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We begin a new series this month, setting out Programme Science as an approach to optimising for differing epidemics the mix of interventions for HIV prevention. Aral and Blanchard1 provide an overview of the methods and ambitions of Programme Science, and an introduction to a planned series they will guest edit.
Readers will be aware of growing international concerns about the spread of antimicrobial resistant strains of gonocci. Chan et al2 demonstrate a paradox that presents real challenges for future control strategies. Where there is antimicrobial resistance, treatment strategies that focus on the ‘core group’ result in maximal dissemination of resistant strains, even though this strategy is the most effective in the absence of resistance.
Incidence of HIV among MSM (men who have sex with men) continues to be a major concern in many parts of the world. This month, McDonald et al3 report trends in Scotland, demonstrating a marked reduction in incidence among intravenous drug users yet stable and high incidence in MSM. HIV testing is one of the keys to effective prevention for MSM. Li et al4 report low HIV testing rates, particularly among married MSM and migrants within China. They emphasise the need for free and anonymous testing.
Research into healthcare structures that can support HIV testing continues, amidst varying regulatory frameworks across the world. Belza et al,5 in a study from Spain, compare the performance and acceptability of self-taken blood testing at a street based HIV testing centre. They conclude that this provides a potentially valuable option for testing without the need for nurses or doctors.
Should chlamydia screening be selectively targeted? This is the question addressed by van den Broek et al6 in the rural component of a web based screening study in the Netherlands. Exclusion of individuals on the basis of a risk score enabled high positivity in the tested population, without reducing participation in the next round. This is an important study with wide-ranging policy implications.
This month's edition includes also a comparison of swabs and urine for the diagnosis of Trichomonas vaginalis7; an exploration of the correlates of condom breakage in a population of sex workers with high rates of condom use8, analysis of the effectiveness of doxycycline in otosyphilis9 and unprotected sex in HIV positive Chinese MSM.10
Provenance and peer review Not commissioned; internally peer reviewed.
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