72 results on '"Town K"'
Search Results
2. Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing
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TOWN, K., FUREGATO, M., FIELD, N., and HUGHES, G.
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- 2017
3. Supporting general practices to provide sexual and reproductive health services: protocol for the 3Cs & HIV programme
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Town, K., Ricketts, E.J., Hartney, T., Dunbar, J.K., Nardone, A., Folkard, K.A., Charlett, A., and McNulty, C.A.M.
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- 2015
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4. Drifting towards ceftriaxone treatment failure in gonorrhoea: risk factor analysis of data from the Gonococcal Resistance to Antimicrobials Surveillance Programme in England and Wales
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Town, K, Obi, C, Quaye, N, Chisholm, S, Hughes, G, Livermore, DM, Bignell, C, Eastick, K, Johnson, A, Paul, J, Robinson, A, Ross, J, Wade, J, Ison, C, Woodford, N, Mulla, R, Sadiq, T, Fifer, H, Andreasen, A, David, M, Ross, J, Williams, OM, Horner, P, Cubbon, M, Dean, G, Brown, N, Carne, C, Howe, R, Drayton, R, Moore, P, DeBurgh-Thomas, A, Jepson, A, Nathan, M, Wade, J, Tenant-Flowers, M, Denton, M, Clarke, J, Anson, J, Bradley, M, McLean, K, McOwan, A, Paul, G, Donaldson, H, Balachandran, T, Qamruddin, A, Sukthankar, A, Valappil, M, Sankar, KN, Majumdar, S, Birley, H, Minassian, M, Riddell, L, Weston, V, Bignell, C, Pammi, M, Wildman, G, Iyer, S, Prtak, L, Bowman, C, Dewnsap, C, Riley, P, Hay, P, Wilkinson, D, Macrae, B, Robinson, A, Jungmann, E, Dobie, D, Tariq, A, DallʼAntonia, M, and Russell, J
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- 2017
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5. O09.5 Characteristics of People with Gonorrhea with Reduced Azithromycin Antimicrobial Susceptibility in 8 Jurisdictions in the United States, 2018–2019
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Learner, E, primary, Gieseker, K, additional, Mauk, K, additional, Town, K, additional, Pham, C, additional, St Cyr, S, additional, Shrestha, D, additional, Barbee, L, additional, McNeil, C, additional, Holderman, J, additional, Johnson, K, additional, Nguyen, T, additional, Albano, T, additional, Schlanger, K, additional, and Kirkcaldy, R, additional
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- 2021
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6. O08.4 Strengthening the U.S. Response to Resistant Gonorrhea (SURRG): A program to enhance local antibiotic resistant gonorrhea preparedness capacity
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Schlanger, K, primary, Mauk, K, additional, Learner, E, additional, Town, K, additional, Pham, C, additional, Bhattacharyya, S, additional, Sankaran, M, additional, Black, J, additional, Wendel, K, additional, McNeil, C, additional, Fukada, A, additional, Golden, M, additional, Schillinger, J, additional, and Kirkcaldy, R, additional
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- 2021
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7. A community-driven resource for genomic epidemiology and antimicrobial resistance prediction of Neisseria gonorrhoeae at Pathogenwatch
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Sánchez-Busó L, Yeats CA, Taylor B, Goater RJ, Underwood A, Abudahab K, Argimón S, Ma KC, Mortimer TD, Golparian D, Cole MJ, Grad YH, Martin I, Raphael BH, Shafer WM, Town K, Wi T, Harris SR, Unemo M, and Aanensen DM
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Pathogenwatch ,Public health ,Surveillance ,Epidemiology ,Genomics ,Antimicrobial resistance ,Neisseria gonorrhoeae - Abstract
Background Antimicrobial-resistant (AMR) Neisseria gonorrhoeae is an urgent threat to public health, as strains resistant to at least one of the two last-line antibiotics used in empiric therapy of gonorrhoea, ceftriaxone and azithromycin, have spread internationally. Whole genome sequencing (WGS) data can be used to identify new AMR clones and transmission networks and inform the development of point-of-care tests for antimicrobial susceptibility, novel antimicrobials and vaccines. Community-driven tools that provide an easy access to and analysis of genomic and epidemiological data is the way forward for public health surveillance. Methods Here we present a public health-focussed scheme for genomic epidemiology of N. gonorrhoeae at Pathogenwatch (). An international advisory group of experts in epidemiology, public health, genetics and genomics of N. gonorrhoeae was convened to inform on the utility of current and future analytics in the platform. We implement backwards compatibility with MLST, NG-MAST and NG-STAR typing schemes as well as an exhaustive library of genetic AMR determinants linked to a genotypic prediction of resistance to eight antibiotics. A collection of over 12,000 N. gonorrhoeae genome sequences from public archives has been quality-checked, assembled and made public together with available metadata for contextualization. Results AMR prediction from genome data revealed specificity values over 99% for azithromycin, ciprofloxacin and ceftriaxone and sensitivity values around 99% for benzylpenicillin and tetracycline. A case study using the Pathogenwatch collection of N. gonorrhoeae public genomes showed the global expansion of an azithromycin-resistant lineage carrying a mosaic mtr over at least the last 10 years, emphasising the power of Pathogenwatch to explore and evaluate genomic epidemiology questions of public health concern. Conclusions The N. gonorrhoeae scheme in Pathogenwatch provides customised bioinformatic pipelines guided by expert opinion that can be adapted to public health agencies and departments with little expertise in bioinformatics and lower-resourced settings with internet connection but limited computational infrastructure. The advisory group will assess and identify ongoing public health needs in the field of gonorrhoea, particularly regarding gonococcal AMR, in order to further enhance utility with modified or new analytic methods.
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- 2021
8. Reducing the Burden of Biopsy: An Institutional Time Series Analysis
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Moayedi, Y., primary, Henricksen, E., additional, Purewal, S., additional, Somerset, E., additional, Fan, S., additional, Town, K., additional, Tremblay-Gravel, M., additional, Ross, H.J., additional, Woo, J.Y., additional, Khush, K.K., additional, and Teuteberg, J.J., additional
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- 2020
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9. Can Too Much Be Bad: Aggressively Lowering LDL Not Associated with Improvement in Maximal Intimal Thickening
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Lee, R., primary, Henricksen, E.J., additional, Moayedi, Y., additional, Runeckles, K., additional, Fan, C.S., additional, Han, J., additional, Feng, K.Y., additional, Yang, W., additional, Town, K., additional, Marks, P., additional, MacArthur, J.W., additional, Khush, K.K., additional, and Teuteberg, J.J., additional
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- 2020
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10. Just Google it! Impact of media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae on online searches, and attendances, testing and diagnoses at sexual health clinics in England between 2015 and 2016: an interrupted time series analysis using surveillance data
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Smolarchuk, C., Mohammed, H., Furegato, M., Town, K., Fifer, H., Wilson, J., Nardone, A., Lee, A., and Hughes, G.
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Objectives To determine if media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae (HL-AziR) impacted online search interest or was temporally associated with health-seeking behaviours in several English cities.\ud \ud \ud Methods A descriptive analysis of outbreak-related online media articles and relative search interest (RSI) using Google and an interrupted time series analysis using routine surveillance data from sexual health clinics (SHCs) in England (GUMCAD STI surveillance system). The main outcomes were adjusted incidence rate ratios (IRRs) of weekly attendances, gonorrhoea tests and diagnoses of gonorrhoea or ‘any STI’ in selected cities after media coverage of the outbreak in 2015 and 2016.\ud \ud \ud Results RSI for outbreak-related terms peaked during media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The greatest increase in RSI was in Leeds, which coincided with a 63% rise (n=1932; IRR 1.26, 95% CI 1.12 to 1.43) in SHC attendances by women. There was only a 7% (n=1358; IRR 1.01, 95% CI 0.91 to 1.11) increase in attendances by men. Modest increases in outcomes occurred in four other cities with a high RSI. There was no evidence of increases in outcomes in cities, other than Leeds, after subsequent media coverage of the outbreak.\ud \ud \ud Conclusions National and local media coverage of the HL-AziR outbreak coincided with peak RSI for related terms, and a transient increase in attendances, gonorrhoea tests and diagnoses of gonorrhoea or ‘any STI’ in some cities with a high RSI. Our analysis demonstrates the potential for media coverage to influence health-seeking behaviours during high-profile STI outbreaks.
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- 2019
11. Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial
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Edet B, Bonilla-Escobar Fj, Creanga Aa, François Dabis, Claire Rekacewicz, Uduak Okomo, Collins Iwuji, Tiggelaar Sm, Charlton Bm, Anthony Nardone, Adelufosi A, Aquaisua E, Marie-Louise Newell, Esu E, Joanna Orne-Gliemann, Kuhlmann Aks, Ejemot-Nwadiaro R, Ellie J Ricketts, Frank Tanser, Zhao H, Jones Lf, Joseph Larmarange, Cam McNulty, Rodolphe Thiébaut, Town K, Wu E, Rugman C, Ogugbue M, Msiska Tw, Gullo S, Jiang T, Thomas Hartney, Kate Folkard, Bello S, M Chibuzor, Nonhlanhla Okesola, Ortega-Loubon C, Galavotti C, Donna M. Lecky, Borus J, Wu R, Ortega-Lenis D, Xu F, Rojas-Mirquez Jc, Iwara Arikpo, Martin M Meremikwu, Dachi Arikpo, Okoye I, Vargas G, DARMIGNY, Sandrine, Research Department of Infection and Population Health [London], University College of London [London] (UCL), Africa Centre for Health and Population Studies, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN)-Medical Research Council of South Africa, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN), Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), Human Health and Development, University of Southampton, University of KwaZulu-Natal (UKZN)-Medical Research Council of South Africa, Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence nationale de recherches sur le sida et les hépatites virales, ANRS France Recherche Nord & sud Sida-hiv hépatites, Global Health Research Institute, Hopkins Marine Station [Stanford], Stanford University, University College of London [London] ( UCL ), University of KwaZulu-Natal ( UKZN ) -Medical Research Council of South Africa, Institut de Santé Publique, d'Epidémiologie et de Développement ( ISPED ), Centre population et développement ( CEPED - UMR_D 196 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), ANRS, University of Southampton [Southampton], HOPKINS MARINE STATION, Stanford University [Stanford], 12249, The French National Agency for Aids and Viral Hepatitis Research (ANRS), 81151938, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, International Initiative for Impact Evaluation, Merck, Gilead Sciences, and 097410/Z/11/Z, Wellcome Trust
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RNA viruses ,Questionnaires ,Male ,Rural Population ,0301 basic medicine ,Epidemiology ,[SDV]Life Sciences [q-bio] ,lcsh:Medicine ,HIV Infections ,Human sexuality ,Pathology and Laboratory Medicine ,Public opinion ,Geographical locations ,South Africa ,0302 clinical medicine ,Immunodeficiency Viruses ,Health care ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,ComputingMilieux_MISCELLANEOUS ,media_common ,education.field_of_study ,AIDS Serodiagnosis ,virus diseases ,HIV diagnosis and management ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,General Medicine ,Continuity of Patient Care ,Middle Aged ,Vaccination and Immunization ,3. Good health ,Abortion law ,[SDV] Life Sciences [q-bio] ,Sexual Partners ,Medical Microbiology ,Research Design ,HIV epidemiology ,Viral Pathogens ,Viruses ,Cluster Trials ,Female ,Health education ,Pathogens ,Attitude to Health ,Research Article ,Adult ,Drug Research and Development ,Anti-HIV Agents ,media_common.quotation_subject ,Immunology ,HIV prevention ,Population ,Antiretroviral Therapy ,Research and Analysis Methods ,Microbiology ,Young Adult ,03 medical and health sciences ,Antiviral Therapy ,Nursing ,Retroviruses ,Humans ,Clinical Trials ,education ,Microbial Pathogens ,Conscience ,Pharmacology ,Survey Research ,[ SDV ] Life Sciences [q-bio] ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,030112 virology ,Mental health ,Diagnostic medicine ,Self Care ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Law ,Africa ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Preventive Medicine ,Clinical Medicine ,People and places ,business - Abstract
Background The 2015 WHO recommendation of antiretroviral therapy (ART) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population. We investigated this approach in a cluster-randomised trial in a high HIV prevalence setting in rural KwaZulu-Natal. We present findings from the first phase of the trial and report on uptake of home-based HIV testing, linkage to care, uptake of ART, and community attitudes about ART. Methods and Findings Between 9 March 2012 and 22 May 2014, five clusters in the intervention arm (immediate ART offered to all HIV-positive adults) and five clusters in the control arm (ART offered according to national guidelines, i.e., CD4 count ≤ 350 cells/μl) contributed to the first phase of the trial. Households were visited every 6 mo. Following informed consent and administration of a study questionnaire, each resident adult (≥16 y) was asked for a finger-prick blood sample, which was used to estimate HIV prevalence, and offered a rapid HIV test using a serial HIV testing algorithm. All HIV-positive adults were referred to the trial clinic in their cluster. Those not linked to care 3 mo after identification were contacted by a linkage-to-care team. Study procedures were not blinded. In all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits. HIV status was ever ascertained for a total of 8,233/9,927 (82.9%), including 2,569 ascertained as HIV-positive (942 tested HIV-positive and 1,627 reported a known HIV-positive status). Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial, 559 (47.5%) visited their cluster trial clinic within 6 mo. In the intervention arm, 89% (194/218) initiated ART within 3 mo of their first clinic visit. In the control arm, 42.3% (83/196) had a CD4 count ≤ 350 cells/μl at first visit, of whom 92.8% initiated ART within 3 mo. Regarding attitudes about ART, 93% (8,802/9,460) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive. Estimated baseline HIV prevalence was 30.5% (2,028/6,656) (95% CI 25.0%, 37.0%). HIV prevalence, uptake of home-based HIV testing, linkage to care within 6 mo, and initiation of ART within 3 mo in those with CD4 count ≤ 350 cells/μl did not differ significantly between the intervention and control clusters. Selection bias related to noncontact could not be entirely excluded. Conclusions Home-based HIV testing was well received in this rural population, although men were less easily contactable at home; immediate ART was acceptable, with good viral suppression and retention. However, only about half of HIV-positive people accessed care within 6 mo of being identified, with nearly two-thirds accessing care by 12 mo. The observed delay in linkage to care would limit the individual and public health ART benefits of universal testing and treatment in this population. Trial registration ClinicalTrials.gov NCT01509508, Collins Iwuji and colleagues report implementation indicators and early health outcomes from the first phase of a cluster-randomized trial of immediate antiretroviral therapy to all HIV-positive individuals in rural KwaZulu-Natal, South Africa., Author Summary Why Was This Study Done? A study in stable sexual partners in which one partner was HIV-positive and the other partner was HIV-negative (and both partners had disclosed to each other) showed that if the HIV-positive partner was on antiretroviral therapy, there was a 96% reduction in HIV transmission from the HIV-positive partner to the HIV-negative partner. However, we do not know if antiretroviral therapy prescribed to HIV-positive individuals in the general population—and where individuals might not disclose their HIV status to sexual partners—would have a similar impact on HIV transmission. It is important to determine whether prescribing antiretroviral therapy to all HIV-positive individuals is more effective at decreasing HIV transmission than starting individuals on antiretroviral therapy only once their HIV has progressed to the point at which local HIV treatment guidelines currently recommend that HIV-positive individuals start treatment. What Did the Researchers Do and Find? We designed an experiment to investigate whether antiretroviral therapy can reduce new HIV infections in the general population, and piloted the trial in ten communities in KwaZulu-Natal, South Africa, to check whether starting HIV-positive individuals on antiretroviral therapy directly after diagnosis is feasible and acceptable. We visited people in their homes, offered HIV rapid tests every six months to all individuals 16 years and older, and referred identified HIV-positive individuals to trial clinics, where they were offered antiretroviral therapy either regardless of their CD4 count (intervention group) or when they were treatment-eligible per current national guidelines (control group). During the two-year study, we contacted 9,927 (77%) of 12,894 eligible individuals and ascertained the HIV status of 80% of contacted women and 75% of contacted men. HIV-positive status was ascertained for 1,339 adults who were not previously in care; 1,177 were followed in the trial at least 6 mo after referral, of whom 559 (47.5%) engaged with care within this period. What Do These Findings Mean? Our findings show good acceptance of home-based HIV testing in rural South Africa but highlight the challenges in reaching adequate numbers of people to offer HIV tests to, especially among men. We also found that linkage to care was slower than expected, but amongst those who reached the clinics, uptake of antiretroviral therapy was high, with the majority of individuals achieving good control of the virus. Our study informs health care professionals, planners, and policy makers about the challenges that need to be addressed to achieve the UNAIDS target of 90% of people living with HIV aware of their HIV diagnosis, 90% on antiretroviral therapy, and 90% achieving good control of the virus, with testing and treatment offered to all.
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- 2016
12. P3.44 Just google it! the impact of media coverage of an outbreak of high-level azithromycin resistant gonorrhoea on attendances, testing and diagnoses at local sexual health clinics
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Smolarchuk, C, primary, Furegato, M, additional, Mohammed, H, additional, Town, K, additional, Fifer, H, additional, Wilson, J, additional, Nardone, A, additional, and Hughes, G, additional
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- 2017
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13. Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model
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Allison, R., primary, Lecky, D. M., additional, Town, K., additional, Rugman, C., additional, Ricketts, E. J., additional, Ockendon-Powell, N., additional, Folkard, K. A., additional, Dunbar, J. K., additional, and McNulty, C. A. M., additional
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- 2017
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14. Drifting towards ceftriaxone treatment failure in gonorrhoea: risk factor analysis of data from the Gonococcal Resistance to Antimicrobials Surveillance Programme in England and Wales
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Town, K, primary, Obi, C, additional, Quaye, N, additional, Chisholm, S, additional, and Hughes, G, additional
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- 2016
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15. P13.09 Evaluation of a pilot to improve primary care sexual health services in england: analysis of chlamydia testing and diagnosis rate changes
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Town, K, primary, Ricketts, EJ, additional, Hartney, T, additional, Nardone, A, additional, Folkard, KA, additional, Rugman, C, additional, Ockendon, N, additional, Charlett, A, additional, McNulty, CAM, additional, and Dunbar, JK, additional
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- 2015
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16. O03.3 Maximising the Efficiency of Gonorrhoea Treatment by Targeting the Use of Previous First Line Therapies to Susceptible Patients
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Town, K, primary, Obi, C, additional, Chisholm, S, additional, Hughes, G, additional, and Ison, C A, additional
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- 2013
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17. O03.1 Risk Factors For Antimicrobial ResistantNeisseria Gonorrhoeaein Europe: Abstract O03.1 Table 1
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Cole, M J, primary, Spiteri, G, additional, Town, K, additional, Unemo, M, additional, Hoffmann, S, additional, Laar, M van de, additional, and Ison, C, additional
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- 2013
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18. P30 An analysis of patient characteristics associated with gonococcal resistance to past therapeutic agents in England and Wales
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Town, K, primary, Lowndes, C M, additional, Chisholm, S, additional, Kall, M, additional, Webster, E, additional, Nichols, T, additional, Anderson, J, additional, Obi, C, additional, Willey, B, additional, and Ison, C, additional
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- 2012
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19. P39 The acceptability and use of SMS text messaging for provider referral partner notification (PRPN)
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Gilbart, V, primary, Town, K, additional, and Lowndes, C M, additional
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- 2012
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20. P99 Socio-demographic and behavioural characteristics of men who have sex with men (MSM) and heterosexuals infected with gonorrhoea
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Obi, C, primary, Chisholm, S, additional, Webster, E, additional, Town, K, additional, Anderson, J, additional, Nichols, T, additional, Ison, C, additional, and Lowndes, C, additional
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- 2012
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21. MEOR Success in Southern Saskatchewan
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Town, K.., primary, Sheehy, A.J.. J., additional, and Govreau, B.R.. R., additional
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- 2010
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22. ChemInform Abstract: HYDROGEN REDUCTION OF COORDINATED CARBON MONOSULFIDE IN (IRH(CS)(PPH3)3) TO THE METHANETHIOLATO-LIGAND AND AN IRIDIUM THIOFORMYL COMPOUND (IR(CHS)CL2(CO)(PPH3)2)
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ROPER, W. R., primary and TOWN, K. G., additional
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- 1978
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23. ChemInform Abstract: SYNTHESIS OF LOW-VALENT THIOCARBONYL COMPLEXES VIA 1,2-ELIMINATION OF METHYLTHIOL FROM CIS-METAL-HYDRIDO-DITHIO METHYL ESTER COMPLEXES. DICARBONYLTHIOCARBONYLBIS(TRIPHENYLPHOSPHINE)OSMIUM AND CHLOROTHIOCARBONYLBIS(TRIPHENYLPHOSPHINE)I
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COLLINS, T. J., primary, ROPER, W. R., additional, and TOWN, K. G., additional
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- 1977
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24. P3.44 Just google it! the impact of media coverage of an outbreak of high-level azithromycin resistant gonorrhoea on attendances, testing and diagnoses at local sexual health clinics
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Smolarchuk, C, Furegato, M, Mohammed, H, Town, K, Fifer, H, Wilson, J, Nardone, A, and Hughes, G
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IntroductionAn outbreak of high-level azithromycin resistant gonorrhoea, dubbed ‘super gonorrhoea’ in the mainstream media, emerged in Leeds, England in 2015 and has since spread to other parts of the country. We aimed to determine if media coverage affected online searches nationally and attendances, and gonorrhoea testing and diagnoses locally at sexual health clinics (SHCs).MethodsGoogle Trends was used to determine Relative Search Interest (RSI) for ‘gonorrh*’ and ‘super gonorrh*’ in England from 2015–2016. Using data from England’s national STI surveillance system (GUMCADv2), an interrupted time series analysis was performed to compare the sex-stratified, weekly rates of attendances, and gonorrhoea testing and diagnoses at 6 SHCs in Leeds and in other affected areas. The analysis compared rates of events 6 weeks before and after initial media coverage of the outbreak in September 2015.ResultsThe RSI peaked during initial media coverage in September 2015 (100) with smaller peaks in December 2015 (47), April 2016 (72), and September 2016 (33), coinciding with subsequent coverage. The number of SHC attendances by women in Leeds rose after initial media coverage (p<0.01) by 36% (from 320 to 435/week), but there was only a 4% increase in attendances (from 326 to 340/week) by men (p=0.70). There was no change in rates of gonorrhoea tests or diagnoses in women (p=0.87 and 0.23) or men (p=0.51 and p=1.00). There were no significant increases in event rates in other areas with a high RSI including Birmingham, Manchester, London, Liverpool and Sheffield. ConclusionMedia coverage of the outbreak was associated temporally with increased online searches for gonorrhoea nationally, and female attendances at SHCs in Leeds only. This demonstrates opportunities for health promotion for the prevention and control of outbreaks and raises the question of how best to target such messaging to those populations and groups most likely to benefit from attending and being tested in SHCs.
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- 2017
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25. Why SARS-CoV-2 vaccination still matters in Africa.
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Taylor-Robinson SD, Morgan MY, Spearman CW, Suliman AAA, Corrah T, Oleribe OO, and Taylor-Robinson AW
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- Africa epidemiology, COVID-19 Vaccines, Humans, Vaccination, COVID-19 epidemiology, COVID-19 prevention & control, SARS-CoV-2
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- 2022
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26. Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae.
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Schlanger K, Learner ER, Pham CD, Mauk K, Golden M, Wendel KA, Amsterdam L, McNeil CJ, Johnson K, Nguyen TQ, Holderman JL, Hasty GL, St Cyr SB, Town K, Nash EE, and Kirkcaldy RD
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- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Azithromycin pharmacology, Ceftriaxone pharmacology, Drug Resistance, Bacterial, Female, Humans, Male, Microbial Sensitivity Tests, Gonorrhea drug therapy, Gonorrhea epidemiology, Neisseria gonorrhoeae
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Background: In 2016, Centers for Disease Control and Prevention initiated Strengthening the US Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies., Methods: Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in sexually transmitted disease and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin., Results: Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018 to 2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% [3412] and 8.9% [4883] of local reported cases in 2018 and 2019, respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts., Conclusions: As a public health model to build capacity to slow the spread of emerging resistance, SURRG successfully expanded culture collection, implemented rapid AST, and implemented an enhanced partner services investigation approach in participating jurisdictions. Findings from SURRG may enhance preparedness efforts and inform a longer-term, comprehensive, and evidence-based public health response to emerging gonococcal resistance. Continued development of innovative approaches to address emerging resistance is needed., Competing Interests: Conflicts of Interest: None declared., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2021
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27. Exploring and Comparing the Structure of Sexual Networks Affected by Neisseria gonorrhoeae Using Sexual Partner Services Investigation and Genomic Data.
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Town K, Learner ER, Chivukula VL, Mauk K, Reimche JL, Schmerer MW, Black J, Pathela P, Bhattacharyya S, Kerani RP, Gieseker KE, Fukuda A, Sankaran M, McNeil CJ, Spicknall IH, Raphael BH, St Cyr SB, Bernstein K, Kersh EN, Kirkcaldy RD, Schlanger K, and Gernert KM
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- Female, Genomics, Humans, Male, Sexual Behavior, Sexual Partners, Gonorrhea epidemiology, Neisseria gonorrhoeae genetics
- Abstract
Background: Sexual networks are difficult to construct because of incomplete sexual partner data. The proximity of people within a network may be inferred from genetically similar infections. We explored genomic data combined with partner services investigation (PSI) data to extend our understanding of sexual networks affected by Neisseria gonorrhoeae (NG)., Methods: We used 2017-2019 PSI and whole-genome sequencing (WGS) data from 8 jurisdictions participating in Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) project. Clusters were identified from sexual contacts and through genetically similar NG isolates. Sexual mixing patterns were characterized by describing the clusters by the individual's gender and gender of their sex partners., Results: Our study included 4627 diagnoses of NG infection (81% sequenced), 2455 people received a PSI, 393 people were negative contacts of cases, and 495 were contacts with an unknown NG status. We identified 823 distinct clusters using PSI data combined with WGS data. Of cases that were not linked to any other case using PSI data, 37% were linked when using WGS data. Overall, 40% of PSI cases were allocated to a larger cluster when PSI and WGS data were combined compared with PSI data alone. Mixed clusters containing women, men who report sex with women, and men who report sex with men were common when using the WGS data either alone or in combination with the PSI data., Conclusions: Combining PSI and WGS data improves our understanding of sexual network connectivity., Competing Interests: Conflict of Interest and Sources of Funding: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry. No author reports any conflict of interest., (Copyright © 2021 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)
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- 2021
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28. Sexually Transmitted Infection Testing Among Transgender Women Living with Human Immunodeficiency Virus in the United States: Medical Monitoring Project, 2015-2019.
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Town K, Tie Y, Dasgupta S, Kirkcaldy RD, Crim SM, Weiser J, and Bernstein K
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- Female, HIV, Humans, United States epidemiology, Chlamydia Infections, Gonorrhea diagnosis, Gonorrhea epidemiology, HIV Infections complications, HIV Infections epidemiology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology, Syphilis, Transgender Persons
- Abstract
National guidelines recommend annual sexually transmitted infection testing for sexually active people living with human immunodeficiency virus, including transgender women. Using data from the US Medical Monitoring Project during 2015-2019, in the previous 12 months, 63.3% of sexually active transgender women who were human immunodeficiency virus positive were tested for syphilis, 56.6% for chlamydia, and 54.4% for gonorrhea., (Published by Oxford University Press for the Infectious Diseases Society of America 2021.)
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- 2021
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29. Sustained Transmission of Neisseria gonorrhoeae with High-Level Resistance to Azithromycin, in Indianapolis, Indiana, 2017-2018.
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Holderman JL, Thomas JC, Schlanger K, Black JM, Town K, St Cyr SB, Pham CD, and Kirkcaldy RD
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- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Azithromycin pharmacology, Ceftriaxone, Drug Resistance, Bacterial, Humans, Indiana, Male, Microbial Sensitivity Tests, Gonorrhea drug therapy, Gonorrhea epidemiology, Neisseria gonorrhoeae genetics
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Background: Since 2014, Neisseria gonorrhoeae azithromycin (AZM) susceptibility has declined in the United States, but high-level AZM resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 N. gonorrhoeae isolates with HL-AZMR identified in Indianapolis over 13 months., Methods: N. gonorrhoeae culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) using Etest. AZM minimum inhibitory concentrations ≥256 µg/mL were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses., Results: During 2017-2018, AST was performed in 1016 N. gonorrhoeae isolates collected at the Bell Flower Clinic. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin susceptible. Of the 12 men, 9 were white and reported male sex partners. Nine of the men were able to be retested; all were cured with 250-mg ceftriaxone plus 1-g AZM. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S ribosomal RNA mutations that appear to have emerged from circulating strains., Conclusions: The close genetic relatedness with limited epidemiologic linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multipronged approach to understanding an outbreak of sexually transmitted disease., (Published by Oxford University Press for the Infectious Diseases Society of America 2021.)
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- 2021
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30. Phylogenomic analysis of Neisseria gonorrhoeae transmission to assess sexual mixing and HIV transmission risk in England: a cross-sectional, observational, whole-genome sequencing study.
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Town K, Field N, Harris SR, Sánchez-Busó L, Cole MJ, Pitt R, Fifer H, Mohammed H, and Hughes G
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- Adult, Cross-Sectional Studies, England epidemiology, Female, Gonorrhea microbiology, Heterosexuality statistics & numerical data, Homosexuality, Male statistics & numerical data, Humans, Male, Sexual Partners, Young Adult, Gonorrhea epidemiology, Gonorrhea transmission, HIV Infections epidemiology, HIV Infections transmission, Neisseria gonorrhoeae classification, Neisseria gonorrhoeae genetics, Phylogeny, Whole Genome Sequencing
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Background: Characterising sexual networks with transmission of sexually transmitted infections might allow identification of individuals at increased risk of infection. We aimed to investigate sexual mixing in Neisseria gonorrhoeae transmission networks between women, heterosexual men, and men who report sex with men (MSM), and between people with and without HIV., Methods: In this cross-sectional observational study, we whole-genome sequenced N gonorrhoeae isolates from the archive of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).w Isolates that varied by five single nucleotide polymorphisms or fewer were grouped into clusters that represented sexual networks with N gonorrhoeae transmission. Clusters were described by gender, sexual risk group, and HIV status., Findings: We sequenced 1277 N gonorrhoeae isolates with linked clinical and sociodemographic data that were collected in five clinics in England during 2013-16 (July 1 to Sept 30 in 2013-15; July 1 to Sept 9 in 2016). The isolates grouped into 213 clusters. 30 (14%) clusters contained isolates from heterosexual men and MSM but no women and three (1%) clusters contained isolates from only women and MSM. 146 (69%) clusters comprised solely people with negative or unknown HIV status and seven (3%) comprised only HIV-positive people. 60 (28%) clusters comprised MSM with positive and negative or unknown HIV status., Interpretation: N gonorrhoeae molecular data can provide information indicating risk of HIV or other sexually transmitted infections for some individuals for whom such risk might not be known from clinical history. These findings have implications for sexual health care, including offering testing, prevention advice, and preventive treatment, such as HIV pre-exposure prophylaxis., Funding: National Institute for Health Research Health Protection Research Unit; Wellcome; Public Health England., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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- 2020
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31. Genomic and Phenotypic Variability in Neisseria gonorrhoeae Antimicrobial Susceptibility, England.
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Town K, Harris S, Sánchez-Busó L, Cole MJ, Pitt R, Fifer H, Mohammed H, Field N, and Hughes G
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- Adult, Anti-Bacterial Agents pharmacology, Biological Variation, Population, England epidemiology, Female, Genomics, Gonorrhea drug therapy, Humans, Male, Microbial Sensitivity Tests, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae genetics, Public Health, Sentinel Surveillance, Young Adult, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial genetics, Gonorrhea epidemiology, Neisseria gonorrhoeae isolation & purification
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Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern. Phylogenetic analyses resolve uncertainties regarding genetic relatedness of isolates with identical phenotypes and inform whether AMR is due to new mutations and clonal expansion or separate introductions by importation. We sequenced 1,277 isolates with associated epidemiologic and antimicrobial susceptibility data collected during 2013-2016 to investigate N. gonorrhoeae genomic variability in England. Comparing genetic markers and phenotypes for AMR, we identified 2 N. gonorrhoeae lineages with different antimicrobial susceptibility profiles and 3 clusters with elevated MICs for ceftriaxone, varying mutations in the penA allele, and different epidemiologic characteristics. Our results indicate N. gonorrhoeae with reduced antimicrobial susceptibility emerged independently and multiple times in different sexual networks in England, through new mutation or recombination events and by importation. Monitoring and control for AMR in N. gonorrhoeae should cover the entire population affected, rather than focusing on specific risk groups or locations.
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- 2020
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32. Just Google it! Impact of media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae on online searches, and attendances, testing and diagnoses at sexual health clinics in England between 2015 and 2016: an interrupted time series analysis using surveillance data.
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Smolarchuk C, Mohammed H, Furegato M, Town K, Fifer H, Wilson J, Nardone A, Lee A, and Hughes G
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- Diagnostic Services statistics & numerical data, Disease Outbreaks, England epidemiology, Facilities and Services Utilization, Female, Gonorrhea diagnosis, Gonorrhea microbiology, Humans, Internet statistics & numerical data, Interrupted Time Series Analysis, Male, Mass Media, Neisseria gonorrhoeae isolation & purification, Anti-Bacterial Agents pharmacology, Azithromycin pharmacology, Drug Resistance, Bacterial, Gonorrhea epidemiology, Information Dissemination, Neisseria gonorrhoeae drug effects, Patient Acceptance of Health Care statistics & numerical data
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Objectives: To determine if media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae (HL-AziR) impacted online search interest or was temporally associated with health-seeking behaviours in several English cities., Methods: A descriptive analysis of outbreak-related online media articles and relative search interest (RSI) using Google and an interrupted time series analysis using routine surveillance data from sexual health clinics (SHCs) in England (GUMCAD STI surveillance system). The main outcomes were adjusted incidence rate ratios (IRRs) of weekly attendances, gonorrhoea tests and diagnoses of gonorrhoea or 'any STI' in selected cities after media coverage of the outbreak in 2015 and 2016., Results: RSI for outbreak-related terms peaked during media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The greatest increase in RSI was in Leeds, which coincided with a 63% rise (n=1932; IRR 1.26, 95% CI 1.12 to 1.43) in SHC attendances by women. There was only a 7% (n=1358; IRR 1.01, 95% CI 0.91 to 1.11) increase in attendances by men. Modest increases in outcomes occurred in four other cities with a high RSI. There was no evidence of increases in outcomes in cities, other than Leeds, after subsequent media coverage of the outbreak., Conclusions: National and local media coverage of the HL-AziR outbreak coincided with peak RSI for related terms, and a transient increase in attendances, gonorrhoea tests and diagnoses of gonorrhoea or 'any STI' in some cities with a high RSI. Our analysis demonstrates the potential for media coverage to influence health-seeking behaviours during high-profile STI outbreaks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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33. A novel therapy for an unusual problem: IL-1 receptor antagonist for recurrent post-transplant pericarditis.
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Parizo JT, Moayedi Y, Nieman K, Town K, Teuteberg JJ, and Khush KK
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- Adult, Cardiomyopathies pathology, Humans, Male, Pericarditis etiology, Pericarditis pathology, Prognosis, Antirheumatic Agents therapeutic use, Cardiomyopathies surgery, Heart Transplantation adverse effects, Interleukin 1 Receptor Antagonist Protein therapeutic use, Pericarditis drug therapy, Receptors, Interleukin-1 antagonists & inhibitors
- Abstract
Heart transplant (HTx) recipients are at increased risk of pericardial disease. Idiopathic recurrent pericarditis has not been previously described following HTx. We describe a 35-year-old male who was admitted with pericarditis and moderate pericardial effusion 10 months after HTx. Two weeks before his admission, his prednisone had been tapered off. A thorough infectious workup and endomyocardial biopsy was unrevealing. He was started on colchicine with the addition of tapering prednisone regimen of 40 mg daily due to unresolved pain. Over the next several years, he had three recurrent episodes of pericarditis requiring re-initiation of prednisone with extensive investigations negative for rejection, autoimmune, and infectious causes. Cardiac MRI confirmed pericardial inflammation. Due to his recurrent course and inability to wean off prednisone, anakinra, an IL-1 receptor antagonist, was started at 100 mg sc daily. This allowed successful discontinuation of prednisone. He is now 34 months post-transplant without recurrence on anakinra and colchicine maintenance. Due to the overlap between idiopathic recurrent pericarditis and auto-inflammatory diseases, there is growing evidence for utilizing IL-1 receptor antagonists in this condition. While pericarditis is common in the HTx population, this is the first report of successful use of an IL-1 receptor blocker for pericarditis in this population., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2019
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34. Detection of tet(M) in high-level tetracycline-resistant Neisseria gonorrhoeae.
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Pitt R, Sadouki Z, Town K, Fifer H, Mohammed H, Hughes G, Woodford N, and Cole MJ
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- Female, Gonorrhea drug therapy, Humans, Male, Microbial Sensitivity Tests, Bacterial Proteins genetics, Gonorrhea microbiology, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae genetics, Tetracycline pharmacology, Tetracycline Resistance
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- 2019
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35. Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018.
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Eyre DW, Town K, Street T, Barker L, Sanderson N, Cole MJ, Mohammed H, Pitt R, Gobin M, Irish C, Gardiner D, Sedgwick J, Beck C, Saunders J, Turbitt D, Cook C, Phin N, Nathan B, Horner P, and Fifer H
- Subjects
- Adult, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Azithromycin administration & dosage, Ceftriaxone administration & dosage, Ertapenem administration & dosage, Female, Gonorrhea diagnosis, Humans, Microbial Sensitivity Tests, Neisseria gonorrhoeae isolation & purification, Polymorphism, Single Nucleotide, Treatment Outcome, United Kingdom, Whole Genome Sequencing, Anti-Bacterial Agents pharmacology, Azithromycin therapeutic use, Ceftriaxone therapeutic use, Drug Resistance, Bacterial genetics, Ertapenem therapeutic use, Gonorrhea drug therapy, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae genetics
- Abstract
We describe detection in the United Kingdom (UK) of the drug-resistant Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate azithromycin resistance. Two female patients developed infection following contact with UK-resident men from the same sexual network linked to travel to Ibiza, Spain. One case failed treatment with ceftriaxone, and azithromycin and gentamicin, before successful treatment with ertapenem. Both isolates had indistinguishable whole-genome sequences. Urgent action is essential to contain this drug-resistant strain.
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- 2019
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36. Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae ? A cross-sectional study using national surveillance data in England.
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Clifton S, Town K, Furegato M, Cole M, Mohammed H, Woodhall SC, Kevin Dunbar J, Fifer H, and Hughes G
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- Adult, Anti-Bacterial Agents therapeutic use, Azithromycin therapeutic use, Ceftriaxone therapeutic use, Cross-Sectional Studies, Drug Resistance, Bacterial drug effects, England, Female, Gonorrhea epidemiology, Humans, Male, Microbial Sensitivity Tests, Sentinel Surveillance, Anti-Bacterial Agents pharmacology, Azithromycin pharmacology, Ceftriaxone pharmacology, Gonorrhea drug therapy, Neisseria gonorrhoeae drug effects
- Abstract
Objectives: It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin., Methods: Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013-2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013-2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012-2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin., Results: Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients., Conclusions: We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions., Competing Interests: Competing interests: HF is on the Scientific Advisory Board for Discuva Ltd. The other authors have no competing interests to declare., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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37. Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis.
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Chandra NL, Broad C, Folkard K, Town K, Harding-Esch EM, Woodhall SC, Saunders JM, Sadiq ST, and Dunbar JK
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- Australia epidemiology, Canada epidemiology, Chlamydia Infections diagnosis, Chlamydia Infections drug therapy, Chlamydia Infections microbiology, Chlamydia trachomatis genetics, Europe epidemiology, Female, Heterosexuality, Humans, Mass Screening, Prevalence, Rectal Diseases drug therapy, Rectal Diseases microbiology, Risk Factors, Sexual Partners, Socioeconomic Factors, United States epidemiology, Chlamydia Infections epidemiology, Chlamydia trachomatis isolation & purification, Coitus, Rectal Diseases epidemiology, Rectum microbiology
- Abstract
Objectives: Chlamydia trachomatis is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI)., Design: Systematic review and four meta-analyses conducted using random-effects modelling., Data Sources: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017., Eligibility Criteria: Studies reporting rectal chlamydia positivity in heterosexual women aged ≥15 years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics., Results: Fourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95% CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95% CI 0.75 to 1.10)., Conclusions: High levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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38. Considering the Potential Application of Whole Genome Sequencing to Gonorrhea Prevention and Control.
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Kirkcaldy RD, Town K, Gernert KM, Bowen VB, Torrone EA, Kersh EN, and Bernstein KT
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- Disease Outbreaks, Drug Resistance, Bacterial genetics, Genome, Bacterial, Gonorrhea transmission, Humans, Gonorrhea prevention & control, Neisseria gonorrhoeae genetics, Whole Genome Sequencing
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- 2018
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39. Neisseria gonorrhoeae molecular typing for understanding sexual networks and antimicrobial resistance transmission: A systematic review.
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Town K, Bolt H, Croxford S, Cole M, Harris S, Field N, and Hughes G
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- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial, Female, Gonorrhea prevention & control, Humans, Male, Microbial Sensitivity Tests, Multilocus Sequence Typing, Neisseria gonorrhoeae drug effects, Public Health, Sexual Behavior, Sexual Partners, Whole Genome Sequencing, Bacterial Typing Techniques, Gonorrhea transmission, Neisseria gonorrhoeae classification, Neisseria gonorrhoeae genetics, Sexual Health statistics & numerical data
- Abstract
Objectives: Neisseria gonorrhoeae (NG) is a significant global public health concern due to rising diagnoses rates and antimicrobial resistance. Molecular combined with epidemiological data have been used to understand the distribution and spread of NG, as well as relationships between cases in sexual networks, but the public health value gained from these studies is unclear. We conducted a systematic review to examine how molecular epidemiological studies have informed understanding of sexual networks and NG transmission, and subsequent public health interventions., Methods: Five research databases were systematically searched up to 31st March 2017 for studies that used sequence-based DNA typing methods, including whole genome sequencing, and linked molecular data to patient-level epidemiological data. Data were extracted and summarised to identify common themes., Results: Of the 49 studies included, 82% used NG Multi-antigen Sequence Typing. Gender and sexual orientation were commonly used to characterise sexual networks that were inferred using molecular clusters; clusters predominantly of one patient group often contained a small number of isolates from other patient groups. Suggested public health applications included using these data to target interventions at specific populations, confirm outbreaks, and inform partner management, but these were mainly untested., Conclusions: Combining molecular and epidemiological data has provided insight into sexual mixing patterns, and dissemination of NG, but few studies have applied these findings to design or evaluate public health interventions. Future studies should focus on the application of molecular epidemiology in public health practice to provide evidence for how to prevent and control NG., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2018
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40. Qualitative impact assessment of an educational workshop on primary care practitioner attitudes to NICE HIV testing guidelines.
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Allison RL, Ricketts EJ, Hartney T, Nardone A, Town K, Rugman C, Folkard K, Dunbar JK, and McNulty CA
- Abstract
Background: In 2013, Public Health England piloted the '3Cs (chlamydia, contraception, condoms) and HIV (human immunodeficiency virus)' educational intervention in 460 GP surgeries. The educational HIV workshop aimed to improve the ability and confidence of staff to offer HIV testing in line with national guidelines., Aim: To qualitatively assess the impact of an educational workshop on GP staff's attitudes to NICE HIV testing guidelines., Design & Setting: Qualitative interviews with GP staff across England before and after an educational HIV workshop., Method: Thirty-two GP staff (15 before and 17 after educational HIV workshop) participated in interviews exploring their views and current practice of HIV testing. Interview transcripts were thematically analysed and examined, using the components of the theory of planned behaviour (TPB) and normalisation process theory (NPT) as a framework., Results: GPs reported that the educational HIV workshop resulted in increased knowledge of, and confidence to offer, HIV tests based on indicator conditions. However, overall participants felt they needed additional HIV training around clinical care pathways for offering tests, giving positive HIV results, and current treatments and outcomes. Participants did not see a place for point-of-care testing in general practice., Conclusion: Implementation of national HIV guidelines will require multiple educational sessions, especially to implement testing guidelines for indicator conditions in areas of low HIV prevalence. Additional role-play or discussions around scripts suggesting how to offer an HIV test may improve participants' confidence and facilitate increased testing. Healthcare assistants (HCAs) may need specific training to ensure that they are skilled in offering HIV testing within new patient checks., Competing Interests: CAMMcN: CAMMcN writes the PHE primary care guidance around testing for chlamydia and STIs. The other authors declare that no competing interests exist.
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- 2018
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41. Prevalence of and factors associated with MDR Neisseria gonorrhoeae in England and Wales between 2004 and 2015: analysis of annual cross-sectional surveillance surveys.
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Clifton S, Bolt H, Mohammed H, Town K, Furegato M, Cole M, Campbell O, Fifer H, and Hughes G
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, England epidemiology, Epidemiological Monitoring, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Prevalence, Risk Factors, Wales epidemiology, Young Adult, Drug Resistance, Multiple, Bacterial, Gonorrhea epidemiology, Gonorrhea microbiology, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae isolation & purification
- Abstract
Objectives: To describe trends in prevalence, susceptibility profile and risk factors for MDR Neisseria gonorrhoeae (MDR-NG) in England and Wales., Methods: Isolates from 16 242 gonorrhoea episodes at sexual health clinics within the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) underwent antimicrobial susceptibility testing. MDR-NG was defined as resistance to ceftriaxone, cefixime or azithromycin, plus at least two of penicillin, ciprofloxacin and spectinomycin. Trends in resistance are presented for 2004-15; prevalence and logistic regression analyses for MDR-NG cover the period of the most recent treatment guideline (ceftriaxone plus azithromycin), 2011-15., Results: Between 2004 and 2015, the proportion of N. gonorrhoeae isolates fully susceptible to all antimicrobial classes fell from 80% to 46%, with the proportion resistant to multiple (two or more) classes increasing from 7.3% to 17.5%. In 2011-15, 3.5% of isolates were MDR-NG, most of which were resistant to cefixime (100% in 2011, decreasing to 36.9% in 2015) and/or azithromycin (4.2% in 2011, increasing to 84.3% in 2015). After excluding azithromycin-resistant isolates, modal azithromycin MICs were higher in MDR versus non-MDR isolates (0.5 versus 0.125 mg/L), with similar results for ceftriaxone (modal MICs 0.03 versus ≤0.002 mg/L). After adjustment for confounders, MDR-NG was more common among isolates from heterosexual men, although absolute differences in prevalence were small [4.6% versus 3.3% (MSM) and 2.5% (women)]., Conclusions: N. gonorrhoeae is becoming less susceptible to available antimicrobials. Since 2011, a minority of isolates were MDR-NG; however, MICs of azithromycin or ceftriaxone (first-line therapies) for many of these were elevated. These findings highlight the importance of continued antimicrobial stewardship for gonorrhoea.
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- 2018
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42. Linkage to HIV care following diagnosis in the WHO European Region: A systematic review and meta-analysis, 2006-2017.
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Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S, Skingsley A, and Delpech V
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- Europe, HIV Infections diagnosis, Humans, World Health Organization, HIV Infections therapy, Time-to-Treatment
- Abstract
Background: Timely linkage to care after HIV diagnosis is crucial as delayed access can result in poor patient outcomes. The aim of this systematic review was to synthesise the evidence to achieve a better understanding of what proportion of patients are linked to care and what factors impact linkage., Methods: Systematic searches were run in six databases up to the end of February 2017. The grey literature was also reviewed. Inclusion criteria were: sample size ≥50 people (aged ≥15), from the WHO European Region, published 2006-2017 and in English. Linkage to care was defined as a patient seen for HIV care after diagnosis. Study selection, data extraction and quality assurance were performed by two independent reviewers. Random-effects meta-analysis was carried out to summarise linkage to care within three months of diagnosis., Results: Twenty-four studies were included; 22 presented linkage to care data and seven examined factors for linkage. Linkage among 89,006 people in 19 countries was captured. Meta-analysis, restricted to 12 studies and measuring prompt linkage within three months, gave a pooled estimate of 85% (95% CI: 75%-93%). Prompt linkage was higher in studies including only people in care (94%; 95% CI: 91%-97%) than in those of all new diagnoses (71%; 95% CI: 50%-87%). Heterogeneity was high across and within strata (>99%). Factors associated with delaying or not linking to care included: acquiring HIV through heterosexual contact/injecting drug use, younger age at diagnosis, lower levels of education, feeling well at diagnosis and diagnosis outside an STI clinic., Conclusion: Overall, linkage to care was high, though estimates were lower in studies with a high proportion of people who inject drugs. The high heterogeneity between studies made it challenging to synthesise findings. Studies should adopt a standardised definition with a three month cut-off to measure prompt linkage to care to ensure comparability.
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- 2018
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43. Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing.
- Author
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McNulty C, Ricketts EJ, Fredlund H, Uusküla A, Town K, Rugman C, Tisler-Sala A, Mani A, Dunais B, Folkard K, Allison R, and Touboul P
- Subjects
- Adolescent, Chlamydia Infections prevention & control, Education, Medical, Continuing methods, England, Estonia, Female, France, General Practice economics, Humans, Interviews as Topic, Male, Mass Screening economics, Needs Assessment, Primary Health Care economics, Qualitative Research, Randomized Controlled Trials as Topic, Reproductive Health Services organization & administration, Stakeholder Participation, Sweden, Time Factors, Workload, Young Adult, Attitude of Health Personnel, Chlamydia Infections diagnosis, General Practice education, General Practice organization & administration, Primary Health Care organization & administration, Sexual Health education
- Abstract
Objective: To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England., Design: Qualitative interviews., Setting: European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013., Participants: 45 GP staff, 13 trainers and 18 stakeholders., Interviews: The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis., Results: Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services., Conclusions: A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2017
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44. Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative.
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Jones LF, Ricketts E, Town K, Rugman C, Lecky D, Folkard K, Nardone A, Hartney TN, and McNulty C
- Subjects
- Adolescent, Condoms, Contraception methods, Delivery of Health Care standards, England, Female, Humans, Interviews as Topic, Male, Mass Screening, Program Evaluation, Qualitative Research, Young Adult, Chlamydia Infections diagnosis, Chlamydia Infections prevention & control, General Practice, HIV Infections diagnosis, HIV Infections prevention & control, Patient Preference statistics & numerical data, Reproductive Health Services standards, Reproductive Health Services trends, Sex Education standards
- Abstract
Background: Opportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013-2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines., Aim: To determine young adults' opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice., Design and Setting: Qualitative interviews were conducted in a general practice setting in England between March and June 2013., Method: Thirty interviews were conducted with nine male and 21 female patients aged 16-24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework., Results: Participants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation., Conclusion: General practice staff should facilitate patients' preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way., (© British Journal of General Practice 2017.)
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- 2017
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45. Service evaluation of an educational intervention to improve sexual health services in primary care implemented using a step-wedge design: analysis of chlamydia testing and diagnosis rate changes.
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Town K, McNulty CA, Ricketts EJ, Hartney T, Nardone A, Folkard KA, Charlett A, and Dunbar JK
- Subjects
- Adolescent, Adult, Chlamydia, Chlamydia Infections microbiology, Condoms, Delivery of Health Care, England, Family Practice, Humans, Program Evaluation, Rural Population, Young Adult, Chlamydia Infections diagnosis, General Practice education, Health Services, Inservice Training, Mass Screening, Primary Health Care, Reproductive Health education
- Abstract
Background: Providing sexual health services in primary care is an essential step towards universal provision. However they are not offered consistently. We conducted a national pilot of an educational intervention to improve staff's skills and confidence to increase chlamydia testing rates and provide condoms with contraceptive information plus HIV testing according to national guidelines, known as 3Cs&HIV. The effectiveness of the pilot on chlamydia testing and diagnosis rates in general practice was evaluated., Methods: The pilot was implemented using a step-wedge design over three phases during 2013 and 2014 in England. The intervention combined educational workshops with posters, testing performance feedback and continuous support. Chlamydia testing and diagnosis rates in participating general practices during the control and intervention periods were compared adjusting for seasonal trends in chlamydia testing and differences in practice size. Intervention effect modification was assessed for the following general practice characteristics: chlamydia testing rate compared to national median, number of general practice staff employed, payment for chlamydia screening, practice urban/rurality classification, and proximity to sexual health clinics., Results: The 460 participating practices conducted 26,021 tests in the control period and 18,797 tests during the intervention period. Intention-to-treat analysis showed no change in the unadjusted median tests and diagnoses per month per practice after receiving training: 2.7 vs 2.7; 0.1 vs 0.1. Multivariable negative binomial regression analysis found no significant change in overall testing or diagnoses post-intervention (incidence rate ratio (IRR) 1.01, 95 % confidence interval (CI) 0.96-1.07, P = 0.72; 0.98 CI 0.84-1.15, P = 0.84, respectively). Stratified analysis showed testing increased significantly in practices where payments were in place prior to the intervention (IRR 2.12 CI 1.41-3.18, P < 0.001) and in practices with 6-15 staff (6-10 GPs IRR 1.35 (1.07-1.71), P = 0.012; 11-15 GPs IRR 1.37 (1.09-1.73), P = 0.007)., Conclusion: This national pilot of short educational training sessions found no overall effect on chlamydia testing in primary care. However, in certain sub-groups chlamydia testing rates increased due to the intervention. This demonstrates the importance of piloting and evaluating any service improvement intervention to assess the impact before widespread implementation, and the need for detailed understanding of local services in order to select effective interventions.
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- 2016
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46. A survey of the use of text messaging for communication with partners in the process of provider-led partner notification.
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Gilbart VL, Town K, and Lowndes CM
- Subjects
- Female, Humans, Male, Surveys and Questionnaires, United Kingdom, Contact Tracing methods, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases transmission, Text Messaging statistics & numerical data
- Abstract
Objectives: Partner notification (PN) is important for sexually transmitted infection (STI) control. With developments in technology, such as text messaging, contacting partners is now easier. This study investigates the frequency and acceptability of text messaging in UK sexual health clinics for STI provider-led PN., Methods: A questionnaire was distributed to health advisers (HAs), cascaded by the Society of Sexual Health Advisers and posted on their website., Results: 65 questionnaires were returned. Most HAs use telephone for the first and second provider-led PN attempt (61, 94% and 51, 78%, respectively) with text messaging as preferred second choice (19, 29% and 32, 49%, respectively). Overall, 56 clinics (86%) used text messaging at some stage, even if not the preferred option. 29 (52%) clinics had text messaging guidelines and 31 (55%) used messaging templates. Messages varied; 33 (59%) request partner make contact, 11 (20%) mention risk of infection, 9 (16%) name the infection and 20 (36%) use a combination of messages. Six (10%) had contact with their Caldicott Guardian about text messaging. No confidentiality concerns were reported and no complaints were reported from partners about receiving unsolicited text messages., Conclusions: Text messaging is widely used and is an important and acceptable tool for STI provider-led PN. It is the second preferred method for contacting partners after telephone for first and second provider-led PN attempts. A small number of clinics never use it. Message content varied; few named the infection. Concerns about confidentiality or negative impact for the partner were not reported. National guidance for the use of text messaging for provider-led PN is needed., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2015
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47. Can previous first-line therapies for Neisseria gonorrhoeae be targeted to specific patient subgroups to treat gonorrhea?
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Town K, Lowndes CM, Hughes G, Obi C, Chisholm S, and Ison CA
- Subjects
- Adolescent, Adult, Cefixime pharmacology, Ciprofloxacin pharmacology, England epidemiology, Epidemiological Monitoring, Feasibility Studies, Female, Gonorrhea epidemiology, Heterosexuality, Humans, Male, Penicillins pharmacology, Prevalence, Sexual Behavior, Wales epidemiology, Young Adult, Anti-Bacterial Agents pharmacology, Drug Resistance, Bacterial drug effects, Gonorrhea drug therapy, Neisseria gonorrhoeae drug effects
- Abstract
Background: Gonorrhea treatment is challenging because of the emergence of resistance, treatment failure with existing drugs, and the lack of alternative agents. This study investigates the feasibility of targeting previously recommended antimicrobials to specific population subgroups where the prevalence of infection susceptible to these antimicrobials is above the World Health Organization cautionary treatment threshold of 95%., Methods: Descriptive data from the Gonococcal Resistance to Antimicrobials Surveillance Programme for England and Wales were analyzed to investigate patient characteristics associated with infection with susceptible isolates using univariate and multivariable analyses., Results: Of 6173 isolates from 2007 to 2011, 4684 (82%) were susceptible to penicillin, 3899 (68%) to ciprofloxacin, and 5240 (91%) to cefixime. All subgroups of the MSM population had fewer than 95% of isolates susceptible to penicillin, ciprofloxacin, or cefixime. Higher proportions of isolates from heterosexual patient subgroups were susceptible to these antimicrobials. Multivariable models identified the following associations between patient characteristics and infection with susceptible isolates: patients aged 13 to 24 years (penicillin: 92.3% susceptible adjusted odds ratio and associated 95% confidence interval [aOR CI] 1.84-2.97; ciprofloxacin: 88.3%, aOR CI 2.22-3.39; cefixime: 98.7%, aOR CI 1.29-3.52) patients of black ethnicity (penicillin: 93.9%, aOR CI 2.72-4.91; ciprofloxacin: 92.0%, aOR CI 3.94-6.7; cefixime: 99.1%, aOR CI 1.78-6.4), and patients with concurrent chlamydia (penicillin: 93.9%, aOR CI 1.8-3.22; ciprofloxacin: 91.7%, aOR CI 2.71-4.58; cefixime: 99.0%, aOR CI 1.27-4.54)., Conclusions: This study demonstrated that of the previous first-line therapies, cefixime would be the only antimicrobial suitable for use for infection in heterosexual patients alone.
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- 2015
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48. Risk factors for antimicrobial-resistant Neisseria gonorrhoeae in Europe.
- Author
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Cole MJ, Spiteri G, Town K, Unemo M, Hoffmann S, Chisholm SA, Amato-Gauci AJ, van de Laar M, and Ison CA
- Subjects
- Adult, Anti-Infective Agents pharmacology, Azithromycin pharmacology, Cefixime pharmacology, Ceftriaxone pharmacology, Europe epidemiology, Female, Gonorrhea drug therapy, Gonorrhea epidemiology, Humans, Male, Microbial Sensitivity Tests, Risk Factors, Sentinel Surveillance, Anti-Infective Agents administration & dosage, Drug Resistance, Microbial, Gonorrhea prevention & control, Neisseria gonorrhoeae drug effects
- Abstract
Background: The European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resistant gonococci in Europe., Methods: From 2009 to 2011, gonococcal isolates from 21 countries were submitted to the European Gonococcal Antimicrobial Surveillance Programme for antimicrobial susceptibility testing. Patient variables associated with resistance to azithromycin, cefixime, and ciprofloxacin were identified using univariate and multivariable logistic regression analyses of odds ratios. Geometric means for ceftriaxone and cefixime minimum inhibitory concentrations (MICs) were compared for patients of different sexual orientation and sex., Results: A total of 5034 gonococcal isolates were tested from 2009 to 2011. Isolates exhibiting resistance to cefixime (MIC > 0.125 mg/L) and ciprofloxacin (MIC > 0.5 mg/L) were significantly associated with infection in heterosexuals (males only for ciprofloxacin), older patients (>25 years of age), or those without a concurrent chlamydial infection in the multivariable analysis. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for men who have sex with men, and isolates from male heterosexuals exhibited the highest MICs in 2011., Conclusions: The linking of epidemiological and behavioral data to the susceptibility profiles of the gonococcal isolates has allowed those at higher risk for acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified. Improved data numbers and representativeness are required before evidence-based risk groups can be identified, and subsequent focused treatments or public health intervention strategies can be initiated with confidence.
- Published
- 2014
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49. Screening for gonorrhoea using samples collected through the English national chlamydia screening programme and risk of false positives: a national survey of local authorities.
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Field N, Kennedy I, Folkard K, Duffell S, Town K, Ison CA, and Hughes G
- Subjects
- Adolescent, Chlamydia Infections epidemiology, Data Collection, England epidemiology, False Positive Reactions, Female, Gonorrhea epidemiology, Humans, Male, Mass Screening, Prevalence, Sensitivity and Specificity, Young Adult, Chlamydia Infections diagnosis, Gonorrhea diagnosis, Nucleic Acid Amplification Techniques, Specimen Handling
- Abstract
Objectives: To investigate use of dual tests for Chlamydia trachomatis and Neisseria gonorrhoeae on samples collected through the National Chlamydia Screening Programme (NCSP) in England., Design and Setting: During May-July 2013, we delivered an online survey to commissioners of sexual health services in the 152 upper-tier English Local Authorities (LAs) who were responsible for commissioning chlamydia screening in people aged 15-24 years., Main Outcome Measures: (1) The proportion of English LAs using dual tests on samples collected by the NCSP; (2) The estimated number of gonorrhoea tests and false positives from samples collected by the NCSP, calculated using national surveillance data on the number of chlamydia tests performed, assuming the gonorrhoea prevalence to range between 0.1% and 1%, and test sensitivity and specificity of 99.5%., Results: 64% (98/152) of LAs responded to this national survey; over half (53% (52/98)) reported currently using dual tests in community settings. There was no significant difference between LAs using and not using dual tests by chlamydia positivity, chlamydia diagnosis rate or population screening coverage. Although positive gonorrhoea results were confirmed with supplementary tests in 93% (38/41) of LAs, this occurred after patients were notified about the initial positive result in 63% (26/41). Approximately 450-4500 confirmed gonorrhoea diagnoses and 2300 false-positive screens might occur through use of dual tests on NCSP samples each year. Under reasonable assumptions, the positive predictive value of the screening test is 17-67%., Conclusions: Over half of English LAs already commission dual tests for samples collected by the NCSP. Gonorrhoea screening has been introduced alongside chlamydia screening in many low prevalence settings without a national evidence review or change of policy. We question the public health benefit here, and suggest that robust testing algorithms and clinical management pathways, together with rigorous evaluation, be implemented wherever dual tests are deployed., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
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50. Decreased susceptibility to cephalosporins among gonococci? Authors' reply.
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Ison CA, Town K, Obi C, Chisholm S, Hughes G, Livermore DM, and Lowndes CM
- Subjects
- Female, Humans, Male, Cefixime pharmacology, Ceftriaxone pharmacology, Drug Resistance, Multiple, Bacterial, Gonorrhea epidemiology, Neisseria gonorrhoeae drug effects
- Published
- 2014
- Full Text
- View/download PDF
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