An Educational Intervention to Improve Provider Screening for Syphilis Among Men Who Have Sex with Men Utilizing an Urban Urgent Care Center.

Rates of syphilis are increasing in the United States especially among men who have sex with men (MSM). The purpose of this project was to implement an educational intervention based on the 2015 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines for urgent care providers with an emphasis on identifying MSM sexual behavior and appropriate screening for syphilis. An urgent care center was identified as a location where men seek care and where STD testing was occurring. After a baseline provider focus group to identify barriers to STD testing, a patient survey was created and given to clients to increase identification of MSM behaviors and to prompt providers to order syphilis testing. In addition, an educational intervention was implemented to improve provider and staff screening for syphilis. The intervention occurred between September 2015-December 2015. A total of 1341 males were seen with 1067 surveys collected. The mean age was 35.6 and 57.4% were Hispanic. Overall, 72 (5.4%) males identified as MSM. Approximately 50% of all MSM identified had RPRs (n = 37) sent and of these 13.5% (n = 5) tested positive for syphilis. The focus group among urgent care providers and staff identified barriers to syphilis testing. Targeted screening of males using a self-administered questionnaire is acceptable to urgent care populations and may assist in identifying MSM which in turn may help to facilitate syphilis screening and other relevant STI testing pertinent to this population.

Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center.

BACKGROUND AND OBJECTIVES: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center. METHODS: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ analyses were used to assess association between STI testing, chief complaint, and sexual history. RESULTS: Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01). DISCUSSION: Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs.

Antiretroviral therapy in HIV-infected adolescents: clinical and pharmacologic challenges.

INTRODUCTION: With the currently available combined antiretroviral therapy regimens, durable suppression of viral replication, preservation of immune function and normalizing life expectancy, are all becoming achievable goals. Teenagers and young adults living with HIV present unique clinical and pharmacologic challenges to optimizing antiretroviral treatment outcomes. Areas covered: In this expert review of the topic, we examine recent clinical trial data and draw on our program's 25 year experience working with both perinatally and behaviorally HIV infected adolescents. Expert commentary: In order to be effective, the antiretrovirals we provide must be combined with multidisciplinary interventions and ongoing socio-behavioral support to ensure treatment adherence and prevent the emergence of viral resistance.

Social Media Use and its Association with Sexual Risk and Parental Monitoring among a Primarily Hispanic Adolescent Population.

STUDY OBJECTIVE: In this study we assessed the association between social media (SM) use with sexual risk, and with parental monitoring among Hispanic adolescents. DESIGN: Self-administered anonymous survey. SETTING: Urban primary care clinics. PARTICIPANTS: Primarily Hispanic adolescents ages 13-21 years old. INTERVENTIONS AND MAIN OUTCOME MEASURES: Chi-square and regression analyses controlling for age and gender were used to assess associations between SM use or sexting and sexual behaviors (kissing, touching genitals, vaginal oral, and anal sex), sexual risk (≥4 lifetime partners, >1 recent partner, inconsistent condom use, and history of sexually transmitted infection diagnosis) and contraceptive use. Similar analyses were used to assess relationships between adolescent-reported parental monitoring and SM use, and sexting. RESULTS: Participants with frequent SM use (social networking sites or apps) had greater odds of all sexual activity. Ever sexters had greater odds of penetrative sex only (oral, vaginal, and anal sex) as well as use of hormonal contraception (except long-acting reversible contraception). Approximately half of the participants reported parental access to profiles on SM. Female participants had higher odds of parental access to online profiles and having a parental discussion of privacy settings. Those having privacy discussions had greater odds of "private" profiles on SM and lower odds of ever sexting. CONCLUSION: Frequent SM use and sexting was associated with an increase in all types of sexual behaviors; sexting alone was associated with more lifetime and recent sexual partners. Parental discussion of privacy settings was found to be protective. Providers and parents should be aware of the effect of SM use on sexual behaviors.

Re-focusing HIV prevention messages: a qualitative study in rural Uganda.

BACKGROUND: After 30 years, the human immunodeficiency virus (HIV) remains an epidemic of global concern. To support the increasing emphasis on biomedical interventions for prevention requires a renewed and reframed focus on HIV prevention messages to motivate engagement in risk-reduction activities. This paper examines youth and adult perceptions of HIV prevention messages and HIV risk assessment in a generalized HIV epidemic context in Uganda. METHODS: We conducted 24 focus group discussions and 24 in-depth interviews with 15-45 year olds (n = 218) from three communities in the Rakai district of Uganda in 2012. RESULTS: We found generational differences in the how people viewed HIV, skepticism around introduction of new interventions, continued misconceptions and fears about condoms, and gender differences in content and salience of HIV prevention messages. CONCLUSIONS: Shifts in HIV education are needed to address gaps in HIV messaging to foster engagement in risk reduction strategies and adoption of newer biomedical approaches to HIV prevention.

Is it ok 2 txt? Reaching out to adolescents about sexual and reproductive health.

As the number of adolescents in the population is growing, it is even more important that healthcare practitioners are provided with the tools and resources that can best educate and connect with those patients at risk in this population, particularly with regard to sexual health behaviours. Notoriously, adolescents are difficult to engage in their own healthcare. However, with the advancement of technology and the ubiquitous use of cell phones, emerging studies suggest that there may be benefits to using text messaging within the adolescent health arena to encourage engagement, compliance and improve health knowledge. The use of text messaging has been implemented within adolescent healthcare in multiple ways but studies are needed to evaluate the content of messages, dosage and efficacy of text messaging in improving health outcomes in this population.