Publications (46) View all
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Article: The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008.
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ABSTRACT: Millions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the United States. We assembled recent (i.e., 2002-2011) cost estimates to determine the lifetime cost per case of 8 major STIs (chlamydia, gonorrhea, hepatitis B virus, human immunodeficiency virus (HIV), human papillomavirus, genital herpes simplex virus type 2, trichomoniasis and syphilis). The total direct cost for each STI was computed as the product of the number of new or newly diagnosed cases in 2008 and the estimated discounted lifetime cost per case. All costs were adjusted to 2010 US dollars. Results indicated that the total lifetime direct medical cost of the 19.7 million cases of STIs that occurred among persons of all ages in 2008 in the United States was $15.6 (range, $11.0-$20.6) billion. Total costs were as follows: chlamydia ($516.7 [$258.3-$775.0] million), gonorrhea ($162.1 [$81.1-$243.2] million), hepatitis B virus ($50.7 [$41.3-$55.6] million), HIV ($12.6 [$9.5-$15.7] billion), human papillomavirus ($1.7 [$0.8-$2.9] billion), herpes simplex virus type 2 ($540.7 [$270.3-$811.0] million), syphilis ($39.3 [$19.6-$58.9] million), and trichomoniasis ($24.0 [$12.0-$36.0] million). Costs associated with HIV infection accounted for more than 81% of the total cost. Among the nonviral STIs, chlamydia was the most costly infection. Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States. The burden of STIs would be even greater in the absence of STI prevention and control efforts.Sexually transmitted diseases 03/2013; 40(3):197-201. · 2.58 Impact Factor -
Article: Suboptimal Adherence to Repeat Testing Recommendations for Men and Women With Positive Chlamydia Tests in the United States, 2008-2010.
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ABSTRACT: Background. Chlamydia is prevalent among young persons in the United States. Infected persons have a high prevalence of infection several months later, most likely from reinfection. Retesting of all men and women with a positive test is recommended 3 months after treatment. A test-of-cure is recommended for pregnant women 3-4 weeks after treatment.Methods. We analyzed 2008-2010 chlamydia testing data from a large US laboratory to estimate test positivity by patient demographic characteristics and diagnoses, and patterns of repeat testing of men and nonpregnant women with a positive test and tests-of-cures of pregnant women with a positive test.Results. During the study period, 7.0% of 0.40 million tests performed in men and 4.0% of 2.92 million tests performed in women were positive. Among young women, positivity rates were highest among those aged 15-19 years, ranging from 8.5% to 10.0%. Retesting rates of persons with a positive test were suboptimal, with 22.3% of men and 38.0% of nonpregnant women retested. Although 60.1% of pregnant women with a positive test were retested, only 22.0% received a test-of-cure within the 4-week recommended time frame. Repeat tests were positive in 15.9% of men, 14.2% of nonpregnant women, and 15.4% of pregnant women.Conclusions. Analyses of laboratory testing data provided important insights into chlamydia testing, retesting, and positivity among a diverse US population of men and women. Too few persons were retested as recommended, and interventions are needed to increase both healthcare provider and patient adherence to recommendations for retesting men and women with positive tests.Clinical Infectious Diseases 10/2012; · 9.15 Impact Factor -
Article: Monitoring HIV testing at visits to emergency departments in the United States: Very low rate of HIV testing.
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ABSTRACT: BACKGROUND:: Early diagnosis and treatment of HIV infection results in improved clinical outcomes and decreased transmission, yet many infected persons are unaware of their infection or diagnosed late. The Centers for Disease Control and Prevention (CDC) recommends routine opt-out testing of all persons aged 13-64 in high prevalence settings. STUDY OBJECTIVE:: To describe methods to estimate HIV testing rates at visits to emergency departments (EDs) for monitoring adherence to recommendations for opt-out testing. METHODS:: We analyzed data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). In 2009, two questions were added to the survey about HIV status and testing. We estimated the frequency of HIV testing at ED visits made by persons aged 13-64 years not known to be HIV infected. RESULTS:: In 2009, 90.5 million visits were made to EDs, including 60.0% by whites, 24.5% by blacks, and 12.1% by Hispanics; and 38.4% by privately insured, 25.7% by Medicaid insured, and 21.4% by uninsured persons. Among 89.9 million visits by patients not known to be HIV infected, HIV testing was performed at only 0.2% of visits. Among 3.4 million visits made by persons in whom targeted testing is recommended-those with increased risk for HIV and other sexually transmitted diseases, or pregnancy-only 2.3% were tested for HIV. CONCLUSIONS:: NHAMCS can be a useful tool to monitor trends in HIV testing in U.S. emergency departments. A high proportion of visits to EDs in the United States were made by persons in historically medically underserved populations and routine HIV testing was a rare event during ED visits.JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2012; · 4.43 Impact Factor -
Article: Self-reported Chlamydia testing rates of sexually active women aged 15-25 years in the United States, 2006-2008.
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ABSTRACT: Using the 2006-2008 National Survey of Family Growth, we estimated a 37.9% annual chlamydia testing rate for sexually active US women aged 15 to 25 years, defined as having ≥ 1 sex partner in the past year. Our results highlight the need for increased testing among sexually active young women.Sexually transmitted diseases 08/2012; 39(8):605-7. · 2.58 Impact Factor -
Article: Higher yet suboptimal chlamydia testing rates at community health centers and outpatient clinics compared with physician offices.
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ABSTRACT: To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics.American Journal of Public Health 06/2012; 102(8):e26-9. · 3.93 Impact Factor
