CHOICES-TEEN: Reducing Substance-Exposed Pregnancy and HIV among Juvenile Justice Adolescent Females.

OBJECTIVE: The feasibility and acceptability of CHOICES-TEEN - a 3-session intervention to reduce overlapping risks of alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP) and HIV - was assessed among females in the juvenile justice system. METHODS: Females 14-17 on community probation in Houston, Texas were eligible if presenting with aforementioned health risks. Outcome measures - obtained at one- and three-months post baseline - included the Timeline Followback, Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory-Short, and open-ended questions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age=16). RESULTS: The results suggest strong acceptability and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% 1-month; 71.4% at 3-months; TEP (77% of smokers (n=17) at reduced risk at 1-month; 50% at 3-months); and HIV (52.4% 1-month; 28.6% at 3-months).

Recent Thymus Emigrant CD4+ T Cells Predict HIV Disease Progression in Patients With Perinatally Acquired HIV.

BACKGROUND: Robust immune restoration in human immunodeficiency virus (HIV)-positive patients is dependent on thymic function. However, few studies have investigated thymic function and its correlation with disease progression over time in HIV-positive patients. METHODS: In this longitudinal prospective study, we followed 69 HIV-positive patients who were perinatally infected. Peripheral blood mononuclear cells were stained with monoclonal anti-CD4 and anti-CD31 and recent thymic emigrants (CD4+recently emigrated from the thymus (RTE), CD4+CD31+) quantified by flow cytometry. Statistical analysis used Wilcoxon rank sum test, Kruskal-Wallis, Spearman correlation, and Kaplan-Meier estimates; Cox regression models were performed for the longitudinal analysis. RESULTS: Median age of HIV positive patients enrolled was 13 years (interquartile range [IQR], 8.6). CD4+RTE% decreased with age and was higher in females. Median CD4+RTE% was 53.5%, IQR, 22.9. CD4+RTE% was closely related to CD4+% and absolute counts but independent of viral load and CD8+CD38+%. Antiretroviral compliance as well as higher nadir CD4+% were associated with higher CD4+RTE%. Low CD4+RTE% predicted poor progression of VL and CD4+% over time. CONCLUSIONS: CD4+RTE% predicts disease progression and may reflect history of disease in HIV-positive patients and adolescents. They are easy to measure in the clinical setting and may be helpful markers in guiding treatment decisions.

Azithromycin efficacy in the treatment of Chlamydia trachomatis among detained youth.

We assessed the efficacy of azithromycin among detained adolescents with Chlamydia trachomatis. Infected adolescents took azithromycin and submitted a test of cure. Of the 128 youth, 5 patients experienced treatment failure. We found that azithromycin was 96.1% (95% confidence interval, 91.1%-98.8%) effective in treating chlamydia infections, supporting its continued use.

Extragenital Sexually Transmitted Infections Testing During COVID-19 Pandemic Among Youth Involved in the Juvenile Justice System.

Studies have shown lower screening for sexually transmitted infections (STIs) during the COVID-19 pandemic. It is unclear how the pandemic affected STI testing among juvenile justice-involved youth, especially for extragenital gonorrhea and chlamydia. Retrospective chart review was conducted between March 2020 and June 2021 utilizing electronic health records of youth seen at a preadjudication facility in the southwest United States. Rates of extragenital testing were compared with prepandemic rates. Overall, 574 youth were observed; 86% were male, mean age was 15.4 years, and 48.6% were Black. Of the youth reporting performing oral sex, 57% were tested for oropharyngeal STIs compared to 33.5% in 2018 to 2019. Twenty percent of those reporting anal receptive sex were tested for rectal infections compared to 25.9% before the pandemic. Pandemic testing for oropharyngeal STIs increased but rectal testing decreased. Overall, testing rates remained low.

Trichomonas Vaginalis Infections Among Youth in Detention in the Southeastern United States.

Most juvenile detention facilities do not screen for Trichomonas Vaginalis (TV) despite being the most common parasitic STI. We aimed to assess TV prevalence and risk factors among young women in a large urban juvenile detention center. We evaluated a retrospective cohort from April to December 2016. Youth submitted an intake urine sample for gonorrhea and chlamydia testing; we tested remnant urine for TV. Outcomes included prevalence of TV and risk factors for infection. A total of 1009 samples were collected, 374 from young women ages 13 - 17 years old. Among females, 8% tested positive for TV with co-infection of either gonorrhea, chlamydia or both occurring in 12/29 (41%) patients. Compared to youth without TV females with TV were more likely to be African American (76%) and report symptoms (41%) (p<0.05). In our study population, prevalence of TV was 8%. As nearly half of those with TV were asymptomatic, we recommend routine screening among this population.

The human papilloma vaccine: A time for NP leadership.

The human papilloma virus (HPV) causes approximately 30,700 annual cancer cases of the cervix, vulva, vagina, penis, oral cavity, and anus. Nurse practitioners can use their unique relationships with patients to advocate for the HPV vaccine. The purpose of this article is to update NPs on current knowledge regarding the HPV vaccine while providing appropriate information necessary for counseling patients and parents.

A Contraception Quality Improvement Initiative with Detained Young Women: Counseling, Initiation, and Utilization.

STUDY OBJECTIVE: To assess the effect of providing standardized counseling to improve the rates of contraception initiation and utilization among detained young women. This was a quality improvement (QI) project conducted at a large urban juvenile short-term detention center. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The intervention included educating all staff and care providers, counseling detained young women on various contraceptive options, and offering contraception initiation with oral contraceptive pills or depot medroxyprogesterone acetate injection. Retrospective chart review before February 2012 established baseline contraception initiation and utilization rates. The QI intervention began in February 2012 and continued for 6 months followed by chart review. Outcomes measured included number of patients counseled about contraception, started contraception, and overall contraception utilization. RESULTS: We reviewed 120 and 186 charts before and after intervention, respectively. Compared with baseline data, the intervention group had statistically significant (P < .05) higher proportions of patients counseled (10% [10/120] baseline vs 84% [156/186] intervention) and who started contraception (7% [8/120] baseline vs 52% [97/186] intervention). CONCLUSION: This contraception QI intervention showed significant improvement in the rates of contraception counseling, contraception initiation, and utilization among detained young women. Most of youths' guardians were supportive and approved contraception initiation. This project showed it is feasible for health care providers to include contraception services for all intake assessments at juvenile detention facilities.

CD31 Expression on CD4+ Cells: A Simple Method for Quantitation of Recent Thymus Emigrant CD4 Cells.

Measurements of CD4+CD31+ cells gave results consistent with those expected for recent thymus emigrant (RTE) CD4+ cells. The method was markedly simpler than established procedures for measurement of CD4+ RTE cells and is usable in locations with limited facilities and budgets.

The epidemiology of sexually transmitted infections in adolescents.

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Prevalence of Sexually Transmitted Infections Among Adolescents Entering Child Protective Services.

STUDY OBJECTIVE: Persons aged 15-24 years have the highest rates of sexually transmitted infections (STIs). Adolescents in protective services custody may be at even greater risk of acquiring STIs, but little is known about the prevalence of STIs among this population. We therefore set out to assess the prevalence of STIs among adolescents seen in the Harris County Child Protective Services Clinic. DESIGN: A retrospective chart review from January 2009 to December 2011 was conducted. SETTING AND PARTICIPANTS: Patients aged 12-18 years seen for their intake physical examination at the Harris County Child Protective Services Clinic in Houston, Texas. MAIN OUTCOME MEASURES: Main outcome measures included the number of positive tests for chlamydia, gonorrhea, syphilis, and HIV. Secondary measures included sexual history, use of condoms and contraception, and reports of drug and alcohol use. RESULTS: Among 437 patients, 60% were female, their mean age was 15 years, and nearly half were African American. There were 27 cases of chlamydia, 12 of gonorrhea, 3 of syphilis, and none of HIV. Three of the teenagers who reported never having sex were positive for an STI. Being female, being older than 15 years, and having had sexual intercourse at least once were significant risk factors. CONCLUSION: The prevalence of STIs in adolescents entering foster care was comparable to national averages. Recommending routine screening of all adolescents in this population is important to ensure better detection and treatment.

Persistently high perinatal transmission of HIV: assessment of risk factors.

BACKGROUND: Despite dramatic decreases in rates of perinatal mother-to-child-transmission (PMTCT) of HIV in the United States, rates in some groups remain above the national average. Our objective was to examine factors contributing to a high rate of PMTCT of HIV. METHODS: We conducted a retrospective chart review of HIV-exposed infants and their mothers referred to the University of Texas-Houston Pediatric HIV Clinic from January 2000 to June 2007. RESULTS: Of 367 newborns studied, 22 (6%) acquired HIV infection perinatally. Associated risk factors included inadequate prenatal care, failure to receive antiretroviral therapy during pregnancy, detectable viral load and intravenous drug abuse. CONCLUSIONS: The composite rate of PMTCT in this high risk cohort was at least 3-fold higher than expected from the current standard of care. Reduction of rates of PMTCT in our population will require ensuring access to appropriate prenatal care, including delivery of antiretroviral therapy and addressing issues of illicit drug use.

Counseling about the HPV vaccine: desexualize, educate, and advocate.

Information is provided for clinicians who treat adolescents and adult women to use when counseling patients about human papillomavirus (HPV) vaccine. A literature search was done to determine: (1) reasons for refusal of the vaccine, including cost and concerns that immunization against HPV will lead to promiscuity; (2) potential for non-sexual transmission of HPV; (3) non-genital locations of HPV; (4) non-genital cancers associated with HPV. Vaccines for Children Program and the Affordable Care Act eliminate many costs.Neither biological nor behavioral evidence supports the idea that sexual behavior changes after immunization. HPV is transmitted from person to person by non-sexual routes including mother to child at birth and apparently by touch after birth. HPV is persistent in the environment, including medical environments. It has been found on apparently sterilized instruments used in vaginal exams. Pathogenic HPV has been recovered from breast tissue, sinonasal areas, and nipples as well as from hair follicles on arms, legs, scalps, eyebrows, and pubic hair. Pathogenic HPV was found in 6.5% of the oral cavities of a random sample of Americans. HPV is known to cause anal and oral cancers. It has also been associated with skin cancers, breast tumors, and prostate cancers. It is not known if the vaccine is protective against these cancers, but it is useful to educate about these other routes of transmission and non-genital HPV linked cancers so that patients/parents do not just focus on the sexual nature of the human papillomavirus.

Honey pacifier use among an indigent pediatric population.

BACKGROUND: Use of honey pacifiers by infants presenting to a pediatric clinic at a county hospital in Houston, Texas, was observed by several of our staff members. Although we could not find any published studies linking the use of honey pacifiers to infant botulism, we also could not find any studies assessing the prevalence of honey pacifier use in general. METHODS: We conducted a cross-sectional, descriptive study using a novel survey that had 19 items. The survey was administered to the parents of children up to age 12 months presenting to a county hospital pediatric clinic for well-child care in Houston, Texas, from February 2010 to April 2011. RESULTS: There were 397 respondents. Approximately 11% of the respondents reported using honey pacifiers with their infant children. Reasons for use included tradition, infant preference, and perceived health benefits (eg, helps with constipation or colic). Approximately 20% of the honey pacifier users and 23% of the entire group reported knowledge of honey potentially causing an illness in children <12 months of age. Nearly 40% of all respondents also reported using herbal or folk remedies. CONCLUSIONS: Honey pacifier use was relatively common among this population, seen in ∼1 out of 10 respondents. A majority of the mothers surveyed (∼80%) were unaware of the potential dangers of giving honey to infants under age 12 months. Herbal medicine use was also common.

Body art among minority high school athletes: prevalence, interest and satisfaction; parental knowledge and consent.

Of 997 minority high school students, 8.6% had tattoos and 8% piercings (excluding earlobes); 21% with tattoos and 59% with piercings would not repeat the experience. Fifty-eight percent with tattoos and 43% with piercings reported parental knowledge before the procedure; 75% and 80%, respectively, were asked for proof of parental consent.