P-719. Artificial Intelligence - Driven Syndromic Algorithm for Point-of-Care STI Management: A Randomized Controlled Trial Across Healthcare Tiers

Bloodstream infections are associated with considerable morbidity and health care costs. Molecular rapid diagnostic tests (mRDTs) are a promising complement to conventional laboratory methods for the diagnosis of bloodstream infections and may reduce the time to effective therapy among patients with bloodstream infections. The concurrent implementation of antimicrobial stewardship programs (ASPs) may reinforce these benefits. The aim of this study was to evaluate the cost-effectivenesses of competing strategies for the diagnosis of bloodstream infection alone or combined with an ASP. To this effect, we constructed a decision-analytic model comparing 12 strategies for the diagnosis of bloodstream infection. The main arms compared the use of mRDT and conventional laboratory methods with or without an ASP. The baseline strategy used as the standard was the use of conventional laboratory methods without an ASP, and our decision-analytic model assessed the cost-effectivenesses of 5 principal strategies: mRDT (with and without an ASP), mRDT with an ASP, mRDT without an ASP, conventional laboratory methods with an ASP, and conventional laboratory methods without an ASP. Furthermore, based on the availability of data in the literature, we assessed the cost-effectivenesses of 7 mRDT subcategories, as follows: PCR with an ASP, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis with an ASP, peptide nucleic acid fluorescent in situ hybridization (PNA-FISH) with an ASP, a blood culture nanotechnology microarray system for Gram-negative bacteria (BC-GP) with an ASP, a blood culture nanotechnology microarray system for Gram-positive bacteria (BC-GN) with an ASP, PCR without an ASP, and PNA-FISH without an ASP. Our patient population consisted of adult inpatients in U.S. hospitals with suspected bloodstream infection. The time horizon of the model was the projected life expectancy of the patients. In a base-case analysis, cost-effectiveness was determined by calculating the numbers of bloodstream infection deaths averted, the numbers of quality-adjusted life years gained, and incremental cost-effectiveness ratios (ICERs). In a probabilistic analysis, uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. In the base-case analysis, MALDI-TOF analysis with an ASP was the most cost-effective strategy, resulting in savings of $29,205 per quality-adjusted life year and preventing 1 death per 14 patients with suspected bloodstream infection tested compared to conventional laboratory methods without an ASP (ICER, -$29,205/quality-adjusted life year). BC-GN with an ASP (ICER, -$23,587/quality-adjusted life year), PCR with an ASP (ICER, -$19,833/quality-adjusted life year), and PCR without an ASP (ICER, -$21,039/quality-adjusted life year) were other cost-effective options. In the probabilistic analysis, mRDT was dominant and cost-effective in 85.1% of simulations. Importantly, mRDT with an ASP had an 80.0% chance of being cost-effective, while mRDT without an ASP had only a 41.1% chance. In conclusion, our findings suggest that mRDTs are cost-effective for the diagnosis of patients with suspected bloodstream infection and can reduce health care expenditures. Notably, the combination of mRDT and an ASP can result in substantial health care savings.

HIV/AIDS has affected nearly every country on the planet. The effect of this surge has brought all major modes of HIV/AIDS transmission to the attention of public health professionals worldwide. Sexually Transmitted Infections (STIs), which are a major mode of transmission, increases the prevalence of HIV/AIDS. The study's aim was to assess knowledge and management of sexually transmitted infections by general Physicians of Lahore. A cross-sectional survey, of 203 general Physicians in Lahore, was conducted using structured questionnaires. Descriptive analysis was used to compute means and proportions. According to the findings of this study, 23 percent of UDS and 5 percent of GPs appropriately managed GUS syndromes. However, none of the GPs were found to managed VDS. The GPs were more likely to be trained in syndromic management who managed UDS appropriately (adj. OR: 8.0; 95% CI: 3.2-20.1), and UDS was appropriately managed (adj. OR: 2.7; 95% CI: 2.0-3.6). This study reveals a significant proportion of GPs in Karachi managed STIs. This provides a fantastic opportunity to treat and counsel STI patients and their partners. However, general Physicians lack the necessary skills. As a result, GPs must be trained in STI management in order to avert the impending disaster of HIV/AIDS. This study suggested that practicing doctors, particularly those who are young and female, should get prioritized training in STI care. Even though both the public and business sectors are actively working in this direction, additional efforts are still required.

Background:Primary care providers are well placed to control the spread of sexually transmitted infections (STI); however, care is likely to be influenced by their attitudes and beliefs. The present study...

ObjectivesSpecific to sexual health, individuals in need of information may be adolescents who have limited ability to formally access healthcare. These digital natives may turn to ChatGPT to address their...

To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. Ten rural primary care clinics, Hlabisa district, South Africa. Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.

Introduction: It is assumed that sexual assault cases presenting at Emergency Departments (ED) are frequently lost to follow-up and should be considered an eligible population for presumptive antimicrobial treatment of sexual transmitted infections (STIs) at initial assessment without lab confirmation. With the growing burden of antibiotic resistance, antimicrobial stewardship guidelines caution against this practice. Among sexual assault cases, our study evaluated STI prevalence, follow-up and retention patterns, and described the prevalence of STI presumptive treatment. Methods: The Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital is the only program in Ottawa offering emergency and forensic care for survivors of sexual assault and domestic violence. Descriptive statistics were used to summarize information on demographics, clinical presentation, STI testing and results using data from the SAPACP case registry (January 1 - December 31, 2015). Results: Among the 406 patients seen by the SAPACP, there were 262 (64.5%) sexual assault cases that were included in this analysis. STI testing was completed for 209 (79.8%) patients at the initial visit, 90 (43.1%) completed via urine nucleic acid testing (NAAT), 140 (67.0%) via culture swab and 20 (9.6%) via both. Laboratory results detected no cases of gonorrhea, 8 (3.8%) cases of chlamydia, 33(15.8%) cases of bacterial vaginosis (BV), 17 (8.1%) cases of yeast vaginitis and 16 (7.7%) indeterminate testing results. Antimicrobial STI presumptive treatment was given to 12 (5.7%) patients at the time of their initial visit prior to lab confirmation. Patient follow-up occurred in 172 (82.3%) patients, with all chlamydia cases treated. Of the 37 (17.7%) patients lost to follow up, 9 were positive for BV, 1 was positive for yeast and 10 were indeterminate, all of which may be underlying vaginal flora. Follow up testing/test of cure was completed in 91 (52.9%) of patients, with 4 (2.3%) positive results, all of which were BV. Conclusion: In our ED, up to 15.8% of sexual assault patients had at least one laboratory confirmed STI and over 80% of all patients returned for follow-up. Our results show that it is safe and effective to only treat STI screen positive cases at follow-up, reducing the frequency of presumptive antimicrobial STI treatment. Benefits of this strategy include decreased patient side effects, cost savings and better antimicrobial stewardship.

There is limited research on sexually transmitted infections (STIs) among adolescents in Korea. The objective of this study was to explore the prevalence of and risk factors for STIs among Korean adolescents under probation. A cross-sectional analysis was conducted in one juvenile-delinquent center and five probation offices in Korea to determine the prevalence of STIs caused by the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus (HSV), human immunodeficiency virus (HIV), Treponema pallidum, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum. Of the 237 (208 male and 29 female) participating adolescents, 152 (64.1%) had a history of coitus. Overall, 133 (56.1%) subjects tested positive for at least one microorganism in their genitourinary tract. The most prevalent pathogen was U. urealyticum (24.7%, n = 65), followed by U. parvum (24.1%, n = 57), M. hominis (17.3%, n = 41), C. trachomatis (13.9%, n = 33), N. gonorrhoeae (1.7%, n = 4), T. vaginalis (0.8%, n = 2), and HSV (0.8%, n = 2). The prevalence of syphilis was 0.8% (n = 2). There were no reported cases of HIV infection. Fifty-four participants (35.5%) were positive with more than two pathogens. We did not find any significant difference between STIs and socioeconomic factors, behavioral factors or sexual practices. In conclusion, the prevalence of STIs among adolescents under probation was high. Systematic screening programs, more practical sexual education, and adequate provision of treatment are essential for the prevention and management of STIs among adolescents, especially those under probation.

Little is known about the prevalence of sexually transmitted infections (STIs) and about sexual and reproductive health in Central and Eastern Europe. However, it is clear that major epidemics of STIs currently exist. To provide baseline information for the development of national guidelines on the management of STIs in Azerbaijan. A prevalence study on STIs, including a questionnaire on sexual and reproductive health, in two regions of Azerbaijan targeted three groups: (1) pregnant women, (2) gynecology patients, and (3) men attending a dermatovenereology clinic. The 407 pregnant women in this study had a mean of 1.47 abortions and 1.40 births per woman. Of these women, 12% reported condom use and 41% previous symptoms of a sexually transmitted infection. Active syphilis was found in 1.7% of the women. The 326 gynecology patients had a mean of 2.54 abortions and 2.63 births per woman. Of these patients, 11% reported use of modern contraceptives, 18.3% previous condom use, and 63% previous symptoms of an STI. The prevalence of active syphilis was 2.2%, Chlamydia trachomatis 3.1%, Neisseria gonorrhoeae 2.8%, Trichomonas vaginalis 7.1%, Candida 33.1%, and bacterial vaginosis 32.5%. Of the 197 male patients, 67% reported multiple partners in the past 3 months, 62% money exchanged for sex, 37% condom use ever, and 40% a history of STIs. Active syphilis was found in 9.5% of the men, C trachomatis in 5.9%, N gonorrhoeae in 17%, and T vaginalis in 4.4%. The data show high-risk behavior in the men attending STI clinics, poor sexual and reproductive health status in the women, and underreporting of official data.

Sexually transmitted infections (STIs) are widespread worldwide and negatively affect sexual and reproductive health. Gaps in evidence and in available tools have long hindered STI programmes and policies, particularly in resource-limited settings. In 2022, WHO initiated a research prioritisation process to identify the most important STI research areas to address the global public health need. Using an adapted Child Health and Nutrition Research Initiative methodology including two global stakeholder surveys, the process identified 40 priority STI research needs. The top priorities centred on developing and implementing affordable, feasible, rapid point-of-care STI diagnostic tests and new treatments, especially for gonorrhoea, chlamydia, and syphilis; designing new multipurpose prevention technologies and vaccines for STIs; and collecting improved STI epidemiologic data on both infection and disease outcomes. The priorities also included innovative programmatic approaches, such as new STI communication and partner management strategies. An additional six research areas related to mpox (formerly known as monkeypox) reflect the need for STI-related research during disease outbreaks where sexual transmission can have a key role. These STI research priorities provide a call to action for focus, investment, and innovation to address existing roadblocks in STI prevention, control, and management to advance sexual and reproductive health and wellbeing for all.

In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

ObjectivePregnant and postpartum women (PPW) in Southern Africa are at increased risk of acquiring HIV and curable sexually transmitted infections (STIs). Oral pre-exposure prophylaxis (PrEP) is safe and effective to...

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

BackgroundDiabetic retinopathy (DR) has become a leading cause of global blindness as a microvascular complication of diabetes. Regular screening of diabetic retinopathy is strongly recommended for people with diabetes so that timely treatment can be provided to reduce the incidence of visual impairment. However, DR screening is not well carried out due to lack of eye care facilities, especially in the rural areas of China. Artificial intelligence (AI) based DR screening has emerged as a novel strategy and show promising diagnostic performance in sensitivity and specificity, relieving the pressure of the shortage of facilities and ophthalmologists because of its quick and accurate diagnosis. In this study, we estimated the cost-effectiveness of AI screening for DR in rural China based on Markov model, providing evidence for extending use of AI screening for DR.MethodsWe estimated the cost-effectiveness of AI screening and compared it with ophthalmologist screening in which fundus images are evaluated by ophthalmologists. We developed a Markov model-based hybrid decision tree to analyze the costs, effectiveness and incremental cost-effectiveness ratio (ICER) of AI screening strategies relative to no screening strategies and ophthalmologist screening strategies (dominated) over 35 years (mean life expectancy of diabetes patients in rural China). The analysis was conducted from the health system perspective (included direct medical costs) and societal perspective (included medical and nonmedical costs). Effectiveness was analyzed with quality-adjusted life years (QALYs). The robustness of results was estimated by performing one-way sensitivity analysis and probabilistic analysis.ResultsFrom the health system perspective, AI screening and ophthalmologist screening had incremental costs of $180.19 and $215.05 but more quality-adjusted life years (QALYs) compared with no screening. AI screening had an ICER of $1,107.63. From the societal perspective which considers all direct and indirect costs, AI screening had an ICER of $10,347.12 compared with no screening, below the cost-effective threshold (1–3 times per capita GDP of Chinese in 2019).ConclusionsOur analysis demonstrates that AI-based screening is more cost-effective compared with conventional ophthalmologist screening and holds great promise to be an alternative approach for DR screening in the rural area of China.

Rural population constitutes a significant population of our country. According to the regions, the sexual behavior and pattern of sexually transmitted infections (STIs) changes because of variation in health facilities, education, and sociocultural belief. To study the sociodemographic profile, sexual behavior, and pattern of STIs based on the syndromic approach in the rural population attending STIs clinic from the east-central zone of India. Between January 2020 and July 2022, a retrospective study was carried out in a STIs clinic at a tertiary care facility in India's east-central region. Data included demographics, clinical profiles (syndromic approach), and sexual behavior from all the rural population suffering from STIs. The data were corroborated using the proper statistical tools. Seven hundred and twenty-two (63.6%) of the 1135 STI cases were from the rural population. The gender ratio was 17:1, with 333 (46.1%) patients between the ages of 20 and 30 years. Four hundred and ninety-four (68.4%) of the rural population had education qualifications below the 10th class. The predominant occupation was a homemaker (582; 80.6%). Drug abuse was noted in 13 (1.8%) cases. Lower abdominal pain was the most clinical manifestation seen in 441 (61%) cases, followed by vaginal discharge in 89 (12.3%) cases. The majority of the patients presented with the first episode of symptoms and had a single regular partner with no symptoms in a partner. In 22.9% of cases, the partner had a history of frequent travel. In 94.1% of cases, protective measures were not used. Young married adults, female partners, lower education, and low-income classes were among those who had STIs, with frequent unprotected sexual activity. Lower abdominal pain is the most common symptom in this area.