Can Social Network Analysis Help Address the High Rates of Bacterial Sexually Transmitted Infections in Saskatchewan?

BACKGROUND: Saskatchewan has one of the highest rates of gonorrhea among the Canadian provinces-more than double the national rate. In light of these high rates, and the growing threat of untreatable infections, improved understanding of gonorrhea transmission dynamics in the province and evaluation of the current system and tools for disease control are important. METHODS: We extracted data from a cross-sectional sample of laboratory-confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. The database was stratified by calendar year, and social network analysis combined with statistical modeling was used to identify associations between measures of connection within the network and the odds of repeat gonorrhea and risk of coinfection with chlamydia at the time of diagnosis. RESULTS: Networks were highly fragmented. Younger age and component size were positively associated with being coinfected with chlamydia. Being coinfected, reporting sex trade involvement, and component size were all positively associated with repeat infection. CONCLUSIONS: This is the first study to apply social network analysis to gonorrhea transmission in Saskatchewan and contributes important information about the relationship of network connections to gonorrhea/chlamydia coinfection and repeat gonorrhea. This study also suggests several areas for change of systems-related factors that could greatly increase understanding of social networks and enhance the potential for bacterial sexually transmitted infection control in Saskatchewan.

Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed gonorrhea cases in a local health region from Saskatchewan, Canada.

OBJECTIVES: We aimed to identify demographic and behavioural determinants associated with risk of repeat STI infection and coinfection with gonorrhea and chlamydia in the Regina Qu'Appelle Health Region, Saskatchewan. METHODS: We extracted data from a cross-sectional sample of laboratory confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. Risk factors for repeater status were examined using logistic regression and for coinfection with gonorrhea and chlamydia using mixed-effects logistic regression to account for multiple diagnoses for individual clients. RESULTS: Data from 1,143 cases (representing 1,027 unique individuals) and 1,524 reported contacts (representing 1,383 unique individuals) were extracted from the 10-year period. Factors associated with repeat infection entries in the database included younger age at first visit (p = 0.01), coinfection (p = 0.01), and sex trade involvement (p < 0.01). Factors associated with coinfection at the time of diagnosis included younger age at diagnosis (p < 0.001) and reported alcohol or drug abuse (p = 0.04). CONCLUSION: In one of the first epidemiologic studies on gonorrhea in Saskatchewan, we have identified age, engagement in the sex trade, and drug and alcohol abuse as potential markers to identify clients with a high risk of reinfection and coinfection in the Regina Qu'Appelle Health Region. This information can help health care professionals in Saskatchewan's urban centres personalize their approach to counselling and treatment to optimize patient outcomes and disease control efforts, including potentially using expedited partner therapy and/or dual therapy where indicated.

Understanding and responding to racial differences in drug court outcomes.

Significant differences in outcomes and characteristics exist between Caucasians and African-Americans in ten Missouri adult drug courts. Caucasians are more likely to graduate and they differ in significant ways from African-Americans in the context in which they lived their lives prior to drug court. Differences were significant between the two groups in employment levels at entry, primary drug of choice, levels of positive family support, and socioeconomic status. Using the evidence from this study, ways that treatment providers can better meet the needs of African-Americans are discussed.