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Evidence Update Issue 10, 2018| August 23, 2018 |
These emails provide bite-size summaries of the latest evidence from key sexual health and blood-borne virus journals and reports with relevance to the Australian setting. We hope that these emails will save you time and help keep you on top of the latest evidence in your interest areas. SiREN regularly Tweets new research articles and reports, so follow us on Twitter.
If you or your organisation publish a report or journal article, let us know and we will share it as part of these emails. And don’t forget, if you are unable to access any journal articles or reports you can email us at firstname.lastname@example.org and we will send you a copy.
Monitoring hepatitis C treatment uptake in Australia Issue 9, July 2018. The Kirby Institute. This report summarises data on the prescription and distribution of hepatitis C treatments and provides insight into the initial phase of the roll-out of DAA therapy in Australia.
Real world efficacy of antiviral therapy in chronic hepatitis C (REACH-C) in Australia Issue 2, July 2018. The Kirby Institute. This report summarises data on the uptake and outcomes of new treatments for chronic hepatitis C during 2016–2017 in the REACH-C network.
Alcohol and other drug treatment services in Australia 2016-17. Australian Institute of Health and Welfare. This report presents information about publicly funded alcohol and other drug treatment services in Australia for 2016-17.
National medication assisted treatment for opioid dependence summit report. Harm Reduction Australia and ScriptWise. This report summarises key outcomes and recommendations from the National Medication Assisted Treatment for Opioid Dependence Summit held in Canberra on 23 May 2018.
What does the research evidence tell us about what Australians think about the legal status of drugs? A 2018 update. Hughes, C., and Ritter, A. This brief report summarises data from The National Drug Strategy Household Survey which asks people their opinions about the legal status of drugs.
Miles to go—closing gaps, breaking barriers, righting injustices. UNAIDS. This global AIDS update describes how progress towards reaching the 2020 targets is not matching ambition. It discusses what is required to stop complacency and get back on course to reach the 2020 targets.
MJA Podcasts 2018 Episode 54: HIV in the Aboriginal population. In this podcast, Associate Professor James Ward, the Head of Aboriginal Health Infectious Disease at the South Australian Health and Medical Research Institute, discusses the worrying increase in the rate of HIV diagnosis in the Aboriginal and Torres Strait Islander population.
HIV Australia Podcast. In this podcast, Dr Jeanne Ellard, Australian Federation of AIDS Organisation's (AFAO) Senior Research Officer, discusses the role of research in Australia’s HIV response with AFAO's Deputy CEO, Heath Paynter.
Journals this edition includes: AIDS and Behavior; Culture, Health & Sexuality; International Journal on Drug Policy; Medical Journal of Australia; Harm Reduction; Sex Education; Sexually Transmitted Infections; Journal of Viral Hepatitis; and Sexual Health.
Only a select number of articles relevant to sexual health, STIs, and BBVs in the Australian context have been summarised.
AIDS and Behavior (vol. 22, issue 8 & 9)
Strategies to increase HIV testing among MSM: A synthesis of the literature. This study reviewed the literature on strategies to increase uptake of HIV testing among men who have sex with men (MSM). It found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. Recommendations for increasing HIV testing rates and status awareness are provided.
HIV testing and counselling among female sex workers: A systematic literature review. This study reviewed the evidence on barriers and facilitators to HIV testing among female sex workers as well as frequencies of testing, willingness to test, and return rates to collect results. The two barriers to HIV testing most commonly reported were financial cost and time. Social support was consistently found to facilitate HIV testing. This calls for the inclusion of social support into current female sex worker HIV testing promotion strategies.
HIV risk and protective factors in the context of alcohol and substance use during Pride. This study identified HIV risk and protective factors among MSM who engaged in anal sex following alcohol or substance use during an international Pride Festival. Of those who engaged in anal sex, most had consumed alcohol or substances prior. It found that improving condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behaviour, even when under the influence of alcohol or substances.
Culture, Health & Sexuality (vol. 20, issues 8 & 9)
Young men’s rationales for non-exclusive gay sexualities. This study explored young men’s rationales for choosing sexuality labels beyond traditional gay or bisexual categories. It found four distinct rationales for identification with a sexual orientation label: sexual, romantic, intellectual and internalised homophobia. The authors argue that future research should place greater focus on sexual identity for non-exclusive gay men.
International Journal of Drug Policy (vol. 57 & 59)
Interventions to increase testing, linkage to care and treatment of hepatitis C virus infection among people in prisons: A systematic review. This review synthesised the evidence on the effectiveness of interventions to increase hepatitis C (HCV) testing, linkage to care and treatment uptake among people in prisons. It found there is a lack of recent data on interventions to improve the HCV care cascade in people in prisons. With the introduction of short-course, well-tolerated direct-acting antivirals (DAA), rigorous controlled studies evaluating interventions to improve testing, linkage and treatment uptake for people in prison are necessary.
The cost-effectiveness of seven behavioural interventions to prevent drug misuse in vulnerable populations. This study developed economic models for seven interventions which aimed to prevent drug use in vulnerable populations. The reduction in drug use for each intervention partly offset the costs of the intervention, and improved health outcomes. However, with high intervention costs and low health outcome gains, none were estimated to be cost-effective. A greater understanding of the consequences of drug misuse and causal factors could facilitate development of cost-effective interventions to prevent drug misuse.
Fentanyl self-testing outside supervised injection settings to prevent opioid overdose: Do we know enough to promote it? This commentary piece reviews the evidence surrounding self-test strips which detect fentanyl, and some of its analogues, that have been developed for off-label use allowing people who use drugs to test their drugs prior to consumption. The authors query whether the accuracy of fentanyl test strips might be mediated according to situated practices of use.
Medical Journal of Australia (vol. 209, issue 2 & 3)
Rendering visible the previously invisible in health care: The ageing LGBTI communities. This perspective piece discusses how recent legislative and policy measures aim to raise awareness of the needs of older lesbian, gay, bisexual, transgender and intersex (LGBTI) people. It then outlines some of the implications for cultural competence of care professionals and clinical practice.
Harm Reduction (online)
A policy analysis exploring hepatitis C risk, prevention, testing, treatment and reinfection within Australia’s prisons. This paper examines whether policies in Australian jurisdictions support DAA treatment scale-up to achieve elimination among this priority population. It found that few jurisdictions have updated or published HCV-related health or prisoner health policies following availability of DAA. Current policies do not provide effective support for implementing treatment scale-up that could be possible under universal access to HCV treatment among this priority population.
Need for women-centerd treatment for substance use disorders: Results from focus group discussions. This study sought to understand the treatment experience, barriers, and facilitators of mothers with substance use disorders through conducting focus groups with women. Women’s personal motivation was a facilitator. Barriers included: concerns with child welfare; identifying treatment programs and admission requirements; wait times; counsellor ability to address woman-centered issues; fear; safety; and stigma. Treatment programs could be improved by allowing children to accompany their mothers, the inclusion of peer support, and women-only programs.
Sex Education (vol. 18, issue 4)
Transgender young people’s narratives of intimacy and sexual health: Implications for sexuality education. This study explores young transgender people’s accounts of intimacy and sexual health though analysing YouTube videos and considers what this means for school-based sexuality education. The authors argue that sexuality education that focuses on function, rather than gendering body parts, will address the needs of transgender young people and provide a more inclusive understanding of their own and other people’s bodies and desires.
‘More than boy, girl, male, female’: Exploring young people’s views on gender diversity within and beyond school contexts. This paper explores the views of English young people aged 12–14 on gender diversity. Findings reveal that many young people have expanded vocabularies of gender identity/expression; critical reflexivity about their own positions; and principled commitments to gender equality, gender diversity and the rights of gender and sexual minorities. Schools are providing some spaces and learning opportunities to support gender and sexual diversity. However, overall, it appears that young people’s immediate social cultural worlds are constructed in such a way that gender binary choices are inevitable.
Sexually Transmitted Infections (vol. 94, issue 5)
Molecular test for chlamydia and gonorrhoea used at point of care in remote primary healthcare settings: A diagnostic test evaluation. This study examined the diagnostic performance of a new molecular test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) (GeneXpert CT/NG) when used by clinicians in remote community health services in Australia with high prevalence of CT and NG infection. It found excellent concordance with conventional nucleic acid amplification tests. The use of the GeneXpert CT/NG at the point of care could potentially transform management and control of these infections in many endemic settings, including low and middle income countries.
Risk factors for oropharyngeal gonorrhoea in men who have sex with men: An age-matched case–control study. This study investigated which oral sex practices were independent risk factors for oropharyngeal gonorrhoea using a case-control study of MSM attending the Melbourne Sexual Health Centre. The authors found that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices. This finding highlights the need for further research to define the probability of transmission from specific sex acts.
Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: A cross-sectional analysis. This study compares users of online sexually transmitted infection (STI) testing services with users of clinic services in England. It found that nearly half of all basic STI testing was done online. Online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.
Journal of Viral Hepatitis (published online and vol. 25, issue 8)
Eliminating hepatitis C: The importance of frequent testing of people who inject drugs in high prevalence settings. This study aimed to determine the testing frequencies (two‐yearly, annually, six‐monthly, three‐monthly) and retention in care required among people who inject drugs (PWID) to achieve the HCV incidence reduction target through treatment‐as‐prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. The authors found that for geographical areas or sub‐populations with high prevalence, reduction targets are unlikely to be met without three‐monthly RNA testing accompanied by other prevention measures. Novel testing strategies, such as rapid point‐of‐care antibody testing or replacing antibody testing with RNA tests as a screening tool, can provide additional population‐level impacts to compensate for imperfect follow‐up or testing coverage.
Impact of electronic reminder systems on hepatitis C screening in primary care. This study explored the effect of electronic medical record (EMR) reminder system on HCV screening in the USA. Results demonstrated an increase in the proportion tested for HCV from 12% prior to the Centers for Disease Control screening recommendations, to 37% after the EMR reminder system. The yield of positive HCV antibody tests decreased from 7% in the “case‐finding” era to 1.6% after the EMR reminder prompted screening of a lower risk population.
Sexual Health (vol. 15, issue 4)
Only recent sexual partners contribute to oropharyngeal gonorrhoea positivity: The number of sexual partners over different time periods as an indicator of gonorrhoea and chlamydia infection duration among men who have sex with men. This study aimed to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity. It found an association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia. This could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence.
Changing pattern of sexually transmissible infections and HIV diagnosed in public sexual health services compared with other locations in New South Wales, 2010-14. This study investigates the proportion of HIV and STI diagnoses in New South Wales (NSW) occurring in publicly funded sexual health clinics stratified by priority population. It found that increasing proportions of STI and HIV are being diagnosed at publicly funded sexual health clinics, mostly among gay and bisexual men. Publicly funded sexual health clinics reorientation to priority populations continues to make a large and increasing contribution to STI and HIV control efforts in NSW.
‘I see it everywhere’: Young Australians unintended exposure to sexual content online. This study conducted focus group discussions with school students aged 14 to 18 years to discover their exposure to sexual content in social media. It found that exposure occurred through networks of ‘friends’ or followers, and paid-for advertising and ranged from subtle messages or photos to explicit pornographic pictures/videos. Most exposure was unintended. Educating young people on mitigating the effect of sexual content, rather than trying to prevent them from viewing it, could be an effective approach.
AIDS Acquired Immune Deficiency Syndrome
CT Chlamydia Trachomatis
DAA Direct Acting Antiviral
HCV Hepatitis C
HIV Human Immunodeficiency Virus
LGBTI Lesbian, Gay, Bisexual, Transgender, and Intersex
MSM Men who have Sex with Men
NT Neisseria Gonorrhoeae
NSW New South Wales
PWID People Who Inject Drugs
STI Sexually Transmitted Infection