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1.  Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges? 
Sexually Transmitted Infections  2007;83(7):503-505.
There is a critical need for appropriate technical innovation and development, as well as dramatically improved health sector financing
PMCID: PMC2598632  PMID: 18024708
2.  Impact on gonorrhoea case reports through concomitant/dual testing in a chlamydia screening population in Liverpool 
Sexually Transmitted Infections  2007;83(7):593-594.
PMCID: PMC2598633  PMID: 18024714
NAATs; chlamydia; gonorrhoea; KC60; community
4.  [No title available] 
PMCID: PMC2598635
5.  [No title available] 
PMCID: PMC2598636
6.  Internet as a tool to access high‐risk men who have sex with men from a resource‐constrained setting: a study from Peru 
Sexually Transmitted Infections  2007;83(7):567-570.
In Peru, current interventions in high‐risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population.
Two nearly identical banner ads—both advertising an online survey but only one offering free HIV/syphilis tests and condoms—were displayed randomly on a Peruvian gay website.
The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high‐risk MSM not previously tested for HIV but interested in a wide variety of preventive Web‐based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis.
The internet can be used as a tool to access MSM in Peru. The compensation of a free HIV/syphilis test increased the frequency of participation in our online survey, indicating that such incentives may be an effective means of reaching this population. However, as only a small percentage of participants actually reported for testing, future research should develop and assess tailored internet interventions to increase HIV/STI testing and delivery of other prevention services to Peruvian MSM.
PMCID: PMC2598637  PMID: 17932128
7.  Vaginal practices, microbicides and HIV: what do we need to know? 
Sexually Transmitted Infections  2007;83(7):505-507.
The goal of a safer vaginal environment could be reached by identifying harmful vaginal practices and an effective microbicide, thereby increasing options for HIV prevention
PMCID: PMC2598638  PMID: 18024709
8.  [No title available] 
PMCID: PMC2598639
9.  Congenital syphilis in Italy 
Sexually Transmitted Infections  2007;83(7):590-591.
The cases are described of two infants who developed clinical and laboratory signs of congenital syphilis in Northern Italy, a region where the disease had not been documented for several years. The report urges greater vigilance and screening for syphilis among pregnant women and newborns, and contributes to the evidence that the incidence of syphilis is rising among women in Italy.
PMCID: PMC2598640  PMID: 18024711
10.  WHO global strategy for the prevention and control of sexually transmitted infections: time for action 
Sexually Transmitted Infections  2007;83(7):508-509.
STI health professionals should use every opportunity to influence those able to initiate change to improve global STI control and prevention activities
PMCID: PMC2598641  PMID: 18024710
11.  Behaviour change in clients of health centre‐based voluntary HIV counselling and testing services in Kenya 
Sexually Transmitted Infections  2007;83(7):541-546.
To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre‐based voluntary counselling and testing (VCT) clients.
Design and setting
Single‐arm prospective cohort with before–after design at three (one urban and two rural) government health centres in Kenya; study duration 2 years, 1999–2001.
Consecutive eligible adult clients.
Main outcome measures
Numbers of sexual partners, partner type, condom use, reported symptoms of sexually transmitted infection, HIV disclosure and life events.
High rates of enrolment and follow‐up provided a demographically representative sample of 401 clients with mean time to follow‐up of 7.5 months. Baseline indicators showed that clients were at higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed a significant reduction of sexual partners at follow‐up (16% to 6%; p<0.001), and numbers reporting symptoms of sexually transmitted infection decreased significantly also (from 40% to 15%; p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV‐positive clients. Overall, no changes in rates of life events were seen.
This study suggests that significant prevention gains can be recorded in clients receiving health centre‐based VCT services in Africa. Prevention issues should be considered when refining counselling and testing policies for expanding treatment programmes.
PMCID: PMC2598642  PMID: 17991688
12.  [No title available] 
PMCID: PMC2598643
13.  Costs and health consequences of chlamydia management strategies among pregnant women in sub‐Saharan Africa 
Sexually Transmitted Infections  2007;83(7):558-566.
Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity—particularly among women and neonates. We compared costs and health consequences of using point‐of‐care (POC) tests with current syndromic management among antenatal care attendees in sub‐Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age‐based chlamydia management.
A decision analytical model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon (1) a study of pregnant women in Botswana, (2) literature reviews and (3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment.
Azithromycin was less costly and more effective than erythromycin. Compared with syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1500 to 3500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high‐prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management.
Using POC tests to diagnose chlamydia during antenatal care in sub‐Saharan Africa entails greater health benefits than syndromic management does—and at acceptable costs—especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people's health and even reduce healthcare budgets.
PMCID: PMC2598644  PMID: 17932126
14.  Evaluating large‐scale HIV prevention interventions: study design for an integrated mathematical modelling approach 
Sexually Transmitted Infections  2007;83(7):582-589.
There is an urgent need to evaluate HIV prevention interventions, thereby improving our understanding of what works, under what circumstances and what is cost effective.
To describe an integrated mathematical evaluation framework designed to assess the population‐level impact of large‐scale HIV interventions and applied in the context of Avahan, the Indian AIDS Initiative, in southern India. The Avahan Initiative is a large‐scale HIV prevention intervention, funded by the Bill & Melinda Gates Foundation, which targets high‐risk groups in selected districts of the six states most affected by the HIV/AIDS epidemic (Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh, Nagaland and Manipur) and along the national highways.
One important component of the monitoring and evaluation of Avahan relies on an integrated mathematical framework that combines empirical biological and behavioural data from different subpopulations in the intervention areas, with the use of tailor‐made transmission dynamics models embedded within a Bayesian framework.
An overview of the Avahan Initiative and the objectives of the monitoring and evaluation of the intervention is given. The rationale for choosing this evaluation design compared with other possible designs is presented, and the different components of the evaluation framework are described and its advantages and challenges are discussed, with illustrated examples.
This is the first time such an approach has been applied on such a large scale. Lessons learnt from the CHARME project could help in the design of future evaluations of large‐scale interventions in other settings, whereas the results of the evaluation will be of programmatic and public health relevance.
PMCID: PMC2598645  PMID: 17942574
15.  [No title available] 
PMCID: PMC2598646
17.  HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers 
Sexually Transmitted Infections  2007;83(7):534-540.
To assess HIV prevalence and risk factors for HIV infection, to investigate condom use among registered female commercial sex workers (CSWs) in Senegal, West Africa, and to examine the association between previous HIV testing, knowledge of HIV serostatus and condom use with both regular sex partners and clients within this population.
A cross‐sectional study was conducted at three sexually transmitted disease clinics among 1052 Senegalese registered CSWs between 2000 and 2004. Inperson interviews soliciting information concerning demographic characteristics, medical history, sexual behaviour with clients and regular partners, and previous HIV testing history were performed. Blood samples were collected for determination of HIV‐1 and/or HIV‐2 serostatus. Multivariable, Poisson and log‐binomial models were used to calculate prevalence ratios.
The overall HIV prevalence was 19.8%. Over 95% of CSWs reported always using a condom with clients, but only 18% reported always using a condom with their regular partners. A history of previous HIV testing was not associated with condom use with clients (adjusted prevalence ratio (APR) = 0.98, 95% confidence intervals, CI: 0.90 to 1.06). However, prior HIV testing was associated with decreased condom use with their regular partners (APR = 0.44, 95% CI: 0.28 to 0.69), especially in women who tested HIV negative (APR = 0.17, 95% CI: 0.08 to 0.36).
CSWs in Senegal have a high HIV prevalence; therefore preventing HIV transmission from this population to the general population is important. Condom use with regular partners is low among registered CSWs in Senegal, and a prior HIV negative test is associated with even less condom use with regular partners. Intervention efforts to increase condom use with regular sexual partners are needed.
PMCID: PMC2598648  PMID: 17942575
18.  Sex partner acquisition while overseas: results from a British national probability survey 
Sexually Transmitted Infections  2007;83(7):517-522.
Over the past 20 years, there has been a huge increase in the number of overseas trips made by UK residents. Although a number of studies have examined the frequency of overseas partner acquisition, they have used convenience samples and thus are not generalisable to the British general population.
A national probability sample survey was carried out in 1999–2001 of 12 110 men and women aged 16–44 years resident in Britain. Sociodemographic, health‐related, travel, sexual behaviour and attitudinal data were collected by computer‐assisted interviewing. The main outcomes were the proportion of British residents who reported new sexual partners overseas in the past 5 years, the country of origin of these new sex partners, and the association between reporting a new partner while overseas with a range of demographic, behavioural and attitudinal variables.
13.9% of men and 7.1% of women reported having new sexual partner(s) while overseas in the past 5 years. Among respondents who were aged 16–24 and never married, the proportions were significantly higher (23.0% of men and 17.0% of women). Half of those with new sex partners overseas reported their partner's origin as the UK, and over a third as another European country. In addition to age and marital status, reporting new partners overseas was associated with a higher number of partners, paying for sex (among men), reporting a diagnosis of sexually transmitted infection, and HIV testing. Adjustment for sociodemographic factors attenuated the magnitude of, but did not remove, these associations.
A substantial minority of young, unmarried people form new sexual partnerships abroad, but these are typically with residents from the UK or other European countries. Those who have new partners abroad are likely to have higher‐risk sexual lifestyles more generally, and to be at higher risk of sexually transmitted infections. Greater attention should be paid to sexual health promotion for travellers abroad, especially young travellers, emphasising the risks of new sexual relationships with compatriots as well as those from other countries in terms of STI/HIV acquisition and onwards transmission.
PMCID: PMC2598649  PMID: 17991687
19.  Sexual behaviour and HIV infection in black‐Africans in England: results from the Mayisha II survey of sexual attitudes and lifestyles 
Sexually Transmitted Infections  2007;83(7):523-529.
To estimate HIV prevalence and the distribution of high risk sexual behaviours, sexual health service use, and HIV testing among black Africans aged 16 years or over in England. To determine demographic, behavioural and service use factors associated with HIV prevalence.
A cross‐sectional community‐based survey (Mayisha II) in London, Luton and the West Midlands. A short (24‐item) anonymous self‐completion questionnaire with linked voluntary anonymous oral fluid sampling, using an Orasure™ device for HIV testing.
A total of 1359 eligible black African men (51.9%) and women (48.1%) were recruited, of whom 74% (1006) provided a sufficient oral fluid sample for HIV testing. 42.9% of men and 50.9% of women reported ever having had an HIV test. Overall, 14.0% (141, 95% CI 11.9 to 16.3) of respondents tested HIV positive (13.1% of men and 15.0% of women); 9.2% (93) had undiagnosed HIV infection, while 4.8% (48) had a diagnosed HIV infection. HIV prevalence was significantly higher in men: born in East Africa; who had had a previous STI diagnosis; or who were recruited in bars and clubs; and in women: born in East or Southern Africa; aged 25 years and over; who had had two new sexual partners in the past 12 months; or who had had a previous STI diagnosis.
Despite about half the sample having had an HIV test at some time in the past, 9.2% of respondents had an undiagnosed HIV infection. This study supports current policy efforts to further promote HIV testing and serostatus awareness.
PMCID: PMC2598650  PMID: 17932129
20.  A systematic review of published evidence on intervention impact on condom use in sub‐Saharan Africa and Asia 
Sexually Transmitted Infections  2007;83(7):510-516.
There has been much debate about the value of condoms in HIV/STI programming. This should be informed by evidence about intervention impact on condom use, but there is limited compiled literature. This review aims to quantify intervention impact on condom use in sub‐Saharan Africa and Asia, in different types of partnership.
A systematic review was conducted of papers published between 1998 and 2006 presenting evaluations of interventions involving condom promotion in sub‐Saharan Africa and Asia. Data on reported postintervention levels of condom use, and various measures of changes in condom use, by partnership type, were compiled.
A total of 1374 abstracts were identified. Sixty‐two met the inclusion criteria (42 reporting significant increases in condom use): 44 from sub‐Saharan Africa and 18 from Asia. Many (19) reported on condom use in commercial sex (15 significant), six on use with casual partners (three significant), 11 on use in marital/steady partnerships (nine significant), 14 on use by youths (eight significant) and 20 combined partnership types (11 significant). There is substantial evidence of interventions targeted at sex workers and clients achieving large increases in condom use. Far less evidence exists of intervention impact on condom use in casual relationships. In primary partnerships, postintervention condom use was low unless one partner was knowingly HIV‐infected or at high‐risk, or avoiding pregnancy. Evaluations of interventions targeting youths recorded limited increases in condom use.
The findings illustrate the range of evidence about postintervention condom use in different partnerships, and how patterns of use are influenced by partnership type and perceptions of risk. Where possible, intervention studies should also assess biological endpoints, since prevention of infection is the measure of most interest in the evaluation of condom promotion interventions.
PMCID: PMC2598651  PMID: 17932124
21.  [No title available] 
PMCID: PMC2598652
22.  Brief Encounters 
PMCID: PMC2598653
23.  Home‐based versus clinic‐based self‐sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial 
Sexually Transmitted Infections  2007;83(7):552-557.
To test whether more women are screened for sexually transmitted infections when offered home‐based versus clinic‐based testing and to evaluate the feasibility and acceptability of self‐sampling and self‐testing in home and clinic settings in a resource‐poor community.
Women aged 14–25 were randomised to receive a home kit with a pre‐paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self‐collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self‐tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrolment on sociodemographic and sexual history, and at the 6‐week follow‐up on feasibility and acceptability.
626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6‐week follow‐up visit. Forty‐seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea.
Self‐sampling and self‐testing are feasible and acceptable options in low‐income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.
PMCID: PMC2598654  PMID: 17901084
25.  [No title available] 
PMCID: PMC2598656

Results 1-25 (1734)