A recent article in the US journal JAIDS, Sugarman & Mayer (S&M), provides a handy outline of the ethical issues around pre-exposure prophylaxis (PrEP) for HIV infection (Sugarman & Mayer). The subject is very topical in the US, now that the Food and Drinks Administration have taken a step ahead of the rest of the […]
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Should ART provision be decentralized to health centres in low and middle income countries?
With the realization of the value of ART as a means of preventing HIV transmission, the question of how best to retain HIV-diagnosed in care becomes all the more pressing. Recent STI blogs have covered such topics as the potential role of computer-generated reminders in retaining patients (sti blogs03/05/13), as well as the re-engagement of […]
“Stewarding” may be the best policy for prolonging the efficacy of anti-Gonorrhoea drugs
With reports of the growing resistance of Neisseria gonorrhoeae to cephalosporins, currently the last weapon in the antibiotic armoury, control seems rapidly to be running out of options. Given the 21,183 reported cases in the UK (2011) – over half the EU total for the same year – this is a matter of grave public […]
How does neighbourhood impact on STI (Chlamydia) risk?
The influence of neighbourhood on STI (and more particularly Chlamydia) acquisition is widely recognized fact. Biello & Nikkolai argue for UK urban populations that neighbourhood socio-economic status (SES) is more closely correlated with Chlamydia risk than individual SES (http://sti.bmj.com/content/87/7/560.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7). In another UK study (Birmingham), Shahmanesh & Ross find residence in neighbourhoods having certain SES characteristics […]
HIV+ mothers without ART: when and how should they wean?
Without antiretrovirals, breastfeeding contributes 28% to the risk of mother-to-child HIV transmission (MTCT) (http://sti.bmj.com/content/88/Suppl_2/i44.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63). Antiretroviral drugs make achieving he WHO goal of near elimination of MTCT imaginable (http://sti.bmj.com/content/87/3/261.full; http://sti.bmj.com/content/86/Suppl_2/ii48.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63). But, in the meantime, what advice should be given to HIV+ mothers in those low-resource settings where antiretrovirals are still not available? In this context, the […]
Taking seriously the public health impact of disengagement from HIV care in the US
ART as a strategy for “treatment-as-prevention” is frequently acknowledged. Public health efforts, in the US as elsewhere, have focussed on prompt initiation of ART for the newly-diagnosed so as to shorten the duration of viremia – and thereby also reduce transmission risk. But what about the public health implications of people living with HIV (PLWH) […]
US HIV screening guidance shifts to a population-based approach
The updating of important US guidelines on HIV testing by the US Planning Services Task Force (USPSTF) (http://annals.org/article.aspx?articleid=1682314) confirms a shift from a risk-based to a population-based approach to HIV testing. The USPSTF guidelines are now in line with the most recent (2006) guidelines of the Communicable Diseases Centre (CDC) http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm). The option for risk-based […]
Computerized “clinical decision support systems” (CDSS): their potential for improving HIV follow-up in low-resource settings
Kit Fairley (http://sti.bmj.com/content/87/Suppl_2/ii25.full) in this journal offers an overview of the many ways in which information technology can be used in the area of STIs. This is most obviously through the role of electronic medical records (EMR); but also through the possibility these offer for clinical decision support systems that can be used to generate […]
Sexual health in the post-HPV vaccination era: implications for genital warts and cervical screening
Quadrivalent HPV vaccination (qHPV) for adolescent girls is recommended and publicly financed in a number of countries. This intervention promises to prevent up to 70% of HPV generated cancers in those vaccinated, as well as vastly reducing the burden of genital warts (GW). In relation to prevention of HPV generated cancer and cancerous lesions, its […]
Are point-of-care tests the answer to meeting WHO target for congenital syphilis?
Congenital syphilis (syphilis transmitted from mother to child (MTCT)) remains a scourge in many low- and middle- income countries (LMIC) causing stillbirth and neonatal death. This is despite the existence of inexpensive, cost-effective and feasible testing and treatment – and despite the fact that a majority of pregnant women, even in LMIC, attend antenatal clinics […]