108 results on '"Sadiq ST"'
Search Results
2. A 30-min nucleic acid amplification point-of-care test for genital chlamydia trachomatis infection in women: A prospective, multi-center study of diagnostic accuracyi-center Study of Diagnostic Accuracy
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Harding-Esch, EM, Cousins, EC, Chow, S-LC, Phillips, LT, Hall, CL, Cooper, N, Fuller, SS, Nori, AV, Patel, R, Thomas-William, S, Whitlock, G, Edwards, SJE, Green, M, Clarkson, J, Arlett, B, Dunbar, JK, Lowndes, CM, and Sadiq, ST
- Abstract
Background Rapid Point-Of-Care Tests for Chlamydia trachomatis (CT) may reduce onward transmission and reproductive sexual health (RSH) sequelae by reducing turnaround times between diagnosis and treatment. The io® single module system (Atlas Genetics Ltd.) runs clinical samples through a nucleic acid amplification test (NAAT)-based CT cartridge, delivering results in 30 min. Methods Prospective diagnostic accuracy study of the io® CT-assay in four UK Genito-Urinary Medicine (GUM)/RSH clinics on additional-to-routine self-collected vulvovaginal swabs. Samples were tested “fresh” within 10 days of collection, or “frozen” at −80 °C for later testing. Participant characteristics were collected to assess risk factors associated with CT infection. Results CT prevalence was 7.2% (51/709) overall. Sensitivity, specificity, positive and negative predictive values of the io® CT assay were, respectively, 96.1% (95% Confidence Interval (CI): 86.5–99.5), 97.7% (95%CI: 96.3–98.7), 76.6% (95%CI: 64.3–86.2) and 99.7% (95%CI: 98.9–100). The only risk factor associated with CT infection was being a sexual contact of an individual with CT. Conclusions The io® CT-assay is a 30-min, fully automated, high-performing NAAT currently CE-marked for CT diagnosis in women, making it a highly promising diagnostic to enable specific treatment, initiation of partner notification and appropriately intensive health promotion at the point of care.
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- 2021
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3. Importation of ciprofloxacin resistant neisseria gonorrhoeae into the UK: a public health challenge
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Furegato, M, Broad, C, Phillips, L, Harrison, M, Pond, M, Zhou, L, Tan, N, Okala, S, Fuller, SS, Sadiq, ST, and Harding-Esch, E
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- 2019
4. Macrolide resistance in mycoplasma genitalium is strongly associated with STI co-infection
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Furegato, M, Broad, C, Phillips, L, Heming De-Allie, E, Zhou, L, Harrison, M, Fuller, SS, Harding-Esch, E, and Sadiq, ST
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- 2019
5. Identifying key stakeholders and their roles in the integration of POCTs for STIs into clinical services
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Pacho, A, Heming De-Allie, E, Furegato, M, Harding-Esch, E, Sadiq, ST, and Fuller, SS
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- 2019
6. How is the value of point-of-care tests for STIs negotiated in the context of a nationalised health system?
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Pacho, A, Heming De-Allie, E, Furegato, M, Harding-Esch, E, Sadiq, ST, and Fuller, SS
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- 2019
7. Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection
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Harrison, MA, Harding-Esch, EM, Marks, M, Pond, MJ, Butcher, R, Solomon, AW, Zhou, L, Tan, N, Nori, AV, Kako, H, Sokana, O, Mabey, DCW, and Sadiq, ST
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bacterial infections and mycoses - Abstract
Background Mass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular Chlamydia trachomatis (CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be suboptimal in Mycoplasma genitalium infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin.\ud \ud Objectives To determine the effect of MDA for trachoma elimination on M. genitalium prevalence, strain type and azithromycin resistance.\ud \ud Methods A secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for M. genitalium infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay. M. genitalium-positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of M. genitalium and underwent phylogenetic analysis by dual locus sequence typing.\ud \ud Results M. genitalium prevalence was 11.9% (28/236) in women pre-MDA and 10.9% (28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2% in women recruited post-MDA and 17.9% (5/28) in those who tested M. genitalium positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA.\ud \ud Conclusion A single round of azithromycin MDA in an island population with high baseline M. genitalium prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on M. genitalium azithromycin AMR in antibiotic experienced and naïve populations is warranted.
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- 2019
8. Hand-held rapid whole genome nanopore sequencing to predict Neisseria gonorrhoeae antibiotic susceptibility: steps towards clinic based tailored antimicrobial therapy
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Phillips, LT, Witney, A, Izquierdo-Carrasco, F, Mayes, S, Wright, A, Laing, K, Gould, K, Pond, M, Hall, CL, Harding-Esch, EM, Butcher, P, Zhou, L, and Sadiq, ST
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- 2017
9. The role of social science and public patient involvement in the development of novel rapid diagnostic tests for STIs and antimicrobial resistance detection
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Pacho, A, Broad, C, Harding-Esch, E, Sadiq, ST, and Fuller, SS
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- 2017
10. 'It's not a 'time spent' issue, it's a 'what have you spent your time doing?' issue...' Patient opinions on potential implementation of Point of Care Tests for multiple STIs and antimicrobial resistance detection
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Fuller, SS, Pacho, A, Harding-Esch, E, and Sadiq, ST
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- 2017
11. Impact of deploying multiple point-of-care tests with a 'sample first' approach on a sexual health clinical care pathway. A service evaluation
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Harding-Esch, EM, Nori, AV, Hegazi, A, Pond, MJ, Okolo, O, Nardone, A, Lowndes, CM, Hay, P, and Sadiq, ST
- Abstract
OBJECTIVES: To assess clinical service value of STI point-of-care test (POCT) use in a 'sample first' clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation for Trichomonas vaginalis (TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment. METHODS: Service evaluation in a south London sexual health clinic. Symptomatic female and male patients and sexual contacts of CT/NG-positive individuals provided samples for diagnostic testing on clinic arrival, prior to clinical consultation. Tests included routine culture and microscopy; CT/NG (GeneXpert) NAAT; non-NAAT POCTs for TV and BV. RESULTS: All 70 (35 males, 35 females) patients approached participated. The 'sample first' pathway was acceptable, with >90% reporting they were happy to give samples on arrival and receive results in the same visit. Non-NAAT POCT results were available for all patients prior to leaving clinic; rapid CT/NG results were available for only 21.4% (15/70; 5 males, 10 females) of patients prior to leaving clinic. Known negative CT/NG results led to two females avoiding presumptive treatment, and one male receiving treatment directed at possible Mycoplasma genitalium infection causing non-gonococcal urethritis. Non-NAAT POCTs detected more positives than routine microscopy (TV 3 vs 2; BV 24 vs 7), resulting in more patients receiving treatment. CONCLUSIONS: A 'sample first' clinical pathway to enable multiple POCT use was acceptable to patients and feasible in a busy sexual health clinic, but rapid CT/NG processing time was too long to enable POCT use. There is need for further development to improve test processing times to enable POC use of rapid NAATs.
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- 2017
12. The pharmacokinetics, safety and efficacy of tenofovir and emtricitabine in HIV-1-infected pregnant women
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Colbers, Ap, Hawkins, Da, Gingelmaier, A, Kabeya, K, Rockstroh, Jk, Wyen, C, Weizsäcker, K, Sadiq, St, Ivanovic, J, Giaquinto, Carlo, Taylor, Gp, Moltó, J, Burger, Dm, and Panna, Network
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Adult ,medicine.medical_specialty ,Anti-HIV Agents ,Pregnancy Trimester, Third ,Immunology ,Organophosphonates ,HIV Infections ,Emtricitabine ,Deoxycytidine ,Young Adult ,Pharmacokinetics ,Acquired immunodeficiency syndrome (AIDS) ,Pregnancy ,medicine ,Humans ,Immunology and Allergy ,Pregnancy Complications, Infectious ,Tenofovir ,Nucleoside analogue ,business.industry ,Obstetrics ,Adenine ,Poverty-related infectious diseases [N4i 3] ,Area under the curve ,Gestational age ,Viral Load ,Fetal Blood ,medicine.disease ,Infectious Disease Transmission, Vertical ,Confidence interval ,Surgery ,Europe ,Infectious Diseases ,HIV-1 ,Female ,Poverty-related infectious diseases Infectious diseases and international health [N4i 3] ,business ,Viral load ,medicine.drug - Abstract
Contains fulltext : 117827.pdf (Publisher’s version ) (Closed access) OBJECTIVE:: To describe the pharmacokinetics of tenofovir and emtricitabine in the third trimester of pregnant HIV-infected women and at postpartum. DESIGN:: A nonrandomized, open-label, multicentre phase IV study in HIV-infected pregnant women recruited from HIV treatment centres in Europe. METHODS:: HIV-infected pregnant women treated with the nucleotide/nucleoside analogue reverse transcriptase inhibitors (NRTIs) tenofovir disoproxil fumarate (TDF 300 mg; equivalent to 245 mg tenofovir disoproxil) and/or emtricitabine (FTC 200 mg) were included in the study. Twenty-four-hour pharmacokinetic curves were recorded in the third trimester (preferably week 33) and postpartum (preferably week 4-6). Collection of a cord blood sample and maternal sample at delivery was optional. Pharmacokinetic parameters were calculated using WinNonlin software version 5.3. Statistical analysis was conducted using SPSS version 16.0. RESULTS:: Thirty-four women were included in the analysis. Geometric mean ratios of third trimester vs. postpartum [90% confidence interval (CI)] were 0.77 (0.71-0.83) for TDF area under the curve (AUC0-24 h); 0.81 (0.68-0.96) for TDF Cmax and 0.79 (0.70-0.90) for TDF C24 h and 0.75 (0.68-0.82) for FTC AUC0-24 h; and 0.87 (0.77-0.99) for FTC Cmax and 0.77 (0.52-1.12) for FTC C24 h. The viral load close to delivery was less than 200 copies/ml in all but one patient, the average gestational age at delivery was 38 weeks. All children were tested HIV-negative and no congenital abnormalities were reported. CONCLUSION:: Although pharmacokinetic exposure of the NRTIs TDF and FTC during pregnancy is approximately 25% lower, this was not associated with virological failure in this study and did not result in mother-to-child transmission.
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- 2013
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13. Research benefits of storing genitourinary samples: 16S rRNA sequencing to evaluate vaginal bacterial communities.
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Wagner, J, Kerry-Barnard, S, Sadiq, ST, Oakeshott, P, Wagner, J, Kerry-Barnard, S, Sadiq, ST, and Oakeshott, P
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- 2017
14. A Cross-Sectional Study on Attitudes to and Understanding of Risk of Acquisition of HIV: Design, Methods and Participant Characteristics
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Sewell, J, Speakman, A, Phillips, AN, Lampe, FC, Miltz, A, Gilson, R, Asboe, D, Nwokolo, N, Scott, C, Day, S, Fisher, M, Clarke, A, Anderson, J, O'Connell, R, Apea, V, Dhairyawan, R, Gompels, M, Farazmand, P, Allan, S, Mann, S, Dhar, J, Tang, A, Sadiq, ST, Taylor, S, Collins, S, Sherr, L, Hart, G, Johnson, AM, Miners, A, Elford, J, and Rodger, A
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HIV transmission ,Original Paper ,HIV undiagnosed ,health and wellbeing ,sexual risk behaviour ,men who have sex with men ,virus diseases ,HIV negative ,HIV infection ,black Africans ,HIV testing - Abstract
Background: The annual number of new human immunodeficiency virus (HIV) infections in the United Kingdom among men who have sex with men (MSM) has risen, and remains high among heterosexuals. Increasing HIV transmission among MSM is consistent with evidence of ongoing sexual risk behavior in this group, and targeted prevention strategies are needed for those at risk of acquiring HIV.\ud \ud Objective: The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study was designed to collect information on HIV negative adults at risk of HIV infection in the United Kingdom, based on the following parameters: physical and mental health, lifestyle, patterns of sexual behaviour, and attitudes to sexual risk.\ud \ud Methods: Cross-sectional questionnaire study of HIV negative or undiagnosed sexual health clinic attendees in the United Kingdom from 2013-2014.\ud \ud Results: Of 2630 participants in the AURAH study, 2064 (78%) were in the key subgroups of interest; 580 were black Africans (325 females and 255 males) and 1484 were MSM, with 27 participants belonging to both categories.\ud \ud Conclusions: The results from AURAH will be a significant resource to understand the attitudes and sexual behaviour of those at risk of acquiring HIV within the United Kingdom. AURAH will inform future prevention efforts and targeted health promotion initiatives in the HIV negative population.
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- 2016
15. Accurate detection of Neisseria gonorrhoeae ciprofloxacin susceptibility directly from genital and extragenital clinical samples: towards genotype-guided antimicrobial therapy
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Pond, MJ, Hall, CL, Miari, VF, Cole, M, Laing, KG, Jagatia, H, Harding-Esch, E, Monahan, IM, Planche, T, Hinds, J, Ison, CA, Chisholm, S, Butcher, PD, and Sadiq, ST
- Abstract
INTRODUCTION: Increasing use of nucleic acid amplification tests (NAATs) as the primary means of diagnosing gonococcal infection has resulted in diminished availability of Neisseria gonorrhoeae antimicrobial susceptibility data. We conducted a prospective diagnostic assessment of a real-time PCR assay (NGSNP) enabling direct detection of gonococcal ciprofloxacin susceptibility from a range of clinical sample types. METHODS: NGSNP, designed to discriminate an SNP associated with ciprofloxacin resistance within the N. gonorrhoeae genome, was validated using a characterized panel of geographically diverse isolates (n = 90) and evaluated to predict ciprofloxacin susceptibility directly on N. gonorrhoeae-positive NAAT lysates derived from genital (n = 174) and non-genital (n = 116) samples (n = 290), from 222 culture-confirmed clinical episodes of gonococcal infection. RESULTS: NGSNP correctly genotyped all phenotypically susceptible (n = 49) and resistant (n = 41) panel isolates. Ciprofloxacin-resistant N. gonorrhoeae was responsible for infection in 29.7% (n = 66) of clinical episodes evaluated. Compared with phenotypic susceptibility testing, NGSNP demonstrated sensitivity and specificity of 95.8% (95% CI 91.5%-98.3%) and 100% (95% CI 94.7%-100%), respectively, for detecting ciprofloxacin-susceptible N. gonorrhoeae, with a positive predictive value of 100% (95% CI 97.7%-100%). Applied to urogenital (n = 164), rectal (n = 40) and pharyngeal samples alone (n = 30), positive predictive values were 100% (95% CI 96.8%-100%), 100% (95% CI 87.2%-100%) and 100% (95% CI 82.4%-100%), respectively. CONCLUSIONS: Genotypic prediction of N. gonorrhoeae ciprofloxacin susceptibility directly from clinical samples was highly accurate and, in the absence of culture, will facilitate use of tailored therapy for gonococcal infection, sparing use of current empirical treatment regimens and enhancing acquisition of susceptibility data for surveillance.
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- 2016
16. A 30-minute nucleic acid amplification point-of-care test for genitalChlamydia trachomatisinfection in women: a prospective, multi-centre study of diagnostic accuracy
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Harding-Esch, EM, primary, Cousins, EC, additional, Chow, S-LC, additional, Phillips, LT, additional, Hall, CL, additional, Cooper, N, additional, Fuller, SS, additional, Nori, AV, additional, Patel, R, additional, Thomas-William, S, additional, Whitlock, G, additional, Edwards, SJE, additional, Green, M, additional, Clarkson, J, additional, Arlett, B, additional, Dunbar, JK, additional, Lowndes, CM, additional, and Sadiq, ST, additional
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- 2017
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17. P3.94 Does mass drug administration with azithromycin for trachoma control have an impact on the prevalence and macrolide resistance of genitalmycoplasma genitaliuminfection?
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Harrison, M, primary, Marks, M, additional, Harding-Esch, E, additional, Pond, MJ, additional, Butcher, R, additional, Solomon, A, additional, Tan, NK, additional, Nori, A, additional, Kako, H, additional, Mabey, D, additional, and Sadiq, ST, additional
- Published
- 2017
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18. Research benefits of storing genitourinary samples: 16S rRNA sequencing to evaluate vaginal bacterial communities
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Wagner, Josef, primary, Kerry-Barnard, Sarah, additional, Sadiq, ST, additional, and Oakeshott, Pippa, additional
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- 2017
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19. 001 OP: UCL QUALITATIVE HEALTH RESEARCH SYMPOSIUM 2015: ENRICHING QUALITATIVE INQUIRY IN HEALTH
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Baim-Lance, A, Black, G, Llewellyn, H, McGregor, LM, Vindrola-Padros, C, Vňuková, M, Vrinten, C, Dobson, CM, Brown, SR, Russell, AJ, Rubin, GP, Stevenson, F, Gibson, W, Pelletier, C, Park, S, Chrysikou, V, Morant, N, Lloyd-Evans, B, Shaw, J, Patel, R, Chatterjee, HJ, Thomson, L, Casal, A Nunez, Contandriopoulos, D, Larouche, C, Gonzalez-Polledo, E, Cornish, F, Tarr, J, Shaw, S, Aicken, CRH, Estcourt, CS, Gibbs, J, Sonnenberg, P, Mercer, CH, Tickle, L, Sutcliffe, LJ, Sadiq, ST, Shahmanesh, M, Arteaga Pérez, MI, Brown, S, Eyre, L, Gilmartin, JFM, Jani, Y, Smith, FJ, Martins, A, Aldiss, S, Taylor, R, Gibson, F, Masana, L, McMullen, H, Griffiths, C, Greenhalgh, T, Moore, KJ, Ozanne, E, Dow, B, Ames, D, Osborne, K, Power, E, Papachristou, I, Hickey, G, Illife, S, Pearce, S, Romero, D, Symmonds, JN, Whitfield, T, Pavitt, A, Ducksbury, R, Lee, L, Walker, Z, and Trusson, D
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Keynote Presentation ,Poster Presentations ,UCL Symposium Abstracts ,Oral Presentations ,Article - Published
- 2015
20. Maraviroc Pharmacokinetics in HIV-1-Infected Pregnant Women
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Colbers, A, Best, B, Schalkwijk, S, Wang, J, Stek, A, Hidalgo Tenorio, C, Hawkins, D, Taylor, G, Kreitchmann, R, Burchett, S, Haberl, A, Kabeya, K, Van Kasteren, M, Smith, E, Capparelli, E, Burger, D, Mirochnick, M, Van Der Ende, ME, Erasmus, M, Van Der Ven, AJAM, Nellen, J, Moltó, J, Nicastri, E, Giaquinto, C, Gingelmaier, A, Lyons, F, Lambert, J, Wyen, C, Faetkenheuer, G, Rockstroh, JK, Schwarze-Zander, C, Sadiq, ST, Gilleece, Y, Wood, C, Buschur, S, Jackson, C, Paul, M, Florez, C, Bryan, P, Stone, M, Katz, M, Auguste, R, Wiznia, A, Bruder, KL, Lewis, G, Casey, D, Losso, MH, Ivalo, SA, Hakim, A, Deveikis, A, Batra, J, Alvarez, JJ, Knapp, KM, Sublette, N, Wride, T, Febo, IL, Santos, R, and Tamayo, V
- Abstract
© The Author 2015. Published by Oxford University Press on behalf of the Infectious. Objective.To describe the pharmacokinetics of maraviroc in human immunodeficiency virus (HIV)-infected women during pregnancy and post partum. Methods.HIV-infected pregnant women receiving maraviroc as part of clinical care had intensive steady-state 12-hour pharmacokinetic profiles performed during the third trimester and ≥2 weeks after delivery. Cord blood samples and matching maternal blood samples were taken at delivery. The data were collected in 2 studies: P1026 (United States) and PANNA (Europe). Pharmacokinetic parameters were calculated. Results.Eighteen women were included in the analysis. Most women (12; 67%) received 150 mg of maraviroc twice daily with a protease inhibitor, 2 (11%) received 300 mg twice daily without a protease inhibitor, and 4 (22%) had an alternative regimen. The geometric mean ratios for third-trimester versus postpartum maraviroc were 0.72 (90% confidence interval,. 60-.88) for the area under the curve over a dosing interval (AUCtau) and 0.70 (0.58-0.85) for the maximum maraviroc concentration. Only 1 patient showed a trough concentration (Ctrough) below the suggested target of 50 ng/mL, both during pregnancy and post partum. The median ratio of maraviroc cord blood to maternal blood was 0.33 (range, 0.03-0.56). The viral load close to delivery was
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- 2015
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21. OP34 Online care for sexually transmitted infections: using qualitative research in intervention development and evaluation
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Aicken, CRH, primary, Fuller, SS, additional, Sutcliffe, LJ, additional, Gibbs, J, additional, Tickle, L, additional, Estcourt, CS, additional, Sonnenberg, P, additional, Mercer, CH, additional, Johnson, AM, additional, Sadiq, ST, additional, and Shahmanesh, M, additional
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- 2016
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22. 2nd BASHH Oxford Diagnostics Course, November 2015
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Patel, RR, primary, White, JA, additional, Menon-Johansson, AS, additional, Sadiq, ST, additional, and Ross, JD, additional
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- 2016
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23. P12.02 Developing and using the eclinical care pathway framework: a novel tool for creating online clinical care pathways and its application to management of genital chlamydia
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Gibbs, J, primary, Sutcliffe, LJ, additional, Gkatzidou, V, additional, Sonnenberg, P, additional, Hone, K, additional, Ashcroft, R, additional, Harding-Esch, E, additional, Lowndes, C, additional, Sadiq, ST, additional, and Estcourt, CS, additional
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- 2015
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24. P12.01 Getting your chlamydia care online: qualitative study among users of the chlamydia online clinical care pathway (chlamydia-occp), in a proof of concept study
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Aicken, CRH, primary, Sutcliffe, LJ, additional, Estcourt, CS, additional, Gibbs, J, additional, Tickle, LJ, additional, Sonnenberg, P, additional, Sadiq, ST, additional, and Shahmanesh, M, additional
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- 2015
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25. P08.28 Patients continue to engage in risky sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment
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Harding-Esch, E, primary, Sherrard-Smith, E, additional, Fuller, SS, additional, Harb, A, additional, Furegato, M, additional, Mercer, C, additional, Sadiq, ST, additional, Howell-Jones, R, additional, Nardone, A, additional, White, PJ, additional, Gates, P, additional, Pearce, A, additional, Keane, F, additional, Colver, H, additional, Nori, A, additional, Dewsnap, C, additional, Schatzberger, R, additional, Estcourt, C, additional, Dakshina, S, additional, and Lowndes, CM, additional
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- 2015
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26. P04.26 Robustness of capturing behavioural and sexual lifestyle data for a complex clinical study using internet-based computer assisted self-interview
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Nori, AV, primary, Hay, PE, additional, Butcher, PD, additional, and Sadiq, ST, additional
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- 2015
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27. P12.03 How accurate and comprehensive are currently available mobile medical applications (apps) for sexually transmitted and genital infections: a comprehensive review
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Gibbs, J, primary, Gkatzidou, V, additional, Tickle, L, additional, Manning, SR, additional, Tilakkumar, T, additional, Hone, K, additional, Ashcroft, RE, additional, Sonnenberg, P, additional, Sadiq, ST, additional, and Estcourt, CS, additional
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- 2015
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28. P07.06 A low cost, hand-held point of care molecular diagnostic device for sexually transmitted infections
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Mackay, RE, primary, Branavan, M, additional, Craw, P, additional, Naveenathayalan, A, additional, Sadiq, ST, additional, and Balachandran, W, additional
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- 2015
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29. P08.29 Web-tool to assess the cost-effectiveness of chlamydia point-of-care tests at the local level
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Harding-Esch, E, primary, Sherrard-Smith, E, additional, Dangerfield, C, additional, Choi, YH, additional, Green, N, additional, Jit, M, additional, Marshall, RD, additional, Mercer, C, additional, Nardone, A, additional, Howell-Jones, R, additional, Johnson, OA, additional, Clarkson, J, additional, Wolstenholme, J, additional, Price, CP, additional, Gaydos, CA, additional, Sadiq, ST, additional, White, PJ, additional, and Lowndes, CM, additional
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- 2015
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30. O14.1 Is an automated online clinical care pathway for people with genital chlamydia (chlamydia-occp) within an esexual health clinic feasible and acceptable? proof of concept study
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Estcourt, CS, primary, Gibbs, J, additional, Sutcliffe, LJ, additional, Gkatzidou, V, additional, Tickle, L, additional, Hone, K, additional, Aicken, C, additional, Lowndes, C, additional, Harding-Esch, E, additional, Eaton, S, additional, Oakeshott, P, additional, Szczepura, A, additional, Ashcroft, R, additional, Hogan, G, additional, Nettleship, A, additional, Pinson, D, additional, Sadiq, ST, additional, and Sonnenberg, P, additional
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- 2015
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31. 005.2 Diagnostic and clinical implications of genotypic fluoroquinolone susceptibility detection forneisseria gonorrhoeae
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Pond, MJ, primary, Hall, C, additional, Cole, M, additional, Laing, KG, additional, Miari, V, additional, Jagatia, H, additional, Harding-Esch, E, additional, Monahan, I, additional, Planche, T, additional, Hinds, J, additional, Ison, C, additional, Chisholm, S, additional, Butcher, PD, additional, and Sadiq, ST, additional
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- 2015
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32. Prospective epidemiological study of the prevalence of human leukocyte antigen (HLA)-B*5701 in HIV-1-infected UK subjects.
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Orkin C, Sadiq ST, Rice L, Jackson F, and UK EPI team
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- 2010
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33. P3.94 Does mass drug administration with azithromycin for trachoma control have an impact on the prevalence and macrolide resistance of genital mycoplasma genitaliuminfection?
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Harrison, M, Marks, M, Harding-Esch, E, Pond, MJ, Butcher, R, Solomon, A, Tan, NK, Nori, A, Kako, H, Mabey, D, and Sadiq, ST
- Abstract
IntroductionThe first round of Mass Drug Administration (MDA) with 1g oral azithromycin for ocular Chlamydia trachomatis(CT) infection, which is a key component of trachoma control strategies, concomitantly reduced genital CT infection in the Solomon Islands. However, this dose is known to be sub-optimal for the treatment of genital Mycoplasma genitalium(MG) infection and may also encourage emergence of antimicrobial resistance (AMR) to macrolides in MG.MethodsPre-MDA and 6 months post-MDA CT-negative self-collected vulvo-vaginal swabs from women attending three outpatient antenatal clinics (Honiara, Solomon Islands), already investigated for the impact of MDA on genital CT prevalence, were tested for MG infection using nucleic acid amplification. MG positive samples were subsequently tested for macrolide resistance by sequencing domain V of 23S rRNA DNA region of MG.ResultsMG positivity was found in 11.9% (28/236) of women pre-MDA and in 10.9% (28/256) 6 months post-MDA (p=0.7467). 22 MG positives from each of the pre-MDA and post-MDA samples were sequenced, all showing a macrolide susceptible genotype.ConclusionA single MDA round in an island population with apparent high MG prevalence with 1g azithromycin did not impact on either MG positivity or detection of genetically determined macrolide resistance in this population, in contrast to decreased genital CT positivity in the same population. It is unclear if this apparent lack of impact is due to inadequate efficacy of single-dose azithromycin or transmission dynamics of the infection. Further investigation of the impact of multiple rounds of MDA on antibiotic-experienced and -naive populations is warranted.
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- 2017
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34. Sexually transmitted infections among at-risk women in Ecuador: implications for global prevalence and testing practices for STIs detected only at the anorectum in female sex workers.
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Llangarí-Arizo LM, Broad CE, Zhou L, Martin Mateo M, Moreno CI, Moreno Cevallos M, Cooper PJ, Romero-Sandoval N, and Sadiq ST
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- Humans, Female, Ecuador epidemiology, Adult, Cross-Sectional Studies, Prevalence, Risk Factors, Young Adult, Neisseria gonorrhoeae isolation & purification, Neisseria gonorrhoeae genetics, Mycoplasma genitalium isolation & purification, Adolescent, Chlamydia trachomatis isolation & purification, Chlamydia Infections epidemiology, Chlamydia Infections diagnosis, Anal Canal microbiology, Trichomonas vaginalis isolation & purification, Rectum microbiology, Vagina microbiology, Sex Workers statistics & numerical data, Gonorrhea epidemiology, Gonorrhea diagnosis, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases diagnosis
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Objectives: Anorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador., Methods: 250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, Mycoplasma genitalium (MG) from all swabs and additionally Trichomonas vaginalis (TV) from VVS. Risk factors were analysed using logistic regression., Results: Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being 'in a relationship' (p=0.038)., Conclusions: High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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35. Clonal dispersion and pathogenic potential of multidrug-resistant Aeromonas spp. isolated from Oncorhynchus mykiss with hemorrhagic septicemia.
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Sadiq ST, Al-Hamdani AHA, and Taha ZM
- Abstract
This study was important to improve proper biosecurity measures and controlling the spread of Aeromonas to prevent future outbreaks. This research sought to determine whether virulent Aeromans species were present in morbid rainbow trout, their resistance and their genetic relatedness. A total number of 542 tissue lesion specimens were collected from gill, liver, heart and kidneys in morbid domesticated fish in Duhok province, Iraq. The gyrB DNA sequence analysis was used to determine the species classification. Drug susceptibility testing was conducted for all isolated strains using disc diffusion technique. The genotyping analysis was carried out using enterobacterial repetitive intergenic consensus-polymerase chain reaction. Thirty-four isolates were found and they were classified into three species ( Aeromonas veronii, Aeromonas sorbia, and Aeromonas allosaccharophila) , where A. veronii stand as one of the most prevalent species. The most frequently affected organ by Aeromonas was the gills among four different organs. The detection frequencies of the virulence genes aerolysin, outer membrane protein, glycerophospholipid-cholesterol acyltransferase, elastase, flagella, serine protease, cytotonic heat- labile , and hemolysin were 100%, 100%, 79.41%, 64.70%, 76.47%, 67.64%, 70.58%, and 41.17, respectively. None of the strains possessed all of the virulence markers. All isolates were completely resistant to ceftazidime, amoxicillin and doxycycline. All isolates were found to be multi-drug-resistant. Regardless of the nearest geographic source area of samples and the same Aeromonas species, there was a high genetic diversity. The results of this study could help farmers and researchers make informed decisions about measures of biosecurity and proper therapeutic drugs to apply to prevent current outbreaks and prevent them from recurring again., Competing Interests: The authors declare that there is no conflict of interest that affects the publication of this work., (© 2024 Urmia University. All rights reserved.)
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- 2024
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36. Time Required for Nanopore Whole-Genome Sequencing of Neisseria gonorrhoeae for Identification of Phylogenetic Relationships.
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Phillips LT, Witney AA, Furegato M, Laing KG, Zhou L, and Sadiq ST
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- Humans, Neisseria gonorrhoeae genetics, Phylogeny, Retrospective Studies, Whole Genome Sequencing methods, Microbial Sensitivity Tests, Drug Resistance, Bacterial, Anti-Bacterial Agents pharmacology, Nanopores, Gonorrhea diagnosis, Gonorrhea epidemiology
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Background: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global health challenge. Limitations to AMR surveillance reporting, alongside reduction in culture-based susceptibility testing, has resulted in a need for rapid diagnostics and strain detection. We investigated Nanopore sequencing time, and depth, to accurately identify closely related N. gonorrhoeae isolates, compared to Illumina sequencing., Methods: N. gonorrhoeae strains collected from a London sexual health clinic were cultured and sequenced with MiSeq and MinION sequencing platforms. Accuracy was determined by comparing variant calls at 68 nucleotide positions (37 resistance-associated markers). Accuracy at varying MinION sequencing depths was determined through retrospective time-stamped read analysis., Results: Of 22 MinION-MiSeq pairs reaching sufficient sequencing depth, agreement of variant call positions passing quality control criteria was 185/185 (100%; 95% confidence interval [CI], 98.0%-100.0%), 502/503 (99.8%; 95% CI, 98.9%-99.9%), and 564/565 (99.8%; 95% CI, 99.0%-100.0%) at 10x, 30x, and 40x MinION depth, respectively. Isolates identified as closely related by MiSeq, within one yearly evolutionary distance of ≤5 single nucleotide polymorphisms, were accurately identified via MinION., Conclusions: Nanopore sequencing shows utility as a rapid surveillance tool, identifying closely related N. gonorrhoeae strains, with just 10x sequencing depth, taking a median time of 29 minutes. This highlights its potential for tracking local transmission and AMR markers., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2023
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37. Vaginal microbiota in ethnically diverse young women who did or did not develop pelvic inflammatory disease: community-based prospective study.
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Kerry-Barnard S, Zhou L, Phillips L, Furegato M, Witney AA, Sadiq ST, and Oakeshott P
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- Humans, Female, Young Adult, Adult, Prospective Studies, RNA, Ribosomal, 16S genetics, Vagina microbiology, Lactic Acid, Pelvic Inflammatory Disease epidemiology, Vaginosis, Bacterial microbiology, Microbiota genetics
- Abstract
Objectives: A lactobacilli-dominated vaginal microbiome may protect against pelvic inflammatory disease (PID), but one dominated by Gardnerella species might increase susceptibility. Not all lactobacilli are equally protective. Recent research suggests that D(-) isomer lactic acid producing lactobacilli ( Lactobacillus crispatus, Lactobacillus jensenii and Lactobacillus gasseri ) may protect against infection with Chlamydia trachomatis , an important cause of PID. Lactobacillus iners , which produces L(+) isomer lactic acid, may be less protective. We investigated the microbiome in stored vaginal samples from participants who did or did not develop PID during the prevention of pelvic infection (POPI) chlamydia screening trial., Methods: Long-read 16S rRNA gene nanopore sequencing was used on baseline vaginal samples (one per participant) from all 37 women who subsequently developed clinically diagnosed PID during 12-month follow-up, and 111 frequency matched controls who did not, matched on four possible risk factors for PID: age <20 versus ≥20, black ethnicity versus other ethnicity, chlamydia positive versus negative at baseline and ≥2 sexual partners in the previous year versus 0-1 partners., Results: Samples from 106 women (median age 19 years, 40% black ethnicity, 22% chlamydia positive, 54% reporting multiple partners) were suitable for analysis. Three main taxonomic clusters were identified dominated by L. iners, L. crispatus and Gardnerella vaginalis . There was no association between a more diverse, G. vaginalis dominated microbiome and subsequent PID, although increased Shannon diversity was associated with black ethnicity (p=0.002) and bacterial vaginosis (diagnosed by Gram stain p<0.0001). Women who developed PID had similar relative abundance of protective D(-) isomer lactic acid producing lactobacilli to women without PID, but numbers of PID cases were small., Conclusions: In the first-ever community-based prospective study of PID, there was no clear association between the vaginal microbiome and subsequent development of PID. Future studies using serial samples may identify vaginal microbial communities that may predispose to PID., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
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- 2022
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38. Facilitators and barriers for clinical implementation of a 30-minute point-of-care test for Neisseria gonorrhoeae and Chlamydia trachomatis into clinical care: A qualitative study within sexual health services in England.
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Pacho A, Harding-Esch EM, Heming De-Allie EG, Phillips L, Furegato M, Sadiq ST, and Fuller SS
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- Chlamydia trachomatis, England, Health Services, Humans, Neisseria gonorrhoeae, Qualitative Research, Chlamydia Infections diagnosis, Gonorrhea diagnosis, Point-of-Care Testing, Sexually Transmitted Diseases diagnosis
- Abstract
Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as "change champions" for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff., Competing Interests: The authors have read the journal’s policy and have the following competing interests to declare: At the time this research was being conducted, all authors were employed by the Applied Diagnostic Research and Evaluation Unit (ADREU) at St George’s University of London; ADREU has received funding from Abbott (https://www.abbott.com/), binx health (https://mybinxhealth.com/), Cepheid (https://www.cepheid.com/), SpeedDx (https://plexpcr.com/), Mologic (https://mologic.co.uk/), Revolugen (https://revolugen.co.uk/), and Sekisui (https://sekisuidiagnostics.com/), for the research and evaluation of their diagnostics. The present study was funded by a collaborative grant (ref: no. 90174-463338; awarded to STS, SSF, EMHE) between binx health and St George’s University of London. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
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- 2022
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39. Single gene targeted nanopore sequencing enables simultaneous identification and antimicrobial resistance detection of sexually transmitted infections.
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Zhou L, Lopez Rodas A, Llangarí LM, Romero Sandoval N, Cooper P, and Sadiq ST
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- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, DNA Gyrase genetics, Ecuador, Female, Fluoroquinolones pharmacology, Fluoroquinolones therapeutic use, Humans, Macrolides pharmacology, Mycoplasma genitalium drug effects, Mycoplasma genitalium isolation & purification, Nanopore Sequencing, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae isolation & purification, RNA, Ribosomal, 23S chemistry, RNA, Ribosomal, 23S genetics, RNA, Ribosomal, 23S metabolism, Real-Time Polymerase Chain Reaction, Sex Workers, Sexually Transmitted Diseases drug therapy, Sexually Transmitted Diseases microbiology, Trichomonas vaginalis drug effects, Trichomonas vaginalis isolation & purification, Vagina microbiology, Drug Resistance, Bacterial genetics, Mycoplasma genitalium genetics, Neisseria gonorrhoeae genetics, Sexually Transmitted Diseases diagnosis, Trichomonas vaginalis genetics
- Abstract
Objectives: To develop a simple DNA sequencing test for simultaneous identification and antimicrobial resistance (AMR) detection of multiple sexually transmitted infections (STIs)., Methods: Real-time PCR (qPCR) was initially performed to identify Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) infections among a total of 200 vulvo-vaginal swab samples from female sex workers in Ecuador. qPCR positive samples plus qPCR negative controls for these STIs were subjected to single gene targeted PCR MinION-nanopore sequencing using the smartphone operated MinIT., Results: Among 200 vulvo-vaginal swab samples 43 were qPCR positive for at least one of the STIs. Single gene targeted nanopore sequencing generally yielded higher pathogen specific read counts in qPCR positive samples than qPCR negative controls. Of the 26 CT, NG or MG infections identified by qPCR, 25 were clearly distinguishable from qPCR negative controls by read count. Discrimination of TV qPCR positives from qPCR negative controls was poorer as many had low pathogen loads (qPCR cycle threshold >35) which produced few specific reads. Real-time AMR profiling revealed that 3/3 NG samples identified had gyrA mutations associated with fluoroquinolone resistance, 2/10 of TV had mutations related to metronidazole resistance, while none of the MG samples possessed 23S rRNA gene mutations contributing to macrolide resistance., Conclusions: Single gene targeted nanopore sequencing for diagnosing and simultaneously identifying key antimicrobial resistance markers for four common genital STIs shows promise. Further work to optimise accuracy, reduce costs and improve speed may allow sustainable approaches for managing STIs and emerging AMR in resource poor and laboratory limited settings., Competing Interests: LZ and STS are inventors on the patent: Detection and antibiotic resistance profiling of microorganisms, WO/2020/178575. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2022
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40. Sexually transmitted infections and factors associated with risky sexual practices among female sex workers: A cross sectional study in a large Andean city.
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Llangarí-Arizo LM, Sadiq ST, Márquez C, Cooper P, Furegato M, Zhou L, Aranha L, Mateo MM, and Romero-Sandoval N
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- Humans, Female, Adult, Cross-Sectional Studies, Young Adult, Risk Factors, Ecuador epidemiology, Adolescent, Prevalence, Risk-Taking, Middle Aged, Sex Workers statistics & numerical data, Sexually Transmitted Diseases epidemiology, Sexual Behavior
- Abstract
Background: There are limited published data on factors related to risky sexual practices (RSP) affecting sexually transmitted infections (STIs) among female sex workers (FSWs) in Ecuador., Methods: Cross-sectional study of FSWs presenting for a consultation in a primary health care centre during 2017. A questionnaire was administered to collect information on RSP and potential risk factors including age, membership of an FSW association, self-report of previous STI diagnosis, previous treatment for suspected STI and temporary migration for sex work. Associations between RSP and potential risk factors were estimated by logistic regression. The proportion of STI was estimated from vaginal swabs by real-time PCR for four sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and Mycoplasma genitalium)., Results: Of 249 FSWs recruited, 22.5% had reported RSPs at least once during sex work. Among FSWs reporting unprotected vaginal sex in the previous three months, 25.5% had at least one other RSP type. 17.6% (95%CI 13.3-22.8) had at least one active STI. Prevalence of co-infections was 2.4% (95%CI 1.1-5.2). In multivariable analysis, RSP was associated with age (adjusted OR 1.06; 95%CI 1.02-1.10), membership of an FSWs association (aOR 3.51; 95%CI 1.60-7.72) and self-reported previous STI (aOR 3.43; 95%CI 1.28-9.17)., Conclusions: Among a population of female sex workers with high proportion of STIs, increasing age and belonging to an FSWs association was associated with a higher likelihood of engaging in RSP with clients. Engaging with FSWs organisations may reduce the burden of STI among sex workers., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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41. High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees.
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Broad CE, Furegato M, Harrison MA, Pond MJ, Tan N, Okala S, Fuller SS, Harding-Esch EM, and Sadiq ST
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- Chlamydia Infections epidemiology, Chlamydia trachomatis drug effects, Female, Gonorrhea epidemiology, Humans, London, Male, Neisseria gonorrhoeae drug effects, Prevalence, Prospective Studies, Anti-Bacterial Agents therapeutic use, Azithromycin therapeutic use, Coinfection epidemiology, Drug Resistance, Bacterial, Mycoplasma Infections epidemiology, Mycoplasma genitalium drug effects
- Abstract
Objectives: Azithromycin treatment of Chlamydia trachomatis (CT) may not be adequate to treat concomitant Mycoplasma genitalium (MG) infection, and particularly if MG has macrolide resistance-associated mutations (MG-MRAMs). We estimated prevalence of coinfections of CT with MG carrying MRAM, and risk factors for MG-MRAM among a sexual health clinic population., Study Design and Setting: Among symptomatic and STI-contact clinic attendees in London, prevalence of CT-MG coinfection and MG-MRAM were estimated using nucleic acid amplification testing and Sanger sequencing, respectively, and their associated risk factors analysed using logistic regression., Results: MG prevalence was 7.5% (23/307), 17.3% (30/173), and 11.4% (8/70) in females, men who have sex with women (MSW) and men who have sex with men (MSM), respectively; MG coinfection in CT-infected participants represented 28.0% (7/25), 13.5% (5/37), 0.0% (0/0), respectively. Presence of MG-MRAM was 39.1% (9/23) in female swabs, 70.0% (21/30) in MSW urine and 83.3% (5/6) in MSM rectal swabs. In multivariate analyses, coinfection with another STI was strongly associated with MG-MRAM (OR: 7.19; 95% CI: 2.4 to 21.5)., Conclusion: A significant proportion of participants in our study of symptomatic patients and STI contacts were infected with macrolide-resistant MG, suggesting that testing for MG and MRAM, for MG positives, might be clinically useful. The findings also suggest services explore potential benefits of testing CT positive samples for MG in these patient groups. Where MG testing is not available, potential high rates of MG coinfection should be borne in mind when considering azithromycin in the treatment of CT among STI contacts and symptomatic patients., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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42. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics.
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Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, and Sadiq ST
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- Ambulatory Care Facilities, Azithromycin economics, Azithromycin pharmacology, Azithromycin therapeutic use, Ceftriaxone economics, Ceftriaxone pharmacology, Ceftriaxone therapeutic use, Cost-Benefit Analysis, England, Humans, Neisseria gonorrhoeae drug effects, Sexual Health, Anti-Bacterial Agents economics, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial drug effects, Gonorrhea drug therapy, Gonorrhea microbiology, Point-of-Care Testing
- Abstract
BackgroundWidespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin).AimAssess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use.MethodsThe five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained).ResultsAll strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706).ConclusionsAMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.
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- 2020
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43. Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the "Test n Treat" trial.
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Fleming C, Drennan VM, Kerry-Barnard S, Reid F, Adams EJ, Sadiq ST, Phillips R, Majewska W, Harding-Esch EM, Cousins EC, Yoward F, and Oakeshott P
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- Adolescent, Adult, Ambulatory Care Facilities, Chlamydia, Chlamydia Infections epidemiology, Clinical Trials as Topic, Ethnicity psychology, Female, Gonorrhea epidemiology, Humans, London epidemiology, Male, Mass Screening methods, Neisseria gonorrhoeae, Prevalence, Process Assessment, Health Care, Qualitative Research, Sexual Behavior psychology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology, Social Stigma, Universities, Young Adult, Chlamydia Infections diagnosis, Gonorrhea diagnosis, Mass Screening psychology, Patient Acceptance of Health Care psychology, Students psychology
- Abstract
Background: Low uptake of sexually transmitted infection testing by sexually active young people is a worldwide public health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The "Test n Treat" feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment for chlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technical colleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low (< 15%). In a qualitative study we explored the acceptability, including barriers and facilitators to uptake, of on-site chlamydia screening., Methods: In 2016-17 we conducted a qualitative study in the interpretative tradition using face to face or telephone semi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews were digitally recorded, transcribed and thematically analysed., Results: From the student perspective, feelings of embarrassment and the potential for stigma were deterrents to sexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for some students volunteering to be screened exposed them to detrimental judgements by their peers. A small financial incentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchers confirmed these views. The very low level of knowledge about sexually transmitted infections influenced students to not view themselves as candidates for testing. There were also suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students and researchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing., Conclusions: This study offers new insights into the acceptability of college-based sexually transmitted infection screening to young, multi-ethnic students. Future studies in similar high risk, hard to reach groups should consider linking testing with education about sexually transmitted infections, offering non stigmatising incentives and engaging peer influencers.
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- 2020
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44. Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the 'Test n Treat' feasibility trial.
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Kerry-Barnard S, Huntington S, Fleming C, Reid F, Sadiq ST, Drennan VM, Adams E, and Oakeshott P
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- Adolescent, Chlamydia Infections epidemiology, Chlamydia Infections therapy, Costs and Cost Analysis, Feasibility Studies, Female, Gonorrhea epidemiology, Gonorrhea therapy, Humans, London epidemiology, Male, Motivation, Prevalence, Students, Surveys and Questionnaires, Universities, Young Adult, Chlamydia Infections diagnosis, Gonorrhea diagnosis, Health Care Costs statistics & numerical data, Mass Screening economics, Sexually Transmitted Diseases diagnosis
- Abstract
Background: Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges., Methods: Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate)., Results: The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected., Conclusions: Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable., Trial Registration: ISRCTN58038795, Assigned August 2016, registered prospectively.
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- 2020
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45. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae .
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Fifer H, Saunders J, Soni S, Sadiq ST, and FitzGerald M
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- Disease Management, Humans, Specimen Handling, United Kingdom, Gonorrhea diagnosis, Gonorrhea drug therapy, Neisseria gonorrhoeae isolation & purification, Practice Guidelines as Topic
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- 2020
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46. Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection.
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Harrison MA, Harding-Esch EM, Marks M, Pond MJ, Butcher R, Solomon AW, Zhou L, Tan N, Nori AV, Kako H, Sokana O, Mabey DCW, and Sadiq ST
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents administration & dosage, Azithromycin administration & dosage, Cluster Analysis, Cross-Sectional Studies, DNA, Bacterial chemistry, DNA, Bacterial genetics, DNA, Ribosomal chemistry, DNA, Ribosomal genetics, Female, Genotype, Humans, Melanesia epidemiology, Middle Aged, Molecular Typing, Mycoplasma Infections microbiology, Mycoplasma genitalium classification, Mycoplasma genitalium genetics, Mycoplasma genitalium isolation & purification, Phylogeny, Prevalence, RNA, Ribosomal, 23S genetics, Sequence Analysis, DNA, Trachoma prevention & control, Young Adult, Anti-Bacterial Agents adverse effects, Azithromycin adverse effects, Drug Resistance, Bacterial, Mass Drug Administration adverse effects, Mycoplasma Infections epidemiology, Mycoplasma genitalium drug effects, Trachoma drug therapy
- Abstract
Background: Mass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular Chlamydia trachomatis (CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be suboptimal in Mycoplasma genitalium infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin., Objectives: To determine the effect of MDA for trachoma elimination on M. genitalium prevalence, strain type and azithromycin resistance., Methods: A secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for M. genitalium infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay. M. genitalium -positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of M. genitalium and underwent phylogenetic analysis by dual locus sequence typing., Results: M. genitalium prevalence was 11.9% (28/236) in women pre-MDA and 10.9% (28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2% in women recruited post-MDA and 17.9% (5/28) in those who tested M. genitalium positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA., Conclusion: A single round of azithromycin MDA in an island population with high baseline M. genitalium prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on M. genitalium azithromycin AMR in antibiotic experienced and naïve populations is warranted., Competing Interests: Competing interests: MAH, EMHE and STS disclose having received funding outside the submitted work from Atlas Genetics, Alere, Cepheid, SpeeDx, Mologic and Sekisui. MJP discloses having received funding outside the submitted work from Atlas Genetics, Alere, Cepheid and Sekisui. AVN discloses having received funding outside the submitted work from Alere, Cepheid, SpeeDx and Sekisui. EMHE discloses their membership of the Becton Dickinson 'Provision of Sexual Health in the UK' advisory board. All other authors have nothing to disclose., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)
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47. Genotypic determinants of fluoroquinolone and macrolide resistance in Neisseria gonorrhoeae.
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Hall CL, Harrison MA, Pond MJ, Chow C, Harding-Esch EM, and Sadiq ST
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- Genes, Bacterial genetics, Genetic Association Studies, Gonorrhea drug therapy, Humans, Neisseria gonorrhoeae drug effects, RNA, Ribosomal, 23S genetics, Anti-Bacterial Agents pharmacology, Drug Resistance, Bacterial genetics, Fluoroquinolones pharmacology, Macrolides pharmacology, Neisseria gonorrhoeae genetics
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Background High rates of antimicrobial resistance (AMR) in Neisseria gonorrhoeae hinder effective treatment, but molecular AMR diagnostics may help address the challenge. This study aimed to appraise the literature for resistance-associated genotypic markers linked to fluoroquinolones and macrolides, to identify and review their use in diagnostics., Methods: Medline and EMBASE databases were searched and data pooled to evaluate associations between genotype and phenotypic resistance. The minimum inhibitory concentration (MIC) cut-offs were ≤ 0.06 mg L-1 for non-resistance to ciprofloxacin and ≤ 0.5 mg L-1 for non-resistance to azithromycin., Results: Diagnostic accuracy estimates were limited by data availability and reporting. It was found that: 1) S91 and D95 mutations in the GyrA protein independently predicted ciprofloxacin resistance and, used together, gave 98.6% (95% confidence interval (CI) 98.0-99.0%) sensitivity and 91.4% (95%CI 88.6-93.7%) specificity; 2) the number of 23S rRNA gene alleles with C2611T or A2059G mutations was highly correlated with azithromycin resistance, with mutation in any allele giving a sensitivity and specificity of 66.1% (95%CI 62.1-70.0%) and 98.9% (95%CI 97.5-99.5%) respectively. Estimated negative (NPV) and positive predictive values (PPV) for a 23S rRNA diagnostic were 98.6% (95%CI 96.8-99.4%) and 71.5% (95%CI 68.0-74.8%) respectively; 3) mutation at amino acid position G45 in the MtrR protein independently predicted azithromycin resistance; however, when combined with 23S rRNA, did not improve the PPV or NPV., Conclusions: Viable candidates for markers of resistance detection for incorporation into diagnostics were demonstrated. Such tests may enhance antibiotic stewardship and treatment options.
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48. 'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges.
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Oakeshott P, Kerry-Barnard S, Fleming C, Phillips R, Drennan VM, Adams EJ, Majewska W, Harding-Esch EM, Cousins EC, Planche T, Green A, Bartholomew RI, Sadiq ST, and Reid F
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- Adolescent, Chlamydia Infections epidemiology, Diagnostic Screening Programs, Ethnicity, Feasibility Studies, Female, Humans, London epidemiology, Male, Prevalence, Risk Factors, Sexual Behavior, Sexual Partners, Sexually Transmitted Diseases epidemiology, Students, Surveys and Questionnaires, Time-to-Treatment, Young Adult, Chlamydia Infections diagnosis, Chlamydia Infections drug therapy, Chlamydia trachomatis isolation & purification, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases drug therapy
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Objectives: We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT., Methods: Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26)., Results: Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs)., Conclusions: Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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49. An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study.
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Newby K, Crutzen R, Brown K, Bailey J, Saunders J, Szczepura A, Hunt J, Alston T, Sadiq ST, and Das S
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Background: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet., Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites., Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies., Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use., Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status., (©Katie Newby, Rik Crutzen, Katherine Brown, Julia Bailey, John Saunders, Ala Szczepura, Jonny Hunt, Tim Alston, S Tariq Sadiq, Satyajit Das. Originally published in JMIR Formative Research (http://formative.jmir.org), 01.05.2019.)
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50. "It's not a time spent issue, it's a 'what have you spent your time doing?' issue…" A qualitative study of UK patient opinions and expectations for implementation of Point of Care Tests for sexually transmitted infections and antimicrobial resistance.
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Fuller SS, Pacho A, Broad CE, Nori AV, Harding-Esch EM, and Sadiq ST
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- Adolescent, Adult, Female, Humans, Male, Middle Aged, United Kingdom epidemiology, Anti-Bacterial Agents administration & dosage, Drug Resistance, Bacterial, Point-of-Care Testing, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases drug therapy, Sexually Transmitted Diseases epidemiology
- Abstract
Sexually transmitted infections (STIs) continue to be a major public health concern in the United Kingdom (UK). Epidemiological models have shown that narrowing the time between STI diagnosis and treatment may reduce the population burden of infection, and rapid, accurate point-of-care tests (POCTs) have potential for increasing correct treatment and mitigating the spread of antimicrobial resistance (AMR). We developed the Precise social science programme to incorporate clinician and patient opinions on potential designs and implementation of new POCTs for multiple STIs and AMR detection. We conducted qualitative research, consisting of informal interviews with clinicians and semi-structured in-depth interviews with patients, in six sexual health clinics in the UK. Interviews with clinicians focused on how the new POCTs would likely be implemented into clinical care; these new clinical pathways were then posed to patients in in-depth interviews. Patient interviews showed acceptability of POCTs, however, willingness to wait in clinic for test results depended on the context of patients' sexual healthcare seeking. Patients reporting frequent healthcare visits often based their expectations and opinions of services and POCTs on previous visits. Patients' suggestions for implementation of POCTs included provision of information on service changes and targeting tests to patients concerned they are infected. Our data suggests that patients may accept new POCT pathways if they are given information on these changes prior to attending services and to consider implementing POCTs among patients who are anxious about their infection status and/or who are experiencing symptoms., Competing Interests: ADREU has received funding from Binx Health (formerly Atlas Genetics Ltd), Alere, Cepheid, SpeedDx, Mologic, Revolugen and Sekisui. SSF and EHE have been members of the BD Diagnostics Advisory Panel on UK Provision of Sexual Health Services. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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