Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with \u3cem\u3eMycoplasma genitalium\u3c/em\u3e and \u3cem\u3eTrichomonas vaginalis\u3c/em\u3e Molecular Assessment: a Retrospective Analysis

Of 1,493 encounters of males at a sexually transmitted infection (STI) clinic in a community with a high prevalence of STI, Chlamydia trachomatis was detected in 8.7% and Neisseria gonorrhoeae was detected in 6.6%. Additional Trichomonas vaginalis and Mycoplasma genitalium screening found 17.4% and 23.9% of the encounters, respectively, to be positive for STI. STI agents were detected in 13.7% of urine specimens; addition of pharyngeal and rectal collections to the analysis resulted in detection of STI agents in 19.0% and 23.9% of encounters, respectively. A total of 101 (23.8%) encounters of identified STI involved sole detection of M. genitalium. Expansion of the STI analyte panel (including M. genitalium) and additional specimen source sampling within a comprehensive STI screening program increase identification of male STI carriers

Home sampling for sexually transmitted infections and HIV in men who have sex with men: a prospective observational study

To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whether the availability of HSK would increase STI testing rates amongst HIV infected MSM, and those attending a community-based HIV testing clinic compared to historical control. Prospective observational study in three facilities providing STI/HIV testing services in Brighton, UK was conducted. Adult MSM attending/contacting a GUM clinic requesting an STI screen (group 1), HIV infected MSM attending routine outpatient clinic (group 2), and MSM attending a community-based rapid HIV testing service (group 3) were eligible. Participants were required to have no symptomatology consistent with STI and known to be immune to hepatitis A and B (group 1). Eligible men were offered a HSK to obtain self-collected specimens as an alternative to routine testing. HSK uptake compared to conventional clinic based STI/HIV testing in group 1, increase in STI testing rates due to availability of HSK compared to historical controls in group 2 and 3, and HSK return rates in all settings were calculated. Among the 128 eligible men in group 1, HSK acceptance was higher (62.5% (95%CI: 53.5–70.9)) compared to GUM clinic-based testing (37.5% (95% CI: 29.1–46.5)), (p = 0.0004). Two thirds of eligible MSM offered an HSK in all three groups accepted it, but HSK return rates varied (highest in group 1, 77.5%, lowest in group 3, 16%). HSK for HIV testing was acceptable to 81%of men in group 1. Compared to historical controls, availability of HSK increased the proportion of MSM testing for STIs in group 2 but not in group 3. HSK for STI/ HIV offers an alternative to conventional clinic-based testing for MSM seeking STI screening. It significantly increases STI testing uptake in HIV infected MSM. HSK could be considered as an adjunct to clinic-based services to further improve STI/HIV testing in MSM

Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

Intimate partner violence, HIV and sexually transmitted infections in fishing, trading and agrarian communities in Rakai, Uganda.

BackgroundIntimate partner violence (IPV), HIV and sexually transmitted infections (STI) can contribute to disparities in population health, depending on the individual, social and environmental factors characterizing a setting. To better understand the place-based determinants and patterns of these key interrelated public health problems in Uganda, we compared risk factors for IPV, HIV and STI in fishing, trading and agrarian communities in Rakai, Uganda by gender.MethodThis study used cross-sectional data collected from 14,464 sexually active men (n = 6531) and women (n = 7933) as part of the Rakai Community Cohort Study, a population-based open cohort study of men and women aged 15-49 years. We used multilevel modified poisson regression models, which incorporated random intercepts for community and households. Factors associated with IPV, HIV and STI were assessed separately for men and women in fishing, trading and agrarian communities.ResultsA larger proportion of participants in the fishing communities than those in trading and agrarian communities were HIV positive, engaged in HIV risk behaviors, had STI symptoms and reported perpetration of or victimization by IPV. Female gender was a shared correlate of IPV, HIV and STI in the fishing communities. Engagement in multiple sexual relationships or partner's engagement in multiple relationships were shared correlates of IPV, and HIV in agrarian communities and IPV and STI in trading communities.ConclusionPrograms should target factors at multiple levels to reduce risk for syndemic conditions of HIV, STI and IPV in Rakai, Uganda particularly among men and women in fishing communities

HIV/STI Risk Factors Among African-American Students Attending Predominantly White Universities

Introduction: The majority of African American college students in the U.S. attend predominantly white institutions (PWIs). However, there is minimal research examining this population’s HIV/STI risk behaviors. The purpose of this investigation was to assess HIV/STI behavioral risk factors among African American college students (aged 18 – 24years) attending PWIs. (n = 2,568) Methods: Backwards step-wise logistic regression analyses were conducted to determine factors associated with a positive HIV/STI diagnosis (past year) among sexually active African American college students who participated in the Spring, 2006 National College Health Assessment. Findings: Nine factors were significantly associated with an HIV/STI diagnosis among African American college students attending PWIs. Different risk factors were associated with having a HIV/STI diagnosis among African American male and female college students. These results may be useful to HIV/STIs prevention programs targeting African American college students attending PWIs

Demographic and Behavioural Factors in Tanzanian and Norwegian Patients with Sexually Transmitted Infections.

To evaluate whether differences in demographic or behavioural factors might explain differences in reported or diagnosed sexually transmitted infections (STI), we have compared data from 1097 Tanzanian and Norwegian STI patients. Most demographic data were similar, whereas some behavioural data differed. Norwegian patients reported significantly higher numbers of sexual partners than Tanzanian. Thirty-three percent of Tanzanian patients tested positive for HIV antibodies, females more often (43%) than males (26%). Approximately one-third and two-thirds of the female HIV-positive Tanzanian STI patients had already seroconverted at the age of 25 and 30 years, respectively. The national differences encountered probably reflect cultural differences, different panoramas of STI and a lower accessibility to optimal health services in Tanzania. Lack of expected statistical associations between some of the data in the Tanzanian STI group might question the validity of the retrospectively collected data in this group, or indicate that questions not included in the questionnaire might be of importance

NASA/DOD Aerospace Knowledge Diffusion Research Project. Report 12: An initial investigation into the production and use of Scientific and Technical Information (STI) at five NASA centers: Results of a telephone survey

A study was conducted to provide NASA management with an 'initial' look at the production and use of scientific and technical information (STI) at five NASA centers (Ames, Goddard, Langley, Lewis, and Marshall). The 550 respondents who were interviewed by telephone held favorable views regarding the NASA STI system. About 65 percent of the respondents stated that it is either very or somewhat important for them to publish their work through the NASA STI system. About 10 percent of those respondents encountered problems using the NASA STI system services for publication. The most frequently reported problem was 'the process is too time consuming' (8.6 percent). Overall, those respondents using the NASA STI system to publish their work rated the system as excellent (24.6 percent) or good (37.6 percent). About 79 percent of the respondents stated that it is either very or somewhat important for them to use the NASA STI system to access information. The most frequently reported problems were 'the time and effort it takes to locate and obtain information through the system' (14.4 percent). Overall, about 83 percent of the respondents stated that the NASA STI system is important to performing their work. Overall, about 73 percent of the respondents stated that the NASA STI system meets their information needs

Rush to Judgment: The STI-Treatment Trials and HIV in Sub-Saharan Africa

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence. Discussion: Examination of the trials reveals critical methodological problems sufficient to account for statistically insignificant outcomes in nine of the ten trials. Shortcomings of the trials include weak exposure contrast, confounding, non-differential misclassification, contamination and effect modification, all of which consistently bias the results toward the null. In any future STI-HIV trial, ethical considerations will again require weak exposure contrast. The complexity posed by HIV transmission in the genital microbial environment means that any future STI-HIV trial will face confounding, non-differential misclassification and effect modification. As a result, it is unlikely that additional trials would be able to answer the question of whether STI control reduces HIV incidence. Conclusions: Shortcomings in published RCTs render invalid the conclusion that treating STIs and other cofactor infections is ineffective in HIV prevention. Meta-analyses of observational studies conclude that STIs can raise HIV transmission efficiency two- to fourfold. Health policy is always implemented under uncertainty. Given the known benefits of STI control, the irreparable harm from not treating STIs and the likely decline in HIV incidence resulting from STI control, it is appropriate to expand STI control programmes and to use funds earmarked for HIV prevention to finance those programmes