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1.
BMC Public Health ; 19(1): 992, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340797

RESUMO

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extending diagnosis to include extra-genital samples; however, there is a lack of evidence on the acceptability of asking young women to provide these samples. METHOD: A mixed methods single group feasibility study explored the acceptability of combined genital and extra-genital testing in young women aged 16-25 years consecutively attending a sexual health centre in Edinburgh, Scotland. Young women were asked to complete a self- administered anonymous questionnaire whether they would be willing to give self-taken throat and ano-rectal samples. Interviews with women (n = 20) willing to self-sample were conducted before and after self-sampling, and these explored the underlying reasons behind their decision, and feelings about the tests. RESULTS: Of 500 women recruited to the study, 422 (84.4%) women provided sufficient data for analysis. From completed questionnaires, 86.3% of respondents reported willingness to self-sample from the throat. Willingness of ano-rectal self-sampling was lower (59.1%), particularly in women under 20 (< 20 years: 44.4%; ≥20 years, 68.2%). Willingness of ano-rectal self-sampling was higher in women who had more sexual partners in the last 6 months (0 partners, 48.3%, n = 14, 3 or more partners, 67.4%, n = 60) and in those who have previous experience of a positive test for a sexually transmitted infection (STI) (positive: 64.5%; negative: 57%). Interviewed women suggested that a lack of knowledge of STIs, embarrassment and lack of confidence in the ability to carry out the sampling were barriers towards acceptability. CONCLUSIONS: In this study, self-sampling of throat samples is largely acceptable; however, the acceptability of taking an ano-rectal sample for C. trachomatis testing in young women was lower in younger women. The study suggests further research to investigate the acceptability of extra-genital testing as an addition to routine C. trachomatis testing, and whether this increases detection and prevents infective sequelae for women.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Chlamydia trachomatis , Estudos de Viabilidade , Feminino , Humanos , Programas de Rastreamento/métodos , Escócia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Adulto Jovem
2.
PLoS One ; 14(6): e0218658, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216341

RESUMO

INTRODUCTION: Response rates in health research are declining, and low response rates could result in biased outcomes when population characteristics of participants systematically differ from the non-respondents. Few studies have examined key factors of non-response beyond demographic characteristics, such as behavioral and psychological factors. The aim of the current study was to identify predictors of non-response and loss to follow-up in a longitudinal sexual health study. MATERIALS AND METHODS: A longitudinal cohort study (iMPaCT) was conducted from November 2016 to July 2018 among heterosexual STI clinic visitors aged 18-24 years. At four different time points in one year, data was collected on sexual behavior, psychological determinants and chlamydia infections. The national STI surveillance database provided data on demographic, behavioral and sexual health-related characteristics for non-respondents. Predictors of non-response at baseline and of loss to follow-up were identified using multivariable logistic regression analyses. RESULTS: In total, 13,658 STI clinic visitors were eligible to participate, of which 1,063 (8%) participated. Male gender, low/medium education level, young age (≤ 20 years) and having a non-Dutch migration background were significant predictors of non-response at baseline. Furthermore, non-respondents at baseline were more likely to report STI-related symptoms, to have been notified by a partner, to have had condomless sex, and to have had ≤ 2 partners in the past six months, compared to participants. Psychological predictors of loss to follow-up differed between STI clinic regions, but low perceived importance of health at baseline was associated with loss to follow-up in all regions. The baseline chlamydia positivity rate was significantly higher in the non-respondents (17%) compared to the participants (14%), but was not a predictor of loss to follow-up. DISCUSSION: Targeted recruitment aimed at underrepresented groups in the population based on demographic, behavioral and psychological characteristics, might be necessary to decrease loss to follow-up, and to prevent non-response bias in health research.


Assuntos
Infecções por Chlamydia/epidemiologia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adolescente , Infecções por Chlamydia/psicologia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Estudos Longitudinais , Perda de Seguimento , Masculino , Países Baixos/epidemiologia , Medição de Risco , Adulto Jovem
3.
Sex Transm Infect ; 95(5): 361-367, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31097677

RESUMO

OBJECTIVES: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations. METHODS: Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "Chlamydia trachomatis") AND (("anal" OR "rect*" OR "anorect*") OR ("extra?genital" OR "multi?site")). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. RESULTS: 25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I2=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I2=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I2=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I2=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I2=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I2=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I2=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I2=0.0%). CONCLUSIONS: Anorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women. TRIAL REGISTRATION NUMBER: CRD42df017080188.


Assuntos
Canal Anal/microbiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Gonorreia/microbiologia , Neisseria gonorrhoeae/isolamento & purificação , Reto/microbiologia , Adolescente , Adulto , Infecções por Chlamydia/psicologia , Chlamydia trachomatis/classificação , Chlamydia trachomatis/genética , Feminino , Gonorreia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/classificação , Neisseria gonorrhoeae/genética , Comportamento Sexual , Parceiros Sexuais/psicologia , Mulheres/psicologia , Adulto Jovem
4.
Sex Transm Infect ; 95(5): 336-341, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31010954

RESUMO

OBJECTIVE: While men who have sex with men (MSM) are disproportionately affected by Peru's overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru. METHODS: We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests. RESULTS: Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1-4 vs 3, 2-6; p=0.001; casual partners: 1, 0-3 vs 2, 1-4; p=0.001) and more stable partnerships (1, 0-1 vs 0, 0-1; p=0.003) in the last month. CONCLUSIONS: Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sífilis/epidemiologia , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/prevenção & controle , Infecções por Chlamydia/psicologia , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/prevenção & controle , Gonorreia/psicologia , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual , Parceiros Sexuais , Sífilis/diagnóstico , Sífilis/prevenção & controle , Sífilis/psicologia , Adulto Jovem
5.
Implement Sci ; 13(1): 130, 2018 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-30348165

RESUMO

BACKGROUND: Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. METHODS: Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). CONCLUSIONS: This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed. TRIAL REGISTRATION: PROSPERO CRD42016041786.


Assuntos
Infecções por Chlamydia/diagnóstico , Medicina Geral/organização & administração , Modelos Psicológicos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Infecções por Chlamydia/psicologia , Inglaterra , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Motivação , Estigma Social , Fatores de Tempo , Adulto Jovem
6.
BMJ Open ; 8(6): e018213, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29960999

RESUMO

INTRODUCTION: Non-specific genital infection (NSGI; non-Chlamydia trachomatis, non-Neisseria gonorrhoeae-associated urethritis) is a common diagnosis in symptomatic heterosexual men attending UK sexual health clinics (SHCs). but little is known about the psychosocial impact of this diagnosis. METHODS: We conducted an observational study among symptomatic heterosexual men attending SHCs to evaluate the psychosocial impact of an NSGI diagnosis compared with a diagnosis of Chlamydia trachomatis (CT), Neisseria gonorrhoeae or no abnormalities detected focusing on the feasibility of our study methodology. Participants completed a computer-assisted self-interviewing (CASI) including two validated measures of psychosocial impact: the EQ-5D-5L health-related quality of life and Rosenberg Self-Esteem Scale, before diagnostic testing and 2 weeks after receiving test results (follow-up 1 (FU-1)) and a qualitative interview. We compared scores between diagnostic groups using paired t-tests, qualitative data were analysed thematically and feasibility was assessed by process analysis. RESULTS: 60 men completed the baseline CASI (75% response rate). 46 (76.6%) were eligible for follow-up; 11/46 (23.9%) completed the follow-up CASI, and 3/11 (27.3%) completed the qualitative interview. 81.7% of all participants left CASI feedback at baseline: 73.5% reported the questionnaire as 'fine' or 'very good'. Qualitative interview participants reported the study was acceptable. Compared with baseline, among patients completing FU-1, only patients with a diagnosis of NSGI (p<0.05) or CT (p<0.05) showed increased EQ-5D-5L Index, whereas patients with a diagnosis of NSGI (p=0.05) showed decreased mean Rosenberg Self-Esteem Scale score. CONCLUSIONS: Although most participants indicated study acceptability at baseline, and we employed measures to increase retention (CASI questionnaires, reminder messages and a focus on men's health), we experienced high loss to follow-up. We found that heterosexual men attending SHCs with symptoms of urethritis experience both positive and negative psychosocial impacts following their clinic attendance, which warrants further investigation.


Assuntos
Doenças dos Genitais Masculinos/psicologia , Qualidade de Vida , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Estudos de Viabilidade , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/microbiologia , Gonorreia/diagnóstico , Gonorreia/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino Unido , Adulto Jovem
7.
Sex Transm Infect ; 94(6): 401-405, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29306870

RESUMO

OBJECTIVES: We aimed to investigate how an infection with Chlamydia trachomatis (CT) influenced patients' well-being and whether there were differences due to gender, age or relationship status, in an effort to strengthen preventive measures and provide better healthcare for patients with CT. METHODS: Patients diagnosed with CT in the county of Västerbotten, Sweden, were asked to fill out a questionnaire about their feelings, thoughts and actions after CT diagnosis. The patients were also asked to fill in the validated questionnaires Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test. Between February 2015 and January 2017, 128 patients (74 women and 54 men) were included in the study. RESULTS: After being diagnosed with CT, men were generally less worried than women (P<0.001). Women worried more about not being able to have children (P<0.001) and about having other STIs (P=0.001) than men did. Men felt less angry (P=0.001), less bad (P<0.001), less dirty (P<0.001) and less embarrassed (P=0.011) than women did. Nineteen per cent of men and 48% of women reported symptoms of anxiety. The majority of both men (60%) and women (72%) had a risk consumption of alcohol. CONCLUSION: Women and men reacted differently when diagnosed with CT. Women worried more about complications and more often blamed themselves for being infected. Being aware of these gender differences may be important when planning preventive measures and during counselling of CT-infected patients. Persons working with patients with CT must also be aware of the high frequency of harmful alcohol consumption among their patients.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Depressão/epidemiologia , Parceiros Sexuais/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Ansiedade/etiologia , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Fatores Sexuais , Estigma Social , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
8.
Sex Transm Infect ; 94(4): 241-247, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28988193

RESUMO

OBJECTIVE: We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. METHODS: Within exploratory studies of the eSHC (2014-2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18-35, 20 female, 16 male). Thematic analysis was conducted. RESULTS: Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support. CONCLUSION: The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences. Positive views on the helpline provide further support for embedding this ehealth intervention within a specialist clinical service.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Chlamydia/terapia , Internet , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Saúde Sexual , Telemedicina , Adolescente , Adulto , Infecções por Chlamydia/psicologia , Comportamento de Escolha , Coleta de Dados , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Adulto Jovem
9.
BMC Health Serv Res ; 17(1): 730, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29141635

RESUMO

BACKGROUND: Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking. METHODS: This qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18-22 years. RESULTS: Our main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group. CONCLUSIONS: While testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Parceiros Sexuais/psicologia , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Busca de Comunicante , Cultura , Feminino , Humanos , Incidência , Masculino , Motivação , Grupo Associado , Prevalência , Pesquisa Qualitativa , Estigma Social , Suécia/epidemiologia , Adulto Jovem
10.
Games Health J ; 6(4): 205-216, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28816513

RESUMO

OBJECTIVES: Herein we describe a methodology for developing a game-based intervention to raise awareness of Chlamydia and other sexually transmitted infections among youth in Boston's underserved communities. MATERIALS AND METHODS: We engaged in three design-based experiments. These utilized mixed methods, including playtesting and assessment methods, to examine the overall effectiveness of the game. In this case, effectiveness is defined as (1) engaging the target group, (2) increasing knowledge about Chlamydia, and (3) changing attitudes toward Chlamydia testing. These three experiments were performed using participants from different communities and with slightly different versions of the game, as we iterated through the design/feedback process. RESULTS: Overall, participants who played the game showed a significant increase in participants' knowledge of Chlamydia compared with those in the control group (P = 0.0002). The version of the game, including elements specifically targeting systemic thinking, showed significant improvement in participants' intent to get tested compared with the version of the game without such elements (Stage 2: P > 0.05; Stage 3: P = 0.0045). Furthermore, during both Stage 2 and Stage 3, participants showed high levels of enjoyment, mood, and participation and moderate levels of game engagement and social engagement. During Stage 3, however, participants' game engagement (P = 0.0003), social engagement (P = 0.0003), and participation (P = 0.0003) were significantly higher compared with those of Stage 2. Thus, we believe that motivation improvements from Stage 2 to 3 were also effective. Finally, participants' overall learning effectiveness was correlated with their prepositive affect (r = 0.52) and their postproblem hierarchy (r = -0.54). CONCLUSION: The game improved considerably from its initial conception through three stages of iterative design and feedback. Our assessment methods for each stage targeted and integrated learning, health, and engagement outcomes. Lessons learned through this iterative design process are a great contribution to the games for health community, especially in targeting the development of health and learning goals through game design.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Jogos Recreativos/psicologia , Educação em Saúde/métodos , Adolescente , Boston , Chlamydia/patogenicidade , Feminino , Educação em Saúde/normas , Humanos , Relações Interpessoais , Masculino , Projetos Piloto , Adulto Jovem
11.
Sex Transm Dis ; 44(7): 390-392, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28608787
12.
Sex Transm Dis ; 44(7): 417-422, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28608791

RESUMO

BACKGROUND: Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS: Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS: A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Chlamydia trachomatis/efeitos dos fármacos , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Cooperação do Paciente , Adulto , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Feminino , Seguimentos , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Estudos Prospectivos , Doenças Retais/diagnóstico , Doenças Retais/tratamento farmacológico , Doenças Retais/psicologia , Recidiva , Falha de Tratamento , Adulto Jovem
13.
Sex Transm Dis ; 44(6): 344-350, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28499283

RESUMO

BACKGROUND: Although understanding chlamydia incidence assists prevention and control, analyses based on diagnosed infections may distort the findings. Therefore, we determined incidence and examined risks in a birth cohort based on self-reports and serology. METHODS: Self-reported chlamydia and behavior data were collected from a cohort born in New Zealand in 1972/3 on several occasions to age 38 years. Sera drawn at ages 26, 32, and 38 years were tested for antibodies to Chlamydia trachomatis Pgp3 antigen using a recently developed assay, more sensitive in women (82.9%) than men (54.4%). Chlamydia incidence by age period (first coitus to age 26, 26-32, and 32-38 years) was calculated combining self-reports and serostatus and risk factors investigated by Poisson regression. RESULTS: By age 38 years, 32.7% of women and 20.9% of men had seroconverted or self-reported a diagnosis. The highest incidence rate was to age 26, 32.7 and 18.4 years per 1000 person-years for women and men, respectively. Incidence rates increased substantially with increasing number of sexual partners. After adjusting age period incidence rates for partner numbers, a relationship with age was not detected until 32 to 38 years, and then only for women. CONCLUSIONS: Chlamydia was common in this cohort by age 38, despite the moderate incidence rates by age period. The strongest risk factor for incident infection was the number of sexual partners. Age, up to 32 years, was not an independent factor after accounting for partner numbers, and then only for women. Behavior is more important than age when considering prevention strategies.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Autorrelato , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Antígenos de Bactérias/isolamento & purificação , Proteínas de Bactérias/isolamento & purificação , Criança , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/prevenção & controle , Infecções por Chlamydia/psicologia , Chlamydia trachomatis/isolamento & purificação , Estudos de Coortes , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Masculino , Nova Zelândia/epidemiologia , Fatores de Risco , Fatores Sexuais , Parceiros Sexuais , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
14.
Sex Reprod Healthc ; 12: 107-115, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28477922

RESUMO

OBJECTIVES: We used qualitative research design to discursively explore expectant fathers' perceptions of chlamydia and HIV, and their masculinity constructions about testing, and explored how they talked about their potential resistance towards testing and their pre-test emotions. STUDY DESIGN: Twenty men were offered chlamydia and HIV testing at the beginning of their partner's pregnancy. Those who agreed to be tested were interviewed in-depth; those who declined testing were also interviewed. The interviews were tape recorded and transcribed verbatim. The analysis was inspired by discourse analysis on masculinity. MAIN OUTCOME: Three discursive themes: Men prefer to suppress their vulnerability to STIs, Body and biology differ between men and women and Men have mixed emotions around STI testing underscore the informants' conversations and sometimes conflicting thoughts about STI testing. CONCLUSION: The majority of men talked about pregnancy as a feminine territory, raised uncertainties about men's roles in the transmission of STIs, and talked about women's and men's essentially different bodies and biology, where few men realised that they could infect both their partner and the unborn child. This knowledge gap that men have must become apparent to healthcare providers, and policy makers must give men equal access to the reproductive arena.


Assuntos
Infecções por Chlamydia/diagnóstico , Pai/psicologia , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Infecções por Chlamydia/psicologia , Infecções por Chlamydia/transmissão , Emoções , Feminino , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Masculino , Masculinidade , Gravidez , Pesquisa Qualitativa , Saúde Sexual , Vergonha , Suécia , Adulto Jovem
15.
Int J STD AIDS ; 28(4): 367-371, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27154958

RESUMO

This cross-sectional study was undertaken to compare health-related quality of life (EQ-5D) in women with and without undiagnosed Chlamydia trachomatis infection. We analysed data from 2401 multi-ethnic sexually active female students aged 16-27 years who were recruited to a randomised controlled trial of chlamydia screening - the prevention of pelvic infection trial in 2004-2006. At recruitment, all participants were asked to provide self-taken vaginal swabs for chlamydia testing and to complete a sexual health questionnaire including quality of life (EQ-5D). Most women (69%) had an EQ-5D of one representing 'perfect health' in the five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. We therefore compared the proportion of women with an EQ-5D score < 1 implying 'less than perfect health' in women with and without chlamydia infection, and women with symptomatic chlamydia versus the remainder. The proportion of women with EQ-5D score < 1 was similar in women with and without undiagnosed chlamydia: 34% (47/138) versus 31% (697/2263; RR 1.11, 95% CI 0.87 to 1.41). However, more women with symptomatic chlamydia had EQ-5D score < 1 than the remainder: 45% (25/55) versus 31% (714/2319; RR 1.47, CI 1.10 to 1.98). In this community-based study, EQ-5D scores were similar in women with and without undiagnosed chlamydia. However, a higher proportion of women with symptomatic chlamydia infection had 'less than perfect health'. Undiagnosed chlamydia infection may not have a major short-term effect on health-related quality of life, but EQ-5D may not be the best tool to measure it in this group.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Qualidade de Vida , Estudantes/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/psicologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Nível de Saúde , Humanos , Londres/epidemiologia , Autocuidado , Comportamento Sexual , Estudantes/psicologia , Inquéritos e Questionários , Saúde da Mulher , Adulto Jovem
16.
Rural Remote Health ; 16(1): 3588, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26961815

RESUMO

INTRODUCTION: The aim of this study was to assess access to sexual health care in remote and rural settings using Chlamydia testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). METHODS: Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. RESULTS: 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. CONCLUSIONS: These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.


Assuntos
Infecções por Chlamydia/diagnóstico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , População Rural/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/psicologia , Chlamydia trachomatis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Escócia , Distribuição por Sexo , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
17.
BMC Public Health ; 16: 55, 2016 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-26790411

RESUMO

BACKGROUND: It is hard to convince people to participate in chlamydia screening programs outside the clinical setting. In two earlier studies (BMC Public Health. 2013;13:1091; J Med Internet Res. 2014;16(1):e24), we identified explicit and implicit determinants of chlamydia screening behavior and attempted, unsuccessfully, to improve participation rates by optimizing the recruitment letter. In the present study, we examined the links between a number of social-cognitive determinants (e.g., stereotypical beliefs about a person with chlamydia, intentions, changes in partner status), and self-reported chlamydia testing behavior six months after the initial study. METHODS: The present study is a follow-up to our first study (T0). We assessed self-reported testing behavior 6 months after the first measure by means of an online questionnaire (T1; N = 269). Furthermore, at T1, we measured the social-cognitive determinants in more detail, and explored the influence of stereotypical beliefs and any changes in partner status during this six month period. RESULTS: In total, 25 (9.1 %) of the participants tested for chlamydia at some point during the six months between baseline (T0) and follow up (T1). Testing behavior was influenced by testing intentions in combination with changes in risk behavior. The higher the participants' own numbers of partners ever, the higher they estimated the number of partners of the stereotypical person with chlamydia. Testing intentions were most strongly predicted by perceived norms and susceptibility, and having had multiple partners in the last 6 months (R(2) = .41). CONCLUSION: The most relevant determinants for testing intentions and behavior were susceptibility, subjective norms and changes in partner status. We found a systematic tendency for individuals to underestimate their own risk, especially the risk of inconsistent condom use. Future research should focus on more promising alternatives to population-based interventions, such as online interventions, screening in primary care, the rescreening of positives, and clinic-based interventions. This future research should also focus on making testing easier and reducing barriers to testing, as well as using social and sexual networks in order to reach more people.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Medição de Risco , Comportamento Sexual/estatística & dados numéricos , Normas Sociais , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Chlamydia trachomatis , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Intenção , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Assunção de Riscos , Adulto Jovem
18.
Sex Transm Infect ; 92(2): 91-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26275416

RESUMO

OBJECTIVES: Risk judgements are key factors in adolescents' decisions related to sexual health. We examine the associations between self-perceived risk and prevalent chlamydia infection, and sexual behaviours related to risk perception in a general adolescent population in Norway. METHODS: Population-based cross-sectional study among 1028 sexually experienced girls and boys, age 15-20 years (85% participation), including web questionnaires and urine samples for Chlamydia trachomatis PCR testing. Participants rated self-perceived risk as: no/low/medium/high/very high. We used binary and ordinal logistic regressions to examine associations with chlamydia prevalence and self-perceived risk, respectively, adjusting for potentially confounding variables. RESULTS: Chlamydia prevalence increased with increasing risk perception. Although girls had twice the chlamydia prevalence of boys (7.3% vs 3.9%), their risk distribution was similar and 65% of both genders rated their risk as no/low with half of infections detected in this group. In multivariable analyses, reporting multiple sexual risk behaviours, non-steady relationship, previous chlamydia testing and treatment, and urogenital symptoms increased self-perceived risk. More boys overestimated their personal risk whereas more girls underestimated it (52% vs 30%, respectively, and 15% vs 31%, p<0.001). The main reasons for perceiving no/low risk were: 'I have a steady partner' and 'I trust my partner will tell me about an infection'. CONCLUSIONS: These sexually experienced adolescents acknowledged their chlamydia infection risk, but wrong beliefs were incorporated in their assessments, and more than half had incorrect risk perception. We suggest that sexually transmitted infection prevention programmes should be directed at closing the gap between perceived and actual risk and focus on how context may bias personal judgement.


Assuntos
Comportamento do Adolescente/psicologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Educação em Saúde/organização & administração , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adolescente , Infecções por Chlamydia/prevenção & controle , Infecções por Chlamydia/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Noruega/epidemiologia , Formulação de Políticas , Vigilância da População , Prevalência , Fatores de Risco , Autoimagem , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
19.
Sex Transm Infect ; 92(2): 97-103, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26268510

RESUMO

OBJECTIVES: Evidence is mixed as to whether meeting sexual partners online ('internet-partners') is associated with risky sexual behaviour and/or sexually transmitted infection transmission. Accordingly, we sought to estimate the prevalence of reporting various online romantic and sexual activities among Norwegian adolescents, including internet-partners, and the reason for meeting them and to examine differences in sexual behaviour, partnership characteristics and chlamydia infection prevalence among those reporting internet-partners versus those reporting only offline partners. METHODS: Population-based cross-sectional survey among sexually experienced girls and boys, 15-20 years, using electronic questionnaires and collecting urine samples for Chlamydia trachomatis PCR testing (79% provided both, n=1023). We used logistic regression to examine associations, adjusting for potentially confounding variables. RESULTS: Overall, 30% of both genders reported internet-partners (ever). Boys (but not girls) with internet-partners had higher chlamydia prevalence than those reporting meeting sexual partners only offline (8.1%, 95% CI 4.3% to 13.7% vs 1.6%, 0.5% to 3.7%). Two-thirds of girls and 37% of boys reported meeting their most recent internet-partner to start a romantic relationship, while the remainder did so with the specific intention of having sex. Among both genders, reporting sexual (vs romantic) reasons for meeting their most recent internet-partners was associated with reporting several risky sexual behaviours, including multiple recent sex partners (adjusted OR girls: 3.27, boys: 2.48) and three-fold higher chlamydia prevalence. CONCLUSIONS: This population-based study suggests that internet-partners are common among adolescents in Norway, and the reason for meeting them was more strongly associated with additionally reporting sexual risk behaviours and prevalent chlamydia infection than the internet itself as a meeting venue.


Assuntos
Comportamento do Adolescente/psicologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Internet , Parceiros Sexuais/psicologia , Apoio Social , Adolescente , Infecções por Chlamydia/prevenção & controle , Infecções por Chlamydia/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Noruega/epidemiologia , Vigilância da População , Prevalência , Fatores de Risco , Assunção de Riscos , Autorrelato , Urinálise , Adulto Jovem
20.
J Pediatr Adolesc Gynecol ; 29(1): 62-4, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26099698

RESUMO

STUDY OBJECTIVE: The purpose of this study was to evaluate whether providers offer chlamydia screening to teenagers and/or whether screening is accepted at different rates depending on insurance type. DESIGN: Retrospective chart review. SETTING: Academic center serving urban and suburban patients between April 2009 and October 2011. PARTICIPANTS: Nine hundred eighty-three health maintenance visits for asymptomatic, insured female adolescents aged 15-19 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Dichotomous dependent variables of interest indicated whether chlamydia screening was: (1) offered; and (2) accepted. The key independent variable insurance type was coded as 'public' if Medicaid or Medicaid Managed Care and 'private' if a commercial plan. χ(2) and logistic regression analyses were used to assess the significance of differences in screening rates according to insurance type. RESULTS: Of asymptomatic health-maintenance visits 933 (95%) had a documented sexual history and 339 (34%) had a documented history of sexual activity. After excluding those who had a documented chlamydia screen in the 12 months before the visit (n = 79; 23%), 260 visits met eligibility for chlamydia screening. Only 169 (65%) of eligible visits had chlamydia screening offered and there was no difference in offer of screening according to insurance type. Significantly more visits covered by public insurance had chlamydia screening accepted (98%) than those covered by private insurance (82%). Controlling for demographic factors, the odds of accepted chlamydia screening was 8 times higher in visits covered by public insurance than those with private insurance. CONCLUSION: Although publically and privately insured teens were equally likely to be offered chlamydia screening, publically insured teens were significantly more likely to accept screening. Future research should investigate reasons for this difference in screening acceptance. These findings have implications for interventions to improve chlamydia screening because more adolescents are covered by parental insurance under the Affordable Care Act.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Cobertura do Seguro , Seguro Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/prevenção & controle , Feminino , Humanos , Medicaid/estatística & dados numéricos , Estudos Retrospectivos , Comportamento Sexual/estatística & dados numéricos , Estados Unidos , Adulto Jovem
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