RESUMEN
This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.
Asunto(s)
Condones/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Trabajadores Sexuales/psicología , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Trabajo Sexual , Trabajadores Sexuales/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & controlRESUMEN
INTRODUCTION: As part of an implementation research study on the feasibility of implementing point-of-care tests for syphilis in Peru, we collected information on partner treatment of syphilis-seropositive pregnant women and explored womens' and health providers' knowledge and practices regarding partner notification and treatment (PNT) for maternal syphilis. METHODS: Mixed methods were used to collect information. Quantitative data were collected from consecutive pregnant women with a positive point-of-care test for syphilis. A subset participated in qualitative interviews. Health providers completed a survey on knowledge, attitudes, and behaviors about PNT. RESULTS: Of the 144 seropositive women, 46 (31.9%) had concurrent patient-partner treatment. From the 98 seropositive women whose partner was not at the clinic, 33 partners (33.7%) received at least 1 dose of penicillin. The multivariate model showed that screening at the antenatal care clinic (prevalence ratio [PR], 3.84), first sex after age 16 years (PR, 0.55), and lifetime number of partners (PR, 0.55 for 2-4 partners; PR, 0.77 for >4 partners) were independently associated with treatment for the partner. Women identified the provider as key for the PNT, but less than half of the providers reported having been trained for counseling and recognize the need for defining the procedures and standardization for PNT. Providers and women both reported that men may not come for treatment once notified because of fear, distrust of the system, or barriers associated with the services. CONCLUSION: There is a need for better training of health providers, for clear and standardized processes for partner counseling, registration and follow-up, and an opportunity to introduce new technologies.
Asunto(s)
Trazado de Contacto , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Atención Prenatal , Sífilis/transmisión , Adulto , Estudios de Factibilidad , Femenino , Humanos , Perú/epidemiología , Sistemas de Atención de Punto , Embarazo , Parejas Sexuales , Encuestas y Cuestionarios , Sífilis/prevención & controlRESUMEN
BACKGROUND: As part of a community-randomized trial of a multicomponent intervention to prevent sexually transmitted infections, we created Mobile Teams (MTs) in ten intervention cities across Peru to improve outreach to female sex workers (FSW) for strengthened STI prevention services. METHODS: Throughout 20 two-month cycles, MTs provided counseling; condoms; screening and specific treatment for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and vaginal Trichomonas vaginalis (TV) infections; and periodic presumptive metronidazole treatment for vaginal infections. RESULTS: MTs had 48,207 separate encounters with 24,814 FSW; numbers of sex work venues and of FSW reached increased steadily over several cycles. Approximately 50% of FSW reached per cycle were new. Reported condom use with last client increased from 73% to 93%. Presumptive metronidazole treatment was accepted 83% of times offered. Over 38 months, CT prevalence declined from 15.4% to 8.2%, and TV prevalence from 7.3% to 2.6%. Among participants in ≥ 9 cycles, CT prevalence decreased from 12.9% to 6.0% (p <0.001); TV from 4.6% to 1.5% (p <0.001); and NG from 0.8% to 0.4% (p = 0.07). CONCLUSIONS: Mobile outreach to FSW reached many FSW not utilizing government clinics. Self-reported condom use substantially increased; CT and TV prevalences declined significantly. The community-randomized trial, reported separately, demonstrated significantly greater reductions in composite prevalence of CT, NG, TV, or high-titer syphilis serology in FSW in these ten intervention cities than in ten matched control cities.
Asunto(s)
Relaciones Comunidad-Institución , Grupo de Atención al Paciente , Trabajo Sexual , Enfermedades de Transmisión Sexual/prevención & control , Femenino , Humanos , Perú/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/clasificación , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
OBJECTIVES: Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. METHODS: The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. RESULTS: Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. CONCLUSIONS: Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing.
Asunto(s)
Pruebas en el Punto de Atención/estadística & datos numéricos , Complicaciones del Embarazo/diagnóstico , Sífilis/diagnóstico , Estudios de Factibilidad , Femenino , Personal de Salud/educación , Humanos , Tamizaje Masivo , Penicilinas/uso terapéutico , Perú , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Atención Prenatal/estadística & datos numéricos , Sífilis/tratamiento farmacológico , Factores de TiempoRESUMEN
BACKGROUND: Sexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru. METHODS AND FINDINGS: After a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. "Prevention Salespersons" visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities. CONCLUSIONS: Training pharmacy workers linked to a referral network of clinicians proved feasible and acceptable. High turn-over was challenging but over come.
Asunto(s)
Educación en Farmacia , Farmacéuticos , Médicos , Enfermedades de Transmisión Sexual/terapia , Certificación , Estudios de Seguimiento , Humanos , Partería/estadística & datos numéricos , Perú/epidemiología , Farmacéuticos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
BACKGROUND: We assessed prevalences of seven sexually transmitted infections (STIs) in Peru, stratified by risk behaviours, to help to define care and prevention priorities. METHODS: In a 2002 household-based survey of the general population, we enrolled randomly selected 18-29-year-old residents of 24 cities with populations greater than 50 000 people. We then surveyed female sex workers (FSWs) in these cities. We gathered data for sexual behaviour; vaginal specimens or urine for nucleic acid amplification tests for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; and blood for serological tests for syphilis, HIV, and (in subsamples) herpes simplex virus 2 (HSV2) and human T-lymphotropic virus. This study is a registered component of the PREVEN trial, number ISRCTN43722548. FINDINGS: 15 261 individuals from the general population and 4485 FSWs agreed to participate in our survey. Overall prevalence of infection with HSV2, weighted for city size, was 13·5% in men, 13·6% in women, and 60·6% in FSWs (all values in FSWs standardised to age composition of women in the general population). The prevalence of C trachomatis infection was 4·2% in men, 6·5% in women, and 16·4% in FSWs; of T vaginalis infection was 0·3% in men, 4·9% in women, and 7·9% in FSWs; and of syphilis was 0·5% in men, 0·4% in women, and 0·8% in FSWs. N gonorrhoeae infection had a prevalence of 0·1% in men and women, and of 1·6% in FSWs. Prevalence of HIV infection was 0·5% in men and FSWs, and 0·1% in women. Four (0·3%) of 1535 specimens were positive for human T-lymphotropic virus 1. In men, 65·0% of infections with HIV, 71·5% of N gonorrhoeae, and 41·4% of HSV2 and 60·9% of cases of syphilis were in the 13·3% who had sex with men or unprotected sex with FSWs in the past year. In women from the general population, 66·7% of infections with HIV and 16·7% of cases of syphilis were accounted for by the 4·4% who had been paid for sex by any of their past three partners. INTERPRETATION: Defining of high-risk groups could guide targeting of interventions for communicable diseases-including STIs-in the general Peruvian population. FUNDING: Wellcome Trust-Burroughs Wellcome Fund Infectious Disease Initiative and US National Institutes of Health.
Asunto(s)
Trabajo Sexual/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/orina , Femenino , Gonorrea/epidemiología , Gonorrea/orina , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Infecciones por HTLV-I/sangre , Infecciones por HTLV-I/epidemiología , Encuestas Epidemiológicas , Herpes Simple/sangre , Herpes Simple/epidemiología , Herpes Simple/virología , Herpesvirus Humano 2 , Humanos , Masculino , Perú/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/sangre , Enfermedades de Transmisión Sexual/orina , Encuestas y Cuestionarios , Sífilis/sangre , Sífilis/epidemiología , Vaginitis por Trichomonas/epidemiología , Vagina/microbiología , Vagina/parasitología , Adulto JovenRESUMEN
BACKGROUND: Previous community-randomised trials of interventions to control sexually transmitted infections (STIs) have involved rural settings, were rarely multicomponent, and had varying results. We aimed to assess the effect of a multicomponent intervention on curable STIs in urban young adults and female sex workers (FSWs). METHODS: In this community-randomised trial, baseline STI screening was done between August, and November, 2002, in random household samples of young adults (aged 18-29 years) and in FSWs in Peruvian cities with more than 50,000 inhabitants. Geographically separate cities were selected, matched into pairs, and randomly allocated to intervention or control groups with an S-PLUS program. Follow-up surveys of random samples were done after 2 years and 3 years. The intervention comprised four modalities: strengthened STI syndromic management by pharmacy workers and clinicians; mobile-team outreach to FSWs for STI screening and pathogen-specific treatment; periodic presumptive treatment of FSWs for trichomoniasis; and condom promotion for FSWs and the general population. Individuals in control cities received standard care. The composite primary endpoint was infection of young adults with Chlamydia trachomatis, Trichomonas vaginalis, or Neisseria gonorrhoeae, or syphilis seroreactivity. Laboratory workers and the data analyst were masked, but fieldworkers, the Peruvian study team, and participants in the outcome surveys were not. All analyses were done by intention to treat. This trial is registered, ISRCTN43722548. FINDINGS: We did baseline surveys of 15,261 young adults in 24 Peruvian cities. Of those, 20 geographically separate cities were matched into pairs, in each of which one city was assigned to intervention and the other to standard of care. In the 2006 follow-up survey, data for the composite primary outcome were available for 12,930 young adults. We report a non-significant reduction in prevalence of STIs in young adults, adjusted for baseline prevalence, in intervention cities compared with control cities (relative risk 0·84, 95% CI 0·69-1·02; p=0·096). In subgroup analyses, significant reductions were noted in intervention cities in young adult women and FSWs. INTERPRETATION: Syndromic management of STIs, mobile-team outreach to FSWs, presumptive treatment for trichomoniasis in FSWs, and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial. FUNDING: Wellcome Trust and Burroughs Wellcome Fund, National Institutes of Health, Center for AIDS Research, CIPRA, and USAID-Peru.
Asunto(s)
Trabajadores Sexuales/estadística & datos numéricos , Enfermedades de Transmisión Sexual/prevención & control , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Condones/estadística & datos numéricos , Femenino , Gonorrea/epidemiología , Gonorrea/prevención & control , Humanos , Análisis de Intención de Tratar , Masculino , Perú/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/epidemiología , Tricomoniasis/epidemiología , Tricomoniasis/prevención & control , Trichomonas vaginalis , Adulto JovenRESUMEN
BACKGROUND: Data on hepatitis B virus (HBV) prevalence are limited in developing countries. There is also limited information of consistent condom use efficacy for reducing HBV transmission at the population level. The study goal was to evaluate the prevalence and factors associated with HBV infection in Peru, and the relationship between anti-HBc positivity and consistent condom use. METHODS AND FINDINGS: Data from two different surveys performed in 28 mid-sized Peruvian cities were analyzed. Participants aged 18-29 years were selected using a multistage cluster sampling. Information was collected through a validated two-part questionnaire. The first part (face-to-face) concerned demographic data, while the second part (self-administered using handheld computers) concerned sexual behavior. Hepatitis B core antibody (anti-HBc) was tested in 7,000 blood samples. Prevalences and associations were adjusted for sample strata, primary sampling units and population weights. Anti-HBc prevalence was 5.0% (95%CI 4.1%-5.9%), with the highest prevalence among jungle cities: 16.3% (95%CI 13.8%-19.1%). In the multivariable analysis, Anti-HBc positivity was directly associated with geographic region (highlands ORâ=â2.05; 95%CI 1.28-3.27, and jungle ORâ=â4.86; 95%CI 3.05-7.74; compared to coastal region); and inversely associated with age at sexual debut (ORâ=â0.90; 95%CI 0.85-0.97). Consistent condom use, evaluated in about 40% of participants, was associated with reduced prevalence (ORâ=â0.34; 95%CI 0.15-0.79) after adjusting for gender, geographic region, education level, lifetime number of sex partners, age at sexual debut and year of survey. CONCLUSION: Residence in highlands or jungle cities is associated with higher anti-HBc prevalences, whereas increasing age at sexual debut were associated with lower prevalences. Consistent condom use was associated with decreased risk of anti-HBc. Findings from this study emphasize the need of primary prevention programs (vaccination) especially in the jungle population, and imply that condom use promotion might be a potential strategy to prevent HBV infection.
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Condones/estadística & datos numéricos , Hepatitis B/sangre , Hepatitis B/epidemiología , Adolescente , Adulto , Femenino , Hepatitis B/inmunología , Anticuerpos contra la Hepatitis B/sangre , Anticuerpos contra la Hepatitis B/inmunología , Humanos , Masculino , Perú/epidemiología , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Clinicians in developing countries have had limited access to continuing education (CE) outside major cities, and CE strategies have had limited impact on sustainable change in performance. New educational tools could improve CE accessibility and effectiveness. METHODOLOGY/PRINCIPAL FINDINGS: The objective of this study was to evaluate an interactive Internet-based CE course on Sexually Transmitted Diseases (STDs) management for clinicians in Peru. Participants included physicians and midwives in private practice drawn from a census of 10 Peruvian cities. The CE included a three-hour workshop for improving Internet skills, followed by a 22-hour online course on STD-syndrome-management, with subsequent educational support. The course used case-based clinical vignettes tailored to local STD problems. Knowledge and reported practices on STD management were assessed before, immediately after and at four months after completion of the course. Statistical analysis included parametric tests-linear regression multivariate analysis, paired t-test and repeated measures ANOVA using SPSS 14.0. Of 1,071 eligible clinicians, 510 agreed to participate, as did an additional 132 public sector clinicians. Of these 642 participants, 619 (96.4%) completed the course, and 596 (96.3%) took the four-month follow-up evaluation. Physician and midwife scores improved from 64.2% correct answers on the pre-test to 77.9% correct on the four-month follow-up test (p<0.001). Most participants (95%) found the online course useful for their work needs. Self reported STD management practices did not change. CONCLUSIONS/SIGNIFICANCE: Among physicians and midwives in Peru, an Internet-based CE course was feasible, acceptable with high participation rates, and led to sustained improvement in knowledge at four months. Further studies are needed to test it as a model for improving the training of physicians, midwives, and other health care providers.
Asunto(s)
Educación Médica Continua/métodos , Partería , Médicos , Enfermedades de Transmisión Sexual , Adulto , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , PerúRESUMEN
OBJECTIVES: To determine how patterns of non-monogamy influence prevalences of sexually transmitted infections (STIs) in individuals and their cohabitating sex partners. METHODS A 2002 survey in 24 Peruvian cities enrolled men and women aged 18-29 years from random household samples. The cohabiting sex partner of each enrolee was also enrolled until approximately 100 couples per city were recruited. Men provided urine and women vaginal swabs or urine for molecular testing for Chlamydia trachomatis and Trichomonas vaginalis; both genders provided blood for serological testing. RESULTS: Among 2099 females and 2052 males providing specimens and behavioural data, 18.2% of males and 2.5% of females reported non-monogamy during the past year. C trachomatis was detected in 121 females (5.8%) and 80 males (4.1%) and T vaginalis in 87 females (4.2%) and 26 males (1.3%). Multivariate analyses showed that C trachomatis infection in females was significantly associated with her male partner's non-monogamy (OR 2.02, CI 1.32 to 3.08) but not significantly with her own non-monogamy; T vaginalis was associated with her own non-monogamy (OR 3.11, CI 1.25 to 7.73) and with her partner's non-monogamy (OR 2.07, CI 1.26 to 3.42). For males, both C trachomatis (OR 2.17, CI 1.29 to 3.69) and T vaginalis (OR 2.49, CI 1.06 to 5.87) were significantly associated only with his own non-monogamy. CONCLUSIONS: Among cohabiting couples, male non-monogamy was common and was associated with C trachomatis and T vaginalis infection in himself and in his female partner, whereas female non-monogamy was reported infrequently and was significantly associated only with her own T vaginalis infection. Patterns of non-monogamy may guide public health interventions.
Asunto(s)
Infecciones por Chlamydia/transmisión , Chlamydia trachomatis , Parejas Sexuales , Vaginitis por Trichomonas/transmisión , Trichomonas vaginalis , Sexo Inseguro , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Femenino , Humanos , Masculino , Análisis Multivariante , Perú/epidemiología , Prevalencia , Vaginitis por Trichomonas/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: To describe the frequency and determinants of self-medication for symptoms of sexually transmitted infections (STI) in a female sex worker (FSW) population. To present a methodology exploring the best predictors as well as the interactions between determinants of self-medication. METHODS: A cross-sectional survey of 4153 FSW carried out in Peru. The prevalence of self-medication was estimated from the subsample of participants who had experienced symptoms of STI in the past 12 months (n=1601), and used successive logistic regression models to explore the determinants. RESULTS: Self-medication prevalence for a reported symptomatic episode during the past 12 months was 32.1% (95% CI 29.8 to 34.6). It was negatively correlated with work in brothels (adjusted odds ratio (OR) 0.51, 95% CI 0.28 to 0.93; p=0.028) and awareness of STI services available for FSW (adjusted OR 0.49, 95% CI 0.29 to 0.81; p=0.006). Other determinants were organised at different levels of proximity to the outcome creating pathways leading to self-medication. CONCLUSIONS: The importance of the staggered analysis presented in this study resides in its potential to improve the understanding of associations between determinants and, consequently, the targeting of interventions. The awareness of STI services available for FSW increases access to health care, which in turn decreases self-medication. In addition, the sharing of information that takes place between brothel-based FSW was also related to a diminishing prevalence of self-medication. These two main predictors provide an opportunity for prevention programmes, in particular those designed to be led by peers.
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Aceptación de la Atención de Salud/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Trabajo Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/terapia , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Perú , Parejas Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
Well-trained people are urgently needed to tackle global health challenges through information and communication technologies. In this report, AMAUTA, a joint international collaborative training program between the Universidad Peruana Cayetano Heredia and the University of Washington, which has been training Peruvian health professionals in biomedical and health informatics since 1999, is described. Four short-term courses have been organized in Lima, offering training to more than 200 graduate-level students. Long-term training to masters or doctorate level has been undertaken by eight students at the University of Washington. A combination of short-term and long-term strategies was found to be effective for enhancing institutional research and training enterprise. The AMAUTA program promoted the development and institution of informatics research and training capacity in Peru, and has resulted in a group of trained people playing important roles at universities, non-government offices, and the Ministry of Health in Peru. At present, the hub is being extended into Latin American countries, promoting South-to-South collaborations.
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Biología Computacional/educación , Personal de Salud/educación , Cooperación Internacional , Informática Médica/educación , Educación de Postgrado/organización & administración , Humanos , Liderazgo , Estudios de Casos Organizacionales , Perú , Desarrollo de Programa , Desarrollo de Personal/organización & administración , WashingtónRESUMEN
BACKGROUND: Mycoplasma genitalium is associated with cervicitis and pelvic inflammatory disease in nonpregnant women. We investigated associations between cervical M genitalium, demographic and behavioral risk factors for sexually transmitted infection and preterm birth among low-income Peruvian women. METHODS: This case-control study, conducted at the Instituto Nacional Materno Perinatal, Lima, Peru, included 661 cases with a spontaneous preterm birth at <37 weeks and 667 controls who delivered at >or=37 weeks. Within 48 hours after delivery, subjects underwent interviews, medical record review, and collection of cervicovaginal specimens for M. genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae by nucleic acid amplification testing, and Trichomonas vaginalis by culture. Odds ratios and 95% confidence intervals were calculated for associations between M. genitalium, other genital infections and risk factors, and preterm birth. Multivariable logistic regression was used to adjust for potential confounders. RESULTS: Cervical M. genitalium was detected in 3% of subjects and was significantly associated with C. trachomatis infection (P < 0.001) and preterm birth (4% vs. 2%; adjusted odds ratio: 2.5, 95% confidence interval: 1.2-5.0, P = 0.014), and marginally associated with T. vaginalis (P = 0.05). M. genitalium detection was also associated with younger maternal age (P = 0.003) but not with other risk factors for preterm birth. The association between cervical M. genitalium detection and preterm birth remained significant after adjustment for maternal age and coinfection with C. trachomatis or T. vaginalis. CONCLUSIONS: Cervical M. genitalium detection was independently associated with younger maternal age and preterm birth, suggesting that this organism may be an infectious correlate of spontaneous preterm birth.
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Infecciones por Mycoplasma , Mycoplasma genitalium , Nacimiento Prematuro , Cervicitis Uterina , Estudios de Casos y Controles , Cuello del Útero/microbiología , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/aislamiento & purificación , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/microbiología , Mycoplasma genitalium/genética , Mycoplasma genitalium/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/métodos , Perú/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/microbiología , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etiología , Vaginitis por Trichomonas/complicaciones , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/parasitología , Trichomonas vaginalis/aislamiento & purificación , Cervicitis Uterina/epidemiología , Cervicitis Uterina/microbiologíaRESUMEN
The public sectors of developing countries require strengthened capacity in health informatics. In Peru, where formal university graduate degrees in biomedical and health informatics were lacking until recently, the AMAUTA Global Informatics Research and Training Program has provided research and training for health professionals in the region since 1999. The Fogarty International Center supports the program as a collaborative partnership between Universidad Peruana Cayetano Heredia in Peru and the University of Washington in the United States of America. The program aims to train core professionals in health informatics and to strengthen the health information resource capabilities and accessibility in Peru. The program has achieved considerable success in the development and institutionalization of informatics research and training programs in Peru. Projects supported by this program are leading to the development of sustainable training opportunities for informatics and eight of ten Peruvian fellows trained at the University of Washington are now developing informatics programs and an information infrastructure in Peru. In 2007, Universidad Peruana Cayetano Heredia started offering the first graduate diploma program in biomedical informatics in Peru.
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OBJECTIVE: Adolescent and young adult women in urban, socioeconomically disadvantaged areas are at high risk of contracting sexually transmitted infections (STIs). We assessed associations of Chlamydia trachomatis (CT) infection with both traditional STI risk factors, and partner and partnership-related factors among low-income women in Lima, Peru, by age group. METHODS: In a cross-sectional analysis of CT infection among 1290 postpartum women, cervical swabs were collected for CT polymerase chain reaction (PCR) within 48 h after delivery, and a structured interview was completed. Multivariate logistic regression was used to evaluate risk factors for CT, with separate models stratified by age: adolescents (12-19 years), young women (20-24 years), and older women (>or=25 years). RESULTS: CT was detected in 9.6% of adolescents, 9.0% of young women, and 5.4% of older women (p = 0.03). Among adolescents, history of drug use (odds ratio [OR] = 5.62, 95% confidence interval [CI] 1.03-30.6) and short duration of current partnership (OR = 2.6, 95% CI 1.14-5.93) were the strongest predictors of CT infection. Among young women, younger age at coitarche (OR = 0.74 for each year older, 95% CI 0.60-0.91) and low income (OR = 2.40, 95% CI 1.04-5.55) were associated with CT, while self-report of ever using condoms was protective (OR = 0.22, 95% CI 0.08-0.61). Among older women, only younger age at coitarche was related to CT (OR = 0.85, 95% CI 0.75-0.97). CONCLUSIONS: Risk factors for CT among women in Lima, Peru, differed for adolescents, young women, and older women, which may reflect differences in biology and/or immunology of CT as well as variability in the occurrence of specific risk behaviors by age group.
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Conducta del Adolescente , Infecciones por Chlamydia/epidemiología , Conducta Sexual/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Salud de la Mujer , Adolescente , Adulto , Distribución por Edad , Intervalos de Confianza , Estudios Transversales , Femenino , Humanos , Oportunidad Relativa , Perú/epidemiología , Prevalencia , Factores de Riesgo , Parejas Sexuales/psicología , Factores Socioeconómicos , Adulto JovenRESUMEN
A woman's partner and the characteristics of their partnership can play an important role in the health of her pregnancy. Yet, with the notable exception of intimate partner violence, there has been little previous research addressing the associations between partner- or partnership-related factors and birth outcomes. This analysis tested the hypothesis that risk factors related specifically to partner or partnership characteristics increased the risk for preterm birth. Between 2003 and 2005, a total of 580 preterm cases (20-36 weeks gestational age at delivery) and 633 term controls (> or =37 weeks) were selected from women delivering at an obstetric hospital in Lima, Peru. Each woman completed a confidential, structured interview and provided biological specimens within 48 h after delivery. Multivariable logistic regression was used to assess associations between partner and partnership characteristics and preterm birth. After adjustment for behavioral, demographic, and obstetric risk factors, ever having had a partner with a history of drug use (aOR = 1.91, 95% CI 1.22-2.99), ever having had anal sex (aOR = 1.40, 95% CI 1.07-1.84), having a current partner with a history of visiting prostitutes (aOR = 1.69, 95% CI 1.22-2.33), and perceiving one's current partner as a "womanizer" (aOR = 1.34, 95% CI 1.02-1.77) were significantly associated with an elevated risk of preterm birth when tested in separate models. These four factors were then used to create a composite partnership risk score, which showed an increasing dose-response relationship with preterm birth risk (per additional partner risk factor: aOR = 1.31, 95% CI 1.16-1.49). These results highlight the importance of considering a broader set of risk factors for preterm birth, specifically those related to a woman's partner and partnership characteristics. Further research could clarify the specific mechanisms through which these partner and partnership characteristics may increase the risk of preterm birth.
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Pobreza , Nacimiento Prematuro , Parejas Sexuales , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido , Entrevistas como Asunto , Masculino , Perú , Embarazo , Factores de RiesgoRESUMEN
BACKGROUND: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS: We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.
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Aborto Criminal/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Aborto Criminal/legislación & jurisprudencia , Aborto Inducido/legislación & jurisprudencia , Aborto Espontáneo , Adolescente , Adulto , Factores de Edad , Coito , Conducta Anticonceptiva , Femenino , Humanos , Incidencia , Análisis Multivariante , Perú/epidemiología , Embarazo , Prevalencia , Factores de Riesgo , Parejas Sexuales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The objective of this paper is to characterize effective patient care reminder strategies for people living with HIV/AIDS (PLWHA) to improve antiretroviral therapy (ART) adherence) using short message service (SMS) based on patient perspectives. We conducted a qualitative study with adult PLWHA in a community-based clinic in Lima, Peru using focus groups. 26 HIV-positive individuals participated in four focus groups (20 men, 6 women). The participants expressed positive perceptions towards receiving reminders via SMS, but specified certain characteristics they wanted them to have (such as being simple and concise). It was also important that the messages maintained confidentiality and privacy by using coded words or phrases ("Remember, it is the time of your life") instead of "sensitive" words (HIV or antiretroviral). This study suggests that patients want healthcare SMS that appropriately notify them, deliver a careful crafted message, and assess the context in which they are received.
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Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Sistemas Recordatorios , Envío de Mensajes de Texto , Adulto , Actitud Frente a la Salud , Teléfono Celular , Femenino , Grupos Focales , Humanos , Masculino , Perú , Investigación CualitativaRESUMEN
BACKGROUND: Cervical cancer, although usually preventable by Pap smear screening, remains the leading cause of cancer-related deaths among women in Peru. The percentages and characteristics of women in Peru who have or have not had a Pap smear have not been defined. METHODS: In an urban community randomized trial of sexually transmitted infection (STI)/HIV prevention in Peru, 6712 randomly selected women between the ages of 18 and 29 from 20 cities were interviewed regarding having had cervical Pap smears. RESULTS: Among women sampled, only 30.9% had had a Pap smear. By multivariate analysis, the main predictors of having a Pap smear were having had sex, having had children, completion of secondary education and increasing age. Regional variations were also found: women from the highlands and rainforest were less likely to have had Pap smears than women from the coast. CONCLUSION: A norm of seeking and receiving Pap smears has not been established among sexually active young Peruvian women. To improve Pap smear coverage in Peru, promotion efforts should target underserved women and regions with less coverage.
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Conocimientos, Actitudes y Práctica en Salud , Prueba de Papanicolaou , Aceptación de la Atención de Salud/estadística & datos numéricos , Frotis Vaginal/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Perú , Población Urbana , Neoplasias del Cuello Uterino/prevención & control , Adulto Joven , Displasia del Cuello del Útero/prevención & controlRESUMEN
BACKGROUND: Low-cost handheld computers (PDA) potentially represent an efficient tool for collecting sensitive data in surveys. The goal of this study is to evaluate the quality of sexual behavior data collected with handheld computers in comparison with paper-based questionnaires. METHODS: A PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima). RESULTS: The first study enrolled 200 participants (18-29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% (Kappa: 0.43-0.86) while numeric variables agreement was between 57.1% and 79.8% (Spearman: 0.76-0.95). Agreement and correlation were higher in those who had completed at least high school than those with less education. The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires. CONCLUSION: This study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.