针对MSM的新型性病预防服务ppt-Responding

1NovelSTDPreventionServicesforMenwhohaveSexwithMen针对与同性发生性行为的男性(MSM)的新型性病预防服务JeffreyD.Klausner,MD,MPHDirector,STDPreventionServicesSanFranciscoDepartmentofPublicHealth旧金山公共卫生部性传播疾病预防服务办公室主任JeffreyD.Klausner医学博士兼公共卫生硕士AssociateClinicalProfessorofMedicineDivisionsofAIDSandInfectiousDiseasesUniversityofCaliforniaSanFrancisco加州旧金山大学艾滋病和传染病学院临床医学副教授Increasesinmalerectalgonorrhea,SanFrancisco男性直肠淋病患者增长率（旧金山）CDCMMWR1999;48(3):45-55GonorrheainMSM,SanFrancisco,1999-20081999-2008年间旧金山MSM淋病患者增长率SFDPH,STDSection,20082008，SFDPH，STD部分4EarlySyphilis1998–20071998–2007年间早期梅毒病例数41447118549552555242742135401002003004005006001998199920002001200220032004200520062007Year年ReportedCases报告的案例5PublicHealthResponse公共健康应对措施•Enhancedsurveillance监管力度增强•Moreclinical&labservices临床与化验服务增多•Healthprovidereducation健康提供者教育•Communityhealthpromotion社区健康程度提高•Addressselectriskfactors解决首要风险因素•PublicHealthEvaluation公共健康评估6JAMA2000;284:447-450Strongassociation(OR=8.7,P.05)betweenmeetingpartnerontheInternetandsyphilis和互联网上认识的性伴侣约会与感染梅毒之间的密切联系(OR=8.7,P.05)70102030402001200220032004200520062007PercentofMSMCases.MSM案例百分比PercentofSyphilisCasesReportingMeetingPartnersbyVenue,California在聚会场所与性伴侣约会感染梅毒的病例比例（加州）Internet互联网Bathhouses/SexClubs洗浴中心/色情俱乐部Private/CircuitParties私人/盛大舞会Bars/Clubs酒吧/俱乐部7/2006ProvisionalData-CADHSSTDControlBranch7/2006临时数据-加利福尼亚DHSSTD控制分支机构8STDControlStrategy性病控制战略•Screen检查•Treat治疗•Treatpartners治疗性伴侣•Screen检查9MostrectalchlamydialinfectionsinMSMareasymptomaticMSM中多数直肠衣原体感染者无症状N=31614%86%Kentetal.CID2005Kent等，CID2005Asymptomatic无症状Symptomatic有症状10STDScreening性病检查•STDsareasymptomatic性病无症状–Promotescreening加大检查力度–Useaccuratescreeningtests采用精确的检查检验方法•Makescreeningeasy使检查简单易行11Screenwithnucleicacidtests采用核酸检验方法进行检查12PharyngealGonorrheaPositivitySanFrancisco,2005(n=9,727)2005年旧金山咽部淋病呈阳性的患者比例(n=9,727)8.8%7.6%6.1%7.0%7.2%6.7%6.3%7.3%3.4%0%5%10%15%STDClnMSMClnSexWrkrClnHomeless/TGClnPrivMDHIVTestPrgHIVSeroconverters2HIVClnsCBSOverallprevalence7.8%总患病率为7.8%13RectalGonorrheaPositivitySanFrancisco,2005(n=6,968)2005年旧金山直肠淋病呈阳性的患者比例(n=6,968)9.1%5.8%5.4%4.7%11.3%3.5%3.3%4.9%3.7%0%5%10%15%20%STDClnMSMClnSexWrkrClnHomeless/TGClnPrivMDHIVTestPrgHIVSeroconverters2HIVClnsCBSOverallprevalence7.0%总患病率为7.0%14RectalChlamydiaPositivityinSanFrancisco,2005(n=6,861)2005年旧金山直肠衣原体呈阳性的患者比例(n=6,861)9.8%7.4%8.3%5.2%7.1%6.2%8.1%4.7%11.3%0%5%10%15%STDClinicMSMClinicCommunityScreeningHIVTestingPrgHIVSeroconverters2HIVClinicsSexWrkClinicHomeless/TGClinicPrivateMDOverallprevalence8.4%总患病率为8.4%15Patientaccesstoservices,education患者获取服务、教育的渠道Klausner,STD,1999;Klausneretal,AIDSCare2004Klausner，STD，1999；Klausner等，AIDS护理200416GayMen’sPreventionCenter男性同性恋疾病预防中心1718OnlineSTDtesting性病网上检验Levineetal,STD,2005Levine等，STD，2005=Newcase=新病例6.4%reactivesyphilstests6.4%反应性梅毒检验19Rapidtreatment快速治疗•Single-doseoraltherapy单剂量口服药疗法•Field-deliveredtherapy现场实施疗法•Internet-basedprescriptions基于互联网的处方•Monitortimetotreatment监督治疗时间20Partnertreatment性伴侣治疗PartnertreatmentinMSM,1998-20081998-2008年MSM性伴侣治疗人数21Partnernotification性伴侣通知•Patientreferral患者转介–Peer-based,confidentialoranonymous同伴转介，以保密或匿名方式•Provider-referral提供者转介–Healthdepartment,voluntaryandanonymous卫生部门，以自愿或匿名方式22Internetpartnernotificationguidelines互联网性伴侣通知指南•MessagessentfromInternetserviceproviderlesslikelytobediscarded;usesamee-mailproviderascase.Healthdepartmentsmayneedmultiplee-mailaccounts.互联网服务提供者发送的邮件丢失的可能性很小；使用与病例相同的电子邮件帐户提供者。卫生部门可能需要多个电子邮件帐户。•Includereferenceto“Serioushealthmatter”inmessageheader;includeverifiableinformation在邮件标题注明“待严肃对待的健康问题”；包含有据可查的信息•Nogroupmessages;usesameprinciplesofconfidentialityaswithpostalserviceortelephone不群发邮件；邮局服务或电话服务采用相同的保密原则•Upone-mailresponse,collectinformationtodevelopmorepersonalcontact收到回复的电子邮件后，收集信息，以获取更多个人联系方式23InSpot.org:Peer-to-peerOnlinePartnerNotificationandTreatmentInSpot.org：同伴对同伴网上性伴侣通知和治疗Woodruff,PlosMed,200824Repeatscreening复查•Repeattestingofanygonorrhea,chlamydiaorsyphiliscaseat3months3个月时对任何淋病、衣原体疾病或梅毒病例进行复查•Repeatscreeningat3-6monthsinthoseMSMwithmultiplepartners3到6个月时对那些有多个性伴侣的MSM进行复查25Conclusion结论•Aculturally-competentandcommunity-informedresponseiscriticalineffectiveSTDprevention,treatmentandcontrolservices具备文化能力，有相关知识的社区的应对措施对于有效的性病预防、治疗和控制服务至为关键•Usetechnology—Internet,molecular,cellular—toincreaseaccessforscreeningandtreatment使用科技—互联网、分子、细胞，增加检查和治疗的渠道26SourcesformoreSTDinformation更多性病信息来源•SFDPHCityClinicSFDPH市诊所–•StateofCA加州–•CDCSTDTreatmentGuidelines2006•2006年CDC性病治疗指南–致谢•SFDPHSTDPreventionandControlServicesSFDPH性病预防和控制服务•KyleBernstein,PhDKyleBernstein博士•SFPartnersinSTD/HIVPrevention性病/艾滋病预防SF合作伙伴•CDC—WendyWolf,FrankStronaCDC—WendyWolf,FrankStrona•DayneCollinsDayneCollins•SFDPHLaboratory—Dr.MarkPandoriandSallyLiskaSFDPH实验室—MarkPandori博士和SallyLiska博士•FundingfromCityandCountyofSanFrancisco,CDC,StateofCalifornia,NIHNIH，加州，CDC，旧金山市和旧金山县赞助ISIS,Inc.