Process models are used to describe and/or guide the process of translating research into practice. Models by Huberman [40], Landry et al. [41], the CIHR (Canadian Institutes of Health Research) Knowledge Model of Knowledge Translation [42], Davis et al. [43], Majdzadeh et al. [44] and the K2A (Knowledge-to-Action) Framework [15] outline phases or stages of the research-to-practice process, from discovery and production of research-based knowledge to implementation and use of research in various settings.
Early research-to-practice (or knowledge-to-action) models tended to depict rational, linear processes in which research was simply transferred from producers to users. However, subsequent models have highlighted the importance of facilitation to support the process and placed more emphasis on the contexts in which research is implemented and used. Thus, the attention has shifted from a focus on production, diffusion and dissemination of research to various implementation aspects [21].
tales from a not so smart miss know it all epub 15
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This Razorcake ebook is made possible in part by grants from the City of Los Angeles, Department of Cultural Affairs and is supported by the Los Angeles County Board of Supervisors through the Los Angeles Arts Commission.
In 2018, CDC staff identified key questions about treatment and clinical management to guide an update of the 2015 STD treatment guidelines (1). To answer these questions and synthesize new information available since publication of the 2015 guidelines, subject matter experts and CDC staff collaborated to conduct systematic literature reviews by using an extensive MEDLINE database evidence-based approach for each section of the 2015 guidelines (e.g., using English-language published abstracts and peer reviewed journal articles). These systematic reviews were focused on four principal outcomes of STI therapy for each disease or infection: 1) treatment of infection on the basis of microbiologic eradication; 2) alleviation of signs and symptoms; 3) prevention of sequelae; and 4) prevention of transmission, including advantages (e.g., cost-effectiveness, single-dose formulations, and directly observed therapy) and disadvantages (e.g., adverse effects) of specific regimens. The outcome of the literature reviews guided development of background materials, including tables of evidence from peer-reviewed publications summarizing the type of study (e.g., randomized controlled trial or case series), study population and setting, treatments or other interventions, outcome measures assessed, reported findings, and weaknesses and biases in study design and analysis.
Polyurethane external condoms provide protection against STIs and HIV and pregnancy comparable to that of latex condoms (20,31). These can be substituted for latex condoms by persons with latex sensitivity, are typically more resistant to deterioration, and are compatible with use of both oil-based and water-based lubricants. The effectiveness of other synthetic external condoms to prevent STIs has not been extensively studied, and FDA labeling restricts their recommended use to persons who are sensitive to or allergic to latex. Natural membrane condoms (frequently called natural skin condoms or [incorrectly] lambskin condoms) are made from lamb cecum and can have pores up to 1,500 nm in diameter. Although these pores do not allow the passage of sperm, they are more than 10 times the diameter of HIV and more than 25 times that of HBV. Moreover, laboratory studies demonstrate that sexual transmission of viruses, including HBV, herpes simplex virus (HSV), and HIV, can occur with natural membrane condoms (31). Therefore, natural membrane condoms are not recommended for prevention of STIs and HIV.
Methods that combine STI and HIV prevention with pregnancy prevention are known as multipurpose prevention technologies (MPTs) (37) ( ). Internal and external condoms are both examples of MPTs because they are effective prevention measures when used correctly for STI and HIV transmission or pregnancy prevention. The multicenter Evidence for Contraception Options and HIV Outcomes (ECHO) trial observed no statistically significant differences in HIV incidence rates among women randomly assigned to one of three contraceptive methods (depot medroxyprogesterone acetate [DMPA], levonorgestrel implant, and copper-containing intrauterine device [IUD]); however, rates of HIV infection were high in all groups, indicating a need for MPTs (38). Development of MPTs is complex and ongoing; products under study include microbicides with contraceptive devices (e.g., tenofovir with a vaginal ring contraceptive delivery package) and other innovative methods (39).
Abstinence from oral, vaginal, and anal sex and participating in a long-term, mutually monogamous relationship with a partner known to be uninfected are prevention approaches to avoid transmission of STIs. For persons who are being treated for an STI (or whose partners are undergoing treatment), counseling that encourages abstinence from sexual intercourse until completion of the entire course of medication is vital for preventing reinfection. A trial conducted among women regarding the effectiveness of counseling messages when patients have cervicitis or vaginal discharge demonstrated that women whose sex partners have used condoms might benefit from a hierarchical message that includes condoms but women without such experience might benefit more from an abstinence-only message (104). A more comprehensive discussion of abstinence and other sexual practices that can help persons reduce their risk for STIs is available in Contraceptive Technology, 21st Edition (31).
STI screening among MSM has been reported to be suboptimal. In a cross-sectional sample of MSM in the United States, approximately one third reported not having had an STI test during the previous 3 years, and MSM with multiple sex partners reported less frequent screening (221). MSM living with HIV infection and engaged in care also experience suboptimal rates of STI testing (222,223). Limited data exist regarding the optimal frequency of screening for gonorrhea, chlamydia, and syphilis among MSM, with the majority of evidence derived from mathematical modeling. Models from Australia have demonstrated that increasing syphilis screening frequency from two times a year to four times a year resulted in a relative decrease of 84% from peak prevalence (224). In a compartmental model applied to different populations in Canada, quarterly syphilis screening averted more than twice the number of syphilis cases, compared with semiannual screening (225). Furthermore, MSM screening coverage needed for eliminating syphilis among a population is substantially reduced from 62% with annual screening to 23% with quarterly screening (226,227). In an MSM transmission model that explored the impact of HIV PrEP use on STI prevalence, quarterly chlamydia and gonorrhea screening was associated with an 83% reduction in incidence (205). The only empiric data available that examined the impact of screening frequency come from an observational cohort of MSM using HIV PrEP in which quarterly screening identified more bacterial STIs, and semiannual screening would have resulted in delayed treatment of 35% of total identified STI infections (206). In addition, quarterly screening was reported to have prevented STI exposure in a median of three sex partners per STI infection (206). On the basis of available evidence, quarterly screening for gonorrhea, chlamydia, and syphilis for certain sexually active MSM can improve case finding, which can reduce the duration of infection at the population level, reduce ongoing transmission and, ultimately, prevalence among this population (228).
Limited information is available regarding transmission of bacterial STIs between female partners. Transmission of syphilis between female sex partners, probably through oral sex, has been reported. Although the rate of transmission of C. trachomatis or N. gonorrhoeae between women is unknown, infection also might be acquired from past or current male partners. Data indicate that C. trachomatis infection among WSW can occur (275,286,308,309). Data are limited regarding gonorrhea rates among WSW and WSWM (170). Reports of same-sex behavior among women should not deter providers from offering and providing screening for STIs, including chlamydia, according to guidelines.
Providers serving persons at risk for STIs are in a position to diagnose HIV infection during its acute phase. Diagnosing HIV infection during the acute phase is particularly important because persons with acute HIV have highly infectious disease due to the concentration of virus in plasma and genital secretions, which is extremely elevated during that stage of infection (421,422) ( -and-adolescent-arv/acute-and-recent-early-hiv-infection?view=full). ART during acute HIV infection is recommended because it substantially reduces infection transmission to others, improves laboratory markers of disease, might decrease severity of acute disease, lowers viral setpoint, reduces the size of the viral reservoir, decreases the rate of viral mutation by suppressing replication, and preserves immune function ( -and-adolescent-arv/acute-and-recent-early-hiv-infection?view=full). Persons who receive an acute HIV diagnosis should be referred immediately to an HIV clinical care provider, provided prevention counseling (e.g., advised to reduce the number of partners and to use condoms correctly and consistently), and screened for STIs. Information should be provided regarding availability of PEP for sexual and injecting drug use partners not known to have HIV infection if the most recent contact was 2ff7e9595c
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