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Nanhoe AC, Visser M, Omlo JJ, Watzeels AJCM, van den Broek IV, Götz HM. A pill for the partner via the chlamydia patient? Results from a mixed method study among sexual health care providers in the Netherlands. BMC Infect Dis 2018; 18:243. [PMID: 29843643 PMCID: PMC5975518 DOI: 10.1186/s12879-018-3139-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chlamydia prevalence in the Netherlands remains high despite targeted efforts. Effective Partner Notification (PN) and Partner Treatment (PT) can interrupt transmission and prevent re-infections. Patient Initiated Partner Treatment (PIPT) may strengthen chlamydia control. This study explores the current practice of PN and PT, and benefits of, and barriers and facilitators for PIPT among professionals in sexual health care in the Netherlands. Methods A qualitative study was performed among GPs, GP-assistants (GPAs), physicians and nurses working at Sexual Health Clinics (SHC) and key-informants on ethnical diversity using topic lists in focus groups (N = 40) and semi-structured questionnaires in individual interviews (N = 9). Topics included current practices regarding PN and PT, attitude regarding PIPT, and perceived barriers and facilitators for PIPT. Interviews were taped, transcribed verbatim, and coded using ATLAS.ti. A quantitative online questionnaire on the same topics was sent to all physicians and nurses employed at Dutch SHC (complete response rate 26% (84/321)). Results The qualitative study showed that all professionals support the need for more attention to PN, and that they saw advantages in PIPT. Mentioned barriers included unwilling PN-behaviour, Dutch legislation, several medical considerations and inadequate skills of GPs. Also, concerns about limited knowledge of cultural sensitivity around PN and PT were raised. Mentioned facilitators of PIPT were reliable home based test-kits, phone-contact between professionals and notified partners, more consultation time for GPs or GPAs and additional training. The online questionnaire showed that SHC employees agreed that partners should be treated as soon as possible, but also that they were reluctant towards PIPT without counselling and testing. Conclusions Professionals saw advantages in PIPT, but they also identified barriers hampering the potential introduction of PIPT. Improving PN and counselling skills with specific focus on cultural sensitivity is needed. PIPT could be considered for specific partners. PIPT in combination with home based testing and using e-healthcare should be further explored and developed.
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Affiliation(s)
- Anita C Nanhoe
- Center for Research and Business Intelligence, Rotterdam, The Netherlands
| | - Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jurriaan J Omlo
- Center for Research and Business Intelligence, Rotterdam, The Netherlands
| | | | - Ingrid V van den Broek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hannelore M Götz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Joore IK, Twisk DE, Vanrolleghem AM, de Ridder M, Geerlings SE, van Bergen JEAM, van den Broek IV. The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care. BMC Fam Pract 2016; 17:161. [PMID: 27855639 PMCID: PMC5114759 DOI: 10.1186/s12875-016-0556-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/02/2016] [Indexed: 01/03/2023]
Abstract
Background European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). We aimed to investigate the incidence of ICs in primary care reported in medical records prior to HIV diagnosis. Methods We did a cross-sectional search in an electronic general practice database using a matched case-control design to identify which predefined ICs registered by Dutch GPs were most associated with an HIV-positive status prior to the time of diagnosis. Results We included 224 HIV cases diagnosed from 2009 to 2013, which were matched with 2,193 controls. Almost two thirds (n = 136, 60.7%) of cases were diagnosed with one or more ICs in the period up to five years prior to the index date compared to 18.7% (n = 411) of controls. Cases were more likely to have an IC than controls: in the one year prior to the index date, the odds ratio (OR) for at least one condition was 11.7 (95% CI: 8.3 to 16.4). No significant differences were seen in the strength of the association between HIV diagnosis and ICs when comparing genders, age groups or urbanisation levels. There is no indication that subgroups require a different testing strategy. Conclusions Our study shows that there are opportunities for IC-guided testing in primary care. We recommend that IC-guided testing be more integrated in GPs’ future guidelines and that education strategies be used to facilitate its implementation in daily practice. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0556-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ivo K Joore
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands.
| | - Denise E Twisk
- National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Ann M Vanrolleghem
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan E A M van Bergen
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - Ingrid V van den Broek
- National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
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van den Broek IV, Sfetcu O, van der Sande MA, Andersen B, Herrmann B, Ward H, Götz HM, Uusküla A, Woodhall SC, Redmond SM, Amato-Gauci AJ, Low N, van Bergen JE. Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey. Eur J Public Health 2015; 26:382-8. [PMID: 26498953 PMCID: PMC4884327 DOI: 10.1093/eurpub/ckv196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.
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Affiliation(s)
- Ingrid V van den Broek
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands
| | - Otilia Sfetcu
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Marianne A van der Sande
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Julius Centre, UMC Utrecht, Utrecht, The Netherlands
| | - Berit Andersen
- Department of Public Health, Randers Hospital, Skovlyvej, Randers, Denmark
| | - Björn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helen Ward
- Infectious Diseases Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | - Hannelore M Götz
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Anneli Uusküla
- Department of Public Health, University of Tartu, Tartu, Estonia
| | - Sarah C Woodhall
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Shelagh M Redmond
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jan E van Bergen
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands STI AIDS Netherlands, Amsterdam, The Netherlands
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van den Broek IV, Gatkoi T, Lowoko B, Nzila A, Ochong E, Keus K. Chloroquine, sulfadoxine-pyrimethamine and amodiaquine efficacy for the treatment of uncomplicated Plasmodium falciparum malaria in Upper Nile, south Sudan. Trans R Soc Trop Med Hyg 2004; 97:229-35. [PMID: 14584383 DOI: 10.1016/s0035-9203(03)90128-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/18/2022] Open
Abstract
The current first-line and second-line drugs for Plasmodium falciparum malaria in South Sudan, chloroquine and sulfadoxine-pyrimethamine (SP), were evaluated and compared with amodiaquine, in an MSF-Holland-run clinic in eastern Upper Nile, South Sudan from June to December 2001. Patients with uncomplicated malaria and fever were stratified by age group and randomly allocated to one of 3 treatment regimes. A total of 342 patients was admitted and followed for 14 d after treatment. The dropout rate was 10.2%. Of those who completed the study, 104 were treated with chloroquine (25 mg/kg, 3 d), 102 with SP (25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine, single dose) and 101 with amodiaquine (25 mg/kg, 3 d). Adequate clinical response was observed in 88.5% of patients treated with chloroquine, 100% of patients treated with SP and 94.1% of patients treated with amodiaquine. In children aged < 5 years, the success rate was lower: 83.3% for chloroquine and 93.0% for amodiaquine. In adults no treatment failures were found, but children aged 5-15 years showed intermediate levels. In addition, we determined the initial genotypes of dhfr and dhps of 44 isolates from the SP-treated group and > 80% were found to be wild type for dhfr and 100% for dhps. Two percent of isolates had a single mutation and 16% had double mutations of dhfr. These data are in full agreement with the clinical effectiveness of SP. A change in malaria treatment protocols for South Sudan is recommended.
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