Publications by authors named "Claire Bristow"

79 Publications

Pooled 3-anatomic site testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A systematic review and meta-analysis.

Sex Transm Dis 2021 Sep 16. Epub 2021 Sep 16.

Department of Family Medicine and Public Health, University of California, San Diego The Library, University of California, San Diego FHI 360, Jakarta, Indonesia Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego.

Background: Pooled testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may be a cost-saving solution to increase screening by simplifying testing procedures and reducing resource burdens. We conducted a systematic review and meta-analysis to examine the performance of pooled three-anatomical site testing (pharyngeal, rectal, and urogenital sites) for CT and NG in comparison to single-anatomical site testing.

Methods: We conducted a systematic literature search in PubMed, Embase, and Web of Science to identify original evaluation studies of the performance of pooled testing for CT and NG infections and identified 14 studies for inclusion. Each study was systematically evaluated for bias. We conducted bivariate fixed-effect and random-effects meta-analyses using a full Bayesian method of the positive percent agreement and negative percent agreement.

Results: The combined positive percent agreement for CT was 93.11% (95% Confidence interval (CI): 91.51%, 94.55%) and the negative percent agreement was 99.44% (95% CI: 99.18%, 99.65%). For NG, the combined positive percent agreement was 93.80% (95% CI: 90.26%, 96.61%) and the negative percent agreement was 99.73% (95% CI: 99.30%, 99.97%).

Conclusion: We found that pooled three-anatomic site tests performed similarly to single-site anatomical tests for the detection of CT and NG. The pooled three-anatomic site tests have the added potential benefit of reduced cost and resource requirement, which could lead to improved testing access and screening uptake.
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http://dx.doi.org/10.1097/OLQ.0000000000001558DOI Listing
September 2021

Selective blood-brain barrier permeabilisation of brain metastases by a type-1 receptor selective tumour necrosis factor mutein.

Neuro Oncol 2021 Jul 23. Epub 2021 Jul 23.

Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK.

Background: Metastasis to the brain is a major challenge with poor prognosis. The blood-brain barrier (BBB) is a significant impediment to effective treatment, being intact during the early stages of tumour development and heterogeneously permeable at later stages. Intravenous injection of tumour necrosis factor (TNF) selectively induces BBB permeabilisation at sites of brain micrometastasis, in a TNF type-1 receptor (TNFR1) dependent manner. Here, to enable clinical translation, we have developed a TNFR1-selective agonist variant of human TNF that induces BBB permeabilisation, whilst minimising potential toxicity.

Methods: A library of human TNF muteins (mutTNF) were generated and assessed for binding specificity to mouse and human TNFR1/2, endothelial permeabilising activity in vitro, potential immunogenicity and circulatory half-life. The permeabilising ability of the most promising variant was assessed in vivo in a model of brain metastasis.

Results: The primary mutTNF variant showed similar affinity for human TNFR1 than wild-type human TNF, similar affinity for mouse TNFR1 as wild-type mouse TNF, undetectable binding to human/mouse TNFR2, low potential immunogenicity and permeabilisation of an endothelial monolayer. Circulatory half-life was similar to mouse/human TNF and BBB permeabilisation was induced selectively at sites of micrometastases in vivo, with a time window of ≥24h and enabling delivery of agents within a therapeutically-relevant range (0.5-150kDa), including the clinically approved therapy, trastuzumab.

Conclusions: We have developed a clinically-translatable mutTNF that selectively opens the BBB at micrometastatic sites, whilst leaving the rest of the cerebrovasculature intact. This approach will open a window for brain metastasis treatment that currently does not exist.
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http://dx.doi.org/10.1093/neuonc/noab177DOI Listing
July 2021

Anti-obesity public health advertisements increase risk factors for the development of eating disorders.

Health Promot Int 2021 Jul 19. Epub 2021 Jul 19.

Faculty of Education, Monash University, Melbourne Victoria, Australia.

Although overweight and obesity are increasing in prevalence, eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder are simultaneously on the rise. It is important to address the burden of disease of overweight and obesity on the population, yet there is concern that some of these efforts may be encouraging unhealthy weight control behaviours (UWCB). Using an online survey, 137 participants were exposed to four anti-obesity public health advertisements presented in random order. Weight satisfaction, shape satisfaction, desire to control weight, desire to control shape and desire to engage in UWCB were measured on a 100-point visual analogue scale. A significant effect of the experimental condition was found after exposure to Image 1 with a decrease in weight satisfaction, and increased desire to control body weight, body shape and engage in UWCB. Mean scores for UWCB also increased, on average, across all four image conditions. Public health advertisements targeting obesity risk encouraging unhealthy weight control and subsequent disordered eating behaviours. Those responsible for the implementation of such advertisements must consider very carefully the potential to cause unintended harm.
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http://dx.doi.org/10.1093/heapro/daab107DOI Listing
July 2021

The Performance of Pooled 3 Anatomic Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae Among Men Who Have Sex With Men and Transgender Women.

Sex Transm Dis 2021 Oct;48(10):733-737

From the Division of Infectious Disease and Global Public Health, Department of Medicine, University of California San Diego.

Background: Although molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is highly sensitive, the cost can be prohibitive. Those high costs are amplified when the recommended screening approach is used, which requires separate testing of specimens from 3 anatomic sites (rectal, pharyngeal and urogenital). Although individual molecular testing is standard of care, pooled testing may offer a cost-saving alternative.

Methods: Using the Xpert® CT/NG assay (Cepheid, Sunnyvale, CA) we tested urine, rectal and pharyngeal swabs for CT and NG in a high-risk cohort of participants assigned male at birth who reported sex with other persons who were assigned male at birth. Remnant specimens (0.34 mL from each anatomic site) were combined to perform a single 'pooled' test. We calculated positive and negative percent agreement between the pooled testing results with standard of care Xpert CT/NG test results as the reference.

Results: We conducted 644 pooled tests. Of those, 598 (92.3%) gave CT and NG results. The CT-positive and -negative percent agreement were 90.1% (95% confidence interval [CI], 80.7-95.9%) and 99.2% (98.1-99.8%), respectively. The NG-positive and -negative percent agreement were 96.2% (95% CI, 86.8-99.5%) and 99.8% (95% CI, 99.0-100%), respectively. Pooled testing identified 4 CT and 1 NG infections that were negative at all anatomic sites by individual testing.

Conclusions: Three-site pooled CT and NG testing performs similarly to single anatomic site testing among tests providing a valid result. Future cost analyses should evaluate the cost effectiveness of pooled 3-site testing to determine if such a strategy improves the feasibility and accessibility of molecular sexually transmitted infection testing.
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http://dx.doi.org/10.1097/OLQ.0000000000001411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435040PMC
October 2021

Acceptability and feasibility of screening pregnant women for sexually transmitted infections in Rawalpindi, Pakistan.

Int J STD AIDS 2021 09 19;32(10):940-945. Epub 2021 May 19.

12222David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

To understand the acceptability and feasibility of sexually transmitted infection (STI) testing during antenatal care, along with the prevalence of STIs, in Rawalpindi, Pakistan. We enrolled pregnant women seeking antenatal care and performed STI testing using Cepheid GeneXpert® CT/NG and TV kits and Alere Determine™ HIV and syphilis tests. We used interviewer-administered surveys to collect medical, social, and sexual histories. Participants testing positive for STIs and their partners were treated. We enrolled 1001 women from September to December 2019. Nearly all women offered to participate in this study enrolled. Most women understood the effects an STI can have on their pregnancy (99.6%) and valued STI screening during pregnancy (98.1%). 11 women tested positive for any STI: ( = 4, = 1, and = 6). Of those, six presented for a test-of-cure, and two were positive for . None tested positive for HIV infection or syphilis ( = 503). STI testing during antenatal care in Rawalpindi was acceptable, valued, understood, and feasible. The prevalence of STIs in pregnant women was low. Continued prevalence monitoring is warranted.
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http://dx.doi.org/10.1177/09564624211007681DOI Listing
September 2021

Impact of Testing on Sexually Transmitted Infections among Female Brothel Sex Workers in Bangladesh: A Randomized Controlled Trial.

Am J Trop Med Hyg 2021 Apr 5. Epub 2021 Apr 5.

1Department of Economics, Monash University, Melbourne, Australia.

Past studies that have designed interventions to reduce the prevalence of sexually transmitted infections (STIs) have typically provided onsite treatment to sex workers who tested positive, which were expensive and difficult to implement. The purpose of this study was to examine the effect of an intervention which tested for STIs and provided information on the closest treatment facility on reducing the prevalence of STIs among female brothel-based sex workers (BSWs) in Bangladesh. The study adopted a pre-post interventional design as well as a randomized controlled study design. A baseline sample and follow-up urine sample were collected to evaluate the prevalence of STIs among participants in the treatment, but not control group. A baseline survey and interviews were also conducted for both the groups. The study found a nonsignificant reduction from baseline to follow-up in STI prevalence among intervention participants (adjusted odds ratio [aOR]: 0.74; 95% CI: 0.38, 1.45). However, the participants in the intervention group were significantly more likely to have a repeat client (aOR: 1.60; 95% CI: 1.12, 2.29) and nonsignificantly less likely to engage with a client suspected of having an STI (aOR: 0.62; 95% CI: 0.39, 1.00) than participants in the control group. The intervention testing of STIs and providing information to the positive cases about nearest treatment facilities were not effective in reducing the prevalence of STIs among BSWs. Further study of the clinical and behavioral impacts of such efforts to reduce STIs among BSWs is warranted.
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http://dx.doi.org/10.4269/ajtmh.20-0942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176494PMC
April 2021

Clinical Factors Associated with Presumptive and Accurate Presumptive Treatment of Neisseria gonorrhoeae Infections in Men Who Have Sex with Men and Transgender Women.

Clin Infect Dis 2021 Feb 24. Epub 2021 Feb 24.

AIDS Healthcare Foundation, Public Health Division, Los Angeles, CA, United States.

Background: Neisseria gonorrhoeae (N. gonorrhoeae) infections have increased among men who have sex with men and are high among transgender women. Presumptive treatment guidelines may lead to inaccurate treatments and possible antibiotic resistance. Using patient data from AIDS Healthcare Foundation sexually transmitted infection (STI) testing clinics in California and Florida, we identified clinical factors associated with accurate presumptive N. gonorrhoeae treatment.

Methods: Multivariable logistic regression analyses were conducted using patient visit data from 2013-2017. A sample of 42,050 patient encounters were analyzed. The primary outcome variable included accurate versus inaccurate presumptive treatment. Risk ratios were generated for particular symptoms, high risk sexual behavior, and history of N. gonorrhoeae.

Results: Twelve percent (5,051/42,050) of patients received presumptive N. gonorrhoeae treatment and 46% (2,329/5,051) of presumptively treated patients tested positive for N. gonorrhoeae infection. Patients presenting with discharge or patients presenting with dysuria were more likely to receive accurate presumptive treatment.

Conclusion: Providers should continue to follow The Centers for Disease Control and Prevention guidelines and consider presumptive N. gonorrhoeae treatment based on specific symptoms. As the STI epidemic continues to rise in the United States, along with increased antibiotic resistance, it is imperative to accurately test, diagnose, and treat populations at risk for N. gonorrhoeae and other STIs.
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http://dx.doi.org/10.1093/cid/ciaa1828DOI Listing
February 2021

Prevalence of bacterial sexually transmitted infections and coinfection with HIV among men who have sex with men and transgender women in Tijuana, Mexico.

Int J STD AIDS 2021 07 3;32(8):751-757. Epub 2021 Feb 3.

Division of Infectious Diseases and Global Public Health, Department of Medicine, 8784University of California, San Diego, CA, USA.

We estimated the prevalence of syphilis and (CT) and (NG) infections, as well as human immunodeficiency virus (HIV) coinfection among cisgender men who have sex with cisgender men (MSM) and transgender women (TW) in Tijuana, Mexico. MSM and TW ( = 212) recruited via respondent-driven and venue-based sampling for HIV testing underwent sexually transmitted infection (STI) testing and completed interviewer-administered surveys in this study (2017-2018). Treponemal rapid tests were used at the point-of-care with positives undergoing confirmatory testing following the reverse syphilis-testing algorithm. Nucleic acid amplification testing of urine and swabs (rectal and pharyngeal) was used to detect CT/NG at three anatomic sites. Chi-squared tests were used to compare STI prevalence by HIV status. Sexually transmitted infection prevalence was 39.6% overall but higher for newly diagnosed HIV-positive (55.7%; = 88) than HIV-negative (28.2%; = 124) participants (-value < 0.0001). Among newly diagnosed HIV-positive participants, the prevalence of syphilis was 35.2% (31/88), CT infection was 27.3% (24/88; nine urethral; 16 rectal; four pharyngeal), and NG infection was 26.1% (23/88; six urethral; 19 rectal; nine pharyngeal). Among HIV-negative participants, the prevalence of syphilis was 12.1% (15/124), CT infection was 13.7% (17/124; seven urethral; nine rectal; two pharyngeal), and NG infection was 9.7% (12/124; three urethral; seven rectal; seven pharyngeal). Over 60% of all CT (25/41) and NG (26/35) infections in the full sample occurred extragenitally in the absence of urethral infections, and over 80% of rectal (30/37) and pharyngeal (16/18) infections were asymptomatic. The high prevalence of syphilis, CT, and NG infections among MSM and TW in Tijuana suggests STI screening that includes extragenital tests, particularly at HIV diagnosis, may help curb HIV/STI transmission.
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http://dx.doi.org/10.1177/0956462420987757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154699PMC
July 2021

Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States.

Sex Transm Dis 2021 07;48(7):466-473

Department of Family Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.

Abstract: Associations between substance use disorders and outbreaks of HIV and acute viral hepatitis have received considerable attention, but less research has focused on links between substance use disorders and sexually transmitted infections, apart from alcohol misuse. This narrative review describes the history of this public health crisis in the United States and direct and indirect effects opioids and specific stimulants have on high-risk sexual behaviors. We also review the epidemiology of sexually transmitted infections associated with opioids and stimulants in the United States and discuss opportunities for integrated interventions.
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http://dx.doi.org/10.1097/OLQ.0000000000001341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184578PMC
July 2021

Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study.

Lancet Infect Dis 2021 05 23;21(5):668-676. Epub 2020 Nov 23.

Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA.

Background: Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device.

Methods: Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Q Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Q Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status.

Findings: Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2-99·2) and specificity of 98·3% (97·5-98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5-99·5) and specificity of 99·4% (98·9-99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5-99·9) and specificity of 96·9% (95·8-97·7) for T vaginalis (n=1449).

Interpretation: This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases.

Funding: Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases.
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http://dx.doi.org/10.1016/S1473-3099(20)30734-9DOI Listing
May 2021

Resistance-Guided Treatment of Gonorrhea: A Prospective Clinical Study.

Clin Infect Dis 2021 07;73(2):298-303

Department of Medicine, University of California, San Diego, La Jolla, California, USA.

Background: Novel treatment strategies to slow the continued emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae are urgently needed. A molecular assay that predicts in vitro ciprofloxacin susceptibility is now available but has not been systematically studied in human infections.

Methods: Using a genotypic polymerase chain reaction assay to determine the status of the N. gonorrhoeae gyrase subunit A serine 91 codon, we conducted a multisite prospective clinical study of the efficacy of a single oral dose of ciprofloxacin 500 mg in patients with culture-positive gonorrhea. Follow-up specimens for culture were collected to determine microbiological cure 5-10 days post-treatment.

Results: Of the 106 subjects possessing culture-positive infections with wild-type gyrA serine N. gonorrhoeae genotype, the efficacy of single-dose oral ciprofloxacin treatment in the per-protocol population was 100% (95% 1-sided confidence interval, 97.5-100%).

Conclusions: Resistance-guided treatment of N. gonorrhoeae infections with single-dose oral ciprofloxacin was highly efficacious. The widespread introduction and scale-up of gyrA serine 91 genotyping in N. gonorrhoeae infections could have substantial medical and public health benefits in settings where the majority of gonococcal infections are ciprofloxacin susceptible.

Clinical Trials Registration: NCT02961751.
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http://dx.doi.org/10.1093/cid/ciaa596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282307PMC
July 2021

Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities.

Int J STD AIDS 2020 08 5;31(9):866-875. Epub 2020 Jul 5.

Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA.

This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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http://dx.doi.org/10.1177/0956462420929463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226424PMC
August 2020

Clinical Test Performance of a Rapid Point-of-Care Syphilis Treponemal Antibody Test: A Systematic Review and Meta-analysis.

Clin Infect Dis 2020 06;71(Suppl 1):S52-S57

District of Columbia Department of Forensic Sciences, Public Health Laboratory Division, Washington, DC, USA.

We reviewed relevant syphilis diagnostic literature and conducted a meta-analysis to address the question, "What is the sensitivity and specificity of the Syphilis Health Check, a rapid qualitative test for the detection of human antibodies to Treponema pallidum." The Syphilis Health Check is the only rapid syphilis test currently cleared by the Food and Drug Administration (FDA). We conducted a systematic review and a meta-analysis using Bayesian bivariate random-effects and fixed-effect models to create pooled estimates of sensitivity and specificity of the Syphilis Health Check. We identified 5 test evaluations published in the literature and 10 studies submitted to the FDA and for a Clinical Laboratory Improvement Amendments waiver application. The pooled sensitivity (95% CI) from the laboratory evaluations (n = 5) was 98.5% (92.1-100%), while pooled specificity was 95.9% (81.5-100.0%). The pooled sensitivity for prospective studies (n = 10) was 87.7% ( 71.8-97.2%), while pooled specificity was 96.7% (91.9-99.2%). Using nontreponemal supplemental testing, the sensitivity improved to a pooled sensitivity of 97.0% (94.8-98.6%). The Syphilis Health Check may provide accurate detection of treponemal antibody.
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http://dx.doi.org/10.1093/cid/ciaa350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312211PMC
June 2020

Anti-obesity public health messages and risk factors for disordered eating: a systematic review.

Health Promot Int 2020 Dec;35(6):1551-1569

Faculty of Education, Monash University, Wellington Road Clayton, Melbourne, VIC 3800, Australia.

In response to the increasing prevalence of overweight and obesity, public health efforts to curb these conditions have been delivered in abundance. There is concern however that the messages used to target these conditions may be increasing risk factors for disordered eating. Therefore, we sought to systematically review the literature on the effects of anti-obesity public health messages on risk factors for disordered eating. Seven electronic databases were searched for articles meeting the inclusion criteria, resulting in the inclusion of 12 studies of various methodologies that measured one or more risk factors for disordered eating following exposure to public health messages. Few studies specifically and accurately measured disordered eating behaviours. Most studies found that messages were stigmatizing towards persons who are overweight/obese, and exacerbate thin ideals and drive for thinness. Interestingly, the same was not found for measures of body dissatisfaction. Messages promoting smaller meals were also thought to be potential triggers for disordered eating. Whilst the studies included in this review offered both quantitative and qualitative insights into how public health messages may have adverse effects on eating behaviours, there was a consistent lack of valid reporting measures and clear classification of outcomes overall. Hence, future research is recommended using valid reporting tools such as validated questionnaires, as well as prolonged exposure to the intervention condition to determine longer-term impact.
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http://dx.doi.org/10.1093/heapro/daaa018DOI Listing
December 2020

Sexually Transmitted Infections in Pregnancy and Reproductive Health: Proceedings of the STAR Sexually Transmitted Infection Clinical Trial Group Programmatic Meeting.

Sex Transm Dis 2020 01;47(1):5-11

Department of Pediatrics.

The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on Sexually Transmitted Infections (STIs) in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, nonprofit, and industry discussed the burden of STIs during pregnancy; the impact of STIs on adverse pregnancy and birth outcomes; interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) alternative treatments and therapies for use during pregnancy are needed; (ii) further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) more research to determine whether STI tests function equally well in pregnant as nonpregnant women is needed; (iv) development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) policies should be implemented that create standard screening and treatment practices globally; (vi) federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).
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http://dx.doi.org/10.1097/OLQ.0000000000001075DOI Listing
January 2020

Measuring Self-Esteem Changes in Children and Adolescents Affected by Overweight or Obesity: A Scoping Review of Instruments Currently Used in Multicomponent Weight-Management Interventions.

Child Obes 2019 12 31;15(8):485-501. Epub 2019 Jul 31.

Department of Nutrition, Dietetics, and Food, Monash University, Notting Hill, Australia.

Children and adolescents affected by overweight or obesity are at risk of greater declines in self-esteem than healthy-weight individuals. Participation in multicomponent weight-management programs can positively influence self-esteem in children and adolescents affected by overweight or obesity; however, the variety of questionnaires used to assess self-esteem makes it difficult to compare changes across and identify effective interventions. This review identified and critically examined questionnaires currently used for monitoring self-esteem in children and adolescents. An electronic search, from 2007 onward, identified multicomponent weight-management interventions that included a measure of self-esteem. A second search identified studies that reported validation assessment of the questionnaires identified in search one. Seven validated self-esteem questionnaires were employed across the 36 studies identified in search one, including (in descending order of use) Harter's Self-Perception Profiles for children and adolescents, Rosenberg Self-Esteem Scale, Marsh's Self-Description Questionnaire-I, Beck Youth Inventory II, Piers-Harris Self-Concept Scale, and Children and Youth Physical Self-Perception Profile. These tools measured global self-esteem ( = 1) as well as self-esteem as a series of subscales (multidimensional), such as physical appearance and social competence ( = 6). In the absence of changes in global self-esteem, multidimensional tools allow the examination of domains of self-esteem. The Harter's Self-Perception Profile for Children (SPPC) and adolescents questionnaire is an example of a tool that encompasses multidimensional aspects of self-esteem and global self-esteem and is appropriate for younger and older aged children and adolescents.
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http://dx.doi.org/10.1089/chi.2019.0058DOI Listing
December 2019

Meta-analysis of the Cepheid Xpert CT/NG assay for extragenital detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections.

Sex Health 2019 08;16(4):314-319

Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA.

Background Most studies evaluating extragenital testing performance for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) detection by the Xpert® CT/NG show high per cent agreement with comparison assays; however, the precision around positive per cent agreement is low and thus the values that have been reported are not highly informative. Therefore, a systematic review was conducted and data from five studies were combined to better assess positive per cent agreement.

Methods: The literature indexed on PubMed.gov was searched. Included studies were those that were an evaluation of the Xpert CT/NG assay with rectal and/or pharyngeal specimen types compared with another nucleic acid amplification test (NAAT), the Aptima transcription mediated amplification assay. A full Bayesian method was used for bivariate fixed-effect meta-analysis of positive and negative per cent agreement and pooled estimates (and 95% confidence intervals (CI)) were presented for each.

Results: The pooled positive and negative per cent agreement for detection of CT in rectal specimens was 89.72% (95% CI: 84.97%, 93.64%) and 99.23% (95% CI: 98.74%, 99.60%), and in pharyngeal specimens, they were 89.96% (95% CI: 66.38%, 99.72%) and 99.62% (95% CI: 98.95%, 99.95%) respectively. For NG detection in rectal specimens, the pooled positive and negative per cent agreement was 92.75% (95% CI: 87.91%, 96.46%) and 99.75% (95% CI: 99.46%, 99.93%), and in pharyngeal specimens, they were 92.51% (95% CI: 85.84%, 97.18%) and 98.56% (95% CI: 97.69%, 99.23%) respectively.

Conclusions: It was found that the Xpert CT/NG assay performed similarly to the Aptima transcription mediated amplification assay for the detection of CT and NG in extragenital specimens. The Xpert assay has the benefit of providing faster results at the point-of-care, thus reducing the turnaround time for results, potentially enabling same-day treatment.
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http://dx.doi.org/10.1071/SH18079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954977PMC
August 2019

Changes in nutrition and dietetic research: A content analysis of the past decade of Dietitians Association of Australia conference abstracts.

Nutr Diet 2019 11 12;76(5):634-641. Epub 2019 Jun 12.

Department of Nutrition, Dietetics & Food, Monash University, Melbourne, Victoria, Australia.

Aim: As a sample of research outputs supported by the nutrition and dietetics profession in Australia, the present study aimed to conduct a content analysis of Dietitians Association of Australia (DAA) conference abstracts to identify themes, methods and contribution by geographical location over time.

Methods: Conference abstracts published during the period 2008-2018 (excluding those from the International Congress of Dietetics in 2012) were obtained. Key outcome data including topics of research and methodological approach were extracted. Leximancer, a computer-assisted content analysis program, was used in the development of concept maps. Thematic analysis was undertaken independently by two authors and consensus was obtained.

Results: A total of 2246 oral and poster presentation abstracts and 56 plenary abstracts were imported and synthesised. The most commonly utilised research designs were cross-sectional studies and evaluation research. There was a significant increase in the proportion of systematic literature reviews, and a decreasing proportion of randomised controlled trials presented across the study period. Output was greatest from authors in Queensland and New South Wales. A clear spike in abstracts was observed for the host state across all years. Since 2015 concept maps appeared more interconnected, suggesting a trend for research focus towards integrated nutrition topics. Overarching themes for emerging research topics included Indigenous nutrition and the curriculum for dietetics education. Food/foods emerged as a theme across multiple research methods and in a wide range of contexts and settings.

Conclusions: The synthesis of findings suggests that research presented at the DAA conference is largely practice driven.
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http://dx.doi.org/10.1111/1747-0080.12563DOI Listing
November 2019

Prevalence and correlates of cervical abnormalities among female sex workers in Tijuana, Mexico.

Int J STD AIDS 2019 08 3;30(9):861-867. Epub 2019 Jun 3.

1 Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.

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http://dx.doi.org/10.1177/0956462419841464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901098PMC
August 2019

Knowledge and testing preferences for , and infections among female undergraduate students.

J Am Coll Health 2020 10 29;68(7):754-761. Epub 2019 May 29.

Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.

Our goal was to evaluate knowledge and testing preferences for (CT) (NG), and (TV) infections. We surveyed female undergraduates attending the University of California, Los Angeles, in May 2017. Using an online survey, we collected demographic information and information on 793 participants' health care seeking behavior, sexual activity, sexually transmitted infection (STI) knowledge, and STI screening preferences. We used conjoint analysis to evaluate testing preferences of hypothetical STI tests. On knowledge questions of CT and NG infections, 193 (27.7%) participants scored >80% correct. Cost had the largest impact on willingness to use a hypothetical STI test, accounting for 41.5% of preference, followed by specimen type (17.4%), and location of testing (16.4%). Knowledge regarding STIs was low. Educational programs implemented through the university health center might increase testing rates. A free, urine-based, home STI test may be desirable for undergraduate females.
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http://dx.doi.org/10.1080/07448481.2019.1616742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883138PMC
October 2020

Assessing the impact of diet, exercise and the combination of the two as a treatment for OSA: A systematic review and meta-analysis.

Respirology 2019 08 22;24(8):740-751. Epub 2019 May 22.

School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.

This study aimed to provide an updated systematic review and meta-analysis of randomized controlled trials (RCT) investigating the effectiveness of lifestyle interventions on weight loss and the impact on the severity of obstructive sleep apnoea (OSA). A systematic search of five databases between 1980 and May 2018 was used to identify all RCT which employed a lifestyle intervention (i.e. diet-only, exercise-only or combination of the two) aiming to reduce the severity of OSA (assessed using the apnoea-hypopnoea index (AHI)). Random-effects meta-analyses followed by meta-regression were conducted. Ten RCT involving 702 participants (Intervention group: n = 354; Control group: n = 348) were assessed in two meta-analyses. The weighted mean difference in AHI (-8.09 events/h, 95% CI: -11.94 to -4.25) and body mass index (BMI, -2.41 kg/m , 95% CI: -4.09 to -0.73) both significantly favoured lifestyle interventions over control arms. Subgroup analyses demonstrated that all interventions were associated with reductions in the AHI, but only the diet-only interventions were associated with a significant reduction in BMI. No association was found between the reduction in AHI or BMI and the length of the intervention, or with baseline AHI and BMI levels. All lifestyle interventions investigated appear effective for improving OSA severity and should be an essential component of treatment for OSA. Future research should be directed towards identifying subgroups likely to reap greater treatment benefits as well as other therapeutic benefits provided by these interventions.
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http://dx.doi.org/10.1111/resp.13580DOI Listing
August 2019

Closed Genome Sequences of Clinical Neisseria gonorrhoeae Strains Obtained from Combined Oxford Nanopore and Illumina Sequencing.

Microbiol Resour Announc 2019 Feb 28;8(9). Epub 2019 Feb 28.

J. Craig Venter Institute, Rockville, Maryland, USA.

Neisseria gonorrhoeae is the etiological agent of gonorrhea, the second most common notifiable disease in the United States. Here, we used a hybrid approach combining Oxford Nanopore Technologies MinION and Illumina MiSeq sequencing data to obtain closed genome sequences of nine clinical N. gonorrhoeae isolates.
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http://dx.doi.org/10.1128/MRA.00072-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395865PMC
February 2019

Field evaluation of a dual rapid Human Immunodeficiency Virus and treponemal syphilis rapid test in community-based clinics in Los Angeles and New York.

Diagn Microbiol Infect Dis 2019 Apr 11;93(4):325-328. Epub 2018 Oct 11.

David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Los Angeles, CA, 90024, USA.

Introduction: Dual human immunodeficiency virus/syphilis rapid diagnostic devices can play an important role in prevention efforts. The field performance of the INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test (Multiplex) was evaluated.

Methods: Fingerstick whole blood was tested using the rapid test. A fourth-generation HIV laboratory assay and treponemal-specific laboratory assays were used as reference. Rapid plasma reagin (RPR) was used to stratify treponemal results. Sensitivity and specificity were calculated.

Results: Overall, 274 patients participated. Sensitivity of the Multiplex for detection of HIV was 98.8% (95% CI, 93.4-100%), and specificity was 100% (95% CI, 98.1-100%). Sensitivity for detection of syphilis antibodies was 56.8% (95% CI, 44.7-68.2%), and specificity was 98.5% (95% CI, 95.7-99.7%). Sensitivity for treponemal antibodies improved with increasing RPR and was 100% (95% CI, 78.2-100%) among samples with RPR titers ≥1:8.

Conclusions: The Multiplex showed excellent performance for detection of HIV antibodies and increasing sensitivity for detection of treponemal antibody with increasing RPR titer.
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http://dx.doi.org/10.1016/j.diagmicrobio.2018.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643540PMC
April 2019

Dual rapid test for HIV and syphilis: A laboratory evaluation of the diagnostic accuracy of the Standard Q HIV/Syphilis Combo Test.

Diagn Microbiol Infect Dis 2019 May 24;94(1):30-32. Epub 2018 Nov 24.

Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.

We evaluated the Standard Q HIV/Syphilis Combo Test (SD Biosensor, South Korea), a dual rapid test using stored sera (N = 400) in a laboratory setting in Lima, Peru. The sensitivity and specificity for HIV antibody detection was 100.0% (95% CI: 98.2-100.0%) and 99.5% (95% CI: 97.2-100.0%), respectively. For treponemal antibody detection the sensitivity and specificity was 97.5% (95%CI:94.3-99.2%) and 100.0% (95%CI:98.2-100.0%), respectively.
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http://dx.doi.org/10.1016/j.diagmicrobio.2018.11.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462422PMC
May 2019

HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru.

PLoS One 2018 29;13(10):e0206204. Epub 2018 Oct 29.

David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.

Background: Men who have sex with men (MSM) and transgender women in Peru are at high risk for acquiring syphilis and HIV infection. The World Health Organization highly recommends screening for HIV and syphilis to reduce morbidity and mortality associated with untreated infections. We aimed to identify factors associated with dual testing preferences for HIV and syphilis infection among MSM and transgender women in Lima, Peru.

Methods: We used conjoint analysis, an innovative method for systematically estimating consumer preferences. We created eight hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), potential for false positive syphilis result (no false positive vs. some risk of false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), test type (rapid vs. laboratory), and number of draws (1 vs. 2). We fit a conjoint analysis model for each participant using a simple main effects ANOVA. Attribute importance values were calculated using percentages from relative ranges in the attribute's utility values. Results were summarized across participants and averages were reported.

Results: We recruited 415 MSM/transgender women over 18 years of age from two STD clinics in Lima, Peru. No potential for syphilis false positive result (no false positive vs. some potential for false positive) had the largest average impact on willingness to use the test and on average accounted for 23.8% of test type preference, followed by cost (free vs. ~USD$4; 21.6%), time to results (20 minutes vs. 1 week; 17.4%), number of blood draws (1 draw vs. 2 draws; 13.8%), method of blood draw (fingerprick vs. venipuncture; 13.7%), and test type (rapid POC vs. laboratory; 9.7%).

Conclusion: MSM/transgender women in Peru prioritized accuracy, cost, timeliness and number of blood draws for HIV and syphilis testing. Implementing a low cost, accurate, rapid and dual testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206204PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205634PMC
March 2019

Antimicrobial Resistance in Neisseria gonorrhoeae: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting.

Sex Transm Dis 2019 03;46(3):e18-e25

Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA.

The goal of the Sexually Transmitted Infection Clinical Trial Group's Antimicrobial Resistance (AMR) in Neisseria gonorrhoeae (NG) meeting was to assemble experts from academia, government, nonprofit and industry to discuss the current state of research, gaps and challenges in research and technology and priorities and new directions to address the continued emergence of multidrug-resistant NG infections. Topics discussed at the meeting, which will be the focus of this article, include AMR NG global surveillance initiatives, the use of whole genome sequencing 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-mediated and chromosomally mediated mechanisms of AMR in NG; (v) novel therapeutic (eg, sialic acid analogs, factor H [FH]/Fc fusion molecule, monoclonal antibodies, topoisomerase inhibitors, fluoroketolides, LpxC inhibitors) and preventative (eg, 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.
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http://dx.doi.org/10.1097/OLQ.0000000000000929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370498PMC
March 2019

Factors in the HIV risk environment associated with bacterial vaginosis among HIV-negative female sex workers who inject drugs in the Mexico-United States border region.

BMC Public Health 2018 Aug 20;18(1):1032. Epub 2018 Aug 20.

Department of Medicine, University of California, San Diego, USA.

Background: Bacterial vaginosis (BV) is the most common cause of vaginitis among women worldwide and is associated with increased susceptibility to sexually transmitted infections (STIs), including HIV. We aimed to determine the impact of the HIV risk environment on BV among female sex workers who inject drugs (FSW-PWIDs) in Tijuana and Ciudad Juarez, Mexico.

Methods: We performed a cross-sectional analysis utilizing baseline data from a randomized controlled trial evaluating a behavioral HIV prevention intervention. Participants underwent testing for BV using the OSOM BVBlue® Rapid Test (Genzyme Diagnostics, San Diego, CA) and completed a survey eliciting information on the HIV risk environment, sexual risk behaviors, and substance use. We applied logistic regression to identify correlates of BV in the physical, social, economic, and political HIV risk environments stratified by study site (Ciudad Juarez vs. Tijuana).

Results: In total, 584 HIV-negative FSW-PWIDs (300 Ciudad Juarez; 284 Tijuana) were enrolled. The prevalence of BV was 39% (n = 228), which was higher in Ciudad Juarez (56.7%) compared to Tijuana (20.4%). In both cities, micro-level components of the physical HIV risk environment were associated with BV. In Ciudad Juarez, BV was associated with past experiences or threats of physical violence in response to proposed condom use (adjusted odds ratio [aOR] = 3.66, 95% confidence interval [CI]: 1.74-7.69, p = 0.001) and lifetime residence in Ciudad Juarez (aOR = 1.74, 95% CI: 1.05-2.87, p = 0.031). In Tijuana, BV was associated with the number of hours spent on the street daily in the past six months looking for, using, or dealing drugs, engaging in other income generating activities, or sleeping (aOR = 1.05, 95% CI: 1.001-1.097, p = 0.045).

Conclusions: Our findings suggest that FSW-PWIDs' risk of BV may be shaped by the microphysical HIV risk environment. Addressing components of the physical risk environment, including interventions to reduce gender-based violence, may alleviate the burden of BV and subsequent susceptibility to HIV/STIs among FSW-PWIDs in the Mexico/US border region.

Trial Registration: National Institute of Health (NIH) Clinical Trials Identifier NCT00840658 , and date of NIH trial registration February 7, 2009.
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http://dx.doi.org/10.1186/s12889-018-5965-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102857PMC
August 2018

Sleeping Well Trial: Increasing the effectiveness of treatment with continuous positive airway pressure using a weight management program in overweight adults with obstructive sleep apnoea-A stepped wedge randomised trial protocol.

Nutr Diet 2019 02 24;76(1):110-117. Epub 2018 May 24.

School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.

Background: The majority of adults diagnosed with obstructive sleep apnoea (OSA) are overweight or obese. Continuous positive airway pressure (CPAP) is the most common effective therapy for OSA. However, adherence declines over time with only 50% of patients prescribed CPAP continuing to use it long term. Furthermore, a recent prospective analysis indicated that those more adherent with CPAP therapy have enhanced weight gain trajectories which in turn may negatively impact their OSA.

Aim: The Sleeping Well Trial aims to establish whether the timing of starting a lifestyle weight loss intervention impacts on weight trajectory in those with moderate-severe OSA treated at home with CPAP, while testing the potential for smart phone technology to improve adherence with lifestyle interventions.

Methods: A stepped wedge design with randomisation of individuals from 1 to 6 months post-enrolment, with 5 months of additional prospective follow up after completion of the stepped wedge. This design will investigate the effect of the 6-month lifestyle intervention on people undergoing CPAP on body weight, body composition and health-related quality of life.

Discussion: This trial tests whether the timing of supporting the patient through a weight loss intervention is important in obtaining the maximum benefit of a lifestyle change and CPAP usage, and identify how best to support patients through this critical period.

Trial Registration: The protocol (v1) is registered prospectively with the International Clinical Trials Registry (CTR) ACTRN12616000203459 (public access). Any amendments to protocol will be documented via the CTR. Recruitment commenced in March 2016 with data collection scheduled to finish by May 2018.
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http://dx.doi.org/10.1111/1747-0080.12435DOI Listing
February 2019

Use of Oral Fluid With a Rapid Treponemal Test for Syphilis Evaluation.

Sex Transm Dis 2018 09;45(9):e65-e67

Division of Infectious Diseases, Department of Medicine, and.

We aimed to determine if rapid treponemal tests intended for whole-blood specimens could be used to detect treponemal antibody in oral fluid. We found a high sensitivity of oral fluid rapid testing, which increased with increasing rapid plasma reagin titer, suggesting potential for the development of accurate rapid oral syphilis tests.
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http://dx.doi.org/10.1097/OLQ.0000000000000840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086727PMC
September 2018

Acceptability and Feasibility of Rapid Chlamydial, Gonococcal, and Trichomonal Screening and Treatment in Pregnant Women in 6 Low- to Middle-Income Countries.

Sex Transm Dis 2018 10;45(10):673-676

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.

Background: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) infections during pregnancy are linked with adverse birth outcomes. However, few countries have prenatal CT, NG, or TV screening programs. In this study, we aimed to evaluate the acceptability and feasibility of CT, NG, and TV screening and treatment among pregnant women across 6 low- to middle-income countries.

Methods: A total of 1817 pregnant women were screened for CT, NG, and TV in Botswana, the Democratic Republic of Congo, Haiti, South Africa, and Vietnam. An additional 640 pregnant women were screened for CT in Peru. Screening occurred between December 2012 and October 2017. Acceptability of screening was evaluated at each site as the proportion of eligible women who agreed to participate in screening. Feasibility of treatment was calculated as the proportion of women who tested positive that received treatment.

Results: Acceptability of screening and feasibility of treatment was high across all 6 sites. Acceptability of screening ranged from 85% to 99%, and feasibility of treatment ranged from 91% to 100%.

Discussion: The high acceptability and feasibility of screening and treatment of CT, NG, and TV among pregnant women supports further research to evaluate the cost-effectiveness of prenatal CT, NG, and TV screening programs.
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http://dx.doi.org/10.1097/OLQ.0000000000000832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129444PMC
October 2018
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