Gonorrhoea and chlamydia screening in HIV clinics: time for new tools and targets

Berry, Stephen

doi:10.1136/sextrans-2014-051700

Cited by 6 publications

(11 citation statements)

References 18 publications

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“…11 A more targeted approach, for example limiting screening to MSM <30 years-old, might be more appropriate if broad screening did not yield increased case detection. 18 The increase in case detection contrasts the findings of two previous studies (one of which occurred at one HIVRN site with that site’s 2004–2007 data included in the present study). 12,17 However, increased case detection with increased screening has been reported in a cohort in Washington State and in a US military cohort in the past decade.…”

Section: Discussioncontrasting

confidence: 99%

“…25 Unique barriers to NG/CT screening include time to obtain urine and mucosal swab samples, difficulty engaging in sexual history discussions, and the lack of Food and Drug Administration approval for rectal and oral site nucleic acid test kits. 18,26 Each of the 4 clinics in our sample undertook one or more systematic efforts to increase NG/CT screening during 2004–2014. Interventions included provider education, electronic health record reminders, clinic-wide performance reports, individual provider report cards, and coupling rectal NG/CT screening with rectal cancer screening.…”

Section: Discussionmentioning

confidence: 99%

“…12,17 The failure of increased testing to increase case detection leads to questions about the utility of the broad approach to screening all sexually active PLWH as compared to a more targeted approach. 12,18 In this study, we determined trends in NG/CT test positivity and case detection in the HIVRN during 2004–2014, to assess whether case detection increased with the known rise in testing over this time period. Based on known variation in testing rates and test positivity by sexual risk group, 12,14,19 we stratified analyses by men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women.…”

Section: Introductionmentioning

confidence: 99%

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Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Raifman

Gebo

Mathews

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives Annual screening for gonorrhea (NG) and chlamydia (CT) is recommended for all sexually-active persons living with HIV (PLWH) but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004–2014, a period of expanding testing. Methods We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women. Results Among 15,614 patients (50% MSM, 26% MSW, 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 (adjusted odds ratio [AOR] per year 1.22 [1.21, 1.22]). Despite the increase in testing, test positivity also increased (AOR per year 1.10 [1.07, 1.12]), and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 (AOR per year 1.20 [1.17, 1.22]). Case detection was highest among MSM but increased over time among all three groups. Conclusions NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among PLWH in order to decrease transmission and complications of NG/CT and of HIV.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Raifman

Gebo

Mathews

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…However, multiple studies have shown that relying on medical providers to conduct complete STI testing in HIV care settings at the recommended frequencies is likely not enough. 2,3 Innovative approaches to systematically incorporate STI testing in HIV care are needed. The STI self-testing program described here is one such option.…”

Section: Discussionmentioning

confidence: 99%

“…the pharynx and the rectum), remains low. 2,3 At 8 large urban HIV care clinics in the United States, between 2004 and 2006, only 2.3% - 8.5% of men were screened at the pharynx or rectum for gonorrhea and/or chlamydia. 2 The U.S. Centers for Disease Control and Prevention (CDC) recommends that all sexually active MSM undergo annual gonorrhea and chlamydia screening of all exposed anatomic sites, and have syphilis and HIV serologies.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research

Barbee

Tat

Dhanireddy

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Rates of screening for bacterial sexually transmitted infections (STI) among men who have sex with men in HIV care settings remain low despite high prevalence of these infections. STI self-testing may help increase screening rates in clinical settings. Methods We implemented an STI self-testing program at a large, urban HIV care clinic, and evaluated its effectiveness and acceptability. We compared measures obtained during the first year of the STI Self-testing Program (Intervention Year, April 1, 2013 – March 31, 2014) to Baseline Year (January 1, 2012 – December 31, 2012) to determine: 1) overall clinic change in STI testing coverage and diagnostic yield and; 2) program-specific outcomes including appropriate anatomic site screening, and patient-reported acceptability. Results Overall, testing for gonorrhea and chlamydia increased significantly between Baseline and Intervention year, and 50% more gonococcal and 47% more chlamydial infections were detected. Syphilis testing coverage remained unchanged. Nearly 95% of 350 men who participated in the STI Self-testing program completed site-specific testing appropriately based on self-reported exposures, and 92% rated their self-testing experience as “good” or “very good”. Conclusions STI Self-testing in HIV care settings significantly increases testing coverage and detection of gonorrhea and chlamydia, and the program is acceptable to patients. Additional interventions to increase syphilis screening rates are needed.

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Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care

Refugio

Klausner

2018

Expert Review of Anti-infective Therapy

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Syphilis continues to be a growing epidemic among men who have sex with men (MSM), particularly for those living with the human immunodeficiency virus (HIV). In 2016, MSM accounted for 80% of primary and secondary syphilis diagnoses in men in the United States; almost half of who were also HIV-infected. The synergistic relationship between HIV and syphilis has significant implications not only for HIV patient management, but also for sexually transmitted infection (STI) control among MSM. Areas covered: We review the literature on STI screening and treatment barriers at the patient-, provider-, and health system-levels, and present strategies to incorporate STI prevention into HIV care settings. Expert commentary: Integration of STI prevention into HIV care is paramount to stop the epidemic of not only syphilis, but also other curable STIs like gonorrhea and chlamydia. Although guidelines have been established for STI testing in HIV-infected MSM, screening rates continue to be lower than desired. Gonorrhea and chlamydia screening is below 50% in HIV-infected MSM; interventions that improve testing of those two infections must be implemented. For syphilis control, other additional strategies such as chemoprophylaxis should be considered given syphilis screening is above 50% in HIV-infected MSM.

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Gonorrhoea and chlamydia screening in HIV clinics: time for new tools and targets

Cited by 6 publications

References 18 publications

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Implementation and Operational Research

Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care

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