Sexually transmitted diseases最新文献

Background: Effective HIV pre-exposure prophylaxis (PrEP) promotion is critical to mitigate PrEP disparities, yet there are gaps in understanding how gay, bisexual, and other men who have sex with men (GBM) respond to and prefer PrEP promotion. The Deep South of the United States, a region with high HIV rates and low PrEP uptake, has unique contextual factors that stifle effective PrEP provision and uptake, which could be overcome with effective PrEP promotional messaging.

Methods: We conducted an exploratory qualitative study grounded in Andersen's Behavioral Model for Healthcare Utilization. We recruited HIV-negative GBM, aged 18-39 years, from social media, dating apps, and community outreach to complete semi-structured interviews to explore perceptions of and preferences for PrEP promotion. Interview transcripts were inductively and deductively coded for thematic analysis.

Results: 40 participants completed interviews (median age 28 years, 68% Black, 48% current PrEP users). Three themes emerged: 1) the role of different identities with sub-themes emphasizing diversity to reduce stigma and improve relatability, 2) interpersonal relationships, i.e., friends, partners, and family, affect PrEP promotion, and 3) reduced emphasis on HIV risk in promotions.

Conclusion: To see behavior change for seeking PrEP knowledge and PrEP uptake, PrEP promotions must evolve to improve diversity to foster relatability and reduce stigma, harness social networks to efficiently transmit messaging, and tactfully discuss risk behaviors without compounding stigma.

Introduction: Bacterial vaginosis (BV) is the most prevalent vaginal condition among women, yet limited data exist on how women manage recurring BV and their perceptions of BV triggers. This study aimed to explore women's experiences with BV onset and recurrence, the various self-treatment strategies used, and adherence to medication regimens.

Methods: From March 2020-May 2022, we recruited females at birth ages ≥18 years, who had received a BV diagnosis within the past year at one of four New York City Department of Health and Mental Hygiene (NYC DOHMH) sexual health clinics (SHCs) to take part in semi-structured interviews.

Results: A total of 41 women participated, with over half (n = 23) from the SHC in the Bronx.Most women identified as non-Hispanic or Hispanic Black (n = 32), and nearly a quarter as bisexual (n = 8). Women cited sexual (e.g., partner infidelity) and non-sexual (e.g., diet, perfumed soaps) triggers for BV recurrence. To reduce BV recurrence, women reported engaging in self-management strategies like dietary and hygiene changes, including some practices (e.g., increased douching) that are known to exacerbate BV. Some women reported low adherence to the seven-day metronidazole pill regimen, primarily due to side effects.

Discussion: Findings highlight self-management strategies women use to reduce BV recurrence and indicate further education about which strategies may be helpful or harmful is needed. Some patients may need additional BV medication adherence support for multi-day dosing of oral metronidazole or access to alternate treatment regimens.

Abstract: Treating Neisseria gonorrhoeae infection in patients with cephalosporin allergy represents a significant challenge and highlights urgent need for alternative therapies. This patient case details use of alternative antimicrobials to cure urogenital and pharyngeal gonorrhea in a patient with a severe ceftriaxone allergy in the outpatient clinical setting.

Background: Pelvic inflammatory Disease (PID) disproportionately impacts adolescents and young adult women. The Technology-Enhanced Community Health Nursing (TECH-N) trial demonstrated the potential benefit of a novel community health intervention for adolescents with PID. We assess the cost-effectiveness of TECH-N compared to standard care.

Methods: We constructed a cohort Markov model to assess the cost-effectiveness of TECH-N for adolescents with PID in an urban setting. The model used nine health states: PID, two states for STIs, four states for PID sequelae, recovery and deceased states. The cohort consisted of 18-year-old female adolescents with mild to moderate PID. Transition probabilities were derived from the TECH-N clinical trial and published literature. Health state utilities were derived from published literature. Intervention costs were estimated using TECH-N data, and health state costs were derived from published literature and public databases. The model took a health system perspective over a 10-year time horizon. Sensitivity analyses were used to assess uncertainty. Cost-effectiveness was estimated using the discounted incremental cost-effectiveness ratio (ICER) with effects measured in quality-adjusted life years (QALYs).

Results: Over ten years, the TECH-N cohort generated 8.16 QALYs per individual at a cost of $20,419 compared to standard care with 8.14 QALYs costing $20,492. The resulting ICER was negative since the intervention produced more QALYs at a lower cost; suggesting TECH-N is cost-saving.

Conclusions: Our model suggests the TECH-N intervention yields better outcomes at lower overall costs. Additionally, the nature of TECH-N lends itself to being coupled with other home-health/community strategies, which could further improve its value proposition.

Abstract: Background: Increased incidence of bacterial sexually transmitted infections including chlamydia, gonorrhea, and syphilis dictates the need for novel prevention strategies. One such strategy, doxycycline prescribed prophylactically, has proven to be effective at reducing transmission among men who have sex with men (MSM) and transgender women. We assessed awareness, attitudes, and interest in doxycycline pre-exposure/post-exposure prophylaxis (doxyPrEP/doxyPEP) among New York City (NYC) Sexual Health Clinic (SHC) patients, including MSM, other cisgender men, women, transgender persons, and patients identifying as gender non-conforming or non-binary.Methods: A self-administered survey was completed by 280 patients from five NYC SHCs between June-August 2023 that collected information assessing their knowledge, concerns, and willingness to use doxyPrEP and doxyPEP. We used Poisson regression models to examine factors associated with willingness to use doxyPEP.Results: Of the 280 patients, 73% (205) and 55% (153) reported they would take doxyPEP and doxyPrEP, respectively, if offered by their provider. Willingness to use doxyPEP was observed across gender groups and significantly associated with history or current use of HIV pre-exposure prophylaxis (adjusted risk ratio (aRR) 1.17, 95% CI: 1.07-1.27). Compared to non-Hispanic white participants, Hispanic (aRR 1.27, 95% CI: 1.07-1.52) and Non-Hispanic Other (Alaskan Native, American Indian, Native Hawaiian, Pacific Islander, multiracial) group (aRR 1.28, 95% CI: 1.06-1.56) participants were more likely to report willingness to use doxyPEP. Possible antibiotic resistance was of highest concern.Conclusions: If offered by a provider, doxyPEP would likely be accepted by patients of all gender groups. Additional research on acceptability in other settings would help guide widespread implementation.

Abstract: In a pharmacy-based Data to Care project in Washington during August 2019-December 2021, two pharmacies identified 762 cases of persons who were 35-65 days late refilling antiretroviral medications; 119 (16%) case investigations led to contact with a person who had discontinued treatment, 43 (36%) of whom restarted medications after outreach.

Background: In 2023, Washington state Medicaid eliminated prior authorizations (PAs) for antiretrovirals (ARVs). We estimated the budget impact of this policy change on Medicaid ARV expenditures, 2023-2027.

Methods: Models used 2022 net drug costs reflecting costs minus rebates. Our base case pre-exposure prophylaxis (PrEP) model assumed changes in the proportions of PrEP users on tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), tenofovir alafenamide/emtricitabine (TAF/FTC), and cabotegravir (CAB) based on 2021-2022 data (prior to elimination of PAs). We compared base case costs to models assuming changes in PrEP prescribing observed 2022-2023 (first year after elimination of PAs), and models assuming an accelerated increase in TAF/FTC and CAB use. For HIV treatment, models assumed ARV changes based on 2021-2022 data (Base Model), changes based on data from 2022-2023 (No PA - Stable Increase), and a model based on 2022-2023 data but with a declining rate of change in the adoption of bictegravir/TAF/FTC and CAB/rilpivirine (No PA - Declining Increase). We estimated the number of persons with HIV (PWH) who might be housed using money required to meet new ARV costs using 2023 local Ryan White Program costs for emergency or temporary housing.

Results: Elimination of PAs will increase Medicaid expenditures for ARVs by an estimated $109.9-$157.7 million over 5 years. This cost would pay for 5 years of housing for approximately 820-1,177 people, or 61-88% of unstably housed PWH in Washington state.

Conclusions: Elimination of Medicaid PAs will result in substantial new costs. Changes in drug formulary policy should consider opportunity costs.

Background: Free-text notes in disease intervention specialist (DIS) records may contain relevant information for STI control. In their current form, the notes are not analyzable without manual reading, which is labor-intensive and prone to error.

Methods: We used natural language processing (NLP) methods to analyze 2019 Ohio DIS syphilis records with non-missing notes (n = 1,987). We identified 21 topics relevant for transmission and case investigations. We manually coded these records to create "gold standard" labels for each topic (0 = topic not present, 1 = topic present), then trained machine learning models to identify the topics in the text. For models to analyze text data, the text must be converted to numbers. We explored two approaches to numerically represent words: (1) term frequency, inverse document frequency (TF-IDF), which measures importance of words based on how many times they appear in a record and in the dataset as a whole, and (2) GloVe embeddings, which are numerical vectors that were developed by researchers for each word in the English language to encode its semantic meaning. We explored three types of statistical models (naïve Bayes, support vector machine [SVM], and logistic regression) using TF-IDF, and one type of neural network model (long short-term memory [LSTM] model) using GloVe. All models were used for binary prediction (i.e., topic not present, topic present).

Results: For most topics, the LSTM model performed the best overall in identifying topics, and the SVM model performed the best among the statistical models. For example, the LSTM model predicted the topic "substance use" with high accuracy (97%), sensitivity (92%), and specificity (98%). No model performed well for uncommon topics (e.g., "alcohol use" or "delays in care").

Conclusions: Machine learning models performed well in identifying some topics in 2019 Ohio syphilis records. This analysis is a first step in applying NLP methods to making DIS notes more accessible for analysis.

Background: The 2022 mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Mpox cases continue to be reported nationally. Vaccination is a tool to prevent the spread of and serious disease from mpox. To understand mpox vaccine uptake and hesitancy, a virtual focus group with unvaccinated GBMSM was conducted.

Methods: In November 2022, a 60-minute, virtual focus group was conducted within an artificial intelligence (AI) platform that engages participants in chat-based conversation. The AI system uses machine learning and natural language processing to analyze and provide results immediately to the moderator. Descriptive frequencies, cross-tabulations, and qualitative themes were analyzed.

Results: Fifty-one GBMSM aged 18 to 55 years participated, of whom 12 had attempted to get the mpox vaccine. The top barriers in accessing the vaccine included challenges in scheduling appointments (4 of 12), available vaccine locations (3 of 12), and transportation (2 of 12). Nine participants reported not wanting the vaccine, and 22 were undecided; of these, 15 (4 of 9 and 11 of 22, respectively) said they did not think they needed the vaccine due to low perceived risk or monogamy. Among the undecided, after receiving health messaging about mpox, 12 of 22 said the messaging made them reconsider getting the vaccine.

Conclusion: During an outbreak, many unvaccinated GBMSM who may be at increased risk for mpox either wanted the vaccine or, with appropriate health messaging, may be open to getting the vaccine. Messaging about mpox vaccine efficacy, potential side effects, and how to access the vaccine may improve vaccine uptake especially as cases continue to occur.