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Pitt-Kendall R, Sun S, Hughes S, Merrick R, Donaldson H, Rayment M, Ivanov Z, Day M, Bari A, Rebec M, Callan E, Mohammed H, Sinka K, Cole M, Fifer H. Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20. J Antimicrob Chemother 2024; 79:1060-1068. [PMID: 38517444 PMCID: PMC11062939 DOI: 10.1093/jac/dkae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea. OBJECTIVES We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae. METHODS We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism. RESULTS A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings. CONCLUSIONS Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.
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Affiliation(s)
| | - Suzy Sun
- UK Health Security Agency, London, UK
| | | | | | | | - Michael Rayment
- Chelsea & Westminster NHS Foundation Trust, London, UK
- Imperial College London, London, UK
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2
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Pitt-Kendall R, Foster C, Rayment M, Orzechowska B, Mammadov R, Soni S, Mortlock S, Owen J, Uglow L, Day MJ, Rai Gurung R, Savary-Trathen A, Jenkins R, McGuire E, Gordon N, Day SL, Kelly AM, Goward C, Folkard K, Charles H, Mohammed H, Brown CS, Fifer H. Retrospective testing for mpox virus in routine STI screens from men who have sex with men in England, August-October 2022. Sex Transm Infect 2023; 99:548-551. [PMID: 37536929 DOI: 10.1136/sextrans-2023-055841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES A global outbreak of mpox (monkeypox) has been ongoing since 2022, with most cases in the UK detected in gay, bisexual and other men who have sex with men (GBMSM). Asymptomatic and pauci-symptomatic mpox infection has been reported outside of the UK. We aimed to investigate whether mpox could be detected in specimens from GBMSM in England who were attending sexual health services (SHSs) for asymptomatic sexually transmitted infection screening. METHODS Anonymised, residual clinical specimens from GBMSM undertaking routine asymptomatic screening for gonorrhoea (Neisseria gonorrhoeae (NG)) and chlamydia (Chlamydia trachomatis (CT)) infection were tested for the presence of mpox virus. Specimens were collected between 1 August and 7 October 2022 from three SHSs in high-mpox incidence areas in England. Testing was performed using a dual-clade, mpox virus-specific real-time PCR. RESULTS During the collection period, 2927 clinical specimens (951 pharyngeal swabs, 1022 urine specimens and 954 rectal swabs) were obtained from 1159 GBMSM. Mpox virus was detected in four specimens from two participants who attended the same SHS at different times (the first during the week 8-12 of August, the second during the week 19-23 of September). One participant was positive in the urine specimen only, while the other tested positive at all three sites. CONCLUSIONS A very low prevalence (2 of 1159, 0.17%) of mpox infection was detected in GBMSM attending SHS in England for asymptomatic NG/CT screening, suggesting that undetected infection in this population was unlikely to be a main driver of transmission. Confirmed mpox cases in the UK declined from over 1100 per month in June and July to 764 cumulatively during the collection period. These data give reassurance that the observed reduction in cases during the collection period was not due to undetected infection or changes in presentation among SHS attendees. Currently, there is insufficient evidence to support routine testing of asymptomatic GBMSM for mpox infection in England.
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Affiliation(s)
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Suneeta Soni
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Jodie Owen
- UK Health Security Agency - Porton, Salisbury, UK
| | | | | | | | | | - Rhian Jenkins
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Adrian M Kelly
- Lead Commissioner Sexual Health e-Service, City of London Corporation, London, UK
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3
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Hayes R, Nutland W, Rayment M, Wayal S, Apea V, Clarke A, McOwan A, Sullivan A, Desai M, Jajja A, Rice B, Horne R, McCormack S, Gafos M. "Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England. AIDS Res Ther 2023; 20:81. [PMID: 37964322 PMCID: PMC10648634 DOI: 10.1186/s12981-023-00568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/02/2023] [Indexed: 11/16/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.
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Affiliation(s)
- Rosalie Hayes
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | | | - Michael Rayment
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Institute for Global Health, Mortimer Market Centre, University College London, London, UK
| | - Vanesa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Royal Sussex County Hospital, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Alan McOwan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- STI & HIV Division, Blood Safety, Health Security Agency, London, UK
| | - Andrew Jajja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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4
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Pallett SJC, Heskin J, Keating F, Mazzella A, Taylor H, Patel A, Lamb G, Sturdy D, Eisler N, Denny S, Charani E, Randell P, Mughal N, Parker E, de Oliveira CR, Rayment M, Jones R, Tedder R, McClure M, Groppelli E, Davies GW, O'Shea MK, Moore LSP. Hybrid immunity in older adults is associated with reduced SARS-CoV-2 infections following BNT162b2 COVID-19 immunisation. Commun Med (Lond) 2023; 3:83. [PMID: 37328651 DOI: 10.1038/s43856-023-00303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/09/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Older adults, particularly in long-term care facilities (LTCF), remain at considerable risk from SARS-CoV-2. Data on the protective effect and mechanisms of hybrid immunity are skewed towards young adults precluding targeted vaccination strategies. METHODS A single-centre longitudinal seroprevalence vaccine response study was conducted with 280 LCTF participants (median 82 yrs, IQR 76-88 yrs; 95.4% male). Screening by SARS-CoV-2 polymerase chain reaction with weekly asymptomatic/symptomatic testing (March 2020-October 2021) and serology pre-/post-two-dose Pfizer-BioNTech BNT162b2 vaccination for (i) anti-nucleocapsid, (ii) quantified anti-receptor binding domain (RBD) antibodies at three time-intervals, (iii) pseudovirus neutralisation, and (iv) inhibition by anti-RBD competitive ELISA were conducted. Neutralisation activity: antibody titre relationship was assessed via beta linear-log regression and RBD antibody-binding inhibition: post-vaccine infection relationship by Wilcoxon rank sum test. RESULTS Here we show neutralising antibody titres are 9.2-fold (95% CI 5.8-14.5) higher associated with hybrid immunity (p < 0.00001); +7.5-fold (95% CI 4.6-12.1) with asymptomatic infection; +20.3-fold, 95% (CI 9.7-42.5) with symptomatic infection. A strong association is observed between antibody titre: neutralising activity (p < 0.00001) and rising anti-RBD antibody titre: RBD antibody-binding inhibition (p < 0.001), although 18/169 (10.7%) participants with high anti-RBD titre (>100BAU/ml), show inhibition <75%. Higher RBD antibody-binding inhibition values are associated with hybrid immunity and reduced likelihood of infection (p = 0.003). CONCLUSIONS Hybrid immunity in older adults was associated with considerably higher antibody titres, neutralisation and inhibition capacity. Instances of high anti-RBD titre with lower inhibition suggests antibody quantity and quality as independent potential correlates of protection, highlighting added value of measuring inhibition over antibody titre alone to inform vaccine strategy.
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Affiliation(s)
- Scott J C Pallett
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Joseph Heskin
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Andrea Mazzella
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Aatish Patel
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Georgia Lamb
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Deborah Sturdy
- Royal Hospital Chelsea, Royal Hospital Road, London, UK
- Chief Nurse, Adult Social Care, UK Department of Health and Social Care, London, UK
| | | | - Sarah Denny
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Esmita Charani
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Nabeela Mughal
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
- North West London Pathology, London, UK
| | - Eleanor Parker
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Michael Rayment
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Rachael Jones
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Richard Tedder
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Myra McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Elisabetta Groppelli
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Gary W Davies
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Matthew K O'Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK.
- North West London Pathology, London, UK.
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK.
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5
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Rayment M, Cole S, Heskin J, Khan S, Wright M, Barrett J, Bird J, Scott C, Byrne R, Girometti N, Dosekun O, McSorley J, Wallis G, Bull L, Randell P, Mughal N, Moore LS, Davies GW, Jones R. Managing mpox using a remote monitoring service. J Infect 2023:S0163-4453(23)00323-7. [PMID: 37295512 DOI: 10.1016/j.jinf.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Stephen Cole
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Joseph Heskin
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Sadia Khan
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Mike Wright
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Jodian Barrett
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF. UK
| | - James Bird
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF. UK
| | - Christopher Scott
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Ruth Byrne
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Nicolo Girometti
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Olamide Dosekun
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF. UK
| | - John McSorley
- London North West University Healthcare NHS Trust, London, UK
| | - Gabriel Wallis
- London North West University Healthcare NHS Trust, London, UK
| | - Lauren Bull
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Paul Randell
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF. UK
| | - Nabeela Mughal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Luke Sp Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK; Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF. UK; Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, 8th Floor Commonwealth Building, Du Cane Road. W12 0NN. UK
| | - Gary W Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH. UK.
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6
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Heskin J, Dickinson M, Brown N, Girometti N, Feeney M, Hardie J, Evans C, McOwan A, Higgs C, Basnayake S, Davies GW, Randell P, Bracchi M, Boffito M, Asboe D, Moore LS, Rayment M, Mughal N, Byrne R, Jones R. Rapid reconfiguration of sexual health services in response to UK autochthonous transmission of mpox (monkeypox). Sex Transm Infect 2023; 99:81-84. [PMID: 36522174 PMCID: PMC9985704 DOI: 10.1136/sextrans-2022-055558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Joseph Heskin
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Molly Dickinson
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicklas Brown
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicolo Girometti
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Margaret Feeney
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - James Hardie
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ceri Evans
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Christopher Higgs
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena Basnayake
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary W Davies
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Paul Randell
- Department of Pathology, Imperial College Healthcare NHS Foundation, London, UK
| | - Margherita Bracchi
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Marta Boffito
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - David Asboe
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Luke Sp Moore
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Pathology, Imperial College Healthcare NHS Foundation, London, UK
| | - Michael Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Nabeela Mughal
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Pathology, Imperial College Healthcare NHS Foundation, London, UK
| | - Ruth Byrne
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachael Jones
- GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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7
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Bradshaw D, Khawar A, Patel P, Tosswill J, Brown C, Ogaz D, Mason E, Osman R, Mitchell H, Dosekun O, Peris BM, Pickard G, Rayment M, Jones R, Hopkins M, Williams A, Kingston M, Machin N, Taha Y, Duncan S, Turner N, Gill N, Andrews N, Raza M, Tazzyman S, Nori A, Cunningham E, Taylor GP. HTLV seroprevalence in people using HIV pre-exposure prophylaxis in England. J Infect 2023; 86:245-247. [PMID: 36773896 DOI: 10.1016/j.jinf.2023.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES HTLV-1 is predominantly a sexually-transmitted infection but testing is not mentioned in HIV-PrEP guidelines. We ascertained HTLV-1/HTLV-2 seroprevalence amongst HIV-PrEP users in England. METHODS An unlinked anonymous seroprevalence study. RESULTS Amongst 2015 HIV-PrEP users, 95% were men, 76% of white ethnicity and 83% had been born in Europe. There were no HTLV-1/HTLV-2 seropositive cases (95% confidence interval 0% - 0.18%). CONCLUSIONS There were no HTLV positive cases, likely reflecting the demographic of mostly white and European-born individuals. Similar studies are needed worldwide to inform public health recommendations for HIV-PrEP using populations, particularly in HTLV-endemic settings.
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Affiliation(s)
- Daniel Bradshaw
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
| | - Arham Khawar
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Poorvi Patel
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | | | - Colin Brown
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Dana Ogaz
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Emily Mason
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Roeann Osman
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Holly Mitchell
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Olamide Dosekun
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Borja Mora Peris
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Graham Pickard
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Mark Hopkins
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Andy Williams
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Margaret Kingston
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Nicholas Machin
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Yusri Taha
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Sarah Duncan
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Neil Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Noel Gill
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mohammad Raza
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Simon Tazzyman
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Achyuta Nori
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Emma Cunningham
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Graham P Taylor
- Imperial College London, London W2 1PG, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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8
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Goodfellow JJ, Hughes S, Smith J, Jones R, Moore LSP, Rayment M. Novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium. Sex Transm Infect 2023; 99:208-210. [PMID: 36717253 DOI: 10.1136/sextrans-2022-055621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 02/01/2023] Open
Abstract
We describe the novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium (M. genitalium) infection in a 20-year-old heterosexual cisgender male presenting with recurrent symptomatic non-gonococcal urethritis. M. genitalium urethritis is an increasingly common clinical conundrum in sexual health clinics and in cases of second-line treatment failure (such as moxifloxacin), UK and international guidelines struggle to make recommendations for third-line treatments. As shown in our case, the evidence base for third-line treatments is lacking, with poor success rates, and may be poorly tolerated. Here we demonstrate the novel use of a well-tolerated oral antimicrobial, chloramphenicol, resulting in rapid microbiological and clinical cure in treatment-resistant M. genitalium urethritis.
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Affiliation(s)
| | - Stephen Hughes
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jo Smith
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachael Jones
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Rayment
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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9
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Pallett SJC, Rayment M, Randell P, Davies GW, Moore LSP. 4 Early identification of high-risk individuals for combination monoclonal antibody therapy is feasible by SARS-CoV-2 anti-spike antibody specific lateral flow assay. BMJ Mil Health 2022. [DOI: 10.1136/bmjmilitary-2022-rsmabstracts.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCombination monoclonal antibody therapy has recently been approved for prevention and treatment of severe COVID-19 infection in the UK. Available data suggests benefit is limited to those yet to mount an effective immune response from natural infection or vaccination, but concern exists around ability to make timely assessment of immune status of community-based patients.MethodsHealthcare workers were invited to undergo paired laboratory-based and rapid point-of- care (POC) lateral flow anti-spike antibody testing. Three commercial POC tests were selected to represent currently available testing methods: a split IgM/IgG anti-spike antibody test, an anti-receptor binding domain total antibody test and an anti-spike neutralisation assay. Qualitative POC colourmetric band intensities were independently scored and correlated with quantitative IgG neutralising antibody titres (Abbott Architect SARS-CoV-2 IgG Quant II chemiluminescent microparticle immunoassay [CMIA]). CMIA titres were correlated with the World Health Organisation international reference standard for neutralising antibody. Negative controls were carried out using 2018 pre-pandemic sera and post-pandemic individuals with negative CMIA results (target population).Results190 individuals (median 40 years, IQR 29-49; 76.2% female) underwent paired testing, with a further 40 pre-pandemic sera tested. Assays demonstrated high performance characteristics: split IgM/IgG assay sensitivity 96.2% (95%CI 92.4.5–98.5), specificity 100.0% (95%CI 91.8–100.0); anti-receptor binding domain total antibody assay sensitivity 100.0% (95%CI 95.5–100.0), specificity 100.0% (95%CI 69.2–100.0). The neutralising antibody assay had a specificity of 97.0% (95%CI 84.2–99.9%) and strongly correlated with neutralising antibody titre (p<0.001). Probability for matched paired results was significant (McNemar’s p<0.001) while band intensity correlated strongly with neutralising titres (p<0.0001). Positive and negative predictive values for total antibody and neutralising assays were both >99%.ConclusionsPOC assays were found to be reliable predictors of both antibody status and broadly of neutralising antibody titre. Anti-S POC assays have potential to act as suitable alternatives for rapid identification of community patient immune status at presentation.
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Panou E, Nikolaou C, Payagala S, Bakkour W, Shaw H, Perrett C, French P, Ratynska M, Brock C, Rayment M, Bunker CB. HIV-related Merkel cell carcinoma: A report of three cases from the UK. Int J STD AIDS 2022; 33:1084-1086. [DOI: 10.1177/09564624221123872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Merkel cell carcinoma (MCC) of the skin is a rare, aggressive and often fatal neuroendocrine skin cancer. The incidence of MCC has significantly increased in the last decades. Factors that have been associated with the development of MCC include infection with Merkel Cell polyomavirus (MCPyV), ultraviolet exposure, hematologic malignancies and immunosuppression.We present three cases of patients living with HIV who were diagnosed with MCC. HIV cases associated with MCC have been rarely reported and to our knowledge, not yet before in the UK.
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Affiliation(s)
- Evdoxia Panou
- Departments of Dermatology, University College London Hospitals NHS Foundation Trust, UK
| | - Christos Nikolaou
- Department of Oncology, Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - Sashini Payagala
- Department of GUM/HIV and Oncology, Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Waseem Bakkour
- Departments of Dermatology, University College London Hospitals NHS Foundation Trust, UK
| | - Heather Shaw
- Oncology and Histopathology, University College London Hospitals NHS Foundation Trust, UK
| | - Conal Perrett
- Departments of Dermatology, University College London Hospitals NHS Foundation Trust, UK
| | - Patrick French
- Department of GUM/HIV, Central and North West London NHS Foundation Trust, UK
| | | | - Cathryn Brock
- Department of GUM/HIV and Oncology, Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Michael Rayment
- Department of GUM/HIV and Oncology, Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - CB Bunker
- Departments of Dermatology, University College London Hospitals NHS Foundation Trust, UK
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Pallett SJC, Rayment M, Heskin J, Mazzelli A, Jones R, Mughal N, Randell P, Davies GW, Moore LSP. Early identification of high-risk individuals for monoclonal antibody therapy and prophylaxis is feasible by SARS-CoV-2 anti-spike antibody specific lateral flow assay. Diagn Microbiol Infect Dis 2022; 104:115788. [PMID: 36084423 PMCID: PMC9371766 DOI: 10.1016/j.diagmicrobio.2022.115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/17/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
Monoclonal antibody therapy has been approved for prophylaxis and treatment of severe COVID-19 infection. Greatest benefit appears limited to those yet to mount an effective immune response from natural infection or vaccination, but concern exists around ability to make timely assessment of immune status of community-based patients where laboratory-based serodiagnostics predominate. Participants were invited to undergo paired laboratory-based (Abbott Architect SARS-CoV-2 IgG Quant II chemiluminescent microparticle immunoassay) and lateral flow assays (LFA; a split SARS-CoV-2 IgM/IgG and total antibody test) able to detect SARS-CoV-2 anti-spike antibodies. LFA band strength was compared with CMIA titer by log-linear regression. Two hundred individuals (median age 43.5 years, IQR 30−59; 60.5% female) underwent testing, with a further 100 control sera tested. Both LFA band strengths correlated strongly with CMIA antibody titers (P < 0.001). LFAs have the potential to assist in early identification of seronegative patients who may demonstrate the greatest benefit from monoclonal antibody treatment.
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12
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Medland NA, Taylor R, Saunders J, Rayment M, Fox A, Sullivan A. Why sexual health clinics are important in the 2020s. Sex Health 2022; 19:329-335. [PMID: 35922116 DOI: 10.1071/sh22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022]
Abstract
To make services more accessible, acceptable and affordable, sexual health service delivery models have embraced innovation, technology, outreach and decentralisation. In particular, some routine high-volume services, like asymptomatic testing for sexually transmitted infections (STIs), can be delivered in general practice, online or in non-clinical settings. On the surface, sexual health clinics, like hospitals or other primary care clinics, might appear to be operating on a model that has not changed significantly in recent times. However, globally sexual healthcare needs are rising both in volume and complexity, not all of which can be adequately met through decentralised care. Sexual health clinics themselves are the site of considerable innovation. The importance of sexual health clinics in the diagnosis and treatment of symptomatic STIs is likely to increase with the increasing burden of disease, the complexity of treatment guidelines and the emergence of new infections. Services essential to patient health such as immediate or complex clinical care, partner notification and safeguarding, and activities essential to the health system like research, training and supervision require expertise to be located where it can be accessed and maintained at reasonable cost. We do not know whether increasing some services outside existing models can safely compensate for reducing other services inside them.
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Affiliation(s)
- Nicholas A Medland
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ruth Taylor
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John Saunders
- Blood Safety, STIs and HIV Division, UK Health Security Agency, London, UK; and Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Ashini Fox
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ann Sullivan
- Blood Safety, STIs and HIV Division, UK Health Security Agency, London, UK; and Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
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13
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Heskin J, Pallett SJC, Al-Hindawi A, Davies GW, Rayment M, Mughal N, Randell P, Jones R, Moore LSP. Evaluating the performance characteristics of five lateral flow assays for the detection of the SARS-CoV-2 nucleocapsid antigen. Sci Rep 2022; 12:8811. [PMID: 35614181 PMCID: PMC9130972 DOI: 10.1038/s41598-022-12805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
In response to the COVID-19 pandemic, lateral flow assays (LFAs) for the detection of SARS-CoV-2 antigen have been proposed as a complementary option to the more costly and time consuming reverse-transcriptase polymerase chain reaction (RT-PCR). We assessed five commercially available SARS-CoV-2 antigen detecting LFAs (ASSUT EUROPE (Rome, Italy), Besthree (Taizhou, China), Encode (Zhuhai, China), Fortress (Antrim UK), and Hughes Medical (Buckinghamshire, UK), using samples collected from hospitalised individuals with COVID-19 and compared these results against established RT-PCR assays with the aim of estimating test performance characteristics. We performed a diagnostic accuracy study of the five LFAs on 110 inpatients with confirmed COVID-19 and 75 COVID-19 negative control participants. Assay evaluation was performed using a modified version of each manufacturer's protocol allowing for parallel testing of a single sample on multiple assays. Additional variables were studied including infection acquisition, oxygenation requirements at time of swabbing, and patient outcomes. The 110 patients were 48% (53) female, with mean age 67 years (range 26-100 years), and 77% (85) cases were community onset SARS-CoV-2. Across the five assays, sensitivity ranged from 64 (95% CI 53-73) to 76% (95% CI 65-85); Fortress performed best with sensitivity of 76% (95% CI 65-85). Specificity was high across all assays with 4/5 LFAs achieving 100%. LFA sensitivity was not dependant on RT-PCR cycle thresholds. SARS-CoV-2 antigen detecting LFAs may complement RT-PCR testing to facilitate early diagnosis and provide community testing strategies for identification of patients with COVID-19, however we find suboptimal test performance characteristics across a range of commercially available manufacturers, below WHO and MHRA pre-set sensitivity performance thresholds. With such variation in sensitivity between LFAs and PCR testing and between assay brands, we advise caution in the deployment of LFAs outside of environments with clinical oversight.
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Affiliation(s)
- J Heskin
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - S J C Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - A Al-Hindawi
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - G W Davies
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - M Rayment
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - N Mughal
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - P Randell
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - R Jones
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - L S P Moore
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, UK
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14
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Platt E, Hepworth E, Rayment M, Melendez-Torres GJ, Duff F, Cohen C. Acceptability of routine domestic abuse enquiry within sexual health services. Int J STD AIDS 2022; 33:608-612. [PMID: 35331066 DOI: 10.1177/09564624221083183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our sexual health services (SHS) introduced routine domestic abuse (DA) enquiry in April 2018 following targeted staff training. A survey was undertaken to ascertain attitudes towards the initiative. METHODS Between October 2019 and March 2020, patients were invited to respond to an anonymous questionnaire by SMS. Clinical staff were emailed a separate survey. RESULTS The patient response rate was 40% (226/562): 72% (161/226) female, 80% (179/226) heterosexual, 19% (42) LGBT, 47% (106) aged 25-34 and 25% (57) aged 18-24. Almost all (97%, 220) recalled routine enquiry at their clinic appointment; 91% (206) felt comfortable when asked, and 95% (214) found this acceptable. Fifty-one staff responded (36% response rate), 67% (34) female, 55% (28) heterosexual, 35% (18) LGBT. 43% (22) were nurses, 31% (16) doctors, 12% (6) health advisers and 8% (4) healthcare assistants. The majority of staff 96% (49) were confident with conducting routine enquiry, 92% (47) agreed patients found it acceptable; 92% (47) felt routine enquiry was appropriate and 92% (47) had received targeted training. CONCLUSION Respondents were overwhelmingly in favour of routine DA enquiry within SHS, and this initiative could be easily adapted in other specialties alongside staff training.
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Affiliation(s)
- Elizabeth Platt
- 9762Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- 9762Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Fiona Duff
- 9762Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Charlotte Cohen
- 9762Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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15
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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16
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Heskin J, Pallett SJC, Mughal N, Davies GW, Moore LSP, Rayment M, Jones R. Caution required with use of ritonavir-boosted PF-07321332 in COVID-19 management. Lancet 2022; 399:21-22. [PMID: 34973713 PMCID: PMC8718360 DOI: 10.1016/s0140-6736(21)02657-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Joseph Heskin
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK.
| | - Scott J C Pallett
- Royal Defence Medical College, Royal Centre for Defence Medicine, Birmingham, UK
| | - Nabeela Mughal
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Gary W Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Luke S P Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
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17
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Pallett SJ, Jones R, Abdulaal A, Pallett MA, Rayment M, Patel A, Denny SJ, Mughal N, Khan M, Rosadas de Oliveira C, Pantelidis P, Randell P, Toumazou C, O'Shea MK, Tedder R, McClure MO, Davies GW, Moore LS. Variability in detection of SARS-CoV-2-specific antibody responses following mild infection: a prospective multicentre cross-sectional study, London, United Kingdom, 17 April to 17 July 2020. Euro Surveill 2022; 27:2002076. [PMID: 35086612 PMCID: PMC8796290 DOI: 10.2807/1560-7917.es.2022.27.4.2002076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/03/2021] [Indexed: 12/13/2022] Open
Abstract
IntroductionImmunoassays targeting different SARS-CoV-2-specific antibodies are employed for seroprevalence studies. The degree of variability between immunoassays targeting anti-nucleocapsid (anti-NP; the majority) vs the potentially neutralising anti-spike antibodies (including anti-receptor-binding domain; anti-RBD), particularly in mild or asymptomatic disease, remains unclear.AimsWe aimed to explore variability in anti-NP and anti-RBD antibody detectability following mild symptomatic or asymptomatic SARS-CoV-2 infection and analyse antibody response for correlation with symptomatology.MethodsA multicentre prospective cross-sectional study was undertaken (April-July 2020). Paired serum samples were tested for anti-NP and anti-RBD IgG antibodies and reactivity expressed as binding ratios (BR). Multivariate linear regression was performed analysing age, sex, time since onset, symptomatology, anti-NP and anti-RBD antibody BR.ResultsWe included 906 adults. Antibody results (793/906; 87.5%; 95% confidence interval: 85.2-89.6) and BR strongly correlated (ρ = 0.75). PCR-confirmed cases were more frequently identified by anti-RBD (129/130) than anti-NP (123/130). Anti-RBD testing identified 83 of 325 (25.5%) cases otherwise reported as negative for anti-NP. Anti-NP presence (+1.75/unit increase; p < 0.001), fever (≥ 38°C; +1.81; p < 0.001) or anosmia (+1.91; p < 0.001) were significantly associated with increased anti-RBD BR. Age (p = 0.85), sex (p = 0.28) and cough (p = 0.35) were not. When time since symptom onset was considered, we did not observe a significant change in anti-RBD BR (p = 0.95) but did note decreasing anti-NP BR (p < 0.001).ConclusionSARS-CoV-2 anti-RBD IgG showed significant correlation with anti-NP IgG for absolute seroconversion and BR. Higher BR were seen in symptomatic individuals, particularly those with fever. Inter-assay variability (12.5%) was evident and raises considerations for optimising seroprevalence testing strategies/studies.
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Affiliation(s)
- Scott Jc Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahmed Abdulaal
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Mitchell A Pallett
- Department of Infectious Disease, MRC Centre for Molecular Bacteriology and Infection, Imperial College London, United Kingdom
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Aatish Patel
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah J Denny
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Nabeela Mughal
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- North West London Pathology, London, United Kingdom
| | - Maryam Khan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Carolina Rosadas de Oliveira
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom
| | | | - Paul Randell
- North West London Pathology, London, United Kingdom
| | - Christofer Toumazou
- Faculty of Engineering, Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Matthew K O'Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Richard Tedder
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Myra O McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Gary W Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Luke Sp Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- North West London Pathology, London, United Kingdom
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, United Kingdom
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18
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Heskin J, Pallett SJC, Mughal N, Jones R, Rayment M, Davies GW, Moore LSP. Healthcare worker perceptions of routine asymptomatic SARS-CoV-2 screening using lateral flow assays: A qualitative analysis across two London hospitals. J Infect 2021; 84:e26-e28. [PMID: 34736983 PMCID: PMC8559300 DOI: 10.1016/j.jinf.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph Heskin
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
| | - Scott J C Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Nabeela Mughal
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom; Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London W6 8RF, United Kingdom
| | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
| | - Michael Rayment
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
| | - Gary W Davies
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
| | - Luke S P Moore
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom; Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London W6 8RF, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, United Kingdom
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19
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Murongazvombo AS, Jones RS, Rayment M, Mughal N, Azadian B, Donaldson H, Davies GW, Moore LSP, Aiken AM. Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study. Infect Prev Pract 2021; 3:100157. [PMID: 34316587 PMCID: PMC8217738 DOI: 10.1016/j.infpip.2021.100157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patient-facing (frontline) health-care workers (HCWs) are at high risk of repeated exposure to SARS-CoV-2. AIM We sought to determine the association between levels of frontline exposure and likelihood of SARS-CoV-2 seropositivity amongst HCW. METHODS A cross-sectional study was undertaken using purposefully collected data from HCWs at two hospitals in London, United Kingdom (UK) over eight weeks in May-June 2020. Information on sociodemographic, clinical and occupational characteristics was collected using an anonymised questionnaire. Serology was performed using split SARS-CoV-2 IgM/IgG lateral flow immunoassays. Exposure risk was categorised into five pre-defined ordered grades. Multivariable logistic regression was used to examine the association between being frontline and SARS-CoV-2 seropositivity after controlling for other risks of infection. FINDINGS 615 HCWs participated in the study. 250/615 (40.7%) were SARS-CoV-2 IgM and/or IgG positive. After controlling for other exposures, there was non-significant evidence of a modest association between being a frontline HCW (any level) and SARS-CoV-2 seropositivity compared to non-frontline status (OR 1.39, 95% CI 0.84-2.30, P=0.200). There was 15% increase in the odds of SARS-CoV-2 seropositivity for each step along the frontline exposure gradient (OR 1.15, 95% CI 1.00-1.32, P=0.043). CONCLUSION We found a high SARS-CoV-2 IgM/IgG seropositivity with modest evidence for a dose-response association between increasing levels of frontline exposure risk and seropositivity. Even in well-resourced hospital settings, appropriate use of personal protective equipment, in addition to other transmission-based precautions for inpatient care of SARS-CoV-2 patients could reduce the risk of hospital-acquired SARS-CoV-2 infection among frontline HCW.
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Affiliation(s)
| | - Rachael S. Jones
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Michael Rayment
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Nabeela Mughal
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Berge Azadian
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Hugo Donaldson
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Gary W. Davies
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Luke SP. Moore
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Du Cane Road, London, W12 0NN, UK
| | - Alexander M. Aiken
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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20
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Lamb G, Heskin J, Randell P, Mughal N, Moore LS, Jones R, Davies GW, Rayment M. Real-world evaluation of COVID-19 lateral flow device (LFD) mass-testing in healthcare workers at a London hospital; a prospective cohort analysis. J Infect 2021; 83:452-457. [PMID: 34364950 PMCID: PMC8340567 DOI: 10.1016/j.jinf.2021.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022]
Abstract
Objectives Real-world evaluation of the performance of the Innova lateral flow immunoassay antigen device (LFD) for regular COVID-19 testing of hospital workers. Methods This prospective cohort analysis took place at a London NHS Trust. 5076 secondary care healthcare staff participated in LFD testing from 18 November 2020 to21 January 2021. Staff members submitted results and symptoms via an online portal twice weekly. Individuals with positive LFD results were invited for confirmatory SARS CoV-2 PCR testing. The positive predictive value (PPV) of the LFD was measured. Secondary outcome measures included time from LFD result to PCR test and staff symptom profiles. Results 284/5076 individuals reported a valid positive LFD result, and a paired PCR result was obtained in 259/284 (91.2%). 244 were PCR positive yielding a PPV of 94.21% (244/259, 95% CI 90.73% to 96.43%). 204/259 (78.8%) staff members had the PCR within 36 hours of the LFD test. Symptom profiles were confirmed for 132/244 staff members (54.1%) with positive PCR results (true positives) and 13/15 (86.6%) with negative PCR results (false positives). 91/132 true positives (68.9%) were symptomatic at the time of LFD testing: 65/91 (71.4%) had symptoms meeting the PHE case definition of COVID-19, whilst 26/91 (28.6%) had atypical symptoms. 18/41 (43.9%) staff members who were asymptomatic at the time of positive LFD developed symptoms in the subsequent four days. 9/13 (76.9%) false positives were asymptomatic, 1/13 (7.7%) had atypical symptoms and 3/13 (23.1%) had symptoms matching the PHE case definition. Conclusions The PPV of the Innova LFD is high when used amongst hospital staff during periods of high prevalence of COVID-19, yet we find frequent use by symptomatic staff rather than as a purely asymptomatic screening tool. LFD testing does allow earlier isolation of infected workers and facilitates detection of individuals whose symptoms do not qualify for PCR testing.
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Affiliation(s)
- Georgia Lamb
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - Joseph Heskin
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Paul Randell
- Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, W6 8RF, United Kingdom
| | - Nabeela Mughal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Luke Sp Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom; Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, W6 8RF, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, W12 0NN, United Kingdom
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Gary W Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
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21
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Pallett S, Jones R, Rayment M, Pallett MA, Mughal N, Oliveira CRD, Randell P, Davies GW, Tedder R, McClure MO, O’Shea MK, Moore LSP. 3 Clinical implications of the differential antibody response in mild-moderate SARS-CoV-2: a prospective multi-centre cross-sectional study. BMJ Mil Health 2021. [DOI: 10.1136/bmjmilitary-2021-rsmabstracts.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionSerological testing can augment delayed case identification programmes for Severe Acute Respiratory Syndrome coronoravirus-2 (SARS-CoV-2). Immunoassays employ anti-nucleocapsid (anti-NP; the majority) or potentially neutralising anti-spike (including anti-receptor binding domain; anti-RBD) antibody targets, yet correlation between assays and variability arising from disease symptomatology remains unclear. We explore these possibly differential immune responses across the disease spectrum.MethodsA multicentre prospective study was undertaken via a SARS-CoV-2 delayed case identification programme (08 May-11 July 2020). Matched samples were tested for anti-NP and anti-RBD (utilising an ‘inhouse’ double-antigen bridged assay), reactivity expressed as test/cut-off binding ratios (BR) and results compared. A multivariate linear regression model analysed age, sex, symptomatology, PCR positivity, anti-NP, and anti-RBD BRs. Participants were followed up for possible reinfection.Results902 individuals underwent matched testing; 109 were SARS-CoV-2 PCR swab positive. Anti-NP, anti-RBD immunoassay agreement was 87.5% (95% CI 85.3–89.6), with BRs strongly correlated (R=0.75). PCR confirmed cases were more frequently identified by anti-RBD (sensitivity 108/109, 99.1%, 95% CI 95.0–100.0) than anti-NP (102/109, 93.6%, 95% CI 87.2–97.4). Anti-RBD identified an additional 83/325 (25.5%) cases in those seronegative for anti-NP. Presence of anti-NP (p<0.0001), fever (p=0.005), or anosmia (p=0.002) were all significantly associated with an increased anti-RBD BR. Age was associated with reduced anti-RBD BR (p=0.052). Three cases with evidence of seroconversion (anti-RBD seropositive) presented with subsequent reactive PCR results, two of which coincided with first time onset of Public Heath England SARS-CoV-2 symptoms.ConclusionsSARS-CoV-2 anti-RBD shows significant correlation with anti-NP for absolute seroconversion, and BRs. Higher BRs are seen in symptomatic individuals with significantly higher levels seen in those with fever and anosmia. The degree of discordant results (12.5%) limits the use of anti-NP as a stand-alone for delayed case finding programmes. Similarly, this discordance limits the utility of non-neutralising anti-NP assays in place of potentially neutralising anti-RBD to infer possible immunity.** this abstract presentation was awarded an Honourable Mention
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22
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Chirwa M, Davies O, Castelino S, Mpenge M, Nyatsanza F, Sethi G, Shabbir M, Rayment M. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS 2021; 32:884-895. [PMID: 34009058 DOI: 10.1177/09564624211003761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.
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Affiliation(s)
- Mimie Chirwa
- Genitourinary Medicine, 9762Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Olubanke Davies
- Genitourinary Medicine, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Sheena Castelino
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mbiye Mpenge
- Consultant Microbiologist, Weston Area Health NHS Trust, Weston-super-Mare, Somerset, UK
| | - Farai Nyatsanza
- Genitourinary Medicine, Cambridge Community Services NHS Trust, Cambridgeshire, UK
| | - Gulshan Sethi
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Majid Shabbir
- Urologist, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Michael Rayment
- Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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23
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Evans CD, Peacock M, Baird AJ, Artz RRE, Burden A, Callaghan N, Chapman PJ, Cooper HM, Coyle M, Craig E, Cumming A, Dixon S, Gauci V, Grayson RP, Helfter C, Heppell CM, Holden J, Jones DL, Kaduk J, Levy P, Matthews R, McNamara NP, Misselbrook T, Oakley S, Page SE, Rayment M, Ridley LM, Stanley KM, Williamson JL, Worrall F, Morrison R. Overriding water table control on managed peatland greenhouse gas emissions. Nature 2021; 593:548-552. [PMID: 33882562 DOI: 10.1038/s41586-021-03523-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
Global peatlands store more carbon than is naturally present in the atmosphere1,2. However, many peatlands are under pressure from drainage-based agriculture, plantation development and fire, with the equivalent of around 3 per cent of all anthropogenic greenhouse gases emitted from drained peatland3-5. Efforts to curb such emissions are intensifying through the conservation of undrained peatlands and re-wetting of drained systems6. Here we report eddy covariance data for carbon dioxide from 16 locations and static chamber measurements for methane from 41 locations in the UK and Ireland. We combine these with published data from sites across all major peatland biomes. We find that the mean annual effective water table depth (WTDe; that is, the average depth of the aerated peat layer) overrides all other ecosystem- and management-related controls on greenhouse gas fluxes. We estimate that every 10 centimetres of reduction in WTDe could reduce the net warming impact of CO2 and CH4 emissions (100-year global warming potentials) by the equivalent of at least 3 tonnes of CO2 per hectare per year, until WTDe is less than 30 centimetres. Raising water levels further would continue to have a net cooling effect until WTDe is within 10 centimetres of the surface. Our results suggest that greenhouse gas emissions from peatlands drained for agriculture could be greatly reduced without necessarily halting their productive use. Halving WTDe in all drained agricultural peatlands, for example, could reduce emissions by the equivalent of over 1 per cent of global anthropogenic emissions.
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Affiliation(s)
- C D Evans
- UK Centre for Ecology and Hydrology, Bangor, UK. .,Department of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - M Peacock
- Department of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - A J Baird
- School of Geography, University of Leeds, Leeds, UK
| | - R R E Artz
- The James Hutton Institute, Aberdeen, UK
| | - A Burden
- UK Centre for Ecology and Hydrology, Bangor, UK
| | - N Callaghan
- UK Centre for Ecology and Hydrology, Bangor, UK
| | - P J Chapman
- School of Geography, University of Leeds, Leeds, UK
| | - H M Cooper
- UK Centre for Ecology and Hydrology, Wallingford, UK
| | - M Coyle
- The James Hutton Institute, Aberdeen, UK.,UK Centre for Ecology and Hydrology, Penicuik, UK
| | - E Craig
- UK Centre for Ecology and Hydrology, Bangor, UK.,School of Natural Sciences, Bangor University, Bangor, UK
| | - A Cumming
- UK Centre for Ecology and Hydrology, Wallingford, UK
| | - S Dixon
- Department of Earth Sciences, Durham University, Durham, UK
| | - V Gauci
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - R P Grayson
- School of Geography, University of Leeds, Leeds, UK
| | - C Helfter
- UK Centre for Ecology and Hydrology, Penicuik, UK
| | - C M Heppell
- School of Geography, Queen Mary University of London, London, UK
| | - J Holden
- School of Geography, University of Leeds, Leeds, UK
| | - D L Jones
- School of Natural Sciences, Bangor University, Bangor, UK.,SoilsWest, Centre for Sustainable Farming Systems, Food Futures Institute, Murdoch University, Murdoch, Western Australia, Australia.,UWA School of Agriculture and Environment, University of Western Australia, Perth, Western Australia, Australia
| | - J Kaduk
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - P Levy
- UK Centre for Ecology and Hydrology, Penicuik, UK
| | - R Matthews
- Rothamsted Research, North Wyke, Okehampton, UK
| | - N P McNamara
- UK Centre for Ecology and Hydrology, Lancaster, UK
| | | | - S Oakley
- UK Centre for Ecology and Hydrology, Lancaster, UK
| | - S E Page
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - M Rayment
- School of Natural Sciences, Bangor University, Bangor, UK
| | - L M Ridley
- School of Natural Sciences, Bangor University, Bangor, UK
| | - K M Stanley
- Institut für Atmosphäre und Umwelt, Goethe Universität Frankfurt, Frankfurt am Main, Germany
| | | | - F Worrall
- Department of Earth Sciences, Durham University, Durham, UK
| | - R Morrison
- UK Centre for Ecology and Hydrology, Wallingford, UK
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24
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Moshe M, Daunt A, Flower B, Simmons B, Brown JC, Frise R, Penn R, Kugathasan R, Petersen C, Stockmann H, Ashby D, Riley S, Atchison C, Taylor GP, Satkunarajah S, Naar L, Klaber R, Badhan A, Rosadas C, Marchesin F, Fernandez N, Sureda-Vives M, Cheeseman H, O'Hara J, Shattock R, Fontana G, Pallett SJC, Rayment M, Jones R, Moore LSP, Ashrafian H, Cherapanov P, Tedder R, McClure M, Ward H, Darzi A, Elliott P, Cooke GS, Barclay WS. SARS-CoV-2 lateral flow assays for possible use in national covid-19 seroprevalence surveys (React 2): diagnostic accuracy study. BMJ 2021; 372:n423. [PMID: 33653694 PMCID: PMC7921617 DOI: 10.1136/bmj.n423] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate the performance of new lateral flow immunoassays (LFIAs) suitable for use in a national coronavirus disease 2019 (covid-19) seroprevalence programme (real time assessment of community transmission 2-React 2). DESIGN Diagnostic accuracy study. SETTING Laboratory analyses were performed in the United Kingdom at Imperial College, London and university facilities in London. Research clinics for finger prick sampling were run in two affiliated NHS trusts. PARTICIPANTS Sensitivity analyses were performed on sera stored from 320 previous participants in the React 2 programme with confirmed previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Specificity analyses were performed on 1000 prepandemic serum samples. 100 new participants with confirmed previous SARS-CoV-2 infection attended study clinics for finger prick testing. INTERVENTIONS Laboratory sensitivity and specificity analyses were performed for seven LFIAs on a minimum of 200 serum samples from participants with confirmed SARS-CoV-2 infection and 500 prepandemic serum samples, respectively. Three LFIAs were found to have a laboratory sensitivity superior to the finger prick sensitivity of the LFIA currently used in React 2 seroprevalence studies (84%). These LFIAs were then further evaluated through finger prick testing on participants with confirmed previous SARS-CoV-2 infection: two LFIAs (Surescreen, Panbio) were evaluated in clinics in June-July 2020 and the third LFIA (AbC-19) in September 2020. A spike protein enzyme linked immunoassay and hybrid double antigen binding assay were used as laboratory reference standards. MAIN OUTCOME MEASURES The accuracy of LFIAs in detecting immunoglobulin G (IgG) antibodies to SARS-CoV-2 compared with two reference standards. RESULTS The sensitivity and specificity of seven new LFIAs that were analysed using sera varied from 69% to 100%, and from 98.6% to 100%, respectively (compared with the two reference standards). Sensitivity on finger prick testing was 77% (95% confidence interval 61.4% to 88.2%) for Panbio, 86% (72.7% to 94.8%) for Surescreen, and 69% (53.8% to 81.3%) for AbC-19 compared with the reference standards. Sensitivity for sera from matched clinical samples performed on AbC-19 was significantly higher with serum than finger prick at 92% (80.0% to 97.7%, P=0.01). Antibody titres varied considerably among cohorts. The numbers of positive samples identified by finger prick in the lowest antibody titre quarter varied among LFIAs. CONCLUSIONS One new LFIA was identified with clinical performance suitable for potential inclusion in seroprevalence studies. However, none of the LFIAs tested had clearly superior performance to the LFIA currently used in React 2 seroprevalence surveys, and none showed sufficient sensitivity and specificity to be considered for routine clinical use.
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Affiliation(s)
- Maya Moshe
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Anna Daunt
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Barnaby Flower
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Bryony Simmons
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Jonathan C Brown
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Rebecca Frise
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Rebecca Penn
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Ruthiran Kugathasan
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Claire Petersen
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Helen Stockmann
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Steven Riley
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Sutha Satkunarajah
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Lenny Naar
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Robert Klaber
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Anjna Badhan
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Federica Marchesin
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Natalia Fernandez
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Macià Sureda-Vives
- Synthetic Biology Group, London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah Cheeseman
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Robin Shattock
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Gianluca Fontana
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Scott J C Pallett
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Cherapanov
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Chromatin Structure and Mobile DNA Laboratory, Francis Crick Institute, London, UK
| | - Richard Tedder
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Myra McClure
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Helen Ward
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Ara Darzi
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliott
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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25
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Palfreeman A, Sullivan A, Rayment M, Waters L, Buckley A, Burns F, Clutterbuck D, Cormack I, Croxford S, Dean G, Delpech V, Josh J, Kifetew C, Larbalestier N, Mackie N, Matthews P, Murchie M, Nardone A, Randell P, Skene H, Smithson K, Trevelion R, Trewinnard K, White A, Young E, Peto T. British HIV Association/British Association for Sexual Health and HIV/British Infection Association adult HIV testing guidelines 2020. HIV Med 2020; 21 Suppl 6:1-26. [PMID: 33333625 DOI: 10.1111/hiv.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adrian Palfreeman
- Honorary Associate Professor, Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Ann Sullivan
- Consultant in HIV and Sexual Health, Chelsea and Westminster Healthcare NHS Foundation Trust and Imperial College, London
| | - Michael Rayment
- Consultant in Genitourinary Medicine and HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Laura Waters
- Chair British HIV Association, Consultant in HIV & Sexual Health, Mortimer Market Centre, CNWL NHS Trust, London
| | - Anna Buckley
- Consultant in Emergency Medicine, University College Hospital NHS Trust, London
| | - Fiona Burns
- Associate Professor in HIV and Sexual Health, Institute for Global Health, University College London
| | - Daniel Clutterbuck
- Clinical Lead for Sexual and Reproductive Health and HIV, Lothian Sexual and Reproductive Health Service, Edinburgh
| | - Ian Cormack
- Clinical Lead HIV Medicine, Croydon University Hospital
| | - Sara Croxford
- Senior HIV/STI Prevention Scientist, Public Health England, London
| | - Gillian Dean
- Consultant in Genitourinary/HIV Medicine, Brighton & Sussex University Hospitals NHS Trust
| | | | | | - Chamut Kifetew
- Project Manager, National HIV Prevention Programme, Terrence Higgins Trust and HIV, Prevention England
| | - Nick Larbalestier
- Consultant in HIV Medicine, Guy's & St. Thomas' NHS Foundation Trust, London
| | - Nicola Mackie
- Consultant in HIV/Sexual Health, Imperial College Healthcare NHS Trust, London
| | - Philippa Matthews
- General Practitioner, Medical Director, Islington GP Federation, Islington Clinical Lead for Sexual Health, London
| | - Martin Murchie
- Lecturer in Adult Nursing/Sexual Health Adviser, Glasgow Caledonian University/Sandyford Sexual Health NHS GGC
| | - Anthony Nardone
- Consultant Scientist (Sexual Health Promotion), HIV/STI Department, Public Health England (September 2016 to June 2018) and Senior Epidemiologist, Epiconcept, Paris (June 2018 to November 2019)
| | - Paul Randell
- Consultant Virologist, Imperial College Healthcare NHS Trust
| | - Hannah Skene
- Clinical Lead for Acute Medicine, Chelsea and Westminster Hospital, London
| | | | | | - Karen Trewinnard
- Sexual and Reproductive Health Clinician and Trainer, Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists
| | | | - Emma Young
- Consultant Emergency Medicine, Barts Health NHS Trust, London
| | - Tim Peto
- Consultant in Infectious Diseases, John Radcliffe Hospital, Oxford
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26
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Brooks A, Lucidarme J, Campbell H, Campbell L, Fifer H, Gray S, Hughes G, Lekshmi A, Schembri G, Rayment M, Ladhani SN, Ramsay ME, Borrow R. Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 - emergence of multiple antibiotic resistance calls for vigilance. ACTA ACUST UNITED AC 2020; 25. [PMID: 32317054 PMCID: PMC7175650 DOI: 10.2807/1560-7917.es.2020.25.15.2000375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its ‘parent’ strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.
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Affiliation(s)
- Avril Brooks
- Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jay Lucidarme
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Laura Campbell
- Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, United Kingdom
| | - Steve Gray
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Gwenda Hughes
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, United Kingdom
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
| | - Gabriel Schembri
- The Northern Integrated Contraception, Sexual Health & HIV Service, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Manchester Royal Infirmary, Public Health England, Manchester, United Kingdom
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Flower B, Brown JC, Simmons B, Moshe M, Frise R, Penn R, Kugathasan R, Petersen C, Daunt A, Ashby D, Riley S, Atchison CJ, Taylor GP, Satkunarajah S, Naar L, Klaber R, Badhan A, Rosadas C, Khan M, Fernandez N, Sureda-Vives M, Cheeseman HM, O'Hara J, Fontana G, Pallett SJC, Rayment M, Jones R, Moore LSP, McClure MO, Cherepanov P, Tedder R, Ashrafian H, Shattock R, Ward H, Darzi A, Elliot P, Barclay WS, Cooke GS. Clinical and laboratory evaluation of SARS-CoV-2 lateral flow assays for use in a national COVID-19 seroprevalence survey. Thorax 2020; 75:1082-1088. [PMID: 32796119 PMCID: PMC7430184 DOI: 10.1136/thoraxjnl-2020-215732] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate antibody tests are essential to monitor the SARS-CoV-2 pandemic. Lateral flow immunoassays (LFIAs) can deliver testing at scale. However, reported performance varies, and sensitivity analyses have generally been conducted on serum from hospitalised patients. For use in community testing, evaluation of finger-prick self-tests, in non-hospitalised individuals, is required. METHODS Sensitivity analysis was conducted on 276 non-hospitalised participants. All had tested positive for SARS-CoV-2 by reverse transcription PCR and were ≥21 days from symptom onset. In phase I, we evaluated five LFIAs in clinic (with finger prick) and laboratory (with blood and sera) in comparison to (1) PCR-confirmed infection and (2) presence of SARS-CoV-2 antibodies on two 'in-house' ELISAs. Specificity analysis was performed on 500 prepandemic sera. In phase II, six additional LFIAs were assessed with serum. FINDINGS 95% (95% CI 92.2% to 97.3%) of the infected cohort had detectable antibodies on at least one ELISA. LFIA sensitivity was variable, but significantly inferior to ELISA in 8 out of 11 assessed. Of LFIAs assessed in both clinic and laboratory, finger-prick self-test sensitivity varied from 21% to 92% versus PCR-confirmed cases and from 22% to 96% versus composite ELISA positives. Concordance between finger-prick and serum testing was at best moderate (kappa 0.56) and, at worst, slight (kappa 0.13). All LFIAs had high specificity (97.2%-99.8%). INTERPRETATION LFIA sensitivity and sample concordance is variable, highlighting the importance of evaluations in setting of intended use. This rigorous approach to LFIA evaluation identified a test with high specificity (98.6% (95%CI 97.1% to 99.4%)), moderate sensitivity (84.4% with finger prick (95% CI 70.5% to 93.5%)) and moderate concordance, suitable for seroprevalence surveys.
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Affiliation(s)
- Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- NIHR BRC, Imperial College NHS Trust, London, UK
| | - Jonathan C Brown
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Bryony Simmons
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Maya Moshe
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Frise
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Penn
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ruthiran Kugathasan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Anna Daunt
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Deborah Ashby
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Steven Riley
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Christina Joanne Atchison
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Sutha Satkunarajah
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Lenny Naar
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Anjna Badhan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Maryam Khan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Natalia Fernandez
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Macià Sureda-Vives
- Synthetic Biology Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah M Cheeseman
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Gianluca Fontana
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Scott J C Pallett
- Centre for Defence Pathology, British Army, Birmingham, UK
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | | | - Rachael Jones
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Luke S P Moore
- Chelsea and Westminster Healthcare NHS Trust, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Myra O McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Peter Cherepanov
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Richard Tedder
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Robin Shattock
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Helen Ward
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Ara Darzi
- NIHR BRC, Imperial College NHS Trust, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliot
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Wendy S Barclay
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- NIHR BRC, Imperial College NHS Trust, London, UK
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28
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Pallett SJC, Jones R, Pallett MA, Rayment M, Mughal N, Davies GW, Moore LSP. Characterising differential antibody response is integral to future SARS-CoV-2 serostudies. J Infect 2020; 81:e28-e30. [PMID: 32739486 PMCID: PMC7392850 DOI: 10.1016/j.jinf.2020.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 01/09/2023]
Affiliation(s)
| | - Rachael Jones
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | | | - Michael Rayment
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Nabeela Mughal
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
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29
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Pallett SJC, Rayment M, Patel A, Fitzgerald-Smith SAM, Denny SJ, Charani E, Mai AL, Gilmour KC, Hatcher J, Scott C, Randell P, Mughal N, Jones R, Moore LSP, Davies GW. Point-of-care serological assays for delayed SARS-CoV-2 case identification among health-care workers in the UK: a prospective multicentre cohort study. Lancet Respir Med 2020; 8:885-894. [PMID: 32717210 PMCID: PMC7380925 DOI: 10.1016/s2213-2600(20)30315-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
Background Health-care workers constitute a high-risk population for acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Capacity for acute diagnosis via PCR testing was limited for individuals with mild to moderate SARS-CoV-2 infection in the early phase of the COVID-19 pandemic and a substantial proportion of health-care workers with suspected infection were not tested. We aimed to investigate the performance of point-of-care and laboratory serology assays and their utility in late case identification, and to estimate SARS-CoV-2 seroprevalence. Methods We did a prospective multicentre cohort study between April 8 and June 12, 2020, in two phases. Symptomatic health-care workers with mild to moderate symptoms were eligible to participate 14 days after onset of COVID-19 symptoms, as per the Public Health England (PHE) case definition. Health-care workers were recruited to the asymptomatic cohort if they had not developed PHE-defined COVID-19 symptoms since Dec 1, 2019. In phase 1, two point-of-care lateral flow serological assays, the Onsite CTK Biotech COVID-19 split IgG/IgM Rapid Test (CTK Bitotech, Poway, CA, USA) and the Encode SARS-CoV-2 split IgM/IgG One Step Rapid Test Device (Zhuhai Encode Medical Engineering, Zhuhai, China), were evaluated for performance against a laboratory immunoassay (EDI Novel Coronavirus COVID-19 IgG ELISA kit [Epitope Diagnostics, San Diego, CA, USA]) in 300 samples from health-care workers and 100 pre-COVID-19 negative control samples. In phase 2 (n=6440), serosurveillance was done among 1299 (93·4%) of 1391 health-care workers reporting symptoms, and in a subset of asymptomatic health-care workers (405 [8·0%] of 5049). Findings There was variation in test performance between the lateral flow serological assays; however, the Encode assay displayed reasonable IgG sensitivity (127 of 136; 93·4% [95% CI 87·8–96·9]) and specificity (99 of 100; 99·0% [94·6–100·0]) among PCR-proven cases and good agreement (282 of 300; 94·0% [91·3–96·7]) with the laboratory immunoassay. By contrast, the Onsite assay had reduced sensitivity (120 of 136; 88·2% [95% CI 81·6–93·1]) and specificity (94 of 100; 94·0% [87·4–97·8]) and agreement (254 of 300; 84·7% [80·6–88·7]). Five (7%) of 70 PCR-positive cases were negative across all assays. Late changes in lateral flow serological assay bands were recorded in 74 (9·3%) of 800 cassettes (35 [8·8%] of 400 Encode assays; 39 [9·8%] of 400 Onsite assays), but only seven (all Onsite assays) of these changes were concordant with the laboratory immunoassay. In phase 2, seroprevalence among the workforce was estimated to be 10·6% (95% CI 7·6–13·6) in asymptomatic health-care workers and 44·7% (42·0–47·4) in symptomatic health-care workers. Seroprevalence across the entire workforce was estimated at 18·0% (95% CI 17·0–18·9). Interpretation Although a good positive predictive value was observed with both lateral flow serological assays and ELISA, this agreement only occurred if the pre-test probability was modified by a strict clinical case definition. Late development of lateral flow serological assay bands would preclude postal strategies and potentially home testing. Identification of false-negative results among health-care workers across all assays suggest caution in interpretation of IgG results at this stage; for now, testing is perhaps best delivered in a clinical setting, supported by government advice about physical distancing. Funding None.
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Affiliation(s)
- Scott J C Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Aatish Patel
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sarah J Denny
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; North West London Pathology, London, UK
| | - Esmita Charani
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - Annabelle L Mai
- Department of Laboratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Kimberly C Gilmour
- Department of Laboratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - James Hatcher
- Department of Laboratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | | | | | - Nabeela Mughal
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; North West London Pathology, London, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; North West London Pathology, London, UK; Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - Gary W Davies
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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30
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Skolimowska K, Rayment M, Jones R, Madona P, Moore LSP, Randell P. Non-invasive saliva specimens for the diagnosis of COVID-19: caution in mild outpatient cohorts with low prevalence. Clin Microbiol Infect 2020; 26:1711-1713. [PMID: 32688069 PMCID: PMC7367808 DOI: 10.1016/j.cmi.2020.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Keira Skolimowska
- North West London Pathology, Imperial College Healthcare NHS Trust, London, UK.
| | | | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Pinglawathee Madona
- North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke S P Moore
- North West London Pathology, Imperial College Healthcare NHS Trust, London, UK; Chelsea and Westminster NHS Foundation Trust, London, UK; Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - Paul Randell
- North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
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31
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Soni S, Horner P, Rayment M, Pinto-Sander N, Naous N, Parkhouse A, Bancroft D, Patterson C, Fifer H. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018). Int J STD AIDS 2019; 30:938-950. [DOI: 10.1177/0956462419825948] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the first British Association for Sexual Health and HIV (BASHH) guideline for the diagnosis and management of Mycoplasma genitalium in people aged 16 years and older. The guideline is primarily aimed at level 3 sexually transmitted infection (STI) management services within the UK, although it could also serve as a reference guide for STI services at other levels.
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Affiliation(s)
| | - Paddy Horner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Nadia Naous
- Imperial College Healthcare NHS Trust, London, UK
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32
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Bradshaw D, Rae C, Rayment M, Turner N, Turner R, Pickard G, Pillay K, Roberts P, Foxton M, Sullivan AK. HIV/HCV/HBV testing in the emergency department: a feasibility and seroprevalence study. HIV Med 2019; 19 Suppl 1:52-57. [PMID: 29488696 DOI: 10.1111/hiv.12590] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to to assess the feasibility of simultaneous testing for the blood-borne viruses (BBV), HIV, hepatitis C (HCV) and hepatitis B (HBV), in the Emergency Department (ED) and ascertain the seroprevalence for these three viruses in this setting. METHODS A pilot BBV testing program was undertaken as part of routine clinical care in the ED. All ED attendees aged between 16 and 65 years old who were able to consent were tested over a 55 week period on an opt out basis. Patients with positive test results were linked to clinical services. Interventions aimed at improving testing rates were implemented and evaluated by quality improvement (QI) methodology. RESULTS Of 25,520 age-eligible ED attendees, 6108 (24%) underwent BBV testing; an additional 1160 (4.5%) underwent a standalone HIV test (total of 7268 (28%) individuals).There were 83/7268 (1.1%) non-negative (ie reactive or equivocal) results for HIV and 103/6108 (1.7%) and 32/6108 (0.52%) for anti-HCV IgG and HBsAg, respectively. Of these, 12 (0.17%), 16 (0.26%) and 8 (0.13%) were new reactive tests for HIV, HCV and HBV, respectively, which were able to be confirmed on a second test. Specific QI interventions led to temporary increases in testing rates. CONCLUSIONS An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.
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Affiliation(s)
- D Bradshaw
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - N Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - R Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - G Pickard
- Imperial College Healthcare NHS Trust, London, UK
| | - K Pillay
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - P Roberts
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M Foxton
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Abstract
BACKGROUND Nutcracker phenomenon (NCP) describes the compression of the left renal vein between the aorta and the superior mesenteric artery. Nutcracker Syndrome (NCS) refers to the clinical manifestations of NCP. AIMS This paper aims to provide education and ultrasound protocol for Clinicians and Sonographers who encounter patients with the symptoms of NCS during their course of practice. METHODS The following report examines two case studies where a diagnosis of NCP was made from clinical history and ultrasound findings. Based on these case studies, we would like to propose an appropriate ultrasound scanning protocol for patients presenting with symptoms of gonadal vein incompetence. RESULTS The above case studies highlight the need for further assessment with ultrasound to help diagnose cases of NCP. CONCLUSION The proposed ultrasound techniques are a valid protocol extension to the ultrasound examination to help diagnose NCP.
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Affiliation(s)
| | - Michael Rayment
- Bryant Radiology 1 South Street Kogarah New South Wales 2217 Australia
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34
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Bull L, Jones R, Rayment M, Cohen C. Patients at a London integrated sexual health clinic are concerned at redirection of contraceptive prescriptions. BMJ Sex Reprod Health 2018; 44:146-147. [PMID: 29921642 DOI: 10.1136/bmjsrh-2018-200083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lauren Bull
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Rachael Jones
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Michael Rayment
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Charlotte Cohen
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
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35
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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36
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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Bull L, Dimitrijevic P, Beverley S, Scarborough A, Mandalia S, Dosekun O, Barber T, Reeves I, McCormack S, Rayment M. Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK. Int J STD AIDS 2017; 29:435-442. [PMID: 28927341 DOI: 10.1177/0956462417730259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) has proven efficacy in reducing the risk of HIV infection in men who have sex with men (MSM), but has not yet been commissioned in the UK. The aim of this study was to investigate perceived need and benefit (or experience of) PrEP among HIV-negative MSM attending sexual health clinics. HIV-negative MSM attending three sexual health centres in London, UK were opportunistically invited to complete a questionnaire. Data collected comprised demographic data and sexual and drug use behaviours as well as questions regarding perceptions of risk and need for PrEP. Logistic regression analysis was undertaken to identify variables predicting acceptability of, and intention to use, PrEP. In addition, data were gathered in respondents already taking PrEP. Eight hundred and thirty-nine questionnaires were analysed. The median age of respondents was 35 years (IQR 28-41, range 18-78), 650 (77%) were of white ethnicity and 649 (77%) had a university education. Four hundred and fifty-six (54%) reported at least one episode of condomless anal sex in the preceding three months, 437 (52%) reported recreational drug use in the preceding three months and 311 (37%) had been diagnosed with a sexually transmitted infection within the preceding six months. Four hundred and sixty-three (64%) of 726 strongly agreed with the statement 'I think I would benefit from PrEP'. Multivariate logistic regression analysis demonstrated that having receptive anal intercourse (RAI) without condoms, having an awareness of the risk of unprotected RAI and having belief in the effectiveness of PrEP were independent predictors for someone thinking they would benefit from taking PrEP. Eight percent of respondents (59/724) had already taken or were currently taking PrEP. The results suggest that individuals at risk are likely to perceive themselves as benefiting from PrEP. The majority perceived their risk of acquiring HIV and benefit from PrEP accurately. Overall they appeared to have little concern over the use of PrEP and generally positive attitudes. Further investigation is warranted to understand why those at risk do not perceive benefit from PrEP.
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Affiliation(s)
- Lauren Bull
- 1 Chelsea and Westminster Hospital, London, UK
| | | | | | | | | | | | | | - Iain Reeves
- 3 Homerton University Hospital foundation trust, London, UK
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Mandlik E, Plaha K, Jones R, Rayment M. P101 Cutting the time to treatment of chlamydia trachomatis (CT) and neisseria gonorrhoeae (NG) with near-patient molecular diagnostics: the utility of the cepheid genexpert system. Br J Vener Dis 2017. [DOI: 10.1136/sextrans-2017-053232.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sammel AM, Spies MC, DeCarle R, Rayment M, Joshua F. Shear-wave elastographic ultrasound of metacarpophalangeal synovium in rheumatoid arthritis - A pilot study. Australas J Ultrasound Med 2017; 20:58-65. [DOI: 10.1002/ajum.12047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Anthony Michael Sammel
- Department of Rheumatology; Prince of Wales Hospital; Randwick New South Wales Australia
- Prince of Wales Clinical School; University of New South Wales; Randwick New South Wales Australia
| | - Michael Carl Spies
- Department of Rheumatology; Prince of Wales Hospital; Randwick New South Wales Australia
- Prince of Wales Clinical School; University of New South Wales; Randwick New South Wales Australia
| | - Rohan DeCarle
- St George Private Radiology; Kogarah New South Wales Australia
| | - Michael Rayment
- St George Private Radiology; Kogarah New South Wales Australia
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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Hamzah L, Jose S, Booth JW, Hegazi A, Rayment M, Bailey A, Williams DI, Hendry BM, Hay P, Jones R, Levy JB, Chadwick DR, Johnson M, Sabin CA, Post FA. Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate. J Infect 2017; 74:492-500. [PMID: 28130143 DOI: 10.1016/j.jinf.2017.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/07/2016] [Accepted: 01/17/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy. METHODS We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes. RESULTS Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m2/year, p < 0.0001). CONCLUSIONS Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.
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Affiliation(s)
- L Hamzah
- Kings College Hospital NHS Foundation Trust, London, UK; King's College London, London, UK.
| | - S Jose
- University College London, London, UK
| | - J W Booth
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - A Hegazi
- St George's Healthcare NHS Trust, London, UK
| | - M Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Bailey
- Imperial College Healthcare NHS Trust, London, UK
| | - D I Williams
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | - P Hay
- St George's Healthcare NHS Trust, London, UK
| | - R Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - J B Levy
- Imperial College Healthcare NHS Trust, London, UK
| | - D R Chadwick
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - M Johnson
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - C A Sabin
- University College London, London, UK
| | - F A Post
- Kings College Hospital NHS Foundation Trust, London, UK
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42
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Tipple C, Rayment M, Mandalia S, Walton L, O'Neill S, Murray J, O'Riordan A, Rebec M, Harrington L, Jones R, Wilkinson D. An evaluation study of the Becton-Dickinson ProbeTec Qx (BDQx) Trichomonas vaginalis trichomoniasis molecular diagnostic test in two large, urban STD services. Sex Transm Infect 2017; 94:334-336. [PMID: 28108699 DOI: 10.1136/sextrans-2016-052902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The BASHH guidelines recommend molecular tests to aid diagnosis of Trichomonas vaginalis (TV) infection; however many clinics continue to use relatively insensitive techniques (pH, wet-prep microscopy (WPM) and culture). Our objectives were to establish a laboratory pathway for TV testing with the Becton-Dickinson Qx (BDQx) molecular assay, to determine TV prevalence and to identify variables associated with TV detection. METHODS A prospective study of 901 women attending two urban sexual health services for STI testing was conducted. Women were offered TV BDQx testing in addition to standard of care. Data collected were demographics, symptoms, results of near-patient tests and BDQx results for TV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Women with any positive TV result were treated and followed up for test of cure (TOC). RESULTS 901 women had a TV BDQx test. 472 (53%) were white, 143 (16%) black and 499 (55%) were symptomatic. Infections detected by BDQx were: 11 TV (1.2%), three GC (0.3%) and 44 CT (4.9%). Of the 11 BDQx-detected TV infections, 8 (73%) were in patients of black ethnicity. Of these, four of seven cases (57%) were WPM-positive. All patients received treatment and nine of nine (100%) were BDQx-negative at TOC. In univariate analysis, only black ethnicity was associated with likelihood of a positive TV BDQx result (relative risk (RR) 10.2 (95% CI 2.15 to 48.4)). CONCLUSIONS The use of the BDQ enhanced detection of TV in asymptomatic and symptomatic populations. Cost-effective implementation of the test will rely on further work to reliably detect demographic and clinical variables that predict positivity.
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Affiliation(s)
- Craig Tipple
- Imperial College Healthcare NHS Trust, London, UK.,GlaxoSmithKline Ltd, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Lisa Walton
- Imperial College Healthcare NHS Trust, London, UK
| | | | - John Murray
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Monica Rebec
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Rayment M, Curtis H, Carne C, McClean H, Bell G, Estcourt C, Roberts J, Wilkins E, Estreich S, Morris G, Phattey J, Sullivan AK. An effective strategy to diagnose HIV infection: findings from a national audit of HIV partner notification outcomes in sexual health and infectious disease clinics in the UK. Sex Transm Infect 2016; 93:94-99. [PMID: 27496615 DOI: 10.1136/sextrans-2015-052532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/15/2016] [Accepted: 07/17/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Partner notification (PN) is a key public health intervention in the control of STIs. Data regarding its clinical effectiveness in the context of HIV are lacking. We sought to audit HIV PN outcomes across the UK. METHODS All UK sexual health and HIV services were invited to participate. Clinical audit consisted of retrospective case-note review for up to 40 individuals diagnosed with HIV per site during 2011 (index cases) and a review of PN outcomes for up to five contacts elicited by PN per index case. RESULTS 169/221 (76%) clinical services participated (93% sexual health/HIV services, 7% infectious diseases/HIV units). Most (97%) delivered PN for HIV. Data were received regarding 2964 index cases (67% male; 50% heterosexual, 52% white). PN was attempted for 88% of index cases, and outcomes for 3211 contacts were audited (from an estimated total of 6400): 519 (16%) were found not to be at risk of undiagnosed HIV infection, 1399 (44%) were informed of their risk and had an HIV test, 310 (10%) were informed of the risk but not known to have tested and 983 (30%) were not informed of their risk of HIV infection. Of 1399 contacts tested through PN, 293 (21%) were newly diagnosed with HIV infection. Regular partners were most likely to test positive (p<0.001). CONCLUSIONS HIV PN is a highly effective diagnostic strategy. Non-completion of PN thus represents a missed opportunity to diagnose HIV in at-risk populations. Vigorous efforts should be made to pursue PN to identify people living with, and at risk of, HIV infection.
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Affiliation(s)
- Michael Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Hilary Curtis
- Audit and Standards Sub-committee, British HIV Association, London, UK
| | - Chris Carne
- Genitourinary Medicine, Cambridge Community Services, Cambridge, UK
| | - Hugo McClean
- City Health Care Partnership, Hull, Kingston Upon Hull, UK
| | - Gill Bell
- Department of GU Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Claudia Estcourt
- Reader in Sexual Health and HIV, Barts and the London School of Medicine and Dentistry, Centre for Immunology and Infectious Disease, London, UK
| | - Jonathon Roberts
- Brighton and Sussex University Hospital NHS Trust, Brighton, East Sussex, UK
| | - Ed Wilkins
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - Steven Estreich
- Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - Georgina Morris
- Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jara Phattey
- Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ann K Sullivan
- Directorate of HIV/GU Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
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Bull L, Dimitrijevic P, Scarborough A, Beverley S, Barber T, Reeves I, McCormack S, Rayment M. O014 Investigating attitudes towards HIV Pre-Exposure Prophylaxis (PrEP). A questionnaire study in men who have sex with men attending sexual health clinics. Sex Transm Infect 2016. [DOI: 10.1136/sextrans-2016-052718.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tipple C, Rayment M, Rebec M, Murray J, Jones R, Wilkinson D. P197 Evaluation of the clinical utility of the Becton Dickinson ProbeTec Qx (BDQ) Trichomonas vaginalismolecular detection test in two large, urban GU medicine services. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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46
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Sammel A, Spies M, DeCarle R, Rayment M, Joshua F. FRI0525 Elastographic Ultrasound of Metacarpophalangeal (MCP) Synovium in Rheumatoid Arthritis (RA). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bradshaw D, Muir D, Rayment M. P187 Estimating cost savings by introducing a reflex Hepatitis B virus screening algorithm in a sexual health service. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
In the UK, outcomes for people living with HIV are excellent. However, a quarter of those living with HIV do not know their status, and almost half are diagnosed late. Strategies to broaden HIV testing are needed. HIV indicator conditions are those thought to be associated with HIV infection because they share risk factors (eg viral hepatitis) or because they arise as a result of early or late immunodeficiency (eg bacterial pneumonia, Kaposi's sarcoma). They comprise all AIDS-defining conditions, but also many non-AIDS-defining conditions spanning the spectrum of medicine. Patients presenting with indicator conditions should routinely be offered an HIV test. This approach is likely to be clinically effective, because knowledge of HIV status is essential in the management of many conditions. It is cost effective if the prevalence of HIV infection is greater than 0.1%. The strategy removes the need for risk assessment, and is acceptable to patients and healthcare practitioners. If broadly implemented, it is likely to be effective at a public health level, and will help to reduce both undiagnosed HIV and late diagnoses of HIV. Here we review the emerging evidence base that supports the value of routine HIV testing in indicator conditions.
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Affiliation(s)
- Lauren Bull
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Michael Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, McBrien B, Tipple C, Turner A, Sullivan AK, Radcliffe K, Cousins D, FitzGerald M, Fisher M, Grover D, Higgins S, Kingston M, Rayment M, Sullivan A. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2015; 27:421-46. [PMID: 26721608 DOI: 10.1177/0956462415624059] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
Abstract
These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.
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Affiliation(s)
- M Kingston
- Manchester Centre for Sexual Health, Manchester, UK
| | - P French
- Mortimer Market Centre, London, UK
| | - S Higgins
- North Manchester General Hospital, Manchester, UK
| | - O McQuillan
- Manchester Centre for Sexual Health, Manchester, UK
| | - A Sukthankar
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Stott
- Manchester Centre for Sexual Health, Manchester, UK
| | - B McBrien
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Tipple
- Jefferiss Wing Centre for Sexual Health, Imperial College Health Care NHS Trust, London, UK
| | - A Turner
- The Public Health England/Clinical Virology Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Keith Radcliffe
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Darren Cousins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Mark FitzGerald
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Martin Fisher
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Deepa Grover
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Stephen Higgins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Margaret Kingston
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Michael Rayment
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Ann Sullivan
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
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Raben D, Mocroft A, Rayment M, Mitsura VM, Hadziosmanovic V, Sthoeger ZM, Palfreeman A, Morris S, Kutsyna G, Vassilenko A, Minton J, Necsoi C, Estrada VP, Grzeszczuk A, Johansson VS, Begovac J, Ong ELC, Cabié A, Ajana F, Celesia BM, Maltez F, Kitchen M, Comi L, Dragsted UB, Clumeck N, Gatell J, Gazzard B, d’Arminio Monforte A, Rockstroh J, Yazdanpanah Y, Champenois K, Jakobsen ML, Sullivan A, Lundgren JD. Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study. PLoS One 2015; 10:e0140845. [PMID: 26560105 PMCID: PMC4641587 DOI: 10.1371/journal.pone.0140845] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022] Open
Abstract
European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe (median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR 86–100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.
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Affiliation(s)
- D. Raben
- CHIP, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - A. Mocroft
- University College London, London, United Kingdom
| | - M. Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | - V. Hadziosmanovic
- Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
| | - Z. M. Sthoeger
- Ben Ari Institute of Clinical Immunology, Rehovot, Israel
| | - A. Palfreeman
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Morris
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | - J. Minton
- St James’s University Hospital, Leeds, United Kingdom
| | - C. Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - A. Grzeszczuk
- Medical University of Bialystok, Department of Infectious Diseases and Hepatology, Bialystok, Poland
| | - V. Svedhem Johansson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J. Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - E. L. C. Ong
- The Newcastle upon Tyne Hospital, Newcastle, United Kingdom
| | - A. Cabié
- Centre Hospitalier Universitaire de Fort de France, Fort de France, Martinique
| | - F. Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - B. M. Celesia
- Unit of Infectious Diseases University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F. Maltez
- Hospital Curry Cabral, Lisbon, Portugal
| | - M. Kitchen
- Medical University of Innsbruck Innsbruck, Austria
| | - L. Comi
- Unit of Infectious Diseases, San Paolo Hospital, Milan, Italy
| | | | - N. Clumeck
- Saint-Pierre University Hospital, Brussels, Belgium
| | - J. Gatell
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - B. Gazzard
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Y. Yazdanpanah
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- IAME, UMR 1137, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Service de Biostatistique, Paris, France
| | | | | | - A. Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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