Showing papers by "Tom Wong published in 2011"
TL;DR: Ciprofloxacin resistance in N. gonorrhoeae within Canada has increased to a level where quinolones are no longer the preferred drugs for the treatment of gonococcal infections and the modal MICs for the third-generation cephalosporins have increased over time.
Abstract: Background:Canada conducts surveillance of penicillin, tetracycline, erythromycin, spectinomycin, ciprofloxacin, cefixime, and ceftriaxone susceptibilities in Neisseria gonorrhoeae isolates to support development of national treatment guidelines for sexually transmitted infections.Methods:N. gonorrh
46 citations
TL;DR: SCRS can be feasibly integrated within existing community venue-based HIV surveillance systems for MSM, and may be a suitable method for monitoring the impact of HPV vaccination in this population, however, participation may be influenced by venue type and availability of on-site collection, and adequacy of SCRS specimens may be lower in community venues as compared with clinical settings.
Abstract: Background: Inclusion of self-collected rectal swabs (SCRS) into existing community venue-based HIV surveillance systems for men who have sex with men (MSM) may provide a feasible method for monitoring human papillomavirus (HPV) vaccine-related outcomes in this population. We measured the prevalence of HPV and anal dysplasia through incorporating SCRS into ManCount, the Vancouver site of the M-Track HIV surveillance system. Methods: Participating MSM were provided with a self-collection kit for collection on-site or at a follow-up venue. Swabs were subject to polymerase chain reaction amplification for HPV detection, and cytology slides were reviewed for anal dysplasia. Factors associated with participation were identified through multivariate logistic regression. Results: Of 766 men completing ManCount, 268 (35%) agreed to participate, self-collecting 252 specimens (247 on-site). Of 239 complete specimens, 33.5% did not have detectable -globin; in the remainder (159 specimens) the prevalence of HPV infection was 62.3% (23.3% HPV type 16 or 18; 38.4% HPV type 6, 11, 16, or 18). In the 62.3% (149) of specimens adequate for cytology, the prevalence of anal dysplasia was 42.3% (HSIL 11.4%, LSIL 18.8%, ASC-US 6.7%, ASC-H 5.4%). Participation was associated with venue type, availability of on-site collection, and other characteristics. Conclusions: SCRS can be feasibly integrated within existing community venue-based HIV surveillance systems for MSM, and may be a suitable method for monitoring the impact of HPV vaccination in this population. However, participation may be influenced by venue type and availability of on-site collection, and adequacy of SCRS specimens may be lower in community venues as compared with clinical settings.
23 citations
TL;DR: The high prevalence of high-risk HPV in this population, particularly in the Aboriginal group, will require further studies to identify specific predictors of infection.
21 citations
TL;DR: Results of this study suggest that some Aboriginal youth do not test for HIV until late in the course of their disease, and once diagnosed, a significant number of youth delay accessing care.
Abstract: The purpose of this community-based research was to examine the experiences of Canadian Aboriginal youth regarding accessing HIV testing and care services. We used a mixed method exploratory research design; 413 participants completed a self-administered survey and 25 youth participated in in-depth semistructured interviews. Findings reported here are from the 26 survey participants (12.4%) and nine interview participants (28.9%) who self-reported being positive for HIV. Results of this study suggest that some Aboriginal youth do not test for HIV until late in the course of their disease, and once diagnosed, a significant number of youth delay accessing care. Support from friends, family, and others is an important motivator for youth to initiate care and treatment. Integrated, comprehensive, youth-friendly, and culturally safe services are important to keep youth in care.
18 citations
TL;DR: It is clear that the HPV vaccine has the potential to lower the prevalence of HPV 6, 11, 16, and 18 infections and related diseases in the M/FN population living in Manitoba, but its impact could be mitigated by the relatively high prevalence of other HPV types.
Abstract: Background Information on human papillomavirus (HPV) prevalence among Aboriginal populations (First Nations, Metis, Inuit) in Canada remains scarce but is needed for informed public health programming. This need is reinforced by the rapidly changing rates of cervical cancer screening in these populations and the introduction of prophylactic vaccines. Method In 2008, 52 clinics across the province of Manitoba, Canada participated in a Pap Week initiative during which left over tissues from conventional Pap tests were used for HPV typing using the Luminex method (developed by the National Microbiology Laboratory). A risk-behaviour survey was also administered to consenting women. Chi-square was used to compare frequencies and logistic regression was used to model the data. The most significant factors were included in the multivariate logistic model. Results Of 592 women recruited, 113 self-reported being Meti or First Nations (M/FN); 70 did not report their ethnic background and were excluded from the analysis. M/FN participants were younger than the non-M/FN participants (mean age: 39 vs 45, p Conclusion Certain types of HPV may be more prevalent in M/FN than in the non-Aboriginal population. Although it is clear that the HPV vaccine has the potential to lower the prevalence of HPV 6, 11, 16, and 18 infections and related diseases in the M/FN population living in Manitoba, its impact could be mitigated by the relatively high prevalence of other HPV types.
4 citations
TL;DR: POC testing for syphilis and HIV is well accepted among high-risk populations in outreach settings in Edmonton, and preliminary results from Edmonton suggest that the utility of these tests in mitigating the further spread of both syphilisand HIV is being assessed.
Abstract: Background Edmonton is in the midst of a syphilis outbreak occurring largely in high risk and hard-to-reach populations. Point of care (POC) testing for syphilis and HIV offers the opportunity for immediate and rapid access to testing, and in the case of syphilis, immediate treatment. POC syphilis tests have not been previously evaluated in clinical settings in Canada. Methods Since 14 February 2011, treponemal syphilis (Bioline Syphilis 3.0) and HIV (INSTI HIV-1/HIV-2 Antibody Test) POC testing, using whole blood from a finger prick specimen, has been offered to outreach clients in Edmonton. POC results were compared to standard testing from simultaneously collected serum specimens. Baseline demographics, sexual and drug use risk behaviour information were collected. Age and gender were collected on individuals who refused POC testing. A descriptive analysis was performed on the characteristics and outcomes of participants and those who refused. Results As of 15 April 2011, 146 individuals had been offered POC testing; 85.6% (n=125) consented. Among participants, 59.2% (74) were male [vs 66.7% (14) of non-participants, p=0.5)] and the median age was 29 yrs (IQR 24–36 yrs) [vs non-participants median age 29 yrs (IQR 25–45 yrs), p=0.2)]. The majority of participants (83.2%; 104) were heterosexual, 59.2% (69) were Aboriginal, and 30.4% (38) reported injection drug use. Among females, 62.7% (32) reported sex trade involvement, while among males, 21.6% (16) reported sex with a sex trade worker. Of 121 syphilis treponemal POC tests, 5 (4.1%) were positive, all in old treated cases of syphilis that were asymptomatic for infectious syphilis at the time of testing. Two syphilis POC (1.7%) tests were falsely negative when compared to the standard screening test (Architect Syphilis TP Microparticles, Abbott Laboratories, Illinois, USA); both were in individuals previously treated for syphilis. Of 123 HIV POC tests, 2 (1.6%) were reactive, both newly diagnosed cases as confirmed by GS HIV-1 Western Blot (BioRad Laboratories, California, USA); both were negative by syphilis POC tests. Conclusion Preliminary results from Edmonton suggest that POC testing for syphilis and HIV is well accepted among high-risk populations in outreach settings in Edmonton. This ongoing study will assess the utility of these tests in mitigating the further spread of both syphilis and HIV through POC testing, and in the case of syphilis, POC treatment.
3 citations
TL;DR: Being 30 yearss of age or older, having ever received money, drugs, or goods for sex, and use of any recreational drug in the 2 h preceding or during sex were all positively associated with being seropositive for HCV.
Abstract: Background Sexual transmission of hepatitis C virus (HCV) is not common compared to other modes of transmission such as injection drug use (IDU). There have been recent reports of sexually transmitted HCV outbreaks among men who have sex with men (MSM) in Europe. The present analysis examines the Canadian HCV seroprevalence in MSM with no reported history of IDU. Methods Data from Phase 1 of M-Track (2005−2007), a national enhanced surveillance system of HIV and other sexually transmitted and blood-borne infections (STBBI) and associated risk behaviours among MSM in Canada, were analysed. HCV and HIV status were ascertained using serology tests on dried blood spot (DBS) specimens, and risk factors were assessed via self-administered questionnaire. Bivariate analyses using χ2 tests and ORs with 95% CIs were performed. Results Overall (regardless of IDU history), 5.3% of M-Track participants were seropositive for HCV. Among MSM who did not report any history of IDU (N=3250), HCV seropositivity was 2.1%, and was higher among HIV-infected MSM compared to those who were uninfected (5.1% vs 1.7% respectively, p Conclusions These findings do not confirm sexual transmission of HCV given the possibility of unreported IDU or other unknown parenteral transmission risk factors in this sample; however, they do support existing evidence of increased risk of HCV infection among HIV-infected MSM. Interpretation of results is limited by the self-reported nature of behaviours and the inability of laboratory tests used to distinguish between current infection from resolved/treated HCV or acute from chronic HCV status. Furthermore, behaviours reported in the past 6 months may not accurately reflect the risk profile of HCV-seropositive individuals at the time of infection. HCV testing for HIV-infected MSM, even in the absence of an IDU history, may be of benefit.
1 citations
TL;DR: In this paper, the authors focus on mechanisms to: Enable adequate, timely AMR surveillance to inform treatment guidelines; Establish a strategy to rapidly detect patients with gonococcal infections who experience a clinical and/or microbiological treatment failure especially with recommended cephalosporin or azithromycin therapy; Promote effective public health and clinical management of patients and their sexual partners.
Abstract: There is growing concern that the increasing prevalence of AMR in N gonorrhoeae will compromise effective treatment and disease control efforts. Early warning systems and the creation of, public health, clinical and laboratory networks are critical to detect the emergence of resistance and treatment failures. Using specific examples to illustrate best practises, this presentation will focus on mechanisms to: Enable adequate, timely AMR surveillance to inform treatment guidelines; Establish a strategy to rapidly detect patients with gonococcal infections who experience a clinical and/or microbiological treatment failure especially with recommended cephalosporin or azithromycin therapy; and Promote effective public health and clinical management of patients and their sexual partners.
1 citations