Stephen Bonett1, Vicky Tam2, Anjali Singapur3, Jungwon Min2, Helen C Koenig4, Sarah M Wood2,4. 1. School of Nursing, 6572University of Pennsylvania, Philadelphia, Pennsylvania, USA. 2. Department of Biomedical and Health Informatics, 6567Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 3. 7761Swarthmore College, Swarthmore, PA, USA. 4. Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Incidence of syphilis has been rising in recent years and disproportionately affects young adults, racial/ethnic minority men, and people living with HIV. This study describes patterns of syphilis infection and syphilis-related care utilization among adolescents and young adults living with HIV (AYALH) in Philadelphia. METHODS: We conducted a retrospective cohort study of AYALH receiving care at an adolescent-specialty clinic who received a syphilis test and/or benzathine penicillin for syphilis treatment from 2011 to 2018 (N = 335). Syphilis incidence rates were calculated by baseline demographic characteristics and by calendar year. Recurrent survival analysis was used to explore how demographic and neighborhood-level factors were associated with incident syphilis and syphilis-related care utilization. RESULTS: Syphilis-related care was provided 145 times and there were 109 episodes of confirmed syphilis among 83 unique participants between 2011 and 2018. The overall syphilis incidence rate was 13.50 (95% CI: 10.9-16.5) cases per hundred person-years. Participants assigned male sex at birth had higher hazards of infection (HR: 6.12, 95% CI: 1.53-24.48), while older participants (HR: 0.64, 95% CI: 0.58-0.72) and those living further from the clinic had lower hazards of infection (HR: 0.97, 95% CI: 0.94-1.00). Race, insurance status, neighborhood diversity index, and neighborhood social disadvantage index were not associated with hazard of infection or syphilis-related care utilization. CONCLUSIONS: Our study found high incidence of syphilis infection among a cohort of AYALH. Integrating comprehensive sexually transmitted infection prevention services into HIV care and improving syphilis prevention services in communities with high syphilis rates should be a priority in future intervention work.
BACKGROUND: Incidence of syphilis has been rising in recent years and disproportionately affects young adults, racial/ethnic minority men, and people living with HIV. This study describes patterns of syphilis infection and syphilis-related care utilization among adolescents and young adults living with HIV (AYALH) in Philadelphia. METHODS: We conducted a retrospective cohort study of AYALH receiving care at an adolescent-specialty clinic who received a syphilis test and/or benzathine penicillin for syphilis treatment from 2011 to 2018 (N = 335). Syphilis incidence rates were calculated by baseline demographic characteristics and by calendar year. Recurrent survival analysis was used to explore how demographic and neighborhood-level factors were associated with incident syphilis and syphilis-related care utilization. RESULTS: Syphilis-related care was provided 145 times and there were 109 episodes of confirmed syphilis among 83 unique participants between 2011 and 2018. The overall syphilis incidence rate was 13.50 (95% CI: 10.9-16.5) cases per hundred person-years. Participants assigned male sex at birth had higher hazards of infection (HR: 6.12, 95% CI: 1.53-24.48), while older participants (HR: 0.64, 95% CI: 0.58-0.72) and those living further from the clinic had lower hazards of infection (HR: 0.97, 95% CI: 0.94-1.00). Race, insurance status, neighborhood diversity index, and neighborhood social disadvantage index were not associated with hazard of infection or syphilis-related care utilization. CONCLUSIONS: Our study found high incidence of syphilis infection among a cohort of AYALH. Integrating comprehensive sexually transmitted infection prevention services into HIV care and improving syphilis prevention services in communities with high syphilis rates should be a priority in future intervention work.
Entities:
Keywords:
Syphilis; adolescents; sexually transmitted infections; survival analysis; young adults
Authors: Gregorio A Millett; John L Peterson; Stephen A Flores; Trevor A Hart; William L Jeffries; Patrick A Wilson; Sean B Rourke; Charles M Heilig; Jonathan Elford; Kevin A Fenton; Robert S Remis Journal: Lancet Date: 2012-07-20 Impact factor: 79.321
Authors: Hilary F Byrnes; Brenda A Miller; Christopher N Morrison; Douglas J Wiebe; Marcie Woychik; Sarah E Wiehe Journal: Health Place Date: 2017-01-04 Impact factor: 4.078
Authors: Robert K Bolan; Matthew R Beymer; Robert E Weiss; Risa P Flynn; Arleen A Leibowitz; Jeffrey D Klausner Journal: Sex Transm Dis Date: 2015-02 Impact factor: 2.830
Authors: Winston E Abara; Kristen L Hess; Robyn Neblett Fanfair; Kyle T Bernstein; Gabriela Paz-Bailey Journal: PLoS One Date: 2016-07-22 Impact factor: 3.240