Improving sexually transmitted infection screening, testing, and treatment among people with HIV: A mixed method needs assessment to inform a multi-site, multi-level intervention and evaluation plan

Bacterial sexually transmitted infections (STIs) continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, that of chlamydia, gonorrhea, and syphilis have not. Despite national recommendations on prevention, screening, and treatment of these STIs, these practices have not been standardized. Nine Health Resources and Services Administration Ryan White HIV/AIDS Program funded clinics across 3 US jurisdictions (Florida, Louisiana, and Washington, DC), were selected as clinical demonstration sites to be evaluated in this mixed method needs assessment to inform a multi-site, multi-level intervention to evaluate evidence-based interventions to improve STI screening and testing of bacterial STIs among people with or at risk for HIV. These 3 US jurisdictions were selected due to having higher than national average incidence rates of HIV and bacterial STIs. Descriptive statistics and deductive analysis were used to assess quantitative and qualitative needs assessment data. Results indicate the following needs across participating sites: inconsistent and irregular comprehensive sexual behavior history taking within and among sites, limited routine bacterial STI testing (once/year and if symptomatic) not in accordance with CDC recommendations, limited extragenital site gonorrhea/chlamydia testing, limited annual training on STI-related topics including LGBTQ health and adolescent/young adult sexual health, and limited efforts for making high-STI incidence individuals feel welcome in the clinic (primarily LGBTQ individuals and adolescents/young adults). These findings were used to identify interventions to be used to increase routine screenings and testing for bacterial STIs.

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1529. Sexually-Transmitted Infection Testing and Positivity among Adults Receiving HIV Pre-Exposure Prophylaxis within an Integrated Health Care Delivery System in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1709 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S765-S765

Author(s):

Mark A Schmidt ◽

John F Dickerson ◽

Suzanne B Schmidt ◽

Maureen O’Keeffe-Rosetti ◽

Judy L Donald ◽

...

Keyword(s):

Sexually Transmitted Infection ◽

Care Delivery ◽

The United States ◽

Health Care Delivery System ◽

Transmitted Infection ◽

Record System ◽

Sexually Transmitted ◽

Sti Testing ◽

Exposure Prophylaxis ◽

The Impact

Abstract Background The goal of this project was to assess the frequency of sexually-transmitted infection (STI) testing and positivity among adult individuals initiating HIV Pre-Exposure Prophylaxis (PrEP) within Kaiser Permanente Northwest (KPNW). Methods We identified KPNW members, 18 years of age and older, who initiated PrEP (tenofovir+emtricitabine) between January 1, 2015 – December 31, 2018. Using data elements abstracted from the electronic health record system, we assessed demographic characteristics of those initiating PrEP and the rate of testing and positivity for HIV, chlamydia (CT) and gonorrhea (GC) and syphilis within a window around 120 days after PrEP initiation. Results Overall, 685 members initiated PrEP during our study period, 661 (96.5%) of whom were male. Mean and median ages were 38 and 36 years, respectively, with those 25-34 years of age comprising the highest proportion (241; 35.2%). The 460 PrEP initiators (67.2% of total) who continued use beyond 120 days were significantly older than those who discontinued use (39 vs. 36 years, p=0.0008). Among continuous users, 78.3% were tested for CT+GC and 83.9% were tested for syphilis roughly 120 days post-initiation, with positivity proportions of 6.9%, 6.7%, and 2.3%, respectively. Among those discontinuing, 39.6% were tested for CT+GC and 37.3% were tested for syphilis, with positivity proportions of 10.1%, 9.0%, and 2.4%, respectively. HIV testing was completed for 87.4% of continuous PrEP users and 40.9% of those who discontinued use; and we identified a total of three individuals who tested positive for HIV, all among the latter group. Manual chart review of these individuals confirmed that HIV exposure and infection occurred after PrEP discontinuation. Conclusion We found high rates of STI testing among individuals receiving PrEP, in accordance with recommendations. Our findings of a lower STI prevalence among PrEP users is encouraging, although further work is required to assess the impact of differential testing rates and age between those who continue and discontinue PrEP use as well as reasons for PrEP discontinuation. Regular testing remains an important part of comprehensive PrEP care management and should continue to be encouraged to identify and treat STI among those at high risk for disease. Disclosures All Authors: No reported disclosures

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1544. Sexually Transmitted Infection Laboratory Testing and Education Trends Among Physician Office Visits in the United States, 2009-2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1724 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S771-S771

Author(s):

Amina R Zeidan ◽

Kelly R Reveles

Keyword(s):

United States ◽

Laboratory Testing ◽

The United States ◽

Age Group ◽

The South ◽

Transmitted Infection ◽

Sti Prevention ◽

Prevention Education ◽

Sexually Transmitted ◽

Sti Testing

Abstract Background Rates of sexually transmitted infections (STIs) have been rising in the United States (US). Physician offices play an important role in providing both STI prevention and education, as well as STI laboratory testing options for patients who present at risk. However, few studies have documented the extent to which physician’s offices have contributed to prevention and testing efforts. We address this gap by evaluating STI testing and education provided in US physician offices from 2009 to 2016. Methods This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey (NAMCS) from 2009 to 2016. Data weights were applied to extrapolate sample data to national estimates. Testing for HIV, HPV, Chlamydia (2009 – 2016) and Hepatitis and Gonorrhea (2014 – 2016) were presented as testing visits per 1,000 total visits. Subgroup analyses were performed for age group, sex, and geographical region by individual STI test and receipt of STI prevention education. Results A total of 7.6 billion visits were included for analysis, of which 0.6% included an STI test. Testing rates increased over the study period for Chlamydia (R2=0.27), HPV (R2=0.28), and HIV (R2=0.51). Peak testing occurred in 2015 for all tests. STI prevention education was provided to 0.5% of patients. Females were tested at a higher rate for all STIs (4.2%) compared to males (0.4%). Females also received more STI prevention education overall (0.6% versus 0.4%, respectively). While the age group 25 – 24 accounted for highest Hepatitis (15.9%) and HPV (11.3%) testing rates, the 15 – 24 age group had the highest overall testing rate (9.4%). STI testing was highest in the South region (Figure 1). Conclusion STI testing in US physician offices increased in recent years. Females accounted for the majority of STI testing and STI prevention education. Testing was more frequent among patients 15 – 24 years old and those seen in the South region. Further research should be conducted to determine reasons for differences in testing and education amongst sex, age group, and geographic region. Disclosures All Authors: No reported disclosures

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Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.10659 ◽

2018 ◽

Author(s):

Albert Liu ◽

Kenneth Coleman ◽

Kelly Bojan ◽

Pedro Alonso Serrano ◽

Temitope Oyedele ◽

...

Keyword(s):

Controlled Trial ◽

The United States ◽

Mobile App ◽

Transmitted Infection ◽

Behavioral Skills ◽

Sexually Transmitted ◽

Sti Testing ◽

Pilot Rct ◽

Sex With Men ◽

Exposure Prophylaxis

BACKGROUND Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. OBJECTIVE The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). METHODS This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. RESULTS Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. CONCLUSIONS The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. CLINICALTRIAL ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/10659

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Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicated Chlamydia trachomatis

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200687 ◽

2020 ◽

pp. bmjsrh-2020-200687

Author(s):

Tom Nadarzynski ◽

Ynez Symonds ◽

Robert Carroll ◽

Jo Gibbs ◽

Sally Kidsley ◽

...

Keyword(s):

Online Survey ◽

Home Delivery ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Sti Testing ◽

Contraceptive Pills ◽

Remote Management ◽

Delivery Services ◽

The Cost ◽

To Receive

ObjectivesThe 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 designAn 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.ResultsThere 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)).ConclusionsPostal 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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Regular STI testing amongst men who have sex with men and use social media is suboptimal – a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462416636780 ◽

2016 ◽

Vol 28 (6) ◽

pp. 573-583 ◽

Cited By ~ 6

Author(s):

Jamie Frankis ◽

Lisa Goodall ◽

Dan Clutterbuck ◽

Abdul-Razak Abubakari ◽

Paul Flowers

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Anal Intercourse ◽

Sex Partners ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Sti Testing ◽

Male Sex ◽

Sex With Men

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more ‘out’ (adjusted odds ratio = 1.79; confidence interval = 1.20–2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03–28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47–3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27–83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00–0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19–0.69) were less likely to test regularly for STIs. As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men’s STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

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A taxonomy of the scope and organization of local sexually transmitted disease services for policy and practice

International Journal of STD & AIDS ◽

10.1177/0956462418787621 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1375-1383

Author(s):

Hector P Rodriguez ◽

Summer Starling ◽

Zosha Kandel ◽

Robert Weech-Maldonado ◽

Nicholas J Moss ◽

...

Keyword(s):

Cluster Analysis ◽

Discriminant Analysis ◽

Critical Role ◽

Transmitted Disease ◽

The United States ◽

Incidence Rates ◽

Contact Tracing ◽

Cluster Solution ◽

Local Health ◽

Sexually Transmitted

Local health departments (LHDs) and their organizational partners play a critical role in controlling sexually transmitted diseases (STDs) in the United States. We examine variation in the differentiation, integration, and concentration (DIC) of STD services and develop a taxonomy describing the scope and organization of local STD services. LHD STD programs (n = 115) in Alabama (AL) and California (CA) responded to surveys assessing STD services available in 2014. K-means cluster analysis identified LHD groupings based on DIC variation. Discriminant analysis validated cluster solutions. Differences in organizational partnerships and scope of STD services were compared by taxonomy category. Multivariable regression models estimated the association of the STD services organization taxonomy and five-year (2010–2014) gonorrhea incidence rates, controlling for county-level sociodemographics and resources. A three-cluster solution was identified: (1) low DIC (n = 74), (2) moderate DIC (n = 31), and (3) high DIC (n = 10). In discriminant analysis, 95% of jurisdictions were classiﬁed into the same types as originally assigned through K-means cluster analysis. High DIC jurisdictions were more likely (p < 0.001) to partner with most organizations than moderate and low DIC jurisdictions, and more likely (p < 0.001) to conduct STD needs assessment, comprehensive sex education, and targeted screening. In contrast, contact tracing, case management, and investigations were conducted similarly across jurisdictions. In adjusted analyses, there were no differences in gonorrhea incidence rates by category. Jurisdictions in CA and AL can be characterized into three distinct clusters based on the DIC of STD services. Taxonomic analyses may aid in improving the reach and effectiveness of STD services.

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Association between intensity of STI screening and development of antimicrobial resistance in N. gonorrhoeae in 12 cities in the USA: An ecological study

F1000Research ◽

10.12688/f1000research.15569.3 ◽

2018 ◽

Vol 7 ◽

pp. 1237

Author(s):

Chris R. Kenyon

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Ecological Study ◽

Geometric Mean ◽

The United States ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Antimicrobial Sensitivity ◽

The Usa ◽

Sex With Men

In this study, we assessed if there was a city-level association between sexually transmitted infection (STI) screening intensity in men who have sex with men and antimicrobial sensitivity in Neisseria gonorrhoeae in the United States, 2007 to 2013. We found positive associations between STI screening intensity and increases in minimum inhibitory concentrations for cefixime and azithromycin, but not ceftriaxone when using change in city geometric mean N. gonorrhoeae MIC between 2005 and 2013.

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Incidence, risk factors and distribution of syphilis in the end-stage renal disease population in the USA

Clinical Kidney Journal ◽

10.1093/ckj/sfz090 ◽

2019 ◽

Vol 13 (4) ◽

pp. 625-630

Author(s):

Erena N Weathers ◽

Jennifer L Waller ◽

N Stanley Nahman ◽

Rhonda E Colombo ◽

Mufaddal F Kheda ◽

...

Keyword(s):

Risk Factors ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Transmitted Infection ◽

Sexually Transmitted ◽

The Usa ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background Syphilis is a sexually transmitted infection with an incidence of 14.9 cases per 100 000 persons in the USA in 2011. Untreated syphilis may remain quiescent for years but can also result in clinical sequelae, including neurosyphilis. End-stage renal disease (ESRD) patients may be at risk for syphilis due to a higher incidence of risk factors for the disease, including human immunodeficiency virus (HIV). Despite the presence of these risk factors, the incidence of syphilis in the ESRD population has not been reported. To address this issue, we investigated the incidence and risk factors for syphilis in the ESRD population using the United States Renal Data System (USRDS). Methods This study analyzed incident ESRD patients from 2004 to 2010. Based on International Classification of Diseases, Ninth Revision codes for syphilis, we determined the incidence and risk factors for syphilis following an inpatient diagnosis. Generalized linear modeling was used to examine the relative risk (RR) for the disease when controlling for demographic and other clinical risk factors. Results A total of 383 diagnoses of syphilis were identified after screening 759 066 patients. The 8-year incidence of any type of syphilis was 50.45 cases per 100 000 person-years. Other unspecified syphilis (29.77 cases per 100 000 person-years) and neurosyphilis (10.93 cases per 100 000 person-years) were the most common diagnoses. The greatest incidence was found on the East and West Coasts. Patients with the disease were younger and more likely to be black and non-Hispanic. In the final model, the adjusted RR for syphilis was significantly increased with HIV (7.61), hepatitis C (3.57), herpes simplex (2.06) and hepatitis B (1.75). Conclusions The incidence of syphilis is >3-fold greater in ESRD patients when compared with the general population and is associated with sexually transmitted viral infections. Neurosyphilis is a common occurrence and is treatable, suggesting that all assessments of confusion in dialysis patients should include screening for the disease.

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Optimizing Screening for HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa024 ◽

2020 ◽

Cited By ~ 1

Author(s):

Antoine Chaillon ◽

Martin Hoenigl ◽

Lorri Freitas ◽

Haruna Feldman ◽

Winston Tilghman ◽

...

Keyword(s):

At Risk ◽

Screening Program ◽

Demographic Data ◽

The United States ◽

Hiv Prevalence ◽

Screening Tests ◽

Transmitted Infection ◽

Sexually Transmitted ◽

At Risk Populations ◽

Zip Code

Abstract Background The HIV epidemic is unevenly distributed throughout the United States, even within neighborhoods. This study evaluated how effectively current testing approaches reached persons at risk for HIV infection across San Diego (SD) County, California. Methods HIV case and testing data, sexually transmitted infection (STI) and socio-demographic data for SD County were collected from the SD Health and Human Services Agency and the ‘Early Test’ community-based HIV screening program between 1998 and 2016. Relationships between HIV diagnoses, HIV prevalence, and STI diagnoses with screening at zip code level were evaluated. Results Overall, 379,074 HIV tests were performed. The numbers of HIV tests performed on persons residing in a zip code or region overall strongly correlated with prevalent HIV cases (R2=0.714), new HIV diagnoses (R2=0.798), and STI diagnoses (R2=0.768 [chlamydia],0.836 [gonorrhea], 0.655 [syphilis]) in those regions. Zip codes with the highest HIV prevalence had the highest number of tests per resident and fewest number of tests per diagnosis. Even though most screening tests occurred at fixed venues located in high prevalence areas, screening of residents from lower prevalence areas was mostly proportional to the prevalence of HIV and rates of new HIV and STI diagnoses in those locales. Conclusion This study supported the ability of a small number of standalone testing centers to reach at-risk populations dispersed across SD County. These methods can also be used to highlight geographic areas, or demographic segments that may benefit from more intensive screening.

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