Operational Research for STD Service: Improvement of Treatment and Care at Siriraj Hospital.

Objective: Operational research for sexually transmitted disease (STD) service was conducted to: 1) create the potential for systematic care: to assess and monitor for HIV and STI; 2) create the linkage among OB-GYN, Medicine and Pediatric Departments of Siriraj Hospital; 3) cervical cancer screening in HIV-infected females by Pap smear once a year; 4) create a system file for collection of STI data of the unit; 5) promote HIV counseling, disclosure and keep records; 6) promote condom usage and reduce risk behaviors of HIV-infected females continuously. Methods: HIV positive females attending STD Clinic, Department of Obstetrics & Gynecology, Siriraj Hospital were enrolled in to the study during March 1, 2005 to September 1, 2006. The procedures include: 1) provide STI testing/treatment, risk-reduction and HIV disclosure counseling, provision of free condoms, and cervical cancer screening at least once a year; 2) develop standardized procedures and data collection tools and strengthen data management; 3) refer women from different departments to the STI clinic for screening; 4) provide training in risk reduction counseling and HIV disclosure counseling. Results: Most of the primary visits were check-up. Chlamydial infection was 2.1% (year 2005). GC infection was 0.5% (year 2005). Abnormal Pap was significantly related to low CD4 count. L-SIL = 9.3%; H-SIL = 26.8%. Among the participants, 10.4% had CD4 count <200. Conclusion: Early detection and treatment of STI is 30%. Early detection of cervical cancer and treatment were increased. Access to ARV for HIV-1 PMTCT was also increased. Cross sectional analysis will show more realistic data since the follow up visit may be a group who came to receive condoms which could be missed as high condom use rate. KPI of success in good clinical tracer include increased condom use and CD4 count, decrease STI, opportunistic infection, and viral load.

Associated risk factors of human papillomavirus cervical infection among human immunodificiency virus-seropositive women at Siriraj Hospital.

This cross sectional type sub-study was established to assess the potential risk factor associated with human papillomavirus (HPV) cervical infection in Human immunodeficiency virus (HIV)-seropositive women. The series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics & Gynecology, Siriraj Hospital. Demographic, obstetrical and behavioral risk factors were interviewed. Laboratory results were recorded. Clinical gynecologic examination was performed including Pap smear. The patients were assigned into two groups, HPV and non-HPV group. The comparison of the potential risk factors between the groups was calculated statistically. It was found that the prevalence of HPV infection was reported in 17 patients (9.6%). HIV-seropositive women, who were infected with HPV, had a significantly more probability to have a single partner in their lifetime than those who were not infected. It could be that HPV cervical infection and HIV-seropositive women share common potential risk factors, as well as, the recognition of sexual intercourse as the important route of HPV transmission.