Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Wi TE [original query] |
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Impact and cost-effectiveness of frequent HIV re-testing among key populations in Viet Nam: A modeling study (preprint)
Green D , Coomes D , Barnabas RV , Sharma M , Barrdichiara M , Jamil MS , Owiredu MN , Macdonald V , Nguyen V , Vo Hai S , Wi TE , Johnson C , Drake AL . medRxiv 2022 02 Background HIV testing and counseling is a key component of HIV prevention and the entry point into the treatment cascade, which improves for individual clinical outcomes and reduces onward HIV transmission. Current guidelines recommend at least annual testing for key populations. More frequent testing could provide health benefits, but these additional services increase the program the cost-effectiveness is not well-evaluated. Methods We used a compartmental mathematical model to simulate the health and economic impact of HIV testing one to four times per year for men who have sex with men, people who inject drugs, and female sex workers in Viet Nam. Model outcomes included costs, HIV infections, HIV-related deaths, and disability-adjusted life years (DALYs) associated with each scenario. We used an opportunity cost-based cost-effectiveness threshold of US $2,255 per DALY averted, discounted costs and health benefits at 3% annually, and used a time horizon from 2021 to 2030 to calculate incremental cost-effectiveness ratios (ICERs). Results Compared to the baseline scenario, more frequent HIV testing was estimated to incrementally avert 10.2%, 5.2%, 3.0%, and 1.6% discounted infections for one-, two-, three-, and four-tests per year, respectively. ICERs associated with each scenario ranged from $464, $1,190, $1,762, and $2,727 per DALY averted for one-, two-, three-, and four-tests per year, respectively. Conclusions Increased HIV testing frequency for key populations was projected to avert HIV incidence, mortality, and disability in Viet Nam and was cost-effective. Settings with a similar context should consider strategies on how to optimize retesting among key populations. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license. |
Syphilis management in pregnancy: a review of guideline recommendations from countries around the world
Trinh T , Leal AF , Mello MB , Taylor MM , Barrow R , Wi TE , Kamb ML . Sex Reprod Health Matters 2019 27 (1) 69-82 Guidelines can help healthcare practitioners manage syphilis in pregnancy and prevent perinatal death or disability. We conducted systematic reviews to locate guidance documents describing management of syphilis in pregnancy, 2003-2017. We compared country and regional guidelines with current World Health Organization (WHO) guidelines. We found 64 guidelines with recommendations on management of syphilis in pregnancy representing 128 of the 195 WHO member countries, including the two WHO guidelines published in 2016 and 2017. Of the 62 guidelines, 16 were for countries in Africa, 21 for the Americas, two for Eastern Mediterranean, six for Europe and 17 for Asia or the Pacific. Fifty-seven (92%) guidelines recommended universal syphilis screening in pregnancy, of which 46 (81%) recommended testing at the first antenatal care visit. Also, 46 (81%) recommended repeat testing including 21 guidelines recommended this during the third pregnancy trimester and/or at delivery. Fifty-nine (95%) guidelines recommended benzathine penicillin G (BPG) as the first-line therapy for syphilis in pregnancy, consistent with WHO guidelines. Alternative regimens to BPG were listed in 42 (68%) guidelines, primarily from Africa and Asia; only 20 specified that non-penicillin regimens are not proven-effective in treating the fetus. We identified guidance recommending use of injectable penicillin in exposed infants for 112 countries. Most guidelines recommended universal syphilis testing for pregnant women, repeat testing for high-risk women and treatment of infected women with BPG; but several did not. Updating guidance on syphilis testing and treatment in pregnancy to reflect global norms could prevent congenital syphilis and save newborn lives. |
Transforming and integrating STI surveillance to enhance global advocacy and investment in STI control
Taylor MM , Wi TE . J Int AIDS Soc 2019 22 Suppl 6 e25361 Sexually transmitted infections (STI) exact an astounding yet preventable toll on the health and lives of men and women worldwide. The World Health Organization (WHO) estimated 376 million new curable STI occurred in 2016, including chlamydia (127 million), gonorrhoea (87 million), syphilis (6.3 million) and trichomoniasis (156 million) 1. More than 500 million people were estimated to have genital infections with herpes simplex virus (HSV‐1 or HSV‐2) in 2012 2. Approximately 290 million women were estimated to have a human papillomavirus (HPV) infection in 2007 3. These infections have predictably serious complications for the men and women infected and their new‐born infants. More than 500,000 incident cervical cancer cases, caused by HPV occurred in 2018, with a greater than 50% mortality rate 4. For 2016, WHO estimated 988,000 pregnant women were infected with syphilis resulting in 660,000 congenital syphilis cases of which 350,000 were adverse birth outcomes including stillbirth and neonatal death 5. Additional STIs such as viral hepatitis, Mycoplasma genitalium infection, and lymphogranuloma venereum add further weight to these estimates 6, 7. Newly emerging viral pathogens Ebola and Zika have gained prominent attention as they are each sexually transmitted. 8, 9 |
Antimicrobial Resistance in Neisseria gonorrhoeae: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting.
Cristillo AD , Bristow CC , Torrone E , Dillon JA , Kirkcaldy RD , Dong H , Grad YH , Nicholas RA , Rice PA , Lawrence K , Oldach D , Shafer WM , Zhou P , Wi TE , Morris SR , Klausner JD . Sex Transm Dis 2018 46 (3) e18-e25 The goal of the Sexually Transmitted Infection Clinical Trial Group's (STI-CTG) Antimicrobial Resistance (AMR) in Neisseria gonorrhoeae (NG) meeting was to assemble experts from academia, government, non-profit and industry to discuss the current state of research, gaps and challenges in research and technology as well as priorities and new directions to address the continued emergence of multi-drug resistant NG infections. Topics discussed at the meeting, that will be the focus of this article, include AMR NG global surveillance initiatives, the use of whole genome sequencing (WGS) and bioinformatics to understand mutations associated with AMR, mechanisms of AMR, and novel antibiotics, vaccines and other methods to treat AMR NG. Key points highlighted during the meeting include: (i) US and International surveillance programs to understand AMR in NG. (ii) The US National Strategy for combating antimicrobial resistant bacteria. (iii) Surveillance needs, challenges and novel technologies. (iv) Plasmid- and chromosomally-mediated mechanisms of AMR in NG, (v) Novel therapeutic (e.g., sialic acid analogs, FH/Fc fusion molecule, monoclonal antibodies, topoisomerase inhibitors, fluoroketolides, LpxC inhibitors) and preventative (e.g., peptide mimic) strategies to combat infection. The way forward will require renewed political will, new funding initiatives and collaborations across academic and commercial research and public health programs. |
A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis
Gliddon HD , Peeling RW , Kamb ML , Toskin I , Wi TE , Taylor MM . Sex Transm Infect 2017 93 S3-s15 BACKGROUND: Mother-to-child transmission (MTCT) of syphilis and HIV continue to be important yet preventable causes of perinatal and infant morbidity and mortality. OBJECTIVES: To systematically review, critically appraise and perform a meta-analysis to evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched seven electronic bibliographic databases from 2012 to December 2016 with no language restrictions. Search keywords included HIV, syphilis and diagnosis. REVIEW METHODS: We included studies that evaluated the operational characteristics of dual HIV/syphilis RDTs. Outcomes included diagnostic test accuracy, cost effectiveness, ease of use and interpretation and acceptability. All studies were assessed against quality criteria and assessed for risk of bias. RESULTS: Of 1914 identified papers, 18 were included for the meta-analysis of diagnostic accuracy for HIV and syphilis. All diagnostic accuracy evaluation studies showed a very high sensitivity and specificity for HIV and a lower, yet adequate, sensitivity and specificity for syphilis, with some variation among types of test. Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients, who cited time to result, cost and the requirement of a single finger prick as important characteristics of dual RDTs. CONCLUSION: The results of this systematic review and meta-analysis can be used by policy-makers and national programme managers who are considering implementing dual RDTs for HIV and syphilis. TRIAL REGISTRATION NUMBER: PROSPERO 2016:CRD42016049168. |
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