Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-28 (of 28 Records) |
Query Trace: Kerndt P[original query] |
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Enhancing HIV positivity yield in southern Mozambique: The effect of a Ministry of Health training module in targeted provider-initiated testing and counselling
Saura-Lázaro A , Fernández-Luis S , Nhampossa T , Fuente-Soro L , López-Varela E , Bernardo E , Augusto O , Sánchez T , Vaz P , Wei SC , Kerndt P , Honwana N , Young P , Amane G , Boene F , Naniche D . PLoS One 2024 19 (5) e0303063 In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas. |
Reasons for non-disclosure of HIV-Positive status to healthcare providers: a mixed methods study in Mozambique
Fuente-Soro L , Figueroa-Romero A , Fernández-Luis S , Augusto O , López-Varela E , Bernardo E , Saura-Lázaro A , Vaz P , Wei SC , Kerndt PR , Nhampossa T , Naniche D . BMC Health Serv Res 2023 23 (1) 925 BACKGROUND: Non-disclosure of known HIV status by people living with HIV but undergoing HIV testing leads to waste of HIV testing resources and distortion of estimates of HIV indicators. In Mozambique, an estimated one-third of persons who tested positive already knew their HIV-positive status. To our knowledge, this study is the first to assess the factors that prevent people living with HIV (PLHIV) from disclosing their HIV-positive status to healthcare providers during a provider-initiated counseling and testing (PICT) campaign. METHODS: This analysis was nested in a larger PICT cross-sectional study performed in the Manhiça District, Southern Mozambique from January to July 2019, in which healthcare providers actively asked patients about their HIV-status. Patients who tested positive for HIV were crosschecked with the hospital database to identify those who had previously tested positive and were currently or previously enrolled in care. PLHIV who did not disclose their HIV-positive status were invited to participate and provide consent, and were interviewed using a questionnaire designed to explore barriers, patterns of community/family disclosure, and stigma and discrimination. RESULTS: We found that 16.1% of participants who tested positive during a PICT session already knew their HIV-positive status but did not disclose it to the healthcare provider. All the participants reported previous mistreatment by general healthcare providers as a reason for nondisclosure during PICT. Other reasons included the desire to know if they were cured (33.3%) or to re-engage in care (23.5%). Among respondents, 83.9% reported having disclosed their HIV-status within their close community, 48.1% reported being victims of verbal or physical discrimination following their HIV diagnosis, and 46.7% reported that their HIV status affected their daily activities. CONCLUSION: Previous mistreatment by healthcare workers was the main barrier to disclosing HIV-positive status. The high proportion of those disclosing their HIV status to their community but not to healthcare providers suggests that challenges with patient-provider relationships affect this care behavior rather than social stigma and discrimination. Improving patient-provider relationships could increase trust in healthcare providers, reduce non-disclosures, and help optimize resources and provide accurate estimates of the UNAIDS first 95 goal. |
Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment
Buck WC , Nguyen H , Siapka M , Basu L , Greenberg Cowan J , De Deus MI , Gleason M , Ferreira F , Xavier C , Jose B , Muthemba C , Simione B , Kerndt P . AIDS Res Ther 2021 18 (1) 3 BACKGROUND: Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. METHODS: A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0-14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. RESULTS: Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). CONCLUSIONS: Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed. |
Risk factors for oral HPV infection among young men who have sex with men - 2 cities, United States, 2012-2014
Oliver SE , Gorbach P , Gratzer B , Steinau M , Collins T , Parrish A , Kerndt PR , Crosby R , Unger ER , Markowitz LE , Meites E . Sex Transm Dis 2018 45 (10) 660-665 BACKGROUND: Men who have sex with men (MSM) are at risk for cancers attributable to human papillomavirus (HPV), including oropharyngeal cancer. HPV vaccination is recommended for U.S. MSM through age 26 years. Oral HPV infection is associated with oropharyngeal cancer. We determined oral HPV prevalence and risk factors among young MSM. METHODS: The Young Men's HPV study enrolled MSM aged 18-26 years from clinics in Chicago and Los Angeles during 2012-2014. Participants self-reported demographics, sexual behaviors, vaccination and HIV status. Self-collected oral rinse specimens were tested for HPV DNA (37 types) by L1-consensus PCR. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for risk factors associated with oral HPV among participants not previously vaccinated. RESULTS: Oral HPV was detected in 87/922 (9.4%); 9-valent vaccine (9vHPV) types were detected in 37/922 (4.0%). Among HIV-positive participants, 17/88 (19.3%) had oral HPV detected. Oral HPV was more prevalent among those reporting first sex at age </=18 years (aPR:2.44; CI:1.16-5.12); HIV infection (aPR:1.99; CI:1.14-3.48); >5 sex partners within the past month (aPR:1.93; CI:1.13-3.31); performing oral sex on >5 partners within the last 3 months (aPR:1.87; CI:1.12-3.13); and having >5 male sex partners within the last 3 months (aPR:1.76; CI: 1.08-2.87). Only 454/922 (49.2%) were aware HPV can cause oropharyngeal cancers. CONCLUSIONS: Many oral HPV infections were with types targeted by vaccination. Oral HPV infections were significantly associated with HIV and sexual behaviors. Fewer than half of participants were aware HPV could cause oropharyngeal cancer. |
Risk factors for oral HPV infection among young men who have sex with men - 2 cities, United States, 2012-2014
Oliver SE , Gorbach P , Gratzer B , Steinau M , Collins T , Parrish A , Kerndt PR , Crosby R , Unger ER , Markowitz LE , Meites E . Sex Transm Dis 2018 45 (10) 660-665 BACKGROUND: Men who have sex with men (MSM) are at risk for cancers attributable to human papillomavirus (HPV), including oropharyngeal cancer. HPV vaccination is recommended for U.S. MSM through age 26 years. Oral HPV infection is associated with oropharyngeal cancer. We determined oral HPV prevalence and risk factors among young MSM. METHODS: The Young Men's HPV study enrolled MSM aged 18-26 years from clinics in Chicago and Los Angeles during 2012-2014. Participants self-reported demographics, sexual behaviors, vaccination and HIV status. Self-collected oral rinse specimens were tested for HPV DNA (37 types) by L1-consensus PCR. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for risk factors associated with oral HPV among participants not previously vaccinated. RESULTS: Oral HPV was detected in 87/922 (9.4%); 9-valent vaccine (9vHPV) types were detected in 37/922 (4.0%). Among HIV-positive participants, 17/88 (19.3%) had oral HPV detected. Oral HPV was more prevalent among those reporting first sex at age </=18 years (aPR:2.44; CI:1.16-5.12); HIV infection (aPR:1.99; CI:1.14-3.48); >5 sex partners within the past month (aPR:1.93; CI:1.13-3.31); performing oral sex on >5 partners within the last 3 months (aPR:1.87; CI:1.12-3.13); and having >5 male sex partners within the last 3 months (aPR:1.76; CI: 1.08-2.87). Only 454/922 (49.2%) were aware HPV can cause oropharyngeal cancers. CONCLUSIONS: Many oral HPV infections were with types targeted by vaccination. Oral HPV infections were significantly associated with HIV and sexual behaviors. Fewer than half of participants were aware HPV could cause oropharyngeal cancer. |
Human papillomavirus vaccination among young men who have sex with men and transgender women in 2 US cities, 2012-2014
Gorbach PM , Cook R , Gratzer B , Collins T , Parrish A , Moore J , Kerndt PR , Crosby RA , Markowitz LE , Meites E . Sex Transm Dis 2017 44 (7) 436-441 BACKGROUND: Since 2011, in the United States, quadrivalent human papillomavirus (HPV) vaccine has been recommended for boys aged 11 to 12 years, men through age 21, and men who have sex with men (MSM) through age 26. We assessed HPV vaccination coverage and factors associated with vaccination among young MSM (YMSM) and transgender women (TGW) in 2 cities. METHODS: During 2012-2014, 808 YMSM and TGW aged 18 to 26 years reported vaccination status in a self-administered computerized questionnaire at 3 sexually transmitted disease (STD) clinics in Los Angeles and Chicago. Associations with HPV vaccination were assessed using bivariate and multivariable models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Few of the diverse participants (Hispanic/Latino, 38.0%; white, 27.0%; and black/African American, 17.9%) reported receiving 1 or more HPV vaccine doses (n = 111 [13.7%]) and even fewer reported 3 doses (n = 37 [4.6%]). A multivariable model found associations between vaccination and having a 4-year college degree or higher (aOR, 2.83; CI, 1.55-5.17) and self-reported STDs (aOR, 1.21; CI, 1.03-1.42). In a model including recommendation variables, the strongest predictor of vaccination was a health care provider recommendation (aOR, 11.85; CI, 6.70-20.98). CONCLUSIONS: Human papillomavirus vaccination coverage was low among YMSM and TGW in this 2-US city study. Our findings suggest further efforts are needed to reach YMSM seeking care in STD clinics, increase strong recommendations from health care providers, and integrate HPV vaccination with other clinical services such as STD testing. |
Concordance between anal and oral human papillomavirus (HPV) infections among young men who have sex with men
Steinau M , Gorbach P , Gratzer B , Braxton J , Kerndt PR , Crosby RA , Unger ER , Markowitz LE , Meites E . J Infect Dis 2017 215 (12) 1832-1835 Prevalence of human papillomavirus (HPV) infections was assessed among 1033 young men who have sex with men (MSM) aged 18-26 years. HPV (any type) was detected in 742 (71.8%) anal specimens and 101 (9.8%) oral specimens. Although HPV was detected in specimens from both anatomical sites in 83 (8.0%) participants, type-specific concordance for at least one HPV type was found in only 35 (3.4%) participants. HIV and smoking were associated with higher prevalence at both sites and frequency of concordant types. Coinfections of identical HPV types were rare, suggesting independent infection events and/or different modes of clearance. |
Monitoring for Human Papillomavirus Vaccine Impact Among Gay, Bisexual, and Other Men Who Have Sex With Men-United States, 2012-2014
Meites E , Gorbach PM , Gratzer B , Panicker G , Steinau M , Collins T , Parrish A , Randel C , McGrath M , Carrasco S , Moore J , Zaidi A , Braxton J , Kerndt PR , Unger ER , Crosby RA , Markowitz LE . J Infect Dis 2016 BACKGROUND: Gay, bisexual, and other men who have sex with men (MSM) are at high risk for HPV; vaccination is recommended for U.S. males, including MSM through age 26. We assessed evidence of HPV among vaccine-eligible MSM and transgender women to monitor vaccine impact. METHODS: During 2012-14, MSM age 18-26 at selected clinics completed a computer-assisted self-interview regarding sexual behavior, HIV status, and vaccinations. Self-collected anal swab and oral rinse specimens were tested for HPV DNA (37 types) by L1 consensus PCR; serum was tested for HPV antibodies (4 types) by multiplexed VLP-based IgG direct ELISA. RESULTS: Among 922 vaccine-eligible participants, mean age was 23, and mean number of lifetime sex partners was 37. Among 834 without HIV, any anal HPV was detected in 69.4% and any oral HPV in 8.4%, yet only 8.5% had evidence of exposure to all quadrivalent vaccine types. In multivariate analysis, HPV prevalence varied significantly (p<0.05) by HIV status, sexual orientation, and lifetime sex partners, but not race/ethnicity. DISCUSSION: Most young MSM lacked evidence of current or past infection with all vaccine-type HPV, suggesting they could benefit from vaccination. Vaccination impact among MSM may be assessed by monitoring HPV prevalence, including in self-collected specimens. |
Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs
Gardner LI , Marks G , Strathdee SA , Loughlin AM , Del Rio C , Kerndt P , Mahoney P , Pitasi MA , Metsch LR . Drug Alcohol Depend 2016 165 15-21 OBJECTIVE: We evaluated whether being in drug use treatment improves linkage to HIV medical care for HIV-infected drug users. We assessed whether an evidence-based intervention for linkage to care ['ARTAS'] works better for HIV-infected drug users who had been in drug use treatment than those who had not. DESIGN: Randomized trial. METHODS: 295 Participants in the Antiretroviral Treatment Access Study ['ARTAS'] trial were followed for time to first HIV medical care. Drug use (injected and non-injected drugs) in the last 30days and being in drug treatment in the last 12 months were assessed by audio-CASI. We used a proportional hazards model of time to care in drug users with and without drug treatment, adjusting for barriers to care, AIDS symptoms, and demographic factors. We tested whether drug treatment modified the intervention effect by using a drug use/drug treatment*intervention interaction term. RESULTS: Ninety-nine participants (30%) reported drug use in the 30days before enrollment. Fifty-three (18%) reported being in a drug treatment program in the last 12 months. Drug users reporting methadone maintenance became engaged in care in less than half the time of drug users without a treatment history [HR 2.97 (1.20, 6.21)]. The ARTAS intervention effect was significantly larger for drug users with a treatment history compared to drug users without a treatment history (AHR 5.40, [95% CI, 2.03-14.38]). CONCLUSIONS: Having been in drug treatment programs facilitated earlier entry into care among drug users diagnosed with HIV infection, and improved their response to the ARTAS linkage intervention. |
Using a multi-test algorithm to improve the positive predictive value of rapid HIV testing and linkage to HIV care in non-clinical HIV test sites
Delaney KP , Rurangirwa J , Facente S , Dowling T , Janson M , Knoble T , Vu A , Hu YW , Kerndt P , King J , Scheer S . J Acquir Immune Defic Syndr 2015 71 (1) 78-86 BACKGROUND: Use of a rapid HIV testing algorithm (RTA) in which all tests are conducted within one client appointment could eliminate off-site confirmatory testing and reduce the number of persons not receiving confirmed results. METHODS: An RTA was implemented in 9 sites in Los Angeles and San Francisco; results of testing at these sites were compared with 23 sites conducting rapid HIV testing with off-site confirmation. RTA clients with reactive results on >1 rapid test were considered HIV+ and immediately referred for HIV care. The positive predictive value (PPV) of a single rapid HIV test and the RTA were calculated compared to laboratory-based confirmatory testing. A Poisson risk-regression model was used to assess the effect of the RTA on the proportion of HIV+ persons linked to HIV care within 90 days of a reactive rapid test. RESULTS: The PPV of the RTA was 100% compared to 86.4% for a single rapid test. The time between testing and receipt of RTA results was on average 8 days shorter than laboratory-based confirmatory testing. For risk groups other than MSM, the RTA increased the probability of being in care within 90 days compared to standard testing practice. CONCLUSIONS: The RTA increased the PPV of rapid testing to 100%, giving providers, clients, and HIV counselors timely information about a client's HIV-positive serostatus. Use of an RTA could reduce loss to follow-up between testing positive and confirmation, and increase the proportion of HIV-infected persons receiving HIV care. |
Comparison of antimicrobial susceptibility of urogenital Neisseria gonorrhoeae isolates obtained from women and men
Kidd S , Moore PC , Kirkcaldy RD , Philip SS , Wiesenfeld HC , Papp JR , Kerndt PR , Venkatasubramanian L , Ghanem KG , Hook EW 3rd . Sex Transm Dis 2015 42 (8) 434-9 BACKGROUND: The US system for gonococcal antimicrobial susceptibility surveillance monitors trends exclusively among men with urethral infection, the population from whom the yield of gonococcal culture is highest. Little is known about the susceptibility of female urogenital isolates, and it is unclear whether gonococcal susceptibility among men who report sex exclusively with women (MSW) is representative of susceptibility among women. METHODS: Using isolates collected during a recent treatment trial in 5 US cities, we performed a secondary analysis to compare antimicrobial susceptibilities of Neisseria gonorrhoeae urogenital isolates obtained from women, MSW, and men who have sex with men (MSM). Pretreatment isolates were collected from trial participants; minimum inhibitory concentrations (MICs) were determined by agar dilution. Geometric mean MICs were adjusted for geographic location using general linear models. RESULTS: Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 mug/mL; 95% confidence interval [CI], 0.0049-0.0092 mug/mL) and MSW (0.0060 mug/mL; 95% CI, 0.0053-0.0066 mug/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 mug/mL; 95% CI, 0.0082-0.0119 mug/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin CONCLUSIONS: Ceftriaxone, cefixime, and azithromycin MICs were higher among MSM than among MSW, but were similar among women and MSW. These findings suggest that gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSW may adequately represent susceptibility of urogenital N. gonorrhoeae in women. |
The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea
Kirkcaldy RD , Weinstock HS , Moore PC , Philip SS , Wiesenfeld HC , Papp JR , Kerndt PR , Johnson S , Ghanem KG , Hook EW 3rd . Clin Infect Dis 2014 59 (8) 1083-91 BACKGROUND: Ceftriaxone is the foundation of currently recommended gonorrhea treatment.There is an urgent need for back-up treatment options for patients withcephalosporin-allergy or infections due to suspected cephalosporin-resistant Neisseria gonorrhoeae. We evaluated the efficacy and tolerability of two combinations of existing non-cephalosporin antimicrobials for treatment of patients with urogenital gonorrhea. METHODS: We conducted a randomized, multisite,open-label, non-comparative trial (ClinicalTrials.gov:NCT00926796) in 5 outpatient sexually transmitted disease clinic sites in Alabama, California, Maryland and Pennsylvania. Patients aged 15-60 years diagnosed with uncomplicated urogenital gonorrhea were randomly assigned to either gentamicin 240 mg intramuscularly plus azithromycin 2 g orally, or gemifloxacin 320 mg orally plus azithromycin 2 g orally. The primary outcome was microbiological cure of urogenital infections (negative follow-up culture) at 10-17 days post-treatment among 401 participants in the per protocol population. RESULTS: Microbiological cure was achieved by 100% (lower one-sided exact 95% confidence interval bound, 98.5%) of 202 evaluable participants receiving gentamicin/azithromycin, and 99.5% (lower one-sided exact 95% confidence interval bound, 97.6%) of 199 evaluable participants receiving gemifloxacin/azithromycin. Gentamicin/azithromycin cured 10/10 pharyngeal infections and 1/1 rectal infection; gemifloxacin/azithromycin cured 15/15 pharyngeal and 5/5 rectal infections. Gastrointestinal adverse events were common in both arms. CONCLUSION: Gentamicin/azithromycin and gemifloxacin/azithromycin were highly effective for treatment of urogenital gonorrhea. Gastrointestinal adverse events may limit routine use. These non-cephalosporin-based regimens may be useful alternative options for patients who cannot be treated with cephalosporin antimicrobials. Additional treatment options for gonorrhea are needed. |
The Project Connect health systems intervention: linking sexually experienced youth to sexual and reproductive health care
Dittus PJ , De Rosa CJ , Jeffries RA , Afifi AA , Cumberland WG , Chung EQ , Martinez E , Kerndt PR , Ethier KA . J Adolesc Health 2014 55 (4) 528-34 PURPOSE: To evaluate a health systems intervention to increase adolescents' receipt of high-quality sexual and reproductive health care services. METHODS: Quasi experimental design. Twelve high schools in a large public school district were matched into pairs. Within each pair, schools were assigned to condition so that no control school shared a geographic border with an intervention school. Five yearly surveys (T1, T2, ..., T5) were administered from 2005 to 2009 (N = 29,823) to students in randomly selected classes in grades 9-12. Community-based providers of high-quality sexual and reproductive health care services were listed on a referral guide for use by school nurses to connect adolescents to care. RESULTS: Statistically significant effects were found for intervention school females on three outcomes, relative to controls. Relative to T1, receipt of birth control in the past year was greater at T4 (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [CI], 1.09-3.15) and T5 (AOR = 2.22; 95% CI, 1.32-3.74). Increases in sexually transmitted disease testing and/or treatment in the past year were greater in T1-T3 (AOR = 1.78; 95% CI, 1.05-3.02), T1-T4 (AOR = 1.73; 95% CI, 1.01-2.97), T1-T5 (AOR = 1.97; 95% CI, 1.17-3.31), and T2-T5 (AOR = 1.76; 95% CI, 1.06-2.91). Increases in ever receiving an HIV test were greater in T1-T4 (AOR = 2.14; 95% CI, 1.08-4.26). Among males, no intervention effects were found. CONCLUSIONS: A school-based structural intervention can improve female adolescents' receipt of services. |
Would young women attending sexually transmitted disease clinics benefit from human papillomavirus vaccination? An assessment of human papillomavirus DNA and seropositivity from human papillomavirus sentinel surveillance, 2003-2005
Dunne EF , Flagg EW , Unger ER , Hsu K , Ghanen K , Kerndt P , Shlay JC , Koutsky LA , Datta DS , Panicker G , Zaidi A , Weinstock H , Markowitz LE . Sex Transm Dis 2014 41 (1) 46-9 BACKGROUND: There are limited data on the proportion who have been exposed to vaccine-type human papillomavirus (HPV) among women attending sexually transmitted disease (STD) clinics; this information could inform the potential benefits of HPV vaccination for women attending this venue. METHODS: Human papillomavirus surveillance was conducted in STD clinics in Baltimore, MD; Boston, MA; Denver, CO; Los Angeles, CA; and Seattle, WA, among women receiving cervical cancer screening from January 2003 to December 2005. The women had specimens collected for cervical cytology HPV testing by L1 consensus polymerase chain reaction testing and serologic assessment for HPV 6, 11, 16, and 18 using the competitive Luminex immunoassay. Results from 880 women with adequate specimens were included. Women were HPV naive if they were both HPV DNA negative and seronegative for a specific HPV type. RESULTS: One hundred seventy women (19.3%) had HPV 16, 18, 6, or 11 DNA, and 418 (47.5%) were HPV 16, 18, 6, or 11 seropositive. Four hundred ten (46.6%) women were naive to all 4 types, 570 (64.8%) were naive to both HPV 16 and 18, and 545 (61.9%) were naive to both HPV 6 and 11. Almost all (99.3%) women were naive to at least 1 vaccine HPV type. CONCLUSIONS: Almost half of young women age eligible for HPV vaccine and attending STD clinics were naive to all 4 HPV types, and more than half were naive to both HPV 16 and 18. This assessment suggests that most young women attending this venue might benefit from HPV vaccination. |
Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States
Chesson HW , Flagg EW , Koutsky L , Hsu K , Unger ER , Shlay JC , Kerndt P , Ghanem KG , Zenilman JM , Hagensee M , Weinstock H , Datta SD . Vaccine 2013 31 (29) 3019-24 BACKGROUND: We present data on Pap test results and HPV prevalence from the HPV Sentinel Surveillance project, a multiyear surveillance project enrolling women from a diverse set of 26 clinics throughout the US from 2003 to 2005. We use mathematical modeling to illustrate the potential timing and magnitude of decreases in Pap test abnormalities in sexually transmitted disease (STD), family planning, and primary care clinics in the US as a result of HPV vaccination. METHODS: The probability of an abnormal Pap result was based on three factors: (1) infection with HPV 16/18, or both; (2) infection with high-risk HPV types other than HPV 16/18; and (3) infection with HPV 6/11, or both. We estimated the relative reduction in the probability of an abnormal Pap result over the first 25 years of a female-only, quadrivalent HPV vaccination program, compared to a scenario of no HPV vaccination in which the probability of abnormal Pap results was assumed constant. RESULTS: The probability of an abnormal Pap result ranged from 7.0% for the lowest risk group (those without any high-risk HPV types and without HPV 6/11) to 45.2% for the highest risk group (those with HPV 16/18 and at least one other high-risk HPV type). Estimated reductions in abnormal Pap results among women in the 21- to 29-year age group were 0.8%, 10.2%, and 11.3% in years 5, 15, and 25 of the vaccine program respectively, in the lower vaccine coverage scenario, and 7.4%, 21.4%, and 22.2%, respectively, in the higher coverage scenario. CONCLUSIONS: Our results suggest that HPV vaccination will have a discernable impact on the probability of Pap abnormalities, but the timing and magnitude of the reduction will depend substantially on vaccine coverage and the degree of cross-protection against high risk HPV types other than HPV 16/18. |
Improving the implementation of a condom availability program in urban high schools
De Rosa CJ , Jeffries RA , Afifi AA , Cumberland WG , Chung EQ , Kerndt PR , Ethier KA , Martinez E , Loya RV , Dittus PJ . J Adolesc Health 2012 51 (6) 572-9 PURPOSE: We conducted an intervention to improve the implementation of a high school condom availability program, and evaluated its effect on students' awareness of the program and acquisition of condoms. METHODS: Twelve public high schools in the Los Angeles, CA area participated, half each in the intervention and control conditions. Project staff facilitated intervention schools' self-assessment of compliance with the school district's condom availability policy, creating an action plan by determining which mandatory program elements were lacking and identifying steps to improve compliance. Staff provided technical assistance and follow-up to assist schools in improving program implementation. From 2005 to 2009 (T1-T5), 29,823 students were randomly selected by classroom and they completed surveys. We tested for changes in students' awareness and acquisition of condoms over time between conditions using mixed model logistic regression analyses. Records of condom orders by schools also were reviewed. RESULTS: Awareness increased significantly among intervention versus control participants from T1 to T3 (adjusted odds ratio [AOR]: 1.28; 95% confidence interval [CI]: 1.01, 1.62), T4 (AOR: 2.17; 95% CI: 1.70, 2.76), and T5 (AOR: 2.78; 95% CI: 2.18, 3.56). Acquisition of condoms increased significantly among intervention versus control participants from T1 to T4 (AOR: 1.69; 95% CI: 1.23, 2.32) and T5 (AOR: 1.81; 95% CI: 1.32, 2.49). Results were similar across gender and different levels of sexual experience. Orders of condoms increased markedly in intervention schools by T5. CONCLUSIONS: Feasible minor enhancements to condom availability program implementation improved program delivery, resulting in increased student awareness of the program and acquisition of condoms. |
Monitoring HPV type-specific prevalence over time through clinic-based surveillance: a perspective on vaccine effectiveness.
Gaffga NH , Flagg EW , Weinstock HS , Shlay JC , Ghanem KG , Koutsky LA , Kerndt PR , Hsu KK , Unger ER , Datta SD . Vaccine 2012 30 (11) 1959-64 ![]() We investigated the feasibility of monitoring trends in prevalence of vaccine-preventable human papillomavirus (HPV) types in different clinic populations. We collected cervical specimens from women presenting to family planning, primary care, and sexually transmitted disease (STD) clinics for routine pap smears in five US cities during 2003-2005. We performed HPV genotyping and calculated annual type-specific prevalences; pre-vaccine era prevalence was highest for HPV 16 (6.0; 95% confidence interval [CI] 5.5-6.6%) and annual prevalences for vaccine-preventable types were stable, with few exceptions, after controlling for clinic type, age group, and city. With sufficient sample size and stable population characteristics, clinic-based surveillance systems can contribute to monitoring HPV vaccine impact in the cervical screening population. |
Performance of an alternative laboratory-based algorithm for HIV diagnosis in a high-risk population
Delaney KP , Heffelfinger JD , Wesolowski LG , Owen SM , Meyer WA 3rd , Kennedy S , Uniyal A , Kerndt PR , Branson BM . J Clin Virol 2011 52 Suppl 1 S5-10 BACKGROUND: An immunoassay (IA) followed by Western blot (WB) or immunofluorescence assay has been the primary algorithm used to provide laboratory confirmation of the diagnosis of HIV infection in the US for more than 20 years. Recently, an alternative diagnostic algorithm was proposed to more accurately identify early HIV-1 infection and differentiate between HIV-1 and HIV-2 infection. OBJECTIVES: Evaluate a sequential alternative algorithm in which reactive IAs are followed by a rapid HIV test and, if negative, a nucleic acid amplification test (NAAT). STUDY DESIGN: Specimens from high-risk persons were tested with 4 HIV IAs, 6 rapid HIV tests and NAAT (APTIMA((R))), which are approved by the United States Food and Drug Administration. IAs were repeated in duplicate if specimen volumes were sufficient. The performance of the alternative algorithm was compared to HIV WB and NAAT. RESULTS: The original study classified 377 specimens as HIV-positive and 3070 as HIV-negative. All 4 IAs correctly identified >99.5% of HIV-positive specimens and, on initial screening, >95.8% of HIV-negative specimens. When repeated, specificity of IAs improved to >99%. Between 6.7% and 12.4% of IA-repeatedly reactive specimens required APTIMA for resolution. The alternative algorithm led to the correct classification of all IA-reactive specimens. CONCLUSIONS: Regardless of screening IA and rapid test used, the alternative algorithm correctly classified the infection status of all persons with reactive screening IA results. Few specimens required NAAT for resolution, and the proportion requiring NAAT was lower when repeat IA test results were considered. |
The association of current hormonal contraceptive use with type-specific HPV detection
Ghanem KG , Datta SD , Unger ER , Hagensee M , Shlay JC , Kerndt P , Hsu K , Koutsky LA . Sex Transm Infect 2011 87 (5) 385-8 BACKGROUND: Increased duration of hormonal contraceptive (HC) use may be positively associated with the risk of invasive cervical cancer. METHODS: This is a secondary analysis from the HPV Sentinel Surveillance Study. The authors examined the association between type-specific human papillomavirus (HPV) detection and current HC use among 7718 women attending 26 sexually transmitted disease, family planning and primary care clinics in the USA. RESULTS: There was an association between HC use and HPV-16 detection (adjusted prevalence rate ratio 1.34 (95% CI 1.05 to 1.71) for oral contraceptive users and 1.41 (1.01 to 2.04) for depot-medroxyprogesterone acetate users); there was no association between HC use and detection of other HPV types or any HPV overall. CONCLUSIONS: Longitudinal studies are needed to better define this type-specific association and its clinical significance. |
School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students
Ethier KA , Dittus PJ , Derosa CJ , Chung EQ , Martinez E , Kerndt PR . J Adolesc Health 2011 48 (6) 562-5 PURPOSE: The current analyses compared receipt of reproductive health care, contraceptive use, and screening for sexually transmitted diseases (STD) among adolescents who are sexually experienced, with or without access to a school clinic. METHODS: A total of 12 urban California high schools, selected from areas with high teen pregnancy and STD rates, half with school-based health centers (SBHCs), participated in an intervention study designed to improve sexual health among adolescents. Of the participating students, 44% indicated that they had ever had intercourse and were included in these analyses. RESULTS: Access to an SBHC did not influence receipt of reproductive health care for either males or females and did not influence contraceptive use, either hormonal or condoms, for males. For females, however, those with access to an SBHC had increased odds of having received pregnancy or disease prevention care (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.16-1.80), having used hormonal contraceptives at last sex (AOR = 1.68, 95% CI = 1.24-2.28), and were more likely to have ever been screened for an STD (AOR = 1.85, 95% CI = 1.43-2.40). Also among female students, those with access to an SBHC were more likely to have used emergency contraception at last sex (AOR = 2.1, 95% CI = 1.08-4.22). CONCLUSION: Although access to an on-site clinic does not seem to lead to increases in all types of reproductive care in the population as a whole, sexually active females are more likely to have received more specific care and to have used hormonal contraceptives if their school has an SBHC. |
Human papillomavirus vaccine initiation among adolescent girls in high-risk communities
Guerry SL , De Rosa CJ , Markowitz LE , Walker S , Liddon N , Kerndt PR , Gottlieb SL . Vaccine 2011 29 (12) 2235-41 BACKGROUND: We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents' intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer. METHODS: Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11-18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County. RESULTS: We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n=387), 62% said they "probably/definitely will" vaccinate within the next year and 21% were undecided or didn't know; only 11% said they definitely won't. CONCLUSIONS: About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents. |
Evaluation of the performance characteristics of 6 rapid HIV antibody tests
Delaney KP , Branson BM , Uniyal A , Phillips S , Candal D , Owen SM , Kerndt PR . Clin Infect Dis 2011 52 (2) 257-63 BACKGROUND: Since 2002, the US Food and Drug Administration has approved 6 rapid human immunodeficiency virus (HIV) tests for use in the United States. To date, there has been no direct comparison of the performance of all 6 tests. METHODS: Persons known to be HIV-infected and persons who sought HIV testing at 2 clinical sites in Los Angeles, California, were recruited for evaluation of 6 rapid HIV tests with whole blood, oral fluid, serum, and plasma specimens. Sensitivity and specificity of the rapid tests were compared with viral lysate and immunoglobulin (Ig) M-sensitive peptide HIV enzyme immunoassays (EIAs). RESULTS: A total of 6282 specimens were tested. Sensitivity was >95% and specificity was >99% for all rapid tests. Compared with the IgM-sensitive EIA, rapid tests gave false-negative results with an additional 2-5 specimens. All rapid tests had statistically equivalent performance characteristics, based on overlapping confidence intervals for sensitivity and specificity, compared with either conventional EIA. CONCLUSIONS: All 6 rapid tests have high sensitivity and specificity, compared with that of conventional EIAs. Because performance was similar for all tests and specimen types, other characteristics, such as convenience, time to result, shelf life, and cost will likely be determining factors for selection of a rapid HIV screening test for a specific application. |
Daily participation in sports and students' sexual activity
Habel MA , Dittus PJ , De Rosa CJ , Chung EQ , Kerndt PR . Perspect Sex Reprod Health 2010 42 (4) 244-250 CONTEXT: Previous studies suggest that student athletes may be less likely than nonathletes to engage in sexual behavior. However, few have explored sexual risk behavior among athletes in early adolescence. METHODS: In 2005, a sample of 10,487 students in 26 Los Angeles public middle and high schools completed a self-administered survey that asked about their demographic characteristics, sports participation, sexual behaviors and expectations, and parental relationships. Chi-square analyses compared reported levels of daily participation in sports, experience with intercourse, experience with oral sex and condom use at last intercourse by selected characteristics. Predictors of sexual experience and condom use were assessed in multivariate logistic regression analyses. RESULTS: One-third of students reported daily participation in sports. This group had higher odds of ever having had intercourse and ever having had oral sex than their peers who did not play a sport daily (odds ratios, 1.2 and 1.1, respectively). The increases in risk were greater for middle school sports participants than for their high school counterparts (1.5 and 1.6, respectively). Among sexually experienced students, daily sports participants also had elevated odds of reporting condom use at last intercourse (1.4). CONCLUSIONS: Students as young as middle school age who participate in sports daily may have an elevated risk for STDs and pregnancy. Health professionals should counsel middle school athletes about sexual risk reduction, given that young students may find it particularly difficult to obtain contraceptives, STD testing and prevention counseling. |
Cost-effectiveness of pooled nucleic acid amplification testing for acute HIV infection after third-generation HIV antibody screening and rapid testing in the United States: a comparison of three public health settings
Hutchinson AB , Patel P , Sansom SL , Farnham PG , Sullivan TJ , Bennett B , Kerndt PR , Bolan RK , Heffelfinger JD , Prabhu VS , Branson BM . PLoS Med 2010 7 (9) e1000342 BACKGROUND: Detection of acute HIV infection (AHI) with pooled nucleic acid amplification testing (NAAT) following HIV testing is feasible. However, cost-effectiveness analyses to guide policy around AHI screening are lacking; particularly after more sensitive third-generation antibody screening and rapid testing. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis of pooled NAAT screening that assessed the prevention benefits of identification and notification of persons with AHI and cases averted compared with repeat antibody testing at different intervals. Effectiveness data were derived from a Centers for Disease Control and Prevention AHI study conducted in three settings: municipal sexually transmitted disease (STD) clinics, a community clinic serving a population of men who have sex with men, and HIV counseling and testing sites. Our analysis included a micro-costing study of NAAT and a mathematical model of HIV transmission. Cost-effectiveness ratios are reported as costs per quality-adjusted life year (QALY) gained in US dollars from the societal perspective. Sensitivity analyses were conducted on key variables, including AHI positivity rates, antibody testing frequency, symptomatic detection of AHI, and costs. Pooled NAAT for AHI screening following annual antibody testing had cost-effectiveness ratios exceeding US$200,000 per QALY gained for the municipal STD clinics and HIV counseling and testing sites and was cost saving for the community clinic. Cost-effectiveness ratios increased substantially if the antibody testing interval decreased to every 6 months and decreased to cost-saving if the testing interval increased to every 5 years. NAAT was cost saving in the community clinic in all situations. Results were particularly sensitive to AHI screening yield. CONCLUSIONS: Pooled NAAT screening for AHI following negative third-generation antibody or rapid tests is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings. |
Sexual intercourse and oral sex among public middle school students: prevalence and correlates
De Rosa CJ , Ethier KA , Kim DH , Cumberland WG , Afifi AA , Kotlerman J , Loya RV , Kerndt PR . Perspect Sex Reprod Health 2010 42 (3) 197-205 CONTEXT: Early sexual initiation is associated with elevated teenage pregnancy and STD risk, yet little is known about the prevalence and correlates of sexual behavior among young adolescents. Better information is needed to guide interventions to prevent early sexual debut. METHODS: Data from a 2005 survey of 4,557 sixth-, seventh- and eighth-grade students at 14 urban public schools in Southern California were analyzed using chi-square tests and logistic regression, to identify correlates of oral sex, intercourse and both. RESULTS: Overall, 9% of youth had ever had sexual intercourse, and 8% had had oral sex. Three percent reported having had oral sex only, 4% intercourse only and 5% both. Among those who reported intercourse, 69% had used a condom at last intercourse, and 43% had had multiple partners. Being male, being black and having at least one friend who had ever been involved in a pregnancy were positively associated with having had intercourse only and both intercourse and oral sex (odds ratios, 1.7–4.2). Being in eighth grade, expecting to have intercourse in the next six months and currently having a boyfriend or girlfriend were positively associated with all three outcomes (2.1–7.2). Intercourse and oral sex were highly correlated. CONCLUSIONS: Interventions addressing oral sex, intercourse and multiple partners should begin before sixth grade and continue throughout the middle school years. Health professionals should target adolescent risk reduction counseling toward males, blacks, youth with a boyfriend or girlfriend, and those with a friend who has been involved in a pregnancy. |
Awareness of diagnosis and knowledge of HPV in women patients: data from a multi-site study
McCree DH , Daley EM , Gorbach P , Hamm RM , Sharpe PA , Brandt HM , McFarlane M , Kerndt P , McDermott RJ , Perrin KM , StLawrence JS . Am J Health Educ 2010 41 (4) 197-205 BACKGROUND: Persistent infection with high-risk types of human papillomavirus (HPV) is associated with cervical and other anogenital cancers. PURPOSE: This paper reports results of awareness of an HPV diagnosis and HPV knowledge from a multi-site study of HPV knowledge, attitudes and behavior, and the impact of an HPV diagnosis on women and their partners. METHODS: During September 2003 - November 2005, a survey containing shared and site-specific items was administered to 736 women who had received HPV DNA testing in conjunction with cytology for cervical cancer screening. RESULTS: Overall, there was low knowledge about HPV transmissibility, curability and the effects of an HPV diagnosis across all sites regardless of a woman's racial/ethnic and/or socio-demographic background. Further, only about 50% of the women were aware of their HPV diagnosis even after receiving their results and counseling from a health care professional. DISCUSSION: There is need for consistent and clear information about HPV and HPV DNA testing as part of cervical cancer screening. Research concerning methods or best practices for improving communication between practitioner and patient about testing, diagnosis, counseling, behavioral consequences and follow-up care may be warranted. TRANSLATION TO HEALTH EDUCATION PRACTICE: General messages as well as population-specific messages need to be developed and disseminated to reduce confusion emanating from HPV diagnosis. Modes for delivering messages may need to vary. Further research should address message content and delivery. |
Detecting acute human immunodeficiency virus infection using 3 different screening immunoassays and nucleic acid amplification testing for human immunodeficiency virus RNA, 2006-2008
Patel P , Mackellar D , Simmons P , Uniyal A , Gallagher K , Bennett B , Sullivan TJ , Kowalski A , Parker MM , LaLota M , Kerndt P , Sullivan PS . Arch Intern Med 2010 170 (1) 66-74 BACKGROUND: The yield of nucleic acid amplification testing (NAAT) after routine screening for human immunodeficiency virus (HIV) antibody to detect acute HIV infection (AHI) may vary with different HIV-antibody assays. METHODS: From April 24, 2006, through March 28, 2008, patients underwent routine HIV-antibody screening using a first-generation assay at 14 county sexually transmitted disease (STD) clinics and 1 community clinic serving homosexual patients in Los Angeles; using a second-generation rapid test at 3 municipal STD clinics in New York; and using a third-generation assay at 80 public health clinics in Florida. To identify AHI, seronegative specimens were pooled for NAAT, followed by individual NAAT of specimens with positive findings. All AHI samples screened by first- and second-generation assays also underwent third-generation testing. RESULTS: We screened 37 012 persons using NAAT after first-generation testing; 35 AHIs were identified, increasing HIV case detection by 8.2%. After a second-generation rapid test, 6547 persons underwent NAAT; 7 AHIs were identified, increasing HIV case detection by 24.1%. After third-generation testing, 54 948 persons underwent NAAT; 12 AHI cases were identified, increasing HIV case detection by 1.4%. Overall, pooled NAAT after negative third-generation test results detected 26 AHI cases, increasing HIV case detection by 2.2%. Most of the AHI cases from Los Angeles (26 of 35 [74%]) were identified at the community clinic where NAAT after third-generation testing increased HIV case detection by 11.9%. CONCLUSIONS: Pooled NAAT after third-generation testing increases HIV case detection, especially in venues of high HIV seropositivity. Therefore, targeted AHI screening using pooled NAAT after third-generation testing may be most effective, warranting a cost-benefit analysis. |
Concurrency, sex partner risk, and high-risk human papillomavirus infection among African American, Asian, and Hispanic women
Javanbakht M , Gorbach PM , Amani B , Walker S , Cranston RD , Datta SD , Kerndt PR . Sex Transm Dis 2009 37 (2) 68-74 BACKGROUND: Although the role of concurrent sexual partnerships (i.e., having sexual activity with another partner after a current partnership has been established) has been most strongly associated with the transmission of bacterial sexually transmitted infections, its role in the transmission of viral sexually transmitted infections, specifically human papillomavirus (HPV) is less clear. METHODS: Analysis of risk behavior data collected from 812 women screened for HPV as part of a sentinel surveillance project conducted in a family planning clinic, a primary care clinic, and 2 sexually transmitted disease clinics in Los Angeles, CA. RESULTS: The mean age of participants was 34.2 years (range: 18-65), with 31.8% identifying as African American 32.8% as Asian, and 28.4% as Hispanic. The overall prevalence of high-risk HPV (HR-HPV) was 21.7% and was higher among women who reported a concurrent partnership (25.7%) as compared to those who reported no concurrency (17.1%; P = 0.004). In multivariate analysis, concurrency was associated with HR-HPV and this relationship varied by race/ethnicity. Among Hispanic women those reporting a concurrent partnership were nearly twice as likely to have HR-HPV as compared to those who did not report concurrency (adjusted odds ration [AOR] = 1.71; 95% confidence interval [CI]: 1.13-2.58). However, among African American women those who reported a concurrent partnership were less likely to be diagnosed with HR-HPV (AOR = 0.60; 95% CI: 0.37-0.98). CONCLUSIONS: This study demonstrates that concurrency is associated with HR-HPV and that there may be differences by race/ethnicity in the individual or partnership characteristics of those who report concurrency. |
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