Transmitted Infection Testing Research Articles

Use of healthcare reimbursement data to monitor bacterial sexually transmitted infection testing in France, 2006 to 2020.

BackgroundDiagnoses of bacterial sexually transmitted infections (STIs) have increased in France since the 2000s. The main strategy to control STI transmission is recommending/facilitating access to condom use, testing, and antibiotic treatments.AimThis study analyses the evolution of STI testing in the private sector in France from 2006 to 2020.MethodsNational health insurance reimbursement data were used to determine numbers and rates of individuals aged ≥ 15 years tested for diagnoses of chlamydia, gonorrhoea and syphilis in the private sector in France and to describe their evolution from 2006 to 2020.ResultsUpward tendencies in testing were observed from 2006 to 2019 for all three STIs. The highest testing rates were identified in people aged 25‒29-years old. The observed testing-increase from 2017 to 2019 was twice as high in young people (< 25 years old) as in older people. In 2019, chlamydia, gonorrhoea and syphilis testing rates were respectively 45.4 (+ 21% since 2017), 41.3 (+ 60%), and 47.2 (+ 22%) per 1,000 inhabitants. For all STIs combined, the number of tested individuals decreased by 37% between March and April 2020 during the first COVID-19 epidemic wave and lockdown in France.ConclusionImprovements found in STI testing rates may have resulted from better awareness, especially among young people and health professionals, of the importance of testing, following prevention campaigns. Nevertheless, testing levels remain insufficient considering increasing diagnoses. In 2020, the COVID-19 pandemic had a considerable impact on STI testing. Partner notification and offering diverse testing opportunities including self-sampling are essential to control STI epidemics particularly in exposed populations.

Effectiveness of a behavioural intervention delivered by text messages (safetxt) on sexually transmitted reinfections in people aged 16-24 years: randomised controlled trial

ObjectiveTo quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years.DesignParallel...

Efficacy of MyPEEPS Mobile, an HIV Prevention Intervention Using Mobile Technology, on Reducing Sexual Risk Among Same-Sex Attracted Adolescent Males

HIV transmission rates in the United States have increased among men who have sex with men. However, there are no published randomized trials examining interventions to reduce sexual risk for HIV acquisition in males younger than 18 years. To determine the efficacy of MyPEEPS Mobile, a mobile-delivered HIV prevention intervention, to reduce sexual risk behavior in same-sex attracted young males. This was a national randomized clinical trial of the efficacy MyPEEPS Mobile vs a delayed intervention among males aged 13 to 18 years to prevent or reduce sexual risk for HIV acquisition. Study activities were completed through 4 study sites in Birmingham, Alabama; New York, New York; Seattle, Washington; and Chicago, Illinois. Study staff at each site met with participants in person or via video conferencing. Data were collected from June 1, 2018, to April 7, 2020, and analyzed from July to October 2021. The MyPEEPS Mobile intervention contains 21 online psychoeducational and skill-building modules, which participants completed over a 3-month period. Participants randomized to the intervention group received access to MyPEEPS Mobile for the first 3 months, while those randomized to the delayed intervention group received access at their 9-month visit after data for the primary efficacy analysis had been collected. The self-reported primary outcome was change in the number of condomless anal sex acts between study conditions. Secondary outcomes were change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing. In the analytic sample of 763 racially and ethnically diverse study participants, the mean (SD) age was 16.2 (1.4) years; 736 participants (97%) were male, 13 (2%) nonbinary; and 6 (1%) genderqueer; 158 (21%) were Black or African American, 311 (41%) were Hispanic or Latino, and 284 (37%) were White. Overall, 382 were randomized to the intervention group and 381 to the delayed intervention group. At 3-month follow-up, there was a significant reduction in the number of condomless anal sex acts in the intervention group compared with the delayed intervention group (incidence rate ratio [IRR], 0.56; 95% CI, 0.32-0.99); however, there was no significant difference between groups at 6 or 9 months. In subgroup analyses, the intervention effect was pronounced among Black non-Hispanic participants at 3-month follow-up (IRR, 0.19; 95% CI, 0.04-0.94) and 6-month follow-up (IRR, 0.15; 95% CI, 0.03-0.78) compared with the delayed intervention group. There were no significant differences in the change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing between the intervention and delayed intervention groups. In this study, the MyPEEPS Mobile intervention demonstrated a 44% overall reduction in condomless anal sex at 3-month follow-up compared with the delayed intervention group, but not at 6 or 9 months. To our knowledge, MyPEEPS Mobile is the first intervention to demonstrate evidence of short-term efficacy for reducing sexual risk among same-sex attracted young males. ClinicalTrials.gov Identifier: NCT03167606.

Associations of Transactional Sex and Sexually Transmitted Infections Among Treatment-Seeking Individuals With Opioid Use Disorder

Coinciding with the rise in opioid use across the U.S., the rates of sexually transmitted infections have reached historically high levels, underscoring the need to understand multiple pathways of disease spread. Although prevention is often focused on injection-related behaviors, this study sought to identify the prevalence and associations of a little understood pathway, transactional sex, among individuals with opioid use disorder, including associations of transactional sex with the prevalence of sexually transmitted infection diagnoses. Data were sourced from a nationwide opioid surveillance program of treatment-seeking individuals with opioid use disorder utilizing a serial, cross-sectional survey of 4,366 new entrants to 1 of 99 substance use treatment programs for opioid use disorder in 37 states from October 2018 to June 2021. A quarter of the sample (24.9%) self-reported a lifetime history of transactional sex for drugs, with rates highest for sexual (56.6%) and gender (53.8%) minority, female (33.4%), Latinx (30.4%), and Black (29.6%) subgroupings. Lifetime diagnoses of all specific sexually transmitted infections analyzed were significantly higher (p<0.001) among those reporting transactional sex, particularly syphilis (14.3% vs 4.4%) and HIV (4.0 vs 0.9%). Financial hardship, trauma, and psychiatric disorder were significantly associated with transactional sex engagement. Transactional sex is relatively common among patients with opioid use disorder, particularly among sexual/gender minorities, which was associated with a greater lifetime prevalence of all sexually transmitted infections assessed. Sexually transmitted infection testing remains at low levels within substance use treatment programs, occurring in just 26.3% of programs; sexual health screenings and sexually transmitted infection prevention/testing need to be prioritized and integrated into opioid use disorder patient care.

COVID-19 Pandemic Impact on Sexually Transmitted Infection Testing in a College Setting

Introduction: COVID-19 pandemic has had a great impact on health systems. Many non-urgent visits were done virtually to limit exposure risks. Objective: Assess the impact of the pandemic on STI (sexually transmitted infections) testing in a college health setting. Material and methods: Quantitative assessment of the number of STI tests done, positive rates and percentage of “compliance to follow-up” for diagnosed STI from March to December 2020 and its comparison with historical data (2015-2019) at the University Health Services, UW-Madison. Measurement: Observed (2020) vs expected (2015-2019) number of STI tests, positive rates and compliance to follow-up testing for STIs. Results: The 2020 period showed a significant decrease in the number of tests done and an increase of positive rate when compared to historical data for total sample and per sex. There was a decrease in the percentage of follow-up for the entire sample and for females and an increase for males. Conclusions: In accordance with national data, our analysis shows significant declines in STI testing and follow-up during 2020 compared to previous years and an increase in positivity rate. A higher positivity with lower number of tests is likely due to triaging patients, facilitating testing for those at highest risk.

Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic.

ObjectivesWe performed a retrospective study of chlamydia, gonorrhea, syphilis, and HIV testing in the Veterans Health Administration (VHA) during 2019-2021.MethodsWe determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019-2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of PrEP.ResultsThe VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV.Declines and subsequent improvements in STI testing occurred unequally across age, sex, race, and geographic groups. Testing for all four STIs in 2021 remained below baseline in rural Veterans. Excluding those <25, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021.ConclusionAfter dramatic reductions from 2019-2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, women, Asian American, Hawaiian/Pacific Islander, and Black Veterans.

Factors correlated with pre-exposure prophylaxis (PrEP) awareness and use among black adults in the United States: implications for improving HIV prevention

ABSTRACT HIV remains a significant public health concern for Black adults (BA) in the United States. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool prescribed to protect the health of HIV-uninfected individuals. Yet, low rates of PrEP awareness and utilization persist among BA. Less is understood about the pathways that may promote PrEP uptake. The present study explored factors associated with PrEP awareness and use among BA. Using a cross-sectional sample of 666 BA, we employed multivariable logistic regression models to examine the relationship between PrEP and several covariates. Most participants were unaware of PrEP (71%). Reporting history of incarceration and lifetime sexually transmitted infection testing [aOR 1.76 (1.19, 2.59), p < 0.05] had greater odds of PrEP awareness. Only 6% of respondents had ever taken PrEP. Reports of incarceration history [aOR 9.96 (2.82, 35.14), p < 0.05], concurrent sexual partners [aOR 1.09 (1.00, 1.18), p < 0.05], and substance use during sex [aOR 4.23 (1.02, 17.48), p < 0.05] had greater odds of PrEP use. Interventions aiming to improve PrEP uptake among BA must consider the individual, social, and structural contexts associated with its awareness and use. Enhanced efforts by healthcare providers and institutions may better facilitate access to PrEP for HIV prevention and control transmission.

Outcomes of systemic screening for syphilis, gonorrhoea and Chlamydia trachomatis among immigrant visa applicants migrating from Japan to the US in 2016-2019.

Identifying sexually transmitted infections is a public health task. Screening at the time of migration detected asymptomatic infections over a range of ages. Reporting infection rates may serve to establish a benchmark for risk assessments. All sexually active people who have never had sexually transmitted infection tests should be offered sexually transmitted infection tests.

Sexually Transmitted Infection Testing Among Unstably Housed, Sexually Active Persons With Human Immunodeficiency Virus in the United States, 2018-2019.

Unstably housed sexually active people with human immunodeficiency virus experience both a high incidence of sexually transmitted infections (STI) and barriers to annual STI screening recommended by Centers for Disease Control and Prevention guidelines. We used Medical Monitoring Project data to describe STI testing among unstably housed people with human immunodeficiency virus by attendance at Ryan White HIV/AIDS Program-funded facilities.

Factors Associated With New Sexual Partnerships During the COVID-19 Pandemic: A Survey of Online Sexually Transmitted Infection Testing Platform Users.

The COVID-19 pandemic has coincided with an explosion of online platforms for sexually transmitted infections (STIs) testing using self-collected, mail-in specimens. Reports on the effect of COVID-19-associated restrictions on sexual behaviors have been mixed, but STI transmissions have continued during the pandemic. We sought to understand the pandemic impact on sexual habits associated with STIs among IWantTheKit users. Users of IWantTheKit, a free, online STI testing platform, were invited to complete an anonymous questionnaire. Descriptive statistics were used to describe survey responses. Associations with reports of new sex partnerships were explored as a marker of STI risk. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze individual characteristics and reported behaviors associated with self-reported new sexual partnerships during the first 2 COVID-19 pandemic waves. Of the 3462 users of the online STI testing platform between June 2020 and February 2021, 1088 (31.4%) completed the online survey; 705 (66.2%) of 1065 reported a new sex partner. One-quarter met their sex partners using apps. Overall, 10% were symptomatic and almost 18% were concerned that their partner had an STI. White race in men (odds ratio, 1.81; 95% confidence interval, 1.04-3.16), women younger than 25 years (odds ratio, 1.85; 95% confidence interval, 1.09-3.14), and increased condom use in both men and women were significantly associated with reports of new sexual partnerships in adjusted analysis. Despite pandemic restrictions on social gatherings, new sexual partnerships were common in this population, associated with common risk factors, and may help to explain ongoing STI transmission.

Food insecurity as a social determinant of sexual health and substance use independent of poverty status among men who have sex with men in the United States

PurposeTo characterize the prevalence of food insecurity among men who have sex with men (MSM) and assess its associations with sexual health measures and substance use, as compared to poverty status. MethodsIn 2017, 10,049 US MSM were recruited online and completed the American Men's Internet Survey. The survey assessed food insecurity, annual household income and past-year behaviors: condomless anal intercourse, exchange sex, any illicit substance use other than marijuana, use of methamphetamine, alkyl nitrites or gamma-hydroxybutyrate (GHB), HIV testing, and sexually transmitted infection testing and diagnosis. We tested associations between behavioral outcomes and food insecurity or poverty, controlling for demographic characteristics. ResultsThe prevalence of food insecurity among AMIS participants was 15.8%. Food insecurity nonresponse was 2.5% while income nonresponse was 19.0%. Food insecurity was significantly and positively associated with all behavioral outcomes, while poverty was significantly and positively associated only with exchange sex, any illicit substance use, methamphetamine, and GHB use. In models that included both food insecurity and poverty as exposures, food insecurity remained independently positively associated with all behavioral outcomes and the associations for poverty level were null for all outcomes except methamphetamine and GHB use. ConclusionsAssessing food insecurity in sexual health and substance use survey research may provide a more robust indicator of economic deprivation and provide insight for HIV and STI prevention interventions.

HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial.

BackgroundGay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education.ObjectiveWe explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan.MethodsWe analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors.ResultsOur findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs.ConclusionsThis study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines.Trial RegistrationClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9414

Providers Assessing Child Abuse and Neglect

Providers Assessing Child Abuse and Neglect

Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic-based data.

IntroductionThe COVID‐19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource‐limited settings. We aimed to understand the pandemic's impact on HIV‐related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India.MethodsBeginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18‐month period covering 2 months preceding the pandemic (January–February 2020) and over the first and second COVID‐19 waves in India (March 2020–June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June–August 2020).ResultsOverall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre‐pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre‐pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre‐pandemic levels. Positivity then increased steadily, eventually becoming higher than pre‐pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing.ConclusionsThe COVID‐19 pandemic led to significant decreases in HIV‐related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.

Sexually Transmitted Infection Testing, Prevalence, and Treatment Among Individuals Receiving HIV Preexposure Prophylaxis Within an Integrated Healthcare Delivery System.

Initial and follow-up sexually transmitted infection (STI) and human immunodeficiency virus (HIV) testing are recommended when taking HIV preexposure prophylaxis (PrEP). We assessed STI services before and after PrEP initiation among persons 18 years or older. We conducted this retrospective cohort study at a US integrated healthcare delivery system. We measured HIV/STI testing rates, STI prevalence and treatment at 3 time points: (1) at PrEP initiation, (2) at 120 days, and (3) at 210 days. Of 685 PrEP initiators, 67.2% continued PrEP use at 120 days and 49.5% at 210 days. Of PrEP users, HIV and STI testing were greater than 85% and greater than 80%, respectively, at all 3 time points. Prevalence for any chlamydia, rectal chlamydia, and any gonorrhea, rectal gonorrhea, or pharyngeal gonorrhea was always high at the 120 days and 210 days (eg, 6.9%, 10.5%, 6.7%, 5.0%, and 5.2%, respectively, at the 120 days for continuous PrEP users). Over 90% of all individuals who tested positive for chlamydia and gonorrhea received antibiotic pharmacy fills within 7 days at 120 and 210 days. Monthly PrEP-related pharmacy cost was about $2259 to $2659. The proportion of the total medical cost that was PrEP-related pharmacy was about 82% for PrEP continuous users. Although HIV/STI testing rates were high, they can still be improved during HIV PrEP management. High STI prevalence after PrEP initiation in this study suggests that patients taking PrEP are at risk of acquiring an STI. Interventions to improve STI services during PrEP management are continuously needed.

Exploring the Use of “Nudges” to Improve HIV and Other Sexually Transmitted Infection Testing Among Men Who Have Sex with Men

Behavioral economics and its applied branch “nudging” can improve individual choices in various health care settings. However, there is a paucity of research using nudges to improve regular testing for HIV and other sexually transmitted infections (STIs). The study examined which reminder system and message type men who have sex with men (MSM) preferred to remind them to undergo regular 3-monthly HIV and STI testing. A cross-sectional survey study was conducted among MSM attending a sexual health clinic in Melbourne, Australia between 13 January and 5 March 2020, exploring the preferred method of reminder and framing of the message. Descriptive statistics and logistic regression were used to analyze the data. A total of 309 responses were received. The majority of the participants (90%) preferred short messaging service (SMS) as the reminder method for HIV/STI testing compared to other types (e.g., email or instant messaging). More than a third of the participants (45%) showed a preference for a neutrally framed reminder message (Your next check-up is now due. Please phone for an appointment), while one-third (35%) preferred a personalized message (Hi [first name], you are due for your next check-up. Please phone for an appointment). Younger men were more likely to favor positive framed messages than older men who favored neutrally framed messages (p < .01). SMS was the preferred reminder method for regular HIV/STI testing. Reminder messages that were neutrally framed, personalized or positive framed messages were preferred over negative or social norm messages.

Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis

BackgroundAdolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons.ObjectiveWe examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services.MethodsThe intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model.ResultsOf the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size.ConclusionsGiven low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services.

Development of a Psychometric Tool to Measure Community Solidarity Among Sexual Minorities: Evidence From a Pay-it-Forward Randomized Controlled Trial.

Community solidarity is increasingly important in public health. However, few studies have examined solidarity in relation to health outcomes. The purpose of this study was to develop a psychometric tool to measure solidarity among Chinese men who have sex with men (MSM) and assess whether community solidarity relates to differences in sexually transmitted infection testing. We used data from the pay-it-forward randomized controlled trial of 301 men from Beijing and Guangzhou, China. Men who have sex with men were randomized into pay-it-forward (participants receive free gonorrhea/chlamydia testing as gifts and choose to donate toward subsequent MSM's tests), pay-what you-want, and standard payment arms. After testing decision, participants completed a cross-sectional questionnaire to assess community solidarity. Factor analysis was conducted to identify dimensions of solidarity. The solidarity factors were compared across study arms and assessed against gonorrhea/chlamydia test uptake in multivariable logistic regression. Two hundred eighty-eight participants responded to the survey. We identified 3 latent community solidarity factors: engagement, social network support, and sense of belonging. Several items related to belonging were significantly greater among participants in the pay-it-forward scenario compared with those assigned to other scenarios. Higher sense of belonging was associated with higher odds of gonorrhea and chlamydia test uptake. Community solidarity among MSM in China can be characterized by 3 factors: engagement, social network support, and sense of belonging. Sense of belonging was higher in the pay-it-forward intervention arm and may be associated with the uptake of gonorrhea/chlamydia test. Future studies are warranted to confirm the psychometric structure of community solidarity and further investigate behavioral mechanisms of pay it forward.

HIV, syphilis, hepatitis B and C in key populations: results of a 10-year cross-sectional study, Southern Brazil.

ABSTRACTObjective:Although the development of prevention and treatment strategies for sexually transmitted infections in key groups has improved over the years, they still remain a challenge for health systems worldwide. In this context, the objective of this study is to assess the seroprevalence in the tested population, with an emphasis on key populations, aiming at identifying the participants’ profile and consequently the development of testing strategies.Methods:The present study analyzed the seroprevalence of HIV, syphilis, and hepatitis B and C, and the epidemiological profiles of key and general populations tested at a reference public health facility for sexually transmitted infections testing and counseling in the city of Curitiba, Southern Brazil. A cross-sectional study was conducted to report data from 2010 to 2019.Results:A total of 9,086 samples were positive across all samples tested, and yielded 3,633 (5%) for HIV, 4,978 (10%) for syphilis, 340 (1%) for hepatitis C virus (HCV), and 135 (<1%) for hepatitis B virus (HBV). Overall, most of the participants were men (79 to 87%), and predominantly white. For HIV and syphilis, the predominant age groups were 21-30 years old (48 and 50%), HBV 21-40 years old (31%), and HCV 41-60 years old (25%). A high seroprevalence of HIV and syphilis was observed in the investigated key populations with a higher frequency in sex workers, men who have sex with men, and transgender.Conclusion:The progressive increase in syphilis cases emphasizes the need for effective interventions to enhance adherence to the use of condoms, and to expand diagnosis and treatment for these key populations.

Factors associated with adherence to HIV testing guidelines among HIV-negative female sex workers in Kampala, Uganda

Frequent human immunodeficiency virus (HIV) testing is recommended among female sex workers. This study examined the extent to which HIV-negative female sex workers (FSWs) in Kampala adhere to the HIV testing guidelines, and identified associated factors. This cross-sectional study used a simple random sampling method to select 12 sex work hotspots. Two hundred participants were allocated proportionally in each hotspot. Frequencies were used to describe categorical characteristics of FSWs, and a multivariable logistic regression model was used to determine the factors associated with adherence to the HIV testing guidelines. Eighty-eight percent of the 200 study participants reported their HIV testing status; of these, 56% had tested three or more times in the 12 months preceding the survey. Attaining a secondary education was associated with adherence to the HIV testing guidelines [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.01-3.44; P=0.047]. Sexually transmitted infection testing in the preceding 3 months (OR 2.13, 95% CI 0.95-4.74; P=0.065) and accessing HIV testing at a drop-in centre (OR 5.90, 95% CI 0.71-49.1; P=0.101) were associated with higher odds of adherence to the HIV testing guidelines. Adherence to the HIV testing guidelines was suboptimal, indicating the need to scale up interventions to improve access to HIV testing, including rigorous behaviour change communication.