Importance of physicians in Chlamydia trachomatis control.

INTRODUCTION: During 2002-2006, reported rates of Chlamydia (CT) increased 17.3% nationally, with 43.6% of guideline eligible females screened in 2006. Annual costs associated with CT exceed $1.88 billion. We sought to determine the importance of private medical doctors (PMDs) and hospitals as screening venues in Illinois, USA and if this varied by county Rural-Urban Continuum Code (RUCC). METHODS: A retrospective analysis of all CT cases reported in Illinois during 2002-2006. Counties were stratified by RUCC and eighteen provider types were condensed into nine venues. Venue positivity rates were derived from laboratory data. RESULTS: PMDs and hospitals reported 247,725 CT cases (33.1% and 25.4%, respectively). Sample positivity rates were 6.2% and 6.1%, comparable to 5.7% for family planning clinics (FPC). Distribution of cases within these venues (and STD clinics) by RUCC was highly significant (p<0.001). DISCUSSION: Even though screening guideline compliance is low, PMDs identify the majority of cases in Illinois and are consistently important screening venues at all levels of urbanization. As PMDs (and/or hospitals) exist in every Illinois county, it may be more efficient to augment screening rates at these venues rather than create new venues of other types which may be cost-ineffective in rural or low-prevalence areas.

Use of the internet and self-collected samples as a sexually transmissible infection intervention in rural Illinois communities.

BACKGROUND: In the USA, reported cases of chlamydia (Chlamydia trachomatis) continue to rise despite substantial funding for screening. National gonorrhoea (Neisseria gonorrhoeae) rates have remained relatively stable, with clusters associated with metropolitan areas. Rural areas are no exception, as every county in Illinois reported cases of chlamydia in 2007. Morbidity associated with infection remains a public health concern, with costs of $US2.5+ billion annually. Novel screening interventions must be examined for their ability to reach those at risk who are missed by traditional methods. METHODS: The website Iwantthekit.org was modified to allow residents from 25 contiguous counties in Central Illinois to request a self-collected sample kit. Returned kits were tested for chlamydia and gonorrhoea. The initial study period was 12 months. RESULTS: During the study period, 343 kits were requested from 20 counties and 39.9% were satisfactorily returned for analysis. Positivity rates for chlamydia and gonorrhoea were 5.8% and 1.2%, respectively, for females and 1.9% and 0% for males. Males comprised 37.7% of all internet samples (compared with 23.4% for traditional screening venues) and 40.4% of all internet samples submitted by whites (compared with only 17.2% of traditional screening). CONCLUSIONS: The female positivity rate was comparable to those seen in other screening venues and the method successfully engaged at-risk males. Overall, participation was low and the costs associated with the program outweighed the averted costs associated with the few cases identified. While this methodology resulted in sample requests from a wide area, it must be utilised by more individuals to become cost-effective.

STD, HIV/AIDS, and hepatitis services in Illinois County Jails.

OBJECTIVE: : To assess the availability of STD, HIV/AIDS, and hepatitis services provided at Illinois adult county jails. GOAL: : Identify opportunities and barriers to service provision. STUDY DESIGN: : Telephone survey to those providing medical services in Illinois county jails. RESULTS: : Eighty-one (89%) of 91 Illinois jails responded. Half (49.3%) of the facilities offered on-site testing for STD, HIV/AIDS, and hepatitis on demand/with symptoms, although only 4 offered routine screening. Discharge planning services were offered in only 40% of facilities. Cost (43.2%) and limited staff (14.8%) were cited as primary barriers to service provision. CONCLUSIONS: : Screening, treatment, and discharge planning services for STD, HIV/AIDS, and hepatitis are not universal in Illinois jails. Despite current levels of funding and staffing assistance from health departments to jails, further collaboration is needed to improve case identification and treatment in this high-risk population. Needs assessments are useful in identifying opportunities and barriers to service provision.

Factors associated with newly diagnosed HIV among persons with concomitant sexually transmitted diseases.

OBJECTIVE: We evaluated Illinois and Chicago Departments of Public Health surveillance databases to determine risk factors associated with newly diagnosed HIV among persons with bacterial sexually transmitted diseases (STDs). METHODS: Test results for Chlamydia, gonorrhea, early syphilis (primary, secondary, and early latent), and HIV from public health clinics in Illinois in 2002 were merged with demographic and behavioral survey data collected during patient visits. STD was defined as any positive non-HIV result. RESULTS: Among 43,517 patient encounters, 5814 (13.4%) had positive STD test results. There were 308 (0.7%) positive new HIV test results, of which 71 (23.1%) had concomitant infection with an STD. Compared with STD-positive, HIV-negative cases, age >30 years (OR = 1.9, 95% CI, 1.0,4.4), men who have sex with men (MSM) (OR = 22.2, 95% CI 11.3-43.7), and bisexual male (OR = 22.4, 95% CI 7.8-64.8) were independently associated with STD and HIV coinfections. Among distinct STDs, syphilis (n = 438) was the least frequent (7.5%), but was reported in the highest proportion (10.1%) of all new HIV infections and conferred the greatest risk (OR = 11.0, 95% CI 7.7-15.8) for newly diagnosed HIV. CONCLUSIONS: MSM were at increased risk for newly diagnosed HIV with STD coinfection. Persons with a concomitant STD and HIV were older than US populations that generally constitute the greatest proportion of STD cases. These results highlight the role in particular of syphilis among populations at high risk for HIV transmission. Public health interventions targeting MSM and older adults for effective testing and prevention strategies are critically needed within high-risk networks for cotransmission of STDs and HIV.

Integrating viral hepatitis prevention into STD clinics in Illinois (excluding Chicago), 1999-2005.

Hepatitis B vaccination is recommended for all clients of sexually transmitted disease (STD) clinics. Hepatitis A vaccination and hepatitis C testing are recommended for STD clinic clients who report specific risks for those viruses. In 1999, the Illinois Department of Public Health began working with local health departments in Illinois (excluding Chicago) to introduce hepatitis B testing and vaccination in public STD clinics. Hepatitis A vaccination and hepatitis C counseling and testing were introduced in 2001. Illinois state funding has covered more than one-third of the costs of offering these integrated viral hepatitis services to STD clients. Hepatitis A and B vaccination and hepatitis C counseling and testing are now the standard of care in almost all (35 of 41) Illinois public STD clinics (excluding Chicago). In 2005, 29.4% of STD client visits included a hepatitis B vaccination. In public STD clinics in Illinois, hepatitis A and B vaccinations and hepatitis C counseling and testing have increased from essentially no activity in 1999 to substantial levels of service in 2005.