Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.

No abstract

Baltimore-area MSM with syphilis, particularly those with repeat infection, represent a unique population for whom coinfection with HIV is high. Increasing frequency of syphilis and HIV testing among Baltimore area MSM with a syphilis diagnosis and prioritizing HIV-infected MSM with syphilis in efforts to achieve viral suppression may improve outcomes locally for both infections.

Objectives An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. Methods HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered “Yes” or “Not Sure,” the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. Results Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded “Not sure” to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). Conclusion Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.

WHAT'S KNOWN ON THIS SUBJECT: Neonatal circumcision in the United States has been estimated to be performed in ∼58% of all neonates, and varies by US geographic region. WHAT THIS STUDY ADDS:This study estimates neonatal and postneonatal circumcision rates among commercially insured males aged 0 to 18 years that were performed in both inpatient and outpatient settings. This study also estimates indications and payments for the procedure. abstract BACKGROUND: Male circumcision confers protection against HIV, sexually transmitted infections, and urinary tract infections. Compared with circumcision of postneonates (.28 days), circumcision of neonates is associated with fewer complications and usually performed with local rather than general anesthesia. We assessed circumcision of commercially insured males during the neonatal or postneonatal period. METHODS:We analyzed 2010 MarketScan claims data from commercial health plans, using procedural codes to identify circumcisions performed on males aged 0 to 18 years, and diagnostic codes to assess clinical indications for the procedure. Among circumcisions performed in the first year of life, we estimated rates for neonates and postneonates. We estimated the percentage of circumcisions by age among males who had circumcisions in 2010, and the mean payment for neonatal and postneonatal procedures. RESULTS:We found that 156 247 circumcisions were performed, with 146 213 (93.6%) in neonates and 10 034 (6.4%) in postneonates. The neonatal circumcision rate was 65.7%, and 6.1% of uncircumcised neonates were circumcised by their first birthday. Among postneonatal circumcisions, 46.6% were performed in males younger than 1 year and 25.1% were for nonmedical indications. The mean payment was $285 for a neonatal and $1885 for a postneonatal circumcision. CONCLUSIONS:The large number of nonmedical postneonatal circumcisions suggests that neonatal circumcision might be a missed opportunity for these boys. Delay of nonmedical circumcision results in greater risk for the child, and a more costly procedure. Discussions with parents early in pregnancy might help them make an informed decision about circumcision of their child. Pediatrics 2014;134:950-956

OBJECTIVES: An effective clinical decision support system (CDSS) may address the current provider training barrier to offering pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV) infection. This study evaluated change in provider knowledge and likelihood to initiate PrEP after exposure to a PrEP CDSS. A secondary objective explored perceived provider utility of the CDSS and suggestions for improving CDSS effectiveness. METHODS: This was a prospective study using survey responses from a convenience sample of pediatric providers who launched the interruptive PrEP CDSS when ordering an HIV test. McNemar’s test evaluated change in provider PrEP knowledge and likelihood to initiate PrEP. Qualitative responses on CDSS utility and suggested improvements were analyzed using Framework Analysis and were connected to quantitative analysis elements using the merge approach. RESULTS: Of the 73 invited providers, 43 had available outcome data and were included in the analysis. Prior to using the CDSS, 86% of participants had never prescribed PrEP. Compared to before CDSS exposure, there were significant increases in the proportion of providers who were knowledgeable about PrEP (p=0.0001), likely to prescribe PrEP (p<0.0001), and likely to refer their patient for PrEP (p<0.0001). Suggestions for improving the CDSS included alternative “triggers” for the CDSS earlier in visit workflows, having a non-interruptive CDSS, additional provider educational materials, access to patient-facing PrEP materials, and additional CDSS support for adolescent confidentiality and navigating financial implications of PrEP. CONCLUSIONS: Our findings suggest that an interruptive PrEP CDSS attached to HIV test orders can be an effective tool to increase knowledge and likelihood to initiate PrEP among pediatric providers. Continual improvement of the PrEP CDSS based on provider feedback is required to optimize usability, effectiveness, and adoption. A highly usable PrEP CDSS may be a powerful tool to close the gap in youth PrEP access and uptake.

No abstract

The study was conducted in 2004 and repeated in 2011 to compare the contact-tracing success rate of the partner notification services routinely provided by the community-based youth health centres in Uppsala County, Sweden. Objective The study had two goals, (i) to compare the number of sexual partners routinely reported by each diagnosed index case with CT and the success rate in tracing and testing these partners for CT infection in 2004 and 2011 (ii) To compare the notification practises in reporting the number of cases of unsuccessful contact tracing to the CMO in 2004 and 2011. Successful contact-tracing is defined as the confirmed attendance of a sexual contact within 12 months of the contact with the index case. Results The number of CT cases diagnosed by the youth health centres during 2004 was 463 (299 females/164 males) and 529 (339/190) during 2011. The females reported 660 male sexual contacts 2004 and 861 in 2011 and the males reported 386 female contacts in 2004 and 494 in 2011. Successful partner notification was achieved for 73% of all sexual contacts in 2004 but only 64% in 2011. 164 (74 females and 90 males) unsuccessful partner notifications were reported to the CMO in 2004 and the corresponding numbers for 2011 were 288 (105 females and 183 males). Conclusions Between 2004 and 2011 there has been an increase in the mean number of sexual contacts among young adults in Uppsala County. Successful partner notification was significantly reduced. When asymptomatic, genital CT infection spreads among sexually active young adults with multiple, unidentified sexual partners, appropriate methods of partner notification are not sufficient to achieve its aims at the population level. Novel strategies are needed. BaSeline ReSultS of a CluSteR-RandomiSed tRial aSSeSSing the effeCtiveneSS of SPoRt-BaSed hiv PRevention in South afRiCan SChoolS