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      Cumplimiento del estudio de contactos de personas diagnosticadas de VIH/ITS en las comarcas de Lleida Translated title: Compliance with the partner notification of HIV/STI patients in the counties of Lleida

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          Abstract

          RESUMEN Fundamentos: El estudio de contactos constituye una de las principales actividades de vigilancia epidemiológica en salud pública. El objetivo principal de este estudio fue estimar el grado de su cumplimiento por parte de los profesionales que informaron sobre las infecciones de transmisión sexual (VIH/gonococia/sífilis/clamidia) en el año 2017 en las comarcas de Lleida. Métodos: Se realizó un estudio descriptivo de prevalencia sobre el cumplimiento del estudio de contactos. Se recogió la información de las encuestas epidemiológicas de las enfermedades citadas y se recuperó información de la realización del estudio de contactos mediante las historias clínicas y el contacto con los profesionales. Se estudiaron los factores asociados a la falta de estudio de contactos mediante un modelo multivariado de regresión logística y el cálculo de la odds ratio ajustada (ORa), con sus intervalos de confianza (IC) del 95%. Resultados: Se estudiaron 203 casos de ITS, con una edad media de 30,6 años (±11,1). El 32,5% eran mujeres. El porcentaje de casos diagnosticados sin estudio de contactos fue del 46,3%, causado principalmente por la falta de colaboración del paciente (23,4%). Las variables asociadas a la falta de estudio de contactos fueron el sexo masculino (ORa=3,5; IC95%=1,6-7,5), la infección gonocócica (ORa=4,9; IC95%=1,2-19,8), la infección por clamidia (ORa=3,9; IC95%=0,9-16,1) y la orientación sexual homosexual/bisexual (ORa=2,2; IC 95%=0,9-5,4). Conclusiones: El cumplimiento de los estudios de contactos es bajo y se relaciona con el sexo masculino, la orientación sexual (homosexual/bisexual) y el tipo de infección (gonococia/clamidia). Reducir el estigma asociado a la orientación sexual y mejorar la información de los profesionales podría favorecer su correcto cumplimiento.

          Translated abstract

          ABSTRACT Background: The partner notification is one of the main activities of epidemiological surveillance in Public Health. The primary objective was to estimate the compliance of the partner notification by health professionals who reported sexually transmitted diseases (HIV, Gonorrhoea, Syphilis and Chlamydia) during 2017 in Lleida’s regions. Methods: We carried out a descriptive epidemiological study of prevalence about the compliance of partner notification. Data collection was done by epidemiological surveys of these notifiable diseases and additional information was recovered through medical record and interview with professionals. The factors associated with the lack of partner notification were studied through the odds ratio (OR) and its 95% confidence interval (CI). ORs were adjusted (ORa) with multivariate logistic regression models. Results: We studied 203 STD cases with an average age of 30.6 years (SD=11.1); 32.5% were women. There was 46.3% without partner notification. The main cause of this absence was the lack of patient cooperation (23.4%). The variables associated with the lack of partner notification were the male sex (aOR-3.5; CI95%=1.6-7.5), gonococcal infection (aOR-4.9; CI95%=1.2-19.8), chlamydia infection (aOR-3.9; CI95%=0.9-16.1) and homosexual/bisexual sexual orientation (aOR-2.2; CI95%=0.9-5.4). Conclusions: Compliance of partner notification is low and it is related to male sex, sexual orientation (homosexual/bisexual/transsexual) and type of infection (Gonorrhoea and Chlamydia). Reducing the social stigma associated with sexual orientation and improving the information of health professionals could favour the contact studies.

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          Improving HIV test uptake and case finding with assisted partner notification services

          Objective: Despite the enormous expansion of HIV testing services (HTS), an estimated 40% of people with HIV infection remain undiagnosed. To enhance the efficiency of HTS, new approaches are needed. The WHO conducted a systematic review on the effectiveness of assisted partner notification in improving HIV test uptake and diagnosis, and the occurrence of adverse events, to inform the development of normative guidelines. Methods: We systematically searched five electronic databases through June 2016. We also contacted experts in the field and study authors for additional information where needed. Eligible studies compared assisted HIV partner notification services to passive or no notification. Where multiple studies reported comparable outcomes, meta-analysis was conducted using a random-effects model to produce relative risks (RRs) or risk ratios and 95% confidence intervals (CIs). Results: Of 1742 citations identified, four randomized controlled trials and six observational studies totalling 5150 index patients from eight countries were included. Meta-analysis of three individually randomized trials showed that assisted partner notification services resulted in a 1.5-fold increase in HTS uptake among partners compared with passive referral (RR = 1.46; 95% CI: 1.22–1.75; I 2 = 0%). The proportion of HIV-positive partners was 1.5 times higher with assisted partner notification than with passive referral (RR = 1.47; 95% CI: 1.12–1.92; I 2 = 0%). Few instances of violence or harm occurred. Conclusion: Assisted partner notification improved partner testing and diagnosis of HIV-positive partners, with few reports of harm. WHO strongly recommends voluntary assisted HIV partner notification services to be offered as part of a comprehensive package of testing and care.
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            Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people.

            Although it is known that only a small minority of people experiencing sexual problems seek treatment for these, barriers to treatment seeking remain relatively unexplored. This is particularly true for older people, whose perceived "asexuality" has led to them being excluded from sexual health research. The aim of the present study was to identify barriers experienced by older people in seeking treatment for sexual problems. Semi-structured interviews were conducted with 22 women and 23 men aged 50-92 years recruited from the age/sex register of a Sheffield general practice. A central component of the interviews involved exploring participants' attitudes towards, and experiences of, seeking help for sexual problems. Interviews were analyzed using the "framework" approach. The GP was seen as the main source of professional help if sexual problems were experienced. However, several barriers were identified as inhibiting help being sought. These included the demographic characteristics of the GP, GP attitudes towards later life sexuality, the attribution of sexual problems to "normal ageing", shame/embarrassment and fear, perceiving sexual problems as "not serious" and lack of knowledge about appropriate services. Twenty-five participants had experienced recent sexual problems which informed their responses. These findings indicate that many older people have sexual problems that they would like to discuss with their GP, but they feel unable to do so. GPs may need to be more proactive in raising sexual health issues in consultations if these needs are to be met.
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              Partner notification for sexually transmitted infections in developing countries: a systematic review

              Background The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs. Methods The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries. Results Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes. Conclusions STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                2019
                : 93
                : e201912096
                Affiliations
                [1] Lleida orgnameAtencion Primaria Onze de Setembre orgdiv1Institut Català de la Salut España
                [3] Lleida orgnameAgència de Salut Pública de Catalunya España
                [4] Barcelona orgnameConsorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública España
                [2] Lleida orgnameInstitut de Recerca Biomèdica de Lleida Spain
                Article
                S1135-57272019000100222 S1135-5727(19)09300000222
                ef992f08-e8d1-4144-9d4c-5ad3224ba4c4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 17 September 2019
                : 03 May 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 0
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                SciELO Public Health

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                Syphilis,Sífilis,VIH,Salud pública,Notificación de enfermedades,Infecciones de Transmisión Sexual,HIV,Public health,Disease notification,Sexually transmitted diseases,Partner notification

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