Bill de Blasio Mayor Oxiris Barbot, MD Commissioner nyc.gov/health

No abstract

Persons living with HIV (PLWH) are living longer, remaining sexually active, and may continue risky sexual behaviors. As such, it is crucial for providers to ask all HIV-positive patients about behaviors related to HIV transmission and STD acquisition. The ''Ask, Screen, Intervene'' (ASI) curriculum was developed to increase provider knowledge, skills, and motivation to incorporate risk assessment and prevention services into the care of PLWH. The ASI curriculum was delivered to 2558 HIV-care providers at 137 sites between September 30, 2007 and December 31, 2010. Immediately post-training, participants self-reported significant gains in perceived confidence to demonstrate ASI knowledge and skills ( p < 0.001) and 89% agreed they would update practices as a result of the training. Three to six months post-training, 320 participants who served PLWH or supervised HIV-care providers self-reported more frequently performing ASI skills ( p < 0.001), and 71% selfreported greater perceived confidence than before training to perform those skills ( p < 0.001). Limitations include self-reported measures and a 30% response rate to the 3-6 month follow-up survey. Our findings suggest that a well-coordinated training program can reach a national audience of HIV-care providers, significantly increase self-reported capacity to incorporate HIV/STD prevention into the care of PLWH, and increase implementation of national recommendations.

Background Information on the potential impact of the presence of an STD and/or family planning (FP) clinic on STD surveillance and control is scant. In the study, we examine the impact of STD and/or publicly funded Title V, X, and XX FP clinics on county-level surveillance and control of three reportable STDs (chlamydia (CT), gonorrhoea (GC) and primary and secondary syphilis (P&S)) in Texas during 2000 and 2007. Specifically, we examined the following two questions: (1) Are the counties with STD/FP clinics reporting relatively more cases of STDs? (2) Does having STD service(s) (the presence of an STD/FP clinic) in a county matter? Methods We used spatial regression to analyse the impact of STD/ FP clinics on county-level STD morbidity using surveillance data on CT, GC, and P&S. the impact of STD/FP clinics on STD control was examined using a backward stepwise regression on the changes in À0.04 (CI 0.01 to À0.09, p<0.10) for CT; À0.08 (CI À0.02 to À0.14, p<0.01) for GC and À0.09 (CI À0.03 to À0.15, p<0.01) for P&S. Thus, the transformed incidence rates of GC and P&S reduced by 8% and 9%, respectively, between 2000 and 2007 for those counties that had at least one STD/FP clinic. Conclusion The results from this ecological study are consistent with (but do not establish) a causal relationship between having an STD/FP clinic and improved surveillance and/or reduction in STDs at the county-level in Texas. However, the results suggest that STD/ FP clinics play an important role in STD surveillance and control. Finer level analyses (such as census block or cities) may be able to establish a strong causal relationship. Issue Almost all the patients who presents to the hospital with symptoms and/or signs of sexually transmitted infection have been engaged with unprotected sexual intercourse, thus they are predispose to contacting STI including HIV and complications. STIs can increase the risk of HIV acquisition and transmission by a factor of up to 10. The WHO estimates that more than three million new curable STI infections occur annually among people aged 15e49 worldwide. In 1995, over half of female patients seeking treatment for a sexually transmitted infection (STI) tested in 13 states were HIV positive. Among STI patients in 10 states, in 2000, HIV prevalence increased by age, the lowest rate was ages 10e19, and the highest among those ages 50+. Akwa Ibom State has one of the highest rates among selected states for 2000 with 21% of STI patients tested HIV positive In 2008, Akwa Ibom and Cross River States had the highest rate of HIV infection in the South South Zone at 9.7% and 6% respectively. The health seeking behaviour of the poor at public health facilities is influenced by cost, the fear that services are not going to be confidential and the fear of meeting people they know at the healthcare facility. Thus this sexual risky population often do not always access care, thus contributing to the underserved most at risk population in the community. Method ECEWS implemented Condom and Other Prevention using the ...

No abstract