Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Ham DC [original query] |
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Candida auris in US correctional facilities
Hennessee I , Forsberg K , Erskine J , Charles A , Russell B , Reyes J , Emery C , Valencia N , Sherman A , Mehr J , Gallion H , Halleck B , Cox C , Bryant M , Nichols D , Medrzycki M , Ham DC , Hagan LM , Lyman M . Emerg Infect Dis 2024 30 (13) S36-s40 Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments. |
Extensively drug-resistant pseudomonas aeruginosa outbreak associated with artificial tears
Grossman MK , Rankin DA , Maloney M , Stanton RA , Gable P , Stevens VA , Ewing T , Saunders K , Kogut S , Nazarian E , Bhaurla S , Mephors J , Mongillo J , Stonehocker S , Prignano J , Valencia N , Charles A , McNamara K , Fritsch WA , Ruelle S , Plucinski CA , Sosa L , Ostrowsky B , Ham DC , Walters MS . Clin Infect Dis 2024 BACKGROUND: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. METHODS: Cases were defined as a U.S. patient's first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022-May 15, 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. RESULTS: We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to controls (crude matched OR: 5.0, 95% CI: 1.1, 22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. FDA inspection of the manufacturing plant identified likely sources of contamination. CONCLUSIONS: A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers. |
Reply to Diekema et al. "Are contact precautions "essential" for the prevention of healthcare-associated methicillin-resistant Staphylococcus aureus?"
Popovich KJ , Aureden K , Ham DC , Harris AD , Hessels AJ , Huang SS , Maragakis LL , Milstone AM , Moody J , Yokoe D , Calfee DP . Clin Infect Dis 2023 As the authors of the 2022 update of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology practice recommendations for prevention of methicillin-resistant Staphylococcus aureus (MRSA) infection and transmission in acute care hospitals [1], we would like to respond to the recently published Viewpoints article by Diekema and colleagues [2]. The purpose of this letter is to highlight that there is more agreement than disagreement between the recently published practice recommendations and what Diekema et al proposed as an alternative. For decades, the infection prevention community has debated the use of contact precautions for MRSA prevention. We agree that studies of contact precautions for MRSA prevention have come to conflicting conclusions and do not provide a definitive answer that applies to all settings. Current data suggest that contact precautions are an important component of a MRSA control program in many but not all hospitals. In some hospitals, a low prevalence of MRSA and/or successful implementation of other control strategies has reduced the incremental benefit of contact precautions to the point that the potential benefits may be outweighed by other considerations and priorities. |
Cluster of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa among patients in an adult intensive care unit - Idaho, 2021-2022
Cahill ME , Jaworski M , Harcy V , Young E , Ham DC , Gable P , Carter KK . MMWR Morb Mortal Wkly Rep 2023 72 (31) 844-846 Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (bla(IMP-84)) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with bla(IMP-84) was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenem-resistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting. |
SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update
Popovich KJ , Aureden K , Ham DC , Harris AD , Hessels AJ , Huang SS , Maragakis LL , Milstone AM , Moody J , Yokoe D , Calfee DP . Infect Control Hosp Epidemiol 2023 44 (7) 1-29 Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.(1) This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. |
Vital Signs: Health disparities in hemodialysis-associated staphylococcus aureus bloodstream infections - United States, 2017-2020
Rha B , See I , Dunham L , Kutty PK , Moccia L , Apata IW , Ahern J , Jung S , Li R , Nadle J , Petit S , Ray SM , Harrison LH , Bernu C , Lynfield R , Dumyati G , Tracy M , Schaffner W , Ham DC , Magill SS , O'Leary EN , Bell J , Srinivasan A , McDonald LC , Edwards JR , Novosad S . MMWR Morb Mortal Wkly Rep 2023 72 (6) 153-159 INTRODUCTION: Racial and ethnic minorities are disproportionately affected by end-stage kidney disease (ESKD). ESKD patients on dialysis are at increased risk for Staphylococcus aureus bloodstream infections, but racial, ethnic, and socioeconomic disparities associated with this outcome are not well described. METHODS: Surveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017-2020 Emerging Infections Program (EIP) were used to describe bloodstream infections among patients on hemodialysis (hemodialysis patients) and were linked to population-based data sources (CDC/Agency for Toxic Substances and Disease Registry [ATSDR] Social Vulnerability Index [SVI], United States Renal Data System [USRDS], and U.S. Census Bureau) to examine associations with race, ethnicity, and social determinants of health. RESULTS: In 2020, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN; 34.2% were attributable to S. aureus. Among seven EIP sites, the S. aureus bloodstream infection rate during 2017-2020 was 100 times higher among hemodialysis patients (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years). Unadjusted S. aureus bloodstream infection rates were highest among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) hemodialysis patients. Vascular access via central venous catheter was strongly associated with S. aureus bloodstream infections (NHSN: adjusted rate ratio [aRR] = 6.2; 95% CI = 5.7-6.7 versus fistula; EIP: aRR = 4.3; 95% CI = 3.9-4.8 versus fistula or graft). Adjusting for EIP site of residence, sex, and vascular access type, S. aureus bloodstream infection risk in EIP was highest in Hispanic patients (aRR = 1.4; 95% CI = 1.2-1.7 versus non-Hispanic White [White] patients), and patients aged 18-49 years (aRR = 1.7; 95% CI = 1.5-1.9 versus patients aged ≥65 years). Areas with higher poverty levels, crowding, and lower education levels accounted for disproportionately higher proportions of hemodialysis-associated S. aureus bloodstream infections. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Disparities exist in hemodialysis-associated S. aureus infections. Health care providers and public health professionals should prioritize prevention and optimized treatment of ESKD, identify and address barriers to lower-risk vascular access placement, and implement established best practices to prevent bloodstream infections. |
Trimethoprim-sulfamethoxazole resistance patterns among Staphylococcus aureus in the United States, 2012-2018
Ham DC , Fike L , Wolford H , Lastinger L , Soe M , Baggs J , Walters MS . Infect Control Hosp Epidemiol 2022 44 (5) 1-4 We reviewed trimethoprim-sulfamethoxazole antibiotic susceptibility testing data among Staphylococcus aureus using 3 national inpatient databases. In all 3 databases, we observed an increases in the percentage of methicillin-resistant Staphylococcus aureus that were not susceptible to trimethoprim-sulfamethoxazole. Providers should select antibiotic regimens based on local resistance patterns and should report changes to the public health department. |
Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018-2019.
Kracalik I , Ham DC , McAllister G , Smith AR , Vowles M , Kauber K , Zambrano M , Rodriguez G , Garner K , Chorbi K , Cassidy PM , McBee S , Stoney RJ , Moser K , Villarino ME , Zazueta OE , Bhatnagar A , Sula E , Stanton RA , Brown AC , Halpin AL , Epstein L , Walters MS . Emerg Infect Dis 2022 28 (1) 51-61 Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States. |
Gram-negative bacteria harboring multiple carbapenemase genes, United States, 2012-2019
Ham DC , Mahon G , Bhaurla SK , Horwich-Scholefield S , Klein L , Dotson N , Rasheed JK , McAllister G , Stanton RA , Karlsson M , Lonsway D , Huang JY , Brown AC , Walters MS . Emerg Infect Dis 2021 27 (9) 2475-2479 Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012-April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation. |
A Comprehensive Approach to Ending an Outbreak of Rare bla OXA-72 gene-positive Carbapenem-resistant Acinetobacter baumannii at a Community Hospital, Kansas City, MO, 2018
McKinsey DS , Gasser C , McKinsey JP , Ditto G , Agard A , Zellmer B , Poteete C , Vagnone PS , Dale JL , Bos J , Hahn R , Turabelidze G , Poiry M , Franklin P , Vlachos N , McAllister GA , Halpin AL , Glowicz J , Ham DC , Epstein L . Am J Infect Control 2021 49 (9) 1183-1185 We identified a cluster of extensively drug-resistant, carbapenemase gene-positive, carbapenem-resistant Acinetobacter baumannii (CP-CRAB) at a teaching hospital in Kansas City. Extensively drug-resistant CRAB was identified from eight patients and 3% of environmental cultures. We used patient cohorting and targeted environmental disinfection to stop transmission. After implementation of these measures, no additional cases were identified. |
Investigation of hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections at eight high burden acute care facilities in the United States, 2016
Ham DC , See I , Novosad S , Crist M , Mahon G , Fike L , Spicer K , Talley P , Flinchum A , Kainer M , Kallen AJ , Walters MS . J Hosp Infect 2020 BACKGROUND: Despite large reductions from 2005-2012, hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections (HO MRSA BSIs) continue be a major source of morbidity and mortality. AIM: To describe risk factors for and underlying sources of HO MRSA BSIs. METHODS: We investigated HO MRSA BSIs at eight high-burden short-stay acute care hospitals. A case was defined as first isolation of MRSA from a blood specimen collected in 2016 on hospital day >/=4 from a patient without an MRSA-positive blood culture in the 14 days prior. We reviewed case-patient demographics and risk factors by medical record abstraction. The potential clinical source(s) of infection were determined by consensus by a clinician panel. FINDINGS: Of the 195 eligible cases, 186 were investigated. Case-patients were predominantly male (63%); median age was 57 years (range 0-92). In the two weeks prior to the BSI, 88% of case-patients had indwelling devices, 31% underwent a surgical procedure, and 18% underwent dialysis. The most common locations of attribution were intensive care units (ICUs) (46%) and step-down units (19%). The most commonly identified non-mutually exclusive clinical sources were CVCs (46%), non-surgical wounds (17%), surgical site infections (16%), non-ventilator healthcare-associated pneumonia (13%), and ventilator-associated pneumonia (11%). CONCLUSIONS: Device-and procedure-related infections were common sources of HO MRSA BSIs. Prevention strategies focused on improving adherence to existing prevention bundles for device-and procedure-associated infections and on source control for ICU patients, patients with certain indwelling devices, and patients undergoing certain high-risk surgeries are being pursued to decrease HO MRSA BSI burden at these facilities. |
Public health importance of invasive methicillin-sensitive Staphylococcus aureus infections: Surveillance in 8 US counties, 2016
Jackson KA , Gokhale RH , Nadle J , Ray SM , Dumyati G , Schaffner W , Ham DC , Magill SS , Lynfield R , See I . Clin Infect Dis 2019 70 (6) 1021-1028 BACKGROUND: Public health and infection control prevention and surveillance efforts in the United States have primarily focused on methicillin-resistant Staphylococcus aureus (MRSA). We describe the public health importance of methicillin-susceptible S. aureus (MSSA) in selected communities. METHODS: We analyzed Emerging Infections Program surveillance data for invasive S. aureus (SA) infections (isolated from a normally sterile body site) in 8 counties in 5 states during 2016. Cases were considered healthcare-associated if culture was obtained >3 days after hospital admission; if associated with dialysis, hospitalization, surgery, or long-term care facility (LTCF) residence within 1 year prior; or if a central venous catheter was present </=2 days prior. Incidence per 100 000 census population was calculated, and a multivariate logistic regression model with random intercepts was used to compare MSSA risk factors with those of MRSA. RESULTS: Invasive MSSA incidence (31.3/100 000) was 1.8 times higher than MRSA (17.5/100 000). Persons with MSSA were more likely than those with MRSA to have no underlying medical conditions (adjusted odds ratio [aOR], 2.06; 95% confidence interval [CI], 1.26-3.39) and less likely to have prior hospitalization (aOR, 0.70; 95% CI, 0.60-0.82) or LTCF residence (aOR, 0.37; 95% CI, 0.29-0.47). MSSA accounted for 59.7% of healthcare-associated cases and 60.1% of deaths. CONCLUSIONS: Although MRSA tended to be more closely associated with healthcare exposures, invasive MSSA is a substantial public health problem in the areas studied. Public health and infection control prevention efforts should consider MSSA prevention in addition to MRSA. |
Evaluation of a rapid syphilis test in an emergency department setting in Detroit, Michigan
Fakile YF , Markowitz N , Zhu W , Mumby K , Dankerlui D , McCormick JK , Ham DC , Hopkins A , Manteuffel J , Sun Y , Huang YA , Peters PJ , Hoover KW . Sex Transm Dis 2019 46 (7) 429-433 BACKGROUND: Syphilis transmission can be prevented by prompt diagnosis and treatment of primary and secondary infection. We evaluated the performance of a point-of-care rapid syphilis treponemal test (RST) in an emergency department (ED) setting. METHODS: Between June 2015 and April 2016, men aged 18-34 years seeking services in a Detroit ED, and with no history of syphilis, were screened for syphilis with the RST, rapid plasma reagin (RPR) test, and Treponema pallidum particle agglutination assay (TP-PA). A positive reference standard was both a reactive RPR and a reactive TP-PA. We compared test results in self-reported MSM to non-MSM. RESULTS: Among 965 participants, 10.9% of RSTs were reactive in MSM and only 1.5% in non-MSM (p<0.001). Sensitivity of the RST was 76.9% and specificity was 99.0% (PPV 50.0%) compared to the positive reference standard. Three discordant specimens found negative with the RST but positive with the reference standard had an RPR titer of 1:1, compared with 10 specimens with concordant positive results that had a median RPR titer of 1:16. The RST sensitivity was 50.0% (PPV 68.4%) compared to the TP-PA test alone. Among men seeking care in an ED, the RST detected 76.9% of participants with a reactive RPR and TP-PA. CONCLUSIONS: The RST detected all of the participants with an RPR titer > 1:2 but less than 20% of participants with a positive TP-PA and negative RPR. The RST was useful to detect a high proportion of participants with an active syphilis in an urban ED.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
Notes from the field: Investigation of carbapenemase-producing carbapenem-resistant Enterobacteriaceae among patients at a community hospital - Kentucky, 2016
Chae SR , Yaffee AQ , Weng MK , Ham DC , Daniels K , Wilburn AB , Porter KA , Flinchum AH , Boyd S , Shams A , Walters MS , Kallen A . MMWR Morb Mortal Wkly Rep 2018 66 (5152) 1410 Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) express plasmid-encoded carbapenemases, enzymes that inactivate carbapenem antibiotics. They have the potential for epidemic spread through person-to-person transmission and horizontal transfer of resistance mechanisms (1,2). Typically, CP-CRE are associated with health care exposure. Clinical CRE infections can have mortality rates as high as 50% (3); however, the majority of CRE patients are asymptomatic. These asymptomatic colonized patients can serve as a source for transmission to other patients (4). |
HIV testing at visits to physicians' offices in the U.S., 2009-2012
Ham DC , Lecher S , Gvetadze R , Huang YA , Peters P , Hoover KW . Am J Prev Med 2017 53 (5) 634-645 INTRODUCTION: HIV testing serves as an entry point for HIV care services for those who test HIV positive, and prevention services for those who test HIV negative. The Centers for Disease Control and Prevention recommends routine testing of adults and adolescents in healthcare settings. To identify missed opportunities for HIV testing at U.S. physicians' offices, data from the National Ambulatory Care Surveys from 2009 to 2012 were analyzed. METHODS: The mean annual number and percentage of visits with an HIV test among HIV-uninfected nonpregnant females and males aged 15-65 years was estimated using weighted survey data. Factors associated with HIV testing at visits to physicians' offices were identified. RESULTS: The mean annual number of U.S. physicians' office visits with an HIV test conducted was 1,396,736 (0.4% of all visits) among nonpregnant females and 986,891 (0.5% of all visits) among males. For both nonpregnant females and males, HIV testing prevalence was highest among those aged 20-29 years (1.3% of all visits by nonpregnant females; 1.7% of all visits by males) and non-Hispanic blacks (1.1% of all visits by nonpregnant females; 1.0% of all visits by males). An HIV test was not conducted at 98.5% of visits at which venipuncture was performed for both nonpregnant females and males. CONCLUSIONS: Important opportunities exist to increase HIV testing coverage at U.S. physicians' offices. Structural interventions, such as routine opt-out testing policies, electronic medical record notifications, and use of non-clinical staff for testing could be implemented to increase HIV testing in these settings. |
Syphilis testing practices in the Americas
Trinh TT , Kamb ML , Luu M , Ham DC , Perez F . Trop Med Int Health 2017 22 (9) 1196-1203 OBJECTIVE: To present the findings of the Pan American Health Organization's 2014 survey on syphilis testing policies and practices in the Americas. METHODS: Representatives of national/regional reference and large, lower-level laboratories from 35 member-states were invited to participate. A semi-structured, electronically administered questionnaire collected data on syphilis tests, algorithms, equipment/commodities, challenges faced, and basic quality assurance (QA) strategies employed (i.e., daily controls, standard operating procedures, technician training, participating in external QA programs, on-site evaluations). RESULTS: The 69 participating laboratories from 30 (86%) member-states included 41 (59%) national/regio-nal reference and 28 (41%) lower-level laboratories. Common syphilis tests conducted were the rapid plasma reagin (RPR) (62% of surveyed laboratories), Venereal Disease Research Laboratory (VDRL) (54%), Fluorescent Treponemal Antibody Absorption (FTA-Abs) (41%) and Treponemal pallidum Hemagglutination Assay (TP-HA) (32%). Only three facilities reported using direct detection methods, and 28 (41% overall, 32% of lower-level facilities) used rapid tests. Most laboratories (62%) used only traditional testing algorithms (non-treponemal screening and treponemal confirmatory testing); however, 12% used only a reverse sequence algorithm (treponemal test first), and 14% employed both algorithms. Another 9 (12%) laboratories conducted only one type of serologic test. Although most reference (97%) and lower-level (89%) laboratories used at least one QA strategy, only 16% reported using all five basic strategies. Commonly reported challenges were stock-outs of essential reagents or commodities (46%), limited staff training (73%), and insufficient equipment (39%). CONCLUSIONS: Many reference and clinical laboratories in the Americas face challenges in conducting appropriate syphilis testing and in ensuring quality of testing. This article is protected by copyright. All rights reserved. |
Health care use and HIV testing of males aged 15-39 years in physicians' offices - United States, 2009-2012
Ham DC , Huang YL , Gvetadze R , Peters PJ , Hoover KW . MMWR Morb Mortal Wkly Rep 2016 65 (24) 619-22 In 2014, 81% of new human immunodeficiency virus (HIV) infection diagnoses in the United States were in males, with the highest number of cases among those aged 20-29 years. Racial and ethnic minorities continue to be disproportionately affected by HIV; there are 13 new diagnoses each year per 100,000 white males, 94 per 100,000 black males, and 42 per 100,000 Hispanic males. Despite the recommendation by CDC for HIV testing of adults and adolescents, in 2014, only 36% of U.S. males aged ≥18 years reported ever having an HIV test, and in 2012, an estimated 15% of males living with HIV had undiagnosed HIV infection. To identify opportunities for HIV diagnosis in young males, CDC analyzed data from the 2009-2012 National Ambulatory Medical Care Survey (NAMCS) and U.S. Census data to estimate rates of health care use at U.S. physicians' offices and HIV testing at these encounters. During 2009-2012, white males visited physicians' offices more often (average annual rate of 1.6 visits per person) than black males (0.9 visits per person) and Hispanic males (0.8 visits per person). Overall, an HIV test was performed at 1.0% of visits made by young males to physicians' offices, with higher testing rates among black males (2.7%) and Hispanic males (1.4%), compared with white males (0.7%). Although higher proportions of black and Hispanic males received HIV testing at health care visits compared with white males, this benefit is likely attenuated by a lower rate of health care visits. Interventions to routinize HIV testing at U.S physicians' offices could be implemented to improve HIV testing coverage. |
Human immunodeficiency virus prevention with preexposure prophylaxis in sexually transmitted disease clinics
Hoover KW , Ham DC , Peters PJ , Smith DK , Bernstein KT . Sex Transm Dis 2016 43 (5) 277-82 Preexposure prophylaxis (PrEP) is an human immunodeficiency virus (HIV) prevention intervention that has been available since the Food and Drug Administration approved the antiretroviral (ARV) medication Truvada for a prevention indication in July 2012, and since the Centers for Disease Control and Prevention (CDC) issued clinical practice guidelines for its use to reduce the risk of acquiring HIV infection for persons at substantial risk in May 2014.1 Clinical trials, demonstration projects, and implementation studies have demonstrated its effectiveness in reducing the risk of HIV acquisition.2–9 Although PrEP has been available for several years, its uptake in the United States has been low but increasing.10,11 Because sexually transmitted diseases (STDs) have been found to be associated with HIV acquisition, they serve as objective markers of HIV risk and can identify STD patients who might benefit from PrEP.12–16 In this article, we aim to increase PrEP awareness among STD health care providers, a group of clinicians who provide prevention services for many persons at substantial risk of HIV acquisition, and we describe models for implementing PrEP in the STD clinic setting. | Human immunodeficiency virus prevention efforts, including ARV treatment as prevention and condom promotion, over the past several years have resulted in the incidence of HIV infection remaining stable or decreasing in many US subpopulations.17 Despite these prevention efforts, incidence continues to increase among men who have sex with men (MSM), with the steepest increases among young black MSM.17 Although HIV diagnosis rates decreased among women from 2010 through 2014, 19% of new diagnoses in 2014 were in women, and black women accounted for 62% of these diagnoses.18 Because of high rates of continuing transmission in some populations, it is especially important to target persons in these key populations, such as young MSM and females with high-risk sexual behaviors, for HIV testing with linkage to HIV prevention and care services. Existing disparities in the incidence of HIV infections might worsen if access and utilization of prevention services, such as PrEP, are not targeted for the most-at-risk populations, especially young black MSM.19 |
Strengthening sexually transmitted disease services in Detroit, Michigan: A call to action
Ham DC , Lentine D , Hoover KW , Boazman-Holmes V , Whiting D , Sobel J , Miller C , Cohn J , Krzanowski K . Sex Transm Dis 2016 43 (1) 65-66 Sexually transmitted diseases (STDs) remain a significant cause of morbidity in the United States. In 2013, 1.4 million cases of chlamydia were reported to the Centers for Disease Control and Prevention (CDC), making it the most commonly reported notifiable disease in the United States.1 With such high case numbers, it is unreasonable to expect state and locally funded STD clinics to care for all patients with STDs. However, dedicated STD clinics often serve as a safety net for uninsured or underinsured individuals and provide higher-quality STD services than general medical/primary care clinics.2 Sexually transmitted disease clinics often provide additional services for free or with sliding scale fees, such as walk in or express visits, onsite diagnostics, and partner services, where clinic staff offer testing and treatment to the partner(s) of the patient.3 Sexually transmitted disease clinics are seen as an important place to receive confidential services.3 Recently, this service model has faced numerous challenges with local STD clinics experiencing budget cutbacks or closing.4 Furthermore, the landscape of healthcare provision in the United States is changing as a result of legislation and is causing a shift in the places where individuals seek care and who pays for it. Large municipalities with significant disease burden have been challenged to find the right balance between state and locally funded STD clinics and other models of STD service provision. Because of budget constraints, high disease burden, and a syphilis outbreak, perhaps nowhere has this struggle been more pronounced than in Detroit, Michigan. |
Quality of sexually transmitted infection case management services in Gauteng Province, South Africa: An evaluation of health providers' knowledge, attitudes, and practices
Ham DC , Hariri S , Kamb M , Mark J , Ilunga R , Forhan S , Likibi M , Lewis DA . Sex Transm Dis 2016 43 (1) 23-29 BACKGROUND: The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. METHODS: From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. RESULTS: Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management. CONCLUSIONS: Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province. |
Improving global estimates of syphilis in pregnancy by diagnostic test type: a systematic review and meta-analysis
Ham DC , Lin C , Newman L , Wijesooriya NS , Kamb M . Int J Gynaecol Obstet 2015 130 Suppl 1 S10-4 BACKGROUND: "Probable active syphilis," is defined as seroreactivity in both non-treponemal and treponemal tests. A correction factor of 65%, namely the proportion of pregnant women reactive in one syphilis test type that were likely reactive in the second, was applied to reported syphilis seropositivity data reported to WHO for global estimates of syphilis during pregnancy. OBJECTIVES: To identify more accurate correction factors based on test type reported. SEARCH STRATEGY: Medline search using: "Syphilis [Mesh] and Pregnancy [Mesh]," "Syphilis [Mesh] and Prenatal Diagnosis [Mesh]," and "Syphilis [Mesh] and Antenatal [Keyword]. SELECTION CRITERIA: Eligible studies must have reported results for pregnant or puerperal women for both non-treponemal and treponemal serology. DATA COLLECTION AND ANALYSIS: We manually calculated the crude percent estimates of subjects with both reactive treponemal and reactive non-treponemal tests among subjects with reactive treponemal and among subjects with reactive non-treponemal tests. We summarized the percent estimates using random effects models. MAIN RESULTS: Countries reporting both reactive non-treponemal and reactive treponemal testing required no correction factor. Countries reporting non-treponemal testing or treponemal testing alone required a correction factor of 52.2% and 53.6%, respectively. Countries not reporting test type required a correction factor of 68.6%. CONCLUSIONS: Future estimates should adjust reported maternal syphilis seropositivity by test type to ensure accuracy. |
Increased HIV and primary and secondary syphilis diagnoses among young men - United States, 2004-2008
Torrone EA , Bertolli JM , Li J , Sweeney PA , Jeffries WL , Ham DC , Peterman TA . J Acquir Immune Defic Syndr 2011 58 (3) 328-35 OBJECTIVES: National data document increases in HIV and syphilis diagnoses in young black men who have sex with men (MSM), but trends could be driven by increases in a few large areas. We describe the extent to which metropolitan areas of varying population sizes have reported increases in HIV and syphilis diagnoses in young MSM. METHODS: We examined trends in HIV and primary and secondary syphilis case reports from 2004 to 2008 in metropolitan areas having more than 500,000 persons and at least 500 black men aged 13-24 years (n=73). We examined differences by age at diagnosis, race/ethnicity, and area size. RESULTS: Comparing 2004/2005 to 2007/2008, HIV diagnoses increased in 85% (n=62) of areas among black MSM aged 13-24 years; primary and secondary syphilis diagnoses in young black men increased in 70% of areas (n=51). Areas had an average percentage increase of 68.7% (Interquartile range (IQR): 25.0, 103.1) in HIV diagnoses among young black MSM and an average increase of 203.5% (IQR: 0.0, 192.7) in primary and secondary syphilis. Across area size strata, the youngest group of black men had the highest average percentage increase in diagnoses of HIV and syphilis as well as the highest percentage of areas with increases in diagnoses. CONCLUSIONS: HIV and syphilis diagnoses increased among young black men in almost all areas, suggesting widespread increases across metropolitan areas of different sizes. Findings highlight the need for continued prevention efforts for young MSM, particularly young black MSM. |
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