International journal of STD & AIDS
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This study reports the prevalence and risk factors of human papillomavirus (HPV) infection in healthy women in Singapore. Demography, education, sexual and reproductive history and cigarette smoking habits were obtained from a cross-sectional population of healthy women and girls aged above 12 years of age. Cervical or vaginal cytology samples were investigated for 37 known anogenital HPV subtypes using the linear array PCR method. ⋯ Significant independent risk factors for any-type HPV infection were multiple sexual partners (adjusted OR 1.4) and low (≤6 years) educational level (adjusted OR 4.0). The distribution of HPV subtypes in healthy women varies between different countries within Asia. In Singapore, the prevalence of HPV infection was 9.31% and was related to penetrative sexual intercourse, multiple sexual partners and low educational level.
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This case describes a young white British man with a one-year history of recurrent genital ulceration managed by the GP. Initially this was thought to be a drug reaction; however, presentation at our genitourinary medicine clinic and onward review with dermatology allowed the diagnosis of Behçet's disease to be made. ⋯ Treatment with oral prednisolone was initiated by dermatology, which resulted in rapid improvement in the genital ulceration. This case highlights that clinicians should consider Behçet's disease in patients with recurrent genital ulceration to ensure prompt diagnosis and prevention of systemic involvement.
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Summary Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of "late testers" (CD4 <200 cells/mm(3) at the time of diagnosis). ⋯ There was no difference in numbers of visits between late testers and non-late testers, although late testers were more likely to have ED visits. Most newly diagnosed HIV-positive patients had multiple encounters prior to diagnosis. Many of these patients presented with CD4 counts below 200 cells/mm(3), indicating true missed opportunities for earlier diagnosis.
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Comparative Study
Hepatitis C prevalence in HIV-infected individuals: a comparison of inpatient and outpatient care.
Summary Due to the shared risk factors for viral transmission, coinfection of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is common. This study examined the seroprevalence of HCV among HIV-infected patients in inpatient and outpatient settings. A retrospective chart review of 256 HIV-infected patients was conducted in Prince George's Hospital Center (inpatients from 1 September 2011 to 1 March 2012) and Glenridge Medical Center (outpatients from 1 January 2011 to 31 December 2012). ⋯ In addition, only 64.9% of HIV-infected and 50.0% of HCV/HIV-coinfected inpatients were followed up with outside care after discharge. To our knowledge, this study, for the first time, revealed that HCV/HIV coinfection was significantly higher in inpatients compared to outpatients. Considering the high prevalence and comorbidities associated with HCV/HIV coinfection, it is recommended that evaluation of hepatic damage, especially fibrosis, should be initiated during hospitalization as well as outpatient care.
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In 2008, nurse-administered HIV oral rapid testing (RT) was introduced at the Veterans Affairs Primary Care Clinic in Downtown Los Angeles. Analysis at five years revealed variable yet increasing rates of HIV RT at that facility despite the fact that no post-launch support was provided by the implementation team. Qualitative interviews among stakeholders conducted at five years revealed the pre-existing implementation practices endemic to this clinic that facilitated this unprecedented success (e.g. history of positive quality improvement implementations, leadership support, clinician involvement at each step of the process to facilitate empowerment, ownership and feasible customisation of the implementation, cohesive communication among clinicians and leadership, training, efficient supply pathway, progressive performance feedback and ongoing encouragement).