Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and syndromic treatment of men with urethral discharge in Kingston, Jamaica, 2018-19.

OBJECTIVES: To quantitatively determine the antimicrobial susceptibility of clinical Neisseria gonorrhoeae isolates from men with urethral discharge in Jamaica and to describe the syndromic treatment therapies administered. METHODS: Urethral eSwabs (Copan) were collected from 175 men presenting with urethral discharge to the Comprehensive Health Centre STI Clinic, Kingston, Jamaica. Clinical information was collected and MICs of eight antimicrobials were determined for N. gonorrhoeae isolates (n = 96) using Etest and interpreted using CLSI criteria. RESULTS: The median age of the subjects was 28 years (range: 18-73 years) with a median of 2 sexual partners (range: 1-25) per male in the previous 3 months. All examined N. gonorrhoeae isolates were susceptible to ceftriaxone (96/96), azithromycin (91/91), cefixime (91/91) and spectinomycin (91/91). For ciprofloxacin and gentamicin, respectively, 98.9% (91/92) and 91.3% (84/92) of the isolates were susceptible and 1.1% (1/92) and 8.7% (8/92) showed intermediate susceptibility/resistance. For tetracycline and benzylpenicillin, respectively, 38.0% (35/92) and 22.0% (20/91) of the isolates were susceptible, 52.2% (48/92) and 74.7% (68/91) showed intermediate susceptibility/resistance and 9.8% (9/92) and 3.3% (3/91) were resistant. Syndromic treatment was administered as follows: 93.1% received 250 mg of ceftriaxone intramuscularly plus 100 mg of doxycycline orally q12h for 1-2 weeks and 6.9% received 500 mg of ciprofloxacin orally plus 100 mg of doxycycline orally q12h for 1 week. CONCLUSIONS: Ceftriaxone (250 mg) remains appropriate for gonorrhoea treatment in the examined population of men in Kingston, Jamaica. Surveillance of N. gonorrhoeae AMR should be expanded in Jamaica and other Caribbean countries to guide evidence-based treatment guidelines.

Barriers and facilitators to participation of men who have sex with men and transgender women in HIV research in Jamaica.

To assess potential barriers and facilitators to participation in bio-behavioural surveillance surveys of men who have sex with men and transgender women (trans women) in Jamaica, we recruited participants for individual interviews and focus group discussions. Respondents included 3 trans women; 46 gay, bisexual and other men who have sex with men; and 3 cis gender women. Data from 46 men and 3 trans women were analysed to describe barriers and facilitators to participation in research. Barriers identified were: lack of perceived benefits from research participation due to high socioeconomic status; concerns about confidentiality and unintended disclosure; HIV fatigue and fear of knowing one's HIV status; distrustful inter-group dynamics; and undesirable study location and hours. Facilitators to participation in research were: belonging to a marginalised subgroup of men who have sex with men or trans women; incentives; and trust in researchers and community input in planning the study. Findings emphasise the need to understand the individual, interpersonal and structural factors that shape relationships, disclosure and interactions to successfully enrol diverse samples of men who have sex with men and trans women.

The HIV epidemic in Jamaica: a need to strengthen the National HIV Program.

OBJECTIVES: To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. METHODS: The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. RESULTS: HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. CONCLUSIONS: Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.

HIV Risk and Gender in Jamaica's Homeless Population.

Rigorous HIV-related data for the homeless population in Jamaica is limited. A cross-sectional survey using a venue-based sampling approach was conducted in 2015 to derive HIV prevalence and associated risk factors. Three hundred twenty-three homeless persons from the parishes of St. James, St. Ann, Kingston, and St. Andrew (the main urban centers) participated. HIV prevalence was 13.8%, with a difference in gender (males 11.6%, females 26.7%, P = .007). Sex work, multiple partnerships, incarceration, non-injecting drug use, and female rape were common among the participants. Long-term, multilayered, HIV-specific, female-focused interventions are required for the population, along with additional female-centric research.

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults.

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15-24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.

Transactional sex and risky sexual practices in Jamaica.

BACKGROUND: Transactional sex relationships (TSRs) create financial and emotional support for men and women, as well as an increased sexual risk. Studies have reported high HIV and STI transmission rates among young women in transactional sex relationships. However, little is known about TSR prevalence in Jamaica and risky sexual practices among participants. This study investigates the sexual behaviour of Jamaicans in TSR. METHODS: Secondary data analysis of a national survey revealed that 586 participants (38%) self-reported being in at least one TSR in the last 12 months. We also identified a third category called "Benefluids", who play both roles of benefactor and beneficiary in transactional sex relationships. RESULTS: 59 percent of male Benefluids had two to five transactional sex relationship partners in the last 12 months, compared to 40% of female Benefluids. Twenty-eight percent of female Benefluids reported sexually transmitted infection symptoms in the last 12 months compared to 13.5% of male Benefluids. While females reported more sexually transmitted infection symptoms, young men had the highest sexual risk precursors. CONCLUSIONS: People in transactional sex relationships often play the role of beneficiaries and benefactors to meet material and sexual needs but this increases the risk of STI symptoms.

"Nothing for Us Without Us": An Evaluation of Patient Engagement in an HIV Care Improvement Collaborative in the Caribbean.

INTRODUCTION: Patient engagement is increasingly recognized as a key strategy to promote patient-centered care and accelerate health care improvements. Ensuring patient participation in improvement efforts is particularly important with stigmatized illnesses and marginalized populations. Despite the attention it has garnered, patient engagement is still not widely implemented and has not been well documented in global health literature. METHODS: We implemented a patient-engagement strategy to involve people living with HIV in quality improvement efforts. As part of the Caribbean Regional Quality Improvement Collaborative, quality improvement teams from Barbados (1 team), Jamaica (20 teams), Suriname (3 teams), and Trinidad and Tobago (2 teams) engaged health care providers from care facilities and people living with HIV to serve as community representatives (CRs) to lead the improvement efforts alongside them. This strategy was evaluated via a mixed method design that included 2 rounds of semistructured, in-depth interviews with patients and providers. RESULTS: Findings suggest that the patient engagement strategy had several key strengths: it promoted the collection, use, and appreciation of patient input to inform health care improvements at the facility level; facilitated the empowerment of CRs; enhanced mutual understanding and empathy between CRs and providers; and helped to dispel HIV stigma and discrimination in health care settings. Moreover, both health care providers and CRs reported that CR opinions and perspectives are as important as providers' and that CR participation in the improvement process was beneficial.

A Call for Low- and Middle-Income Countries to Commit to the Elimination of Cervical Cancer.

The World Health Organization has called for the global elimination of cervical cancer. While high income countries have made significant progress, the incidence and mortality due to cervical cancer is unacceptably high in low and middle income countries (LMIC). Jamaica is an upper middle income country with cervical cancer incidence and mortality of 21.6/100,000 and 13.6/100,000 person years respectively compared to 14.9/100,000 and 7.6/100,000 person years in Latin America and the Caribbean. Jamaica's pathway to reducing the burden of cervical cancer highlights challenges and opportunities for other LMIC. High prevalence of HPV infection (54% women attending primary care clinics), low levels of cervical cancer screening (<50% women 15 to 54 years old screened in the last 3 years) and suboptimal uptake of HPV vaccination (approximately 30%) are persistent barriers to achieving this goal. Lessons learned from the response to the human immunodeficiency virus (HIV) epidemic confirm the need for serious political commitment by global and national leaders, meaningful engagement of stakeholders and innovative strategies to improve uptake of HPV vaccination and cervical cancer screening. Commitment of technical and financial resources are critical for establishing robust cancer registries and strengthening monitoring and evaluation systems in LMIC.

The HIV epidemic in Jamaica: a need to strengthen the National HIV Program

[ABSTRACT]. Objectives. To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods. The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results. HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions. Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.

[RESUMEN]. Objetivos. Evaluar el estado de la epidemia de la infección por el VIH en Jamaica y de la ejecución programática, y determinar las estrategias para lograr un control eficaz de la infección por el VIH. Métodos. La evaluación incluyó una revisión de los indicadores básicos del Marco de Vigilancia Mundial del ONUSIDA, un estudio teórico de informes programáticos y entrevistas no estructuradas a los interesados directos. Resultados. La prevalencia de la infección por el VIH en adultos en Jamaica fue del 1,5% en el 2018, con unas 32 617 personas infectadas y unas 27 324 personas (83,8%) con diagnóstico de infección por el VIH; 12 711 personas (39,0% del total de personas con infección por el VIH, o el 46,5% de las que conocían su estado) estaban bajo tratamiento antirretroviral en el sector de salud pública, y el 61,8% de las personas con infección por el VIH que recibieron tratamiento antirretroviral alcanzó la supresión viral. La prevalencia de la infección por el VIH en hombres que tienen relaciones sexuales con hombres sigue siendo alta (31,4% en el 2011, 29,6% en el 2017), aunque ha descendido en las trabajadoras sexuales (12% en 1990, 2% en el 2017). En los últimos años, la prevalencia de la infección por el VIH en personas que acuden a centros públicos de atención de infecciones de transmisión sexual, presidiarios y personas sin hogar ha aumentado. En el 2018, aproximadamente 200 000 personas (14% de la población entre 15 y 49 años) se sometieron a la prueba de VIH, de las cuales 1 165 fueron diagnosticadas como personas recién infectadas por el HIV, lo cual indica que muchas de las 1 600 personas recién infectadas en el 2018 desconocían su estado. Conclusões. Se necesitan iniciativas políticas fundamentales para reducir los obstáculos que impiden el acceso a los servicios de atención de la infección por el VIH, asegurar que las personas jóvenes tengan acceso a preservativos y anticonceptivos, afirmar los derechos de las personas marginadas, reducir la estigmatización y la discriminación, e introducir la profilaxis previa a la exposición. Si bien la propagación de la infección por el VIH se ha desacelerado en Jamaica, el logro de los Objetivos de Respuesta Rápida del ONUSIDA está demorado. Debe fortalecerse el Programa contra el VIH para controlar eficazmente la epidemia.

[RESUMO]. Objetivos. Avaliar a situação da epidemia de HIV e a implementação do Programa Nacional de HIV na Jamaica, identificando estratégias eficazes para controlar o HIV. Métodos. A avaliação incluiu uma revisão dos indicadores-chave da Estrutura de Monitoramento Global do UNAIDS, uma revisão documental dos relatórios do programa e entrevistas não estruturadas com participantes. Resultados. A prevalência de infecção pelo HIV em adultos na Jamaica foi de 1,5% em 2018. Estima-se que haja 32.617 pessoas vivendo com o HIV (PVHIV), das quais 27.324 (83,8%) foram diagnosticadas; 12.711 (39,0% de todas as PVHIV, e 46,5% das que conhecem seu diagnóstico) estavam em terapia antirretroviral (TAR) no setor da saúde pública, e 61,8% das PVHIV em ART alcançaram a supressão viral. A prevalência de HIV entre homens que fazem sexo com homens continua alta (31,4% em 2011, 29,6% em 2017), mas diminuiu entre mulheres profissionais do sexo (12% em 1990, 2% em 2017). A prevalência de HIV entre os pacientes que frequentam clínicas públicas de atenção a infecções sexualmente transmissíveis, presidiários e desabrigados tem aumentado nos últimos anos. No ano de 2018, aproximadamente 200.000 pessoas (14% da população de 15 a 49 anos) foram testadas, sendo feitos 1.165 novos diagnósticos de infecção pelo HIV, o que indica que muitas das 1.600 pessoas recém-infectadas estimadas em 2018 não estavam cientes de sua infecção. Conclusões. São necessárias iniciativas políticas essenciais para reduzir as barreiras no acesso aos serviços de HIV, assegurar que os jovens tenham acesso a preservativos e métodos contraceptivos, afirmar os direitos dos marginalizados, reduzir o estigma e a discriminação e introduzir a profilaxia pré-exposição. Embora a propagação do HIV na Jamaica tenha perdido velocidade, o progresso para alcançar as metas da estratégia Fast Track do UNAIDS tem sido lento. Para controlar a epidemia de forma eficaz, é preciso fortalecer o Programa Nacional de HIV.