Journal articles on the topic 'HIV infections Victoria Melbourne'
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1
Guy, Rebecca, Megan S. C. Lim, Yung-Hsuan J. Wang, Nicholas Medland, Jonathan Anderson, Norman Roth, and Margaret E. Hellard. "A new surveillance system for monitoring HIV infection in Victoria, Australia." Sexual Health 4, no. 3 (2007): 195. http://dx.doi.org/10.1071/sh07011.
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Objectives: To establish a new mechanism for monitoring patterns of HIV infection, in the context of a sustained increase in HIV diagnosis among men who have sex with men (MSM) in Victoria. Methods: Between April 2004 and August 2005, a linked voluntary HIV sentinel surveillance system was implemented at five medical clinics with a high case load of MSM. Using a questionnaire, doctors collected HIV testing history, demographic and sexual risk behaviour information from all clients undergoing voluntary HIV testing. Questionnaires were linked with HIV test results. Logistic regression analysis was conducted to determine factors associated with HIV infection. Results: Of 3435 MSM tested for HIV at participating sites, 1.7%, (95% CI = 1.2–2.2) were newly diagnosed with HIV; between 2004 and 2005 the proportion increased from 1.3% (95% CI = 1.2–1.5) to 2.0% (95% CI = 1.8–2.2), P = 0.107. There was no significant change in the number of HIV tests conducted per month or in demographic characteristics, testing history and sexual behaviour characteristics between time periods. In multivariate analysis, reporting unprotected anal intercourse (UAI) with any partner, UAI with a HIV-positive partner/s and being aged 30–39 years or 40 years or greater were significantly associated with HIV infection. Conclusion: This new surveillance mechanism, based on linked testing at participating clinics, indicates that the increase in HIV notifications in 2005 was unrelated to changes in testing and data from a Melbourne sexual behavioural survey suggests the increase was more likely to be attributed to increases in transmission within the past few years. The sentinel system highlighted UAI, especially with HIV positive partner/s are important transmission factors.
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Thompson, Sandra C., Gill E. Checkley, Jane S. Hocking, Nick Crofts, Anne M. Mijch, and Fiona K. Judd. "HIV Risk Behaviour and HIV Testing of Psychiatric Patients in Melbourne." Australian & New Zealand Journal of Psychiatry 31, no. 4 (August 1997): 566–76. http://dx.doi.org/10.3109/00048679709065079.
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Objectives: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne. Methods: Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing. Results: Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex); 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population sample. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%C11.49–14.0). Conclusions: This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant; strategies to encourage safer behaviour are urgently needed.
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Thomas, S. L., K. Lam, L. Piterman, A. Mijch, and P. A. Komesaroff. "Complementary medicine use among people living with HIV/AIDS in Victoria, Australia: practices, attitudes and perceptions." International Journal of STD & AIDS 18, no. 7 (July 1, 2007): 453–57. http://dx.doi.org/10.1258/095646207781147292.
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There is limited evidence suggesting the underlying reasons for the use of complementary and alternative medicines (CAMs) by people with HIV/AIDS, or individual attitudes and beliefs about the use of CAMs. Using focus groups and a survey with 151 individuals attending the HIV Clinics at The Alfred Hospital, Melbourne, we aimed to provide insights into factors that influence the use of CAMs among people living with HIV/AIDS. Roughly half (49%) of the participants had used CAMs to manage their HIV/AIDs. Users of CAMs utilized a wide range of treatments in managing their condition, but costs of the CAMs meant that users were not necessarily able to use them as much as they might have liked. Use of CAMs was based on a desire to find something beneficial rather than on being dissatisfied with conventional medicine. Further research is needed into (a) the effects of CAMs and (b) the enhancement of communication and collaboration between patients, doctors and complementary medicine practitioners.
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Zablotska, I., G. Prestage, A. Grulich, J. Imrie, and S. Kippax. "27. CAN UNPROTECTED ANAL INTERCOURSE WITH REGULAR AND CASUAL PARTNERS EXPLAIN THE DIVERGING TRENDS IN HIV EPIDEMIC IN AUSTRALIA?" Sexual Health 4, no. 4 (2007): 295. http://dx.doi.org/10.1071/shv4n4ab27.
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Introduction: Worldwide, increases in unprotected anal intercourse have been linked to the resurgence in HIV and STI in gay men. We assessed whether changes in UAI within regular and casual relationships may explain the diverging trends in HIV in three Australian states - NSW, Victoria and Queensland. Methods: We used the data from the annual cross-sectional Gay Community Periodic Surveys conducted annually in Sydney since 1996 and in Melbourne and Queensland since 1998. A short self-administered questionnaire asks about HIV serostatus, sexual health testing and behaviours relevant to HIV epidemic. We present time trends in seroconcordance and unprotected sex with regular and casual partners. Results: Currently, about one third of gay men report being in monogamous regular relationships, and this proportion has been slowly increasing everywhere. The self-reported UAI with regular partners (UAIR) was highest among men in seroconcordant positive relationships, lower among seroconcordant negative partners and lowest in non seroconcordant relationships. From 1998 to 2006, the rates of UAIR consistently increased by 10% in all three states and in all relationships by serostatus. The rates of UAI with casual partners (UAIC) were historically highest in NSW. From a peak in 2001, UAIC rates have consistently declined in NSW, but continuing increases were observed in Victoria and Queensland. Higher rates of nondisclosure of HIV were also observed in the context of UAIC in the latter two states. Conclusion: Changes in unprotected sex with casual partners may be responsible for the slowing of HIV epidemic in NSW. Sustained investment in policies and programs are important in achieving behaviour change.
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Chow, Eric PF, Deborah A. Williamson, Ria Fortune, Catriona S. Bradshaw, Marcus Y. Chen, Glenda Fehler, Vesna De Petra, Benjamin P. Howden, and Christopher K. Fairley. "Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing." Sexually Transmitted Infections 95, no. 6 (May 21, 2019): 398–401. http://dx.doi.org/10.1136/sextrans-2018-053957.
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ObjectiveThe Victorian legislation requires sex workers to have quarterly screening for genital chlamydia and gonorrhoea, but screening for oropharyngeal infection is not mandatory in Victoria, Australia. In 2017, oropharyngeal screening for gonorrhoea and chlamydia was added as part of the routine quarterly screening for sex workers attending the Melbourne Sexual Health Centre (MSHC). The aim of this study was to examine the prevalence of oropharyngeal gonorrhoea and chlamydia among female sex workers (FSW).MethodsWe included females who (1) self-identified as sex workers or were attended MSHC for a sex work certificate and (2) had tested for any STI or HIV, between March 2015 and December 2017. The prevalence of HIV, syphilis, chlamydia and gonorrhoea was calculated.ResultsThere were 8538 FSW consultations among 2780 individuals during the study period. There was a twofold increase in genital gonorrhoea (from 0.5% (95% CI 0.3% to 0.9%) to 1.1% (95% CI 0.8% to 1.5%); ptrend=0.047) and a 1.5-fold increase in genital chlamydia (from 2.2% (95% CI 1.6% to 2.8%) to 3.2% (95% CI 2.6% to 3.8%); ptrend=0.031) during the period. Overall, the prevalence of HIV (0.2% (95% CI 0.1% to 0.3%)) and syphilis (0.1% (95% CI 0.0% to 0.2%)) remained low and did not change over time. In 2017, the prevalence of oropharyngeal gonorrhoea was 2.0% (95% CI 1.6% to 2.6%) and oropharyngeal chlamydia was 2.1% (95% CI 1.6% to 2.7%). Among FSW who were tested positive for gonorrhoea and chlamydia, 55% (n=41) and 34% (n=45) only tested positive in the oropharynx but not genital for gonorrhoea and chlamydia, respectively.ConclusionThe prevalence of oropharyngeal gonorrhoea and chlamydia is similar to the prevalence at genital sites and is often independent of genital infection. It is important to test the oropharynx and genital site for chlamydia and gonorrhoea among FSW.
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McDonald, A., and J. M. Kaldor. "37. MONITORING HIV TRANSMISSION AMONG MEN SEEN AT METROPOLITAN SEXUAL HEALTH CLINICS IN AUSTRALIA, 1996-2005." Sexual Health 4, no. 4 (2007): 299. http://dx.doi.org/10.1071/shv4n4ab37.
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National surveillance for newly diagnosed HIV infection indicates an increasing trend in Queensland, South Australia and Victoria but not in New South Wales. It was not clear if trends in newly diagnosed HIV infection were due to different patterns of HIV antibody testing. We report the pattern of HIV antibody testing among people seen through a network of sexual health clinics in Australia. Six public metropolitan sexual health clinics (Sydney Sexual Health Centre (SSHC), South West Sexual Health Centre (SSWSHC), NSW; Brisbane Sexual Health Clinic (BSHC), Gold Coast Sexual Health Clinic (GCSHC), QLD; Clinic 275, SA; Melbourne Sexual Health Centre (MSHC), VIC) provide annual tabulations of the number of people seen, the number tested for HIV antibody, and the number with newly diagnosed HIV infection, broken down by sex, exposure category and testing history. The number of men seen at the clinics ranged from 17 138 in 1996 to 19 184 in 2005. Among men seen, the percentage who were tested for HIV declined from 62% in 1996 to 50% in 2001 and increased to 56% in 2005. HIV prevalence remained stable in 1996-2005 at 0.5% and was highest at SSHC (0.7-1.1%) and among homosexually active men (1.8% in 1996 and 1.6% in 2005). The percentage of men retested within 12 months of a negative test increased from 41% in 1996 to 44% in 2005. At SSHC, retesting among homosexually active men declined from 56% in 1996 to 44% in 2001 and increased to 58% by 2005. At Clinic 275 and MSHC, 50-60% and around 50% of homosexually active men were retested in 1996 - 2005 and in 2004-2005, respectively. HIV infection was newly diagnosed in 0.4% (8) in 1996 and in 0.8% (26) in 2005. While HIV antibody testing patterns vary between the clinics, incidence of newly diagnosed HIV infection has remained low.
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Burrell, Sam, Lenka A. Vodstrcil, Christopher K. Fairley, Alex Kilner, Catriona S. Bradshaw, Marcus Y. Chen, and Eric P. F. Chow. "Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018." Sexually Transmitted Infections 96, no. 2 (July 25, 2019): 110–14. http://dx.doi.org/10.1136/sextrans-2019-054132.
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ObjectivesIn 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne.MethodsAll MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine.ResultsOf the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28; 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A.ConclusionThe critical vaccination threshold for hepatitis A has been estimated at >70%. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.
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Ong, Jason J., Andre Landika, Christopher K. Fairley, Catriona Bradshaw, Marcus Chen, Tim R. H. Read, and Eric P. F. Chow. "Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia." Sexual Health 13, no. 6 (2016): 555. http://dx.doi.org/10.1071/sh16092.
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Background Non-occupational post-exposure prophylaxis (NPEP) is available to people with a potential risk for HIV exposure within the preceding 72 h. We sought to determine if men who have sex with men (MSM) and receive NPEP had a significantly different risk profile (before the preceding 72 h) from MSM not receiving NPEP. If this is the case, NPEP consultations may act as a cue for also discussing pre-exposure prophylaxis. Methods: We conducted a retrospective analysis to compare the demographic characteristics, sexual practices and clinical diagnoses of MSM who were NPEP users and those who were non-NPEP users attending Melbourne Sexual Health Centre from January 2008 to December 2014. Univariate and multivariate logistic regression models were used to examine the association between NPEP use and risk practices. Generalised estimating equations were used to adjust for within-individual correlations related to multiple visits of the same individual. Results: Of the 40 395 MSM consultations included in the study, 1776 consultations (4%) were related to NPEP prescription. NPEP prescribing was associated with ever having injected drugs (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.4–2.3), sex with males only (AOR 1.9, 95% CI: 1.6–2.3), more than three male partners in the past 3 months (AOR 1.5, 95% CI: 1.4–1.7) and inconsistent condom use with these partners within the past 3 months (AOR 2.1, 95% CI: 1.9–2.4). Sex workers (AOR 0.6, 95% CI: 0.3–0.9), and men reporting sex overseas within the past 12 months (AOR 0.7, 95% CI: 0.6–0.8) were less likely to receive NPEP. MSM who used NPEP were more likely to test positive for any sexually transmissible infection (AOR 1.2, 95% CI: 1.0–1.4). Conclusions: MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP, indicating that NPEP was used by MSM at higher risk for HIV. Therefore, consultations for NPEP may be an opportune time for also discussing pre-exposure prophylaxis for HIV.
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Bush, Matiu R., Henrietta Williams, and Christopher K. Fairley. "HIV is rare among low-risk heterosexual men and significant potential savings could occur through phone results." Sexual Health 7, no. 4 (2010): 495. http://dx.doi.org/10.1071/sh09088.
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Background: The legislation in Victoria requires HIV-positive results to be given in person by an accredited health professional. Many sexual health clinics require all men to receive HIV results in person. Our aim was to determine the proportion of low-risk heterosexual men at a sexual health centre who tested HIV-positive. Methods: The electronic data on all HIV tests performed between 2002 and 2008 on heterosexual men at the Melbourne Sexual Health Centre (MSHC) was reviewed. The individual client files of all heterosexual men who tested HIV-positive were reviewed to determine their risks for HIV at the time that the HIV test was ordered. Results: Over the 6 years there were 33 681 HIV tests performed on men, of which 17 958 tests were for heterosexual men. From these heterosexual men, nine tested positive for the first time at MSHC (0.05%, 95% confidence interval (CI): 0.01%, 0.09%). These nine cases included six men who had had sex with a female partner from the following countries: Thailand, Cambodia, China, East Timor, Botswana and South Africa. Two men had injected drugs and one had a HIV-positive female partner. Of the 17 958 test results for heterosexual males, 14 902 (83% 95% CI: 84%, 86%) test results were for men who did not have a history of intravenous drug use or had sexual contact overseas. Of these 14 902 low-risk men, none tested positive (0%, 95% CI: 0, 0.00025). Conclusion: Asking the 83% of heterosexual men who have an extremely low risk of HIV to return in person for their results is expensive for sexual health clinics and inconvenient for clients. We have changed our policy to permit heterosexual men without risk factors to obtain their HIV-negative results by phone.
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Martín-Sánchez, Mario, Christopher K. Fairley, Catriona S. Bradshaw, Marcus Y. Chen, and Eric P. F. Chow. "Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia." Sexually Transmitted Infections 96, no. 4 (January 9, 2020): 246–50. http://dx.doi.org/10.1136/sextrans-2019-054318.
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ObjectiveIn 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne.MethodsThis was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit.ResultsOf the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16–25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26–35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21).ConclusionsTwo-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.
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Needleman, Robert, Eric P. F. Chow, Janet M. Towns, Vincent J. Cornelisse, Tim Z. T. Yang, Marcus Y. Chen, Catriona S. Bradshaw, Ria Fortune, and Christopher K. Fairley. "Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis." Sexual Health 15, no. 6 (2018): 528. http://dx.doi.org/10.1071/sh17182.
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Background On 26 July 2016, Victoria began a large study of HIV pre-exposure prophylaxis, called PrEPX, that involved the creation of around 2600 appointments over 3 months across multiple sites in Melbourne, Australia. At this time, the Melbourne Sexual Health Centre (MSHC) appeared to have a larger demand on its services. The aim of the present study was to determine whether this apparent increase in demand was substantially different from other demand fluctuations. Methods: Patients presenting to the MSHC from 2014 to 2016 were reviewed. Demographic characteristics, sexual risks and sexually transmitted infection diagnoses were extracted from the clinical database. Results: There were 115522 walk-in presentations for care and a rise in presentations in the week following the launch of the PrEPX study, but at least six similar peaks occurred that year. The peak coinciding with the launch of PrEPX was only apparent for men who have sex with men. There was a substantial increase in the proportion of patients who could not be seen (i.e. triaged out), from 10% in the week before PrEPX to 22.2% in the second week after, but this was primarily due to staff absences. At the time of the PrEPX study, data were collected on the duration of symptoms for common conditions and found no significant (P>0.29) change in the average duration of symptoms compared with that seen before the PrEPX launch. Conclusions: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services.
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Lim, M. S. C., M. Hellard, C. El-Hayek, M. Cuevas, C. Fairley, D. Leslie, N. Roth, B. Tee, and M. Stoove. "P3.123 Hepatitis C Testing and Incidence in HIV-Positive Men Who Have Sex with Men in Melbourne, Victoria. A Retrospective Cohort Study." Sexually Transmitted Infections 89, Suppl 1 (July 2013): A186.1—A186. http://dx.doi.org/10.1136/sextrans-2013-051184.0582.
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Body, Amy, Jennifer F. Hoy, Allen C. Cheng, and Michelle L. Giles. "Incident hepatitis B infection subsequent to the diagnosis of HIV infection in a Melbourne cohort: missed opportunities for prevention." Sexual Health 11, no. 1 (2014): 5. http://dx.doi.org/10.1071/sh13019.
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Background The characteristics associated with incident hepatitis B (HBV) infection in HIV-positive individuals are not well described in the Australian setting. The aim of this study is to determine the characteristics of and risk factors for HBV infection within HIV-infected individuals in a Melbourne cohort between 1985 and 2011. Methods: Individuals susceptible to HBV at their HIV diagnosis were identified using their HBV serology stored within the Victorian HIV database. Within this group, those who had a subsequent positive test for hepatitis B surface antigen or hepatitis B core antibody were identified as infected with HBV after their HIV diagnosis. Incident cases were matched with controls from the initially susceptible group who did not seroconvert for analysis. An incidence rate was calculated from the number of seroconversions and the cumulative time at risk (in 1000 patient-years of follow-up). Results: Of the 4711 patients with HIV seen more than once, 3223 had HBV testing. Of the 174 with positive HBV test results, 39 individuals met the definition of seroconversion after HIV diagnosis, representing the incident cases. The estimated HBV incidence rate was 1.81 (95% confidence interval: 1.28–2.47) per 1000 patient-years at risk. These individuals form the basis of a detailed case series and case–control study. Data collected include demographic details, immunological and virological characteristics, antiretroviral treatment and vaccination history. Conclusions: HIV-infected individuals should be screened for HBV and monitored for incident infection. Optimal control of HIV and improved vaccination coverage provide the best opportunity for prevention.
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SC Lim, Megan, Kavitha Sundaram, Campbell K Aitken, and Margaret E Hellard. "Blood-borne Viruses and Risk Behaviours among Injecting Drug Users Recruited from Needle and Syringe Programs in Victoria's Eastern Metropolitan Region." Australian Journal of Primary Health 13, no. 3 (2007): 69. http://dx.doi.org/10.1071/py07040.
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Little has been reported about the risk behaviour and service accessibility of injecting drug users (IDU) living beyond the inner suburbs of Melbourne. This study describes IDUs in the Department of Human Services' Eastern metropolitan region (EMR), including the prevalence of blood-borne viruses and risk behaviours. Fifty-two IDUs were recruited directly from EMR Needle and Syringe Programs (NSP) and through snowball recruitment. IDUs completed a questionnaire and provided a finger-prick blood specimen that was tested for the presence of HIV and Hepatitis C virus (HCV) antibodies. No participants were HIV antibody positive; 29 (56%) were HCV antibody positive. HCV seropositivity was associated with having a tattoo in univariate analysis. The prevalence of HCV in surveyed EMR IDUs was similar to that of Victorian IDUs surveyed in the National Needle and Syringe Program Survey; however, the EMR sample exhibited significantly greater levels of risk behaviour, including the sharing of needles and other injecting equipment, and unsafe sex. Similarly, EMR IDUs from outer and rural suburbs reported greater levels of risk behaviours and lower levels of HCV infection than those from the inner EMR. This study shows that with high levels of risk behaviour and relatively low access to NSP services, Victoria's EMR IDU population is vulnerable to future blood-borne virus outbreaks.
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Feigin, Anita, Carol El-Hayek, Margaret Hellard, Alisa Pedrana, Ellen Donnan, Christopher Fairley, B. K. Tee, and Mark Stoové. "Increases in newly acquired HIV infections in Victoria, Australia: epidemiological evidence of successful prevention?" Sexual Health 10, no. 2 (2013): 166. http://dx.doi.org/10.1071/sh12064.
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Background Rates of newly acquired HIV notifications provide useful data for monitoring transmission trends. Methods: We describe 10-year (2001–10) trends in newly acquired HIV notifications in Victoria, Australia. We also examine recent trends in HIV testing and incidence and risk behaviours among gay and other men who have sex with men (MSM) attending four high MSM caseload clinics. Results: Between 2001 and 2010 there was a significant increasing linear trend in newly acquired HIV that was driven primarily by increases between 2009–2010. MSM accounted for 85% of newly acquired HIV notifications. Between 2007–10, the total number of HIV tests per year at the high caseload clinics increased 41% among MSM and HIV incidence declined by 52%; reported risk behaviours remained relatively stable among these MSM. Conclusion: More newly acquired HIV notifications may reflect recent increased testing among MSM; continued scrutiny of surveillance data will assess the sustained effectiveness of testing as prevention, health promotion and the contribution of risk and testing behaviours to HIV surveillance outcomes.
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Crock, Elizabeth, and Judy-Ann Butwilowsky. "The HIV Resource Nurse Role at the Royal District Nursing Service (Melbourne): Making A Difference for People Living with HIV/AIDS in the Community." Australian Journal of Primary Health 12, no. 2 (2006): 83. http://dx.doi.org/10.1071/py06026.
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The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.
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Guy, Rebecca, and Margaret Hellard. "Rising HIV infections in Victoria, the need for a new approach to preventative interventions." Sexual Health 1, no. 2 (2004): 69. http://dx.doi.org/10.1071/sh03003.
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Hoare, Alexander, David P. Wilson, David G. Regan, John Kaldor, and Matthew G. Law. "Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections." Sexual Health 5, no. 2 (2008): 169. http://dx.doi.org/10.1071/sh07099.
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Background: Since 1999 there has been an increase in the number of HIV diagnoses in Australia, predominantly among men who have sex with men (MSM), but the magnitude of increase differs between states: ~7% rise in New South Wales, ~96% rise in Victoria, and ~68% rise in Queensland. Methods: Epidemiological, clinical, behavioural and biological data were collated into a mechanistic mathematical model to explore possible reasons for this increase in HIV notifications in MSM. The model was then used to make projections to 2015 under various scenarios. Results: The model suggests that trends in clinical and behavioural parameters, including increases in unprotected anal intercourse, cannot explain the magnitude of the observed rise in HIV notifications, without a substantial increase in a ‘transmission-increasing’ factor. We suggest that a highly plausible biological factor is an increase in the prevalence of other sexually transmissible infections (STI). It was found that New South Wales required an ~2-fold increase in other STI to match the data, Victoria needed an ~11-fold increase, and Queensland required an ~9-fold increase. This is consistent with observed trends in Australia for some STI in recent years. Future projections also indicate that the best way to control the current rise in HIV notifications is to reduce the prevalence of other STI and to promote condom use, testing for HIV, and initiation of early treatment in MSM diagnosed during primary infection. Conclusions: Our model can explain the recent rise in HIV notifications with an increase in the prevalence of other STI. This analysis highlights that further investigation into the causes and impact of other STI is warranted in Australia, particularly in Victoria.
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Pedrana, Alisa E., Margaret E. Hellard, Kim Wilson, Rebecca Guy, and Mark Stoové. "High Rates of Undiagnosed HIV Infections in a Community Sample of Gay Men in Melbourne, Australia." JAIDS Journal of Acquired Immune Deficiency Syndromes 59, no. 1 (January 2012): 94–99. http://dx.doi.org/10.1097/qai.0b013e3182396869.
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Ondondo, R. O., Z. W. Ng’ang’a, S. Mpoke, M. K. Kiptoo, and E. A. Bukusi. "P3.220 Incidence and Prevalence of HIV Infections Among Fishermen Around Lake Victoria in Kisumu Kenya." Sexually Transmitted Infections 89, Suppl 1 (July 2013): A217.1—A217. http://dx.doi.org/10.1136/sextrans-2013-051184.0677.
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Mallitt, Kylie-Ann, David P. Wilson, Ann McDonald, and Handan Wand. "HIV incidence trends vary between jurisdictions in Australia: an extended back-projection analysis of men who have sex with men." Sexual Health 9, no. 2 (2012): 138. http://dx.doi.org/10.1071/sh10141.
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Background Trends in HIV diagnoses differ across Australia and are primarily driven by men who have sex with men (MSM). We use national population surveillance data to estimate the incidence of HIV infections among MSM by jurisdiction and infer the proportion of undiagnosed infections. Methods: Annual surveillance data for AIDS diagnoses, HIV diagnoses and recently acquired HIV infections were obtained from 1980 to 2009. A modified statistical back-projection method was used to reconstruct HIV incidence by jurisdiction. Results: HIV incidence among MSM peaked for all jurisdictions in the early 1980s and then declined into the early 1990s, after which incidence increased. Trends then differ between jurisdictions. In New South Wales (NSW) and South Australia, estimated HIV incidence peaked at 371 and 50 cases respectively in 2003, and has since decreased to 258 and 24 cases respectively in 2009. HIV infections in Queensland (Qld) have more than doubled over the past decade, from 84 cases in 2000 to 192 cases in 2009. Victoria and Western Australia have seen a rise in HIV incidence from 2000 to 2006 (to a peak of 250 and 38 incident cases respectively), followed by a plateau to 2009. HIV incidence in the Northern Territory, Tasmania and Australian Capital Territory have increased since 2000; however, case numbers remain small (<20 per year). The estimated proportion of HIV infections not yet diagnosed to 2009 ranges from 10% (NSW) to 18% (Qld), with an average of 12% across Australia. Conclusions: HIV diagnosis trends among MSM in Australia reflect changes in estimated incidence to 2009, and reveal the largest increase in the past 10 years in Qld.
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Hoare, Alexander, Richard T. Gray, and David P. Wilson. "Could implementation of Australia's National Gay Men's Syphilis Action Plan have an indirect effect on the HIV epidemic?" Sexual Health 9, no. 2 (2012): 144. http://dx.doi.org/10.1071/sh10145.
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Objectives The number of incident infections of syphilis and HIV have increased over the past decade across Australia, particularly among gay men. In other industrialised settings, syphilis epidemics have also resurged coincidentally with increases in HIV diagnoses. Sexually transmissible infections (STI) are a biologically plausible cofactor for increasing HIV transmission. We pose the question: could strategies purely targeting syphilis also have an indirect impact on HIV incidence? Methods: We developed an agent-based computer model that simulates the transmission and disease progression of HIV and syphilis among a population of sexually active gay men, calibrated to reflect the epidemics in Victoria, Australia. The model was informed by detailed behavioural data from a variety of sources and was used to investigate the potential epidemiological impact of different public health interventions. Results: Assuming that syphilis could act as a biological cofactor for HIV transmission, from no effect to increasing risk by five-fold, our model indicates that if Australia’s syphilis action plan is effectively implemented then the number of HIV infections could decrease by up to 48% over the next decade in the absence of any specific HIV interventions. Conclusion: It is plausible that effective implementation of interventions targeting syphilis epidemics can have an indirect effect of mitigating the spread of HIV. The possible effects of STI should be considered in the design, implementation and evaluation of public health strategies and programs.
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Goller, Jane L., Rebecca J. Guy, Judy Gold, Megan S. C. Lim, Carol El-Hayek, Mark A. Stoove, Isabel Bergeri, et al. "Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings." Sexual Health 7, no. 4 (2010): 425. http://dx.doi.org/10.1071/sh09116.
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Objective: To describe the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria, Australia. Methods: The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites. Target populations included men who have sex with men (MSM), young people and injecting drug users (IDU). Sites collected demographic and risk behaviour information electronically or using paper surveys from patients undergoing routine HIV or STI (syphilis, chlamydia (Chlamydia trachomatis)) or hepatitis C virus (HCV) testing. These data were linked with laboratory results. Results: Between April 2006 and June 2008, data were received for 67 466 tests and 52 042 questionnaires. In clinics providing electronic data, >90% of individuals tested for HIV, syphilis and chlamydia had risk behaviour information collected. In other clinics, survey response rates were >85% (HIV), 43.5% (syphilis), 42.7–66.5% (chlamydia) and <20% (HCV). Data completeness was >85% for most core variables. Over time, HIV, syphilis and chlamydia testing increased in MSM, and chlamydia testing declined in females (P = 0.05). The proportion of positive tests among MSM was 1.9% for HIV and 2.1% for syphilis. Among 16–24-year-olds, the proportion positive for chlamydia was 10.7% in males and 6.9% in females. Among IDU, 19.4% of HCV tests were antibody positive. Conclusions: The VPCNSS has collected a large, rich dataset through which testing, risk behaviours and the proportion positive can be monitored in high-risk groups, offering a more comprehensive BBV and STI surveillance system for Victoria. Building system sustainability requires an ongoing focus.
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Xu, Xianglong, Zongyuan Ge, Eric P. F. Chow, Zhen Yu, David Lee, Jinrong Wu, Jason J. Ong, Christopher K. Fairley, and Lei Zhang. "A Machine-Learning-Based Risk-Prediction Tool for HIV and Sexually Transmitted Infections Acquisition over the Next 12 Months." Journal of Clinical Medicine 11, no. 7 (March 25, 2022): 1818. http://dx.doi.org/10.3390/jcm11071818.
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Background: More than one million people acquire sexually transmitted infections (STIs) every day globally. It is possible that predicting an individual’s future risk of HIV/STIs could contribute to behaviour change or improve testing. We developed a series of machine learning models and a subsequent risk-prediction tool for predicting the risk of HIV/STIs over the next 12 months. Methods: Our data included individuals who were re-tested at the clinic for HIV (65,043 consultations), syphilis (56,889 consultations), gonorrhoea (60,598 consultations), and chlamydia (63,529 consultations) after initial consultations at the largest public sexual health centre in Melbourne from 2 March 2015 to 31 December 2019. We used the receiver operating characteristic (AUC) curve to evaluate the model’s performance. The HIV/STI risk-prediction tool was delivered via a web application. Results: Our risk-prediction tool had an acceptable performance on the testing datasets for predicting HIV (AUC = 0.72), syphilis (AUC = 0.75), gonorrhoea (AUC = 0.73), and chlamydia (AUC = 0.67) acquisition. Conclusions: Using machine learning techniques, our risk-prediction tool has acceptable reliability in predicting HIV/STI acquisition over the next 12 months. This tool may be used on clinic websites or digital health platforms to form part of an intervention tool to increase testing or reduce future HIV/STI risk.
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Lister, Nichole A., Anthony Smith, Sepehr N. Tabrizi, Suzanne Garland, Peter Hayes, and Christopher K. Fairley. "Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic." International Journal of STD & AIDS 16, no. 12 (December 1, 2005): 794–98. http://dx.doi.org/10.1258/095646205774988163.
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During 2001 and 2002 an anonymous outreach-screening programme in Melbourne, Australia, offered testing for gonorrhoea and chlamydia on-site at men-only saunas. Modifications were made to this screening programme to offer a comprehensive testing clinic for sexually transmissible infections (STIs), including HIV. The comprehensive clinic was evaluated after one year of operation, and comparisons were made with the earlier anonymous screening programme. The comprehensive outreach clinic made contact with fewer men ( n = 557), however, men tested had a higher prevalence of gonorrhoea and chlamydia (17%), and all men tested positive for STIs/HIV were followed up. The findings and comparisons outlined in this paper may be used for different communities to decide what screening programme model best suits their individual situation: anonymous programme with fewer tests offered, confidential and comprehensive STI/HIV testing programme, or both. On the basis of our evaluation, we have opted to continue the comprehensive STI/HIV testing programme in local men-only saunas.
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Batool, Tayyaba, Shaheena Nawab, Badar Mehmood, Nadeem Shahid Younas, Muhammad Irfan Khan, and Khadija Nadeem. "The Analysis of Transfusion Transmitted Infections (TTIs) in Thalassemia Patients." Pakistan Journal of Medical and Health Sciences 16, no. 2 (February 26, 2022): 269–71. http://dx.doi.org/10.53350/pjmhs22162269.
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Objective: To find out the analysis of transfusion transmitted infections (TTIs) in β-thalassemia patients at a tertiary care hospital of South Punjab, Pakistan. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, “Bahawal Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from February January 2020 to December 2021. Methodology: Patients of blood transfusion-dependent 𝛽-thalassaemia of both genders and aged 5 to 12 years were analyzed. Blood was collected from patients aseptically and serum separated in Eppendorf tubes and stored at –200C. Screening for hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis and human immunodeficiency virus (HIV) were performed through Chemiluminescence Immunoassay (CLIA) technique. Results: In a total of 1212 patients, 745 (61.5%) were male. Overall, mean age was calculated to be 8.7±4.6 years while 874 (72.1%) patients were below 10 years of age. There were 866 (71.5%) patients who belonged to rural areas of residence. Parental consanguineous marriages were reported in 951 (78.5%) cases. There were 205 (16.9%) patients who were found to have TTIs. Out of these 205 patients, 169 (13.9%) were having HCV, 11 (0.9%) HBV, 20 (1.7%) syphilis whereas HIV was noted in 5 (0.4%) patients. Conclusion: Prevalence of TTIs was found to be high among multi-transfused patients of β-thalassemia. Most common types of TTIs were HCV which is consistent to what has previously been reported in the local literature. Identification of HIV in 0.5% cases in the present study is pointing towards disturbing development regarding spread of HIV in our region. Keywords: β-thalassemia, blood transfusion, hepatitis C, hepatitis B, human immunodeficiency virus.
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Martín-Sánchez, Mario, Richard Case, Christopher Fairley, Jane S. Hocking, Catriona Bradshaw, Jason Ong, Marcus Y. Chen, and Eric P. F. Chow. "Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia." BMJ Open 10, no. 11 (November 2020): e037608. http://dx.doi.org/10.1136/bmjopen-2020-037608.
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ObjectivesIn the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW.DesignRepeated cross-sectional study.SettingA sexual health centre in Melbourne, Australia.ParticipantsMSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW.Primary outcome measuresDemographic characterics, sexual practices and HIV/STI positivity.ResultsCompared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW.ConclusionsMSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.
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Kiwanuka, Noah, Ali Ssetaala, Ismail Ssekandi, Annet Nalutaaya, Paul Kato Kitandwe, Julius Ssempiira, Bernard Ssentalo Bagaya, et al. "Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda." PLOS ONE 12, no. 2 (February 16, 2017): e0171200. http://dx.doi.org/10.1371/journal.pone.0171200.
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Peel, Joanne, Eric P. F. Chow, Ian Denham, Tina Schmidt, Andrew Buchanan, Christopher K. Fairley, Deborah A. Williamson, Melanie Bissessor, and Marcus Y. Chen. "Clinical Presentation of Incident Syphilis Among Men Who Have Sex with Men Taking HIV Pre-Exposure Prophylaxis in Melbourne, Australia." Clinical Infectious Diseases 73, no. 4 (February 1, 2021): e934-e937. http://dx.doi.org/10.1093/cid/ciab052.
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Abstract Background Current international guidelines on human immunodeficieny virus (HIV) Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine 3-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled3-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. Methods This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at 3-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. Results There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary, and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. Conclusions Syphilis screening at routine 3-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.
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AITKEN, C. K., P. HIGGS, and S. BOWDEN. "Differences in the social networks of ethnic Vietnamese and non-Vietnamese injecting drug users and their implications for blood-borne virus transmission." Epidemiology and Infection 136, no. 3 (May 17, 2007): 410–16. http://dx.doi.org/10.1017/s0950268807008679.
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SUMMARYThe social networks of 49 ethnic Vietnamese injecting drug users (IDUs) and 150 IDUs of other ethnicities recruited in Melbourne, Australia, were examined for ethnic differences in distribution of hepatitis C virus infection risk using social network analysis and molecular epidemiology. Vietnamese IDUs were more highly connected than non-Vietnamese IDUs, and more likely to be members of dense injecting sub-networks. More related infections were detected in IDUs with discordant ethnicities than were captured in the social network data; nonetheless, most dyads and most IDU pairs with related infections had matching ethnicity, confirming that mixing was assortative on that criterion. Mixing was not obviously dissortative by risk; low-risk Vietnamese IDUs injected more frequently than did correspondingly low-risk non-Vietnamese IDUs, but results for other measures were reversed or equivocal. Network measurements suggest that ethnic Vietnamese IDUs are at elevated risk of blood-borne infection, a conclusion supported by their relatively high HIV prevalence.
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Turek, Evelyn M., Christopher K. Fairley, Marjan Tabesh, Tiffany R. Phillips, and Eric P. F. Chow. "Group sex events among female sex workers in Melbourne, Australia." Sexual Health 17, no. 6 (2020): 534. http://dx.doi.org/10.1071/sh20136.
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Background Group sex is associated with increased risk of HIV and sexually transmissible infections (STIs), but there is limited data on group sex among female sex workers (FSW). Understanding current group sex practices among FSW may assist with understanding and addressing the rise in STIs observed among Australian FSW in the 2010s. The aim of this study was to examine the proportion of FSWs who had engaged in group sex. Methods: A cross-sectional survey was conducted among FSWs attending the Melbourne Sexual Health Centre, Australia, between March and April 2019. Females aged ≥18 years who self-reported as a sex worker were invited to participate in the survey asking whether they had had group sex in the past 3 months. Group sex was defined as sex that involved two or more sexual partners. Results: Of the 51 FSWs who completed the survey, the median age was 29 years (IQR 24–34). Almost half (49%; n = 25) reported having group sex in the past 3 months, with a median number of group sex events of two (IQR 1–4). Australian-born FSW were more likely to report group sex than overseas-born FSW (76% vs 42%; P = 0.02). Age, number of paid clients and injecting drug use were not associated with group sex. Conclusion: The present study findings show that group sex is common among FSW and should be included in peer sexual health education and interventions among FSW.
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Gamagedara, Nimal, Sheranne Dobinson, Rosey Cummings, Christopher K. Fairley, and David Lee. "An evaluation of an express testing service for sexually transmissible infections in low-risk clients without complications." Sexual Health 11, no. 1 (2014): 37. http://dx.doi.org/10.1071/sh13156.
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Background One effective way of reducing the prevalence of sexually transmissible infections (STIs) in a population is ensuring easy access to clinical services and screening of populations at high risk of STIs, including HIV. We aimed to describe the features of clients using the express testing service (ETS) and the overall impact on the service. Methods: This retrospective cross-sectional study involved all clients attending the walk-in triage service at Melbourne Sexual Health Centre before the introduction of ETS in 2009 and after ETS (2011 and 2012). Results: There were 32 720 and 82 265 consultations before and after ETS respectively. The ETS saw 4387 (9%) of 55 648 consultations (excluding appointments and results), giving rise to a fall in the proportion of lower-risk clients having full consultations (from 53% to 50% of consultations; P < 0.001). The consultations testing for HIV and chlamydia (Chlamydia trachomatis) were marginally higher (HIV: 48% v. 47%, P = 0.017; chlamydia: 70% v. 68%, P = 0.015) with ETS. Young (26 v. 27 years) females (38% v. 34%) utilised the ETS more (P < 0.001). The time taken for consultation and the total time spent in the clinic was significantly decreased during the ETS period (from 25 min to 6 min for consultation time and from 59 min to 29 min for total clinic time; P < 0.001). Conclusions: The data suggest that fast-track services such as ETS are effective in increasing access for higher-risk individuals while streamlining screening of asymptomatic low-risk clients.
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Xu, Xianglong, Zhen Yu, Zongyuan Ge, Eric P. F. Chow, Yining Bao, Jason J. Ong, Wei Li, Jinrong Wu, Christopher K. Fairley, and Lei Zhang. "Web-Based Risk Prediction Tool for an Individual's Risk of HIV and Sexually Transmitted Infections Using Machine Learning Algorithms: Development and External Validation Study." Journal of Medical Internet Research 24, no. 8 (August 25, 2022): e37850. http://dx.doi.org/10.2196/37850.
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Background HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission. Objective The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms. Methods We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external “validation data 1” and data from January 2020 and January 2021 as external “validation data 2.” We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an individual’s risk of HIV or an STI. Results The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning–based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78; AUC for syphilis=0.84; AUC for gonorrhea=0.78; AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79; AUC for syphilis=0.85; AUC for gonorrhea=0.81; AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71; AUC for syphilis=0.84; AUC for gonorrhea=0.79; AUC for chlamydia=0.69). Conclusions Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage individuals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk individuals for further interventions.
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Towns, Janet M., Sarah Huffam, Eric P. F. Chow, Ian Denham, Lei Zhang, Andrea Ryan, Clare Elizabeth Bellhouse, et al. "Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study." Sexually Transmitted Infections 94, no. 8 (November 30, 2017): 571–73. http://dx.doi.org/10.1136/sextrans-2017-053297.
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BackgroundSyphilis infections continue to increase among men who have sex with men (MSM) in many countries, with rates often higher among HIV-positive MSM. There is limited understanding of the risk and determinants of syphilis transmission between men. We aimed to examine the concordance of early syphilis infection between male sexual partners and clinical factors associated with transmission.MethodsMen attending Melbourne Sexual Health Centre with their male partners, where at least one was diagnosed with early syphilis, were identified from linkage of partner records between March 2011 and April 2016. Early latent syphilis was defined as a new asymptomatic syphilis presentation of less than 2 years’ duration. Associations between concordance and potential risk factors were examined using Fisher’s exact test.ResultsAmong 43 couples (86 men) identified, there were 13 couples (26 men) where both were diagnosed with early syphilis, representing a concordance rate of 30.2% (95% CI 17.2% to 46.1%). Among the 13 concordant couples, 5 men had primary syphilis (4 penile, 1 anal), 11 secondary syphilis (8 generalised rash, 3 penile, 2 anal, 1 oral lesion) and 10 early latent infections. Concordance was higher among couples where at least one partner had secondary syphilis compared with couples where neither partner had secondary syphilis (53% (9/17) vs 15% (4/26), P=0.016). Furthermore, concordance was higher among couples where one was HIV positive compared with couples where both were HIV negative (62% (5/8) vs 23% (8/35), P=0.042).ConclusionsThere was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.
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Carlton, Caroline, Jacqueline M. Norris, Evelyn Hall, Michael P. Ward, Stephanie Blank, Shelby Gilmore, Anjuli Dabydeen, Vivian Tran, and Mark E. Westman. "Clinicopathological and Epidemiological Findings in Pet Cats Naturally Infected with Feline Immunodeficiency Virus (FIV) in Australia." Viruses 14, no. 10 (September 30, 2022): 2177. http://dx.doi.org/10.3390/v14102177.
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Feline immunodeficiency virus (FIV) infection in experimentally infected domestic cats produces characteristic clinical manifestations including hematological changes, neurological disease, neoplasia (most notably lymphoma) and lymphopenia-mediated immunodeficiency predisposing cats to a range of secondary infections. Conflicting reports exist, however, with regard to disease associations and survival time in naturally FIV-infected cats. The purpose of this retrospective case–control study was to investigate the effect of natural FIV infection on hematological, blood biochemical and urinalysis parameters and survival time in three cohorts of pet cats in Australia. Cohorts 1 and 2 were recruited from a large veterinary hospital in Melbourne, Victoria (n = 525 and 282), while a third cohort consisted of cats recruited from around Australia as part of a FIV field vaccine efficacy trial (n = 425). FIV-infected cats in cohorts 1, 2 and 3 were found to have 15/37 (41%), 13/39 (33%) and 2/13 (15%) clinicopathological parameters significantly different to FIV-uninfected cats, respectively. Two changes in FIV-infected cats in cohort 1, hypochromia (low hemoglobin) and hyperglobulinemia, were outside the supplied reference intervals and should serve as diagnostic triggers for FIV testing. Kaplan–Meier survival analysis of cats in cohorts 1 and 2 combined did not find any difference between FIV-infected and FIV-uninfected cats, however a confounding factor was a large euthanasia rate within the first 12 months in both groups. Three significant (p < 0.05) spatial clusters of FIV infection were identified in Melbourne. A possible relationship between FIV infection status and socioeconomic disadvantage was discovered, based on three government indices of socioeconomic status (p < 0.001). Until longitudinal field studies are performed in Australia to further investigate the long-term effects of natural FIV infection, Australian veterinarians should consider FIV to be an important infection of pet cats, and recommend measures to prevent FIV infection.
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Eu, Beng, and Norman Roth. "Association between known recent HIV infections and methamphetamine use (ASK HIM study) in Melbourne between 2011 and 2013: a case-control study." Sexual Health 11, no. 6 (2014): 583. http://dx.doi.org/10.1071/sh14141.
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Guy, Rebecca J., Ann M. McDonald, Mark J. Bartlett, Jo C. Murray, Carolien M. Giele, Therese M. Davey, Ranil D. Appuhamy, et al. "Characteristics of HIV diagnoses in Australia, 1993-2006." Sexual Health 5, no. 2 (2008): 91. http://dx.doi.org/10.1071/sh07070.
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Objective: To describe recent trends in the diagnosis of HIV infection in Australia. Methods: National HIV surveillance data from 1993 to 2006 were analysed with a focus on geographic differences by HIV exposure route and late presentation (HIV within 3 months of a first AIDS-defining illness or a CD4 count of less than 200 cells μL–1). Results: In 1993–99, the number of HIV diagnoses declined by 32%, and then increased by 39% from 1999 to 2006. From 2000 onwards, rates increased significantly in Victoria, Queensland, South Australia and Western Australia. The most frequently reported routes of HIV exposure were male to male sex (71%) and heterosexual contact (18%), and the population rate of diagnoses have increased in both categories. Among the cases reported as heterosexually acquired (n = 2199), 33% were in people born in a high-prevalence country and 19% in those with partners from a high-prevalence country. Late presentation was most frequent in heterosexually acquired infections in persons who had a partner from a high-prevalence country: 32% compared with 20% overall. Conclusions: Recent increases in annual numbers of HIV diagnoses in Australia underline the continuing need for HIV-prevention programs, particularly among men having male to male sex. Early diagnosis and access to care and treatment should also be emphasised, as a substantial proportion of people with HIV infection are unaware of their status until late in the course of disease.
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Ong, Jason J., Christopher K. Fairley, Ria Fortune, Melanie Bissessor, Chantal Maloney, Henrietta Williams, Adrian Castro, et al. "Improving Access to Sexual Health Services in General Practice Using a Hub-and-Spoke Model: A Mixed-Methods Evaluation." International Journal of Environmental Research and Public Health 19, no. 7 (March 25, 2022): 3935. http://dx.doi.org/10.3390/ijerph19073935.
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Improving access to sexual health services is critical in light of rising sexually transmitted infections (STIs). We evaluated a hub-and-spoke model for improving access to sexual health services in three general practices in Victoria, Australia. The primary outcome was the impact on HIV and STI (chlamydia, gonorrhoea, syphilis) testing. Segmented linear regression analysis was conducted to examine the trends in the total HIV/STI tests pre- (from January 2019 to June 2020) and post-implementation (from July 2020 to July 2021). We evaluated the feasibility and acceptability of integrating this model into the general practices using semi-structured individual interviews. There was a statistically significant rise in testing for HIV and STIs in all general practices: post-implementation, there was an increase of an average of 11.2 chlamydia tests per month (p = 0.026), 10.5 gonorrhoea tests per month (p = 0.001), 4.3 syphilis tests per month (p = 0.010), and 5.6 HIV tests per month (p = 0.010). Participants reported increases in knowledge level and confidence in offering STI testing and managing a greater variety of sexual health cases. This study demonstrates the feasibility of implementing a hub-and-spoke model to enable GPs to deliver sexual health care with support from a sexual health specialist service.
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Wang, Jennifer, Zyg Chapman, Emma Cole, Satomi Koide, Eldon Mah, Simon Overstall, and Dean Trotter. "Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites." Journal of Clinical Medicine 10, no. 21 (November 5, 2021): 5176. http://dx.doi.org/10.3390/jcm10215176.
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Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.
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Latimer, Rosie Louise, Lenka Vodstrcil, Vesna De Petra, Christopher K. Fairley, Tim RH Read, Deborah Williamson, Michelle Doyle, Eric PF Chow, and Catriona Bradshaw. "Extragenital Mycoplasma genitalium infections among men who have sex with men." Sexually Transmitted Infections 96, no. 1 (June 19, 2019): 10–18. http://dx.doi.org/10.1136/sextrans-2019-054058.
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ObjectivesThere are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice.MethodsThis was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status.ResultsRectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079).ConclusionThese data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.
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Chow, Eric P. F., John B. Carlin, Tim R. H. Read, Marcus Y. Chen, Catriona S. Bradshaw, Jun K. Sze, and Christopher K. Fairley. "Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne, Australia." Sexual Health 15, no. 4 (2018): 350. http://dx.doi.org/10.1071/sh18024.
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Background The number of sexual partners is one of the most important risk factors for sexually transmissible infections (STIs), including HIV. The aim of the present study was to examine the association between declining to report the number of partners using computer-assisted self-interviewing (CASI) and HIV or STI positivity at a public sexual health centre in Melbourne, Australia, in 2016. Methods: Individuals were categorised into three risk populations: women, men who have sex with women only (MSW) and men who have sex with men (MSM). Logistic regression analysis was used to examine the association between declining to report the number of sexual partners in the past 12 months and HIV or STI positivity for women and MSW, with generalised estimating equations (GEE) used for estimation in MSM to address repeated-measures within individuals. Results: In all, 18085 individuals (5579 women, 6013 MSW, 6493 MSM) were included in the final analysis. There was no association between chlamydia positivity and declining to respond among women and MSW. MSM who declined to respond were more likely to be chlamydia positive (adjusted odds ratio1.21; 95% confidence interval (CI) 1.01–1.43). Known HIV-positive MSM and MSM newly diagnosed with HIV had 3.31-fold (95% CI 2.48–4.42) and 2.82-fold (95% CI 1.84–4.32) greater odds respectively of declining to respond compared with HIV-negative MSM. Gonorrhoea and syphilis positivity in MSM were not associated with declining to respond. Conclusions: There was no association between declining to report the number of partners and chlamydia positivity among women and MSW. However, MSM who declined to report the number of partners were slightly more likely to have chlamydia and substantially more likely to be HIV positive.
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Constantinou, Heidi, Christopher K. Fairley, Jane S. Hocking, Catriona S. Bradshaw, Edmond P. H. Choi, Kate Maddaford, Tiffany R. Phillips, and Eric P. F. Chow. "Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia." JMIR Formative Research 5, no. 7 (July 20, 2021): e26202. http://dx.doi.org/10.2196/26202.
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Background The association between meeting partners on the web and sexual practices has been understudied in heterosexuals. Objective This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. Methods We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants’ HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants’ sexual practices, IVDU, and STI status. Results A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3% men; 245/373, 65.7% women; P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party; 126/325, 38.8%), whereas the women met partners most commonly through friends or family (178/373, 47.7%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95% CI 26.13-808.51) and on the internet (AOR 10.00, 95% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95% CI 1.94-5.71) and women (AOR 2.58, 95% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95% CI 1.24-7.48) and women (AOR 3.75, 95% CI 1.58-8.89). Conclusions Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a public setting.
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Read, Tim R. H., Jane Hocking, Vikki Sinnott, and Margaret Hellard. "Risk factors for incident HIV infection in men having sex with men: a case-control study." Sexual Health 4, no. 1 (2007): 35. http://dx.doi.org/10.1071/sh06043.
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Background: HIV notifications affecting men having sex with men (MSM) in Victoria, Australia have been increasing. This study aimed to determine current risk factors for HIV infection in this population. Methods: Case-control study. Cases were MSM infected within the previous year (incident cases) as indicated by a previous negative test or seroconversion illness. Controls were MSM with a negative HIV test at the same clinic. From May 2001 to May 2003, cases and controls were interviewed about sexual behaviour, drug and alcohol use and mental health and sexually transmissible infections (STI) in the year before their HIV diagnosis. Results: Twenty-six cases and 52 controls were recruited. Risk factors in the year before diagnosis of incident HIV infection included: receptive unprotected anal intercourse (UAI) with ejaculation with casual partners (odds ratio [OR] and 95% confidence interval 57.2 [6.7, 489.4]); insertive UAI with ejaculation with >1 casual partners (OR 19.2 [2.2, 168.9]); having >14 casual partners at sex venues (OR 3.2 [1.1, 9.1]); and consuming >60 g alcohol at one sitting at least weekly (OR 3.6 [1.1, 11.4]). Cases were also more likely to have anal sex with >100 partners in their life and cases had more casual partners than controls in the year before the test. Cases were more likely to have consumed alcohol or amphetamines during a high-risk sexual episode in the year before the test. Conclusions: UAI remains the most important behavioural risk for HIV in Australian MSM. Risk is increased by larger numbers of partners, partners met at sex venues and sex under the influence of alcohol.
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Akobi, William Kala, John Paul Oyore, and George Ochieng Otieno. "Interventional behavioural change communication on HIV and aids related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya." International Journal Of Community Medicine And Public Health 9, no. 12 (November 28, 2022): 4368. http://dx.doi.org/10.18203/2394-6040.ijcmph20223194.
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Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of STIs/HIV infections among the fisher folks. Behavioural change mechanisms such as condom use, and abstinence are some of the interventions used in the prevention HIV/AIDS spread in Kenya.Methods: This was a follow up study on a three tie quasi-experimental study involving 246 randomly selected fisher folks in Mbita and Usenge along Lake Victoria. The study had three phases. baseline, intervention and endline. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: Various variables were influenced by behavior change communication strategies used. These includes use of condom every time of sexual encounter p>0.000, risk associated with non-condom use p>0.004, stopping using condom and fear of getting HIV/AIDS p>0.009, Sexual intercourse without condom use is dangerous p>0.000, whether remembering to use condom every time of sex is difficult P.0.000, whether they are keeping many sexual partners p=0.004, receiving fish/money in exchange for sex in last six months p=0.006.Conclusions: Multiple sexual partners, non-condom use, fish for sex, alcohol consumption and circumcision were significantly associated with risky sexual behavior among the Fisherfolks, therefore other existing interventions need to be intensified to supplement behavior change communication to curb sexually transmitted diseases and further spread of HIV and AIDS.
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Cornelisse, Vincent J., Christopher K. Fairley, Tiffany Phillips, Sandra Walker, and Eric PF Chow. "Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk." International Journal of STD & AIDS 29, no. 1 (July 6, 2017): 44–50. http://dx.doi.org/10.1177/0956462417717647.
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‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).
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Akobi, William Kala, John Paul Oyore, and George Ochieng Otieno. "Effects of behavioural change communication on HIV and AIDS related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya." International Journal Of Community Medicine And Public Health 9, no. 6 (May 27, 2022): 2334. http://dx.doi.org/10.18203/2394-6040.ijcmph20221503.
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Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of sexually transmitted diseases (STIs) /HIV infections among fisher folks. Behavioral change mechanisms as condom use and abstinence are some of interventions used in prevention HIV/AIDS spread in Kenya. Risky sexual behaviors increase risk of contracting STIs including HIV/AIDSMethods: This was a cross-sectional descriptive study involving 246 randomly selected fisher folks in Mbita- and Usenge along Lake Victoria. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: The mean age of respondents was 31 years old. The 72% of the participants were directly involved in fishing. Participants who had extra marital relationship though married were 56.1% in Mbita and 47% in Usenge. Respondents who took alcohol with friends were 94.1% in Mbita and 96.2% in Usenge. Respondents who indicated that they had unprotected sex under influence of alcohol were 48.3% in Mbita and 77.1% in Usenge. Those who were sexually taken advantage of while under the influence of alcohol were 23.8% in Mbita and 38.3% in Usenge while those had sexually taken advantage of under the influence of alcohol were 18.3% in Mbita and 37.8% in Usenge.Conclusions: Targeted behaviour change communication (BCC) strategies designed specifically for fisherfolks is needed to curb high incidences of risky sexual behaviours noted among the fishermen.
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Goller, Jane L., Jacqueline Coombe, Meredith Temple-Smith, Helen Bittleston, Lena Sanci, Rebecca Guy, Christopher Fairley, et al. "Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial." BMJ Open 12, no. 12 (December 2022): e067488. http://dx.doi.org/10.1136/bmjopen-2022-067488.
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IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis.Methods and analysisMoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12–18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice.Ethics and disseminationEthics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
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Lister, N. A., A. Smith, T. Read, and C. K. Fairley. "Testing men who have sex with men for Neisseria gonorrhoeae and Chlamydia trachomatis prior to the introduction of guidelines at an STD clinic in Melbourne." Sexual Health 1, no. 1 (2004): 47. http://dx.doi.org/10.1071/sh03005.
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Background: Guidelines for testing men who have sex with men (MSM) were published in 2002. They did not recommend asymptomatic screening for urethral gonorrhoea or pharyngeal screening for chlamydia. To determine if these guidelines were appropriate, we audited gonorrhoea and chlamydia testing of MSM at our centre. Methods: We carried out two audits at our Centre between August 2001 to July 2002. The first was an audit of testing MSM for gonorrhoea and/ or chlamydia over 12 days. The second was an audit of all positive tests over this 12-month period for gonorrhoea or chlamydia among MSM. Results: During the 12 selected days 89 of 286 men tested (31%) were MSM. Among the MSM testing positive for gonorrhoea and/ or chlamydia infection (15, 17%), symptomatic urethral infection was the most common (n = 8). No rectal and pharyngeal infections had site-specific symptoms. Based on the guidelines, 100 of the 334 tests ordered (30%) were not recommended according to the guidelines, and none of these 100 tests yielded a positive result. Over the 12-month audit period, 135 MSM were diagnosed with gonorrhoea and/ or chlamydia. For gonorrhoea, site specific symptoms were present in 42 of 43 cases of urethral infection (98%), six of 23 cases of rectal infection (26%), and no cases of pharyngeal infection had symptoms. For chlamydia, site-specific symptoms were present in 29 of 48 cases of urethral infection (60%), six of 33 cases of rectal infection (18%), and in one of the two cases of pharyngeal chlamydia identified. A substantial proportion of cases occurred in clients with HIV infection (21, 16%). Conclusions: These findings strongly support screening among MSM and in particular not testing asymptomatic MSM for urethral gonorrhoea or any MSM for pharyngeal Chlamydia.
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Harney, Brendan L., Paul A. Agius, Carol El-Hayek, Christopher K. Fairley, Eric P. F. Chow, Norman Roth, B. K. Tee, et al. "Risk of Subsequent HIV Infection Following Sexually Transmissible Infections Among Men Who Have Sex With Men." Open Forum Infectious Diseases 6, no. 10 (August 23, 2019). http://dx.doi.org/10.1093/ofid/ofz376.
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Abstract Background HIV and bacterial sexually transmissible infection (STI) notifications among men who have sex with men (MSM) have increased in Australia and many other countries. The relationship between HIV infection and other STIs has been demonstrated previously. However, the relationship between the cumulative history of STIs and subsequent HIV infection remains largely unexplored and limits our understanding of the mechanisms underpinning the elevated HIV risk. Methods Data from HIV-negative MSM who attended high–HIV caseload primary care clinics in Melbourne, Australia, from 2007 to 2014 with 2 or more HIV and STI tests were included. Controlling for sexual behaviors self-reported at clinic visits, discrete time survival analyses using generalized linear modeling estimated the effect of an STI at the prior test event and the cumulative history of STIs (none, 1, 2, or more [repeated]) on risk of HIV infection. Results A total of 8941 MSM met the study criteria; 227 (2.5%) were diagnosed with HIV over the follow-up period. Adjusting for sexual behaviors, a cumulative history of repeated rectal gonorrhea infections (adjusted hazard ratio [aHR], 6.27; 95% confidence interval [CI], 2.68–14.50) and a single rectal gonorrhea infection (aHR, 2.09; 95% CI, 1.15–3.79) were associated with increased HIV infection risk. Conclusions Repeated and single rectal gonorrhea infections were independently associated with increased HIV infection risk. These findings suggest that MSM with any history of rectal gonorrhea, particularly repeat rectal gonorrhea, represent a group for whom preventive interventions for HIV should be emphasized.
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Panga, Onna Duuma, Agricola Joachim, Florence George Samizi, Catherine Gale Gitige, Nyambura Moremi, Japhet Simeo, Majigo Mtebe, and Ahmed Abade. "Prevalence, recent infection and predictors of HIV infection in fishing community along the shore of Lake Victoria in Tanzania." Journal of Public Health, June 12, 2021. http://dx.doi.org/10.1093/pubmed/fdab189.
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Abstract Background Fishing communities are a subpopulation burdened by human immunodeficiency virus (HIV), mainly due to their mobility and cash income access. Strategies to mitigate the spread of HIV in fishing communities have varying outcomes. We conducted a study to determine the prevalence of HIV, recent infection and associated factors among fishing communities at Lake Victoria in Tanzania. Methods We conducted a cross-sectional study in the first quarter of 2019. The participants' information was collected using a structured questionnaire. Blood samples were screened for HIV infection; the positive samples were tested for avidity and viral load to determine the recent infection. Logistic regression analysis was used to determine the factors associated with HIV infection. Results A total of 1048 individuals were included with a mean age of 34 years (SD ± 11.5). The overall prevalence of HIV was 9.1%, while 7.4% had a recent infection. Lack of formal education, being separated/divorced/widowed, transactional sex, history of sexually transmitted infections, not tested for HIV in the last 12 months had 1.7 to three times more odds of contracting HIV. Conclusion A proportion of HIV recent infection among the fisherfolks was relatively high, signifying the continuous spread, which is predisposed by some demographic and behavioural characteristics.