HIVQUAL-T: monitoring and improving HIV clinical care in Thailand, 2002-08.

Objective: We report experience of HIVQUAL-T implementation in Thailand.

Design: Program evaluation.

Setting: Twelve government hospital clinics.

Prevalence of hepatitis B, tetanus, hepatitis A, human immunodeficiency virus and feasibility of vaccine delivery among injecting drug users in Bangkok, Thailand, 2003-2005.

Objectives: To estimate the prevalence of hepatitis B virus (HBV), tetanus, hepatitis A virus (HAV) and human immunodeficiency virus (HIV) in injecting drug users (IDUs), risk factors associated with infection and the feasibility of HBV vaccine delivery in HBV seronegatives.

Methods: Cross-sectional seroprevalence survey of 1535 IDUs recruited from 17 Bangkok Metropolitan Administration (BMA) methadone clinics and HBV vaccination of seronegatives.

Results: Prevalence of antibody to HBV, tetanus, HAV and HIV was 87.

Respondent-driven sampling to assess characteristics and estimate the number of injection drug users in Bangkok, Thailand.

Background: Since early in Thailand's HIV epidemic, HIV seroprevalence among injection drug users (IDUs) in Bangkok has been around 40%. As Thailand moves to strengthen HIV prevention and care programs for Bangkok IDUs, information on current patterns of drug use and an estimate of the size and composition of the IDU population are essential.

Methods: We used respondent-driven sampling (RDS) to recruit Bangkok IDUs who reported injecting in the past 6 months.

HIV/AIDS care and treatment in three provinces in northern Thailand before the national scale-up of highly-active antiretroviral therapy.

In 2003, Thailand launched a program to place 50,000 persons on highly active antiretroviral therapy (HAART) by the end of 2004, following a series of efforts since the early 1990s to develop comprehensive HIV/AIDS care services. To evaluate existing services and needs in advance of the national HAART scale-up, in 2002 we surveyed 31 hospitals and 389 community health centers in three northern Thai provinces, and interviewed 1,015 HIV-infected patients attending outpatient clinics. All hospitals offered voluntary HIV counseling and testing, 84% provided primary prophylaxis for Pneumocystis carinii pneumonia, 58% for tuberculosis, 39% for cryptococcal meningitis, and 87% had some experience providing antiretroviral therapy.

Screening HIV-infected women for cervical cancer in Thailand: findings from a demonstration project.

Objectives: Although cervical cancer is an AIDS-defining illness, few HIV-infected women are routinely screened for cervical cancer in Thailand. We screened HIV-infected women for cervical cancer as a component of HIV care and assessed high-risk human papillomavirus (HPV) and cervical cancer prevalence.

Methods: From July 2003 through February 2004, HIV-infected women attending either an infectious disease clinic or a sexually transmitted infection (STI) clinic in Bangkok were tested for high-risk HPV types by Hybrid Capture 2 and screened for cervical cancer by Pap test; those with abnormal cervical cytology were referred for diagnosis and treatment.

Sexually transmitted infection services as a component of HIV care: findings of a demonstration project among HIV-infected women in Thailand.

Objectives: As Thailand scales up its antiretroviral treatment program, the role of sexually transmitted infection (STI) services to prevent HIV transmission has not been addressed. We provided STI services for HIV-infected women as a component of HIV care and assessed STI prevalence and risk behaviors.

Methods: HIV-infected women attending an infectious disease clinic and an STI clinic in Bangkok were screened for the presence of genital ulcers by visual inspection, for gonorrhea and chlamydial infection by polymerase chain reaction, for trichomoniasis by wet mount, and for syphilis by serology.

Evaluation of a new single-parameter volumetric flow cytometer (CyFlow(green)) for enumeration of absolute CD4+ T lymphocytes in human immunodeficiency virus type 1-infected Thai patients.

Use of the standard dual-platform flow cytometric method for determination of CD4(+) T-lymphocyte counts, which needs both a flow cytometer (FCM) and hematological analyzer, would inevitably lead to increased variability. The development of new single-platform (SP) FCMs that provide direct CD4(+) T-lymphocyte counts for improved assay precision and accuracy have recently attracted attention. This study evaluated one of those systems, CyFlow(green) (Partec), a single-parameter SP volumetric FCM.

A survey of sexually transmitted diseases/HIV coinfection testing and reporting practices among health care providers in New Jersey.

Objectives: A survey was conducted to ascertain the adherence of health care providers (HCPs) to national guidelines recommending human immunodeficiency virus (HIV) testing among persons with sexually transmitted diseases (STDs) and STD testing among HIV-infected persons.

Study: A random sample of HCPs reporting STD and HIV cases in New Jersey were surveyed regarding their STD/HIV testing and reporting practices.

Results: Questionnaires were returned by 90 of 162 (55.

Fluoroquinolone resistance among Neisseria gonorrhoeae isolates in Hawaii, 1990-2000: role of foreign importation and increasing endemic spread.

Objectives: In 1999, an increase in ciprofloxacin-resistant Neisseria gonorrhoeae isolates was identified in Hawaii, prompting initiation of investigative studies.

Goals: The goal of this study was epidemiologic evaluation of this increase.

Study: The authors conducted a review of laboratory data; case-series and case-control studies based on medical record review; and a prospective case-control study based on patient interviews.

Indirect estimation of Chlamydia screening coverage using public health surveillance data.

Although routine screening of all sexually active adolescent females for Chlamydia trachomatis infection is recommended at least annually in the United States, no national or state-specific population-based estimates of chlamydia screening coverage are known to exist. Conclusions regarding screening coverage have often been based on surveys of health care provider or facility screening practices, but such surveys do not consider persons who do not seek care at these facilities or who seek care at more than one facility. The authors developed a method to estimate the proportion of sexually active females aged 15-19 years screened for chlamydia in 45 states and the District of Columbia by using national data on chlamydia positivity, estimates of sexual activity from the National Survey of Family Growth, and chlamydial infections reported to the Centers for Disease Control and Prevention.

The emergence of Neisseria gonorrhoeae with decreased susceptibility to Azithromycin in Kansas City, Missouri, 1999 to 2000.

Background And Objectives: We describe the first cluster of persons with Neisseria gonorrhoeae with decreased susceptibility to azithromycin (AziDS; minimum inhibitory concentration >/=1.0 microg/mL) in the United States. GOAL The goal of this study was to identify risk factors for AziDS N.

National survey of sexual behavior and sexual behavior policies in facilities for individuals with mental retardation/developmental disabilities.

To obtain information regarding sexual behavior and related policies in state residential facilities for individuals with mental retardation/developmental disabilities, we sent surveys to 168 members listed in the Association of Public Developmental Disabilities Administrators 1998-1999 directory. Response rate was 68.5%.

Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000.

Background: No recent national data address the prevalence of gonorrhea.

Goal: The goal was to describe gonorrhea prevalence and chlamydial coinfection among women aged 15 to 24 years.

Study Design: Data were analyzed from tests for chlamydia and gonorrhea at family planning, STD, and prenatal clinics in 2000.

Findings from STD screening of adolescents and adults entering corrections facilities: implications for STD control strategies.

Background: Persons entering corrections facilities are at high risk for sexually transmitted diseases (STDs) because of risky sexual behavior and lack of access to routine screening.

Goal: The goal of the study was to develop a national picture of STD prevalence in this population.

Study Design: We analyzed information on age, race/ethnicity, urethral symptoms (men only), and test results for approximately 85,000 chlamydia, 157,000 gonorrhea, and 293,000 syphilis tests for persons entering 23 jails and 12 juvenile detention centers in 13 US counties from 1996 through 1999.

Prevalence monitoring in syphilis surveillance: results from a multicenter research program.

Background: Syphilis seroprevalence data can be used as an independent measure of syphilis trends and to augment syphilis case report data for program planning. The prevalence of reactive syphilis serology in jails, delivery rooms, and drug treatment centers was examined from 1995 to 1999. Prevalence was evaluated by age and gender at each site and compared with county primary and secondary syphilis case rates.

U.S. Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases: an opportunity to unify clinical and public health practice.

Sexually transmitted diseases (STDs) constitute an epidemic of tremendous magnitude, with an estimated 15 million persons in the United States acquiring a new STD each year. Effective clinical management of STDs is a strategic common element in efforts to prevent HIV infection and to improve reproductive and sexual health. Sexually transmitted diseases may result in severe, long-term, costly complications, including facilitation of HIV infection, tubal infertility, adverse outcomes of pregnancy, and cervical and other types of anogenital cancer.

Mortality associated with congenital syphilis in the United States, 1992-1998.

Objective: To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality.

Methods: We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992-1998.

Results: From 1992-1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.

Screening women in jails for chlamydial and gonococcal infection using urine tests: feasibility, acceptability, prevalence, and treatment rates.

Background: Women entering jails are at high risk for sexually transmitted diseases; however, screening for chlamydial and gonococcal infection is not routinely performed in most jails. New urine tests have made it easier to screen for these infections in nonclinical settings.

Goal: The feasibility and acceptability of urine-based screening for women entering jails and the prevalence of and treatment rates for chlamydial and gonococcal infections were determined.

A pseudo-outbreak of Chlamydia trachomatis in a state residential facility: implications for diagnostic testing.

In December 1998, an outbreak of Chlamydia trachomatis genital infections was reported among 18 residents of a state residential facility housing 392 mentally retarded clients. The initial patient tested positive by ligase chain reaction (LCR); 17 others tested positive by culture. Serologic test results for C.

Waterborne Disease Outbreaks, 1986-1988.

From 1986 to 1988, 24 states and Puerto Rico reported 50 outbreaks of illness due to water that people intended to drink, affecting 25,846 persons. The protozoal parasite Giardia lamblia was the agent most commonly implicated in outbreaks, as it has been for the last 10 years; many of these outbreaks were associated with ingestion of chlorinated but unfiltered surface water. Shigella sonnei was the most commonly implicated bacterial pathogen; in outbreaks caused by this pathogen, water supplies were found to be contaminated with human waste.