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Mulhall BP, Wright S, Allen D, Brown K, Dickson B, Grotowski M, Jackson E, Petoumenos K, Read P, Read T, Russell D, Smith DJ, Templeton DJ, Fairley CK, Law MG. High rates of sexually transmissible infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study. Sex Health 2019; 11:291-7. [PMID: 25109880 DOI: 10.1071/sh13074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/19/2014] [Indexed: 01/24/2023]
Abstract
UNLABELLED Background In HIV-positive people, sexually transmissible infections (STIs) probably increase the infectiousness of HIV. METHODS In 2010, we established a cohort of individuals (n=554) from clinics in the Australian HIV Observational Database (AHOD). We calculated retrospective rates for four STIs for 2005-10 and prospective incidence rates for 2010-11. RESULTS At baseline (2010), patient characteristics were similar to the rest of AHOD. Overall incidence was 12.5 per 100 person-years. Chlamydial infections increased from 3.4 per 100 person-years (95% confidence interval (CI): 1.9-5.7) in 2005 to 6.7 per 100 person-years (95% CI: 4.5-9.5) in 2011, peaking in 2010 (8.1 per 100 person-years; 95% CI: 5.6-11.2). Cases were distributed among rectal (61.9%), urethral (34%) and pharyngeal (6.3%) sites. Gonococcal infections increased, peaking in 2010 (4.7 per 100 person-years; 95% CI: 5.6-11.2; Ptrend=0.0099), distributed among rectal (63.9%), urethral (27.9%) and pharyngeal (14.8%) sites. Syphilis showed several peaks, the largest in 2008 (5.3 per 100 person-years; 95% CI: 3.3-8.0); the overall trend was not significant (P=0.113). Genital warts declined from 7.5 per 100 person-years (95% CI: 4.8-11.3) in 2005 to 2.4 per 100 person-years (95% CI: 1.1-4.5) in 2011 (Ptrend=0.0016). CONCLUSIONS For chlamydial and gonococcal infections, incidence was higher than previous Australian estimates among HIV-infected men who have sex with men, increasing during 2005-2011. Rectal infections outnumbered infections at other sites. Syphilis incidence remained high but did not increase; that of genital warts was lower and decreased.
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Affiliation(s)
- Brian P Mulhall
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stephen Wright
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Debbie Allen
- Holden Street Sexual Health Clinic, PO Box 361, Gosford, NSW 2250, Australia
| | | | | | - Miriam Grotowski
- Clinic 468, Tamworth Sexual Health, Hunter New England Area Health Service, NSW 2340, Australia
| | - Eva Jackson
- Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood NSW 2747, Australia
| | - Kathy Petoumenos
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Phillip Read
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy Read
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic. 3181, Australia
| | - Darren Russell
- Cairns Sexual Health Service, PO Box 902, Cairns, Qld 4214, Australia
| | - David J Smith
- Lismore Sexual Health Services, 4 Shepherd Lane, Lismore, NSW 2480, Australia
| | - David J Templeton
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Matthew G Law
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
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Dukers-Muijrers NHTM, Somers C, Hoebe CJPA, Lowe SH, Niekamp AMEJWM, Lashof AO, Bruggeman CAMVH, Vrijhoef HJM. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison. BMC Public Health 2012; 12:1118. [PMID: 23270463 PMCID: PMC3537529 DOI: 10.1186/1471-2458-12-1118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 12/20/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. METHODS The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients' pre-test care needs (n=254), and quality rating. RESULTS Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. CONCLUSIONS The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.
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Affiliation(s)
- Nicole HTM Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Carlijn Somers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
| | - Christian JPA Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Selwyn H Lowe
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, section Infectious Diseases, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Anne-Marie EJWM Niekamp
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Astrid Oude Lashof
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, section Infectious Diseases, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Cathrien AMVH Bruggeman
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Integrated Care, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Hubertus JM Vrijhoef
- Department of Integrated Care, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
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Heller R, Fernando I, MacDougall M. Factors associated with a clinician's offer of screening HIV-positive patients for sexually transmitted infections, including syphilis. Int J STD AIDS 2011; 22:351-2. [PMID: 21680675 DOI: 10.1258/ijsa.2010.010410] [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
This retrospective study assessed whether Quality Improvement Scotland national standards for the sexual health care offered to HIV-positive individuals are being met by the Edinburgh genitourinary (GU) medicine clinic; specifically whether HIV-positive patients are offered: (a) sexually transmitted infection (STI) screening annually and (b) syphilis testing six-monthly. The study also reviewed what factors were associated with a clinician's offer of STI screening and syphilis testing. Of the 509 patients seen within the study period, case notes documented that 64% were offered STI screens, and 69% were offered syphilis testing, results consistent with audits of services elsewhere. Sexual orientation (P < 0.0005), relationship status (P = 0.007) and receipt of antiretrovirals (P = 0.001) were independent predictors of clinician offer of STI screening, while gender (P < 0.0005) and receipt of antiretrovirals (P = 0.063) were independent predictors of offer of syphilis testing. Our results suggest that one explanation for clinicians failing to offer STI screens and syphilis serology testing is their (implicit) risk assessment that STI testing is not required in individual patients.
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Affiliation(s)
- R Heller
- University of Edinburgh Medical School, Edinburgh, UK
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