Caroline van Gemert

An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011

BACKGROUND Injecting drug use (IDU) is a growing concern in Tanzania compounded by reports of high-risk injecting and sexual risk behaviours among people who inject drugs (PWID). These behaviours have implications for transmission of blood-borne viruses, including HIV and hepatitis C (HCV). METHODS We recruited 267 PWID (87% male) from Temeke District, Dar-es-Salaam through snowball and targeted sampling. A behavioural survey was administered alongside repeated rapid HIV and HCV antibody testing. HIV and HCV prevalence estimates with 95% confidence intervals (CIs) were calculated. RESULTS Among PWID, 34.8% (95%CI 29.1-40.9) tested HIV positive (29.9% of males and 66.7% of females); 27.7% (95%CI 22.0-34.0) tested HCV antibody positive. Almost all (97%) participants were aware of HIV and 34% of HCV. 45% of male and 64% of female PWID reported a previous HIV test; only five (2%) PWID reported a previous HCV test. Of HIV and HCV positive tests, 73% and 99%, respectively, represented newly diagnosed infections. CONCLUSION High prevalence of HIV and HCV were detected in this population of PWID. Rapid scale-up of targeted primary prevention and testing and treatment services for PWID in Tanzania is needed to prevent further transmission and consequent morbidities.

Assessing the cultural competence of oral health research conducted with migrant children

OBJECTIVES Traditional assessment of research quality addresses aspects of scientific rigor, however, ensuring barriers to participation by people of different cultural backgrounds are addressed requires cultural competence. The aim of this research was to assess the cultural competence of oral health research conducted with migrant children. METHODS A protocol was developed with explicit inclusion and exclusion criteria. Electronic databases were searched from 1995 to 2009. Each study was assessed for cultural competence using the assessment criteria and a template developed as a proof-of-concept approach. RESULTS Of the 2059 articles identified, 58 met inclusion criteria (n = 48 studies). There were four (8.3%) cohort studies, five (10.4%) intervention studies, 37 (77.1%) quantitative cross-sectional studies, and two (4.2%) were qualitative studies. Overall, migrant children had worse oral health outcomes in all studies compared with their host-country counterparts. All studies rated poorly in the cultural competence assessment. CONCLUSIONS Appropriate inclusion of all potentially vulnerable groups in research will result in better estimates and understandings of oral health, and more reliable recommendations for prevention and management.

Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010

BackgroundChlamydial infection is the most common notifiable disease in Australia, Europe and the US. Australian notifications of chlamydia rose four-fold from 20,274 cases in 2002 to 80,846 cases in 2011; the majority of cases were among young people aged less than 29 years. Along with test positivity rates, an understanding of the number of tests performed and the demographics of individuals being tested are key epidemiological indicators. The ACCESS Laboratory Network was established in 2008 to address this issue.MethodsThe ACCESS Laboratory Network collected chlamydia testing data from 15 laboratories around Australia over a three-year period using data extraction software. All chlamydia testing data from participating laboratories were extracted from the laboratory information system; patient identifiers converted to a unique, non-reversible code and de-identified data sent to a single database. Analysis of data by anatomical site included all specimens, but in age and sex specific analysis, only one testing episode was counted.ResultsFrom 2008 to 2010 a total of 628,295 chlamydia tests were referred to the 15 laboratories. Of the 592,626 individual episodes presenting for testing, 70% were from female and 30% from male patients. In female patients, chlamydia positivity rate was 6.4% overall; the highest rate in 14 year olds (14.3%). In male patients, the chlamydia positivity rate was 9.4% overall; the highest in 19 year olds (16.5%). The most common sample type was urine (57%). In 3.2% of testing episodes, multiple anatomical sites were sampled. Urethral swabs gave the highest positivity rate for all anatomical sites in both female (7.7%) and male patients (14%), followed by urine (7.6% and 9.4%, respectively) and eye (6.3% and 7.9%, respectively).ConclusionsThe ACCESS Laboratory Network data are unique in both number and scope and are representative of chlamydia testing in both general practice and high-risk clinics. The findings from these data highlight much lower levels of testing in young people aged 20 years or less; in particular female patients aged less than 16 years, despite being the group with the highest positivity rate. Strategies are needed to increase the uptake of testing in this high-risk group.

Reflections on cultural diversity in oral health promotion and prevention

Dental caries is an extremely debilitating disease with lifelong consequences. In most developed countries significant oral health inequalities exist in disadvantaged communities, including refugee and migrant populations. Addressing these inequalities is becoming increasingly challenging as communities become more culturally diverse. An awareness of traditional oral health practices would enable the dental and broader health professions, to understand these differences and consequently better meet the needs of disadvantaged communities. The use of miswak is a common traditional oral hygiene practice used by a number of culturally diverse groups. Further research is required into the use and effectiveness of traditional oral health practices within developed countries. Such practices need to be understood, respected and incorporated within oral health care, policies and practices in order to reduce significant inequalities experienced in our communities. This commentary describes the current literature on miswak, its effectiveness and the implications for promoting oral health.

Intrahousehold Transmission of Pandemic (H1N1) 2009 Virus, Victoria, Australia

TOC Summary: Antiviral prophylaxis for quarantined contacts reduces secondary transmission.

Characteristics of a Sexual Network of Behaviorally Bisexual Men in Vientiane, Lao PDR, 2010

Men who have sex with both men and women (behaviorally bisexual men) may be at increased risk of HIV acquisition and transmission due to risky sexual behaviors. We recruited a sexual network comprised of behaviorally bisexual men and their sexual partners in Vientiane, Lao PDR in 2010 to inform our understanding of the potential for HIV transmission among heterosexual, homosexual, and bisexual networks. Participants completed a sexual behavior questionnaire and referred < 5 sexual partners. A total of 298 people were recruited, including 63 behaviorally bisexual men. Behaviorally bisexual men reported riskier sexual behaviors (number of sexual partners in the previous 12 months and consistent condom use) than behaviorally homosexual and heterosexual men. Using social network diagrammatic representation, heterosexual, homosexual, and bisexual networks are shown to be interlinked. This study demonstrates that behaviorally bisexual men are potential key drivers of HIV epidemics and require a targeted approach to sexual health promotion.

Identifying Risk: A Comparison of Risk Between Heterosexual-Identifying Bisexual Men and Other Bisexual Men in Vientiane, Laos

Men who have sex with men are a priority population for HIV control in Laos, but encompass men diverse in sexual orientation, gender identification, and behavior. Behaviorally bisexual men and their sexual partners were recruited in Vientiane, Laos, in 2010 using modified snowball sampling. Heterosexual-identifying bisexual men identified as exclusively/predominantly heterosexual and other bisexual men identified as bisexual or predominantly/exclusively homosexual. Sixty (68%) heterosexual-identifying and 38 (32%) other bisexual men were recruited; the median number of sex partners in the past year was eight and seven, respectively. Consistent condom use was low with regular (7%) and casual (35%) partners and did not differ by identity. More heterosexual-identifying (53%) than other bisexual (29%) men reported weekly alcohol consumption. Twelve (20%) heterosexual-identifying and 15 (54%) other bisexual men correctly answered all HIV-knowledge questions. High-risk behaviors for STI and HIV transmission were common. Targeted HIV prevention initiatives are needed, particularly to reach heterosexual-identifying bisexual men.

An overview of hepatitis B prevalence, prevention, and management in the Pacific Islands and Territories

There are over 500–750 000 deaths per year because of hepatitis B virus (HBV)‐related cirrhosis and liver cancer worldwide and the World Health Organization Western Pacific Region has some of the highest endemic levels of HBV in the world, particularly within China, South East Asia and Pacific Island Countries and Territories (PICT). The PICT have unique ethnic diversity and a very high prevalence of smoking and metabolic syndrome, both important risk factors for liver fibrosis and liver cancer. However, in contrast to many Asian countries, there is little published data on HBV prevalence and related liver disease burden in PICT. In this review, the available published literature and World Health Organization data for HBV prevalence and related liver disease and liver cancer burden in PICT is outlined, and unmet needs for improving HBV prevention and control in the region are highlighted.

It goes both ways: a cross-sectional study of buying and selling sex among young behaviourally bisexual men in Vientiane, Laos

UNLABELLED Background Transactional sex may increase risk of HIV and sexually transmissible infections (STIs). In Laos, men who have sex with men are disproportionately affected by HIV, and bisexual behaviour among men is relatively common. The occurrence of transactional sex among behaviourally bisexual men in Vientiane, Laos was explored. METHODS In 2010, behaviourally bisexual men were recruited through enhanced snowball sampling to complete a behavioural survey. Reports of transactional sex partners (anal/vaginal sex) in the previous year, by direction of payment and partner gender, is described. RESULTS Of 88 participating behaviourally bisexual men (median age 22 years), 17 (19%) reported only selling sex, eight (9%) reported only paying for sex and nine (10%) reported both selling and paying for sex. Men reporting any transactional sex reported a median of four transactional sex partners and reported a higher number of total sex partners in the previous 12 months (median: 18.5 partners) than men reporting no transactional sex partners (median: 6 partners). Of 26 men who reported selling sex, 15 (58%) were paid by females, 15 (58%) were paid by males and 14 (55%) were paid by transgender sex partner(s); 11 (42%) reported consistent condom use (CCU) when selling sex. Of 17 men who reported paying for sex, 13 (76%) paid females, six (35%) paid males and two (12%) paid transgender partner(s); eight (47%) reported CCU when paying for sex. CONCLUSIONS Young behaviourally bisexual men engaging in transactional sex may be at increased risk of HIV and STIs. Prevention interventions should consider the transient and informal nature of transactional sex in this population.

Reattendance and chlamydia retesting rates at 12 months among young people attending Australian general practice clinics 2007-10: a longitudinal study.

UNLABELLED Background Clinical guidelines commonly recommend annual chlamydia (Chlamydia trachomatis) testing in young people. General practice (GP) clinics can play an important role in annual testing, as a high proportion of young people attend these clinics annually; however, little is known about the timing of attendance and testing in this setting. METHODS The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses system extracted consultation and pathology data on 16-29-year-olds attending 25 GP clinics in 2007-10. We calculated the proportion of individuals with an initial negative test that reattended at 12 months (±3 months) and retested at 12 months (±3 months). Individuals with an initial positive test were excluded, as guidelines recommend retesting at 3 months. RESULTS Among 3852 individuals who had an initial negative test, 2201 (57.1%) reattended at ~12 months; reattendance was higher among females (60.8%) than males (44.1%; P<0.001) and higher among 16-19-year-olds (64.2%) than 25-29-year-olds (50.8%; P<0.001). Of 2201 individuals who reattended at 12 months, 377 had a chlamydia test (retesting rate of 9.8%); retesting was higher among females (10.8%) than males (6.1%; P<0.01) and higher among 16-19-year-olds (13.3%) than 25-29-year-olds (7.5%; P<0.001). CONCLUSION Although over half of young people reattended their GP clinic ~1 year after a negative chlamydia baseline test, only 9.8% were retested at this visit. Strategies are needed to promote regular attendance and testing to both patients and clinicians.