• Evaluation of Outcomes of a Newly Implemented Sexually Transmitted Infection Rapid Testing System

      Sein, Vicki; The University of Arizona College of Medicine - Phoenix; Khurana, Renuka (The University of Arizona., 2011-03)
      Objectives: To evaluate the outcomes of a newly implemented express testing system for sexually transmitted infections at the Maricopa County Public Health Department. Methods: This study reviewed data that was collected by the Maricopa County Public Health Department. There are two avenues for sexually transmitted infection (STI) testing at the department. Individuals are given a questionnaire at the time of check-in to assess their possible exposure to others who might have sexually transmitted infections and their symptoms at the time of presentation. Those who are asymptomatic and deemed to be at low risk for infection are sent to the express testing system, while individuals who are determined to be at higher risk for infection or are actively symptomatic, are seen by a provider for a comprehensive visit. Testing that is offered to patients, regardless of visit type is; urine nucleic acid amplification for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC), and blood tests for syphilis and HIV. Results were evaluated from September 2008 to March 2010. Data were evaluated for difference in positivity of the express testing patients as opposed to those who saw a provider, as 5 well as the demographic differences between the two groups. Also evaluated, was the treatment obtained by individuals in the express testing group, and the time to return for treatment. Results: Between September 01, 2008 and March 31, 2010, there were 33294 visits made to the clinic for STI testing. Of these, 4232 (12.7%) were express testing visits. During this time, a total of 3268 cases of CT and 1030 cases of GC were diagnosed. Express testing had a lower incidence of CT and GC, with 204 and 24 cases respectively. Compared the provider visits, the incidence of CT and GC were lower in express testing with CT being 4.8% (vs 10.5% in provider visits), and GC 0.6% (vs 6.5% in provider visits). Of the express testing CT cases, 90.2% returned for treatment, with an average return time of 16.9 days, as compared to 92.6% treatment with an average return time of 13.8 days in the provider visit group (66% were treated the same day). Of the express testing GC cases, 87.5% returned for treatment, with an average return time of 9.8 days, as compared to 88.5% return for treatment and average return time of 13.7 days in the provider visit group (70.2% were treated the same day).
    • HIV and Syphilis Co-Infection in Maricopa County

      Thomas, Sarah; The University of Arizona College of Medicine - Phoenix; Khurana, Renuka; Campos-Outcalt, Douglas; Mickey, Tom (The University of Arizona., 2011-02)
      BACKGROUND: The past decade has seen a resurgence of Syphilis infections on the global, national and local levels, and Arizona has been no exception. After having fallen to record lows nationally in 1999, rates of Primary and Secondary (P&S) syphilis increased incrementally each year from 2001-2008 [5] [16]. Overall increases in rates between 2001 and 2008 were observed primarily among men [5]. Concurrently, the estimated proportion of all P&S syphilis cases occurring in men nationally who have sex with men (MSM) increased dramatically from 5% in 2000 to 62% in 2004 [15]. This trend has been described in epidemiologic research from coast to coast in Washington State’s King County, Southern California and New York City [9] [10] [11]. These national trends are mirrored locally in Arizona. In Arizona early syphilis (primary, secondary and early latent) has increased from 2004-2008 [19]. The majority of these cases have occurred in Maricopa County. Also noted has been an apparent increase in patients who are concurrently infected with HIV, by self report and testing. OBJECTIVES: This study aims to evaluate these trends in syphilis rates, HIV rates and co-infection rates in Maricopa County over an 11 year period. METHODS: The study enrolled all individuals diagnosed with of Primary, Secondary and Early Latent Syphilis identified in Maricopa County between the years 1998-2008. At time of diagnosis all individuals with a syphilis diagnosis were interviewed for demographic and risk factor variables by the Maricopa County Public Health Investigators. This data was then matched and merged with the Arizona State HIV database to identify individuals with confirmed HIV positive status and early syphilis diagnosis. All personal identifiers were removed once the data was merged. Co-morbidity was defined as any individual with any known diagnosis of HIV and early syphilis regardless of the order of the diagnoses. Co-infection was defined as individuals with a diagnosis of early syphilis 3 or more months after the diagnosis of HIV. This information was then analyzed using SAS statistical software. Logistic regression analysis evaluated for significant risk factors within individuals co-infected HIV and Syphilis, as compared to individuals with early Syphilis diagnosis without HIV positive status. The study examined demographics including gender, age, and race as well as behavioral risk factors; men 5 who have sex with men, meeting sex partners on the internet, having anonymous sex partners, number of sexual partners in the past year, citizenship status, drug use, receiving money or drugs for sex, giving money or drugs for sex, and incarceration within the past year. RESULTS: Initial evaluation using Chi Squared analysis revealed that among all factors examined, MSM behavior was most strongly associated with HIV co-infection (Chi Squared Odds Ratio 42.242, 95% CI 29.736 – 60.008). Subsequent analysis was stratified and Non-MSM and MSM populations were considered separately. Early syphilis and HIV co-infection in the non-MSM population (including men that do not have sex with men, women, and transgendered individuals) is associated with several expected STD risk factors; receiving money or drugs for sex (adjusted OR 2.714, 95% CI (1.229 – 5.992)), more than 5 sexual partners (adjusted OR 5.256, 95% CI (1.207 – 5.283)), more than 10 sexual partners (adjusted OR 2.784, 95% CI (1.201 – 6.451)), and having been in jail in the last 12 months (adjusted OR 3.096, 95% CI (1.260 – 7.608), while showing no differences among racial groups when using White/non-Hispanic as a reference group. However, among MSM individuals none of the behavioral risk factors examined were statistically associated with co-infection. The only factor with which an association was demonstrated was citizenship of the United States (adjusted OR 1.925, 95% CI (1.052 – 3.525)) while Hispanic race was negatively associated with co-infection risk among MSM (OR 0.400, 95% CI (0.288 – 0.555)). No other association with co-infection among racial groups was found when using White/non-Hispanic as a reference group. CONCLUSIONS: It is clear that in Maricopa County the population affected by syphilis from 1998-2008 is characterized by increased rates of HIV co-infection. The population affected by early syphilis and HIV co-infection is largely dimorphic between MSM and non-MSM affected, with distinct risk factors and demographic attributes. Clearly there is a need for public health interventions and awareness campaigns regarding the risk of HIV and syphilis co-infection and morbidity, as well as the increasing incidence of syphilis within the community of men who have sex with men, are needed in Maricopa County.
    • Parental Attitudes Regarding HPV Vaccination of Pre-Adolescent and Adolescent Females in Arizona

      Morris, Stephanie M.; The University of Arizona College of Medicine - Phoenix; Taylor, Melanie (The University of Arizona., 2011-03)
      Background – HPV (human papillomavirus) is considered to be the most pervasive sexually transmitted disease among sexually active young adults in the U.S. and is responsible for approximately 90% of cervical cancers worldwide. In 2006, the FDA (Federal Drug Administration) licensed the first HPV vaccine for use in girls aged 9 to 26; however, evidence shows that vaccine uptake rates among adolescent females remains to be low throughout the country. Objective – To assess parental attitudes and beliefs regarding HPV and HPV vaccination of pre-adolescent and adolescent females in order to identify factors that affect intent to vaccinate. Methods – A questionnaire instrument was distributed to parent members of the AZPTA (Arizona Parent-Teacher Association) and the general internet population in Arizona from March 2010 to August 2010. Results – Of the eligible respondents, 61.1% expressed intent to vaccinate their daughter(s) with the HPV vaccine. Approximately 92% of parents who did not intend to vaccinate their daughter(s) had completed some or all of a post-secondary education. Parents who believed that the HPV vaccine promotes earlier sexual debut (33.3% vs. 68.8%), unsafe sexual behavior (40.0% vs. 73.5%) and sexual promiscuity (25.0% vs. 74.0%) showed significantly less intent to vaccinate with the HPV vaccine than parents who did not believe that the HPV vaccine promotes high-risk sexual activity. 75% of parents were aware that HPV causes cervical cancer and is transmitted by sexual contact; however, 75% of parents answered incorrectly to other HPV knowledge questions. Parents who believed that vaccinations, in general, are unsafe universally did not intend to vaccinate with the HPV vaccine. Conclusions – Barriers to HPV vaccination included parental aversion to vaccinations, miseducation or lack of education about human papillomavirus infection, belief that vaccination will encourage risky sexual behavior among teenagers and concerns regarding efficacy and safety of the HPV vaccine. Efforts to educate parents regarding