IU researchers discuss pharmacists' role in HIV care, high risk for STIs after prison and more
VIENNA -- Around 20 Indiana University researchers, including those from the IU School of Medicine, Regenstrief Institute, IU School of Public Health-Bloomington, the Rural Center for AIDS/STD Prevention and the Fairbanks School of Public Health, are participating in the STI & AIDS World Congress, July 14 to 17, in Vienna, Austria. The congress is a biennial meeting of international STI researchers and practitioners.
Community pharmacists support more involved role in customers' HIV treatment
Ex-offender data shows high risk of sexually transmitted infections after release
Study: STD clinics could reduce obstacles to much-needed cervical cancer screenings
Community pharmacists in the United States have a unique opportunity to consult with customers about HIV treatment when selling over-the-counter HIV tests, according to a study by researchers at the Indiana University School of Public Health-Bloomington, the Rural Center for AIDS/STD Prevention and Butler University College of Pharmacy and Health Sciences.
In a study lead by Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention, licensed community pharmacists in Indiana reported that they wanted an active consultation role when customers purchased over-the-counter HIV tests. A rapid HIV home test kit, approved by FDA in the summer of 2012, is being sold through the U.S in pharmacies and on the Internet.
"Pharmacists understood the benefit of greater access to HIV testing, but they felt that their role as pharmacists was beyond that of OTC test seller," Meyerson said. "Instead, pharmacists saw themselves as health consultants and wished to build on the strong relationships that they have with customers during the point at which they sell the test.
"The pharmacy system could be an effective environment for HIV consultation because it would help to strengthen the current system of linkage to care," Meyerson said. Currently, 20 percent of those living with HIV in the U.S. do not yet know it; but among those who do, only 24 percent are in treatment with suppressed viral loads. "This essentially means that people are not testing for HIV, that they are not properly linked to treatment when they do test positive, and they are not maintained in care."
She said rural communities have the most to gain from an engaged pharmacy environment because these communities often lack an HIV testing and treatment infrastructure, and people often feel stigmatized about HIV testing.
"If pharmacists are engaged and supportive, then it might help to increase the number of those who test for HIV and also the number of people linked to HIV treatment," she said.
The study is one of several studies presented by Meyerson and IU School of Public Health-Bloomington colleagues at the STI & AIDS World Congress. Co-authors of "More Than Just Selling the Test: Pharmacist Opinion About the Sale of Over-the-Counter HIV Rapid Tests," include Priscilla T. Ryder and Kelsey Coy, Butler University College of Pharmacy and Health Sciences; and Christiana von Hippel, IU School of Public Health-Bloomington and the Rural Center for AIDS/STD Prevention. The study was supported by the Indiana Clinical and Translational Sciences Institute.
The American health care system may be missing a golden opportunity to curtail sexually transmitted infections in communities, according to a new study of offenders following release from the justice system. Researchers at Indiana University School of Medicine and Regenstrief Institute will present their findings at the STI & AIDS World Congress, showing that individuals released from the justice system have a high risk of contracting a sexually transmitted infection within the first year.
Sarah E. Wiehe, associate professor of pediatrics at the IU School of Medicine and an affiliated scientist at the Regenstrief Institute, said studies have shown that criminal offenders have a high rate of sexually transmitted infections when entering the justice system and that communities with a high percentage of incarcerations also have an increased number of STI cases.
The analysis using existing justice system and public health data by the IU researchers also shows that ex-offenders had a high risk of contracting a sexually transmitted infection within the first year of release. That risk was particularly high for those released from the juvenile system, Wiehe said.
Wiehe and colleagues worked with the Marion County (Indiana) Courts, the Marion County Health Department, the Indianapolis Metropolitan Police Department and the Indiana Department of Corrections to track 260,000 youths and adults who had interaction with the justice system through arrest, jail, juvenile detention, juvenile prison or adult prison from 2000 to 2008.
Wiehe said that of those who tested positive for sexually transmitted infections from 2000 to 2008, 16 percent contracted the infection within the first 365 days of release from the justice system. That incidence rate includes:
- 10 percent from adult prison.
- 13 percent from jail.
- 10 percent of those arrested but not jailed or imprisoned.
- 26 percent from juvenile prison.
- 22 percent from juvenile detention.
"The one-year time period following release from the justice system represents a high-impact opportunity to reduce the sexually transmitted infection rates at a population level. Even modestly successful efforts to reduce post-incarceration STI and STI risk could have substantive effects on community STI burden across infection types," Wiehe said.
This research, funded by a National Institute of Allergy and Infectious Diseases grant (R21AI084060), is the first of a series the IU investigators hope to pursue. Other IU School of Medicine investigators contributing to this research are J. Dennis Fortenberry, Matthew C. Aalsma and Marc B. Rosenman.
Wiehe said the next phase of research will be looking at the rates and effect of sexually transmitted infection related to ex-offenders in the community, followed by a review to see whether racial disparities in the justice system correlate to similar disparities in sexually transmitted infection rates.
A new study found that STD clinics could provide important access to cervical cancer screenings for women who traditionally have trouble receiving these screenings because of lack of insurance and other obstacles.
Cervical cancer can be painful and deadly but can be effectively treated if caught soon enough. Yet in the U.S., reaching women who are underscreened for this cancer remains a public health challenge because insurance is the primary indicator for screening.
"Women who are uninsured, as well as women of color, are at highest risk for being underscreened for cervical cancer. The primary medical system misses these women completely because of their access challenges," said Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention and lead researcher in the study, "Can STD Clinics Ride the Cervical Cancer Screening Bike? Experiences From an Urban STD Clinic," presented at the STI & AIDS World Congress in Vienna.
"We have all the tools to address cervical cancer: a safe and effective vaccine, accurate diagnostic tools and treatment options if cervical disease is identified soon enough," Meyerson said. "Yet access is not equal in this country, and we need to find ways to expand our health systems for greater access. This study was about finding a new point of access for women who need it most."
Researchers recruited women from urban STD clinics to examine their willingness to receive cervical cancer screenings. The vast majority of women elected to participate in the study, primarily because they lacked a primary health care relationship. Participants expressed gratitude -- and sometimes relief -- for the opportunity to receive the cancer screening given their lack of insurance.
"This study shows that STD clinics -- places where women access care episodically -- could be a great place to offer cervical cancer screening," Meyerson said. "If we find ways to increase access to screening by women who need it most, we could increase our chances of eliminating a cancer in this generation.
"Our experience suggests that women at STD clinics are eager to receive cervical cancer screenings and the results," Meyerson said. "The majority of them are in need of this important health service, as they reported not having a pap smear for at least three years."
Meyerson is also an assistant professor of health policy and management at the IU School of Public Health-Bloomington and on the faculty of the Center for HPV Research at the IU School of Medicine.
Co-authors include Barbara Van Der Pol, IU School of Public Health-Bloomington and Center for HPV Research at the IU School of Medicine; Janet Arno, Marion County Health Department in Indiana; Gregory Zimet, Center for HPV Research and the Department of Pediatrics at the IU School of Medicine; A. Davis, doctoral student at IU School of Public Health-Bloomington and Rural Center for AIDS/STD Prevention; Lynn Barclay, American Sexual Health Association; and I. Rivera, MPH graduate of IU School of Public Health-Bloomington.
The study was supported by the Indiana Clinical and Translational Sciences Institute, an incubator for National Institutes of Health-funded projects.
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