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Sharpe JD, Charniga K, Byrd KM, Stefanos R, Lewis L, Watson J, Feldpausch A, Pavlick J, Hand J, Sokol T, Ortega E, Pathela P, Hennessy RR, Dulcey M, McHugh L, Pietrowski M, Perella D, Shah S, Maroufi A, Taylor M, Cope A, Belay ED, Ellington S, McCollum AM, Zilversmit Pao L, Guagliardo SAJ, Dawson P. Possible Exposures Among Mpox Patients Without Reported Male-to-Male Sexual Contact - Six U.S. Jurisdictions, November 1-December 14, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:944-948. [PMID: 37651279 DOI: 10.15585/mmwr.mm7235a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The extent to which the 2022 mpox outbreak has affected persons without a recent history of male-to-male sexual contact (MMSC) is not well understood. During November 1-December 14, 2022, CDC partnered with six jurisdictional health departments to characterize possible exposures among mpox patients aged ≥18 years who did not report MMSC during the 3 weeks preceding symptom onset. Among 52 patients included in the analysis, 14 (27%) had a known exposure to a person with mpox, including sexual activity and other close intimate contact (eight) and household contact (six). Among 38 (73%) patients with no known exposure to a person with mpox, self-reported activities before illness onset included sexual activity and other close intimate contact (17; 45%), close face-to-face contact (14; 37%), attending large social gatherings (11; 29%), and being in occupational settings involving close skin-to-skin contact (10; 26%). These findings suggest that sexual activity remains an important route of mpox exposure among patients who do not report MMSC.
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Karki S, Peterman TA, Johnson K, Hennessy RR, Matthias J, Wilson C, Mishra N, Weinstock H. An Automated Syphilis Serology Record Search and Review Algorithm to Prioritize Investigations by Health Departments. Sex Transm Dis 2021; 48:909-914. [PMID: 34091581 PMCID: PMC10339230 DOI: 10.1097/olq.0000000000001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reactive syphilis serologies are investigated by health departments to determine if they represent new infection, reinfection, or treatment failure. Serologies prioritized for investigation based on nontreponemal test titer and age (using a "reactor grid") undergo manual record search and review. We developed a computerized algorithm that automates the record search and review. METHODS We developed and tested the algorithm using a Florida Department of Health data set containing serologies reported January 2016 to December 2018 and previous records linked to each individual. The algorithm was based on the syphilis case definition, which requires (except primary cases with signs and symptoms) (1) a positive treponemal test result and a newly positive nontreponemal test result or (2) a 4-fold increase in nontreponemal test titer. Two additional steps were added to avoid missing cases. New York City Department of Health and Mental Hygiene validated this algorithm. RESULTS The algorithm closed more investigations (49.9%) than the reactor grid (27.0%). The algorithm opened 99.4% of the individuals investigated and labeled as cases by the health department; it missed 75 cases. Many investigations opened by the algorithm were closed by the reactor grid; we could not assess how many would have been cases. In New York City, the algorithm closed 70.9% of investigations, likely because more individuals had previous test in the database (88.2%) compared with Florida (56.5%). CONCLUSIONS The automated algorithm successfully searched and reviewed records to help identify cases of syphilis. We estimate the algorithm would have saved Florida 590 workdays for 3 years.
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Affiliation(s)
- Saugat Karki
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas A. Peterman
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kimberly Johnson
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Robin R. Hennessy
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - James Matthias
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Florida Department of Health, Tallahassee, FL
| | | | - Ninad Mishra
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hillard Weinstock
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Braunstein SL, Slutsker JS, Lazar R, Shah D, Hennessy RR, Chen SX, Pathela P, Daskalakis DC, Schillinger JA. Epidemiology of Reported HIV and Other Sexually Transmitted Infections During the COVID-19 Pandemic, New York City. J Infect Dis 2021; 224:798-803. [PMID: 34134130 PMCID: PMC8344782 DOI: 10.1093/infdis/jiab319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/15/2021] [Indexed: 11/12/2022] Open
Abstract
Early in the coronavirus disease 2019 (COVID-19) crisis, a statewide executive order (PAUSE) severely restricted the movement of New Yorkers from 23 March to 7 June 2020. We used New York City surveillance data for human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis to describe trends in diagnosis and reporting surrounding PAUSE. During PAUSE, the volume of positive HIV/sexually transmitted infection tests, and diagnoses of HIV, chlamydia, gonorrhea, and syphilis declined substantially, reaching a nadir in April before rebounding. Some shifts in characteristics of reported cases were identified.
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Affiliation(s)
- Sarah L Braunstein
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Jennifer Sanderson Slutsker
- Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Rachael Lazar
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Dipal Shah
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Robin R Hennessy
- Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York, New York, USA.,Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB, US Centers for Disease Control, Atlanta, Georgia, USA
| | - Shirley X Chen
- Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Preeti Pathela
- Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Demetre C Daskalakis
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Julia A Schillinger
- Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York, New York, USA.,Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB, US Centers for Disease Control, Atlanta, Georgia, USA
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Quilter LAS, de Voux A, Amiya RM, Davies E, Hennessy RR, Kerani RP, Madera R, Matthias J, Pearson VM, Walters JK, Wilson C, Kidd S, Torrone E. Prevalence of Self-reported Neurologic and Ocular Symptoms in Early Syphilis Cases. Clin Infect Dis 2021; 72:961-967. [PMID: 32103243 DOI: 10.1093/cid/ciaa180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosyphilis, a complication of syphilis, can occur at any stage of infection. Measuring the prevalence of neurosyphilis is challenging, and there are limited data on the prevalence of neurologic or ocular symptoms among patients with syphilis. We sought to describe the prevalence of neurologic and/or ocular symptoms among early syphilis (ES) cases and the clinical management of symptomatic cases enrolled in the STD Surveillance Network (SSuN) Neuro/Ocular Syphilis Surveillance project. METHODS Persons diagnosed with ES were selected for interviews based on current health department protocols in 5 participating SSuN jurisdictions from November 2016 through October 2017. All interviewed ES cases were screened for self-reported neurologic and/or ocular symptoms. Additional clinical information on diagnostic testing and treatment for cases concerning for neurosyphilis/ocular syphilis was obtained from providers. RESULTS Among 9123 patients with ES who were interviewed, 151 (1.7%; 95% confidence interval [CI], 1.4%-1.9%) reported ≥ 1 neurologic or ocular symptom. Of the 53 (35%) who underwent lumbar puncture, 22 (42%) had documented abnormal cerebrospinal fluid, of which 21 (95%) were treated for neurosyphilis/ocular syphilis. Among the remaining 98 symptomatic patients with no documented lumbar puncture (65%), 12 (12%) were treated for and/or clinically diagnosed with neurosyphilis/ocular syphilis. CONCLUSIONS We observed a low prevalence of self-reported neurologic and/or ocular symptoms in interviewed ES cases. Approximately one-third of ES cases who self-reported symptoms underwent further recommended diagnostic evaluation. Understanding barriers to appropriate clinical evaluation is important to ensuring appropriate management of patients with possible neurologic and/or ocular manifestations of syphilis.
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Affiliation(s)
- Laura A S Quilter
- Epidemic Intelligence Service, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alex de Voux
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel M Amiya
- Washington State Department of Health, Shoreline, Washington, USA
| | - Erin Davies
- Washington State Department of Health, Shoreline, Washington, USA
| | - Robin R Hennessy
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Roxanne P Kerani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Robbie Madera
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - James Matthias
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Florida Department of Health, Tallahassee, Florida, USA
| | | | | | - Craig Wilson
- Florida Department of Health, Tallahassee, Florida, USA
| | - Sarah Kidd
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Torrone
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Liao TS, Hashmi A, Lazaroff J, Hennessy RR, Sanders Kim A, Evans Lloyd P, Rosen JB. Effect of Policy Change to Require Laboratory Reporting With Pregnancy Indicated for Syphilis and Hepatitis B Virus Infection, New York City, January 2013-June 2018. Public Health Rep 2020; 135:182S-188S. [PMID: 32735204 DOI: 10.1177/0033354920932542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We evaluated the impact of a 2014 New York City health code change requiring laboratories to indicate if a patient is pregnant or probably pregnant in the electronic laboratory report (ELR) when reporting syphilis and hepatitis B virus (HBV) cases to the New York City Department of Health and Mental Hygiene (DOHMH). METHODS We calculated the number of pregnant persons with syphilis or HBV infection reported to DOHMH from January 1, 2013, through June 30, 2018. We compared the proportion in which the first report to DOHMH was an ELR with pregnancy indicated before and after the policy change. We calculated time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR and the proportion of cases in which ELR with pregnancy indicated was the only report source. RESULTS A total of 552 new syphilis and 8414 HBV-infected cases were reported to DOHMH. From January 2013-June 2014 (pre-change) to January 2017-June 2018 (post-change), the proportion of cases in which ELR with pregnancy indicated was the first report to DOHMH increased significantly (14.7% [23/156] to 46.2% [80/173] for syphilis; 8.0% [200/2498] to 45.3% [851/1879] for HBV infection [P < .001]). Median time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR was 9.0 days for syphilis and 51.0 days for HBV infection. ELR with pregnancy indicated was the only report for 43.1% (238/552) of syphilis cases and 23.4% (1452/6200) of HBV cases during the study period. CONCLUSION Including pregnancy status with ELR can increase the ability of public health departments to conduct timely interventions to prevent mother-to-child transmission.
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Affiliation(s)
- Tim S Liao
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Ariba Hashmi
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Julie Lazaroff
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Robin R Hennessy
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.,Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Afua Sanders Kim
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Pamela Evans Lloyd
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Jennifer B Rosen
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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Slutsker JS, Hennessy RR, Schillinger JA. Factors Contributing to Congenital Syphilis Cases - New York City, 2010-2016. MMWR Morb Mortal Wkly Rep 2018; 67:1088-1093. [PMID: 30286056 PMCID: PMC6171893 DOI: 10.15585/mmwr.mm6739a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oliver SE, Aubin M, Atwell L, Matthias J, Cope A, Mobley V, Goode A, Minnerly S, Stoltey J, Bauer HM, Hennessy RR, DiOrio D, Fanfair RN, Peterman TA, Markowitz L. Ocular Syphilis - Eight Jurisdictions, United States, 2014-2015. MMWR Morb Mortal Wkly Rep 2016; 65:1185-1188. [PMID: 27811837 DOI: 10.15585/mmwr.mm6543a2] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Ocular syphilis, a manifestation of Treponema pallidum infection, can cause a variety of ocular signs and symptoms, including eye redness, blurry vision, and vision loss. Although syphilis is nationally notifiable, ocular manifestations are not reportable to CDC. Syphilis rates have increased in the United States since 2000. After ocular syphilis clusters were reported in early 2015, CDC issued a clinical advisory (1) in April 2015 and published a description of the cases in October 2015 (2). Because of concerns about an increase in ocular syphilis, eight jurisdictions (California, excluding Los Angeles and San Francisco, Florida, Indiana, Maryland, New York City, North Carolina, Texas, and Washington) reviewed syphilis surveillance and case investigation data from 2014, 2015, or both to ascertain syphilis cases with ocular manifestations. A total of 388 suspected ocular syphilis cases were identified, 157 in 2014 and 231 in 2015. Overall, among total syphilis surveillance cases in the jurisdictions evaluated, 0.53% in 2014 and 0.65% in 2015 indicated ocular symptoms. Five jurisdictions described an increase in suspected ocular syphilis cases in 2014 and 2015. The predominance of cases in men (93%), proportion of those who are men who have sex with men (MSM), and percentage who are HIV-positive (51%) are consistent with the epidemiology of syphilis in the United States. It is important for clinicians to be aware of potential visual complications related to syphilis infections. Prompt identification of potential ocular syphilis, ophthalmologic evaluation, and appropriate treatment are critical to prevent or manage visual symptoms and sequelae of ocular syphilis.
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Isaac BM, Masonbrink A, Kennedy J, Greene SK, Hennessy RR, Rosen JB, Trieu L, Ngai S, Morse SS, Weiss D. Reportable Bacterial Infections among New York City-Born Infants, 2001-2009. J Pediatr 2016; 174:218-225.e4. [PMID: 27117198 DOI: 10.1016/j.jpeds.2016.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/05/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine rates of reportable bacterial infections among infants in New York City and identify populations at risk and preventable causes of morbidity. STUDY DESIGN This retrospective cohort study matched live births in New York City from 2001-2009 to reported cases of bacterial infections among infants less than 1 year of age. Characteristics recorded on birth certificates were compared between infants with bacterial enteric infection, bacterial nonenteric infection, and no reportable bacterial infection. Multinomial logistic regression and multivariable logistic regression were used to identify risk factors for infection. RESULTS Bacterial infection was reported in 4.6 cases per 1000 live births. Of 4524 infants with a reportable infection, the majority (2880, 63%) had an enteric infection. Asian/Pacific Islanders in Brooklyn were the borough-level race/ethnic group with the highest enteric infection rate (8.5 per 1000 live births). Citywide, infants with enteric infections were disproportionately male, from higher poverty neighborhoods, born to foreign-born mothers, and enrolled in Special Supplemental Food Program for Women, Infants, and Children or Medicaid. In contrast, infants with nonenteric infections were more likely to have low birthweight and mothers characterized by US birth and black race or white Hispanic race/ethnicity. CONCLUSIONS Distinct patterns of risk factors for enteric and nonenteric bacterial infections among infants were identified. The results suggest that infants born to Asian/Pacific Islander mothers residing in Brooklyn should be a focus of enteric disease prevention. More research is necessary to better understand what behaviors increase the risk of enteric disease in this population.
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Affiliation(s)
- Beth M Isaac
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY; Mailman School of Public Health, Columbia University, New York, NY.
| | - Abbey Masonbrink
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Joseph Kennedy
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Sharon K Greene
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Robin R Hennessy
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY; Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer B Rosen
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Lisa Trieu
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Stephanie Ngai
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Stephen S Morse
- Mailman School of Public Health, Columbia University, New York, NY
| | - Don Weiss
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
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Buffington J, Murray PJ, Schlanger K, Shih L, Badsgard T, Hennessy RR, Wood R, Weisfuse IB, Gunn RA. Low prevalence of hepatitis C virus antibody in men who have sex with men who do not inject drugs. Public Health Rep 2007; 122 Suppl 2:63-7. [PMID: 17542456 PMCID: PMC1831798 DOI: 10.1177/00333549071220s212] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE It is well documented that injection drug users (IDUs) have a high prevalence of antibodies to hepatitis C virus (HCV). Sexual transmission of HCV can occur, but studies have shown that men who have sex with men (MSM) without a history of injection drug use are not at increased risk for infection. Still, some health-care providers believe that all MSM should be routinely tested for HCV infection. To better understand the potential role of MSM in risk for HCV infection, we compared the prevalence of antibody to HCV (anti-HCV) in non-IDU MSM with that among other non-IDU men at sexually transmitted disease (STD) clinics and human immunodeficiency virus (HIV) counseling and testing sites in three cities. METHODS During 1999-2003, public health STD clinics or HIV testing programs in Seattle, San Diego, and New York City offered counseling and testing for anti-HCV for varying periods to all clients. Sera were tested using enzyme immunoassays, and final results reported using either the signal-to-cutoff ratio or recombinant immunoblot assay results. Age, sex, and risk information were collected. Prevalence ratios and 95% confidence intervals were calculated. RESULTS Anti-HCV prevalence among IDUs (men and women) was between 47% and 57% at each site, with an overall prevalence of 51% (451/887). Of 1,699 non-IDU MSM, 26 (1.5%) tested anti-HCV positive, compared with 126 (3.6%) of 3,455 other non-IDU men (prevalence ratio 0.42, 95% confidence interval 0.28, 0.64). CONCLUSION The low prevalence of anti-HCV among non-IDU MSM in urban public health clinics does not support routine HCV testing of all MSM.
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Affiliation(s)
- Joanna Buffington
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Hennessy RR, Weisfuse IB, Schlanger K. Does integrating viral hepatitis services into a public STD clinic attract injection drug users for care? Public Health Rep 2007; 122 Suppl 2:31-5. [PMID: 17542450 PMCID: PMC1831812 DOI: 10.1177/00333549071220s206] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Injection drug users (IDUs) are at high risk for multiple health problems, including human immunodeficiency virus (HIV), viral hepatitis, and sexually transmitted diseases (STDs), and are likely to have poor access to health care. To more effectively serve high-risk clients, experts recommend that programs accessed by such client populations offer integrated services. In 2000, the New York City Department of Health and Mental Hygiene integrated viral hepatitis services (vaccine and screening) into a publicly funded STD clinic. We evaluated integrated service delivery to high-risk IDUs at this clinic. METHODS Hepatitis data were reviewed to identify clients who self-reported as IDUs. STD medical records of these clients were abstracted to ascertain primary reason for clinic visit, STD/HIV services received, and diagnoses made. RESULTS Between May 2000 and March 2004, 8,778 individuals received hepatitis services, of whom 3% (279/8,778) reported injection drug use. Nearly 60% (161/279) of IDUs reported availability of hepatitis services as the primary reason for the clinic visit. Of these 161 clients, 103 (64%) also received other services; 54% (55/103) had an STD exam (yielding 12 new STD diagnoses), and 59% (61/103) had HIV counseling and testing (yielding two new HIV cases). Of these 103 clients, 31 (30%) were referred to the clinic for hepatitis services from a drug treatment center, and 77% (24/31) tested positive for the antibody to hepatitis C virus. CONCLUSIONS Integrated hepatitis services appeared to attract IDUs to this STD clinic, where many also benefited from STD/HIV exams, testing, treatment, and referrals they may not have received otherwise.
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Affiliation(s)
- Robin R Hennessy
- Bureau of STD Control/Hepatitis C Program, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
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