The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru

Tang, Eric C.; Segura, Eddy R.; Clark, Jesse L.; Sánchez, Jorge; Lama, Javier R.

doi:10.1136/bmjopen-2015-008552

Cited by 14 publications

(17 citation statements)

References 30 publications

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“…Given that MSM and transgender women are often difficult to access populations that are often lost to follow up, it is important for policy makers and health care workers to understand these groups’ preferences if there is the potential to increase testing and retention in care [ 7 – 11 ]. We found that MSM and transgender women prefer tests that have lower costs, improved accuracy, timeliness, and lower number of blood draws.…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted in 2013 to 2014 among MSM and transgender women in Lima, Peru, our group observed the prevalence of HIV infection to be 30.1% among MSM and 33.7% among transgender women and the prevalence of recent syphilis infection to be 16.8% among MSM and 6.7% among transgender women [ 6 ]. In addition, MSM and transgender women may be averse to health care engagement and those who access care are often lost to follow up [ 7 – 11 ]. Among MSM and transgender women attending sexually transmitted infection (STI) clinics in Lima, Peru, 41% reported never being tested for HIV prior to their current visit [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru

et al. 2018

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BackgroundMen who have sex with men (MSM) and transgender women in Peru are at high risk for acquiring syphilis and HIV infection. The World Health Organization highly recommends screening for HIV and syphilis to reduce morbidity and mortality associated with untreated infections. We aimed to identify factors associated with dual testing preferences for HIV and syphilis infection among MSM and transgender women in Lima, Peru.MethodsWe used conjoint analysis, an innovative method for systematically estimating consumer preferences. We created eight hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), potential for false positive syphilis result (no false positive vs. some risk of false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), test type (rapid vs. laboratory), and number of draws (1 vs. 2). We fit a conjoint analysis model for each participant using a simple main effects ANOVA. Attribute importance values were calculated using percentages from relative ranges in the attribute’s utility values. Results were summarized across participants and averages were reported.ResultsWe recruited 415 MSM/transgender women over 18 years of age from two STD clinics in Lima, Peru. No potential for syphilis false positive result (no false positive vs. some potential for false positive) had the largest average impact on willingness to use the test and on average accounted for 23.8% of test type preference, followed by cost (free vs. ~USD$4; 21.6%), time to results (20 minutes vs. 1 week; 17.4%), number of blood draws (1 draw vs. 2 draws; 13.8%), method of blood draw (fingerprick vs. venipuncture; 13.7%), and test type (rapid POC vs. laboratory; 9.7%).ConclusionMSM/transgender women in Peru prioritized accuracy, cost, timeliness and number of blood draws for HIV and syphilis testing. Implementing a low cost, accurate, rapid and dual testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru

et al. 2018

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“…While existing studies showed that non-clinic based programs were effective in improving the access of key populations to syphilis screening services, particularly among those who were more hidden and had higher STI risks 12,69,142 , few studies have evaluated linkage to care and related services. The gap between testing and treatment services could compromise the effectiveness of these strategies 143 . In addition, advances in new syphilis testing approaches have yet to translate into clinic seeking and clinic service uptake.…”

Section: Expert Commentarymentioning

confidence: 99%

Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations

Ong

Smith

et al. 2018

Expert Review of Anti-infective Therapy

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Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.

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“…The HIV cascade of care describes a continuum of testing and treatment outcomes from the initial diagnosis of infection, to linkage and retention in care, through initiation and maintenance of antiretroviral therapy, and ultimately long-term virologic suppression. The cascade of care concept has also been applied to management of HIV pre-exposure prophylaxis, syphilis treatment, and EPT [ 2 , 49 – 51 ]. In the EPT cascade, an initial diagnosis of GC/CT infection is followed by provision of EPT, acceptance of partner therapy by the index patient, delivery of treatment to the partner, and finally partner treatment.…”

Section: Discussionmentioning

confidence: 99%

Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial

Clark

Segura

Oldenburg

et al. 2017

BMC Med

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BackgroundExpedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection.MethodsWe enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up.ResultsThe median age of participants was 26 (interquartile range [IQR]: 23–31) with a median of 3 sexual partners (IQR: 2–4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0–2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68–7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0–62.0% versus 36.4%, 95% CI: 27.0–47.4%).ConclusionsProvision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks.Trial registrationClinicalTrials.gov, NCT01720654. Registered on 10/29/2012.

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The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru

Cited by 14 publications

References 30 publications

HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru

HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru

Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations

Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial

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