Accounting for informative sampling in estimation of associations between sexually transmitted infections and hormonal contraceptive methods

AbstractThe relationship between hormonal contraceptive method use and sexually transmitted infections is not well understood. Studies that implement routine screening for STIs among different contraceptive users, such as the ASPIRE HIV-1 prevention trial, can be useful for identifying potential risk factors of STIs. However, the complex nature of non-random data can lead to challenges in estimation of associations for potential risk factors. In particular, if screening for the disease is not random (i. e. it is driven by symptoms or other clinical indicators), estimates of association can suffer from bias, often referred to as informative sampling bias. Time-varying predictors and potential stratification variables can further contribute to difficulty in obtaining unbiased estimates. In this paper, we estimate the association between time- varying contraceptive use and Sexually transmitted infections acquisition, in the presence of informative sampling, by extending the work Buzkova (2010). We use a two-step procedure to jointly model the non-random screening process and sexually transmitted infection risk. In the first step, inverse intensity rate ratios (IIRR) weights are estimated. In the second step, a weighted proportional rate model is fit to estimate the IIRR weighted hazard ratio. We apply the method to evaluate the relationship between hormonal contraception and risk of sexually transmitted infections among women participating in a biomedical HIV-1 prevention trial. We compare our results using the proposed weighted method to those generated using conventional approaches that do not account for potential informative sampling bias or do not use the full potential of the data. Using the IIRR weighted approach we found depot medroxyprogesterone acetate users have a significantly decreased hazard of Trichomonas vaginalis acquisition compared to IUD users (hazard ratio: 0.44, 95% CI: (0.25, 0.83)), which is consistent with the literature. We did not find significant increased or decreased hazard of other STIs for hormonal contraceptive users compared to non-hormonal IUD users.

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Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

Infectious Diseases of Poverty ◽

10.1186/s40249-020-00792-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Karla Y. Ganley ◽

Marta Wilson-Barthes ◽

Andrew R. Zullo ◽

Sandra G. Sosa-Rubí ◽

Carlos J. Conde-Glez ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Mexico City ◽

Sex Workers ◽

Incidence Rates ◽

Consistent Condom ◽

Vaginal Intercourse ◽

Time Varying ◽

Male Sex Workers ◽

Sexually Transmitted ◽

Male Sex

Abstract Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

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Mortality and associated risk factors in diabetics

Acta Endocrinologica ◽

10.1530/acta.0.110s021 ◽

1985 ◽

Vol 110 (4_Suppl) ◽

pp. S21-S26 ◽

Cited By ~ 33

Author(s):

R. J. Jarrett ◽

M. J. Shipley

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Mortality Risk ◽

Mortality Rates ◽

Potential Risk Factors ◽

Diabetic Population ◽

Associated Risk Factors ◽

The Relationship

Summary. In 168 male diabetics aged 40-64 years participating in the Whitehall Study, ten-year age adjusted mortality rates were significantly higher than in non-diabetics for all causes, coronary heart disease, all cardiovascular disease and, in addition, causes other than cardiovascular. Mortality rates were not significantly related to known duration of the diabetes. The predictive effects of several major mortality risk factors were similar in diabetics and non-diabetics. Excess mortality rates in the diabetics could not be attributed to differences in levels of blood pressure or any other of the major risk factors measured. Key words: diabetics; mortality rates; risk factors; coronary heart disease. There are many studies documenting higher mortality rates - particularly from cardiovascular disease -in diabetics compared with age and sex matched diabetics from the same population (see Jarrett et al. (1982) for review). However, there is sparse information relating potential risk factors to subsequent mortality within a diabetic population, information which might help to explain the increased mortality risk and also suggest preventive therapeutic approaches. In the Whitehall Study, a number of established diabetics participated in the screening programme and data on mortality rates up to ten years after screening are available. We present here a comparison of diabetics and non-diabetics in terms of relative mortality rates and the influence of conventional risk factors as well as an analysis of the relationship between duration of diabetes and mortality risk.

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Internet-Based Screening for Sexually Transmitted Infections to Reach Nonclinic Populations in the Community: Risk Factors for Infection in Men

Sexually Transmitted Diseases ◽

10.1097/olq.0b013e3181e3d771 ◽

2010 ◽

Vol 37 (12) ◽

pp. 756-763 ◽

Cited By ~ 64

Author(s):

Shua J. Chai ◽

Bulbulgul Aumakhan ◽

Mathilda Barnes ◽

Mary Jett-Goheen ◽

Nicole Quinn ◽

...

Keyword(s):

Risk Factors ◽

Sexually Transmitted Infections ◽

Sexually Transmitted ◽

Community Risk ◽

Community Risk Factors

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High Prevalence of Sexually Transmitted Infections and Risk Factors Among HIV-Positive Individuals in Yunnan, China

10.21203/rs.3.rs-936581/v1 ◽

2021 ◽

Author(s):

Wei Tu ◽

Yu-Ye Li ◽

Yi-Qun Kuang ◽

Rong-Hui Xie ◽

Xing-Qi Dong ◽

...

Keyword(s):

Risk Factors ◽

Sexually Transmitted Infections ◽

Genital Tract ◽

Mycoplasma Genitalium ◽

Cross Sectional Study ◽

Multiple Infections ◽

Hiv Positive ◽

Cross Sectional ◽

Sexually Transmitted ◽

High Prevalence

Abstract Background Yunnan has the highest rates of HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with accelerated HIV transmission and poor ART outcomes, but are only diagnosed by syndromic algorithms. Methods We recruited 406 HIV-positive participants for a cross-sectional study (204 ART-naive and 202 ART). Blood samples and first-voided urine samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG). Syphilis and HSV-2 tests were also performed. Results Among 406 participants, the overall prevalence of STI was 47.0% and 45.1% in ART-naive individuals and 49.0% in ART individuals, respectively. Testing frequency was 11.6% (11.8% vs 11.4%), 33.2% (29.4% vs 37.1%), 3.2% (3.4% vs 3.0%), 2.0% (3.4% vs 0.5%) and 4.7% (6.4% vs 3.0%) for active syphilis, HSV-2, chlamydia, gonorrhoeae and genitalium. Percentage of multiple infections in both groups was 10.8% (22/204) in ART-naive participants and 9.9% (20/202) in ART participants. Females, age between 18 to 35 years, ever injected drugs, homosexual or bisexual, HIV/HBV coinfection, and not receiving ART were identified as risk factors. Self-reported asymptom was not eliminating of having a laboratory-diagnosed STI. Conclusions STI prevalence was 47.0% (45.1% vs 49.0%), HSV-2, syphilis and MG were the most common STIs in HIV-infected individuals. We found high prevalence (6.4%) of Mycoplasma genitalium in ART-naive individuals. ART can reduce the diversity of STI-HIV coinfection but not the prevalence. HIV-positive individuals tend to neglect or maybe hide their genital tract discomfort, thus we suggest strengthening STI joint screening and treatment services among HIV-infected individuals whether they describe genital tract discomfort or not.

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