful methods to implement when cascade screening relatives of known FH patients. CONCLUSIONS Most studies support direct contact of relatives via letter, mailed from the provider. Provider-initiated communication more often resulted in relatives being tested when compared with other methods of communication. CLINICAL IMPLICATIONS On the basis of the literature, family members of current FH patients will be more likely to present to a provider for cascade screening if they receive written communication from the provider.
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Clark JL, Perez-Brumer A, Salazar X. "Manejar la Situacion": Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru. AIDS Behav 2015; 19:2245-54. [PMID: 25821149 DOI: 10.1007/s10461-015-1049-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous analyses of partner notification (PN) have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections (STI) among men who have sex with men (MSM) and men who have sex with men and women (MSMW) in Lima, Peru. Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to "manejar la situacion" (manage the situation) by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of "managing the situation" as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America.
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2015; 27:333-48. [PMID: 26608577 DOI: 10.1177/0956462415618837] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 12/19/2022]
Abstract
Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, United Kingdom
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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20
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Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1-137. [PMID: 26042815 PMCID: PMC5885289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
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Affiliation(s)
- Kimberly A. Workowski
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
- Emory University, Atlanta, Georgia
| | - Gail A. Bolan
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Marinelli T, Chow EPF, Tomnay J, Fehler G, Bradshaw CS, Chen MY, Forcey DS, Fairley CK. Rate of repeat diagnoses in men who have sex with men for Chlamydia trachomatis and Neisseria gonorrhoeae: a retrospective cohort study. Sex Health 2015; 12:418-24. [DOI: 10.1071/sh14234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/27/2015] [Indexed: 11/23/2022]
Abstract
Background
Sexually transmissible infections (STIs) have increased rapidly among men who have sex with men (MSM). One of the most effective strategies to control STIs is partner notification. Inadequate partner notification may be associated with high rates of repeat diagnoses with STIs. The aim of this study is to estimate and compare the rate of chlamydia and gonorrhoea infection following primary infection to the overall clinic rate. Methods: A retrospective cohort analysis of MSM attending the Melbourne Sexual Health Clinic was conducted. For both infections, the overall incidence and that following diagnosis and treatment was calculated. Results: Of the 13053 MSM, the incidence of diagnoses for chlamydia and gonorrhoea was 8.5 (95% CI: 8.2–8.9) and 6.2 (95% CI: 5.9–6.5) per 100 person-years, respectively. Seventy per cent of chlamydia and 64% of gonorrhoea cases were retested at 10–365 days after diagnosis and treatment. Following diagnosis and treatment of chlamydia, the rate ratio in these individuals in the first quarter was 16- and 8-fold higher for chlamydia and gonorrhoea, respectively, compared with the background incidence of diagnoses. Similarly, following diagnosis and treatment of gonorrhoea, the rate ratio in these individuals in the first quarter was 18- and 10-fold higher for gonorrhoea and chlamydia, respectively. Conclusions: These data suggest that approximately half of MSM who test positive for chlamydia or gonorrhoea within 90 days after an initial infection represent contact with either a previous sexual partner or member of the same sexual network, the remainder representing the particularly high STI risk for these MSM.
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Wilson TE, Fraser-White M, Williams KM, Pinto A, Agbetor F, Camilien B, Henny K, Browne RC, Gousse Y, Taylor T, Brown H, Taylor R, Joseph MA. Barbershop Talk With Brothers: using community-based participatory research to develop and pilot test a program to reduce HIV risk among Black heterosexual men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:383-397. [PMID: 25299804 PMCID: PMC4208304 DOI: 10.1521/aeap.2014.26.5.383] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a need for feasible, evidence-based interventions that support HIV risk reduction among heterosexual Black men. In this article, we describe the process for development of the Barbershop Talk With Brothers (BTWB) program and evaluation. The BTWB program is a theoretically grounded and community-based HIV prevention program that seeks to improve individual skills and motivation to decrease sexual risk, and that builds men's interest in and capacity for improving their community's health. Formative data collection included barbershop observations and barber focus groups, brief behavioral risk assessments of men in barbershops, and focus groups and individual interviews. Based on this information and in consultation with our steering committee, we developed the BTWB program and accompanying program evaluation. From April through November 2011, 80 men were recruited and completed a baseline assessment of a pilot test of the program; 78 men completed the program and 71 completed a 3-month assessment. The pilot evaluation procedures were feasible to implement, and assessments of pre- and post-test measures indicate that key behavioral outcomes and proposed mediators of those outcomes changed in hypothesized directions. Specifically, attitudes and self-efficacy toward consistent condom use improved, and respondents reported lower levels of sexual risk behavior from baseline to follow-up (all p < 0.05). Perceptions of community empowerment also increased (p = 0.06). While HIV stigma decreased, this difference did not reach statistical significance. Our approach to community-engaged program development resulted in an acceptable, feasible approach to reaching and educating heterosexual Black men about HIV prevention in community settings.
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Knight V, Ryder N, Bourne C, McNulty A. A cross sectional study of how people diagnosed with a bacterial sexually transmitted infection inform their partners. Sex Transm Infect 2014; 90:588-91. [PMID: 25237126 DOI: 10.1136/sextrans-2013-051482] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. METHODS At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners. RESULTS Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67). CONCLUSIONS Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.
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Affiliation(s)
- Vickie Knight
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia The Kirby Institute, Wallace Worth Building, UNSW Australia, Sydney, New South Wales, Australia
| | - Nathan Ryder
- Sexual Health and Blood Borne Virus Unit, Department of Health, Darwin, Northern Territory, Australia
| | - Chris Bourne
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia STI Programs Unit, NSW Ministry of Health, Sydney, New South Wales, Australia School of Public Health and Community Medicine, University of NSW, Kensington, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia STI Programs Unit, NSW Ministry of Health, Sydney, New South Wales, Australia
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Abstract
Partner notification is an essential part of case management for sexually transmitted infections. Done correctly it reduces persistent or recurrent infection in the index patient, identifies previously undiagnosed infections, and may thus contribute to reduced transmission in the population. The effectiveness of patient referral of partners can be enhanced through the provision of written information and easy access to tests and medication. A recent systematic review of partner notification found that enhanced partner therapy (helping get treatment to partners more rapidly) reduced re-infection in the index case by almost 30% compared with simple patient referral. Provider referral, where the healthcare worker contacts partners directly, can also be effective, and provides an important service for patients who are wary of informing partners themselves. Partner notification services should be available for all patients found to have a sexually transmitted infection, whether the diagnosis is made in specialist settings, or in primary or community-based care. For patients with HIV, partner notification should be addressed when the infection is first diagnosed and revisited for subsequent partners. Access to specialist partner notification services is an important part of any sexual healthcare system. The professional competencies required to undertake partner notification have now been clearly defined.
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Affiliation(s)
- Helen Ward
- is a Professor of Public Health, Imperial College London, UK. Competing interests: none declared
| | - Gill Bell
- is a Professor of Public Health, Imperial College London, UK. Competing interests: none declared
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Carmine L, Castillo M, Fisher M. Testing and treatment for sexually transmitted infections in adolescents--what's new? J Pediatr Adolesc Gynecol 2014; 27:50-60. [PMID: 24119658 DOI: 10.1016/j.jpag.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant changes are taking place in the diagnosis and management of sexually transmitted infections (STI) in adolescents and young adults. FINDINGS In this review article, we provide an update of STIs in adolescents and young adults including: (1) Adolescent risk; (2) Screening guidelines; (3) Clinical manifestations; (4) Diagnostic testing; (5) Treatment; and (6) Prevention; with an emphasis on "what's new" in the field. CONCLUSIONS/SIGNIFICANCE While the impacts of STI epidemiology and health care access are leading to new recommendations for screening and prevention, changes in technology and drug resistance are promoting new methods of STI testing and ongoing revisions of STI treatment recommendations.
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Affiliation(s)
- Linda Carmine
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY.
| | - Marigold Castillo
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
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Ferreira A, Young T, Mathews C, Zunza M, Low N. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database Syst Rev 2013; 2013:CD002843. [PMID: 24092529 PMCID: PMC7138045 DOI: 10.1002/14651858.cd002843.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Partner notification (PN) is the process whereby sexual partners of an index patient are informed of their exposure to a sexually transmitted infection (STI) and the need to obtain treatment. For the person (index patient) with a curable STI, PN aims to eradicate infection and prevent re-infection. For sexual partners, PN aims to identify and treat undiagnosed STIs. At the level of sexual networks and populations, the aim of PN is to interrupt chains of STI transmission. For people with viral STI, PN aims to identify undiagnosed infections, which can facilitate access for their sexual partners to treatment and help prevent transmission. OBJECTIVES To assess the effects of different PN strategies in people with STI, including human immunodeficiency virus (HIV) infection. SEARCH METHODS We searched electronic databases (the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE) without language restrictions. We scanned reference lists of potential studies and previous reviews and contacted experts in the field. We searched three trial registries. We conducted the most recent search on 31 August 2012. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) or quasi-RCTs comparing two or more PN strategies. Four main PN strategies were included: patient referral, expedited partner therapy, provider referral and contract referral. Patient referral means that the patient notifies their sexual partners, either with (enhanced patient referral) or without (simple patient referral) additional verbal or written support. In expedited partner therapy, the patient delivers medication or a prescription for medication to their partner(s) without the need for a medical examination of the partner. In provider referral, health service personnel notify the partners. In contract referral, the index patient is encouraged to notify partner, with the understanding that the partners will be contacted if they do not visit the health service by a certain date. DATA COLLECTION AND ANALYSIS We analysed data according to paired partner referral strategies. We organised the comparisons first according to four main PN strategies (1. enhanced patient referral, 2. expedited partner therapy, 3. contract referral, 4. provider referral). We compared each main strategy with simple patient referral and then with each other, if trials were available. For continuous outcome measures, we calculated the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, we calculated the risk ratio (RR) with 95% CI. We performed meta-analyses where appropriate. We performed a sensitivity analysis for the primary outcome re-infection rate of the index patient by excluding studies with attrition of greater than 20%. Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information. MAIN RESULTS We included 26 trials (17,578 participants, 9015 women and 8563 men). Five trials were conducted in developing countries. Only two trials were conducted among HIV-positive patients. There was potential for selection bias, owing to the methods of allocation used and of performance bias, owing to the lack of blinding in most included studies. Seven trials had attrition of greater than 20%, increasing the risk of bias.The review found moderate-quality evidence that expedited partner therapy is better than simple patient referral for preventing re-infection of index patients when combining trials of STIs that caused urethritis or cervicitis (6 trials; RR 0.71, 95% CI 0.56 to 0.89, I(2) = 39%). When studies with attrition greater than 20% were excluded, the effect of expedited partner therapy was attenuated (2 trials; RR 0.8, 95% CI 0.62 to 1.04, I(2) = 0%). In trials restricted to index patients with chlamydia, the effect was attenuated (2 trials; RR 0.90, 95% CI 0.60 to 1.35, I(2) = 22%). Expedited partner therapy also increased the number of partners treated per index patient (three trials) when compared with simple patient referral in people with chlamydia or gonorrhoea (MD 0.43, 95% CI 0.28 to 0.58) or trichomonas (MD 0.51, 95% CI 0.35 to 0.67), and people with any STI syndrome (MD 0.5, 95% CI 0.34 to 0.67). Expedited partner therapy was not superior to enhanced patient referral in preventing re-infection (3 trials; RR 0.96, 95% CI 0.60 to 1.53, I(2) = 33%, low-quality evidence). Home sampling kits for partners (four trials) did not result in lower rates of re-infection in the index case (measured in one trial), or higher numbers of partners elicited (three trials), notified (two trials) or treated (one trial) when compared with simple patient referral. There was no consistent evidence for the relative effects of provider, contract or other patient referral methods. In one trial among men with non-gonococcal urethritis, more partners were treated with provider referral than with simple patient referral (MD 0.5, 95% CI 0.37 to 0.63). In one study among people with syphilis, contract referral elicited treatment of more partners than provider referral (MD 2.2, 95% CI 1.95 to 2.45), but the number of partners receiving treatment was the same in both groups. Where measured, there was no statistical evidence of differences in the incidence of adverse effects between PN strategies. AUTHORS' CONCLUSIONS The evidence assessed in this review does not identify a single optimal strategy for PN for any particular STI. When combining trials of STI causing urethritis or cervicitis, expedited partner therapy was more successful than simple patient referral for preventing re-infection of the index patient but was not superior to enhanced patient referral. Expedited partner therapy interventions should include all components that were part of the trial intervention package. There was insufficient evidence to determine the most effective components of an enhanced patient referral strategy. There are too few trials to allow consistent conclusions about the relative effects of provider, contract or other patient referral methods for different STIs. More high-quality RCTs of PN strategies for HIV and syphilis, using biological outcomes, are needed.
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Affiliation(s)
- Adel Ferreira
- Stellenbosch UniversityFaculty of Medicine and Health SciencesCape TownSouth Africa
| | - Taryn Young
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 19063TygerbergCape TownSouth Africa7505
- South African Medical Research CouncilSouth African Cochrane CentrePO Box 19070TygerbergCape TownSouth Africa7505
| | - Catherine Mathews
- University of Cape TownSchool of Public Health and Family MedicineRondeboschCape TownSouth Africa7700
| | - Moleen Zunza
- Stellenbosch UniversityDepartment of Paediatrics and Child Health , Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Nicola Low
- University of BernInstitute of Social and Preventive Medicine (ISPM)Finkenhubelweg 11BernSwitzerlandCH‐3012
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Yu YY, Frasure-Williams JA, Dunne EF, Bolan G, Markowitz L, Bauer HM. Chlamydia partner services for females in California family planning clinics. Sex Transm Dis 2013; 38:913-8. [PMID: 21934563 DOI: 10.1097/olq.0b013e3182240366] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prompt treatment of exposed partners is critical for preventing further transmission of chlamydia, reinfection, and sequelae among females. Patient-delivered partner therapy (PDPT) has been allowable in California since 2001; however, few data are available regarding PDPT use and treatment outcomes. METHODS Eight family planning clinics participated in a partner services evaluation from 2005 to 2006. Females aged 16 to 35 years with chlamydia were interviewed to determine the partner service received and partner treatment outcomes; a subset of partners was also interviewed. Determinants of reported partner treatment were assessed using multivariate logistic regression. Selected medical records were reviewed to assess reinfection rates. RESULTS Overall, 743 female patients disclosed 952 partners; 58% of whom were identified as steady partners. Reported partner services included concurrent patient-partner treatment visits (15% of partners), PDPT (19%), patient referral (55%), health department referral (0.1%), and no partner management (11%). On the basis of patient report, 82% of partners were notified and 54% received treatment. Of the 166 (17%) partners interviewed, 139 (84%) reported that they had received treatment, which correlated well with patient report. Reported partner treatment was higher for concurrent treatment visits and PDPT (79% and 80%, respectively) compared to patient referral (44%, P < 0.0001). Adjusted for clinic and relationship status, partners managed with concurrent treatment visits or PDPT were more likely to receive treatment compared with partners managed with patient referral (adjusted odds ratios, 3.5; 95% confidence interval, 2.1-5.8 and adjusted odds ratios, 4.3; 95% confidence interval, 2.6-7.2, respectively). Among the patients retested within 6 months after treatment, 18% were reinfected; reinfection rates did not differ by type of partner service. CONCLUSIONS Although overall rates of reported partner treatment were low, concurrent patient-partner treatment visits and PDPT were associated with significantly higher rates of partner treatment. However, these methods may be underutilized in California family planning settings.
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Affiliation(s)
- Ying-Ying Yu
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Sexually Transmitted Disease Control Branch, Richmond, CA 94804, USA
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Arunkumar S, Kamoji SG, Kasatti G. Partner notification and treatment Institute of Venereology-experience. Indian J Sex Transm Dis AIDS 2013. [PMID: 23919048 PMCID: PMC3730467 DOI: 10.4103/2589-0557.112863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There has been a significant increase in general awareness about Sexually transmitted diseases (STD's) among the general public. However, rates of partner notification and treatment which are an integral part of STD awareness is still questionable. METHODOLOGY AND RESULTS We analyzed the statistics for prevalence of partner notification (which is about 52%) as well as the possible reasons for non-compliance. An overview of various ways of partner notification has been given as patient delivered partner medication (PDPM) and patient based partner referral (PBPR) of which PDPM is the most acceptable and effective method worldwide.
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Affiliation(s)
- S. Arunkumar
- Department of STD, Chengalpattu Medical College, Chennai, Tamil Nadu, India,Address for correspondence: Dr. S. Arunkumar, Department of STD, Chengalpattu Medical College, Chengalpattu - 603 001, Chennai, Tamil Nadu, India. E-mail:
| | | | - Gajendran Kasatti
- Institute of Venereology, Madras Medical College, Chennai, Tamil Nadu, India
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Abstract
PURPOSE OF REVIEW In 2006, the Centers for Disease Control and Prevention recommended Expedited Partner Therapy (EPT) as a clinical option for assuring treatment of sex partners of persons infected with sexually transmitted infections. In this review, we provide an update on research, evaluation and efforts to increase EPT coverage. We also attend to EPT for gonorrhea in the context of antimicrobial resistance. RECENT FINDINGS Controlled trials in the United States and United Kingdom have presented increasing variety in intervention approaches. Trials and program evaluations typically demonstrate increased partner treatment rates, although only some studies show reductions in follow-up infection rates. Coverage has increased substantially, with over 30 states permitting EPT for chlamydial infection, gonorrhea, or both. The prospect of cephalosporin-resistant gonorrhea, however, raises the prospect that EPT may become less feasible as a partner treatment approach for gonorrhea patients. SUMMARY Clinicians should continue to be aware of the importance of partner managements for STD-infected patients, with EPT being an evidence-based intervention in that respect. The variety in EPT models provides alternatives that may suit some practices and venues. For clinicians seeing gonorrhea patients, effective counseling models - enhanced patient referral - should be closely examined in case oral treatment for gonorrhea becomes infeasible.
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Affiliation(s)
- Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Harel O, Pellowski J, Kalichman S. Are we missing the importance of missing values in HIV prevention randomized clinical trials? Review and recommendations. AIDS Behav 2012; 16:1382-93. [PMID: 22223301 DOI: 10.1007/s10461-011-0125-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Missing data in HIV prevention trials is a common complication to interpreting outcomes. Even a small proportion of missing values in randomized trials can cause bias, inefficiency and loss of power. We examined the extent of missing data and methods in which HIV prevention randomized clinical trials (RCT) have managed missing values. We used a database maintained by the HIV/AIDS Prevention Research Synthesis (PRS) Project at the Centers for Disease Control and Prevention (CDC) to identify related trials for our review. The PRS cumulative database was searched on June 15, 2010 and all citations that met the following criteria were retrieved: All RCTs which reported HIV/STD/HBV/HCV behavioral interventions with a biological outcome from 2005 to present. Out of the 57 intervention trials identified, all had some level of missing values. We found that the average missing values per study ranged between 3 and 97%. Averaging over all studies the percent of missing values was 26%. None of the studies reported any assumptions for managing missing data in their RCTs. Under some relaxed assumptions discussed below, we expect only 12% of studies to report unbiased results. There is a need for more detailed and thoughtful consideration of the missing data problem in HIV prevention trials. In the current state of managing missing data we risk major biases in interpretations. Several viable alternatives are available for improving the internal validity of RCTs by managing missing data.
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Low N, Hawkes SJ. Putting the magic in magic bullets: top three global priorities for sexually transmitted infection control. Sex Transm Infect 2012; 87 Suppl 2:ii44-6. [PMID: 22110155 PMCID: PMC3612838 DOI: 10.1136/sextrans-2011-050207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicola Low
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland.
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Godoy P. [The monitoring and control of sexually transmitted infections: a pending problem yet]. GACETA SANITARIA 2011; 25:263-6. [PMID: 21715057 DOI: 10.1016/j.gaceta.2011.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
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Scott-Sheldon LAJ, Huedo-Medina TB, Warren MR, Johnson BT, Carey MP. Efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections: a meta-analysis, 1991 to 2010. J Acquir Immune Defic Syndr 2011; 58:489-98. [PMID: 22083038 PMCID: PMC5729925 DOI: 10.1097/qai.0b013e31823554d7] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In the absence of an effective HIV vaccine, safer sexual practices are necessary to avert new infections. Therefore, we examined the efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections (STIs), including HIV. DESIGN Studies that examined a behavioral intervention focusing on reducing sexual risk, used a randomized controlled trial or a quasi-experimental design with a comparison condition, and provided needed information to calculate effect sizes for condom use and any type of STI, including HIV. METHODS Studies were retrieved from electronic databases (eg, PubMed, PsycINFO) and reference sections of relevant papers. Forty-two studies with 67 separate interventions (N = 40,665; M age = 26 years; 68% women; 59% Black) were included. Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed-effects and random-effects models, were calculated. Potential moderators of intervention efficacy were assessed. RESULTS Compared with controls, intervention participants increased their condom use [d+ = 0.17, 95% confidence interval (CI) = 0.04, 0.29; k = 67], had fewer incident STIs (d+ = 0.16, 95% CI = 0.04, 0.29; k = 62), including HIV (d+ = 0.46, 95% CI = 0.13, 0.79; k = 13). Sample (eg, ethnicity) and intervention features (eg, skills training) moderated the efficacy of the intervention. CONCLUSIONS Behavioral interventions reduce sexual risk behavior and avert STIs and HIV. Translation and widespread dissemination of effective behavioral interventions are needed.
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Lanjouw E, Ossewaarde JM, Stary A, Boag F, van der Meijden WI. 2010 European guideline for the management of Chlamydia trachomatis infections. Int J STD AIDS 2011; 21:729-37. [PMID: 21187352 DOI: 10.1258/ijsa.2010.010302] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This guideline aims to provide comprehensive information regarding the management of infections caused by Chlamydia trachomatis in European countries. The recommendations contain important information for physicians and laboratory staff working with sexually transmitted infections (STIs) and/or STI-related issues. Individual European countries may be required to make minor national adjustments to this guideline as some of the tests or specific local data may not be accessible, or because of specific laws.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus MC, Rotterdam, Netherlands.
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Perceived Financial Need and Sexual Risk Behavior Among Urban, Minority Patients Following Sexually Transmitted Infection Diagnosis. Sex Transm Dis 2011; 38:230-4. [DOI: 10.1097/olq.0b013e3181f41b81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Edmiston N, Merritt T, Ooi C. Make contact: a comparative study of contact tracing strategies. Int J STD AIDS 2010; 21:431-4. [PMID: 20606225 DOI: 10.1258/ijsa.2010.010118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the ongoing chlamydia epidemic, improving contact tracing is a priority. The aim of this research was to develop and evaluate contact tracing resources for chlamydial infection. We compared contact tracing outcomes before and during an intervention using information resources in the form of a wallet-sized 'Make Contact' card and a website. The notification index was similar in the pre-intervention phase and the intervention phase (1.83 versus 1.91, P = 0.74), as was the treatment index (0.94 versus 0.91, P = 0.89). Although the intervention did not demonstrate an effect, this study adds to the published data on contact tracing outcomes in Australia. Further research to evaluate contact tracing strategies, both in sexual health clinics and other settings, remains a priority.
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Affiliation(s)
- N Edmiston
- Pacific Clinic, Newcastle Sexual Health Services, NSW, Australia
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Wetmore CM, Manhart LE, Wasserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Epidemiol Rev 2010; 32:121-36. [PMID: 20519264 DOI: 10.1093/epirev/mxq010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Globally, sexually transmitted infections (STIs) represent a significant source of morbidity and disproportionately impact the health of women and children. The number of randomized controlled trials testing interventions to prevent STIs has dramatically increased over time. To assess their impact, the authors conducted a systematic review of interventions to prevent sexual transmission or acquisition of STIs other than human immunodeficiency virus, published in the English-language, peer-reviewed literature through December 2009. Ninety-three papers reporting data from 74 randomized controlled trials evaluating 75 STI prevention interventions were identified. Eight intervention modalities were used: behavioral interventions (36% of interventions), vaginal microbicides (16%), vaccines (16%), treatment (11%), partner services (9%), physical barriers (5%), male circumcision (5%), and multicomponent (1%). Overall, 59% of interventions demonstrated efficacy in preventing infection with at least 1 STI. Treatment interventions and vaccines for viral STIs showed the most consistently positive effects. Male circumcision protected against viral STIs and possibly trichomoniasis. Almost two-thirds of behavioral interventions were effective, but the magnitude of effects ranged broadly. Partner services yielded similarly mixed results. In contrast, vaginal microbicides and physical barrier methods demonstrated few positive effects. Future STI prevention efforts should focus on enhancing adherence within interventions, integrating new technologies, ensuring sustainable behavior change, and conducting implementation research.
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Affiliation(s)
- Catherine M Wetmore
- Center for AIDS and STD and Department of Global Health, University of Washington, Box 358210, Suite 600, 2301 Fifth Avenue, Seattle, WA 98121, USA.
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Partner notification in the clinician's office: patient health, public health and interventions. Curr Opin Obstet Gynecol 2009; 21:365-70. [PMID: 19633553 DOI: 10.1097/gco.0b013e3283307c2a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Partner notification is an essential element of sexually transmitted disease infection control. Patients may be interviewed by public health staff, followed by public health staff notification of those partners (provider referral), or they receive some form of instruction to notify and refer their own partners (patient referral). In this review, we review partner notification and current research and programmatic activity. RECENT FINDINGS Resource limitations restrain provider referral to a minority of cases. Patient referral is far more widely practiced and is the subject of some recent enhancements. Foremost among these is the growing practice of expedited partner therapy, in which partner treatment may occur through the provision of medications or prescriptions prior to a clinical evaluation. Trials in which patients took medications to their partners have been supported, and the practice is gaining acceptance nationally. Other counseling also increases patient referral efficacy. Finally, the role of the internet in both provider and patient referral has received increasing attention and is being incorporated into program practice. SUMMARY Clinical providers can intervene at the point of care to serve both patients as individuals and infection control more broadly. Cooperation between public health agencies, other organizations and clinical providers can facilitate both goals.
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Hogben M, Niccolai LM. Innovations in sexually transmitted disease partner services. Curr Infect Dis Rep 2009; 11:148-54. [DOI: 10.1007/s11908-009-0022-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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