Purpose Improving pregnancy outcomes for women and children is one of the nation’s top priorities. The Healthy Start (HS) program was created to address factors that contribute to high infant mortality rates (IMRs) and persistent disparities in IMRs. The program began in 1991 and was transformed in 2014 to apply lessons from emerging research, past evaluation findings, and expert recommendations. To understand the implementation and impact of the transformed program, there is a need for a robust and comprehensive evaluation. Description The national HS evaluation will include an implementation evaluation, which will describe program components that affect outcomes; a utilization evaluation, which will examine the characteristics of women and infants who did and did not utilize the program; and an outcome evaluation, which will assess the program’s effectiveness with regard to producing expected outcomes among the target population. Data sources include the National HS Program Survey, a HS participant survey, and individual-level program data linked to vital records and the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Assessment Descriptive analyses will be used to examine differences in risk profiles between participants and non-participants, as well as to calculate penetration rates for high-risk women in respective service areas. Multivariable analyses will be used to determine the impact of the program on key outcomes and will explore variation by dose, type of services received, and grantee characteristics. Conclusion Evaluation findings are expected to inform program decisions and direction, including identification of effective program components that can be spread and scaled.

Background As part of an on-going STI microbiological surveillance programme, we investigated associations between Chlamydia trachomatis infection and the demographic, clinical, microbiological and behavioural characteristics of patients presenting with either male urethral discharge syndrome (MUDS) or vaginal discharge syndrome (VDS) to a public healthcare facility in Johannesburg, South Africa Methods 1,218 MUDS and 1,232 VDS cases were consecutively recruited during 6 annual surveys, starting in 2007. Genital discharge pathogens were detected using a molecular assay for N. gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium and by microscopy of vaginal smears (bacterial vaginosis, Candida). Serology was used to detect syphilis, HSV-2 and HIV infections. Chi-squared tests and logistic regression analyses were used to identify predictors of C. trachomatis infection. Results Overall, 286 (23.5%) men and 197 (16.0%) women were C. trachomatis positive, with the highest prevalence observed in men (30.5%) and women (25.9%) aged 20-24 years. In the multivariate analysis, C. trachomatis was less likely to be detected in MUDS patients co-infected with N. gonorrhoeae (aOR 0.36, 95% CI, 0.26-0.49) and HSV-2 (aOR 0.70, 95% CI, 0.51-0.95) as well as patients who had received antibiotics recently (aOR 0.43. 95% CI, 0.20-0.91). In contrast, the likelihood of C. trachomatis infection was higher in VDS patients co-infected with either N. gonorrhoeae (aOR 2.22, 95% CI, 1.48-3.32) or M. genitalium (aOR 2.24, 95% CI, 1.45-3.47) infection but lower in women who were older (aOR 0.68, 95% CI 0.60-0.77) or who had Candida morphotypes detected (aOR 0.66, 95% CI 0.44-0.98). Conclusion The increased likelihood of co-existent gonococcal or M. genitalium infections, but the decreased likelihood of Candida infection, in women with VDS-associated chlamydial infection suggests that these women are at higher risk of STIs, and potentially HIV. Paradoxically, gonococcal infection as well as recent antibiotic use, reduced the likelihood of MUDS patients having chlamydial infection.

The joint meeting of International Society for Sexually Transmitted Diseases Research (ISSTDR) and International Union against Sexually Transmitted Infections (IUSTI) was held in July 2013 in Vienna, Austria. The conference had attracted over 1300 submissions and was divided into six tracks. The track chairs reviewed all presentations and identified key themes and data that delegates should be aware of. In a conference summary session, each track chair presented these highlights. This conference report details and expands on this summary.