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Kaneda Y. From novel coronavirus disease 2019 pandemic to sexually transmitted infection concerns: Japan's multifaceted birth rate dilemma. Int J Health Plann Manage 2024; 39:152-154. [PMID: 37837309 DOI: 10.1002/hpm.3718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Affiliation(s)
- Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Canabarro APF, Eriksson M, Nielsen A, Zeebari Z, Salazar M. Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study. Heliyon 2023; 9:e20812. [PMID: 37876418 PMCID: PMC10590937 DOI: 10.1016/j.heliyon.2023.e20812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 09/12/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden. Methods A population-based cross-sectional study was conducted in 2017 with men aged 20-29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a12-monthperiod, tested only beyond a12-monthperiod, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR). Results After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7-16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2-7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1-6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5-8.8). Conclusion Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.
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Affiliation(s)
- Ana Paula Finatto Canabarro
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Malin Eriksson
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Anna Nielsen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Gjuterigatan 5, 553 18, Jönköping, Sweden
| | - Mariano Salazar
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
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He W, Zhao P, Yang T, Wan Y, Wu D, Chen X, Huang Z, Luo H, Xu DR, Huang S, Wang C. Exploring causal mechanisms and essential factors in the prevention and control of chlamydia in Guangdong, Southern China: a study protocol. BMC Infect Dis 2023; 23:628. [PMID: 37749484 PMCID: PMC10519073 DOI: 10.1186/s12879-023-08597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Chlamydia Trachomatis (CT) is among the most prevalent sexually transmitted diseases (STDs) globally. According to the World Health Organization, more than 131 million people get infected with CT annually. CT is usually transmitted via sexual contact or perinatal exposure and can result in severe long-term complications. In developing nations, particularly, the prevention and control of CT is challenging. Hence, this study will explore the feedback mechanisms of chlamydia prevention and control, as well as identify the essential factors affecting the control and prevention of this infection in China. METHODS Our study will employ a mixed-methods research design that encompasses both qualitative and quantitative methods. Firstly, we will develop a causal loop diagram (CLD) based on the literature review and optimize it via in-depth interviews with stakeholders. Additionally, we will utilize a quantitative method called MICMAC(Impact Matrix Cross-Reference Multiplication Applied to a Classification tool) to obtain consensus among different stakeholders and pinpoint the key information. Next, the CLD will be transformed into a system dynamics model (SDM) to evaluate the feedback mechanisms within the CLD. The causality in the CLD will be modeled using mathematical equations, which facilitate the transformation into an SDM. As such, we will be able to analyze the dynamic behavior of the system and its response to different decisions. DISCUSSION Our study offers a systematic perspective on the control and prevention of chlamydia infection through system dynamics modeling, examining the dynamic properties and background factors of the system. The creation of the CLD affords stakeholders the chance to comprehend the functionality of their relationships and improve cooperation. Consequently, by evaluating the outcomes of these simulations, it will be possible to analyze and determine potential interventions and their effects on chlamydia infections. This modeling approach can help us gain insight into the dynamic characteristics of the system, evaluate the potential outcomes of different decisions, and design control strategies to either stabilize the system or adjust its behavior.
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Affiliation(s)
- Wenjun He
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
| | - Tao Yang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yuting Wan
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Xiaoshan Chen
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Zizhen Huang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Huanyuan Luo
- Southern Medical University Institute for Global Health, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Roman Xu
- School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies, Southern Medical University, Guangzhou, China.
- Acacia Lab for Implementation Science, Southern Medical University Institute for Global Health (SIGHT), Guangzhou, China.
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China.
| | - Shujie Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. Public Health Res (Southampt) 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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Rodrigues R, Sousa C, Vale N. Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities. Diagnostics (Basel) 2022; 12:1795. [PMID: 35892506 PMCID: PMC9331119 DOI: 10.3390/diagnostics12081795] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Chlamydia is one of the most common sexually transmitted bacterial infections (STIs) worldwide. It is caused by Chlamydia trachomatis (CT), which is an obligate intracellular bacterium. In some cases, it can occur in coinfection with other parasites, increasing the pathologic potential of the infection. The treatment is based on antibiotic prescription; notwithstanding, the infection is mostly asymptomatic, which increases the risk of transmission. Therefore, some countries have implemented Chlamydia Screening Programs in order to detect undiagnosed infections. However, in Portugal, there is no CT screening plan within the National Health Service. There is no awareness in the general healthcare about the true magnitude of this issue because most of the methods used are not Nucleic Acid Amplification Technology-based and, therefore, lack sensitivity, resulting in underreporting infection cases. CT infections are also associated with possible long-term severe injuries. In detail, persistent infection triggers an inflammatory milieu and can be related to severe sequels, such as infertility. This infection could also trigger gynecologic tumors in women, evidencing the urgent need for cost-effective screening programs worldwide in order to detect and treat these individuals adequately. In this review, we have focused on the success of an implemented screening program that has been reported in the literature, the efforts made concerning the vaccine discovery, and what is known regarding CT infection. This review supports the need for further fundamental studies in this area in order to eradicate this infection and we also suggest the implementation of a Chlamydia Screening Program in Portugal.
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Nadarzynski T, Symonds Y, Carroll R, Gibbs J, Kidsley S, Graham CA. Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicated Chlamydia trachomatis. BMJ Sex Reprod Health 2021; 47:185-192. [PMID: 33214195 DOI: 10.1136/bmjsrh-2020-200687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing and 'medication-by-post' in SRH. STUDY DESIGN An online survey assessing attitudes towards remote management was distributed in three UK SRH clinics and via an integrated sexually transmitted infection (STI) postal self-sampling service. Logistic regressions were performed to identify potential correlates. RESULTS There were 1281 participants (74% female and 49% <25 years old). Some 8% of participants reported having received medication via post and 83% were willing to receive chlamydia treatment and contraceptive pills by post. Lower acceptability was observed among participants who were: >45 years old (OR 0.43 (95% CI 0.23-0.81)), screened for STIs less than once annually (OR 0.63 (0.42-0.93)), concerned about confidentiality (OR 0.21 (0.90-0.50)), concerned about absence during delivery (OR 0.09 (0.02-0.32)) or unwilling to provide blood pressure readings (OR 0.22 (0.04-0.97)). Higher acceptability was observed among participants who reported: previously receiving medication by post (OR 4.63 (1.44-14.8)), preference for home delivery over clinic collection (OR 24.1 (11.1-51.9)), preference for home STI testing (OR 10.3 (6.16-17.4)), ability to communicate with health advisors (OR 4.01 (1.03-15.6)) and willingness to: register their real name (OR 3.09 (1.43-10.6)), complete online health questionnaires (OR 3.09 (1.43-10.6)) and use generic contraceptive pills (OR 2.88 (1.21-6.83)). CONCLUSIONS Postal treatment and entering information online to allow remote prescribing were acceptable methods for SRH services and should be considered alongside medication collection in pharmacies. These methods could be particularly useful for patients facing barriers in accessing SRH. The cost-effectiveness and implementation of these novel methods of service delivery should be further investigated.
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Affiliation(s)
| | | | | | - Jo Gibbs
- University College London, London, UK
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Thompson RN, Gilligan CA, Cunniffe NJ. Will an outbreak exceed available resources for control? Estimating the risk from invading pathogens using practical definitions of a severe epidemic. J R Soc Interface 2020; 17:20200690. [PMID: 33171074 PMCID: PMC7729054 DOI: 10.1098/rsif.2020.0690] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/12/2022] Open
Abstract
Forecasting whether or not initial reports of disease will be followed by a severe epidemic is an important component of disease management. Standard epidemic risk estimates involve assuming that infections occur according to a branching process and correspond to the probability that the outbreak persists beyond the initial stochastic phase. However, an alternative assessment is to predict whether or not initial cases will lead to a severe epidemic in which available control resources are exceeded. We show how this risk can be estimated by considering three practically relevant potential definitions of a severe epidemic; namely, an outbreak in which: (i) a large number of hosts are infected simultaneously; (ii) a large total number of infections occur; and (iii) the pathogen remains in the population for a long period. We show that the probability of a severe epidemic under these definitions often coincides with the standard branching process estimate for the major epidemic probability. However, these practically relevant risk assessments can also be different from the major epidemic probability, as well as from each other. This holds in different epidemiological systems, highlighting that careful consideration of how to classify a severe epidemic is vital for accurate epidemic risk quantification.
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Affiliation(s)
- R N Thompson
- Mathematical Institute, University of Oxford, Oxford, UK.,Christ Church, University of Oxford, Oxford, UK
| | - C A Gilligan
- Department of Plant Sciences, University of Cambridge, Cambridge, UK
| | - N J Cunniffe
- Department of Plant Sciences, University of Cambridge, Cambridge, UK
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8
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Edwards J, Hinds A, Lyons N, Edwards J, Quammie S, Figueroa JP. A Chart Review Study of Sexually Transmitted Infections Among Persons Living with HIV Attending an STI Clinic in Trinidad. J Int Assoc Provid AIDS Care 2020; 18:2325958219888463. [PMID: 31726934 PMCID: PMC6859682 DOI: 10.1177/2325958219888463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/22/2022] Open
Abstract
A chart review study of the sexually transmitted infection (STI) prevalence among persons living with HIV (PLHIV) was conducted among STI clinic attendees in Trinidad between January 2012 and December 2012. Data were abstracted from client records to obtain the clinical and the laboratory diagnoses of STIs. Descriptive and bivariate analyses were conducted, and factors significantly associated with the presence of a STI were assessed using multiple logistic regression. During this period, 385 PLHIV were seen; 104 (27.0%) were newly HIV diagnosed and 281 (73.0%) had a known history of HIV infection; 135 (35.1%) were diagnosed with a STI. Patients with known HIV infection were more likely to be diagnosed with a STI than those who were newly diagnosed (odds ratios: 6.99; 95% confidence interval: 3.79-12.89). The STI prevalence was high among PLHIV in Trinidad, identifying them as a critical target group for public health interventions to prevent the spread of HIV and STIs.
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Affiliation(s)
- Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad and Tobago
| | - Avery Hinds
- Caribbean Public Health Agency (CARPHA), Port of Spain, Trinidad and Tobago
| | - Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad and Tobago
| | - Jonathan Edwards
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad and Tobago
| | - Shauntelle Quammie
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad and Tobago
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Wong WCW, Lau STH, Choi EPH, Tucker JD, Fairley CK, Saunders JM. A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing. Epidemiol Rev 2020; 41:168-175. [PMID: 31565737 DOI: 10.1093/epirev/mxz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis is the most common bacterial sexually transmitted infection, causing significant morbidity and economic burden. Strategies like national screening programs or home-testing kits were introduced in some developed countries, yet their effectiveness remains controversial. In this systematic review, we examined reviews of chlamydia screening interventions to assess their effectiveness and the elements that contribute to their success to guide public policy and future research. We assessed English material published after 2000 in PubMed, the Cochrane Library, the British Nursing Index, Medical Database, and Sociological Abstracts, in addition to World Health Organization Global Health Sector Strategies, the European Center for Disease Prevention and Control guidelines, and the Prospective Register of Systematic Reviews. Systematic reviews that focused on chlamydia screening interventions were included. Using the socioecological model, we examined the levels of interventions that may affect the uptake of chlamydia screening. A total of 19 systematic reviews were included. Self-collection in home-testing kits significantly increased screening among girls and women 14-50 years of age. At the organizational level, using electronic health records and not creating additional costs facilitated testing. At the community level, outreach interventions in community and parent centers and homeless shelters achieved high screening rates. At the policy level, interventions with educational and advisory elements could result in significant improvements in screening rates.
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Affiliation(s)
- William Chi Wai Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of General Practice, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Stephanie Tsz Hei Lau
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John M Saunders
- University College London Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, London, United Kingdom
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10
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Wayal S, Aicken CRH, Griffiths C, Blomquist PB, Hughes G, Mercer CH. Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review. PLoS One 2018; 13:e0208315. [PMID: 30532145 PMCID: PMC6285827 DOI: 10.1371/journal.pone.0208315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk. METHODS Studies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS Of 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity. CONCLUSIONS Further research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Catherine R. H. Aicken
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Griffiths
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
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11
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Huai P, Li F, Li Z, Sun L, Fu X, Pan Q, Yu G, Chai Z, Chu T, Mi Z, Bao F, Wang H, Zhou B, Wang C, Sun Y, Niu G, Zhang Y, Fu F, Lang X, Wang X, Zhao H, Liu D, Liu H, Liu D, Liu J, Xu A, Zhang F. Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study. BMC Infect Dis 2018; 18:534. [PMID: 30367605 PMCID: PMC6204023 DOI: 10.1186/s12879-018-3432-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/23/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background A population-based study of Chlamydia trachomatis (CT) infections is essential in designing a specific control program; however, no large investigation of CT infections among the general population in mainland China has been conducted since 2000. We aimed to determine the prevalence, risk factors, and associated medical costs of CT among residents, 18–49 years of age, in Shandong, China. Methods From May to August 2016, a multistage probability sampling survey involving 8074 individuals was distributed. Data were collected via face-to-face interviews, followed by self-administered questionnaire surveys. First-void urines were collected and tested for CT and Neisseria gonorrhoeae (NG) using nucleic acid amplification. Results The weighted prevalence of CT infection was 2.3% (95% confidence interval [CI], 1.5–3.2) in females and 2.7% (1.6–3.8) in males. Women, 30–34 years of age, had the highest prevalence of CT infections (3.5%, 2.6–4.4), while the highest prevalence of CT infections in males was in those 18–24 years of age (4.3%, 0.0–8.8). Neisseria gonorrhoeae infection had a prevalence of 0.1% (0.0–0.3) in women and 0.03% (0.0–0.1) in men. Risk factors for CT infections among females included being unmarried, divorced, or widowed (odds ratio [OR], 95% CI 3.57, 1.54–8.24) and having two or more lifetime sex partners (3.72, 1.14–12.16). Among males, first intercourse before 20 years of age (1.83, 1.10–3.02) and having two or more lifetime sex partners (1.85, 1.14–3.02) were associated with CT infections. The estimated lifetime cost of CT infections in patients 18–49 years of age in Shandong was 273 million (range, 172–374 million) China Renminbi in 2016. Conclusions This study demonstrated a high burden of CT infections among females < 35 years of age and males < 25 years of age in Shandong. Thus, a CT infection control program should focus on this population, as well as others with identified risk factors. Electronic supplementary material The online version of this article (10.1186/s12879-018-3432-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Furong Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zhen Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Lele Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xi'an Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Qing Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Gongqi Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Zemin Chai
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Tongsheng Chu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zihao Mi
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fangfang Bao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Honglei Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Bingni Zhou
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Chuan Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Guiye Niu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yuan Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fanghui Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoqiao Lang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoling Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hui Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Daina Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Dianchang Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Jian Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.,Shandong Center for Disease Control and Prevention, Jinan, China
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China. .,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China.
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12
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Omori R, Chemaitelly H, Althaus CL, Abu-Raddad LJ. Does infection with Chlamydia trachomatis induce long-lasting partial immunity? Insights from mathematical modelling. Sex Transm Infect 2018; 95:115-121. [PMID: 30181327 PMCID: PMC6580764 DOI: 10.1136/sextrans-2018-053543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/18/2018] [Revised: 06/20/2018] [Accepted: 08/07/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore whether existence of long-lasting partial immunity against reinfection with Chlamydia trachomatis is necessary to explain C. trachomatis prevalence patterns by age and sexual risk, and to provide a plausible estimate for the effect size, defined here as a reduction in susceptibility to reinfection. METHODS A population-based mathematical model was constructed to describe C. trachomatis natural history and transmission dynamics by age and sexual risk. The model was parameterised using natural history, and epidemiological and sexual behaviour data, and applied for UK and US data. Sensitivity analyses were conducted to assess the robustness of predictions to variations in model structure and to examine the impact of alternative assumptions for the mechanism underlying partial immunity. RESULTS Partial immunity against reinfection was found necessary to explain observed C. trachomatis prevalence patterns by age and sexual risk. The reduction in susceptibility to reinfection was estimated at 93% using UK data (95% uncertainty interval (UI)=88%-97%) and at 67% using US data (95% UI=24%-88%). The model-structure sensitivity analyses affirmed model predictions. The immunity-mechanism sensitivity analyses suggested a mechanism of susceptibility reduction against reinfection or a mechanism of infectious-period duration reduction upon reinfection. CONCLUSIONS A strong long-lasting partial immunity against C. trachomatis reinfection should be present to explain observed prevalence patterns. The mechanism of immunity could be either a reduction in susceptibility to reinfection or a reduction in duration of infection on reinfection. C. trachomatis infection appears to naturally elicit a strong long-lasting immune response, supporting the concept of vaccine development.
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Affiliation(s)
- Ryosuke Omori
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan .,JST, PRESTO, 4-1-8 Honcho, Kawaguchi, Saitama, Japan.,Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Christian L Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York City, New York, USA.,College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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13
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Lang AS, An der Heiden M, Jansen K, Sailer A, Bremer V, Dudareva S. Not again! Effect of previous test results, age group and reason for testing on (re-)infection with Chlamydia trachomatis in Germany. BMC Infect Dis 2018; 18:424. [PMID: 30144825 PMCID: PMC6109262 DOI: 10.1186/s12879-018-3323-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/07/2017] [Accepted: 08/10/2018] [Indexed: 12/01/2022] Open
Abstract
Background Infection with Chlamydia trachomatis (Ct) is the most commonly reported sexually transmitted infection in Europe. In Germany, Ct screening is offered free of charge to pregnant women since 1995 and to women < 25 years of age since 2008. For symptomatic individuals, testing is covered by statutory health insurance. Study results have shown that repeat Ct infection occurs in 10–20% of previously infected women and men. Our aim was to describe persons tested for Ct and to investigate the determinants of (repeat) Ct infection in women and men in Germany. Methods We analysed Ct test results from men and women tested between 2008 and 2014 in laboratories participating in the German Chlamydia trachomatis Laboratory Sentinel surveillance. Reinfection was defined as at least 2 positive laboratory tests within more than 30 days. We performed logistic regression stratified by sex and, for women, reason for testing to determine the effect of previous test results and age group on subsequent test results. Results In total, 2,574,635 Ct tests could be attributed to 1,815,494 women and 123,033 men. 5% of women and 14% of men tested positive at least once. 15–19- and 20–24-year-old women tested positive at least once respectively in 6.8 and 6.0%, while men respectively in 16.6 and 21.2%. Altogether, 23.1% of tested women and 11.9% of tested men were tested repeatedly between 2008 and 2014. Among those who previously tested positive, reinfection occurred in 2.0% of women and 6.6% of men. Likelihood to be tested Ct positive was higher in women and men with a positive Ct test in the past compared to previously tested Ct negative, odds ratios 4.7 and 2.6 (p < 0.01) respectively. Odds ratios ranged by age group and test reason. Conclusion A history of Ct infection increased the likelihood of infection with Ct in women and men taking into account the result of the previous test. Health education, safer sex and treatment of partners are necessary for women and men who have tested positive to prevent reinfection and complications and to interrupt the chain of transmission. To identify potential reinfection repeat testing after treatment should be performed. Electronic supplementary material The online version of this article (10.1186/s12879-018-3323-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Sarah Lang
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | | | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andrea Sailer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sandra Dudareva
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Charité Universitätsmedizin Berlin, Berlin, Germany
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14
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Nielsen A, De Costa A, Bågenholm A, Danielsson KG, Marrone G, Boman J, Salazar M, Diwan V. Trial protocol: a parallel group, individually randomized clinical trial to evaluate the effect of a mobile phone application to improve sexual health among youth in Stockholm County. BMC Public Health 2018; 18:216. [PMID: 29402241 PMCID: PMC5799911 DOI: 10.1186/s12889-018-5110-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Genital Chlamydia trachomatis infection is a major public health problem worldwide affecting mostly youth. Sweden introduced an opportunistic screening approach in 1982 accompanied by treatment, partner notification and case reporting. After an initial decline in infection rate till the mid-90s, the number of reported cases has increased over the last two decades and has now stabilized at a high level of 37,000 reported cases in Sweden per year (85% of cases in youth). Sexual risk-taking among youth is also reported to have significantly increased over the last 20 years. Mobile health (mHealth) interventions could be particularly suitable for youth and sexual health promotion as the intervention is delivered in a familiar and discrete way to a tech savvy at-risk population. This paper presents a protocol for a randomized trial to study the effect of an interactive mHealth application (app) on condom use among the youth of Stockholm. METHODS 446 youth resident in Stockholm, will be recruited in this two arm parallel group individually randomized trial. Recruitment will be from Youth Health Clinics or via the trial website. Participants will be randomized to receive either the intervention (which comprises an interactive app on safe sexual health that will be installed on their smart phones) or a control group (standard of care). Youth will be followed up for 6 months, with questionnaire responses submitted periodically via the app. Self-reported condom use over 6 months will be the primary outcome. Secondary outcomes will include presence of an infection, Chlamydia tests during the study period and proxy markers of safe sex. Analysis is by intention to treat. DISCUSSION This trial exploits the high mobile phone usage among youth to provide a phone app intervention in the area of sexual health. If successful, the results will have implications for health service delivery and health promotion among the youth. From a methodological perspective, this trial is expected to provide information on the strength and challenges of implementing a partially app (internet) based trial in this context. TRIAL REGISTRATION ISRCTN 13212899, date of registration June 22, 2017.
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Affiliation(s)
- Anna Nielsen
- Stockholm County Council. Department of Women’s and Childrens Health K6, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Aspasia Bågenholm
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women’s and Children’s Health K6’, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Jens Boman
- Department of Clinical Microbiology, Umeå Universitet, SE-90185 Umeå, Sweden
| | - Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Vinod Diwan
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
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15
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Nielsen A, De Costa A, Danielsson KG, Salazar M. Repeat testing for chlamydia trachomatis, a "safe approach" to unsafe sex? a qualitative exploration among youth in Stockholm. BMC Health Serv Res 2017; 17:730. [PMID: 29141635 PMCID: PMC5688721 DOI: 10.1186/s12913-017-2681-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/15/2017] [Accepted: 11/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking. Methods This qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18–22 years. Results Our main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group. Conclusions While testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change. Electronic supplementary material The online version of this article (10.1186/s12913-017-2681-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Nielsen
- Department of Women's and Children's Health K6, Karolinska University Hospital Solna, 17176, Stockholm, Sweden.
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health K6, Karolinska University Hospital Solna, 17176, Stockholm, Sweden
| | - Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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16
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Allison R, Lecky DM, Town K, Rugman C, Ricketts EJ, Ockendon-Powell N, Folkard KA, Dunbar JK, McNulty CAM. Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model. BMC Fam Pract 2017; 18:43. [PMID: 28327096 PMCID: PMC5361828 DOI: 10.1186/s12875-017-0618-0] [Citation(s) in RCA: 15] [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: 09/22/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims: a) Explore why the modified intervention did not increase screening across all general practices. b) Suggest recommendations for future intervention implementation. METHODS Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model. RESULTS Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers. CONCLUSION Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
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Affiliation(s)
- R Allison
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.
| | - D M Lecky
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C Rugman
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, GL1 3NN, UK
| | - E J Ricketts
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Derriford Hospital, Derriford Road, Plymouth, UK
| | - N Ockendon-Powell
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Biotechnology and Biological Sciences Research Council (BBSRC), Polaris House, North Star Avenue, Swindon, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C A M McNulty
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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17
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Olaleye O, Olamijulo JA. The value of chlamydial antibody level for predicting tubal blockage among women undergoing hysterosalpingography in Lagos, Nigeria. Int J Gynaecol Obstet 2016; 134:33-6. [PMID: 27177510 DOI: 10.1016/j.ijgo.2015.12.009] [Citation(s) in RCA: 6] [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] [Received: 08/02/2015] [Revised: 11/26/2015] [Accepted: 03/29/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of Chlamydia trachomatis infection among Nigerian women undergoing hysterosalpingography (HSG) and to identify any correlation between chlamydial antibody levels and a diagnosis of tubal disease. METHODS A prospective cross-sectional study was conducted from January 1 to June 30, 2013, among women scheduled to undergo HSG in the radiology department of Lagos University Teaching Hospital, Nigeria. Endocervical swabs and serum samples were collected to assess the levels of chlamydial antigen and antibody, respectively. RESULTS Among 150 participants, 83 (55.3%) had bilateral tubal patency and 67 (44.7%) had tubal disease. Overall, 53 (35.3%) women had positive test results for chlamydial antibodies; however, none of the participants tested positive for chlamydial antigen. Women with tubal disease were more likely to test positive for chlamydial antibodies (n=44 [65.7%]) than were those whose test results were negative (n=9 [10.8%]; P<0.001). The sensitivity and specificity of chlamydial antibody testing to predict tubal disease diagnosed by HSG were 66% and 89%, respectively. CONCLUSION The presence of chlamydial antibodies was quantitatively related to the likelihood of HSG-diagnosed tubal disease.
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Affiliation(s)
- Olalekan Olaleye
- Department of Obstetrics and Gynecology, Lagoon Hospitals, Lagos, Nigeria
| | - Joseph A Olamijulo
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria.
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Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia. Biomed Res Int 2016; 2016:9315757. [PMID: 27144177 PMCID: PMC4837252 DOI: 10.1155/2016/9315757] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/09/2016] [Indexed: 12/28/2022]
Abstract
Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.
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Affiliation(s)
- Kristina Adachi
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Jeffrey D. Klausner
- Department of Medicine, Division of Infectious Diseases: Global Health, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA 90024, USA
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Wynn A, Ramogola-Masire D, Gaolebale P, Moshashane N, Agatha Offorjebe O, Arena K, Klausner JD, Morroni C. Acceptability and Feasibility of Sexually Transmitted Infection Testing and Treatment among Pregnant Women in Gaborone, Botswana, 2015. Biomed Res Int 2016; 2016:1251238. [PMID: 27119076 DOI: 10.1155/2016/1251238] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
Abstract
Introduction. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are curable sexually transmitted infections (STIs) that can cause adverse maternal and birth outcomes. Most countries do not conduct routine testing during antenatal care. We present data on the acceptability and feasibility of testing and treating pregnant women for STIs in an antenatal clinic in Gaborone, Botswana. Materials and Methods. We offered CT, NG, and TV testing using self-collected vaginal swabs to eligible pregnant women. Participants received same-day test results. Those who tested positive were given treatment. Results. Among the 225 women who were eligible and recruited, 200 (89%) agreed to participate. The median age of our study sample was 30 years; most were unmarried (77%), with a median gestational age of 27 weeks and a 23% HIV prevalence. All participants received their results with at least 72% (n = 143) on the same day. Thirty participants (15%) tested positive for an STI, all were treated, and 24 (80%) were treated on the same day. Conclusion. The acceptability of STI testing was high, and the intervention was feasible. This study provides support for continued research into STI prevalence, cost-effectiveness, and the association of STIs with adverse maternal and infant outcomes.
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Cassell JA, Dodds J, Estcourt C, Llewellyn C, Lanza S, Richens J, Smith H, Symonds M, Copas A, Roberts T, Walters K, White P, Lowndes C, Mistry H, Rossello-Roig M, Smith H, Rait G. The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care. Health Technol Assess 2015; 19:1-115, vii-viii. [PMID: 25619445 DOI: 10.3310/hta19050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Partner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient's behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system. OBJECTIVE We aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice. DESIGN Cluster randomised controlled trial. SETTING General practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system. INTERVENTIONS Three different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral. MAIN OUTCOME MEASURES (1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months. RESULTS As testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions. CONCLUSIONS External recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information. TRIAL REGISTRATION Current Controlled Trials ISRCTN24160819. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jackie A Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Julie Dodds
- Medical Research Council, General Practice Research Framework, London, UK
| | - Claudia Estcourt
- BICMS, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK
| | - Carrie Llewellyn
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Stefania Lanza
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - John Richens
- Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK
| | - Helen Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Merle Symonds
- BICMS, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK
| | - Andrew Copas
- Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK
| | - Tracy Roberts
- Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK
| | - Peter White
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Catherine Lowndes
- STI Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Hema Mistry
- Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK
| | - Melcior Rossello-Roig
- Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK
| | - Hilary Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Greta Rait
- Medical Research Council, General Practice Research Framework, London, UK
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Soetens LC, van Benthem BH, Op de Coul EL. Chlamydia test results were associated with sexual risk behavior change among participants of the Chlamydia screening implementation in The Netherlands. Sex Transm Dis 2015; 42:109-14. [PMID: 25668640 DOI: 10.1097/OLQ.0000000000000234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of a laboratory-confirmed Chlamydia trachomatis (Ct) test result on subsequent sexual risk behavior in a large population-based screening program. METHODS The study population consisted of 16- to 29-year-old participants of the Chlamydia Screening Implementation who completed Ct testing and questionnaires in 2 or more rounds. The influence of a Ct test result on sexual behavior was analyzed by generalized estimating equation models, in which the Ct test result of the previous round was the independent variable and 1 of the 8 sexual risk behavior indicators was the dependent variable, adjusted for covariates. RESULTS Of 48,910 Chlamydia Screening Implementation participants with completed questionnaires and test results, 14.1% (n = 6802) and 2.6% (n = 1272) completed 2 and 3 rounds, respectively, and were included in this study. Analysis showed that Ct positives less often reported to "never" use condoms with a casual partner (%change pretest/posttest = -5.7% [-10.3 to -0.9]), whereas Ct negatives less often reported to "always" use condoms with a casual partner (-4.6% [-6.4 to -2.8]; odds ratio [95% confidence interval], 1.75 [1.09 to 2.80]). Ct positives also had more sexual partners in the subsequent round than did participants with a Ct-negative test result (relative risk [95% confidence interval], 1.14 [1.01 to 1.29]). CONCLUSIONS Ct test results were associated with subsequent sexual risk behavior. In general, Ct positives were more likely to change their behavior after a Ct test result in a more positive and protective direction than Ct negatives, who were more likely to change their behavior toward more risky behavior. Effects over time after a Ct test should be investigated further, especially in the Ct negatives.
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Paudyal P, Llewellyn C, Lau J, Mahmud M, Smith H. Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients' experiences. PLoS One 2015; 10:e0124310. [PMID: 25909508 PMCID: PMC4409059 DOI: 10.1371/journal.pone.0124310] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/11/2015] [Indexed: 12/15/2022] Open
Abstract
Background Routine screening is key to sexually transmitted infection (STI) prevention and control. Previous studies suggest that clinic-based screening programmes capture only a small proportion of people with STIs. Self-sampling using non- or minimally invasive techniques may be beneficial for those reluctant to actively engage with conventional sampling methods. We systematically reviewed studies of patients’ experiences of obtaining self-samples to diagnose curable STIs. Methods We conducted an electronic search of MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, and Cochrane Database of Systematic Reviews to identify relevant articles published in English between January 1980 and March 2014. Studies were included if participants self-sampled for the diagnosis of a curable STI and had specifically sought participants’ opinions of their experience, acceptability, preferences, or willingness to self-sample. Results The initial search yielded 558 references. Of these, 45 studies met the inclusion criteria. Thirty-six studies assessed patients’ acceptability and experiences of self-sampling. Pooled results from these studies shows that self-sampling is a highly acceptable method with 85% of patients reporting the method to be well received and acceptable. Twenty-eight studies reported on ease of self-sampling; the majority of patients (88%) in these studies found self-sampling an “easy” procedure. Self-sampling was favoured compared to clinician sampling, and home sampling was preferred to clinic-based sampling. Females and older participants were more accepting of self-sampling. Only a small minority of participants (13%) reported pain during self-sampling. Participants were willing to undergo self-sampling and recommend others. Privacy and safety were the most common concerns. Conclusion Self-sampling for diagnostic testing is well accepted with the majority having a positive experience and willingness to use again. Standardization of self-sampling procedures and rigorous validation of outcome measurement will lead to better comparability across studies. Future studies need to conduct rigorous economic evaluations of self-sampling to inform policy development for the management of STI.
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Affiliation(s)
- Priyamvada Paudyal
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail:
| | - Carrie Llewellyn
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Jason Lau
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Helen Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
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Wetten S, Mohammed H, Yung M, Mercer CH, Cassell JA, Hughes G. Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000-2011: a population-based study using data from the UK Clinical Practice Research Datalink. BMJ Open 2015; 5:e007776. [PMID: 26022269 PMCID: PMC4452740 DOI: 10.1136/bmjopen-2015-007776] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine the relative contribution of general practices (GPs) to the diagnosis of chlamydia and gonorrhoea in England and whether treatment complied with national guidelines. DESIGN Analysis of longitudinal electronic health records in the Clinical Practice Research Datalink (CPRD) and national sexually transmitted infection (STI) surveillance databases, England, 2000-2011. SETTING GPs, and community and specialist STI services. PARTICIPANTS Patients diagnosed with chlamydia (n=1,386,169) and gonorrhoea (n=232,720) at CPRD GPs, and community and specialist STI Services from 2000-2011. MAIN OUTCOME MEASURES Numbers and rates of chlamydia and gonorrhoea diagnoses; percentages of patients diagnosed by GPs relative to other services; percentage of GP patients treated and antimicrobials used; percentage of GP patients referred. RESULTS The diagnosis rate (95% CI) per 100,000 population of chlamydia in GP increased from 22.8 (22.4-23.2) in 2000 to 29.3 (28.8-29.7) in 2011 (p<0.001), while the proportion treated increased from 59.5% to 78.4% (p=0.001). Over 90% were prescribed a recommended antimicrobial. Over the same period, the diagnosis rate (95% CI) per 100,000 population of gonorrhoea in GP ranged between 3.2 (3-3.3) and 2.4 (2.2-2.5; p=0.607), and the proportion treated ranged between 32.7% and 53.6% (p=0.262). Despite being discontinued as a recommended therapy for gonorrhoea in 2005, ciprofloxacin accounted for 42% of prescriptions in 2007 and 20% in 2011. Over the study period, GPs diagnosed between 9% and 16% of chlamydia cases and between 6% and 9% of gonorrhoea cases in England. CONCLUSIONS GP makes an important contribution to the diagnosis and treatment of bacterial STIs in England. While most patients diagnosed with chlamydia were managed appropriately, many of those treated for gonorrhoea received antimicrobials no longer recommended for use. Given the global threat of antimicrobial resistance, GPs should remain abreast of national treatment guidelines and alert to treatment failure in their patients.
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Affiliation(s)
- Sally Wetten
- HIV & STI Department, Public Health England, London, UK
| | | | - Mandy Yung
- HIV & STI Department, Public Health England, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London, UK
| | - Jackie A Cassell
- Division of Primary Care & Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
- Kent Surrey and Sussex Public Health England Centre. County Hall North. Chart Way, Horsham, West Sussex, UK
| | - Gwenda Hughes
- HIV & STI Department, Public Health England, London, UK
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Lampert T, Saß A, Beermann S, Burger R, Ziese T. Gesundheitsberichterstattung. Medizinökonomie 1 2015. [DOI: 10.1007/978-3-658-01966-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Die Gesundheitsberichterstattung (GBE) des Bundes stellt kontinuierlich aktuelle Daten und Informationen zum Gesundheitszustand und zur Gesundheitsversorgung der Bevölkerung in Deutschland bereit. Das Themenspektrum ist vielfältig und reicht von Krankheiten, Beschwerden und Risikofaktoren über die subjektive Gesundheit und gesundheitsbezogene Lebensqualität bis hin zur Inanspruchnahme von Präventions- und Versorgungsangeboten sowie den Strukturen und Kosten des Gesundheitswesens. Die Themen werden auf breiter Datengrundlage und unter Berücksichtigung ihrer gesellschaftlichen Relevanz sowie der sozialen, ökonomischen und politischen Rahmenbedingungen behandelt. Die Ergebnisse werden fortlaufend veröffentlicht, wobei unterschiedliche, auf den Informationsbedarf der jeweiligen Adressaten abgestimmte Publikationsformen genutzt werden.
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Gimenes F, Souza RP, Bento JC, Teixeira JJ, Maria-Engler SS, Bonini MG, Consolaro ME. Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol 2014; 11:672-87. [PMID: 25330794 DOI: 10.1038/nrurol.2014.285] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.
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Falasinnu T, Gilbert M, Hottes TS, Gustafson P, Ogilvie G, Shoveller J. Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines. Int J STD AIDS 2014; 26:839-51. [PMID: 25324350 DOI: 10.1177/0956462414555930] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/24/2014] [Indexed: 11/16/2022]
Abstract
SummarySexually transmitted diseases (STDs) are leading causes of substantial morbidity worldwide. Identification of risk factors for estimating STD risk provides opportunities for optimising service delivery in clinical settings, including improving case finding accuracy and increasing cost-efficiency by limiting the testing of low-risk individuals. The current study was undertaken to synthesise the evidence supporting commonly cited chlamydia and gonorrhoea risk factors. The level of empirical support for the following predictors was strong/moderate: age, race/ethnicity, multiple lifetime sexual partners, sex with symptomatic partners and concurrent STD diagnosis. The following predictors had weak evidence: socio-economic status, transactional sex, drug/alcohol use, condom use and history of STD diagnosis. The most frequently listed predictors among nine clinical guidelines were younger age and multiple sexual partners; the least consistently listed predictor was inconsistent condom use. We found reasonably good concordance between risk factors consistently listed in the recommendations and predictors found to have strong empirical support in the literature. There is a need to continue building the evidence base to explicate the mechanisms and pathways of STD acquisition. We recommend periodic reviews of the level of support of predictors included in clinical guidelines to ensure that they are in accordance with empirical evidence.
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Affiliation(s)
- Titilola Falasinnu
- The School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centres for Disease Control, Vancouver, BC, Canada
| | | | - Paul Gustafson
- The Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- British Columbia Centres for Disease Control, Vancouver, BC, Canada
| | - Jean Shoveller
- The School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Gimenes F, Medina FS, de Abreu ALP, Irie MMT, Esquiçati IB, Malagutti N, Vasconcellos VRB, Discacciati MG, Bonini MG, Maria-Engler SS, Consolaro MEL. Sensitive simultaneous detection of seven sexually transmitted agents in semen by multiplex-PCR and of HPV by single PCR. PLoS One 2014; 9:e98862. [PMID: 24921247 PMCID: PMC4055596 DOI: 10.1371/journal.pone.0098862] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/07/2014] [Indexed: 01/12/2023] Open
Abstract
Sexually transmitted diseases (STDs) may impair sperm parameters and functions thereby promoting male infertility. To date limited molecular studies were conducted to evaluate the frequency and type of such infections in semen Thus, we aimed at conceiving and validating a multiplex PCR (M-PCR) assay for the simultaneous detection of the following STD pathogens in semen: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Herpes virus simplex (HSV) −1 and −2, and Treponema pallidum; We also investigated the potential usefulness of this M-PCR assay in screening programs for semen pathogens. In addition, we aimed: to detect human Papillomavirus (HPV) and genotypes by single PCR (sPCR) in the same semen samples; to determine the prevalence of the seven STDs, HPV and co-infections; to assess the possibility that these infections affect semen parameters and thus fertility. The overall validation parameters of M-PCR were extremely high including agreement (99.2%), sensitivity (100.00%), specificity (99.70%), positive (96.40%) and negative predictive values (100.00%) and accuracy (99.80%). The prevalence of STDs was very high (55.3%). Furthermore, associations were observed between STDs and changes in semen parameters, highlighting the importance of STD detection in semen. Thus, this M-PCR assay has great potential for application in semen screening programs for pathogens in infertility and STD clinics and in sperm banks.
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Affiliation(s)
- Fabrícia Gimenes
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Fabiana Soares Medina
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - André Luelsdorf Pimenta de Abreu
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Mary Mayumi Taguti Irie
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Isis Baroni Esquiçati
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Natália Malagutti
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Michele Garcia Discacciati
- Clinical Chemistry and Toxicology Department, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcelo Gialluisi Bonini
- College of Medicine, Department of Pharmacology, University of Illinois at Chicago, Illinois, Chicago, United States of America
| | - Silvya Stuchi Maria-Engler
- Clinical Chemistry and Toxicology Department, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Edilaine Lopes Consolaro
- Section of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
- * E-mail:
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Affiliation(s)
- William C Miller
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, , Chapel Hill, North Carolina, USA
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Fageeh W, Badawood S, Al Thagafi H, Yasir M, Azhar E, Farraj S, Alomary M, Alsaeed M, Yaghmoor S, Kumosani T. Chlamydia trachomatis infection among female inmates at Briman prison in Saudi Arabia. BMC Public Health 2014; 14:267. [PMID: 24649964 PMCID: PMC3994489 DOI: 10.1186/1471-2458-14-267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis infection is the most common sexually transmitted infection (STI) in the western countries; its prevalence in the conservative Muslim population of Saudi Arabia is not known, but it is generally believed to be low. This study is the first to investigate the prevalence of and risk factors for C. trachomatis infection in the high-risk group of female inmates at Briman Prison in Jeddah. METHODS The inmates were interviewed using a pre-designed questionnaire, and their urine samples were tested for C. trachomatis infection by real-time PCR assay. RESULTS The overall prevalence of C. trachomatis infection was 8.7% in the study population. The ≤25 age group was predominantly affected, with an average prevalence of 16.6%. Two out of five (2/5, 40%) Yamani, (4/33 12.1%) Indonesian, (3/33, 9.1%) Somalian and (2/26, 7.7%) Ethiopian inmates were positive for infection. None of the Saudi inmates (0/14) were positive for infection. Among the studied variables, only age was significantly associated with the infection rate. The other variables (marital status, nationality, religion, employment status, education level, nature of the offense committed, knowledge about protection from STIs, and knowledge about condom use and the purpose of condom use) did not show a significant correlation with Chlamydia infection. CONCLUSIONS The overall prevalence of C. trachomatis infection was within the range published by other reports in similar prison settings in developed countries. The results indicate the need for a countrywide screening and treatment program for all inmates at the time of entry into prison.
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Affiliation(s)
- Wafa Fageeh
- Obstetrics and Gynecology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Niza C, Rudisill C, Dolan P. Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial. Appl Econ Perspect Policy 2014; 36:109-124. [PMID: 25061507 PMCID: PMC4105573 DOI: 10.1093/aepp/ppt033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/01/2013] [Indexed: 05/26/2023]
Abstract
In this cluster randomised trial (N=1060), we tested the impact of financial incentives (£5 voucher vs. £200 lottery) framed as a gain or loss to promote Chlamydia screening in students aged 18-24 years, mimicking the standard outreach approach to student in halls of residence. Compared to the control group (1.5%), the lottery increased screening to 2.8% and the voucher increased screening to 22.8%. Incentives framed as gains were marginally more effective (10.5%) that loss-framed incentives (7.1%). This work fundamentally contributes to the literature by testing the predictive validity of Prospect Theory to change health behaviour in the field.
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Affiliation(s)
- Claudia Niza
- Department of Social Policy London School of Economics and Political Science
| | - Caroline Rudisill
- Department of Social Policy London School of Economics and Political Science
| | - Paul Dolan
- Department of Social Policy London School of Economics and Political Science
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Lim MSC, El‐Hayek C, Goller JL, Fairley CK, Nguyen PLT, Hamilton RA, Henning DJ, McNamee KM, Hellard ME, Stoove MA. Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007–2011. Med J Aust 2014; 200:166-9. [DOI: 10.5694/mja13.10108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Megan S C Lim
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Carol El‐Hayek
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Jane L Goller
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Christopher K Fairley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
- Melbourne Sexual Health Centre, Melbourne, VIC
| | | | | | - Dorothy J Henning
- Young People's Health Service, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC
| | - Kathleen M McNamee
- Family Planning Victoria, Melbourne, VIC
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC
| | | | - Mark A Stoove
- Centre for Population Health, Burnet Institute, Melbourne, VIC
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Yang CJ, Li SY, Chang SY, Wu PY, Liao MH, Liu WC, Wu H, Wu CH, Sun HY, Hung CC. Associated factors with and genotypes of Chlamydia trachomatis infection among clients seeking voluntary counseling and testing for HIV infection in Taiwan. J Microbiol Immunol Infect 2013; 47:526-32. [PMID: 24387885 DOI: 10.1016/j.jmii.2013.10.007] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/20/2013] [Accepted: 09/16/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE This study aimed to investigate the factors associated with Chlamydia trachomatis infection and the genotype distribution of the strains among the clients seeking voluntary counseling and testing (VCT) for human immunodeficiency virus (HIV) in Taiwan. METHODS The VCT clients completed an anonymous self-administered questionnaire interview to inquire into the risks for sexually transmitted diseases, followed by providing a 10-mL first-catch urine specimen to detect C. trachomatis with the use of polymerase-chain-reaction assays. The genotyping of C. trachomatis strains was performed by sequencing of omp1 gene. A case-control study was performed to identify factors associated with chlamydial infection. RESULTS From 2008 to 2011, 140 (4.2%) of the 3323 VCT clients tested positive for C. trachomatis by polymerase chain reaction assays of urine specimens. Compared with 280 control individuals without C. trachomatis infection, cases were more likely to be female (adjusted odds ratio, 3.28; 95% confidence interval, 1.56-6.90) and to report dysuria or urethral discharge (adjusted odds ratio, 2.57; 95% confidence interval, 1.44-4.61). Infections with genotypes Da and G were significantly more common in male than female individuals (genotype Da, 22.2% vs. 0%; and genotype G, 24.4% vs. 3.3%) and in men who have sex with men than heterosexuals (genotype Da, 22.2% vs. 0%; and genotype G, 24.4% vs. 3.3%). CONCLUSION Among the VCT clients in Taiwan, female sex and presence of urethral symptoms were associated with C. trachomatis infection of the genitourinary tract. Homosexual male clients were more likely to be infected with genotypes Da and G than heterosexual clients were.
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Affiliation(s)
- Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Oriental Institute of Technology, New Taipei City, Taiwan
| | - Shu-Ying Li
- Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ying Wu
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Huei Liao
- Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiu Wu
- Field Epidemiology Training Program, Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Cheng-Hsin Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
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Fathollahzadeh B, Bahador A, Majnooni A, Kamalimanesh B, Moshkani S, Haghighi Hasanabad M. Screening of Chlamydia trachomatis Infection in Men, Is It Necessary in Iran? Jundishapur J Microbiol 2013; 6. [DOI: 10.5812/jjm.7782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Booth AR, Norman P, Harris PR, Goyder E. Using the Theory of Planned Behavior to identify key beliefs underlying chlamydia testing intentions in a sample of young people living in deprived areas. J Health Psychol 2013; 20:1229-39. [DOI: 10.1177/1359105313510335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Theory of Planned Behavior was used to identify the key behavioural, normative and control beliefs underlying intentions to test regularly for chlamydia among young people living in socially and economically deprived areas – a high-risk group for infection. Participants ( N = 278, 53% male; mean age 17 years) were recruited from a vocational college situated in an area in the most deprived national quintile (England). Participants completed measures of behavioural, normative and control beliefs, plus intention to test regularly for chlamydia. The behavioural, normative and control beliefs most strongly correlated with intentions to test regularly for chlamydia were beliefs about stopping the spread of infection, partners’ behaviour and the availability of testing. These beliefs represent potential targets for interventions to increase chlamydia testing among young people living in deprived areas.
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Stewart CM, Schoeman SA, Wilson JD. Comparing swabs for diagnosing chlamydia and gonorrhea in women: recent findings. J Comp Eff Res 2013; 2:405-7. [PMID: 24236734 DOI: 10.2217/cer.13.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Catherine Mw Stewart
- The Goodman Centre, Lance Burn Health Centre, Churchill Way, Salford, M6 5QX, UK
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Geelen TH, Rossen JW, Beerens AM, Poort L, Morré SA, Ritmeester WS, van Kruchten HE, van de Pas MM, Savelkoul PH. Performance of cobas® 4800 and m2000 real-time™ assays for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in rectal and self-collected vaginal specimen. Diagn Microbiol Infect Dis 2013; 77:101-5. [DOI: 10.1016/j.diagmicrobio.2013.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/10/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
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Abstract
OBJECTIVES To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention called Emergency Contraception Mediated Pharmacy Access to Chlamydia Testing (ECOMPACT). DESIGN Selective, opportunistic and cross-sectional study targeting asymptomatic women requesting emergency contraception (EC). SETTING 20 community pharmacies in the Perth metropolitan region, Australia. METHODS ECOMAPCT was developed through literature review and stakeholder consensus. Pharmacists were trained to offer ECOMPACT after the EC consultation. Women with signs and symptoms of sexually transmitted infections (STI) were referred to a physician for a full sexual health check. Asymptomatic women were offered a free ECOMPACT testing kit. The women self-collected a low-vaginal swab and returned their pathological specimen to designated drop-off sites. A pathology service analysed the specimens and sent the results to a sexual health physician. The effectiveness of ECOMPACT was determined by the uptake of the intervention and how well the target population was reached. An effective screening rate was calculated. Qualitative analysis was undertaken to understand acceptability issues from the perspective of the consumer and the pharmacists. RESULTS Of the 769 EC consultations in a 6-month period, 569 (78%) women were given information on chlamydia screening. All 247 (41%) agreed to participate. 81 (33%) of these women were ineligible. They were either symptomatic (n=33; 41%), or were under 18 years of age (n=48; 59%). Pharmacists successfully requested 166 (67%) pathology tests, of which 46 (28%) were returned to a pathology drop-off site. All tested negative for Chlamydia trachomatis. The effective screening rate was 6%. Consumers and pharmacists considered ECOMPACT to be highly convenient and the time taken to offer a chlamydia test along with an EC consultation as highly appropriate. CONCLUSIONS ECOMPACT was found to be simple, effective and acceptable. Given the opportunity, adequate training and support, community pharmacists in Australia were capable of requesting direct-to-consumer chlamydia tests.
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Affiliation(s)
- Sajni Gudka
- Centre for Optimisation of Medicines, Pharmacy, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Lewis Marshall
- School of Medicine and Pharmacology Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Alison Creagh
- Family Planning Western Australia Sexual Health Services, Perth, Western Australia, Australia
| | - Rhonda M Clifford
- Centre for Optimisation of Medicines, Pharmacy, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
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Gravningen K, Simonsen GS, Furberg AS, Wilsgaard T. Factors associated with Chlamydia trachomatis testing in a high school based screening and previously in clinical practice: a cross-sectional study in Norway. BMC Infect Dis 2013; 13:361. [PMID: 23915415 DOI: 10.1186/1471-2334-13-361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022] Open
Abstract
Background High school based chlamydia screening has been shown to increase uptake and detect hidden infections among sexually active adolescents. Our study aimed to: i) examine the proportions of 15–20 year-olds tested in a high school based screening and previously in clinical practice, ii) determine chlamydia prevalence according to testing pattern, and iii) examine factors associated with testing in the two settings. Methods A population based cross-sectional study was conducted in 5 high schools in Norway in 2009, using web-questionnaires and Chlamydia trachomatis PCR in first-void urine (800 girls/818 boys, mean age 17.2 years). Only sexually active participants at risk for chlamydia infections were included in the analyses. Crude and multivariable logistic regression models were applied with ‘clinic based testing’ and ‘school based screening’ as outcome variables. Results 56% of girls and 21% of boys reported previous clinic based testing. In the school based screening, 93% were tested with no gender difference. 42% of girls and 74% of boys were tested for the first time at school (‘school-only test’). Both girls with clinic based testing and girls with school-only test had high chlamydia prevalence (7.3% vs 7.2%). Boys with clinic based testing had twice the prevalence of those with school-only test (6.2% vs 3.0%, p = 0.01). Half of infections were detected in participants with school-only test. One-fifth were repeat infections. In multivariable analysis of girls and boys combined, female gender, older age, early sexual debut, no condom use at first and last intercourse, steady relationship, and higher number of lifetime partners increased the odds of clinic based testing. The odds of school based screening increased with male gender, academic affiliation, later sexual debut, condom use at first intercourse, and current urogenital symptoms in multivariable analysis. Conclusions More than half the girls had been tested prior to the school based screening and had high prevalence independent of previous clinic based testing. School screening was mostly associated with factors unknown to increase chlamydia infection risk, while clinic based testing was associated with traditional risk factors. The unusually high and equal participation between genders and the detection of a large chlamydia reservoir confirms the value of school based screening suggesting this approach to be further explored in Norway.
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Nsuami MJ, Nsa M, Brennan C, Cammarata CL, Martin DH, Taylor SN. Chlamydia positivity in New Orleans public high schools, 1996-2005: implications for clinical and public health practices. Acad Pediatr 2013; 13:308-15. [PMID: 23685203 DOI: 10.1016/j.acap.2013.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/26/2013] [Accepted: 02/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the trends in chlamydia positivity among New Orleans high school students tested in a schoolwide screening between 1996 and 2005, and to determine factors associated with chlamydia positivity among students during the 10-year period. METHODS Between school years 1995-1996 and 2004-2005, students in New Orleans public high schools were tested for chlamydia using nucleic acid amplification tests (NAAT) in urine specimens (LCx assay until 1999-2000; BD assay from 2000-2001 to 2004-2005). For each year, we calculated chlamydia positivity by dividing the number of students testing positive by the total number of students tested. Data were analyzed separately by gender. Logistic regressions were performed to determine independent predictors of chlamydia positivity during the 10-year period. RESULTS Between 1996 and 2005, the average chlamydia positivity was 7.0% (95% confidence interval 6.6-7.4) in boys and 13.1% (95% confidence interval 12.6-13.7) in girls (P < .001). Chlamydia detection increased with the switch from LCx to BD assay. In multivariate analyses, chlamydia positivity among boys and girls was significantly associated with age, black race, and gonorrhea coinfection. Additionally, positivity was significantly different by school year among boys (P = .03) and by NAAT used among girls (P = .008). CONCLUSIONS The trends in chlamydia positivity observed between 1996 and 2005 more likely reflected a high and stable prevalence of chlamydia in the New Orleans school-age adolescent population. Any benefit of screening on individuals tested was likely to be mitigated by participants' uninterrupted social interactions with the dynamic forces that sustain the sexual transmission of chlamydia in the population.
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Abstract
BACKGROUND Chlamydia trachomatis infection is a worldwide-distributed sexually transmitted infection that may lead to infertility. OBJECTIVES This study aims to report the prevalence of Chlamydia trachomatis infection among infertile women in Saudi Arabia. PATIENTS AND METHODS A community-based study carried out at the obstetrics and gynecology clinic at Jazan General Hospital, Saudi Arabia. The study group included 640 Saudi infertile women who were aged between 18 and 40 years and who attended the gynecology clinic for infertility examination throughout 1 year of study (from July 1, 2011 to June 30, 2012). The randomized control group included 100 Saudi fertile women who attended the obstetrics clinic for routine antenatal care. All recruited women were screened for chlamydia infection by enzyme-linked immunosorbent assay (ELISA) for detection of serum-specific antibodies and then retested by the McCoy cell culture technique. RESULTS The prevalence of Chlamydia trachomatis infection among infertile women was high, at 15.0%. The rate of chlamydia infection detected by ELISA was 9.84%, and it was 12.03% by the culture method (P = 0.2443). CONCLUSION The high prevalence of Chlamydia trachomatis infection among Saudi infertile women demands a national screening program for early detection among infertile couples. ELISA is available as a simple screening test alternative to the culture method.
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Affiliation(s)
- Remah M Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Jazan, Saudi Arabia
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Gudka S, Bourdin A, Watkins K, Eshghabadi A, Everett A, Clifford RM. Self-reported risk factors for chlamydia: a survey of pharmacy-based emergency contraception consumers. Int J Pharm Pract 2013; 22:13-9. [PMID: 23711359 DOI: 10.1111/ijpp.12042] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the self-reported risk factors for Chlamydia trachomatis in pharmacy-based emergency contraception (EC) consumers, evaluate their pharmacy experience and determine whether they would be willing to accept a chlamydia test from the pharmacy. METHODS A survey for women to complete after their EC consultation was developed from themes identified in a literature search. Nineteen pharmacies in the Perth metropolitan region and 13 pharmacies in rural, regional and remote Western Australia (WA) participated in this study. KEY FINDINGS From the 113 surveys completed (n = 75 from Perth metropolitan; n = 38 from rural, regional and remote WA), 85% of respondents were between 16 and 29 years of age and all (100%) of the women had inconsistent barrier contraception. Almost all (94%) of the women had at least two, and nearly half (47%) had at least three out of the four risk factors for chlamydia. Nearly 70% of the women found it very easy/easy to access a pharmacy and felt very comfortable/comfortable discussing EC with the pharmacist. Significantly more women said they would be willing to accept a chlamydia test from a rural, regional and remote WA pharmacy than from a Perth metropolitan pharmacy (P = 0.003). CONCLUSION Pharmacy-based EC consumers are at high risk of chlamydia and would be willing to accept a chlamydia test from the pharmacy. There is an urgent need to re-orientate health services in Australia so that all EC consumers, including those obtaining EC from pharmacies, have the opportunity to be tested for chlamydia.
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Affiliation(s)
- Sajni Gudka
- Division of Pharmacy, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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Gobin M, Verlander N, Maurici C, Bone A, Nardone A. Do sexual health campaigns work? An outcome evaluation of a media campaign to increase chlamydia testing among young people aged 15-24 in England. BMC Public Health 2013; 13:484. [PMID: 23683345 PMCID: PMC3671151 DOI: 10.1186/1471-2458-13-484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 08/14/2012] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background A national multimedia campaign was launched in January 2010, to increase the proportion of young people tested for chlamydia. This study aimed to evaluate the impact of the campaign on the coverage and positivity within the National Chlamydia Screening Programme (NSCP) in England. Method An interrupted time series of anonymised NCSP testing reports for England for a 27 month period (1st April 2008 to 30th June 2010) was analysed. Reports were assigned to a pre-campaign, campaign and post campaign phase according to the test date. Exclusion criteria included tests for clinical reasons, contacts of known cases, and tests returned from prisons or military services. Negative binomial and logistic regression modelling was used to provide an estimate for the change in coverage and positivity, during, and after the campaign and estimates were adjusted for secular and cyclical trends. Results Adjusting for cyclical and secular trends, there was no change in the overall testing coverage either during (RR: 0.91; 95% CI: 0.72-1.14) or after (RR: 0.88; 95%CI: 0.69-1.11) the campaign. The coverage varied amongst different socio-demographic groups, testing of men increased during the campaign phase while testing of people of black and other ethnic groups fell in this phase. The positivity rate was increased during the campaign (OR: 1.18; 95% CI 1.13-1.23) and further increased in the post-campaign phase (OR: 1.40; 95% CI 1.30-1.51). The proportion of chlamydia infections detected increased for all socio-demographic and self-reported sexual behaviour groups both during and after the campaign. Conclusion The uptake of chlamydia testing rose during the campaign; however, this apparent increase was not maintained once overall trends in testing were taken into account. Nonetheless, once secular and cyclical trends were controlled for, the campaign was associated with an increased positivity linked to increased testing of high risk individuals groups in the target population who were previously less likely to come forward for testing. However, our study indicated that there may have been a disparity in the impact of the campaign on different population groups. The content and delivery of ongoing and future information campaigns aimed at increasing chlamydia screening should be carefully developed so that they are relevant to all sections of the target population.
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Affiliation(s)
- Maya Gobin
- Field Epidemiology Service, Public Health England, Bristol, UK.
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Schmid BV, Over EAB, van den Broek IVF, Op de Coul ELM, van Bergen JEAM, Fennema JSA, Götz HM, Hoebe CJPA, de Wit GA, van der Sande MAB, Kretzschmar MEE. Effects of population based screening for Chlamydia infections in the Netherlands limited by declining participation rates. PLoS One 2013; 8:e58674. [PMID: 23527005 PMCID: PMC3604006 DOI: 10.1371/journal.pone.0058674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/05/2013] [Indexed: 12/31/2022] Open
Abstract
Background A large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008–2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16–29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future. Methods and Findings We used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run. Conclusions Decreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.
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Affiliation(s)
- Boris V. Schmid
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Eelco A. B. Over
- Center for Nutrition, Prevention and Health Services, RIVM, Bilthoven, The Netherlands
| | | | | | - Jan E. A. M. van Bergen
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- STI AIDS Netherlands, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hannelore M. Götz
- Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christian J. P. A. Hoebe
- Public Health Service Southern Limburg, The Netherlands
- School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - G. Ardine de Wit
- Center for Nutrition, Prevention and Health Services, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne A. B. van der Sande
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam E. E. Kretzschmar
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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Lien CS, Chang CH, Wu HC, Chen WC. Genital chlamydial infection in Taiwan. Urological Science 2013. [DOI: 10.1016/j.urols.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Darville T. Recognition and Treatment of Chlamydial Infections from Birth to Adolescence. Advances in Experimental Medicine and Biology 2013; 764:109-22. [DOI: 10.1007/978-1-4614-4726-9_8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Fatholahzadeh B, Bahador A, Haghighi Hasanabad M, Bazarjani F, Haghighi F. Comparative screening of Chlamydia trachomatis infection in women population in tehran, iran. Iran Red Crescent Med J 2012; 14:289-93. [PMID: 22829988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/27/2012] [Indexed: 12/02/2022]
Abstract
BACKGROUND There are more than 30 different sexually transmissible agents while the most common one is Chlamydia trachomatis. In this prospective study, we decided to compare the prevalence of infection in symptomatic and asymptomatic females. METHODS Two hundred sixty urine samples of women in two groups (symptomatic and asymptomatic) were collected from patients attending Mehrad Hospital in Tehran, Iran and tested by polymerase chain reaction. RESULTS Thirty nine women in both groups were infected (14.99%), while 27/130 subjects were in symptomatic group (20.76%), compared with 12/130 person in asymptomatic group (9.23%). No statistically significant difference was found between two groups. Data analysis showed infection with C. trachomatis in symptomatic women to be significantly associated with history of sexually transmitted infections, white blood cells in urine and epithelial cells in urine. CONCLUSION The present study recommends that targeted screening programs in high risk sexually active women (like as individuals who had a history of STIs) are needed as part of case-finding strategies and treatment.
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Zenner D, Molinar D, Nichols T, Riha J, Macintosh M, Nardone A. Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening. BMC Public Health 2012; 12:261. [PMID: 22471791 PMCID: PMC3350390 DOI: 10.1186/1471-2458-12-261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Received: 12/05/2011] [Accepted: 04/02/2012] [Indexed: 11/29/2022] Open
Abstract
Background Patient financial incentives ("incentives") have been widely used to promote chlamydia screening uptake amongst 15-24 year olds in England, but there is scarce evidence of their effectiveness. The objectives of the study were to describe incentives used to promote chlamydia screening in Primary Care Trusts (PCTs) in England and to evaluate their impact on coverage and positivity rate. Methods PCTs that had used incentives between 1/1/2007 and 30/6/2009 (exposed) were matched by socio-demographic profile and initial screening coverage with PCTs that had not (unexposed). For each PCT, percentage point change in chlamydia screening coverage and positivity for the period before and during the incentive was calculated. Differences in average change of coverage and positivity rate between exposed and unexposed PCTs were compared using linear regression to adjust for matching and potential confounders. Results Incentives had a significant effect in increasing average coverage in exposed PCTs (0.43%, CI 0.04%-0.82%). The effect for voucher schemes (2.35%) was larger than for prize draws (0.16%). The difference was greater in females (0.73%) than males (0.14%). The effect on positivity rates was not significant (0.07%, CI -1.53% to 1.67%). Conclusions Vouchers, but not prize draws, led to a small absolute but large relative increase in chlamydia screening coverage. Incentives increased coverage more in females than males but had no impact on reported positivity rates. These findings support recommendations not to use prize draws to promote chlamydia screening and contribute to the evidence base of the operational effectiveness of using patient incentives in encouraging public health action.
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Affiliation(s)
- Dominik Zenner
- Health Protection Agency, Centre for Infections, London, UK.
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Greenland KE, Op de Coul EL, van Bergen JE, Brouwers EE, Fennema HJ, Götz HM, Hoebe CJ, Koekenbier RH, Pars LL, van Ravesteijn SM, van den Broek IV. Acceptability of the internet-based Chlamydia screening implementation in the Netherlands and insights into nonresponse. Sex Transm Dis 2011; 38:467-74. [PMID: 21217416 DOI: 10.1097/OLQ.0b013e318204546e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The study assessed the acceptability of internet-based Chlamydia screening using home-testing kits among 16- to 29-year-old participants and nonparticipants in the first year of a Chlamydia Screening Implementation program in the Netherlands. METHODS Questionnaire surveys were administered to randomly selected participants (acceptability survey) and nonparticipants (nonresponse survey) in 3 regions of the Netherlands where screening was offered. Participants received email invitations to an online survey; nonparticipants received postal questionnaires. Both surveys enquired into opinions on the screening design, reasons for (non-) participation and future willingness to be tested. RESULTS The response rate was 63% (3499/5569) in the acceptability survey and 15% (2053/13,724) in the nonresponse survey. Primary motivation for participating in the screening was "for my health" (63%). The main reason for nonresponse given by sexually active nonparticipants was "no perceived risk of infection" (40%). Only 2% reported nonparticipation due to no internet access. Participants found the internet (93%) and home-testing (97%) advantages of the program, regardless of test results. Two-thirds of participants would test again, 92% via the screening program. Half of nonparticipants were appreciative of the program design, while about 1 in 5 did not like internet usage, home-testing, or posting samples. CONCLUSIONS The screening method was highly acceptable to participants. Nonparticipants in this survey were generally appreciative of the program design. Both groups made informed choices about participation and surveyed low-risk nonparticipants accurately perceived their low-risk status. Although many nonparticipants were not reached by the nonresponse survey, current insights on acceptability and nonresponse are undoubtedly valuable for evaluation of the current program.
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Cunningham KA, Carey AJ, Hafner L, Timms P, Beagley KW. Chlamydia muridarum Major Outer Membrane Protein-Specific Antibodies Inhibit In Vitro Infection but Enhance Pathology In Vivo. Am J Reprod Immunol 2011; 65:118-26. [DOI: 10.1111/j.1600-0897.2010.00894.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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