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Zhao R, Fairley CK, Cook AR, Phanuphak N, He S, Tieosapjaroen W, Chow EPF, Phillips TR, Jin Tan RK, Wei Y, Shen M, Zhuang G, Ong JJ, Zhang L. Optimising HIV pre-exposure prophylaxis and testing strategies in men who have sex with men in Australia, Thailand, and China: a modelling study and cost-effectiveness analysis. Lancet Glob Health 2024; 12:e243-e256. [PMID: 38245115 DOI: 10.1016/s2214-109x(23)00536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Men who have sex with men (MSM) in the Asia-Pacific region have a disproportionately high burden of HIV infection compared with the general population. Although pre-exposure prophylaxis (PrEP) for HIV is highly effective at preventing new HIV infections, the cost-effectiveness of PrEP for MSM in different countries in the Asia-Pacific region with varying PrEP coverage and HIV testing frequencies remains unstudied. We aimed to analyse the economic and health benefits of long-acting injectable cabotegravir (CAB-LA) compared with oral PrEP in high-income countries and low-income and middle-income countries within the Asia-Pacific region. METHODS We developed a decision-analytic Markov model to evaluate the population impact and cost-effectiveness of PrEP scale-up among MSM in Australia, Thailand, and China. We assumed a static cohort of 100 000 MSM aged 18 years or older who were at risk of HIV infection, with a monthly cycle length over a 40-year time period. We evaluated hypothetical scenarios with universal PrEP coverage of 80% among 100 000 suitable MSM in each country. We modelled oral PrEP and CAB-LA for MSM with diverse HIV testing frequency strategies. We adopted the health-care system's perspective with a 3% annual discount rate. We calculated the incremental cost-effectiveness ratio (ICER), measured as additional cost per quality-adjusted life-year (QALY) gained, to compare different strategies with the status quo in each country. All costs were reported in 2021 US$. We also performed one-way, two-way, and probabilistic sensitivity analyses to assess the robustness of our findings. FINDINGS Compared with the status quo in each country, expanding oral PrEP to 80% of suitable MSM would avert 8·1% of new HIV infections in Australia, 14·5% in Thailand, and 26·4% in China in a 40-year period. Expanding oral PrEP use with 6-monthly HIV testing for both PrEP and non-PrEP users was cost-saving for Australia. Similarly, expanding oral PrEP use remained the most cost-effective strategy in both Thailand and China, but optimal testing frequency varied, with annual testing in Thailand (ICER $4707 per QALY gained) and 3-monthly testing in China (ICER $16 926 per QALY gained) for both PrEP and non-PrEP users. We also found that replacing oral PrEP with CAB-LA for MSM could avert more new HIV infections (12·8% in Australia, 27·6% in Thailand, and 32·8% in China), but implementing CAB-LA was not cost-effective due to its high cost. The cost of CAB-LA would need to be reduced by 50-90% and be used as a complementary strategy to oral PrEP to be cost-effective in these countries. INTERPRETATION Expanding oral PrEP use for MSM, with country-specific testing frequency, is cost-effective in Australia, Thailand, and China. Due to the high cost, CAB-LA is currently not affordable as a single-use strategy but might be offered as an additional option to oral PrEP. FUNDING Ministry of Science and Technology of the People's Republic of China, the Australian National Health and Medical Research Council, National Key Research and Development Program of China, and National Natural Science Foundation of China.
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Affiliation(s)
- Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shiyi He
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; University of North Carolina Project-China, Guangzhou, China
| | - Yuhang Wei
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China; Interdisciplinary Center for Mathematics and Life Sciences, School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
| | - Guihua Zhuang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
| | - Jason J Ong
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
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Coleman TA, Phillips NE, Rizkalla C, Tran B, Coulombe S, Davis C, Cameron R, Travers R, Wilson C, Woodford M. Exploring community enabling factors associated with recent HIV testing in a regional sample of gay, bisexual, and other men who have sex with men. AIDS Care 2022; 35:942-952. [PMID: 35637571 DOI: 10.1080/09540121.2022.2074959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV testing and diagnosis are the gateway into treatment and eventual viral suppression. With gay, bisexual, and other men who have sex with men (GBMSM) persistently over-representing new HIV diagnoses in Canada, combined with the evolving nature of community social connection, an exploration of factors associated with recent HIV testing is warranted. As most studies of GBMSM rely on samples obtained from larger metropolitan regions, examining HIV testing from an under-researched region is necessary. With data collected from an online survey of LGBTQ+ persons 16 or older living, working, or residing in the Region of Waterloo, Ontario, Canada, we used multinomial logistic regression to explore socio-demographic, behavioural, and psychosocial factors associated with recent HIV testing for GBMSM. In the final multivariate multinomial logistic regression model: sense of belonging was associated with more recently testing, as was having an increasing proportion of LGBT friends, app use to find sex partners in the past 12 months, access to the local AIDS service organization, and general sense of belonging to local community, among other. This analysis highlights the continued importance of enabling and need factors when accessing testing, and suggests areas for further testing promotion in physical and virtual spaces frequented by GBMSM.
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Affiliation(s)
- Todd A. Coleman
- Department of Health Sciences, Wilfrid Laurier University, Ontario, Canada
| | | | - Celina Rizkalla
- Department of Health Sciences, Wilfrid Laurier University, Ontario, Canada
| | - Billy Tran
- Department of Health Sciences, Wilfrid Laurier University, Ontario, Canada
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Simon Coulombe
- Department of Psychology, Wilfrid Laurier University, Ontario, Canada
| | - Charlie Davis
- Department of Psychology, Wilfrid Laurier University, Ontario, Canada
| | - Ruth Cameron
- Department of Psychology, Wilfrid Laurier University, Ontario, Canada
- AIDS Committee of Cambridge, Kitchener, Waterloo and Area, Ontario, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Ontario, Canada
| | - Ciann Wilson
- Department of Psychology, Wilfrid Laurier University, Ontario, Canada
| | - Michael Woodford
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
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Leitinger D, Ryan K, Wilkinson AL, Pedrana A, Hellard M, Stoové M. Implications of HIV Self-Testing for Other Sexually Transmissible Infection Testing and Broader Sexual Health Needs: A Mixed-Methods Study of Gay and Bisexual Men in Australia. Sex Transm Dis 2021; 48:417-423. [PMID: 33122598 DOI: 10.1097/olq.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although HIV self-tests can support frequent HIV testing, their impact on attending clinics for other sexually transmissible infection (STI) testing and sexual health care is largely unknown. We explored intentions to use HIV self-tests and how this might affect patterns of attending sexual health services among gay, bisexual, and other men who have sex with men (GBM) in Victoria, Australia. METHODS Gay, bisexual, and other men who have sex with men self-completed an online survey between March 10 and June 10, 2019. Among GBM reporting lifetime HIV testing and intentions to self-test at least once annually, we used logistic regression to identify correlates of intending to replace clinic-based HIV testing with self-tests. Qualitative interviews with purposively selected survey participants undertaken between May and June 2019 explored the implications of self-testing on clinic-based sexual health care. RESULTS Of the 279 survey participants, 79 (29%) reported they would replace most or all clinic-based HIV tests with self-tests, with longer time since last testing for HIV and younger age associated with reporting this outcome in the multivariate analysis. Qualitative interviews revealed different perceived roles for self-tests and clinic-based testing, and the importance of integrating HIV self-tests within broader sexual health routines. CONCLUSIONS Although GBM see a distinct role for HIV self-testing, its rollout will likely result in missed opportunities for clinic-based STI testing and education for some GBM, particularly among younger and less-recently tested GBM. Convenient, non-clinic-based approaches to STI testing are needed alongside support platforms to maximize the benefits of HIV self-testing within comprehensive sexual health routines.
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Increases in HIV Testing Frequency in Australian Gay and Bisexual Men are Concentrated Among PrEP Users: An Analysis of Australian Behavioural Surveillance Data, 2013-2018. AIDS Behav 2020; 24:2691-2702. [PMID: 32162094 DOI: 10.1007/s10461-020-02826-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing HIV testing frequency in gay and bisexual men (GBM) is critical to reducing the time between HIV infection and diagnosis. Using anonymous national behavioural surveillance data (2013-2018) from 43,753 surveys of Australian GBM, we examined HIV testing frequency trends and factors differentiating PrEP-users, non-PrEP-users reporting two or more tests in the previous year, and non-PrEP-users reporting less frequent testing. The proportion tested at least annually increased from 64.4% in 2013 to 70.8% in 2018 (p-trend < 0.001), and from 73.9% to 84.6% among the 51.6% of men classified as higher-risk. Among higher-risk men, having two or more tests in the previous year increased from 48.0% to 69.3% (p-trend < 0.001). Among higher-risk non-PrEP-users, it increased from 47.2% to 54.8% (p-trend < 0.001), however, there was a decrease since 2016 (p-trend < 0.001). Among PrEP-users, it increased from 82.1% in 2013 to 97.3% in 2018 (p-trend < 0.001). Non-PrEP-using higher-risk men having less frequent tests reported lower risk than PrEP-users and non-PrEP-using men reporting two or more tests in the previous year. However, recent risk behaviour was not uncommon: nearly half reported condomless sex; one-fifth reported receptive condomless sex with ejaculation; over half reported group sex; one-quarter used drugs for the purposes of sex; and one-fifth had more than ten sex partners. Efforts are needed to encourage frequent testing and PrEP use among non-PrEP-users who are at higher-risk.
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Molecular dynamic simulations to investigate the structural impact of known drug resistance mutations on HIV-1C Integrase-Dolutegravir binding. PLoS One 2020; 15:e0223464. [PMID: 32379830 PMCID: PMC7205217 DOI: 10.1371/journal.pone.0223464] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/21/2020] [Indexed: 12/18/2022] Open
Abstract
Resistance associated mutations (RAMs) threaten the long-term success of combination antiretroviral therapy (cART) outcomes for HIV-1 treatment. HIV-1 Integrase (IN) strand transfer inhibitors (INSTIs) have proven to be a viable option for highly specific HIV-1 therapy. The INSTI, Dolutegravir is recommended by the World Health Organization for use as first-line cART. This study aims to understand how RAMs affect the stability of IN, as well as the binding of the drug Dolutegravir to the catalytic pocket of the protein. A homology model of HIV-1 subtype C IN was successfully constructed and validated. The site directed mutator webserver was used to predict destabilizing and/or stabilizing effects of known RAMs while FoldX confirmed any changes in protein energy upon introduction of mutation. Also, interaction analysis was performed between neighbouring residues. Three mutations known to be associated with Raltegravir, Elvitegravir and Dolutegravir resistance were selected; E92Q, G140S and Y143R, for molecular dynamics simulations. The structural quality assessment indicated high reliability of the HIV-1C IN tetrameric structure, with more than 90% confidence in modelled regions. Change in free energy for the three mutants indicated different effects, while simulation analysis showed G140S to have the largest affect on protein stability and flexibility. This was further supported by weaker non-bonded pairwise interaction energy and binding free energy values between the drug DTG and E92Q, Y143R and G140S mutants suggesting reduced binding affinity, as indicated by interaction analysis in comparison to the WT. Our findings suggest the G140S mutant has the strongest effect on the HIV-1C IN protein structure and Dolutegravir binding. To the best of our knowledge, this is the first study that uses the consensus wild type HIV-1C IN sequence to build an accurate 3D model to understand the effect of three known mutations on DTG drug binding in a South Africa context.
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Lee E, Mao L, Bavinton B, Prestage G, Holt M. Which Gay and Bisexual Men Attend Community-Based HIV Testing Services in Australia? An Analysis of Cross-Sectional National Behavioural Surveillance Data. AIDS Behav 2020; 24:387-394. [PMID: 30863977 DOI: 10.1007/s10461-019-02435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ben Bavinton
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
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Selvey LA, Slimings C, Adams E, Manuel J. Incidence and predictors of HIV, chlamydia and gonorrhoea among men who have sex with men attending a peer-based clinic. Sex Health 2019; 15:451-459. [PMID: 30236212 DOI: 10.1071/sh17181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/27/2018] [Indexed: 11/23/2022]
Abstract
Introduction Despite a range of interventions, annual numbers of new diagnoses of HIV infection among men who have sex with men (MSM) in Australia have not declined in recent years. Peer-based sexual health clinics targeting MSM, such as the M Clinic in Perth (WA, Australia), have been put in place to provide safe sex counselling and to increase testing rates among MSM and who are at high risk of HIV infection. The aim of this study was to assess the incidence of HIV, chlamydia and gonorrhoea among men attending the M Clinic. METHODS This was a historical cohort study of repeated M Clinic clients from January 2011 to June 2015 inclusive. Testing and risk factor data from M Clinic client software were used to estimate the incidence of HIV, chlamydia and gonorrhoea and associated factors. RESULTS The incidence of HIV, chlamydia and gonorrhoea was 1.87, 13.58 and 6.48 per 100 person-years respectively. Older men had a higher incidence of HIV infection but a lower incidence of chlamydia and gonorrhoea than younger men. CONCLUSIONS The HIV incidence was higher than found in similar studies in other Australian sexual health clinics, but the incidence of chlamydia and gonorrhoea was similar. The high HIV incidence among clients of the M Clinic points to the importance of making pre-exposure HIV prophylaxis available to clients of the M Clinic and similar services.
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Affiliation(s)
- Linda A Selvey
- School of Public Health, The University of Queensland, Herston, Qld 4006, Australia
| | - Claudia Slimings
- School of Medicine, Australian National University, Acton, ACT 2601, Australia
| | - Emma Adams
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Justin Manuel
- M Clinic, Western Australian AIDS Council, West Perth, WA 6005, Australia
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HIV Testing With and Without a Clinical Consultation Among Men Who Have Sex With Men: A Randomized Controlled Trial. J Acquir Immune Defic Syndr 2019; 78:406-412. [PMID: 29608445 DOI: 10.1097/qai.0000000000001688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing the frequency of HIV testing among men who have sex with men (MSM) maximizes the preventive effect of antiretroviral therapy, by reducing time to diagnosis and treatment. SETTING Melbourne Sexual Health Centre, Australia. METHODS This randomized controlled trial evaluated whether access to testing, without seeing a clinician would increase testing frequency. MSM attending for HIV testing between July 2014 and April 2015 were randomized in 1:1 ratio to the intervention arm (access to HIV and syphilis testing at 300 pathology centers, without requiring consultations) or the control arm (consultation at every test), without blinding. The primary outcome was the incidence of HIV testing over 12 months. RESULTS Of 443 men referred, 422 were randomized, 3 HIV positives at baseline were excluded, and 419 were analyzed. Of 208 control, 202 (97.1%) and 200 (94.8%) of 211 intervention group members were followed to 12 months. The intervention group had 453 tests in 205.6 person-years, incidence rate was 2.2 (95% confidence interval [CI]: 2.0 to 2.4) tests per year. The control group had 432 tests during 204.0 person-years, incidence rate was 2.1 (95% CI: 1.9 to 2.3) tests per year, and incidence rate ratio was 1.04 (95% CI: 0.89 to 1.2; P = 0.63). The annual rate of consultations was as follows: intervention, 1.61 (95% CI: 1.44 to 1.79); controls, 2.12 (95% CI: 1.92 to 2.33); rate ratio, 0.76 (95% CI: 0.65 to 0.88; P = 0.0001). There was no difference in quality of life scores (P = 0.61). CONCLUSIONS MSM permitted HIV and syphilis testing outside of clinical consultations did not test more frequently than controls but had 24% fewer consultations, reducing service demand. TRIAL REGISTRATION ACTRN12614000760673.
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Holt M, Lea T, Mao L, Zablotska I, Lee E, de Wit JBF, Prestage G. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health 2019; 14:72-79. [PMID: 27567489 DOI: 10.1071/sh16072] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
Abstract
Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. METHODS The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. RESULTS Between 2000 and 2015, there were significant increases (P<0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. CONCLUSIONS Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
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Affiliation(s)
- Martin Holt
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Toby Lea
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Limin Mao
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Iryna Zablotska
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
| | - Evelyn Lee
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - John B F de Wit
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Garrett Prestage
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
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Li B, Bi P, Ward A, Bell C, Fairley CK. Trends and predictors of recent HIV testing over 22 years among a clinic sample of men who have sex with men in South Australia. Sex Health 2019; 14:164-169. [PMID: 27832580 DOI: 10.1071/sh16091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/10/2016] [Indexed: 11/23/2022]
Abstract
Increasing the frequency of HIV testing is crucial for effective HIV prevention and care. The aim of the present study was to determine whether there has been a change in HIV testing among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) clinic over the past two decades. METHODS Computerised medical records of MSM who attended the SASSH at their first visit between 1994 and 2015 were used to determine whether HIV testing had changed among MSM. First HIV tests in each calendar year and return tests within 12 months were analysed. Factors associated with recent HIV testing were also examined. RESULTS There were 24036 HIV tests conducted among 8163 individual MSM over the study period. The proportion of newly registered MSM who reported ever being tested for HIV declined (Ptrend=0.030), the proportion who reported recent HIV testing did not change (Ptrend=0.955) and the proportion who have had current HIV testing increased (Ptrend=0.008). The proportion of MSM who returned to the clinic for HIV testing within 12 months did not change (Ptrend >0.05), with less than 40% of MSM returning for HIV testing. Factors independently associated with recent HIV testing included MSM aged ≥20 years, (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.53-2.10), higher education (OR 1.28; 95% CI 1.12-1.45), non-Caucasian (African OR 1.68; 95% CI 1.30-2.17), having multiple sex partners (OR 1.47; 95% CI 1.29-1.69), having had sex interstate (OR 1.61; 95% CI 1.42-1.82) or overseas (OR 1.53; 95% CI 1.33-1.76) and injecting drug use (OR 1.56; 95% CI 1.29-1.88). CONCLUSIONS HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population.
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Affiliation(s)
- Bin Li
- School of Public Health, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia
| | - Alison Ward
- South Australia Specialist Sexual Health, Infectious Disease Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide, SA 5000, Australia
| | - Charlotte Bell
- South Australia Specialist Sexual Health, Infectious Disease Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide, SA 5000, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 89 Commercial Road, Melbourne, Vic. 3004, Australia
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Pierce AB, El-Hayek C, McCarthy D, Armishaw J, Watson K, Wilkinson A, Price B, Wright EJ, Hoy JF, Stoové MA. Comparing non-occupational post-exposure prophylaxis drug regimens for HIV: insights from a linked HIV surveillance system. Sex Health 2019; 14:179-187. [PMID: 27914484 DOI: 10.1071/sh16132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022]
Abstract
Background International non-occupational post-exposure prophylaxis (NPEP) guidelines recommend routine use of three drug NPEP regimens, despite absence of evidence for greater prevention efficacy compared with two drug regimens. This study examines the potential for excess HIV seroconversions among high-risk men who have sex with men (MSM) reporting receptive anal intercourse with a source of unknown HIV serostatus (RAIU) following a two-drug versus a three-drug NPEP regimen. METHODS Data for MSM in the Victorian NPEP service database between 10 August 2005 and 31 December 2012 were linked with all Victorian HIV notifications up to 31 December 2013. The primary outcome was NPEP failure following NPEP presentation among MSM reporting RAIU, stratified by the number of drugs prescribed. RESULTS Among 1482 MSM reporting 2002 episodes of RAIU and prescribed two- or three-drug NPEP, 70 seroconverted to HIV, but only 19 were considered possible NPEP failures. HIV diagnosis incidence among men reporting RAIU was 1.2/100 person years (PY) (95%CI=1.0-1.6); 1.1/100 PY (95%CI=0.8-1.4) among MSM prescribed two drugs and 2.2/100 PY (95%CI=1.4-3.7) among MSM prescribed three drugs (P<0.01). Of the 19 possible NPEP failures, 13 (0.7%) were prescribed two drugs and six (2.7%) three drugs (P<0.001). CONCLUSIONS This study suggests that two-drug NPEP regimens do not result in excess seroconversions compared with three-drug regimens when used following RAIU. Clinical services should carefully consider their use of three drug NPEP and whether resources might be better invested in other prevention strategies, particularly pre-exposure prophylaxis (PrEP).
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Affiliation(s)
- Anna B Pierce
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Carol El-Hayek
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Damien McCarthy
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Jude Armishaw
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Kerrie Watson
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Anna Wilkinson
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Brian Price
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Edwina J Wright
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Jennifer F Hoy
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Mark A Stoové
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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12
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Ryan KE, Wilkinson AL, Chow E, Read T, Chen M, Locke P, Leitinger D, Bradshaw C, Pedrana A, Hellard M, Fairley CK, Stoové M. A comparative, retrospective analysis of HIV testing among gay, bisexual and other men who have sex with men in Melbourne, Australia. Aust N Z J Public Health 2019; 43:419-423. [PMID: 31141274 DOI: 10.1111/1753-6405.12903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE PRONTO!, a peer-led rapid HIV-testing service in Melbourne, Australia, opened to improve HIV testing among gay and bisexual men (GBM). We compared client characteristics and return testing among GBM testing at PRONTO! with GBM testing at Melbourne Sexual Health Centre (MSHC). METHODS All GBM attending PRONTO! and MSHC for HIV testing between August 2013 and April 2016 were included. We describe the number of tests, percentage of clients who returned during follow-up, the mean number of tests and median time between tests at the two services. RESULTS At PRONTO!, 33% of 3,102 GBM and at MSHC 50% of 9,836 GBM returned for a further HIV test at least once. The mean number of tests per client was 1.7 and 2.5 at PRONTO! and MSHC (p<0.01), respectively. A majority of clients at both services reported behaviours that would recommend up to quarterly testing, however, the median time between tests was 20.0 and 17.0 weeks at PRONTO! and MSHC (p<0.01), respectively. CONCLUSIONS A greater proportion of clients returned and returned frequently at MSHC compared to PRONTO!, however, at both services HIV testing frequency was suboptimal. Implications for public health: Novel HIV testing services should provide convenient and comprehensive sexual health services.
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Affiliation(s)
- Kathleen E Ryan
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | | | - Eric Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Tim Read
- Melbourne Sexual Health Centre, Melbourne, Victoria
| | - Marcus Chen
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Peter Locke
- PRONTO!, Victorian AIDS Council, Melbourne, Victoria
| | | | | | - Alisa Pedrana
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Margaret Hellard
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Mark Stoové
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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13
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Gray RT, Wilson DP, Guy RJ, Stoové M, Hellard ME, Prestage GP, Lea T, de Wit J, Holt M. Undiagnosed HIV infections among gay and bisexual men increasingly contribute to new infections in Australia. J Int AIDS Soc 2019; 21:e25104. [PMID: 29638044 PMCID: PMC5894250 DOI: 10.1002/jia2.25104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/09/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction We determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12‐year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage. Methods We generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus. Results Between 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion (<7%) originated from GBM with suppressed virus. Discussion Our study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV.
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Affiliation(s)
- Richard T Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Rebecca J Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Toby Lea
- German Institute for Addiction and Prevention Research (DISuP), Catholic University of Applied Sciences, North Rhine-Westphalia, Germany.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
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14
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Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review. ACTA ACUST UNITED AC 2018; 44:337-347. [PMID: 31517954 DOI: 10.14745/ccdr.v44i12a05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Human immunodeficiency virus (HIV) testing plays a crucial role in Canada's HIV prevention and treatment efforts and is the first step to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; however, how often Canadians, including populations at increased risk of HIV exposure, should be tested is unclear. We conducted a systematic literature review to determine the optimal HIV screening and testing intervals. Objective To examine the current evidence on HIV testing intervals in HIV-negative individuals from various risk groups and to assess the potential harms and patients' values and preferences associated with different testing frequencies. Methods We searched MEDLINE/PubMed, Scopus, Embase, the Cochrane Library, PsychINFO and EconLit for studies on different frequencies of HIV testing published between January 2000 and September 2016. An additional search was conducted for grey literature published between January 2000 and October 2016. Data extraction included study characteristics, participants, exposure, outcomes and economic variables. The quality of the studies was assessed and results summarized. Results Of the 2,702 articles identified from the searches, 27 met the inclusion criteria for review. This included assessments of HIV testing intervals among the general population, men who have sex with men, people who use injection drugs and sex workers. Optimal testing intervals across risk groups ranged from one-time testing to every three months. Data from modelling studies may not be representative of the Canadian context. Few studies identified potential harms of increased screening, specifically an increase in both false positive and false negative results. There were only two studies that addressed patient values and preferences concerning HIV screening, which suggested that the majority of participants were amenable to routine screening through their primary care provider. Conclusion There was insufficient evidence to support optimal HIV screening and testing intervals for different populations. Context-specific factors, such as budget allocation, human resources, local epidemiology, socioeconomic factors and risk behaviours, along with clinical judgement, inform whom and how often to screen, suggesting the need for research specific to Canada. Research on patient preferences as well as the benefits and harms of more frequent screening are also indicated.
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15
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Ryan KE, Wilkinson AL, Leitinger D, El-Hayek C, Ryan C, Pedrana A, Hellard M, Stoové M. Characteristics of gay, bisexual and other men who have sex with men testing and retesting at Australia's first shop-front rapid point-of-care HIV testing service. Sex Health 2018; 13:560-567. [PMID: 27509318 DOI: 10.1071/sh16027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia's first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers. METHODS Univariable and multivariable logistic regression using data collected at clients' first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!. RESULTS In the first year, 1226 GBM tested at PRONTO! (median age=30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR)=1.48, 95% confidence interval (CI)=1.10-2.0), reporting a regular check-up as reason to test (AOR=1.53, 95% CI=1.01-2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR=1.73, 95% CI=1.09-2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (<30 years; AOR=1.78, 95% CI=1.18-2.71) and negatively associated with reporting a regular check-up as reason to test (AOR=0.45, 95% CI=0.29-0.71) and recent group sex (AOR=0.37, 95% CI=0.23-0.59). CONCLUSION Despite PRONTO! being designed to reduce barriers to HIV testing, return testing rates in the first year were low and not associated with client risk. Service refinements, including the provision of comprehensive sexually transmissible infection testing, are needed to increase testing frequency and enhance population HIV prevention benefits.
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Affiliation(s)
- Kathleen E Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Anna L Wilkinson
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - David Leitinger
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Carol El-Hayek
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Claire Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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16
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Ryan KE, Mak A, Stoove M, Price B, Fairley CK, Ruth S, Lal L, Asselin J, El-Hayek C, Nguyen L, Batrouney C, Wilson D, Lockwood J, Murphy D, Cornelisse VJ, Roth N, Willcox J, Chang CC, Armishaw J, Tee BK, Penn M, Forgan-Smith G, Williams C, Montgomery J, Byron K, Coelho A, Allen B, Wiggins J, Kelsall J, Vujovic O, West M, Pierce AB, Gallant D, Bell C, de Wit JBF, Hoy JF, Wesselingh SL, Grant RM, Wright EJ. Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study. Front Public Health 2018; 6:151. [PMID: 29896468 PMCID: PMC5987055 DOI: 10.3389/fpubh.2018.00151] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent HIV transmission in people at high risk of HIV acquisition. PrEP is highly efficacious when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate if the provision of PrEP to up to 3800 individuals at risk of HIV in Victoria, Australia reduces HIV incidence locally by 25% generally and 30% among GBM. Methods: PrEPX is a population level intervention study in Victoria, Australia in which generic PrEP will be delivered to 3800 individuals for up to 36 months. Study eligibility is consistent with the recently updated 2017 Australian PrEP guidelines. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tests and other clinical care as required. Study visits and STI diagnoses will be recorded electronically through the ACCESS surveillance system. At each study visit participants will be invited to complete behavioral surveys that collect demographics and sexual risk data. Diagnosis and behavioral data will be compared between PrEPX participants and other individuals testing within the ACCESS surveillance system. A subset of participants will complete in depth surveys and interviews to collect attitudes, beliefs and acceptability data. Participating clinics will provide clinic level data on implementation and management of PrEPX participants. The population level impact on HIV incidence will be assessed using Victorian HIV notification data. Discussion: This study will collect evidence on the real world impact of delivery of PrEP to 3800 individuals at risk of acquiring HIV in Victoria. This study will provide important information for the broader implementation of PrEP planning upon listing of the tenofovir-emtricitabine on the national subsidized list of medicines. The study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12616001215415)
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Affiliation(s)
- Kathleen E Ryan
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Mak
- Alfred Health Pharmacy, Melbourne, VIC, Australia
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Simon Ruth
- Victorian AIDS Council, Melbourne, VIC, Australia
| | - Luxshimi Lal
- The Burnet Institute, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | | | | | - Long Nguyen
- The Burnet Institute, Melbourne, VIC, Australia
| | | | | | | | - Dean Murphy
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, VIC, Australia
| | | | - Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | | | - Ban K Tee
- The Centre Clinic, Melbourne, VIC, Australia.,Access Health and Community Richmond, Melbourne, VIC, Australia
| | - Matthew Penn
- PRONTO! Community Health Centre, Melbourne, VIC, Australia
| | | | | | | | - Kat Byron
- Victorian Aboriginal Community Controlled Health Organisation Inc., Melbourne, VIC, Australia
| | - Alison Coelho
- Centre for Culture, Ethnicity and Health, Melbourne, VIC, Australia
| | - Brent Allen
- Living Positive Victoria, Melbourne, VIC, Australia
| | - Jeremy Wiggins
- Victorian AIDS Council, Melbourne, VIC, Australia.,Peer Advocacy Network for the Sexual Health of Trans Masculinities, Melbourne, VIC, Australia
| | | | - Olga Vujovic
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Michael West
- Sexual Health and Viral Hepatitis Service Department of Health and Human Services, Government of Victoria, Melbourne, VIC, Australia
| | - Anna B Pierce
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Daniel Gallant
- Sexually Transmissible Infection and Blood Borne Virus Section, Communicable Disease Control Branch, Department of Health and Ageing, Government of South Australia, Adelaide, SA, Australia
| | - Charlotte Bell
- Clinic 275, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John B F de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert M Grant
- School of Medicine, University of California San Francisco, Gladstone Institutes, San Francisco, CA, United States
| | - Edwina J Wright
- The Burnet Institute, Melbourne, VIC, Australia.,The Centre Clinic, Melbourne, VIC, Australia.,Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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17
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Understanding the Targeting and Uptake of HIV Testing Among Gay and Bisexual Men Attending Sexual Health Clinics. AIDS Behav 2018; 22:513-521. [PMID: 29260354 DOI: 10.1007/s10461-017-2012-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed trends in HIV testing outcomes during a period of clinic-based initiatives introduced to increase HIV testing among gay and bisexual men (GBM) attending sexual health clinics (SHCs) in New South Wales (NSW). A cohort of 25,487 HIV-negative GBM attending 32 SHCs in NSW (2009-2015) was classified into six sub-groups each year based on client-type (new/existing), risk-status (low/high-risk), and any recent HIV testing. Poisson regression methods were used to assess HIV testing outcomes in sub-groups of GBM. HIV testing outcomes and the sub-groups with greatest statistically significant annual increases were: individuals attending (26% in high-risk existing clients with recent testing); testing uptake (4% in low-risk existing clients with no recent testing); testing frequency (6% in low-risk existing clients with no recent testing and 5% in high-risk existing clients with recent testing); and total tests (31% in high-risk existing clients with recent testing). High-risk existing clients with recent testing had a 13% annual increase in the proportional contribution to total tests. Our findings show improved targeting of testing to high-risk GBM at NSW SHCs. The clinic-based initiatives should be considered for translation to other similar settings.
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18
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Acceptability and HIV Prevention Benefits of a Peer-Based Model of Rapid Point of Care HIV Testing for Australian Gay, Bisexual and Other Men Who Have Sex with Men. AIDS Behav 2018; 22:178-189. [PMID: 28849434 PMCID: PMC5758652 DOI: 10.1007/s10461-017-1888-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Frequent HIV testing among gay, bisexual and other men who have sex with men (GBM) is a strategic priority for HIV prevention in Australia. To overcome barriers to testing in conventional clinical services, Australia recently introduced peer HIV rapid point of care (RPOC) testing services for GBM. This mixed methods evaluation describes client acceptability and HIV prevention benefits of a peer HIV testing model. Most aspects of the service model were overwhelmingly acceptable to clients. Two-thirds of survey participants reported preferring testing with peers rather than doctors or nurses and over half reported learning something new about reducing HIV risk. Focus group findings suggested peer-delivered HIV RPOC testing reduced stigma-related barriers to frequent testing and provided novel opportunities for GBM to openly discuss HIV prevention and sexual practices, enhancing their HIV risk-reduction knowledge. Analysis of survey data suggested knowledge transfer occurred particularly among younger and less gay community-attached GBM.
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Ryan KE, Pedrana A, Leitinger D, Wilkinson AL, Locke P, Hellard ME, Stoové M. Trial and error: evaluating and refining a community model of HIV testing in Australia. BMC Health Serv Res 2017; 17:692. [PMID: 29017561 PMCID: PMC5635501 DOI: 10.1186/s12913-017-2635-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The 2012 regulatory approval of HIV rapid point of care (RPOC) tests in Australia and a national strategic focus on HIV testing provided a catalyst for implementation of non-clinical HIV testing service models. PRONTO! opened in 2013 as a two-year trial delivering peer-led community-based HIV RPOC tests targeting gay, bisexual and other men who have sex with men (GBM), with the aim of increasing HIV testing frequency. Initial data suggested this aim was not achieved and, as part of a broader service evaluation, we sought to explore client acceptability and barriers to testing at PRONTO! to refine the service model. METHODS We present descriptive and thematic analyses of data from two in-depth evaluation surveys and four focus groups with PRONTO! clients focused on service acceptability, client testing history, intentions to test and barriers to testing for HIV and other sexually transmitted infections (STIs). RESULTS The three novel aspects of the PRONTO! model, testing environment, rapid-testing, peer-staff, were reported to be highly acceptable among survey and focus group participants. Focus group discussions revealed that the PRONTO! model reduced anxiety associated with HIV testing and created a comfortable environment conducive to discussing sexual risk and health. However, an absence of STI testing at PRONTO!, driven by restrictions on medical subsidies for STI testing and limited funds available at the service level created a barrier to HIV testing. An overwhelming majority of PRONTO! clients reported usually testing for STIs alongside HIV and most reported plans to seek STI testing after testing for HIV at PRONTO!. When deciding where, when and what to test for, clients reported balancing convenience and relative risk and consequences for each infection as guiding their decision-making. CONCLUSIONS A community-based and peer-led HIV testing model reduced previously reported barriers to HIV testing, while introducing new barriers. The absence of STI testing at PRONTO! and the need to access multiple services for comprehensive sexual health screening, created a significant service engagement barrier for some clients. Understanding client motivations to access testing and ensuring novel service models meet client needs is crucial for developing acceptable sexual health services for high-risk populations.
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Affiliation(s)
- Kathleen E Ryan
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia. .,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Huntington Avenue, Cambridge, MA, 02115, USA
| | - David Leitinger
- PRONTO!, Victorian AIDS Council, Rose St, Fitzroy, VIC, 3065, Australia
| | - Anna L Wilkinson
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Peter Locke
- PRONTO!, Victorian AIDS Council, Rose St, Fitzroy, VIC, 3065, Australia
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.,Infectious Disease Department, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia
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20
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Stoové M, Asselin J, Pedrana A, Lea T, Hellard M, Wilson D, Prestage G, de Wit J, Holt M. Declining prevalence of undiagnosed HIV in Melbourne: results from community-based bio-behavioural studies of gay and bisexual men. Aust N Z J Public Health 2017; 42:57-61. [PMID: 28749540 DOI: 10.1111/1753-6405.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To measure changes in undiagnosed HIV among gay and bisexual men (GBM) in Melbourne. METHODS Undiagnosed HIV was compared between GBM recruited anonymously in 2008 in gay venues only and GBM anonymously or confidentially (results delivery) recruited in 2014 at gay venues and a community festival. Surveys were completed and oral fluid specimens collected for HIV testing; positive tests among GBM reporting being HIV-negative or unknown/untested were classified as undiagnosed. Tests of proportions compared serological prevalence, undiagnosed prevalence and participant characteristics. RESULTS HIV prevalence was 9.5% and 7.1% among 639 and 993 GBM recruited in 2008 and 2014, respectively; undiagnosed prevalence declined significantly from 31.1% to 7.1% (p<0.001). Sexual risk and undiagnosed HIV was highest among venue-recruited participants in 2014 (17.6%). Fewer diagnosed GBM participated confidentially in 2014, but this did not meaningfully influence comparative undiagnosed HIV prevalence. CONCLUSION We provide the first estimates of changes in undiagnosed HIV in Australia, demonstrating a marked decline in undiagnosed HIV among GBM. Implications for public health: Our findings are consistent with reports of increases in HIV testing among GBM. Given sustained high HIV diagnosis rates, new testing models that encourage high frequency testing are needed to control the local HIV epidemic.
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Affiliation(s)
- Mark Stoové
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Jason Asselin
- Centre for Population Health, Burnet Institute, Victoria
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Toby Lea
- Centre for Social Research in Health, UNSW, New South Wales
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - David Wilson
- Centre for Population Health, Burnet Institute, Victoria.,Kirby Institute, UNSW, New South Wales
| | | | - John de Wit
- Centre for Social Research in Health, UNSW, New South Wales
| | - Martin Holt
- Centre for Social Research in Health, UNSW, New South Wales
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21
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Wilkinson AL, El-Hayek C, Fairley CK, Roth N, Tee BK, McBryde E, Hellard M, Stoové M. Wilkinson et al. Respond to "Latent Transition Analyses in Clinical Cohorts". Am J Epidemiol 2017; 185:639-640. [PMID: 28338972 DOI: 10.1093/aje/kww238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/08/2016] [Indexed: 11/15/2022] Open
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The Impact of a Social Marketing Campaign on HIV and Sexually Transmissible Infection Testing Among Men Who Have Sex With Men in Australia. Sex Transm Dis 2016; 43:49-56. [PMID: 26650997 DOI: 10.1097/olq.0000000000000380] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In response to increasing HIV and other sexually transmissible infection (HIV/STI) notifications in Australia, a social marketing campaign Drama Downunder (DDU) was launched in 2008 to promote HIV/STI testing among men who have sex with men (MSM). We analyzed prospective data from (1) an online cohort of MSM and (2) clinic-level HIV/STI testing to evaluate the impact of DDU on HIV, syphilis, gonorrhea, and chlamydia testing. MATERIALS AND METHODS (1) Cohort participants who completed 3 surveys (2010-2014) contributed to a Poisson regression model examining predictors of recent HIV testing.(2) HIV, syphilis, gonorrhea, and chlamydia tests among MSM attending high caseload primary care clinics (2007-2013) were included in an interrupted time series analysis. RESULTS (1) Although campaign awareness was high among 242 MSM completing 726 prospective surveys, campaign recall was not associated with self-reported HIV testing. Reporting previous regular HIV testing (adjusted incidence rate ratio, 2.4; 95% confidence interval, 1.3-4.4) and more than 10 partners in the previous 6 months (adjusted incidence rate ratio, 1.2; 95% confidence interval, 1.1-1.4) was associated with recent HIV testing. (2) Analysis of 257,023 tests showed increasing monthly HIV, syphilis, gonorrhea, and chlamydia tests pre-DDU. Post-DDU, gonorrhea test rates increased significantly among HIV-negative MSM, with modest and nonsignificant increasing rates of HIV, syphilis, and chlamydia testing. Among HIV-positive MSM, no change in gonorrhea or chlamydia testing occurred and syphilis testing declined significantly. CONCLUSIONS Increasing HIV/STI testing trends among MSM occurred pre- and post-DDU, coinciding with other plausible drivers of testing. Modest changes in HIV testing post-DDU suggest that structural changes to improve testing access may need to occur alongside health promotion to increase testing frequency.
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Keen P, Conway DP, Cunningham P, McNulty A, Couldwell DL, Davies SC, Smith DE, Gray J, Holt M, O'Connor CC, Read P, Callander D, Prestage G, Guy R. Multi-centre field evaluation of the performance of the Trinity Biotech Uni-Gold HIV 1/2 rapid test as a first-line screening assay for gay and bisexual men compared with 4th generation laboratory immunoassays. J Clin Virol 2016; 86:46-51. [PMID: 27914286 DOI: 10.1016/j.jcv.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Trinity Biotech Uni-Gold HIV test (Uni-Gold) is often used as a supplementary rapid test in testing algorithms. OBJECTIVE To evaluate the operational performance of the Uni-Gold as a first-line screening test among gay and bisexual men (GBM) in a setting where 4th generation HIV laboratory assays are routinely used. STUDY DESIGN We compared the performance of Uni-Gold with conventional HIV serology conducted in parallel among GBM attending 22 testing sites. Sensitivity was calculated separately for acute and established infection, defined using 4th generation screening Ag/Ab immunoassay (EIA) and Western blot results. Previous HIV testing history and results of supplementary 3rd generation HIV Ab EIA, and p24 antigen EIA were used to further characterise cases of acute infection. RESULTS Of 10,793 specimens tested with Uni-Gold and conventional serology, 94 (0.90%, 95%CI:0.70-1.07) were confirmed as HIV-positive by conventional serology, and 37 (39.4%) were classified as acute infection. Uni-Gold sensitivity was 81.9% overall (77/94, 95%CI:72.6-89.1); 56.8% for acute infection (21/37, 95%CI:39.5-72.9) and 98.2% for established infection (56/57, 95%CI:90.6-100.0). Of 17 false non-reactive Uni-Gold results, 16 were acute infections, and of these seven were p24 antigen reactive but antibody negative. Uni-Gold specificity was 99.9% (10,692/10,699, 95%CI:99.9-100.0), PPV was 91.7% (95%CI:83.6-96.6) and NPV was 99.8% (95%CI:99.7-99.9), respectively. CONCLUSIONS In this population, Uni-Gold had good specificity and sensitivity was high for established infections when compared to 4th generation laboratory assays, however sensitivity was lower in acute infections. Where rapid tests are used in populations with a high proportion of acute infections, additional testing strategies are needed to detect acute infections.
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Affiliation(s)
- P Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - D P Conway
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
| | - P Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia; St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW 2052, Australia
| | - A McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - D L Couldwell
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, NSW 2150, Australia; The Marie Bashir Institute for Infectious Diseases, University of Sydney, NSW 2145, Australia
| | - S C Davies
- Northern Sydney Sexual Health Service, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - D E Smith
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Albion Centre, Surry Hills, NSW 2010, Australia
| | - J Gray
- ACON, Surry Hills, Sydney, NSW 2010, Australia
| | - M Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - C C O'Connor
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; RPA Sexual Health, Community Health, Sydney LHD, Camperdown, Sydney, NSW 2050, Australia; Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - P Read
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; Kirketon Road Centre, PO Box 22, Kings Cross, NSW 1340, Australia
| | - D Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - G Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC 3000, Australia
| | - R Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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“Seek, Test, Treat” Lessons From Australia. J Acquir Immune Defic Syndr 2015. [DOI: 10.1097/qai.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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