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Objective To evaluate the case-finding effectiveness of a clinic-based partner notification effort for early syphilis in Madagascar. Methods We asked index cases who had proven early syphilis to identify and provide contact information of recent sex partners (in the past 3, 6, and 12 months for primary, secondary, and early latent syphilis, respectively). Named sex partners were contacted by index cases (patient notification) or, if approved by the index case, clinic staff members (provider notification); notified of their potential exposure to syphilis; and asked to come to the clinic for evaluation. We assessed case-finding effectiveness and calculated the ‘brought-to-treatment’ index (number of newly-diagnosed syphilis cases per number of index cases interviewed). Results Of 565 index cases, 534 reported recent sex with at least one sex partner. A total of 3167 sex partners were reported, of whom 276 were contactable (9% of 3167). Providers notified 76% and cases notified 24% of these partners. 270 partners were contacted (98% of 276), and of these, 199 presented to the clinic for evaluation (74% of 270). A total of 99 partners tested positive for syphilis and received treatment (50% of 199). The ‘brought-to-treatment’ index was 0.18 (99 diagnoses per 565 index cases). Conclusion Partner notification was possible in this setting, resulting in treatment of syphilis-infected individuals who otherwise would likely have remained untreated. However, given <10% of the partners reported by index cases were contactable; the results highlight the limitations of partner notification and the need for additional sexually transmitted infection control strategies. [ABSTRACT FROM AUTHOR]

Background: Women's perceived control over condom use has been found to be an important determinant of actual condom use in some studies. However, many existing analyses used cross-sectional data and little quantitative information exists to characterize the relationships between perceived control and actual condom use among sex worker populations. Methods: We assessed the association between measures of perceived condom use control and self-reported use of male condoms employing data from a longitudinal pilot study among 192 sex workers in Madagascar. Results: In multivariable models, a lack of perceived control over condom use with a main partner and having a main partner ever refuse to use a condom when asked were both associated with an increased number of sex acts unprotected by condoms in the past week with a main partner (RR 1.86; 95% CI 1.21-2.85; RR 1.34; 95% CI 1.03-1.73, respectively). Conversely, no measure of condom use control was significantly associated with condom use with clients. Conclusion: Perceived control over condom use was an important determinant of condom use with main partners, but not clients, among sex workers in Madagascar. Programs working with sex workers should reach out to main and commercial partners of sex workers to increase male condom use. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design: We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results: Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions: Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers. [Copyright &y& Elsevier]

The article discusses a study on the venues or places un Madagascar where people meet sexual partners and the need for venue-based prevention. It explains that prevention in HIV and sexually transmitted diseases plays a significant role in reaching for individuals who have high risk of infection. The study uses an interview method conducted in several towns of Madagascar. Through the interview conducted, it shows that community informants identified numerous venues such as streets, bars and hotels.

The article presents a randomized pilot study among female sex workers in Madagascar on their adherent use of diaphragms and microbicide gel. It states that female-controlled methods for prevention of HIV and sexually transmitted infections (STIS), such as vaginal microbicides and cervical barriers like diaphragms, are those that do not rely on cooperation from male partners. It notes that the methods could prevent sex workers from acquiring sexually transmitted diseases. Accordingly, the study aims to evaluate the effectiveness of the diaphragm vaginal microbicide methods in preventing sexual infection among female sex workers. Moreover, the study concludes that gel-diaphragm users had better adherence that gel-only users and counseling sessions may improve adherence.

The article presents a study which evaluates the cases of Treponema pallidum resistance to azithromycin in Madagascar. It states that the study is designed to record the number of patients who experienced therapeutic failure with azithromycin as there have been similar cases documented in the U.S., Canada, and Ireland. It centers on 141 individuals with syphilitic lesions. The study found that there are no traces of resistance to azithromycin in specimens from 141 patients.