Tendencia y determinantes de la infección genital por Chlamydia trachomatis en menores de 25 años. Cataluña 2007-2014 / Trends and determinants factors of Chlamydia trachomatis genital infection in young people under 25 years. Catalonia 2007-2014

INTRODUCCIÓN: Chlamydia trachomatis (clamidia) causa la infección de transmisión sexual (ITS) bacteriana más frecuente. Sin embargo, la prevalencia entre los jóvenes es desconocida en nuestro país. En 2007 la monitorización de la prevalencia y conductas relacionadas con su adquisición se inició en Cataluña en jóvenes ≤25 años. OBJETIVOS: Conocer y monitorizar la prevalencia de clamidia y determinantes entre la población joven ≤25años sexualmente activa atendida en los centros de Atención a la Salud Sexual y Reproductiva (CT/NG-ASSIR) e interna en centros penitenciarios (CT/NG-Prisiones). MATERIAL Y MÉTODOS: Se analizan los datos de 6 estudios transversales realizados en 2 poblaciones centinela de jóvenes para el periodo 2007-2014. Se recogen indicadores conductuales y muestras de orina que serán analizadas mediante PCR. Se describe la prevalencia y la tendencia de clamidia, y mediante el análisis multivariante de regresión logística se evalúan las variables asociadas a la infección. RESULTADOS: La media de la prevalencia para CT/NG-ASSIR fue del 7,4%, con tendencia creciente (p = 0,174) e incremento del 46,5%. Para CT/NG-Prisiones la media fue del 8,0%, con tendencia creciente (p = 0,282) e incremento del 31,6%. La edad y el origen extranjero se presentan como factores de riesgo en ambas poblaciones. La concurrencia de parejas se añade a CT/NG-ASSIR, y el tiempo de estancia en prisión, en CT/NG-Prisiones. DISCUSIÓN: Los resultados obtenidos ponen de relieve la necesidad de un enfoque más eficiente en las actividades de control para clamidia en Cataluña, y de intensificar las políticas de promoción de comportamientos sexuales más seguros y la búsqueda activa de casos con un cribado oportunista en menores de 25 años

INTRODUCTION: Chlamydia trachomatis (chlamydia) infection is the most common bacterial sexually transmitted diseases (STD). However, the prevalence among young people is unknown in our country. In 2007, the monitoring of the prevalence and behaviours related to acquiring it began in Catalonia in young people ≤25 years. OBJECTIVES: To determine and monitor the prevalence and determining factors of chlamydia among a young sexually active population ≤25 years, treated in sexual and reproductive health care centras (CT/NG-ASSIR) and in prisons (CT/NG-Prisons). MATERIALS AND METHODS: An analysis was performed on 6 cross-sectional data studies in two sentinel populations of young people from the period 2007-2014. Behavioural indicators were recorded and urine specimens were collected for analysis by PCR. The prevalence and trends are described, and the variables associated with infection were evaluated using multivariate logistic regression analysis. RESULTS: The mean prevalence for CT/NG-ASSIR was 7.4%, with an upward trend (P=.174), and an increase of 46.5%. CT/NG-Prisons had a mean 8.0%, with an upward trend (P=.282), and an increase of 31.6%. Age and foreign origin are presented as risk factors in both populations. The concurrent sexual partners added to CT/NG-ASSIR and the time spent in prison to CT/NG-Prisons. DISCUSSION: The results underscore the need for a more efficient approach to control activities related to chlamydia infection in Catalonia. Policies need to be strengthened to promote safer sexual behaviours and active case finding by opportunistic screening in less than 25 year-old

[Trends and determinants factors of Chlamydia trachomatis genital infection in young people under 25 years. Catalonia 2007-2014]. / Tendencia y determinantes de la infección genital por Chlamydia trachomatis en menores de 25 años. Cataluña 2007-2014.

INTRODUCTION: Chlamydia trachomatis (chlamydia) infection is the most common bacterial sexually transmitted diseases (STD). However, the prevalence among young people is unknown in our country. In 2007, the monitoring of the prevalence and behaviours related to acquiring it began in Catalonia in young people ≤25years. OBJECTIVES: To determine and monitor the prevalence and determining factors of chlamydia among a young sexually active population ≤25years, treated in sexual and reproductive health care centras (CT/NG-ASSIR) and in prisons (CT/NG-Prisons). MATERIALS AND METHODS: An analysis was performed on 6 cross-sectional data studies in two sentinel populations of young people from the period 2007-2014. Behavioural indicators were recorded and urine specimens were collected for analysis by PCR. The prevalence and trends are described, and the variables associated with infection were evaluated using multivariate logistic regression analysis. RESULTS: The mean prevalence for CT/NG-ASSIR was 7.4%, with an upward trend (P=.174), and an increase of 46.5%. CT/NG-Prisons had a mean 8.0%, with an upward trend (P=.282), and an increase of 31.6%. Age and foreign origin are presented as risk factors in both populations. The concurrent sexual partners added to CT/NG-ASSIR and the time spent in prison to CT/NG-Prisons. DISCUSSION: The results underscore the need for a more efficient approach to control activities related to chlamydia infection in Catalonia. Policies need to be strengthened to promote safer sexual behaviours and active case finding by opportunistic screening in less than 25year-old.

Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort.

INTRODUCTION: Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013. MATERIALS AND METHODS: We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models. MORTALITY RESULTS: 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)]. SURVIVAL RESULTS: Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3-5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4-1.7) and heterosexual female (sHR:2.8; CI:1.1-7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7-123.2) and heterosexual male (sHR:11.8; CI:2.5-56.4) versus MSM. CONCLUSION AND RECOMMENDATION: There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.

Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study.

BACKGROUND: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. METHODS: Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. RESULTS: HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. CONCLUSION: An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.

Conductas de riesgo y prevalencia de Chlamydia trachomatis en presos según el tiempo de estancia en prisión / Risk behaviours and Chlamydia trachomatis prevalence in prisoners by length of stay in prison

Fundamento y objetivo: La población joven penitenciaria presenta elevadas conductas de riesgo y una precariedad socioeconómica que incrementa su vulnerabilidad frente a la adquisición de Chlamydia trachomatis (CT). Monitorizar su prevalencia ayudará a reducir las tasas de infección. Pacientes y métodos: Estudio transversal a partir de una muestra de conveniencia de presos de 18-25 años. Se obtuvieron muestras de orina para determinar CT. Se utilizó un cuestionario estandarizado anónimo para recoger las variables de estudio. Resultados: La prevalencia global de CT fue del 11%, significativamente superior en aquellos con menos de un año de estancia en prisión, presentando también frecuencias más elevadas en las conductas de riesgo, disminuyendo estas en aquellos que llevaban más de un año presos. Conclusiones: Los valores de prevalencia obtenidos dan una idea de la concentración de la población vulnerable a esta afección en las cárceles y subrayan la necesidad de continuar con los programas de prevención y control de infecciones de transmisión sexual (ITS). El hecho de estar mayor tiempo preso disminuyó los comportamientos de riesgo. Por tanto, creemos importante el cribado de ITS en el momento del ingreso, ya que hay una mayor probabilidad de estar infectado, e incidir en ese momento en la educación sexual, puesto que es cuando presentan conductas de riesgo más elevadas, que son las que probablemente realizaban cuando estaban en libertad

Background and objective: Young prisoners have high-risk behaviors and socio-economic insecurity that increases vulnerability for Chlamydia trachomatis (CT) acquisition. Monitoring its prevalence will help to reduce infection rates. Patients and methods: Cross-sectional study from a convenience sample of prisoners aged 18-25 years. Urine samples were obtained to determine CT. A standardized and anonymous questionnaire was used to collect the study variables. Results: The overall CT prevalence was 11%, significantly higher in those with less than one year in prison, who also presented higher frequencies in risk behaviors, while these were reduced in those who had been imprisoned for more than a year. Conclusions: The prevalence values obtained give an idea of the concentration of the population vulnerable to this disease in prisons and underscore the need to continue programs for the prevention and control of sexual transmitted infections (STIs). Being imprisoned longer decreased risk behaviors; therefore, it is important to screen for STIs upon admission because they are more likely to be infected and it would be thus possible to influence at that time in sex education because, at that time, risk behaviors occur more commonly, which are most likely done when they were free

[Risk behaviours and Chlamydia trachomatis prevalence in prisoners by length of stay in prison]. / Conductas de riesgo y prevalencia de Chlamydia trachomatis en presos según el tiempo de estancia en prisión.

BACKGROUND AND OBJECTIVE: Young prisoners have high-risk behaviors and socio-economic insecurity that increases vulnerability for Chlamydia trachomatis (CT) acquisition. Monitoring its prevalence will help to reduce infection rates. PATIENTS AND METHODS: Cross-sectional study from a convenience sample of prisoners aged 18-25 years. Urine samples were obtained to determine CT. A standardized and anonymous questionnaire was used to collect the study variables. RESULTS: The overall CT prevalence was 11%, significantly higher in those with less than one year in prison, who also presented higher frequencies in risk behaviors, while these were reduced in those who had been imprisoned for more than a year. CONCLUSIONS: The prevalence values obtained give an idea of the concentration of the population vulnerable to this disease in prisons and underscore the need to continue programs for the prevention and control of sexual transmitted infections (STIs). Being imprisoned longer decreased risk behaviors; therefore, it is important to screen for STIs upon admission because they are more likely to be infected and it would be thus possible to influence at that time in sex education because, at that time, risk behaviors occur more commonly, which are most likely done when they were free.

Sexual behaviour of inmates with Chlamydia trachomatis infection in the prisons of Catalonia, Spain.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT) and high risk factors for acquisition in preventive prisoners in Catalonia. METHODS: Cross-sectional study of a convenience sample of 478 prisoners aged between 18 and 35 years was analysed using real-time polymerase chain reaction. A standardized questionnaire was used to collect behavioural data. Significant differences were analysed in the descriptive study using Pearson's χ(2). The association between CT and its determinants was analysed using the Mantel-Haenszel test and a multivariate logistic regression model. RESULTS: The overall prevalence of CT was 5.4%. The independent risk factors for infection by CT were as follows: foreign origin, having had concurrent sexual partners, and alcohol consumption. CONCLUSIONS: This is the first study performed in prisons of Catalonia that shows the prevalence of CT in young prisoners. The high mobility of young detainees could explain the similarity in prevalence obtained about young people in Catalonia. Systematic monitoring of CT infection in young preventive prisoners is important in order to prevent further problems in themselves and in the general population, since they become a 'bridge population' in sexually transmissible infection spreading.

Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009.

BACKGROUND: Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09. METHODS: Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation. RESULTS: Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002). CONCLUSION: Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.

[Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results]. / Declaración de los nuevos diagnósticos de infección por el VIH en Cataluña. Implementación y resultados.

OBJECTIVES: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. METHODS: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. RESULTS: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. CONCLUSIONS: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.

Declaración de los nuevos diagnósticos de infección por el VIH en Cataluña. Implementación y resultados / Reporting of newly diagnosed HIV infections in Catalonia. Barcelona. Spain. Implementation and results

Objetivos: Describir los resultados de la notificación de nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (NDIVIH) en Cataluña (2001-2003), y comparar las características de la epidemia como resultado de la utilización de este nuevo sistema de información junto con el Registro de casos de sida de Cataluña, con las halladas únicamente en el Registro de casos de sida. Métodos: Datos de las notificaciones de NDIVIH y de casos de sida entre 2001 y 2003 en Cataluña. Resultados: Entre los NDIVIH (n = 1.765), la vía de transmisión más frecuente fue las relaciones heterosexuales (46,8%), seguida de las relaciones homosexuales entre varones (26,7%) y el uso de drogas por vía parenteral (19,9%). Entre los 1.210 casos de sida, la forma de transmisión más frecuente fue el uso de drogas por vía parenteral (42,2%), seguida de relaciones heterosexuales (34,5%) y de las relaciones homosexuales entre varones (18,0%). La diferencia de utilizar una o 2 fuentes de información respecto a la variable vía de transmisión de la infección fue estadísticamente significativa. Conclusiones: El sistema de información basado en los datos sobre NDIVIH es viable, ha sido útil para conseguir los objetivos previstos en el sistema de vigilancia epidemiológica del VIH y proporciona información más precisa que el Registro de sida para describir los actuales patrones de transmisión del virus. La exhaustividad del nuevo sistema de información podría mejorar mediante la incorporación del diagnóstico de infección al sistema de enfermedades de declaración obligatoria

Objectives: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. Methods: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. Results: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. Conclusions: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification