Background Nucleic acid amplification testing (NAAT) is the preferred method to detect Chlamydia trachomatis and Neisseria gonorrhoeae, but information regarding performance of currently available assays is needed. This study evaluated the performance of the Aptima Combo 2, GeneXpert, cobas4800, and ProbeTec QX (CTQ/GCQ) to detect chlamydia and gonorrhea in pharyngeal, rectal, and urine specimen. Methods Adult male patients seen at an urban human immunodeficiency virus clinic in Birmingham, Alabama who reported sex with men (men who have sex with men) and no antibiotic use in the past 30 days were enrolled between November 2014 and December 2016. Following a baseline survey, rectal and initial void urine specimens were self-collected. A composite infection standard was used, where 1 assay was compared with 3 others to determine sensitivity and specificity estimates for rectal and urine samples. Two pharyngeal samples were clinician-collected for chlamydia and gonorrhea testing and both had to be positive to be considered a true positive. Results Among the 181 men enrolled into the study, 15.5% and 7.2% had at least 1 positive chlamydia and gonorrhea result at any site, respectively. Among all 4 assays, chlamydia sensitivity rates ranged from 82% to 96% among rectal samples. Rectal gonorrhea sensitivity estimates ranged from 67% to 99%. The GCQ assay was less sensitive in detecting rectal gonorrhea compared with the other assays (P = 0.02). Conclusions More than 80% of chlamydia and gonorrhea infections would have been missed with urine-only screening, highlighting the importance in using NAATs to detect chlamydia and gonorrhea infections among men who have sex with men.

Effective mentoring of underrepresented scholars in the biobehavioral and health sciences is vital for the future of scientific inquiry, as well as for clinical and public health applications. Through the mentoring process, both the mentee and mentor can benefit by broadening their knowledge, skills, and perspectives relative to the professional goals and interests of the mentee. Establishing a trusting and nurturing relationship allows the mentor and mentee to identify short-and long-term goals, accompanied by strategies designed to maximize the mentee's success. Many relationships benefit from establishing explicit working guidelines early on, with recognition that flexibility may be necessary as the relationship matures. Adapting to the specific needs and challenges facing underrepresented doctoral trainees and early career scholars, we propose an integrative developmental framework informed by 3 fundamental assumptions: (a) the mentee's professional growth and personal development are intertwined; (b) the mentee's goals will evolve and sometimes change over time; and (c) reflective analysis of the distinctive skill sets, life experiences, and limits of the mentor and mentee will help strengthen the mentoring plan. A challenging issue in mentoring is how to individualize the approach for each mentee, recognizing the need to balance mentor support and advice with opportunities for mentee independence, self-appraisal, and creativity. We share our developmental framework with the hope that others may adapt this as a practical template to develop a joint plan amenable to intermittent monitoring to optimize productivity and personally rewarding professional career trajectories for an increasingly diverse workforce. Public Policy Relevance StatementBuilding on current initiatives and incorporating new and innovative resources while recognizing inadequacies of the past are critical for effective mentoring of underrepresented doctoral trainees and early career scholars in biobehavioral and health sciences. We advance an integrative developmental framework to help navigate this process. We wholeheartedly believe that mentoring is an honor and privilege and that it should support a professional environment that will be attractive for future recruitment and retention of a diverse workforce.

Introduction Black men in the Deep South have been disproportionally affected by high human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection rates. Conventional clinic-based screening approaches have had limited success in reaching those undiagnosed with HIV or HCV infection. The purpose of this study was to evaluate the acceptability, feasibility and best practices of an integrated HIV and HCV community-based health screening approach. Methods The study used a mixed-methods approach – focus group discussion, individual interviews and surveys - assessing perceptions, perspectives, and HIV and HCV awareness among six communities across Alabama and Mississippi. Data were collected and analyzed in 2014–2017. Results While HIV and HCV knowledge was limited among community members surveyed, the results of this study suggest that a) using an integrated, community-based HIV and HCV testing approach is acceptable and feasible; b) formation of a community advisory board is a key element of successful community mobilization; c) education and training of community members on disease specific topics and overcoming stigma are essential; and d) focus on and inclusion of young community members will be critical for the sustainability of screening efforts. Conclusion Including and engaging communities at risk for HIV and HCV infection in prevention research is a promising strategy to overcome existing barriers of stigma and discrimination. Integration of HIV and HCV testing in universal health screening efforts utilizing a Community Health Advisors model encourages unbiased communication with a focus on overall community health. Community health advisors are recognized as important agents in this effort.

Chlamydia and gonorrhea are 2 of the most common bacterial sexually transmitted infections (STIs) worldwide. Rising chlamydia and gonorrhea rates along with increased closing of STI clinics has led many to seek STI testing in clinical settings such as urgent cares and walk-in clinics. However, with competing priorities, providing effective and efficient STI care can be difficult in these settings. This has left a growing need for the implementation of novel STI screening programs in other clinical settings. This review summarizes previous studies that have evaluated the clinical implementation of chlamydia and gonorrhea screening programs in these settings. Literature from January 2015 to February 2020 regarding the implementation or evaluation of STI screening programs in clinical settings was reviewed. Constructs from the Capability, Opportunity, Motivation, and Behavior model were used to organize results, as this model can aid in identifying specific strategies for behavior/process change interventions. We found that multiple STI screening programs have been implemented and evaluated in 5 different countries and multiple health care facilities including sexual health clinics, urgent cares, walk-in clinics, and university health clinics. When implementing new STI screening programs, sample-first, test-and-go services and molecular point-of-care (POC) testing approaches were found to be effective in increasing screening and reducing costs and time to treatment. At the health care systems level, these programs can help reduce STI screening costs and generate additional revenue for clinics. At the provider level, clear communication and guidance can help clinical and administrative staff in adopting new screening programs. Finally, at the patient level, new programs can reduce time to treatment and travel costs in visiting clinics multiple times for testing and treatment services.

BackgroundA strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations.Design and MethodsSemi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017.ResultsMany clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed.ConclusionsThe current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.Significance for public healthMore than a decade after its introduction, human papillomavirus (HPV) vaccination coverage remains low in the United States despite a robust record of safety and effectiveness. A strong recommendation from a clinician is one of the most important determinants of uptake, yet clinicians often fail to provide effective recommendations. One potential barrier to effective recommendations by clinicians that has not been explicitly studied is the widespread lack of school entry requirements for HPV vaccination. In this qualitative study, we found the lack of requirements to be an important reason for clinicians’ framing HPV vaccination recommendations as optional and non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that is focused on disease prevention and uncoupled from requirements. Additionally, greater support for HPV vaccination requirements among clinicians may be needed to successfully enact requirements in the future.