An Integrated Surveillance System to Examine Testing, Services, and Outcomes for Sexually Transmitted Diseases

Despite laws that require reporting of sexually transmitted diseases (STDs) to governmental health agencies, integrated surveillance of STDs remains challenging. Data and information about testing are fragmented from information on treatment and outcomes. To overcome this fragmentation, data from multiple electronic systems spanning clinical and public health environments were integrated to create an STD surveillance registry. Electronic health records, disease case records, and birth registry records were linked and then stored in a de-identified, secure server for use by health officials and researchers. The registry contains nearly 6 million tests for 628,138 individuals over a 12-year period. The registry supports efforts to understand the epidemiology of STDs as well as health services and outcomes for those diagnosed with STDs. Specialized disease registries hold promise for collaboration across clinical and public health domains to improve surveillance efforts, reduce health disparities, and increase prevention efforts at the local level

Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission?

BACKGROUND: Amongst injecting drug users (IDUs), HIV is transmitted sexually and parenterally, but HCV is transmitted primarily parenterally. We assess and model the antibody prevalence of HCV amongst HIV-infected IDUs (denoted as HCV-HIV co-infection prevalence) and consider whether it proxies the degree of sexual HIV transmission amongst IDUs. METHODS: HIV, HCV and HCV-HIV co-infection prevalence data amongst IDU was reviewed. An HIV/HCV transmission model was adapted. Multivariate model uncertainty analyses determined whether the model's ability to replicate observed data trends required the inclusion of sexual HIV transmission. The correlation between the model's HCV-HIV co-infection prevalence and estimated proportion of HIV infections due to injecting was evaluated. RESULTS: The median HCV-HIV co-infection prevalence (prevalence of HCV amongst HIV-infected IDUs) was 90% across 195 estimates from 43 countries. High HCV-HIV co-infection prevalences (>80%) occur in most (75%) settings, but can be lower in settings with low HIV prevalence (0.75). The model without sexual HIV transmission reproduced some data trends but could not reproduce any epidemics with high HIV/HCV prevalence ratios (>0.85) or low HCV-HIV co-infection prevalence (10%. The model with sexual HIV transmission reproduced data trends more closely. The proportion of HIV infections due to injecting correlated with HCV-HIV co-infection prevalence; suggesting that up to 80/60/90%. CONCLUSION: Substantial sexual HIV transmission may occur in many IDU populations; HCV-HIV co-infection prevalence could signify its importance

Sexually Transmitted Infections: Educational Settings

Background: Sexually transmitted infections (STIs) are a major public health concern in Canada and worldwide. Nearly two-thirds of STIs are seen among youth. Therefore, it is crucial to provide effective STI interventions to youth. Substance use is an important factor for STI acquisition among youth because of high prevalence and its ability to link proximal sexual risk behaviors and distal contextual factors. STI preventive behavioral interventions remain the gold standard due to the limitations in biomedical interventions. Educational institutions are recognized as ideal settings to target youth. Thus, it is essential to assess whether integrating substance use into STI prevention programs at educational settings is worthwhile as well as whether STI preventive interventions at educational settings are effective and how can they be improved. Objectives and Methods: The objectives and methodologies of this thesis include 1) determine the prevalence and association between substance use and STIs among Canadian post-secondary students (descriptive analysis and logistic regression of the ACHA-NCHA II Spring 2016 survey data and 2) assess the efficacy and effectiveness of STI preventive intervention programs at educational settings (a systematic review and meta-analysis). Results: Positive association exists between current cannabis use or other drug use and STIs among Canadian post secondary students. STI preventive interventions at educational institutions in developed countries show effectiveness. Interventions are more effective in promoting knowledge compared to enhancing motivational factors, behavioral skills and behaviors, and for female students. No significant difference in effectiveness is seen based on the type of provider (peer-involved and non-peer-involved) and type of intervention (face-to-face and technology-based). Recommendations: Based on our findings, it is recommended to integrate substance use preventive interventions into STI preventive interventions at Canadian post-secondary institutions. A potential framework for effective STI preventive interventions at educational settings which can possibly be inferred to the Canadian post-secondary institutions is presented based on our results. This thesis will help inform, evaluate and guide STI preventive interventions at educational settings to effectively reduce the burden of STIs among Canadian youth. Future research with more rigorous methodology should be undertaken to provide conclusive evidence

Bolstering State Efforts to Implement the National HIV/AIDS Strategy: Key Indicators and Recommendations for Policymakers and Community Stakeholders

The report builds upon the Centers for Disease Control and Prevention's (CDC) 2014 "State Prevention Progress Report," which provided state-level data on indicators related to national HIV prevention goals. The release of the report coincides with the release by the White House Office of National AIDS Policy of the National HIV/AIDS Strategy Update, which sets priorities to guide the nation's HIV response through 2020. While significant progress has been made since the release of the National HIV/AIDS Strategy in 2010, the report indicates that states can, and should, do more to align their efforts with the national goals of 1) reducing new infections; 2) increasing access to care and improving health outcomes for people with HIV; and 3) reducing HIV-related health disparities

Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-

PCSI

"CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's (NCHHSTP) program collaboration and service integration (PCSI) strategic priority is working to strengthen collaborative work across disease areas and integrate services that are provided by related programs, especially prevention activities related to HIV/AIDS, viral hepatitis, other sexually transmitted diseases (STDs), and tuberculosis (TB) at the client level. PCSI is a mechanism for organizing and blending interrelated health issues, activities, and prevention strategies to facilitate a comprehensive delivery of services. There are five principles that form the decision making framework for PCSI: appropriateness, effectiveness, flexibility, accountability, and acceptability. By following these five principles for PCSI, programs can deliver more comprehensive integrated services to identify and treat disease more effectively to improve the health outcomes of the persons they serve. PCSI combines two approaches for improving public health outcomes: program collaboration and service integration. Program Collaboration involves a mutually beneficial and well-defined relationship between two or more programs, organizations, or organizational units to achieve common goals. It involves many aspects of comprehensive program management at state and local levels; the 10 essential public health functions, developed by the Core Public Health Functions Steering Committee in 1994, provide a useful framework for categorizing collaboration strategies among programs. Service Integration provides persons with seamless comprehensive services from multiple programs without repeated registration procedures, waiting periods, or other administrative barriers. NCHHSTP describes three levels of service integration at the client-provider interface: nonintegrated services, core integrated services, and expanded integrated services. "Core" integrated services are combinations of services for which CDC has published guidance or recommendations, and "expanded" integrated services are best and promising evidence-based practice for which CDC has not yet published specific guidance. NCHHSTP is committed to supporting PCSI efforts initiated by staff, grantees, and partners. The use of PCSI as a structural intervention by CDC's national, state and local partners will help achieve multiple related health goals to appropriate populations whenever they interact with the health system." -- p. 1Executive summary -- Introduction -- Program collaboration and service integration -- Program collaboration -- Service integration -- Public health and related prevention services -- Monitoring and evaluation -- Toward implementation -- Conclusions -- References. -- Appendix 1: Key Findings from the 2007 CDC PCSI Consultation Meeting -- Appendix 2: Framework for Integrated Diagnostics -- Appendix 3: PCSI Logic Model -- Appendix 4: Key Recommendations for PCSI ResearchMode of access: World Wide Web as an Acrobat .pdf file (1.09 MB, 50 p.)Includes bibliographical references (p. 35-37).Centers for Disease Control and Prevention. Program Collaboration and Service Integration: Enhancing the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009

Linkage and Referral to HIV and Other Medical and Social Services: A Focused Literature Review for Sexually Transmitted Disease Prevention and Control Programs

BACKGROUND: Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. METHODS: Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. RESULTS: Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. CONCLUSIONS: Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain

Integration of FHIR to Facilitate Electronic Case Reporting: Results from a Pilot Study

Current approaches to gathering sexually transmitted infection (STI) case information for surveillance efforts are inefficient and lead to underreporting of disease burden. Electronic health information systems offer an opportunity to improve how STI case information can be gathered and reported to public health authorities. To test the feasibility of a standards-based application designed to automate STI case information collection and reporting, we conducted a pilot study where electronic laboratory messages triggered a FHIR-based application to query a patient’s electronic health record for details needed for an electronic case report (eCR). Out of 214 cases observed during a one week period, 181 (84.6%) could be successfully confirmed automatically using the FHIR-based application. Data quality and information representation challenges were identified that will require collaborative efforts to improve the structure of electronic clinical messages as well as the robustness of the FHIR application

Sex Transm Dis

Unstably housed sexually active people with human immunodeficiency virus experience both a high incidence of sexually transmitted infections (STI) and barriers to annual STI screening recommended by Centers for Disease Control and Prevention guidelines. We used Medical Monitoring Project data to describe STI testing among unstably housed people with human immunodeficiency virus by attendance at Ryan White HIV/AIDS Program-funded facilities.CC999999/ImCDC/Intramural CDC HHSUnited States