scholarly journals Reduced sensitivity from pooled urine, pharyngeal and rectal specimens when using a molecular assay for the detection of chlamydia and gonorrhoea near the point of care

Sexual Health ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 15 ◽  
Author(s):  
Steven G. Badman ◽  
Sara F. E. Bell ◽  
Judith A. Dean ◽  
Jime Lemoire ◽  
Luke Coffey ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Molecular Detection ◽  
Point Of Care ◽  
Molecular Assay ◽  
Test Sensitivity ◽  
At Risk Populations ◽  
Individual Specimen ◽  
Overall Performance ◽  
Sex With Men ◽  
The Individual

Background The aim of this study was to compare the performance of pooled self-collected urogenital, pharyngeal and anorectal specimens to that of individual specimen results for the molecular detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) near the point of care (POC) for diagnostic sensitivity. Methods: Clients (mostly men who have sex with men) attending an urban community testing service and three sex-on-premises venues in Brisbane, Australia, were offered CT and NG testing by trained lay providers. Participants provided three self-collected specimens (urine, pharyngeal and rectal) for testing by GeneXpert (Cepheid, Sunnyvale, CA, USA). If any of the individual specimens from a participant were positive, all three specimens were pooled and retested. Results: Of the 388 participants who provided three individual anatomical specimens, 76 (19.6%) were found to be positive for CT and/or NG at one or more sites. The pooling approach failed to detect five CT rectal and four NG pharyngeal infections. The overall performance (sensitivity) of the pooling approach compared with individual specimen testing and Cohen’s κ were 90.0% and 0.86 respectively for CT and 89.7% and 0.89 respectively for NG. Conclusions: Reduced sensitivity was observed when using pooled specimens for the detection of CT and NG using GeneXpert near the POC, similar to results reported in laboratory-based CT and NG pooling studies. These data suggest specimen pooling is feasible near to the POC, potentially saving time and costs when screening at-risk populations for CT and NG. Our data also suggest a reduction in pooled urine could improve overall test sensitivity.

scholarly journals Paper-based molecular diagnostic for Chlamydia trachomatis

RSC Advances ◽  
2014 ◽  
Vol 4 (80) ◽  
pp. 42245-42251 ◽  
Author(s):  
Jacqueline C. Linnes ◽  
Andy Fan ◽  
Natalia M. Rodriguez ◽  
Bertrand Lemieux ◽  
Huimin Kong ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Point Of Care ◽  
Molecular Diagnostic ◽  
Rapid Diagnostics ◽  
Molecular Assay

The paper-based molecular assay can be performed at the point of care and is 100× more sensitive than current rapid diagnostics forchlamydiadetection.

scholarly journals 1294. Acceptability and Feasibility of a Pharmacist-led Pre-exposure Prophylaxis Program in the Midwestern United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S395-S395
Author(s):  
Sara Bares ◽  
Joshua Havens ◽  
Kimberly Scarsi ◽  
Donald Klepser ◽  
Susan Swindells
Keyword(s):  
Point Of Care ◽  
Retention Rates ◽  
Management Support ◽  
Research Support ◽  
Collaborative Practice Agreement ◽  
Tenofovir Df ◽  
Adherence Counseling ◽  
At Risk Populations ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Despite evidence that HIV pre-exposure prophylaxis (PrEP) substantially reduces the risk of infection in at-risk populations, significant barriers exist to its prescription and use. Utilizing pharmacists may help increase patient access to PrEP services. We designed and implemented a novel pharmacist-led PrEP program in Omaha, Nebraska. Methods Our pharmacist-led PrEP program was developed in the fall of 2016. Six pharmacists from four sites (one community pharmacy, two community-based clinics and one HIV-specialized clinic) were selected for participation based on interest, senior management support, and availability of appropriate infrastructure. All pharmacists received training for the provision of PrEP. Through a collaborative practice agreement, pharmacists met with patients individually, obtained a medical history, performed a risk assessment and point-of-care laboratory testing (HIV screen, creatinine, and syphilis), and collected samples for gonorrhea and chlamydia. They also provided medication and adherence counseling, and prescribed emtricitabine-tenofovir DF when appropriate. Pharmacists completed a survey reporting their experience after each visit. Presented here are patient demographics, retention rates, and pharmacist-reported experience from the first 6 months of the program. Results Sixty patients enrolled in the pharmacist-led PrEP program between January and June 2017 and completed 139 visits. 95% of participants were men, 83% were white, 80% were privately insured, and 90% had completed some college or higher. The mean age of participants was 34 years (range 20–61 years) and 88% identified as men who have sex with men. 73% were retained in care at 3 months and 58% were retained in care at 6 months. To date, no patient has seroconverted. Pharmacists reported feeling comfortable performing point-of-care testing at all visits and only reported feeling uncomfortable counseling patients on three occasions (2.2%). Finally, pharmacist-reported workflow disruption only occurred on 1 occasion (0.7%). Conclusion Implementation of a pharmacist-led PrEP program is feasible, associated with high rates of pharmacist acceptability, and results in retention rates that are comparable to other real-world PrEP programs. Disclosures S. Bares, Gilead: Grant Investigator, Grant recipient. S. Swindells, Merck: Investigator, Research support. ViiV: Investigator, Research support.

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

2017 ◽  
Vol 94 (4) ◽  
pp. 293-297 ◽  
Author(s):  
David John Speers ◽  
I-Ly Joanna Chua ◽  
Justin Manuel ◽  
Lewis Marshall
Keyword(s):  
Nucleic Acid ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Sexual Health ◽  
Point Of Care ◽  
Standard Of Care ◽  
Urine Samples ◽  
Health Clinic ◽  
Sex With Men ◽  
The Cost

ObjectivesScreening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing.MethodsWe prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic.ResultsWe found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests.ConclusionsPooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation.

scholarly journals Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Owain D. Williams ◽  
Judith A. Dean ◽  
Anna Crothers ◽  
Charles F. Gilks ◽  
Jeff Gow
Keyword(s):  
Point Of Care ◽  
Cost Model ◽  
Cost Effective ◽  
Positive Diagnosis ◽  
Trade Offs ◽  
Self Testing ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
The Individual ◽  
The Cost

Abstract Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.

scholarly journals Computer-assisted contralateral side comparison of the ankle joint using flat panel technology

2021 ◽  
Author(s):  
Sarina Thomas ◽  
Lisa Kausch ◽  
Holger Kunze ◽  
Maxim Privalov ◽  
André Klein ◽  
...  
Keyword(s):  
Information Gain ◽  
Contralateral Side ◽  
Computer Assisted ◽  
Ankle Joints ◽  
Additional Radiation ◽  
Median Position ◽  
Operative Evaluation ◽  
Overall Performance ◽  
The Individual ◽  
Segmentation Problem

Abstract Purpose Reduction and osteosynthesis of ankle fractures is a challenging surgical procedure when it comes to the verification of the reduction result. Evaluation is conducted using intra-operative imaging of the injured ankle and depends on the expertise of the surgeon. Studies suggest that intra-individual variance of the ankle bone shape and pose is considerably lower than the inter-individual variance. It stands to reason that the information gain from the healthy contralateral side can help to improve the evaluation. Method In this paper, an assistance system is proposed that provides a side-to-side view of the two ankle joints for visual comparison and instant evaluation using only one 3D C-arm image. Two convolutional neural networks (CNN) are employed to extract the relevant image regions and pose information of each ankle so that they can be aligned with each other. A first U-Net uses a sliding window to predict the location of each ankle. The standard plane estimation is formulated as segmentation problem so that a second U-Net predicts the three viewing planes for alignment. Results Experiments were conducted to assess the accuracy of the individual steps on 218 unilateral ankle datasets as well as the overall performance on 7 bilateral ankle datasets. The experiments on unilateral ankles yield a median position-to-plane error of $$0.73\pm 1.36$$ 0.73 ± 1.36 mm and a median angular error between 2.98$$^\circ $$ ∘ and 3.71$$^\circ $$ ∘ for the plane normals. Conclusion Standard plane estimation via segmentation outperforms direct pose regression. Furthermore, the complete pipeline was evaluated including ankle detection and subsequent plane estimation on bilateral datasets. The proposed pipeline enables a direct contralateral side comparison without additional radiation. This has the potential to ease and improve the intra-operative evaluation for the surgeons in the future and reduce the need for revision surgery.

scholarly journals Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state

2020 ◽  
pp. 095646242094756
Author(s):  
Sabina O Nduaguba ◽  
Kentya H Ford ◽  
James P Wilson ◽  
Kenneth A Lawson ◽  
Robert L Cook
Keyword(s):  
At Risk ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Interaction Terms ◽  
Late Hiv Diagnosis ◽  
Increased Risk ◽  
At Risk Populations ◽  
Sex With Men ◽  
Aids Diagnosis ◽  
Racial Ethnic

We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.

scholarly journals Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heleen Vermandere ◽  
Santiago Aguilera-Mijares ◽  
Liliane Martínez-Vargas ◽  
M. Arantxa Colchero ◽  
Sergio Bautista-Arredondo
Keyword(s):  
Partner Notification ◽  
Key Populations ◽  
Structured Interviews ◽  
Hiv Diagnosis ◽  
Serostatus Disclosure ◽  
Hiv Epidemic ◽  
Contact Information ◽  
Hiv Awareness ◽  
Sex With Men ◽  
The Individual

Abstract Background Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators. Methods We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS. Results Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions. Conclusions While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

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