STI control. Dr. Jane Morgan Hamilton Sexual Health Clinic

Transcription

1 STI control Dr. Jane Morgan Hamilton Sexual Health Clinic

2 Overview STI control in theory NZ s reality Where to from here?

3 STI control framework R0=ßcD R0 = reproductive rate; the rate at which infection spreads in a susceptible population ß = Probability of transmission c = Number of sexual contacts D = Duration of infectiousness if R0 > 1, the infection spreads; if R0 < 1, it dies out Anderson, RM and May RM; Nature 1988;333:

4 R=Bcd Intervention Probability of transmission Condoms and barrier methods vs Hormonal contraceptives HPV & Hep B: vaccination

5 R=Bcd Intervention Number of sexual contacts Later sexual debut Abstinence Serial monogamy Fewer partners (Partner choice)

6 R=Bcd Intervention Duration of infectiousness Case-finding and screening Treatment guidelines Presumptive treatment Partner notification

7 Dreams vs Reality. Quality sexuality education ERO report 2006 Condoms as the norm Vaccine uptake Access to health-care

8 Chlamydia infections: international context Six country comparison Australia Denmark Netherlands New Zealand Sweden Switzerland Each country asked to supply same data: Testing vols, chlamydia cases, hospital admissions for related complications (PID, ectopic pregnancy, infertility)

9 Cross-national comparison of chlamydia tests and test positivity, New Zealand Denmark Sweden Bender N et al. STI, epub Oct

10 Cross-national comparison of chlamydia case reports, Countries Australia Denmark New Zealand The Netherlands Sweden Switzerland Bender N et al. STI, epub Oct

11 Cross-national comparison of cases and related complications, Bender N et al. STI, epub Oct

12 Where To From Here? World champions of PID admissions Reduce STIs, reduce re-infection ~ 10% of those infected with CT develop PID 1 in 5 reinfected < 6 mths More focus on 1st infection Empower to avoid re-infection Partner management Sexual networks Re-test at 3-6 months

13 Role of Health Care in STI Control: adapted Piot Fransen model

14 Improving STI case management Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Treatment completed Promotion of health care seeking behaviour Improve quality of care Attitudes of personnel Cure

15 APTIMA Combo 2 FEMALE Sample Sensitivity C. Trachomatis N. Gonorrhoeae Endocervical swab 88-94% 96-99% First void (not MSU) urine 95% 91% Patient collected vulvo-vaginal swab 97% 99%

16 Changing Paradigm For Urogenital Specimen Collection Pre-NAATs: specimen quality critical Endocervical and urethral swabs NAATs: more forgiving specimen collection Vulvo-vaginal swab = endocervical swab Endocervical/vag swab > female 1st void urine 1st void urine for men, self-swab for women No antimicrobial susceptibility testing

17 Improving STI case management Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Treatment completed Syndromic approach Include STI drugs in essential list Prescribe single dose Advice about compliance Cure

18 Improving partner notification

19 Improving STI case management Population with STI Aware and worried asymptomatic STI Seeking care Correct diagnosis Correct treatment Treatment completed Partner notification Case finding Screening Selective mass treatment?? Cure

20 Potential Metrics for CQI 1. Testing coverage among target groups 2. Effective treatment of those who test positive 3. Secondary prevention Patient education, provide condoms Effective partner notification & management Re-test in 3-6 months Prevent re-infection: 1 in 5 re-infected < 6 months

21 Improving STI case management Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Treatment completed Promotion of health care seeking behaviour Improve quality of care Attitudes of personnel Cure

22 Insanity is doing the same thing over and over again and expecting a different result Albert Einstein